A PAIN IN THE NECK

Far too often, people attribute neck pain to stress and take medication to mask the symptoms. Sound familiar? Fortunately, if you’re a chiropractic patient, you know there’s a better, safer way.

My neck feels OK right now. I can turn my head left and right and down and back. (Well, that bending back thing actually doesn’t feel very good right now.) So, maybe my neck does get a little annoying sometimes.

But I have no idea when this periodic discomfort started.

Sound familiar? You’re not alone. A report published earlier this year in the medical journal Spine revealed many people are often a little hazy on when their neck pain started. This monumental study, sponsored by the World Health Organization (WHO), started about seven years ago. WHO launched the Bone and Joint Decade and assigned a special task force the job of reviewing all the research about neck and associated disorders, and then evaluating the best treatment options. They reviewed 31,878 citations, 1,203 reviewed papers and four research projects – it makes me tired just thinking about it

Sure enough, most people often don’t remember when their neck discomfort or pain really got started. Researchers concluded, “There is usually no single cause of neck pain.” Unless you have had an injury to your neck like “whiplash” from an auto accident, neck pain usually sneaks up on you. The study notes neck pain is quite common, and most people simply carry on with their activities of daily living. However, about 5 percent to 10 percent of people develop debilitating symptoms. Unfortunately, even among those folks who do not have disabling pain, the majority find their neck pain is stubborn and recurrent to some degree.

The task force also came up with a new classification of neck pain, which seems to be one of those things researchers like to do. They suggested four grades of neck problems, no matter whether it comes from injury, arthritis or any other cause. To paraphrase:

Grade I: Neck pain that doesn’t interfere with living.

Grade II: Neck pain that does significantly interfere with living.

Grade III: Neck pain associated with a “pinched nerve,” causing radiating pain, weakness or numbness in the arm.

Grade IV: Neck pain associated with tumors, infections, fractures and other serious conditions.

As you might guess, most neck discomfort is Grade I and II. However, what was quite gratifying from the task force report was the acknowledgement of what doctors of chiropractic already know: “Cervical manipulation is a reasonable option for people with Grade I or II neck pain.”

On a near-daily basis, a patient with a significant neck disorder tells me their pain has decreased and they are more functional as a result of chiropractic care. Recently, a patient with chronic neck pain told me he had been sleeping in a recliner chair since he could not get comfortable enough in bed to sleep through the night. “Hands-on” manual treatment in my office finally improved his condition to the point he could once again join his wife (and their Rottweiler) in bed

Chiropractors “adjust” the joints, muscles and connective tissues of the body in order to improve motion by reducing restrictions and nerve irritation. Concerning patients with Grade III neck problems including “pinching” or crowding of larger nerves, the Spine article suggests more research is needed to identify the best candidates for manual or manipulative treatment. Of course, chiropractors are the recognized experts in this type of care and are best trained to make that determination.

The renewed interest in neck disorders among clinical researchers has spurred some interesting studies. In the March/April issue of the Journal of Manipulative and Physiological Therapeutics (JMPT), Canadian scientists have shown that arthritis in the neck might affect balance. This could mean that in cases of poor balance or repeated falls among the elderly, treatment of the cervical spine might have value. This could represent a “top down” strategy, which is a bit different from the “bottom up” approach to balance training more commonly utilized in rehabilitation

 In the February issue of JMPT, a complementary study by New Zealand and Canadian researchers suggested spinal manipulation of the neck can relax muscles in the arms and could be useful in relaxation of the whole body. This implies anything causing tightness in the neck joints also might cause muscle pain in the arms or elsewhere. Since manipulation and manual therapy are primary treatments for neck problems, a doctor of chiropractic should be among the first providers consulted for this type of pain

So, how fast can a patient with neck pain expect to feel better with chiropractic care? By chance, in the same March issue of JMPT, British authors studied which neck symptoms might respond the quickest to hands-on treatment. Overall, considering all possible neck area complaints, about 70 percent of patients reported immediate favorable responses to manipulation. However, if patients complained about more specific things like headaches, shoulder or arm pain, reduced arm or neck movement, neck pain, or upper or middle back pain, the percentage of those who reported immediate improvement in pain rose to an incredible 95 percent!

The popular humorist Nora Ephron wrote a book titled I Feel Bad About My Neck, in which she describes her thoughts about being a woman getting older. This also has been called the “I Hate My Neck” book.

Well, hating your neck won’t make it better, but chances are a trip to the chiropractor will

Medical Research Supports Maintenance Care

The subject of maintenance care is often a controversial one in many chiropractic offices.
Here are the conclusions of a few peer reviewed medical research studies.

1. A study published in PLOS/ONE in September 2018 concluded that maintenance care was more effective than symptom-based treatment in reducing the total number of days over 52 weeks with bothersome non-specific low back pain. For patients with recurrent or persistent non-specific LBP who responded well to initial chiropractic care, maintenance care should be considered an option for prevention.

2. A study published in the medical journal The Spine concluded that chiropractic manipulation is effective in the treatment of low back pain and suggests maintenance adjustments after the initial intensive therapy.

3. A study in 2011 published in The Journal of Occupational and Environmental Medicine provides additional support for the value of chiropractic maintenance care for post injury low back pain patients. The study followed 894 injured workers for a period of one year. During that year there were four different types of therapy available to the workers: medical management, physical therapy, chiropractic and no treatment. Episodes of repeat disability were recorded during the year following the initial injury. Physical therapy had the highest percentage of reinjured workers followed by those receiving medical management or no treatment at all. The lowest incidence of repeat injury was found among those workers who had received chiropractic maintenance care.

Water Gymnastics To Relieve Back Pain During Pregnancy

Ah, the indescribable joys of pregnancy. The anticipation of new life, the intimate, developing bond between mother and child … and the back pain. More than 50% of women experience back pain during pregnancy, especially in the third trimester, and frequently the pain can be excruciating and debilitating.

A Swedish study involving 258 pregnant women investigated whether water gymnastics could reduce the intensity of back pain and the number of days taken for sick leave. Women were divided equally into two groups: an exercise group that participated in water gymnastics (one hour of relaxation exercises, performed in a swimming pool and accompanied by music) during the second half of their pregnancy; and a control group that did not participate in water gymnastics.

Although back pain intensity increased during the course of pregnancy for both groups, the exercise group reported less pain compared with the control group. The total number of reported days on sick leave was also lower in the exercise group (982 days taken) compared with controls (1,484 days taken).

Many of the joys and frustrations of parenthood will last much longer than nine months, so prepare yourself.

But back pain is one frustration that doesn¹t have to last. If you’re expecting a child and are experiencing back pain, talk to your doctor of chiropractic about making your pregnancy as pain-free as possible.

Aging: how to stay active when it hurts to do so

PUBLISHED OCTOBER 30, 2018 Globe and Mail

Tom Kellar and his wife, Colleen Fraser, from Sudbury, Ont., have always tried to stay active by going to the gym, walking, or hitting the trails on snowshoes or skis during the winter. But in recent years, pain made exercise a challenge for both of them.

For Kellar, the pain was particularly bad in his left knee, while Fraser had both hand and knee pain. “When you’re in pain, you’re tired all the time. It has a negative effect on your day,” says Kellar, 60, who works as a sales rep. His sister had a knee replaced, so he assumed he would as well someday.

Fraser, 61, was diagnosed with osteoarthritis (OA) first, through X-rays ordered by their family doctor. Kellar went through the same process himself a year ago. As a result, his chiropractor, Dr. Anjelica Mazzella at Back 2 Health Rehabilitation Centre in Sudbury, referred him to Good Life with osteoArthritis in Denmark (GLA:D) Canada, a program she teaches locally that was first developed in Denmark. After reading the course information, Fraser also decided to join the program.

With sites across Canada, GLA:D offers eight weeks of health education and exercise instruction to help people with knee and hip pain, mostly from OA. The program is supervised by trained practitioners in the GLA:D program, which include chiropractors, physiotherapists and kinesiologists

The couple found themselves stretching regularly and working muscles they didn’t know they had. Within weeks, the pain associated with their OA almost entirely went away. Now they’re exercising independently — Kellar uses the elliptical and weights and performs stretches; Fraser sometimes joins him but also does Pilates and yoga classes. While they exercised before, the GLA:D program had them adding in more cardiovascular exercise, plus doing it more often

Aging, obesity and chronic health conditions amongst other things, can lead to limited mobility and strength that can contribute to problems in the musculoskeletal (MSK) system, which includes the bones, muscles, tendons, joints and ligaments. Women are more at risk. According to an MSK report prepared for the 2015 World Health Organization (WHO) Report on Ageing and Health 2015, OA, osteoporosis and sarcopenia (muscle loss) affect millions, and can lead to serious outcomes, such as falls that shorten lifespans and serious outcomes, such as falls that s  shorten lifespans

“We’re living longer but not necessarily healthier,” says Dr. John Antoniou, an orthopaedic surgeon and president of the Canadian Orthopaedic Association.

More collaboration between health care providers can help Canadians with these conditions get healthier. For example, an integrated approach between a physician who is supporting patients with chronic health conditions and a chiropractor assisting in managing the MSK components can help those patients become more active. This, in turn, can then positively impact their chronic health conditions.

Exercise also impacts health. One 2018 review study found that, among more than 2,300 people with chronic knee and hip pain from OA, exercise helped with pain and function. “It’s the golden rule of nature. You don’t use it, you lose it,” says Dr. Kenneth Stelsoe, a chiropractor and owner of Enhanced Wellness Studio in Waterloo, Ont., and a provider of the GLA:D program

A complex interplay

For most people, musculoskeletal problems start with mild symptoms, such as the joint pain, stiffness and swelling seen in early OA. Discomfort can cause you to limit activity, leading to weaker muscles. You lose more range of motion and things start to increasingly hurt. “You begin using muscles and joints wrong, which makes it worse,” says Dr. Stelsoe. At this point, people may stop exercising and begin limiting their everyday activities too

“A sedentary lifestyle tends to lead to a lot of chronic diseases, including cardiovascular disease and diabetes,” says Ed Ziesmann, vice-president of education programs and services for the Arthritis Society. It triggers balance problems, which put you at risk of falls. Meanwhile, when people have multiple conditions, they must juggle a wide range of medications and all their potential side effects

Exercise’s power

Being physically active can turn things around for those with MSK conditions, but only one in five Canadian seniors get the recommended 150 minutes of activity per week.

It has to be the right exercise: controlled movements that build strength and range of motion. A combination of activities such as swimming, cardio gym machines (Kellar finds the elliptical ideal), weight bearing exercises and low-impact aerobics can be effective. For those whose range of motion is limited, yoga and Pilates can be helpful, along with further support from chiropractic, massage therapy and physiotherapy. Dr. Stelsoe prescribes therapeutic exercises to his patients to increase strength and range of motion in affected areas. “Most patients will benefit from prescribed exercise therapy,” he says. “This can include stretching, strengthening, postural awareness, balance training and neuromuscular exercise.”

Exercise as therapy can be a challenge for those who instinctively stop moving once they have mild pain. “The mentality is sometimes it hurts, so I won’t do it,” Ziesmann says. They need to push through discomfort, but stop when they feel true pain. Guidance from health care professionals on “hurt versus harm” can make sure exercise is healing, not hurting. Meanwhile, for the many people who don’t enjoy traditional exercise, such as going to the gym, Ziesmann advises focusing on doing everyday life activities such as walking, gardening and playing golf.

The right activity for the right person can make a big difference. With OA, for example, Dr. Antoniou says: “You won’t reverse the damage that’s occurred, but it’ll maintain the function that’s still there.” Exercise can also help slow the rate of bone loss in osteoporosis, and can cause some reversal of muscle mass loss. With less pain, stronger muscles and better balance, people find they can do much more. Kellar and Fraser are taking up curling this winter. They’ll be kneeling on the ice and bending over to sweep, actions that would have been excruciating a year ago. But Kellar is looking forward to the challenge. “I suspect I’ll be fine.”

Age-related musculoskeletal conditions

Osteoarthritis (OA)

The most common type of arthritis, it affects 4.6 million people. A

ccording to the Arthritis Society, it’s a progressive disease of the whole joint, which over time leads to the breakdown of joint cartilage and underlying bone. Severe OA may lead to hip- and knee-replacement surgeries

Osteoporosis

Our bones decline in density as we age, starting at age 30, and if bone mass gets dangerously low, it’s called osteoporosis. “The higher you get your bone mass up before 30, the lower the risk of getting osteoporosis later,” says chiropractor Kenneth Stelsoe. The condition affects two million Canadians, and many only get diagnosed after breaking a bone

Sarcopenia

Muscles naturally get weaker as we get older, but underlying conditions or inactivity can lead to this condition, which involves serious muscle loss and weakness. In Canada, it affects about 12 per cent of women and seven per cent of men between the ages of 60 and 69. One 2012 study, published by the U.S. National Centre for Biotechnology Information (NCBI), found patients with sarcopenia were more than three times more likely to be at risk of falls

 

The Pain Problem

CANADIANS ARE NO STRANGERS TO PAIN. According to the Canadian Chiropractic Association (CCA) 2017 report, All Pain, No Gain: Shining a Light on Canada’s Back Pain and Opioid Crisis, almost 90 per cent of Canadians have experienced muscle and/or joint pain in the last year, the most common being back pain and headache.

Pain affects the way people work, play and generally live. In fact, the World Health Organization reports lower back pain as a leading cause of disability worldwide. And a study in the Canadian Medical Association Journal found that back pain was the most common diagnosis for which emergency and family physicians prescribed opioids.

That’s why more attention is being paid to muscle and joint health, and pain prevention. A person’s musculoskeletal (MSK) system includes bones, muscles, tendons, joints and ligaments, and it supports every movement a person makes.

Sleeping posture is the number-one cause of muscle and joint pain, according to those surveyed in CCA’s report. Shovelling snow, picking up a child or sitting at a desk for hours at a time can also have a severe impact on one’s spine, muscle and nervous system.

And with an aging population, the number of conditions is expected to increase significantly. By 2031, the number of Canadians suffering from these conditions will increase from 11 to 15 million.

 

Muscle and joint pain often stems from physical trauma, repetitive strain or overuse, and frequently impacts the head, neck, shoulders, back or pelvis. Most people will experience some form of muscle and joint pain in their lifetime — think strained muscles from moving boxes or overdoing it at the gym. While not all of this discomfort is bad, ensuring proper technique when doing strenuous or repetitive activities may prevent disorders and pain.

Research demonstrates that many conditions can be managed through patient education, exercise and manual therapies rather than through surgery or medication. And nine in ten Canadians who have used a chiropractor to help with their muscle and joint pain believe that it improved their quality of life.

CHIROPRACTIC CARE

The word “chiropractic” is derived from “chiro,” meaning “hand,” and the Greek word “praktikos,” meaning “practical,” reflecting the hands-on, non-invasive approach of modern practitioners. Canada’s chiropractors play a key role in helping Canadians better manage their muscle and joint pain through non-invasive treatments that support the body’s spine, muscle and nervous system.

With clinical tools and specialized training, chiropractors are uniquely positioned to offer treatment through active care and preventive strategies, like patient education and exercises.

 

CHIROPRACTIC CARE IS AVAILABLE UNDER MANY EXTENDED HEALTH BENEFITS PROGRAMS.

TALK TO YOUR EMPLOYER FOR DETAILS OF YOUR COVERAGE.

Are Standing Desks Good For Our Health?

 

 

Working in an office means dealing with a number of health risks related to factors like the hygiene levels of the workplace to the type of coworkers you are surrounded by. But let’s face it, the sedentary lifestyle takes the cake for the most obvious downside.

For most workers, a majority of each day is spent sitting on a chair in front of a computer. Clearly, this does not sound like the best way to treat your body in the long run. But what is the solution?

Perhaps, one can remove one of the elements from that harmful equation — how about the chair?

The likes of Benjamin Franklin and Leonardo Da Vinci were said to work while standing upright, so they may have endorsed the trend of standing desks today. Many companies have begun including standing desks as a part of their wellness programs to protect the health of their employees.

While the concept does sound healthier than slumping in a chair for hours, the science behind it is rather weak, according to a new CNN report published on Oct. 3. The report looked at various studies from recent years to understand just how beneficial a standing desk is

Findings from a 2016 meta-analysis noted very little proven benefit, especially given that most studies are poorly designed and do not look at the long-term effects of using such desks.

And if you hoped they would serve as an extended workout at the very least, another study conducted at Harvard has some bad news. Turns out, standing could only burn around eight calories more than sitting on an hourly basis. “In other words, use of a standing desk for three hours burns an extra 24 calories,” the authors wrote, “about the same number of calories in a carrot.”

This brings us back to square one, trying to figure out what people can do to effectively tackle the sedentary office routine. According to experts, the key is to never stay in one position for a prolonged period

“Make sure you stand up every hour for one to five minutes,” said Sergio Pedemonte, a fitness instructor and certified trainer based in Toronto, Canada. And while you sit down, he recommends a few small changes to make a big difference.

“When sitting back down, make sure you’re not leaning your neck forward and that your shoulder blades are retracted so that your back muscles aren’t rounding. These simple things will assist in getting your spine to be better aligned for improved posture,” he said.

You can also try performing desk exercises — or deskercises — to work out specific muscles in your body. Importantly, make sure you get enough exercise outside the workplace. Merely taking the stairs instead of the elevator can count toward the 30 minutes of physical activity you need every day.

Standing Desks Could Be Making Back Pain Worse

 

 Nearly half of people who use a standing desk are at risk of developing lower back pain, according to a study from the University of Waterloo.

The study tested 40 adults, evenly split between male and female, with no previous back issues. It found that 40 percent developed low back pain after standing for two hours. Moreover, if they were previously fatigued, their muscle strength was not able to recover while standing.

“People have different amounts of standing tolerance,” said Daniel Viggiani, lead author and a PhD candidate in kinesiology at Waterloo. “The key take-away, regardless of whether you are sitting or standing at work, is to move around and shift your posture often.”

The adults in the study performed two hours of standing work, such as transcribing a document on a computer, or sorting cards to mimic a standing office, two times – once with a tiring hip abductor exercise before the session, and once without

The people who did not have back pain during standing recovered their muscle strength by the end of the two hours. Females in general did not fatigue as quickly.

“Those with less standing tolerance use their muscles differently than others while they stand. They might stand with their back a bit more curved than those with more tolerance, for example,” said Viggiani. “Not everyone needs the same frequency of breaks, but people can usually tolerate sitting for longer than they can standing.”

He added that other studies have shown that prolonged standing can have negative implications on lower back pain later in life, but in this study, the immediate pain usually dissipated within 10 to 15 minutes of sitting down.

The study, which Viggiani co-authored with Jack Callaghan, a kinesiology professor at Waterloo, appears in the Journal of Applied Biomechanics.

Standing Desks Could Be Making Back Pain Worse

Nearly half of people who use a standing desk are at risk of developing lower back pain, according to a study from the University of Waterloo.

The study tested 40 adults, evenly split between male and female, with no previous back issues. It found that 40 percent developed low back pain after standing for two hours. Moreover, if they were previously fatigued, their muscle strength was not able to recover while standing.

“People have different amounts of standing tolerance,” said Daniel Viggiani, lead author and a PhD candidate in kinesiology at Waterloo. “The key take-away, regardless of whether you are sitting or standing at work, is to move around and shift your posture often.”

The adults in the study performed two hours of standing work, such as transcribing a document on a computer, or sorting cards to mimic a standing office, two times – once with a tiring hip abductor exercise before the session, and once without

The people who did not have back pain during standing recovered their muscle strength by the end of the two hours. Females in general did not fatigue as quickly.

“Those with less standing tolerance use their muscles differently than others while they stand. They might stand with their back a bit more curved than those with more tolerance, for example,” said Viggiani. “Not everyone needs the same frequency of breaks, but people can usually tolerate sitting for longer than they can standing.”

He added that other studies have shown that prolonged standing can have negative implications on lower back pain later in life, but in this study, the immediate pain usually dissipated within 10 to 15 minutes of sitting down.

The study, which Viggiani co-authored with Jack Callaghan, a kinesiology professor at Waterloo, appears in the Journal of Applied Biomechanics.

Standing Desks Could Be Making Back Pain Worse

Nearly half of people who use a standing desk are at risk of developing lower back pain, according to a study from the University of Waterloo.

The study tested 40 adults, evenly split between male and female, with no previous back issues. It found that 40 percent developed low back pain after standing for two hours. Moreover, if they were previously fatigued, their muscle strength was not able to recover while standing.

“People have different amounts of standing tolerance,” said Daniel Viggiani, lead author and a PhD candidate in kinesiology at Waterloo. “The key take-away, regardless of whether you are sitting or standing at work, is to move around and shift your posture often.”

The adults in the study performed two hours of standing work, such as transcribing a document on a computer, or sorting cards to mimic a standing office, two times – once with a tiring hip abductor exercise before the session, and once without

The people who did not have back pain during standing recovered their muscle strength by the end of the two hours. Females in general did not fatigue as quickly.

“Those with less standing tolerance use their muscles differently than others while they stand. They might stand with their back a bit more curved than those with more tolerance, for example,” said Viggiani. “Not everyone needs the same frequency of breaks, but people can usually tolerate sitting for longer than they can standing.”

He added that other studies have shown that prolonged standing can have negative implications on lower back pain later in life, but in this study, the immediate pain usually dissipated within 10 to 15 minutes of sitting down.

The study, which Viggiani co-authored with Jack Callaghan, a kinesiology professor at Waterloo, appears in the Journal of Applied Biomechanics.

Myth: My daily workouts at the gym will prevent back pain

Truth:  An unfortunate reality is that one of the more common reasons that people come to my office is for back pain that occurred as a result of exercising at the gym or at home

I see patients often perplexed by the fact that they take care of their bodies when an “unfit Joe” they know seems to get by with no back trouble at all.

The truth is that someone hitting the gym every day without using proper technique or doing the correct spine sparing exercises during their workout, will develop cumulative trauma in their discs. Repeatedly bending your back at the gym, followed by long periods of sitting at work, chased down with poorly executed daily tasks such as getting dressed, gardening, vacuuming etc., conspire together to cause the slow degeneration of the spinal joints and discs and eventual back pain.

“Unfit Joe,” who sits all day, doesn’t experience the same strain on his back that a gym superstar does by aggravating their disc injuries every time they sit. In terms of pain, their spines are better off! The key is not to stop working out! The secret is in changing your default movement patterns and doing the proper exercises so that you can enjoy the benefits of fitness without compromising your back.