Tuesday, May 22, 2018

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 www.nhwc.ca.

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 16, 2018

Changing How You Move To Relieve Low Back Pain - Part 1


By Dr. R. Greg Lusk, DC

If you've read my last few articles you'll recall that I've been trying to create more awareness of a functional diagnosis for low back pain (LBP), versus only knowing what is structurally wrong with a specific anatomical tissue. In other words, it is important to figure out which movements or biomechanical loading directions cause LBP. You may also remember that bending forward (i.e. spine flexion) was identified as a very common direction of motion that results in LBP. With that in mind, practicing "spine hygiene" with common postures and activities of daily living can reduce the amount of flexion imposed on your low back, thereby keeping it relatively neutral, which in turn minimizes unwanted symptoms.

Changing how we move and rest, with the goal of sparing the low back, can be challenging as our current methods of doing things and moving our bodies are well rooted. However, with increased attention and regular practice new habits and patterns of motion can be adopted. Starting with sitting, affectionately referred to as "the new smoking", many of us have a tendency to slouch, especially with prolonged time in this position. The fact that we often sit on soft, minimally supportive couches or recliners doesn't help as they encourage sagging of the spine into a rounded position. I often suggest to put a small pillow or rolled up towel behind the lower back to help support and maintain the neutral curve. Better yet, and particularly if you're in significant discomfort, sitting on a more firm piece of furniture such as a dining chair can offer more relief. Move one into your living room if you must to discourage use of the alternatives. You want to sit as far back as possible though as not having your behind against the back of the chair encourages more slouching. The same advice can be applied to sitting while driving and sitting at work, which most of us do much of daily. Use that pillow, towel, or rolled up sweater for that matter, to support the low back curve if your vehicle seat or desk chair doesn't offer enough lumbar support intrinsically. Adjusting the back rest to a more upright, vertical position can also help you achieve the goal of a more neutral spine position. Variable, adjustable height workstations have become increasingly popular and the options out there are numerous. Thankfully, the cost of some are quite reasonable, well worth the value it could add to managing low back pain. Not that standing all the time is the answer, but having the flexibility to alternate body positions regularly changes how we stress our spines and disperses the accumulating stresses that occur if only a singular posture is used.

Standing with poor posture, where the shoulders are rounded forward and the head is drooped, is commonly observed in those with or without low back pain. Once again, this encourages mild spine flexion while also increasing muscle activity in our low back extensor muscles. This adds more compression to our spinal tissues which doesn't help when things are already sensitive. Instead, roll the shoulders back and lift your rib cage to position your upper body more over your hips. Interlacing your hands behind your low back while standing helps to maintain this posture if prolonged standing is needed, and is also preferable to standing with your arms crossed, which also increases demand on the back muscles.

Sitting and standing are two major culprits, but there are many other things to consider to practice good spine hygiene while performing the multitude of our daily tasks. More to come.

This article is for general information purposes only and is not to be taken as professional medical advice

Monday, May 14, 2018

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 www.nhwc.ca.

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 7, 2018

Common Back Pain Myths


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

80% of all Canadians will suffer from at least one significant episode of back pain in their lives.  Below are some of the common myths surrounding back pain and what modern science has to say about them.

Myth 1:  If you’ve injured a disc (i.e. herniation, rupture), you must have surgery.
Truth:  Surgery to relieve back pain should only be used as a last resort.  Even if specific testing reveals a damaged disc, recovery often results without surgery.  An injured disc in the back may become inflamed and put pressure on nerves and surrounding pain sensitive structures.  Non-surgical treatment aims at minimizing pain and discomfort from joint irritation and muscle spasm, and prescribing specific exercises to help with recovery.

Myth 2:  Most back pain is caused by injuries or heavy lifting.
Truth:  Injuries caused by heavy lifting do not account for all back pain.  In up to 85% of cases, individuals can’t recall a specific incident that brought on their back pain.  Back pain can result from a single exposure to a bending or twisting incident or it can be small cumulative loads placed on the spine over time.  Scientific research also links the following risk factors to back pain: smoking, being overweight, poor posture, poor physical fitness, and stressful life events.

Myth 3:  X-ray images, CT and MRI scans can always identify the cause of pain.
Truth:  Even the best imaging tests cannot identify a muscle spasm or ligament sprain that may be the cause of pain.  Imaging is usually reserved for special cases such as those suffering trauma in a fall or accident, surgical candidates, unresolved cases of severe chronic back pain, and suspicion of underlying tumor, infection or other serious disease.

Myth 4:  If your back hurts, you should take it easy until the pain goes away.  Bed rest is the mainstay of therapy.
Truth:  Clinical data indicates that individuals who remain active do better than those who try bed rest.  Remaining active means continuing with daily activities as tolerated and easing back into a regular routine.  Activities may have to be modified while recovery occurs, but movement is important for recovery provided it does not put the individual at risk for further injury.

Myth 5:  Diagnosing back pain is simple and straightforward.
Truth:  The causes of back pain can be complex and difficult to diagnose.  There are many biological tissues that can generate pain in the back.  These may include muscles, ligaments, bones, nerves, and joints.  Quite often it is a combination of several or all of these structures that can manifest into back pain, and potentially radiating pain into the buttock or leg regions.  Sometimes stress and depression can also contribute to back pain.  A licensed health practitioner who deals with back pain is best trained to diagnose the source(s) of your problem and prescribe appropriate therapy when required.  For more information, visit www.nhwc.ca.

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, April 30, 2018

How To Choose The Right Mattress


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

Choosing the right mattress can go a long way in determining the quality of your sleep.  Using a mattress that does not provide adequate support and comfort can also be a significant source of muscle and joint pain, especially in the shoulder, back, and hip regions.

The right mattress is usually defined as any mattress that helps a person sleep well, so that they wake up feeling rested and without pain and stiffness.  However, there is no single best mattress for everyone as there are a variety of factors that go into choosing the right mattress.

Below are some useful tips that can help you find the mattress that's right for you:

·       Consider how your mattress is made.  Mattress support is determined by the internal architecture of the mattress.  This can include innerspring coil mattresses (most common), memory foam, latex, and air mattresses.  Each offer different degrees of support and comfort.  Some manufacturers also include additional padding on top of the mattress for extra comfort, but this may not be necessary for all individuals.

·        Sleep experts recommend replacing your mattress on average every 8-10 years or sooner.  Look for visible sagging and/or material breakdown as a sign to replace your mattress.  Over time, mattresses collect dust mites and other germs that can exacerbate allergies and impact sleep.  In addition, our bodies change over time and an old mattress that had originally been comfortable may no longer be providing the comfort and support it once did.

·    Your physical health and your mattress.  Sleeping with painful conditions such as osteoarthritis, hip bursitis, and degenerative disc disease can be minimized by choosing the right mattress.  You can also incorporate additional sleep positioning tips to get the most comfort out of your mattress.

·      Try before you buy.  Lay on a variety of mattresses (i.e. firm, medium, pillow top) for at least 10-15 minutes in several simulated sleep positions to get a sense of how the mattress feels.

·    Shop at stores that specialize in mattresses.  These stores will offer a diverse range of choices and other important factors such as manufacturer and comfort warranties.

·  The right mattress achieves a balance between comfort and support.  A mattress that is too firm may cause pain in pressure points such as the hips.  A mattress that is too soft may not offer enough support and cause pain and stiffness.  Most people do well with a medium-firm mattress.  However, at the end of the day, a person's overall comfort level will determine which mattress is right for them.

If you experience muscle and joint pain that is causing difficulty with your sleep, you should contact a licensed health professional who deals in the diagnosis and treatment of these conditions.  For more information, visit www.nhwc.ca.

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 24, 2018

5 Ways To Avoid Backache While With Your Newborn

Ontario Chiropractic Association

You were up all night. The baby is crying. The telephone is ringing and the kettle is boiling. For most parents, this is a daily scenario. Parents are also continually faced with strenuous physical demands such as lifting, feeding, comforting and chasing after children.



Consider the fact that parents may be lifting a 7-10 pound baby 50 times a day. By 12 months, your baby weighs approximately 17 pounds, and at 2 years, that child has become a 25-30 pound toddler. The repetitive lifting of your child may put you at risk for back problems.

What’s a parent to do? Well, here are some simple tips that can help parents avoid some common aches and pains.

Lifting
  • Stand with your feet at least a shoulder width apart.
  • Keep your back in neutral position and bend your knees.
  • Bring your baby as close to your chest as possible, and then lift using both arms.

Carrying
  • When carrying your little one, pivot with your feet instead of twisting your back.
  • This will ensure that you’re turning with your hips, which will reduce your risk of back pain.
  • Lower your child into the crib or onto the floor by bending at the knees, with a neutral back.

Holding
  • Hold your child in an upright position, directly against your chest.
  • Carrying a child on one hip creates postural imbalances that can lead to low back pain over time.

Feeding
  • Always sit in a chair with back support and avoid leaning forward to reach your newborn’s mouth.
  • Instead, use pillows or blankets to support and position your baby closer to you.

Exercise

There is no time for back pain in parenthood. Talk to your chiropractor about specific exercises to stretch and strengthen your muscles so that you can stay on your toes and a step ahead of your toddler.

Monday, April 16, 2018

Understanding A "Pinched Nerve" In The Neck


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

About two-thirds of people will experience neck pain at some point in their lives.  Occasionally, neck pain can spread to involve other structures such as the upper back, shoulder, and arm regions.  Pain in these regions is often dismissed simply as muscle pain.  However, a “pinched nerve” originating from the neck can radiate pain to these nearby anatomical sites and be a significant source of discomfort.

The “cervical spine” is the medical name given to the region of the neck.  Nerve roots originate from the cervical spine on each side.  These nerves send off various branches that travel to distinct regions in the upper back and arms to supply strength to muscles and provide sensation/feeling.  The term “pinched nerve” is often used to describe a mechanical and/or inflammatory irritation directly affecting any component of the nerve root(s) in the neck/cervical spine.

A “pinched nerve” in the neck can cause symptoms almost anywhere along the nerve pathway.  This may result in neck symptoms only, and/or symptoms that radiate into the chest, upper back, shoulder, arm, hand and finger regions.  The symptoms can vary widely and may include:  a cramping or achy feeling, tightness, burning or a sharp electric shock sensation, numbness, tingling, and arm muscle weakness.  The symptoms may start gradually and intensify over time.  Activities such as movement of the neck or shoulder, prolonged sitting or laying down, lifting, and even coughing or sneezing may aggravate the symptoms.

Below is a brief summary of three common causes of a "pinched nerve" in the neck:

1.     Spinal disc herniation/bulge – Spinal discs separate and cushion cervical vertebra.  Repetitive and cumulative loads or a heavy single load has the potential to cause a disc bulge or herniation, thereby causing a mechanical and/or inflammatory irritation of the nerve root(s).  This most commonly occurs in adults aged 20-50.

2.     Degeneration and Osteoarthritis – The normal aging process causes cervical disc degeneration and osteoarthritis of the cervical joints.  The consequence of these processes is that mechanical irritation from bony spurs on the vertebrae along with inflammation can cause irritation of the nerve root(s).  This most commonly occurs in adults over 50.

3.   Cervical spinal stenosis – This condition may cause “pinched nerve” symptoms due to narrowing of the spinal canal and/or nerve pathways, which puts pressure on the nerve root(s) or spinal cord.  This most commonly occurs in adults over 60.  It is usually secondary to degeneration and osteoarthritis.

Other causes of a “pinched nerve” in the neck include: direct irritation of nerve tissue by overlying muscles; direct trauma or injury to the nerve root(s); and mechanical changes in the neck associated with poor postural habits (i.e. head poking forward in the sitting position).  Some common causes of symptoms that act like a “pinched nerve” in the neck include muscular trigger points, ligament sprains and arthritic joints from the neck, upper back, and shoulder regions.

Treatment for a “pinched nerve” in the neck will often be different depending on the underlying cause of the symptoms.  Therefore, it is important to obtain an accurate diagnosis.  A proper medical history, along with physical examination consisting of range of motion, strength, neurological and orthopaedic testing, along with diagnostic imaging (if necessary) should be performed to aid in the diagnosis.  It is extremely important to rule out rare causes of “pinched nerve” symptoms such as spinal tumors, fractures and infections.  Disorders of the esophagus, trachea (windpipe), heart and thyroid can cause symptoms that overlap with those of a “pinched nerve” in the neck.  These potential causes require appropriate medical referral when applicable.

There are natural and conservative treatment options available for those suffering from a "pinched nerve" in the neck.  These may include: mechanical traction, spinal manipulation and mobilization, soft tissue techniques, acupuncture, ice/heat application, electrotherapy, activity modification, postural education, and rehabilitative exercise.  A qualified health professional can determine the cause of your symptoms and prescribe appropriate therapy and rehabilitation strategies specifically for your circumstance.  For more information, visit www.nhwc.ca.

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.