October 8, 2008
· Filed under Health Resources, Health Tips, Research, exercise · Tagged aging, chiropractic vancouver, chiropractor vancouver, elderly, fall prevention, flexibility, healthy aging, prevent falls, stretches, stretching, thrive chiropractic, thrive wellness, vancouver chiropractic, vancouver chiropractor
I wrote in a previous post about the public education campaign launched by the Canadian Chiropractic Association which dealt with falls prevention for the elderly. That information can be found here.
It is well documented that injuries sustained from falls can be a huge factor affecting health into our later years. A recent study in the Archives of Physical Medicine and Rehabilitation demonstrates a simple home stretching routine which can help to improve functional levels.
Previous studies have shown that walking speed declines with age, and that this is an indicator of ones risk for falls and decreasing function. This recent study tested out two simple stretches in order to measure their effect on hip flexibility, and in return their effect on walking speed.
The two stretches were a standard calf stretch with one foot flat on the ground, and a hip flexor stretch supported in a shallow lunge position (see pictures). The stretches were done twice per day, 3 times per side and held for 45 seconds. This program went on for a total of 8 weeks.
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Hip Flexor Stretch
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Calf Stretch
When measured against a control group, the stretching group showed a faster walking speed and more hip and ankle flexibility.
It is important to note though that this study was done in a population of healthy adults with an average age of 72. We can’t extend these findings to those adults with health or joint problems. However, it does show some promise for chiropractors and other clinicians to begin to implement a simple home program with their aging patients.
October 4, 2008
· Filed under Health Tips, Research · Tagged chiropractic vancouver, chiropractor vancouver, vancouver chiropractic, vancouver chiropractor, thrive chiropractic, thrive wellness, back pain, low back pain, chiropractic, MRI, disc bulge, herniated disc, back pain research
Here in Vancouver, the wait time for a non-emergency MRI can be upwards of 6 months unless you’re lucky enough to get in on a cancellation. It is not uncommon in my office to have people recovered well before their MRI appointment comes around. It often spurs a conversation about the need to get an MRI, specifically for low back disc and nerve problems. Often, the patient will want to go for the scan anyways, just to see the state of their discs and get a good picture of what’s going on. I frequently disagree with this idea, for the simple fact that an MRI is not always what it seems.
What do I mean by this?
It has been well documented in the research that when it comes to the low back, MRI findings do not predict the occurrence of actual low back pain. One of the first studies on the subject was published in the New England Journal of Medicine in 1994. They took 98 people who had never had low back pain and gave them an MRI. What they found was that 52% of all people had at least one disc bulge, with 27% having a disc protrusion (more severe). 38% had a problem at more than one level, with the likelihood of finding problems increasing with age. This led the authors to conclude that the finding disc bulges or protrusions in people with low back pain is frequently simply a co-incidence.
A better designed study was published in 2001 in the Journal of Bone and Joint Surgery. In this study, the authors subjected 67 people without any symptoms to an MRI in 1989. They found that 31% of these people had some sort of disc abnormality. They then followed up with these same people 7 years later to determine if the abnormal findings in 1989 had lead to the development of back pain in later life. While they did find that the second scans showed more abnormalities than the ones done seven years earlier, the findings on the scans did not predict whether someone got low back pain or how bad the pain was.
In my opinion, there are very good reasons why someone should go for further scans - a history of cancer, progressing neurological problems, or severe worsening of the problem to name a few. It is, however, important to realize that an MRI may just be a red herring in the search for the cause of the problem. It is especially important in this day and age of ballooning health care costs to use our resources in the wisest manner possible, and not as a first line of investigation if its not warranted.
September 30, 2008
· Filed under Health Tips · Tagged cell phones, chiropractic, chiropractic vancouver, chiropractor vancouver, thrive chiropractic, thrive wellness, vancouver chiropractic, vancouver chiropractor
Just a quick post today after experiencing something in my office that drives me nuts - Cell Phones.
I’ve never been a huge fan of big signs asking you to turn off cell phones, I think they are tacky and usually I don’t have to ask anyone twice to turn off their phone. Most times, people are very apologetic if a cell phone accidentally goes off during a treatment.
In reality, I’m not bothered at all if the occasional cell phone rings. What drives me nuts is when people actually get up off the table to pick it up.
In my chiropractic practice, I work mainly out of one room. Each person has their allotted time and usually I am not running in and out. Unless its an absolute emergency, I never leave the room to take a phone call or speak to someone. My patients expect me to be fully present for their appointment, and I expect the same thing.
Is this unreasonable? Does anyone else have any experience with this, or more effective ways of putting a stop to it other than mentioning that its not appreciated?
Okay, rant over!
September 28, 2008
· Filed under Health Tips, Research · Tagged chiropractic vancouver, chiropractor vancouver, vancouver chiropractic, thrive chiropractic, thrive wellness, health, exercise, stop smoking, smoking, chiropractic, nutrition, diet, obesity, smoking cessation, alcohol, early death, hearth disease, cancer
All of my patients can now stop rolling their eyes every time this Vancouver Chiropractor tells them to stop smoking, exercise more, eat well and drink moderately. My patients are quite used to my preachings on living a healthier lifestyle, and now (as if I didn’t have enough research to back me up) a new article has been posted in the British Medical Journal extolling these virtues.
This 24-year long study followed a group of over 77,000 women between the ages of 34 and 59 who had no signs of heart disease (when the study began). They wanted to determine the relation of their health to 5 lifestyle factors:
- Being overweight
- Smoking
- Excessive drinking
- Poor Diet
- Little physical activity
Over the years 8882 of the women died - 1790 from heart disease and 4527 from cancer. Each of the above lifestyle factors was found to significantly increase the chance of dying from any disease (not just those listed above). Another interesting fact is that women who drank moderately (up to one drink per day) actually had less chance of dying from heart disease than those who did not drink at all.
While it may seem like a tall order to follow the recommendations of this study, it really doesn’t need to be that complicated. You don’t need to hit the gym, lift weights and run ten miles everyday. Often, a healthy lifestyle is all about the little things.
Quitting smoking is a must. No if, ands or buts. If you are having trouble, both acupuncture and low intensity laser therapy are safe and effective options. You don’t need to give up your wine or spirits, simply moderate it to a one-drink a day maximum.
Simple diet choices can significantly improve your nutrition, while decreasing obesity. Choose whole grain foods, less red meats and cut out the soda and excess sugar. As for exercise, walking to work or the corner store will ensure that you achieve the 30 minutes of exercise per day that is considered minimum.
Revamping your entire life to begin an unsustainable nutritional and exercise plan is not the answer - you need to make sure you take small steps in the right direction and change your lifestyle in a comfortable way. These simple changes can literally mean cutting your risk of early death by 50%.
September 21, 2008
· Filed under Health Tips, Research · Tagged arthritis, back pain, back pain treatment, chiropractic vancouver, chiropractor vancouver, disc degeneration, disc pain, spinal problem, spine degeneration, thrive chiropractic, thrive wellness, vancouver chiropractic, vancouver chiropractor
In my view, disc degeneration is somewhere along the lines of death and taxes - inevitable and it affects everyone. However, while everyone may show the signs of disc degeneration (on X-ray), what that actually means in terms of pain, quality of life and disability varies from person to person.
Intervertebral discs (IVDs) are crucial when it comes to support, stability and proper motion in the spine. They are also prone to breakdown and degeneration which can contribute to low back pain. How much contribution IVDs make to low back conditions, and how to treat them, are hotly debated issues.
A recent review article in the Journal of Orthopaedic & Sports Physical Therapy states that surprisingly, the biggest predictive factor for disc degeneration is genetic factors as opposed to lifestyle factors (heavy lifting, smoking, vibration exposure). Even weight lifting, when performed properly, did not lead to an increase in the presence of degeneration.
I can’t count the number of times someone has come into my office after receiving the diagnosis of “disc degeneration” from a set of X-rays recently taken. This is always a misleading diagnosis, as patients will often assume it is a permanent condition which is causing their pain and that there is nothing to be done about the irreversible process. This Vancouver Chiropractor has become quite adept at communicating to them that this is a normal process of aging and rarely does it lead to serious disease. The best ways to combat the progression is through a healthy lifestyle including cardiovascular exercise and strength training. It should also be made clear that lumbar traction (or decompression) has not been consistently shown to help disc problems, even if practitioners do have great marketing campaigns with expensive machines!
September 14, 2008
· Filed under Health Resources, treatment options · Tagged chiropractic vancouver, chiropractor vancouver, vancouver chiropractic, vancouver chiropractor, thrive chiropractic, thrive wellness, knee pain, knee surgery, knee arthritis, arthritis treatment, arthroscopy, arthroscopic surgery, arthritis
A research study published this week in the New England Journal of Medicine states that “Arthroscopic surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy.”
Researchers followed two groups of patients with knee arthritis randomly assigned to receive either knee surgery or physical therapy plus over the counter medication. A follow up at two years showed no difference in pain level and quality of life between the two groups.
This study is not the first to demonstrate the ineffectiveness of knee surgery for osteoarthritis. A study in the July 2002 edition of the New England Journal of Medicine demonstrated that the outcome after knee surgery was no different than that of placebo treatment (incisions but no surgery).
Knee surgery is a common procedure recommended for arthritis sufferers for the simple reason that it has always been done. Now, there is mounting evidence that conservative care is just as effective as the surgery, never mind being less invasive, safer and less of a cost on the health care system.
It is my opinion that as responsible health care consumers, we must make smart informed choices on treatment options. Practically speaking, for most conditions it is wise to choose the most conservative form of therapy first and save the most invasive (surgery) for later. The worst thing that will happen with most conservative therapies is that you don’t improve. Conversely, the worst consequences for surgery include infection, sepsis and death (especially with all the drug resistant bacteria in hospitals such as c. difficile).
The effectiveness of many common surgical procedures (including those for low back pain) is starting to be questioned. If you would like to learn more about what your options are for conservative therapy, please contact your Vancouver Chiropractor.
September 10, 2008
· Filed under Research, treatment options · Tagged back pain, chiropractic vancouver, chiropractor vancouver, chronic pain, electrical stimulation, heat therapy, low back pain, TENS, thrive chiropractic, thrive wellness, ultrasound, vancouver chiropractic, vancouver chiropractor
Chronic low back pain has been the subject of much research and funding, with very little relevant information coming from the effort. It is a very difficult condition to manage, and its effect on society can be valued into the billions of dollars. However, it is also a condition that is seen with much frequency at the office of this Vancouver Chiropractor.
A recent study in the prestigious journal Spine set out to analyze the evidence-based management of chronic low back pain with electrical stimulation, interferential current, ultrasound and hot/cold packs. These modalities are used often in the offices of manual medicine practitioners, usually with the goal of relieving pain and inflammation.
What was surprising about this study was the blatant lack of evidence to support the use of these modalities, especially given that they are so prevalent. No eligible studies of good quality were even found for interferential current, ultrasound and hot/cold pack therapy, leading to the suggestion that these modalities should be avoided. Of the 6 studies that were found for electrical stimulation, 4 were of very poor quality and the remaining 2 found benefit only in the short term. These results suggest that electrical stimulation should be used as only one component of a short term treatment plan (and not on its own).
This article was part of a special edition of Spine in which many different treatments were analyzed for their effectiveness. The general consensus is that not enough research exists to choose one specific treatment over another, however “when viewed optimistically, the articles in this special focus issue do suggest that a reasonable approach to CLBP (chronic low back pain) would include education strategies, exercise, simple analgesics, a brief course of manual therapy in the form of spinal manipulation, mobilization, or massage, and possibly acupuncture.” Haldeman S, Dagenais S. What have we learned about the evidence-informed management of chronic low back pain? Spine J. 2008 Jan-Feb;8(1):266-77.
If you have any questions about chronic low back pain, feel free to contact your Vancouver Chiropractor.
September 3, 2008
· Filed under Health Tips, treatment options · Tagged active release therapy, ART, chiropractic vancouver, chiropractor vancouver, kinesiotape, laser therapy, rotator cuff, shoulder pain, tendonitis, thrive chiropractic, thrive wellness, vancouver chiropractic, vancouver chiropractor
One of the most common things that this Vancouver Chiropractor sees in my practice is rotator cuff tendonitis. I’ll treat at least 2-3 per day, sometimes as a primary complaint but usually as an add-on to other complaints. Most often, the problem with be chronic and will have been around for many months. Most people believe that since the pain is not too bad, it will go away on its own. Sadly, it often doesn’t, but progressively gets worse as time goes on.
The rotator cuff of your shoulder is a group of small muscles which help to co-ordinate the movement of your arm bone in your shoulder socket. When they aren’t functioning properly, the head of the arm bone doesn’t rotate smoothly in the socket and you will get clicking, clunking and pinching of the tendon of one of the muscles. This will result in pain with certain arm movements such as lifting it up to the side, putting on your coat or opening the door. Often it will be accompanied by night pain, resulting from sleeping on the sore side.
Rotator cuff problems are fairly straightforward to diagnose with a proper orthopedic examination. Once diagnosed, the goal of therapy should be to restore proper functioning of the rotator cuff and the shoulder joint. In our Vancouver Chiropractic office, this entails active release therapy for the muscles, joint mobilization and manipulation, kinesiotaping and many home stretching and strengthening exercises. Once the shoulder has regained a full and painless range of motion, it is imperative that the muscles are strengthened in order to prevent the problem from coming back.
Another option which works well, especially for chronic and stubborn cases, is low intensity laser therapy. Although current research has variable results, I have had great success with laser therapy in my practice. Once specific case involved complete resolution of left-sided shoulder pain in two treatments, and no further recurrence in the last 6 months. What makes this case more remarkable is that the patient had previously had rotator cuff surgery on the other shoulder, and was slated to follow the same course for the left side.
The most important thing to remember about rotator cuff problems is that the sooner they are diagnosed and treated, the faster they get better. Leaving a rotator cuff for too long can make recovery a longer process, and can increase your chances of developing frozen shoulder syndrome which has a recovery time measured in years. If you have any questions about rotator cuff pain, feel free to contact your Vancouver Chiropractor.
August 24, 2008
· Filed under Research, treatment options · Tagged chiropractic vancouver, chiropractor vancouver, vancouver chiropractic, vancouver chiropractor, thrive chiropractic, thrive wellness, knee pain, cycling knee pain, kinesiotape, kinesiotaping, Iliotibial band, ITB Syndrome, running injury, cycling injury, running knee pain
Iliotibial Band
Iliotibial band syndrome (ITBS) can be described as outside (lateral) knee pain that is made worse by any lower limb activities, most notably running and cycling. The incidence of this injury is on the rise in my practice, but research also shows that ITBS is the most common running injury in the lateral knee, with an incidence of 1.6-12%. In cycling, ITBS may account for up to 15-24% of all overuse injuries.
It is thought that ITBS is an overuse injury in which the portion of the iliotibial band which runs over the outside knee rubs over the femoral bone with repetitive knee bending and straightening. This results accumulated tissue damage and irritation of the ITB. Specifically with running, as each leg comes forward before heel strike, the tensor fascia latae (TFL) and gluteus maximus/medius are contracting to slow down the leg, which can result in a large amount of tissue tension generated in the ITB.
A study published in Manual Therapy systematically reviewed all studies on ITB treatment in order to determine which was the most successful method. What they found is that there is a marked lack of good evidence to support any one given treatment for ITBS. All forms reviewed - ultrasound, friction massage, medication or ice all had very little benefit on the condition.
Part of the reason for this is that different treatments could work for different subsets of people (i.e. older cyclists respond better to one thing, while runners with chronic ITBS respond better to another). This Vancouver Chiropractor will often see good results with ART (active release therapy) and other such soft tissue therapies, kinesiotaping, and chiropractic adjustments to restore proper function of the pelvis, hips and back. Of course, one must always look above the problem (pelvis) as well as below the problem (feet) for a source of dysfunction.
So the bottom line of this post? So far, the evidence doesn’t point to one therapy being better than another. So when seeking out treatment, be sure to set an appropriate treatment plan that includes regular re-evaluation with your therapist. If something isn’t working, don’t be afraid to move on and try another modality once you’ve given the first one a good shot.
If you have any questions about ITBS, feel free to contact your Vancouver Chiropractor for more information.
August 15, 2008
· Filed under Health Resources, treatment options · Tagged chiropractic vancouver, chiropractor vancouver, kinesiotape, kinesiotaping, knee injuries, taping, thrive chiropractic, thrive wellness, vancouver chiropractic, vancouver chiropractor
Many of you have been watching the Olympics. If you’ve been watching beach volleyball, you’ve no doubt spotted the peculiar black tape all over the shoulder of one of the American women. This taping method which was developed by a chiropractor, called Kinesiotaping, is very popular amongst trainers and chiropractors especially when working with elite athletes. I’ve been using Kinesiotape in my office for about 6 months now with great results.
From the Kinesiotaping website:
The Kinesio Taping® Method has taken the Rehabilitation and Sports Medicine world by storm. This amazing taping method was developed by Dr. Kenzo Kase over 25 years ago in Japan. Kinesio Taping® has quickly become the gold, or should we say “platinum” standard, for therapeutic rehabilitative taping. The proprietary method of taping uses a uniquely designed and patented tape for treatment of muscular disorders and lymphedema reduction.
The Kinesio Taping® Method involves taping over and around muscles in order to assist and give support or to prevent over-contraction. The first technique gives the practitioner the opportunity to actually give support while maintaining full range of motion. This enables the individual to participate in their normal physical activity with functional assistance. The second technique, which is most commonly used in the acute stage of rehabilitation, helps prevent overuse or over-contraction and helps provide facilitation of lymph flow for an entire 24 hour period.
On a personal note, I have been using Kinesiotape for my knee sprain. When the tape is not applied, I have alot of pain walking, standing for long periods of time, and going from a sitting to a standing position. As soon as the tape is applied over the inside surface of my knee, I get instant relief from pain which enables me to strengthen and heal the injury quicker.
I have used this method on various injuries in my office. Just yesterday, the tape was used to reduce the inflammation of biceps tendonitis, pregnancy-related pelvic pain and shin splints. If you have any questions about how Kinesiotape can help you, feel free to contact your Vancouver Chiropractor.
drdebbie