Monday, January 26, 2015

What Smoking Does To Your Musculoskelatal System

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

The musculoskeletal (MSK) system includes the muscles, tendons, joints, and bones of the body.  Cigarettes contain many harmful chemicals, including nicotine and carbon monoxide which negatively affect the physical health and integrity of the MSK system.  Included below is a summary of those affects:
1.      Smoking decreases bone mineral density (BMD) and increases the risk of osteoporosis and future fractures.  Studies have shown that nicotine reduces the blood supply to bones, slows the production of bone forming cells, and decreases the absorption of calcium.  Post-menopausal women who smoke have greater spinal osteoporosis than non-smoking counterparts.  Among men, a consistently lower BMD at all bony sites is observed regardless of when in their life they smoked.  In addition, a relationship between cigarette smoking and low BMD in adolescence and early adulthood has been identified.
2.      Smoking delays healing times for bony fractures and soft tissue injuries such as rotator cuff tears.  Nicotine has been shown to decrease the production of fibroblasts (the main cells responsible for tissue repair).  In addition, the carbon monoxide found in tobacco smoke reduces oxygen levels in the body which is critical for all tissue healing.
3.      Smoking contributes to an increase in spinal problems.  The reduced blood circulation found in smokers deprives spinal discs of vital nutrients which can lead to premature degeneration.  Smoking may also provoke disc herniation through coughing.  Studies demonstrate a definite link between smoking and low back pain that increases with the duration and frequency of the smoking.  Exposure to secondhand smoke during childhood may also increase the risk of developing neck and back problems later in life.
4.      Smoking increases pain levels.  Smokers complain more often of MSK pain than non-smokers.  Studies indicate that smoking makes individuals more susceptible to sensing pain at lower thresholds.  In addition, smoking causes general damage to the MSK system through direct chemical irritation, chronic inflammation, and restricting blood and nutrient flow.
5.      Smoking causes stress and de-conditioning in the body.  For optimal functioning, your muscles and joints need a steady supply of oxygen-rich blood.  Smoking not only stiffens your arteries, it also decreases the rate at which oxygen and carbon dioxide are exchanged in the blood.  Other side effects of smoking include fatigue, lung disorders, impaired healing, and chronic pain.  Impaired healing means that injuries affect you for longer than usual, and healing from surgeries or infections can be problematic.  These side effects can lead to inactivity, which causes deconditioning.
Scientific evidence has established links between cigarette smoking and its detrimental impact on the MSK system.  However, it is never too late to try and quit smoking.  Some of the negative health aspects of smoking start to reverse after a smoker quits.  Those looking for help in trying to quit should speak to a medical professional.  Valuable resources can also be found on the Health Canada and Canadian Lung Association websites.  For additional information on health and wellness, 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, January 22, 2015

New Parent? New Achy Neck or Back?

By Dr. Greg Lusk, DC
Having recently welcomed a daughter to the family, I've been reminded of the many feelings that come along with the new addition -  excitement, anticipation, and sleep deprivation to name a few.  However, as I march, skip, and squat around the living room with my daughter in my arms I'm keenly aware of an ache in my back.  It is incredibly common to feel back soreness when interacting with our children and not entirely preventable.  When you consider that you go from dealing with your own postural imperfections to then holding the growing weight of a child it is no surprise that soreness is felt.  Factor in the repetitive nature of carrying and feeding, the awkwardness of transporting a car seat, and bending over to pick up the child, and the risk for discomfort increases.  That being said, there are things you can do to "compete" so you feel your best.
Carry on BOTH sides
We all favour a side to carry a child on since we are hand dominant.  For example, a right-handed mother often carries on the left to leave her right, more coordinated hand free for use.  This is a must at times but whenever finer tasks are not being done carrying on the other side is a great idea.  This keeps the forces on the spine and muscles more balanced which is important in preventing back pain.
Keep Things Neutral
With respect to the neck, avoid “craning” the neck for a prolonged period of time to look at your child, especially while feeding.  Supporting your arms with a pillow will help with this.
Picking up children, reaching into cribs, and prolonged holding of children takes a toll on your low back.  Hinge at your hips, bend your knees, and keep your back straight.  Also, when standing and holding your child for a length of time, avoid over-extending your low back in an attempt to better balance the load of the child, as this can compress and eventually irritate the joints of your back.  Combining “neutral” spine positioning with bracing (described below) will make you injury resistant.
Bracing is the act of maintaining a mild abdominal contraction in order to support your low back.  With your spine straight (i.e. neutral) contract your abdominal muscles slightly, making your stomach firm.  You should be able to breathe evenly while bracing so if you can’t talk or breathe you are doing it too intensely.  Performing a “brace” with a straight back while holding or prior to picking up your child will go a long way.
Don’t Combine Movements
Lifting and twisting at the same time is a common cause of low back injury.  Now picture yourself putting your child in a car seat.  Try to separate the lift and twist by stepping up into the vehicle….and don’t forget to brace!  Move your feet to turn your body instead of asking your back to rotate.
Take Breaks
While your child is napping or playing independently, make it a priority to do 5 to 10 minutes of stretching/exercises to offset some of the muscle tension that has set in.  Stretching your chest and neck, as well as strengthening your core muscles, can help you avoid aches and pains and give you an energy boost.
This article is for general information purposes only and is not to be taken as professional medical advice.  If you experience neck or back pain that lasts more than two to three days, contact a licensed health professional for an evaluation.  For more information visit

Monday, January 19, 2015

Protecting Your Back During The Winter Season

By:  Dr. John A. Papa, DC, FCCPOR(C)

The winter season is upon us and extra precaution must be taken as snow removal and icy walking surfaces can contribute to an increased risk of back injuries.  Included below are some useful tips that can be followed to help keep your back healthy and injury free this winter season.
1.    Warm up:  Prepare your body for physical activity by stimulating the joints and muscles, and increasing blood circulation.  Climbing stairs, marching on the spot, or going for a quick walk around the block, can serve as excellent warm ups in five to ten minutes.  Follow this with some gentle stretches and exercises for the back.
2.    Push, don’t lift:  Push the snow to one side and avoid lifting.  If you must lift, keep the shovel close to your body and avoid twisting and turning by positioning yourself to lift and throw straight at the snow pile.  Be sure to lift slowly and smoothly and do not jerk with your lifts.
3.    Bend the knees, keep the back straight and brace:  Use your knees, legs and arm muscles to do the pushing and lifting while keeping your back straight.  Maintaining the natural and neutral curves of your back is important, as this is its strongest and most secure position.  Contracting and bracing your abdominal muscles during lifting improves spinal stability and decreases the chance of injury.
4.    Use the right shovel:  Use a lightweight, non-stick, push-style shovel.  Separate your hands as much as possible on the shovel handle for better leverage against the weight of the snow.
5.    Dress for the job:  Wear warm clothing to protect yourself against the elements.  Shoes and boots with solid treads and soles can help minimize the risk of awkward twisting, slips and falls.
6.    Don’t let the snow pile up:  Removing small amounts of snow on a frequent basis is less strenuous in the long run.
7.    Watch the ice:  Caution should be exercised around icy walkways and slippery surfaces.  Intermittent thaws and subsequent freezing can give way to ice build-up under foot increasing the risk of back twisting, slips and falls.  Coarse sand, ice salt, ice melter, or even kitty litter can help give your walkways and driveways more traction.
8.    Take a break:  Know your physical limits.  If you feel tired or short of breath, stop and take a rest.  Make a habit to rest for a moment every 10 or 15 minutes during shoveling.  This is especially important if the snow is wet and heavy.  Stop shoveling immediately if you feel chest or back pain.
In the event that you suffer a back injury that does not subside, you should contact a licensed health professional who deals in the diagnosis and treatment of back pain.  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, January 15, 2015

The Physical Strain Of Sitting

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

From smart phones to computers to video games, modern technology has significantly influenced our daily postural habits and caused us to sit more often and for longer periods of time than ever before.  As a result, our increased exposure to sitting has contributed to rising levels of inactivity, and chronic ailments such as headaches, neck pain, and back pain.

People who sit for prolonged periods of time 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.  This can eventually lead to painful symptoms as these less than ideal positions put cumulative compression, stretch, and shear forces on spinal tissues such as joints and discs.

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.

Structural changes can also result from poor or prolonged sitting habits.  For example, aside from providing anatomical support, ligaments also function as neurological sense organs to the spine and influence reflexes that help muscles fire.  When an individual is exposed to prolonged sitting postures, they load their spinal ligaments which results in a delayed reflex action of muscles.  As a result, when this individual moves, the muscles may not fire quickly enough to protect the spine and this can lead to episodes of neck and back pain.  This is known as the biomechanical principle of CREEP, which stands for Continuous or Repetitive Elongation of the Elastic Properties of tissue.

Scientific research has also identified changes in muscle tissue associated with inactivity and prolonged sitting.  Over time, muscle tissue will accumulate fatty infiltrations that make it weaker and less capable of providing support for physical activity.

Below are some useful tips that can help overcome the physical strain of sitting:

1.    Proper posture is key:  Make sure weight is evenly distributed, your shoulders are not rounding forward, and you are not slouching.  A lumbar support can also be used to help maintain the natural hollow of your low back and proper spinal alignment.  Even slight slouching to the side, backward, or forward can put undesirable forces on biological tissues.
2.    Take a break from sitting:  Take 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.    Consider ergonomics:  The use of a properly designed workstation, along with ergonomic tools and assistive devices can help maintain mechanically advantageous positions while working in a seated position.

4.    Engage in regular physical activity and exercise:  Exercise strengthens our muscles and joints, while inactivity and poor posture weakens them.  Regular exercise can help overcome the effects of cumulative spinal forces, compensation, CREEP, and fatty infiltrations associated with poor posture and prolonged sitting.

Sitting can undeniably cause real physical change and breakdown in the body.  Chiropractors are well positioned to effectively evaluate and treat the effects of poor posture and prolonged sitting.  This may include symptomatic treatment, the prescription of appropriate exercises, and ergonomic advice 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.

Monday, January 5, 2015

Understanding Neck Pain

By Dr. John A. Papa, DC, FCCPOR(C)
Neck pain is a widespread experience among the general population, with 30-50% of adults reporting pain symptoms at any given time.  Once an episode of neck pain happens, most individuals will find it is a persistent or recurrent condition.  The purpose of this article is to outline our current scientific understanding of neck pain.
The cause of neck pain is usually multi-factorial, meaning that there is usually no single cause.  Factors such as overall physical and mental health, along with work and daily activities are just a few factors that can contribute to the development of neck pain.  Most causes are not the result of serious injury or disease.
Neck pain can affect people in different ways and is usually classified into the following categories:
GRADE 1: Neck pain with no signs or symptoms suggestive of major structural pathology, and little or no interference with daily activities.
GRADE 2:  Neck pain with no signs or symptoms suggestive of major structural pathology that limits daily activities.
GRADE 3:  Neck pain with no signs or symptoms suggestive of major structural pathology, with presence of neurologic signs of nerve compression (i.e. radiculopathy or "pinched nerve") and may include pain, weakness and/or numbness in the arm.
GRADE 4:  Neck pain with signs or symptoms suggestive of serious structural pathology (i.e. tumor, fracture, infection, systemic or visceral disease).
Evaluation of neck pain should include a proper medical history, along with a physical examination consisting of inspection, range of motion testing, and palpation for tenderness, along with strength, neurological, orthopaedic and functional testing.  Diagnostic tests such as x-rays, CT or MRI scans are only required in a minority of cases.
The majority of neck pain is classified as Grade 1 or 2.  There is scientific evidence to support the following treatments for Grades 1 and 2 neck pain: education, exercise, mobilization, manipulation, acupuncture, soft tissue therapy, and analgesics.  Conservative treatment of Grade 3 neck pain should proceed with caution.  The majority of Grade 4 neck pain will require specialty medical management.
Due to the persistent and recurring nature of neck pain, individuals need to have realistic expectations hen addressing their symptoms as pain relief is often modest and short-lived.  The scientific literature does not identify any “best” treatment that is effective for everyone.  Trying a variety of therapies or combination of therapies may be required to find relief and help manage neck pain.  It is important that individuals play an active role in managing their symptoms by participating in their usual daily activities as tolerated, exercising, and reducing mental stress.
Most people can expect to experience some neck pain in their lifetime that may or may  not limit daily activities.  For those with neck pain that may be interfering with their activities of daily living, a qualified health professional can prescribe appropriate conservative 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.