Myth: Lying in bed is good for back pain

Truth:

One of the more common responses I get when I ask patients to describe their back pain, is that they are stiff and sore when they get up in the morning but it gets better as the day goes on.

Some people are told or believe that lying down is always the best thing to do with back pain.

Here is my take on this subject.

First off let me say that if you have a normal functioning spine with no amount of disc degeneration or arthritis you should not experience this problem.

Those who do have these problems are susceptible to many things and one of these is that lying in bed for excessive periods actually  causes back pain. Let’s examine this more closely. A little known fact is that we are all actually taller first thing in the morning than we are before we go to bed at night. This comes down to our spinal disks. The disks in between each of our vertebrae are packed with very concentrated protein chains that love water. When we lie horizontally, the discs fill with fluid and gently push the vertebrae away from one another, lengthening the spine. The reason, our backs are often stiff in the morning is that weak or damaged discs are so full of fluid, like water balloons ready to burst. When we get up in the morning, and our spines are once again vertical, the excess of fluid in each disc begins to seep out and an hour or two after rising from bed we have returned to our normal heights.

This natural ebb and flow of water in and out of the discs is what allows the discs to obtain nutrition. Problems arise, however, when the spine remains in a horizontal position for too long.

Chiropractic First For Occupational Back Pain

If a recent study is any indication, more injured workers could be returning to work earlier if they seek chiropractic care first for work related back pain.

According to a new study published in the Journal of Occupational Rehabilitation, workers who went to a chiropractor first for occupational back pain had a significantly shorter duration of compensation during the first five months, compared to those who sought a medical doctor first.

In comparison, workers who sought a physiotherapist first for back pain experienced a longer period of compensation than those who consulted a medical doctor first.

Is Crossing Your Legs Bad For Your Health

So often I get asked if crossing your legs while working is ‘bad’ or can cause your body harm. For this answer, you need to check out the rest of this post! In many cases, crossing your legs can be an indication that something is a little ‘off’ in the ergonomics of your office set-up and you are working this way to compensate for it. It could be that your chair is just a little too high for you and you cross your legs to reach the floor. Or you may sit like this just because its a habit and old habits can be really difficult to change. Ensuring that your desk is set-up in an ergonomic manner is one way to reduce the likelihood of you wanting to cross your legs. Check out the rest of this post for insights of the ergonomic risks associated with crossing your legs as well as what you can do to reduce the risk

Why You Should Limit Crossing Your Legs

  1. Lower Leg Circulation Is Impeded

Crossing your legs is considered to be an awkward leg posture, with more symptoms accumulating the longer that the position is held for. It can contribute to injury, swelling, and pain in the lower extremities and even in the back and shoulders (more on this in the next section). Research supports that there is a risk to lower leg blood circulation as a result of crossing your legs. Without question, optimal circulation is an essential part of health. Our circulatory system ensures that oxygen rich blood reaches our tissues (via arteries) and removes oxygen-depleted blood with other waste products too (via veins). This research shows that there is much more musculoskeletal discomfort symptoms in a person’s thighs, knees and legs among those who crossed their legs throughout their workday compared to those who sat in a neutral posture. And these researchers found that crossing your legs increases the blood pressure in the lower leg veins due to the fact that the knee is flexed to such a tight angle. Note: A neutral posture is when the knees are bent between 90 and 120 degrees with the feet in secure contact with the floor. Leg crossing leads to poorer circulation and increases the risk of lower leg swelling (aka blood pooling), varicose veins, and even nerve issues – have you ever felt ‘pins and needles’ in your legs after a particularly long bout of sitting crossed legged? It’s something to think about

  1. Awkward Postures In The Legs And Beyond

As I mentioned in the first point, crossing your legs is considered to be an awkward ergonomic posture. And, awkward ergonomic postures can lead to discomfort and injury overtime. But what happens if I said that crossing your legs can actually increase the ergonomic risk to your upper extremities too? There is a lot of evidence to support this claim. Firstly, this research does not recommend crossing your legs during long-term computer work because crossing your legs has reactive poor postures in the back (increased back flexion) and increased pressure in the buttocks. For reference, the most-up-to-date sitting research recommends that the back should be slightly reclined (between 95 and 115 degrees flexed) to limit long-term wear and tear on the spine. Crossing your legs tends to reduce this preventative back position. For many musculoskeletal injury risks, its the duration spent in the posture that tends to compound the problem. On this note, these researchers found that sitting with the legs crossed for longer than 3 hours per day can increase ergonomic risk factors for some counter-intuitive body areas – including the shoulders (via raised shoulder postures), pelvis (via lateral pelvic tilt) and neck (via forward head positions). If that research doesn’t convince you, this research found that 80-90% of low back pain is a result of habitual asymmetric sitting postures – specifically crossing your legs. There are certainly some complications related to long-term leg-crossing behaviours. These researchers noted that specifically sitting with crossed legs can lead to spinal imbalances and maybe even risk of spine disease because of unequal use of supportive abdominal muscles. What do all of these points suggest? That a simple, cost-effective way to reduce long-term harm to your spine (in addition to other areas of the body) is to eliminate crossed leg postures for extended periods of time

  1. What You Can Do To Reduce The Risk

Since this is an ergonomics blog, I wouldn’t be doing my job without stating what can be done to improve sitting postures to reduce the tendency for people to want to cross their legs. As always, using the right ergonomics set-up is paramount in this situation. If something in the workstation isn’t quite optimal for the user, I have noticed that there tends to be a tendency for people to cross their legs. Specifically I have noticed that a chair height that is much too high or a poorly adjusted chair in general tends to correlate with leg-crossing behaviours. While a good solid ergonomic set-up is part of the solution, the user’s habits and behaviours should probably be where any sort of ergonomic intervention is focussed on. Simply remembering to sit with an optimal position may prove to be a lot more difficult for some people to do, especially if they have been crossing their legs for years without any negative health outcomes associated with it. For those people, I suggest focusing on a foundation of a good workstation set-up and perhaps suggesting a graduated schedule for them to slowly ease into the transition of sitting without crossing their legs. It will likely take some time and have some opposition, but if that person is really interested in improving their overall health as well limiting the negative health consequences that I mentioned above, it would be well worth it

Let’s Talk Arthritis

Every so often I have a patient comes into my office and informs me that their doctor says they have arthritis in their neck or back. Their immediate thought is that nothing can be done for that…..right?

Many people make the assumption that a diagnosis of “arthritis” condemns them to a life of constant pain and every joint pain must just be arthritis.

Nothing could be further from the truth. Let me explain.

First off let me say that ”arthritis” is a rather ‘catch all’ diagnosis often used to cover a myriad of conditions. The term arthritis comes from the terms “arth” meaning joint and “itis” meaning inflammation. So technically any inflamed joint is an arthritis so this diagnosis doesn’t really mean much.

The only types of arthritis that are systemic, meaning that they affect the whole body, are ones like rheumatoid arthritis, lupus, ankylosing spondylitis etc. The arthritis that the majority of individuals have is osteoarthritis or degenerative arthritis. There is some debate over whether there  is a type of systemic osteoarthritis but for this discussion let’s talk about degenerative arthritis.

Degenerative arthritis is the “wear and tear” type of arthritis that usually affects one joint but can affect multiple areas. Knees, hips, hands, neck and lower back are common sites. It is caused by repeated stress or trauma over time or a specific injury. These change the normal movement pattern of the joint causing the joint to become inflamed, painful and eventually to wear out.

In the spine this degenerative process involves the deterioration of the discs often with accompanying nerve pressure

The Chiropractic goal in these cases is to return the movement of the joint(s) to as close to normal as possible. This will reduce the symptoms and slow down the degenerative process in the joint.

Don’t let a diagnosis of “arthritis” disrupt your life…chiropractic can help

 

 

Preventing Injury When Lifting And Holding An Infant

Many mothers suffer from repetitive stress injuries from the daily physical demands of lifting, carrying and loading their infants into the car seat, high chair and crib. Preoccupied with the demands of newborn care and postpartum recovery, many moms easily overlook the fact that the regular care of a new baby can take its toll on many parts of the body, including neck, upper and lower back, arms, hips and knees.

Here are some of the best practices that I recommend to our new moms as well.

When carrying a car seat: many moms make the mistake of putting the car seat handle over their forearm. They lean sideways at the hip to accommodate the bulk and weight. This strains muscles in the back and will eventually cause pain to the arm holding the seat. Instead, grip the handle with both hands and carry the car seat in front of your body. Avoid standing and holding the car seat when it isn’t necessary- if you pause to chat outside your car, put the car seat inside first, or set it down at your feet.

When lifting your baby out of the crib: Make sure to lower the railing.  Lifting and holding the infant at arm’s length puts too much pressure on your spinal disks. Your arms will tire much more easily the further the baby is from your body. Instead, lower the railing, bring baby close to you, and lift from your knees.

Another common mistake occurs when lifting your toddler up onto your lap. Most moms will lean forward and pick the child up while still seated themselves.  This increases the weight of pressure on your spine anywhere from 3 to 10 times! To your spine, you’re no longer lifting a 15lb toddler- you could be experiencing as much as 150lbs of stress to your spinal discs.

Instead, get on the floor with your baby. Kneel on one knee and lift using your whole body. Then sit down together on the chair or sofa.

With any of these daily lifting scenarios, be mindful of your own discomfort- if you start to feel recurring pain or think you’ve injured yourself, don’t ignore it! Repeatedly stressing the same muscles and discs could exacerbate the problem quickly. Instead, treat your body well, be careful when lifting, and remember that caring for an infant or toddler can be a major physical demand.

Remember, chiropractic care can help correct and maintain your pelvis and spine during this post- delivery transition time.

Big Money? … The Truth About Athletic Team Doctors

Many young high school students preparing to further their education in the medical field are swayed by the allure of becoming the Team doctor, chiropractor, physiotherapist or trainer.

When I was in chiropractic school a professor told me chiropractors in the NFL made a salary of $250,000 per year. I believe my professor was telling me what they thought to be the truth  although they have been misinformed.

I recently read a wonderful article in the Canadian Chiropractic Association magazine, Back Matters, about the chiropractor for the CFL’s Toronto Argos. It was a very engaging read. What struck me as odd was that there was no mention of financials, abstract business arrangements, or any indication of how a chiropractor on a CFL team is reimbursed for their time.

The reality is that chiropractors in the CFL and NFL do not get reimbursed fairly for their time. Essentially, it is volunteer work – and it is the same for the medical staff as well. A team medical doctor in the CFL makes a little over $2,000 per year in travel stipend. In fact, believe it or not, the team MDs in the NFL actually pay anywhere from $300,000 to $750,000 per year to be the official group MDs for that NFL team. Chiropractors in the NFL and CFL usually receive tickets, memorabilia, and team clothing as compensation. These were all verified by team DCs and MDs from both respective football leagues.

A CFL team medical doctor, who asked to remain anonymous, said doctors in pro sports in Canada usually receive a minimal travel stipend. This doctor contends that MDs, DCs, physios, chiropractors and trainers are all undervalued in Canadian athletics. “Most MDs do it because they love the sport. It definitely does not have a financial reward. It’s a personal reward.”

The CBA allows NFL teams to hire medical groups who pay the team between $300,000 to $750,000 per year to be considered as the team’s official doctors. The medical group who becomes the team doctors can recoup their money by billing players and team staff for all medical services provided that year. The NFL teams then use a portion of the money paid to them to advertise for the medical groups at games, on TV and print media.

Wait a second. The doctors pay the team? According to Dr. David Geier, a medical doctor, this is actually true.

“Often there is a separate contract that allows the physicians to advertise that they are the official team physicians. Those contracts involve huge amounts of money. Whether paying a lot of money to advertise serving as a physician for a pro team generates enough patients to make it worthwhile is debatable,” Geier says.

In an article by Darren Rovell, NFL Raiders’ team medical doctor for eight years, Dr. Robert Huizenga, said: “In this arrangement, a medical organization provides the team doctors often for free and also pays for a marketing arrangement which advertises the deal to fans. Does the Hospital For Special Surgery in New York really have the best doctors for the Mets, Giants, Knicks, Nets and Red Bulls or is it because they pay for the right to say they treat the teams?”

Voltaren…just another topical gel?

Over the years in my office the question of which topical cream or gel is best or what which one do  I recommend, is one of the most common ones.

All topical rubs (Tiger Balm, Deep Relief,  A535, Icy Hot, Bio Freeze) work on the same premise known as the “GateTheory” of pain control. Their active ingredients (menthol, camphor, methyl salicilate) act as counterirritants which trick the brain into paying more attention to the warming or cooling sensation than to pain.

As far as which one is best, it is purely preference.  They can work differently for each person.  In my office I like BioFreeze because it seems to work best for most people.

Over the last number of months patients have been asking about a new topical rub called Voltaren. Is it just another rub like the others… absolutely NOT. Here’s why.

Voltaren is the brand name for a drug called Diclofenac. Diclofenac is a pain reliever in the drug class NSAID (non-steroidal anti-inflammatory drug). Voltaren can be taken orally (diclofenac potassium) or used as a topical rub (diclofenac sodium)

How NSAIDs Work.

All non-steroidal anti-inflammatory drugs like Advil (ibuprofen),  Motrin,  Aleve (naproxen), Celebrex and  including diclofenac sodium  are designed to inhibit activity of COX-1 and COX-2 enzymes, which cause the pain. This enzymes are produced by the cells of the body, and are responsible for the creation of the agents called prostaglandins, which promote inflammation, pain and fever

Diclofenac is a nonselective NSAID, which means that it blocks both COX-1 and COX-2 to stop the production of more types of prostaglandins than some other NSAIDs. This means that it is more likely to cause side effects due to the action of the other prostaglandins that are reduced.

Obviously a topical rub is less likely to produce side effects than oral intake but let’s cover them anyway.

Nausea

Heartburn (dyspepsia)

Diarrhea

Headache

Dizziness

Gastrointestinal ulcer

Gastrointestinal bleeding

Hypertension

So is Voltaren topical gel safe and effective? Because so little of the active ingredient is absorbed into the rest of the body (6-10%) it appears to be safe from side effects.

Voltaren topical gel appears to be very effective for knees, feet & hands, elbows, shoulders and back) pain.

Ice fishing carries risk for musculoskeletal injuries, study says.

Ice fishing carries risk for musculoskeletal injuries, study says.
ROCHESTER, Minn. – Ice fishing might seem like a benign sport for everyone – except the fish. Sitting in a cozy shanty waiting for a bite, what could go wrong? A lot, Mayo Clinic surgeons have found. The ice fishing injuries they have chronicled seem more like a casualty list from an extreme sport: burns, broken bones, concussions and more. The findings are published in the American Journal of Emergency Medicine.
The study team analyzed data on emergency department visits between 2009 and 2014 obtained from the National Electronic Injury Surveillance System – All Injury Program and found 85 patients hurt while ice fishing. There may be more cases than they could find; the researchers had to search case narratives to identify ice fishing injuries.

Most of the 85 patients were treated and released. Roughly 11 per cent were injured so severely they had to be admitted to the hospital.

“Falling through the ice is the most feared risk of ice fishing,” says lead author Cornelius Thiels, a surgical resident at Mayo Clinic. “However, it turns out that burns are just as common, but rarely discussed. Ice fishing huts often contain rudimentary heating systems, and we have seen injuries from fires and carbon monoxide inhalation. We hope this research will bring awareness to the safety issues that surround this pastime and help prevent similar incidents.

“Nearly half of the injuries were orthopedic or musculoskeletal: broken bones, sprains and strains. Just over one-third involved minor trauma, such as cuts, abrasions, punctures and fishing hook injuries. There were five cases of major trauma, a category that includes concussions, loss of an appendage and organ injuries.

Four anglers were injured falling into cold water: two in December and two in March. Four were burned, likely due to the heating systems they were using, the study found.

The researchers also looked for differences between injured ice anglers and people hurt while fishing on open water. Intoxication was likelier to be reported with ice fishing injuries. Those harmed while ice fishing were likelier to have injuries to the torso or lower half of the body, and to have more serious injuries. Both groups were similar in age and gender: Most injured anglers were men under 40.

“Ice fishing has become more popular in the last few years, and, with this, we have seen an increase in ice fishing-related injuries,” Dr. Thiels says. “What is even more concerning is that ice fishing injuries tend to be more severe than injuries associated with traditional fishing.

Thunder Bay Chiropractor Says Headaches Are Under Treated

With all the different types of pain relievers available at the corner drug store, you’d think headache sufferers would have a solution to their problem. But, such is not the case, and headaches continue to be a great burden on society, afflicting millions of people and causing economic and social losses, in addition to personal pain. What’s more, it seems this common problem is often under-diagnosed .
A recent study from England (Br J Gen Pract ; 58(547):102) has highlighted this widespread issue. The researchers studied over 91,000 adult patients who had recently reported a headache. Amazingly, seventy percent of these patients were not given a diagnosis.
It’s important to diagnose the cause of a headache. The spine is often overlooked as having the potential for causing a headache. Too often, headaches are thought to have their cause in the head. While this is where the pain is most prominent (as opposed to the neck), neck symptoms such as muscle tension, knots and painful tissues also contribute to the pain picture. If your neck mobility is also reduced, this can also be a indicator that the neck could be the source of the head pain.
When bad neck posture is present, this can manifest as a forward head posture. Patients who have had previous whiplash injuries can often show this type of posture. Sprains of the small vertebral joints can be enough to produce head pain and need to be addressed. When the headache is thought to originate in the neck, it is called “cervicogenic.”
Neck problems have also been implicated in certain cases of tension-type, as well as migraine headaches, but how this occurs exactly is still being investigated.
Whatever their cause, headaches have a devastating impact on our quality of life and need to be effectively treated. Chiropractic care has been shown in several studies to reduce headache pain and is an important non-drug option for patients. While drug treatments can be quite effective for some patients, one also has to consider long-term side effects when considering this management approach.
For more information click the “Headache Free Report Button” on the right for my special 7 page report.

Canadian Chiropractic Association to attend the national Opioid Conference and Summit

The federal government has taken a critically important step forward in recognizing the value of chiropractic care.

The CCA was invited as one of Canada’s leading primary care professions to the national Opioid Conference and Summit on November 18 and 19, 2016.

Opioids have quickly emerged as one of the primary means for managing acute and chronic non‐cancer pain in primary care settings. With an estimated 2,000 Canadians dying annually from prescription opioids, it is clear that we are facing a national crisis.

“Solutions must be compassionate and collaborative, and address both the immediate crisis of overdose and death as well as their root causes.”

The CCA has engaged in months of advocacy with the federal government and other health professions to build awareness that available evidence points to back pain and other musculoskeletal conditions are a leading reason for opioid prescribing. The key to addressing this crisis is to reduce the pressure to prescribe by increasing utilization of chiropractic care and addressing the underlying causes of musculoskeletal pain.