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Masks and Neck Pain

Wearing your mask wrong can cause neck pain

Among icky mask-related side effects including “mask mouth” and maskne (acne breakouts from wearing a mask), your annoyingly necessary face covering could be behind yet another unwanted physical symptom: a stiff, achy neck.

The American Chiropractic Association has observed a connection between people spending long periods of the day in masks, and increases in jaw pain, neck stiffness, eye tension, upper back pain and headaches.

“Masks can limit the lower field of vison —particularly if they are not well fitted — causing people to tuck in their chins, shift their body position and hold their necks and posture stiffly to maintain a line of sight,” an ACA announcement read.

Ninia Agustin, a clinical director at Spear Physical Therapy in Times Square, said that while ill-fitting masks are most likely not the sole cause of a patient’s neck pain, they can absolutely be a contributing factor.

“Impediment of the peripheral vision [when wearing masks] is a real thing,” she told The Post. Why? “I can’t just look down with my eyes; I have to look down with my head and neck.”

Doing this quickly every now and then won’t cause a problem, said Agustin. But, “If I’m going to look down at my belly button to read a text message and stay there for 30 minutes, of course my neck is going to hurt,” she said.

Agustin said that because wearing masks is still necessary to stop the spread of coronavirus, it’s crucial that people take the time to find ones that fit correctly

The CDC advises that good-fitting masks will not have gaps on the sides of the face or the nose, and will have ear loops that allow the mask to sit comfortably close to the face. The ACA said that it shouldn’t drastically impede your field of vision, either. Test out a few different masks and look side to side and around to make sure you can see, noting if you’re changing your body position to compensate.

Other sources of increased neck and upper back pain may be coming from your work-from-home set-up and increased stress levels, said Agustin.

The best way to prevent this is to move as much as possible. “Motion is lotion,” the physical therapist advised. “The more you move your neck, the better off you’re going to be. Posture isn’t static, it’s dynamic. Whenever you’re working or on the phone, be mindful of moving every hour, minimum.” If you can’t get up, make sure to do a quick neck or shoulder roll instead

There are other ways to alleviate the pressure, like a side neck stretch. “Put your arm behind you. Take your other arm, wrap it around your head and gently pull toward one side,” Agustin advised. Repeat on the other side.

If neck pain or upper back pain remains persistent or is particularly intense, you should get it checked out by a chiropractor. “If you notice any numbness or tingling down your arm,” pain that’s waking you up at night or severe headaches, “you definitely want to get that checked out sooner rather than later,” said Augustin.

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


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


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.


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.




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.

Myth: Lying in bed is good for back pain


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