Wednesday, June 29, 2016

Understanding Golfer's And Tennis Elbow

By Dr. John A. Papa, DC, FCCPOR(C)
The elbow is a complex joint that allows movements of flexion, extension, and rotation.  Most daily activities require a combination of these actions to produce motion in the arm, forearm, wrist, and hand.  Two common elbow injuries include Golfer's Elbow (GE) and Tennis Elbow (TE).  Both of these elbow conditions can cause pain and weakness which results in functional limitations with gripping, pushing, pulling, and lifting activities of the affected arm.
Golfer's Elbow (GE) is medically known as medial epicondylitis and causes the inner part of the elbow to become sore and tender.  This typically affects the muscles and tendons that flex the fingers and wrist, and roll the forearm inwards.
Tennis Elbow (TE) is medically known as lateral epicondylitis and causes the outer part of the elbow to become sore and tender.  This typically affects the muscles and tendons that extend the fingers and wrist, and roll the forearm outwards.
GE and TE can affect anyone involved in activities that require rapid and/or repetitive motion of muscles and joints in the forearm, wrist, and hand.  It is more likely to happen if these movements are combined with awkward posture(s), excessive force, poor technique, and using the wrong equipment or tool.  Occasionally, a direct blow to the elbow may be a causative factor.  Physical deconditioning can also make individuals susceptible to these conditions.
GE and TE can affect a broad variety of people including:  trade workers such as electricians, painters, and carpenters; recreational athletes such as tennis players and golfers; and labourers such as cleaners and assembly line workers.  Computer use, and even hobbies like gardening and knitting can be associated with GE and TE.
It is important to establish an accurate diagnosis of GE and TE.  This can be accomplished by performing a proper medical history, along with a physical examination.  Other causes of elbow pain may include: fractures, bursitis, arthritis, sprains, nerve irritation, or referred pain from the neck and/or shoulder region.  Any elbow injury with obvious evidence or suspicion of fracture or joint dislocation necessitates the need for emergency medical care.
Chiropractors are healthcare professionals skilled in diagnosing and treating muscle and joint conditions such as GE and TE.  Initially, relative rest and altering or eliminating the conditions that contributed to the injury is important.  This may include making changes to a work station, using the correct tools/equipment, and taking breaks to relax overworked muscles and joints.  Treatment options include electrotherapy, acupuncture, ultrasound, taping, bracing, specialized soft tissue therapy, and manual joint mobilization.  In addition, a comprehensive rehabilitation program should also include stretching and strengthening exercises that target the muscles of the forearm, upper arm, shoulder and upper back.
If elbow pain is keeping you away from your favourite activities, consider chiropractic care.  A chiropractor will assess your symptoms, diagnose your condition, and recommend a treatment plan to put you on the road to recovery.  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, June 24, 2016

High And Low Impact Activities For Everyone

Canadian Chiropractic Association (CCA)

It is no secret that at the Canadian Chiropractic Association (CCA) we often promote the benefits of regular physical activity as a way to stay healthy and happy. In fact, the CCA thinks it’s so important that we’ve created a free app: Straighten Up Canada! The app is currently available for download via Apple Store, Google Play and Blackberry World. Featuring easy-to-follow exercises, it helps to improve your posture and allows you to stay active during your day!

Investing time to do activities or sports that you enjoy is key to healthy aging and an active lifestyle. Being physically active is often a good way to prevent and manage musculoskeletal (MSK) injuries as well as helping maintain strength and mobility. Varying your routine between high- and low-impact activities is a great way to modify your workouts and challenge the body. We’ve outlined some great suggestions for both so you can get up and get moving!
High Impact
High-impact exercise is typically described as an (often aerobic) activity where both feet leave the ground at the same time1. Often, high-impact activities may include exercise classes which involve jumping, leaping, or jogging in place. Doing high-impact exercise can put you at greater risk of injury if your body is not prepared, especially if you’re just starting out. Be cautious and adapt to a lower impact version of the activity if in doubt. Otherwise, before starting high-impact exercises make sure you have warmed-up.
Good examples of high-impact exercises are:
  • Jumping jacks
  • Jumping rope
  • Running or jogging on a treadmill (or outdoors)
  • Performing plyometric exercises
High-impact exercises tend to be more intense and expend more energy, so it’s important that if you’re doing high-impact exercises that you’re well-prepared. For some, high-impact exercises are not appropriate: they may increase the risk of injury, commonly to the ankles, knees, hips, and even the back. That being said, high-impact exercises can have a lot of great benefits too2:
  • Improves bone density
  • Increases an individual’s heart rate more quickly, thereby burning more calories
  • Improves a person’s stability, balance, and coordination
  • Strengthens the heart and lungs
Low Impact3
Low-impact exercise tends to be less jarring on the body and joints, and less intense overall. According to the American Council on Exercise, keeping at least one foot on the ground at all times also reduces your risk of musculoskeletal injury. Some examples include4:
  • Working out on an elliptical machine
  • Low-impact aerobics
  • Using a rowing machine
  • Home exercise
  • Dancing
  • Swimming
  • Nordic walking
It’s important to realize that low impact doesn’t mean low intensity (unless purposely designed to be so) because you can still get an intense workout keeping both feet on the ground. Low-impact exercises are great for beginners, people with arthritis or osteoporosis, older adults, individuals who are obese, pregnant women, and people with bone, joint, or connective tissue injuries.
Whichever form of physical activity you choose, make sure you do it safely. Talk to your chiropractor if you have any questions. For more ways to get fit, check out Fit-in 15.


1Amy Gonsalves, “High Impact versus low impact.” Diabetes Outside blog. April 19, 2011.

2Paige Waehner, “High Impact Exercise—Is High Impact Exercise Right for You?” May 2, 2016.

3Nicole Nichols, “low impact vs. high impact exercise: Which is right for you?” April 14, 2010.

4NHS, “Easy exercises.” NHS Choices. Page last reviewed: 01/03/2016.

Monday, June 20, 2016

Summer Season Safety Tips For Your Body

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

The summer season is upon us, which for many individuals means spending time outdoors and becoming more physically active.  Whether you’re an aspiring athlete, a serious nature lover, or someone who enjoys fun in the sun, there are special precautions that need to be taken to protect your body during the summer season.

1.    Prepare your body for activity and exercise:  There are many activities made more enjoyable during the summer season such as gardening, walking, running, swimming, canoeing, bicycling, and golfing to name a few.  Prepare your body for physical activity by stimulating the joints and muscles, and increasing blood circulation with a proper warm-up.  If you have been inactive for a period of time, gradually ease into activity and take it slow.

2.    Drink plenty of water:  The body’s water supply is responsible for many important functions such as digestion, controlling body temperature, and protecting our joints by providing lubrication and cushioning.  In warmer temperatures, we lose more water from the body through increased perspiration.  The consequences of inadequate water intake/dehydration may include: headaches, fatigue, digestive problems, joint pain, muscle pain and cramping.  Therefore, special care should be taken to replenish fluids lost during the summer season.  Limit diuretics such as caffeinated and alcoholic beverages which actually drain the body of water.

3.    Get just enough sun:  Appropriate sun exposure can provide many health benefits associated with the natural production of Vitamin D.  Avoid sunburn which is a result of overexposure to the sun’s UV radiation and can contribute to certain skin cancers, along with premature aging and wrinkling of the skin.  To protect yourself, apply sunscreen regularly, wear a wide-brim hat and light-colored clothing that covers your exposed skin.  Your eyes should also be protected with UV blocking sunglasses.  Outdoor activities and sports should be limited to the early morning or late afternoon when UV rays are not as strong.  Be cautious on cloudy days, as your skin is still susceptible to burn under these conditions.

4.    Think safety first:  Water sports and other outdoor activities should always be performed with safety in mind.  This means wearing a life jacket in deeper water or if you are not a strong swimmer.  Parents should always keep a watchful eye on young children around water.  Diving into shallow or unknown waters should never be performed to eliminate the chance of serious spinal injury.  Running on pool decks may result in serious slip and fall injuries.  When bicycling, in-line skating, or skateboarding/longboarding, be sure to wear bright reflective clothing and protective headgear.  In addition, wearing appropriate footwear for the activities you are performing will give you balance, support, and protection.

Following the above rules and safety tips can go a long way in protecting your body during the summer season.  For additional information on health, wellness, muscle and joint health, visit our website at
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, June 13, 2016

Ice Therapy For Muscle & Joint Injuries

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

Ice therapy is an effective self-care treatment strategy for muscle and joint injuries.  It is commonly used for acute injuries (within the first 72 hours), but can also be very helpful in managing flare-ups of chronic problems, and as a preventative measure following activities or exercise.
Ice therapy reduces the amount of swelling and inflammation at the injury site and also acts as an anesthetic to provide pain relief.  Icing as soon as possible after an injury will help with speeding up recovery time, and minimize the chances of secondary problems such as muscle spasm and joint irritation.
Below are some helpful  tips that should be followed when using ice therapy:
·        Crushed ice and ice cubes are ideal sources of ice because they easily mold around an injury site and can stay cold for long periods of time.  Commercial ice/gel packs and frozen vegetable bags are good secondary choices when crushed ice or cubes are not available.
·        Use compression when applying ice to an injury site.  Compression is most easily achieved with an elastic tensor bandage to add support and slow swelling.  The principles of elevating and resting the injured site should also be followed during initial injury management.
·        Ideal ice application time is 10 to 20 minutes.  There should also be a period of 10 to 20 minutes or more where there is no ice application before icing is done again so that skin temperature can return to normal.  This cycle can be repeated as often as necessary within the first 24 to 72 hours after injury or activity.
Below are some precautions that should be followed with ice therapy:

·        Ice should never be applied directly over the skin for a prolonged period of time as this can damage skin tissue.  A wet towel can safely be used as a barrier between the ice and skin and acts as an excellent conductor of cold.
·        Ice should never be applied on blisters, open cuts or sores.
·        Ice should not be applied before exercise or activity as this impairs your body’s ability to detect proper joint and muscle function, making one more susceptible to further injury.
·        Ice therapy should not exceed the treatment time recommended as prolonged exposure can reverse the positive effects of ice and can lead to possible frostbite.
·        Special care must be taken when icing the elbow, wrist, knee, or foot as superficial nerves in these areas can become irritated or damaged with prolonged icing.
·        People hypersensitive or allergic to cold and those who have a circulation problem should avoid ice.
If you have a muscle and joint injury that is not resolving, 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.

Thursday, June 9, 2016

Running Outside - Getting Started

Canadian Chiropractic Association
Have you finally moved your running regimen from the treadmill to outside? Summer is a great time of year to enjoy the outdoors through exercise and activity. With just your running shoes you can get out and explore new areas in your city or even better nature trails. Yet, if you are an avid indoor runner, there are likely a few adjustments to make when transitioning to the outdoors. Not surprising, the mechanics of running on a stationary treadmill will vary from running outside on an uneven surface, with various obstacles along the way. So, you will need to prepare and transition before heading out.
Typically, a treadmill has a motorized platform that moves under a runner’s (or walker’s) feet at a determined speed and slope. Unless programmed otherwise, the treadmill will continue to offer the same force without environmental factors like wind or terrain that often challenge runners. Also, many treadmills are padded, offering extra absorption of the forces of impact for runners.

We have gathered a few helpful tips to get started, and transition you to the outdoors.

Shape Magazine1 shared some great tips for runners:
  • Start slow: Running outside is more taxing on your muscles, joints and bones, and are more prone to injuries like shin splints. Start off with shorter distances on flat roads or trails, and as your endurance improves, gradually increase your mileage and hill work.
  • Maintain a constant pace: Don’t feel compelled to push yourself to run at the same pace that you would on a treadmill. Start by running at a moderate and comfortable pace that allows you to run safely, and gradually increase your speed over several weeks as your body allows.
  • Wear the appropriate footwear: Adapt your shoes to your environment. A regular running sneaker may have been ideal for the flat, predictable surface of a treadmill, but once you are outdoors, make sure the sneaker’s tread can handle the gravel, dirt roads, and slick trails. Runners should get a sneaker that supports the feet while having the appropriate sole to help maneuver and support uneven surfaces.
Before heading out, familiarize yourself with the route and check that it is appropriate for your level of fitness or to help you meet your goals2.
  • Pick a road or trail you are familiar with. When starting out, the last thing you want to worry about is getting lost. Before even lacing up your sneakers, do some research: ask friends where they like to run, use online running forums to find popular routes, and check to see if your park has designated trails. The more popular and visible the trail, the better.
  • Like any activity, make sure you do a proper warm-up before starting.
We have some great tips for proper stretching that can help prevent injury. If in doubt, talk to your chiropractor about how to improve your running, and prevent and manage injuries.

1 Shape Magazine, “Don’t make these mistakes when running.

2 Popsugar, 4 things you need to know before running outside.

Monday, June 6, 2016

Everyday Activities That May Be Hurting Your Back

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

80% of all Canadians will suffer at least one significant episode of back pain in their lives.  Back pain can negatively impact an individual’s work, recreational, and social life.  Back pain prevention can go a long way in reducing the risk of injury.  Below are some tips on how to overcome some of the common everyday activities that can contribute to back pain.
1.    Improper lifting is a risk factor associated with back pain. There are several strategies that should be employed during lifting activities.  Maintaining the natural curve/hollow (lordosis) of your low back is important, as this is its strongest and most secure position.  Avoid awkward postures such as bending, reaching, and twisting/turning.  Whenever possible, you should square your body toward the object being lifted, turn your whole body by moving your feet, and keep the object close to your body.  Contracting your abdominal muscles during lifting, lowering, and moving activities improves spinal stability, referred to as bracing.  You should also bend at the legs and not the waist, lifting slowly and smoothly, not jerking.  Minimizing lift load and exposure, taking mini-breaks, and job rotations can also be helpful.  The use of assistive devices such as dollies, handgrips, and pull carts is also recommended.
2.    The physical strain of sitting:  Most people that sit for prolonged periods of time will eventually adopt a poor posture that includes losing the natural hollow of the low back, rounding or slouching forward of the upper back and shoulders, and a forward head poking position.  This can lead to significant back pain as these less than ideal positions put cumulative compression and strain on the spine.  Take 10 to 30 second stretch or posture breaks every 20 to 40 minutes to make sure weight is evenly distributed, your shoulders are not rounding forward, and you are not slouching.
3.    Working in stooped positions:  When we keep our backs in a neutral/straight position, the mechanical load on the spine is considerably lower than when your back is bent forward.  Many activities around the home and workplace cause you to bend forward and stoop.  The longer you work in these forward bent positions, the more likely you are to experience back problems.  In order to minimize the risk of injury, you should interrupt the stooped position at regular intervals before pain starts.  Trying to find alternative ways of completing tasks without stooping is ideal.
4.    Smoking contributes to an increase in spinal problems.  Smoking has been shown to decrease bone mineral density and increase the risk of osteoporosis and future fractures.  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.  Exposure to secondhand smoke during childhood may also increase the risk of developing back problems later in life.
5.    Lack of physical activity de-conditions the body.  This makes us more susceptible to cumulative spinal strain and injury.  For optimal functioning, your muscles and joints need a steady supply of oxygen-rich blood.  Regular exercise increases our functional capacity to withstand occupational, recreational, and everyday stresses on our back more efficiently, thereby minimizing the risk of injury.
Decreasing your risk for back pain is the first step in prevention.  For some, back pain can be dramatically minimized or avoided; while for others it needs to be managed so that its negative effects on activities of daily living can be reduced.  If you are suffering from back pain, a qualified health professional can determine the cause of your pain and prescribe appropriate therapy, exercises, and back sparing 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.

Thursday, June 2, 2016

Heel Fat Pad Syndrome

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

Heel Fat Pad Syndrome (HFPS) refers to damage or disruption of the fatty pad that sits under our heel bone (calcaneous).  This structure is approximately one inch thick and is made up of fatty tissue enclosed by ligamentous chambers.  The purpose of this structure is to absorb shock and cushion the heel bone.  If the fat pad is displaced or thins, then its ability to protect the heel bone from impact is decreased, which can result in heel pain.
HFPS is commonly misdiagnosed as plantar fasciitis.  Plantar fasciitis symptoms tend to be located towards the inner front portion of the heel and can extend into the arch of the foot, whereas symptoms of HFPS are characteristically located in the centre of the heel and described as a deep, dull ache that feels like a bruise.  Other symptoms characteristic of HFPS include central heel pain that is aggravated by prolonged periods of standing and barefoot walking on hard surfaces.  It is also possible to have both plantar fasciitis and HFPS present at the same time.
There are several factors that can contribute to the development of HFPS.  Trauma to the heel from high impact sports or a forceful blow to the heel from a fall can cause injury to the fat pad.  Repetitious chronic overload from activities such as running, jumping or prolonged walking and standing can also cause injury which can be exacerbated by the use of improper footwear.  It is known that the fatty heel pad breaks down as we get older which can make an individual susceptible to this condition.  Carrying extra pounds can also break down the protective fatty tissue under the heel bone.
Self-care strategies for reducing the pain of HFPS include: relative rest from any painful activities; ice application; and gentle stretching of the achilles tendon, and calf muscles.  Gel or “donut pads” placed under the affected heel(s) in shoes may also provide relief.  Long-term strategies may include activity modification and weight loss where applicable.
HFPS that does not respond to self-care strategies may require professional treatment.  This can include electrotherapeutic 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.  Supporting the foot with proper footwear and correcting faulty foot mechanics can decrease excessive strain on the fat pad.  A custom made orthotic with a deep heel cup design to cradle and cushion the fat pad may also be helpful for decreasing symptoms.
It is important to establish an accurate diagnosis of HFPS.  Other causes of heel pain may include stress fractures, 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.