Thursday, May 18, 2017

Common Conditions Of The Shoulder Joint

By Dr. John A. Papa, DC, FCCPOR(C)
The shoulder is one of the largest and most complex joints in the body.  It is anatomically designed to allow for an individual to perform a wide range of movements and activities.  This versatility, along with the high physical demands placed on a shoulder can also make it vulnerable to breakdown and injury.
Listed below are some of the conditions that commonly cause shoulder problems:
·        Osteoarthritis: Results from the protective layers of cartilage in the shoulder becoming worn over a period of time, leading to change in the composition of the bone underneath the cartilage. This process may also be related to previous injury/trauma to the shoulder joint.
·        Frozen Shoulder:  Also known as adhesive capsulitis, this condition is a painful and persistent stiffness in the shoulder.  It is believed to be caused by thickening, swelling, and tightening of the flexible tissue that surrounds the joint.  Symptoms can vary greatly and can last anywhere from several months to several years.
·        Rotator Cuff and Soft Tissue Injuries:  The rotator cuff is a group of muscles and tendons that provide stability and rotational movements of the shoulder joint in a balanced fashion.  Other shoulder muscles are responsible for different ranges of motion of the upper arm (humerus) and proper positioning and movement of the shoulder blade (scapula) along the ribcage.  An injury can occur to any of these muscles which can lead to shoulder problems.

·        Mechanical Conditions:  Scapular dyskinesis is a mechanical term used to describe irregular movement of the shoulder blade.  It can be an early sign that a shoulder problem may develop, or it may already be accompanied by pain or dysfunction in the shoulder.  A mechanical change in shoulder blade movement can be associated with a variety of problems including an internal pinching of soft-tissue structures (impingement), irritation of the cushioning bursa (bursitis), or a feeling of the shoulder dislocating with certain movements (instability).

·       Traumatic Injuries:  Vigorous lifting, pushing, and pulling activities, or a fall onto or blow to the shoulder can result in ligament sprains or muscle strains.  More significant injuries can result in shoulder dislocations and separations, rotator cuff and soft tissue tears, cartilage labral tears, and fracture.

Balanced and stable movements are key to a healthy shoulder.  If this does not occur, there is potential for many shoulder problems to exist simultaneously at any given time.  For example, an individual may strain their shoulder from heavy lifting.  The shoulder strain may be causing pain, but it can also be accompanied by pain and weakness from impingement and bursitis that may arise from the irregular movement pattern of the shoulder.  Therefore, it is important that a proper evaluation is performed to best guide the treatment of shoulder conditions.

If you suffer from a shoulder problem that is limiting your daily functioning, contact a qualified health professional who can prescribe appropriate therapy, rehabilitation, and self-management strategies specifically for your circumstance.  For more information, visit

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Wednesday, May 10, 2017

Solutions For Overcoming Poor Sitting Posture

By Dr. John A. Papa, DC, FCCPOR(C)

An ideal posture allows an individual to maintain an efficient, strong, and balanced position while interacting and adapting to their physical environment.  Good postural habits can help decrease abnormal and excessive physical strain on the body, thereby minimizing the chance of injury.
Unfortunately, modern technology has significantly influenced our daily postural habits, which has resulted in having people sit more often and for longer periods of time.  Individuals exposed to these sitting positions may adopt a poor posture that includes losing the natural hollow of the low back, rounding or slouching of the upper back and shoulders, and a forward head poking position.
Less than ideal posture puts cumulative compression, stretch, and shear forces on the body.  The cumulative effects of sitting are often offset by the body’s ability to compensate.  However, even in the absence of pain, these compensatory changes may begin a vicious cycle of unbalanced motion, muscle and joint stress, and secondary areas of discomfort.  As a result, the physical consequences of chronic poor posture can lead to symptoms such as muscle and joint stiffness, nerve pain, headaches, shoulder pain, neck pain, upper and lower back pain.
Listed below are some potential solutions that can minimize the chance of postural injury, specifically as it pertains to the sitting position:
1.    Pay attention to how you sit by making sure weight is evenly distributed in your seat, your shoulders are not rounding forward, and you are not slouching.  Your head should be resting on your torso and not poking forward.

2.    Take a break from sitting with 10 to 30 second stretch or posture breaks every 20 to 40 minutes.  Some activities such as computer work, talking on the phone, and business meetings can also be done while standing.

3.    The use of a properly designed workstation (i.e. adjustable chair and desk), along with ergonomic tools and assistive devices (i.e. speakerphones, foot stools, lumbar supports) can help maintain mechanically advantageous positions while working in a seated position.

4.    Avoid unnatural positions such as looking down, awkward twisting, or slouching for long periods of time as this can cause unnecessary strain.  A simple solution may be to bring your smartphone, tablet, or book closer to eye level, or adjusting your seat position to help you maintain a more natural/neutral position.

5.    Engaging in regular physical activity and exercise can keep your body strong and help overcome the effects of cumulative strain associated with poor posture.  Exercise activities can include general cardiovascular conditioning, along with postural, stretching and strengthening exercises for the neck, shoulders, upper and lower back regions.

Prolonged sitting and poor posture can undeniably cause real physical change and breakdown in the body.  If you have ongoing pain as a result of postural strain, you should contact a licensed health professional who deals in the diagnosis and treatment of these conditions.  For more information visit

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Friday, May 5, 2017

What Does It Mean To Have Degenerative Joint Changes?

By Dr. John A. Papa, DC, FCCPOR(C)

Have you had a joint problem and been told that you have "degeneration" or "degenerative changes"?  What exactly does this mean?  Is this something that can be fixed?  Let's take a closer look at two common types of degenerative changes and some potential management strategies that can be employed.
1.    Degenerative Joint Disease (DJD) is also known as osteoarthritis, and is the most common form of arthritis.  Weight-bearing joints such as the hips and knees are most commonly affected, but DJD can affect any area of the body, including the hands, neck, and low back.
Most joints in our body have smooth cartilage surfaces that glide against each other, which allow two or more opposing bones to move freely and perform a specific set of movements.  A joint becomes "degenerated" or arthritic when there is wearing down of these cartilage surfaces, and a change in the composition of the bone underneath the cartilage occurs.  An arthritic joint does not mechanically function like it is supposed to.  This may result in a number of symptoms including:  muscle tightness and weakness, joint pain and stiffness, decreased ranges of motion, creaking in the joints, swelling, inflammation, and joint thickening (i.e. finger nodules, bunions).
2.    Degenerative Disc Disease (DDD) specifically affects the spinal discs between each vertebrae and is also considered an arthritic disorder.  Spinal discs allow for some movement between vertebrae, and they also absorb compressive, tensile, and shearing loads with everyday activities.
      The centre of the disc, called the nucleus pulposis, is jelly-like and mostly made up of water. The outside of the disc, called the annulus fibrosis, is tough and thick and contains the nucleus pulposis.  Over time, the water content of the spinal disc diminishes, causing it to dry out and become fibrotic (tough and brittle).  As the disc becomes fibrotic it can develop tears.  This breakdown can result in disc herniations, the development of bony spurs, and sciatica.
Risk factors/causes for DJD and DDD are typically multi-factorial, meaning that there is usually no single cause, but rather a combination of several different factors.  These risk factors/causes may include but are not limited to: advancing age, genetic predisposition, mechanical overload from occupational and recreational activities, direct injury to the affected region, cigarette smoking, lack of exercise, and being overweight or obese.
Degenerative changes can result in debilitating symptoms for some individuals and can be managed a number of ways.  Maintaining an ideal body weight through a healthy diet and regular exercise consisting of strength, flexibility, and endurance training can reduce the risk of pain and subsequent disability.  Treatment from licensed health professionals who utilize manual mobilization therapies, soft tissue therapy, electrotherapy, acupuncture, exercise and rehabilitation strategies can also significantly help to decrease pain by restoring normal muscle and joint motion, and promote healing of arthritic or injured areas.
In the event that you suffer from degenerative joint changes, you should contact a licensed health professional who deals in the diagnosis and treatment of these conditions.  For more information, visit
This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Monday, May 1, 2017

Taking Care Of Your Feet

By Dr. John A. Papa, DC, FCCPOR(C)

The feet are an individual’s contact points with the ground, so how they support the rest of the body is critical.  Our feet have nearly 100 individual working parts, which all have to function together when we stand, walk, run and jump to provide proper stability and balance.
When a small problem develops in our feet, the subtle changes in the way we move can cause a chain reaction of adjustments in our posture and walking mechanics.  This can lead to symptoms such as: localized foot pain, arch and heel pain, along with ankle, knee, hip, and back pain.
Protecting your feet and choosing proper footwear can go a long way in preventing injury and pain.  Below are some helpful tips that can ensure your feet are protected and functioning to the best of their ability.
·        Choose footwear that is appropriate for your foot type.  For example, people with low arches, called pronators, will need a shoe that provides some degree of stability.  A shoe with good cushioning is important for people with high arches, called supinators.
·        Select a footwear store with knowledgeable staff who can provide advice on the shoe that best suits your activity, body structure and type of foot.  Shop in the afternoon or evening, as your feet tend to accumulate fluid and swell throughout the day.  What may have been comfortable earlier in the day could now feel tight later in the day.
·        Remember that not all shoes are created equally.  The same shoe sizes can have different fits depending on the manufacturer.  Be sure to try several sizes to find the most comfortable shoe.
·        Avoid buying shoes that you feel need a break-in period.  Shoes should be comfortable from the first time you put them on.
·        Don't cheap out on your shoes!  Better quality shoes may cost more but will pay off in terms of support and sturdiness.  A mid-priced shoe may offer the best value.
·        Do not hesitate to replace footwear after excessive wear as it may not be providing you with proper support and stability.
·        Consider custom orthotics to help support your feet.  Orthotics are mechanical aids that fit into your shoes as comfortably as an insole and work on your feet much like glasses work on your eyes – they decrease stress and strain on your body by bringing your feet into proper alignment.  This helps rebalance your feet and reduces pain and discomfort by enhancing your body’s natural movements.
·        Remember to exercise regularly and try to maintain a healthy weight.  Extra weight adds extra stress on your feet, knees, hips, and back.
In the event that you suffer a muscle or joint injury related to your feet that does not subside, you should contact a licensed health professional.  For more information, visit
This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Thursday, April 27, 2017

Get Set To Garden

Ontario Chiropractic Association (OCA)

Plant and Rake Without the Ache
Gardening is a great way to stay active and have fun in the sun. But many Canadians sustain injuries that can be easily prevented with a little know-how.

The right moves

Use the right moves to lighten the load on your back. Kneel, don’t bend, to plant. Change your body position often. Take frequent breaks. Alternate between light and heavy chores. Drink lots of water. And most importantly, loosen-up before you start out.

Warm up

Before you begin any physical activity, warming up is a key factor in preventing injury. Take a walk, even on the spot. Ten to 15 minutes should do it. Don’t forget to lift your knees and gently swing your arms.

Stretch before you start

To plant and rake without the ache, do each of these stretches five times. Don’t bounce, jerk or strain. Stretches should be gentle and should not cause pain.

Upper Body


  1. Extend your right arm over your head.
  2. Bend to the left from the waist.
  3. Hold for 15 seconds and repeat on the other side.


  1. Hug yourself snugly.
  2. Slowly rotate at the waist as far as is comfortable to the left, then to the right.


  1. In a seated position, bend forward from the hips, keeping your head down.
  2. Reach for the ground.


Lower Body


  1. Face a wall or tree and support yourself against it with one arm.
  2. Bend your right knee and grasp your ankle or pant leg with your left hand.
  3. Hold for 15 seconds and repeat on the other side.


  1. Stand.
  2. Reach your hands to the sky.
  3. Then bend at the waist and reach toward your toes.
  4. Hold for 15 seconds.

Monday, April 24, 2017

Plantar Fasciitis: A Common Source Of Heel Pain

By Dr. John A. Papa, DC, FCCPOR(C)

Plantar fasciitis is caused by injury to the plantar fascia, which is the tendon-like soft-tissue along the bottom of the foot that connects your heel bone to your toes.  This condition is a common source of heel pain that can be quite disabling.
Plantar fasciitis usually develops gradually, but it can also come on suddenly.  Sharp, knife-like pain on the inside-bottom part of the heel is often characteristic.  Pain and discomfort can also extend into the arch of the foot.  Heel pain tends to be worse with the first few walking steps in the morning, and after extended periods of sitting or inactivity.  If plantar fasciitis becomes severe or chronic, heel and/or arch pain will be present with all weight-bearing activities, and may result in secondary areas of discomfort in the foot, knee, hip or back due to compensatory movements.
Under normal circumstances, your plantar fascia acts like a shock-absorbing rubber band, supporting the arch of your foot.  Excessive tension and repetitive stretching can create small tears in this soft-tissue fascia, causing it to become irritated or inflamed.  This may occur with activities that require running, jumping or prolonged walking and standing.  Improper footwear can make the plantar fascia more susceptible to stretch and strain during these activities.
Faulty foot mechanics may also contribute to the development of plantar fasciitis.  Individuals with flat feet or those who excessively pronate (role feet inward) will experience added strain on their plantar fascia.  Old lower extremity injuries such as ankle sprains and fractures can increase susceptibility due to altered lower limb movements.  Being overweight is also a risk factor.  Carrying extra pounds can break down the protective fatty tissue under the heel bone, causing heel pain and putting additional mechanical load on the plantar fascia.
Self-care strategies for reducing the pain of plantar fasciitis include: ice application; rolling a tennis ball or soup can from your heel and along the arch of your foot; and gentle stretching of the achilles tendon, calf muscles, and plantar fascia.  Gel or “donut pads” placed under the affected heel(s) in shoes may also provide relief.
Plantar fasciitis that does not respond to self-care strategies may require professional treatment.  This can include electrotherapeutic or laser modalities to assist in healing, manual and soft tissue therapy to supporting structures, therapeutic taping of the heel, and specific rehabilitative  exercises for the muscles and joints of the lower leg and foot.  A custom made orthotic may also be helpful by minimizing pronation, cushioning the heel, and supporting the arch.
It is important to establish an accurate diagnosis of plantar fasciitis.   Other causes of heel pain may include stress fractures, heel fat pad syndrome, achilles tendonitis/bursitis, arthritis, gout, or nerve irritation.  If you are having difficulty with heel pain, a qualified health professional can determine the cause of your pain and prescribe appropriate therapy and rehabilitation strategies specifically for your circumstance.  For more information, visit
This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Tuesday, April 18, 2017

Non-Invasive Recommendations For Managing Low Back Pain

By Dr. R. Greg Lusk, DC

In January of this year a new clinical practice guideline was published in the European Journal of Pain with respect to the non-invasive management of low back pain (LBP).  A clinical practice guideline aims to summarize research evidence, with the goal of optimizing patient care and improving health outcomes, and to prevent clinicians from considering interventions that are ineffective, expensive or harmful.  LBP affects 80% of people throughout their lives, is a common cause of disability, and is the most common musculoskeletal complaint for which people visit a healthcare provider.  In more ways than one it is a very expensive condition that warrants guidance from best evidence.  For this particular guideline, over 2500 research titles and abstracts were reviewed with only 10 previously published guidelines being included due to quality.  The recommendations are as follows.
For Acute LBP (i.e. LBP that started suddenly or has only been present for a few days or weeks), or Chronic LBP (i.e. LBP that persists beyond 3 months), all 10 guidelines recommended:
1.    Advice, reassurance or education with evidence-based information regarding the expected course of recovery and effective self-care options (e.g. ice or heat for pain, short-term rest, medication).  With respect to course of recovery, most cases of LBP improve much or completely within six weeks of onset, with a slower rate of improvement noted beyond six weeks if it persists.  Recovery is also affected by risk factors such as job demands, sedentary lifestyle, body weight, age, and smoking.
2.    Acetaminophen (e.g. Tylenol) or NSAIDs (e.g. Advil) if indicated, with advice and consideration of risks and warning signs and symptoms.
For Acute LBP only, all guidelines encouraged an early return to activity, staying active, and the avoidance of prolonged bed rest.  A short course of muscle relaxants alone or in addition to NSAIDs if acetaminophen or NSAIDs did not reduce pain was also an option.  Spinal manipulation (i.e. spinal joint "adjustment") was also advised for those not improving with self-care methods.  Also, in rare cases when the pain is severe and unmanageable, short-term use of opioids was mostly recommended as long term use is associated with significant risk, something we have all become increasingly aware of due to the amount of media coverage on the topic.
For the management of Chronic LBP, other interventions recommended by all guidelines were exercise or yoga (for up to 12 weeks), manual therapy (i.e. spinal manipulation or mobilization) for up to 12 weeks, and extensive rehabilitation with both physical and psychological components over 8 weeks.  If acetaminophen or NSAIDs have not provided adequate pain relief, short-term use of opiods was also recommended taking into consideration side-effects, risks, and evidence of ongoing pain relief on re-assessment.  Massage, acupuncture, and antidepressant medication was also recommended by most guidelines.
Some interventions for Chronic LBP were also NOT recommended by most guidelines.  This does not mean these treatments don't provide relief, just that the supporting evidence isn't strong enough to warrant a recommendation.  This included the use of muscle relaxants, gabapentin (a medication for nerve-based pain), and passive electrotherapeutic modalities including TENS, laser, IFC, or ultrasound.
A key thing to remember with all of these interventions is that there are options and patient preference is an important consideration.  Some people want to avoid medications at all costs and others have no interest in having their low back manipulated.  For chronic LBP, results are often better with the inclusion of a more active component of treatment (e.g. exercise) but many patients admit that they will not comply with a regular program.  Thankfully the passive approaches still have value.
This article is for general information purposes only and is not to be taken as professional medical advice.