Wednesday, November 30, 2016

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, November 28, 2016

Laser Therapy

Class IV K-Lasers deliver specific red and near-infrared wavelengths of laser light to induce a therapeutic effect within the body. The painless application of laser energy has been shown to:
  • decrease pain
  • reduce swelling/inflammation and
  • enhance tissue repair
It does this by increasing microcirculation, allowing more red blood cells with oxygen to reach injured tissues to help with healing. It will also increase venous and lymphatic drainage from the injured region. At the cellular level, it stimulates enzymes which will improve the rate at which energy is made in the cell. More energy in the cell means a quicker healing process.


Numerous studies show that Laser Therapy can help with:

- Low Back Pain & Sciatica
- Neck Pain & Headaches
- Mid & Upper Back Pain
- Carpal Tunnel Syndrome
- Muscle Strains & Spasms
- Repetitive Stress Injuries
- Osteoarthritis & Bursitis
- Shoulder & Elbow Pain
- Wrist & Hand Conditions
- Hip & Knee Pain
- Ankle Sprains
- Plantar Fasciitis & Heel Pain
- Fibromyalgia
- Sports Injuries
- Auto & Work Related Injuries
- Post-surgical Healing
  • Q: Does it hurt? What does a treatment feel like?
    There is little or no sensation during treatment. Occasionally one feels a mild, soothing warmth
    or tingling. Areas of pain or inflammation may be sensitive briefly before pain reduction.
  • Q: Are there any side effects or associated risks?
    During more than twenty years of use by healthcare providers all over the world, very few side
    effects have ever been reported. Occasionally some old injuries or pain syndromes may feel
    aggravated for a few days, as the healing response is more active after treatment.
  • Q: How many treatments does it take?
    This depends on the nature of the condition being treated. For some acute conditions 1 to 6
    treatments may be sufficient. Those of a more chronic nature may require 10 to 14 (or more)
    treatments. Certain conditions such as severe arthritis may require ongoing periodic care to
    control pain.
  • Q: Can it be used in conjunction with other forms of treatment?
    Yes. Laser Therapy is often used with other forms of treatment, including Rehabilitative Exercise
    and Physical Therapy
    , Active Release Therapy (ART), Graston Soft Tissue Therapy, and
    Standard Chiropractic Treatments. These other healing modalities are complementary and can
    be used with laser to increase the effectiveness of the treatment.
  • Q: Am I covered under my Extended Health Care Plan (EHC) for Laser Therapy?
    Many EHC insurance policies cover chiropractic care. This would also include Laser Therapy
    services which would be billed under the chiropractic coverage umbrella.
  • Q: Has effectiveness been demonstrated scientifically?
    Yes. There are thousands of published studies demonstrating the clinical effectiveness of
    Laser Therapy. Among these, there are more than one hundred rigorously controlled, scientific
    studies that document the effectiveness of laser for many clinical conditions.

Wednesday, November 23, 2016

Sciatica - Too Broad A Term For Leg Pain

By Dr. R. Greg Lusk, DC
Over the years I have listened to many patients tell me that they have "sciatica".  Either they think they do based on what they found after a Google search, another healthcare professional has told them that they do, or a well-intentioned friend or family member has made the suggestion.  Sciatica is a term often used broadly to refer to pain or other symptoms, such as tingling or numbness, in one or both legs.  However, it is often used incorrectly to describe pain from another nerve and in and of itself offers very little value in understanding the source of one's symptoms.  It's similar to being told that you have tendonitis.  Tendons attach muscles to bones, and because we have many muscles we also have many tendons.  Saying that you have an inflamed tendon ("itis" = inflammation) doesn't inform someone where certain treatments (e.g. laser/ultrasound/soft tissue therapies) should be applied or what actions/exercises should be avoided, or done, to assist with recovery.  The same holds true for sciatica, but understanding the source is crucial to successfully managing the condition.
The sciatic nerve is like the trunk of a tree.  There are various roots that come together to form the "trunk" and then the trunk offers up many branches.  This nerve is the longest and widest in the entire body and forms deep in the pelvis as 5 nerve roots (L4&5,S1,2,3) come together.  It exits the back of the pelvis through deep buttock muscles and then runs down the back of the leg where it distributes its various branches.  It is responsible for sensation of the skin on the back of the thigh, the outside front and back of the calf, and most of the foot.  It does not supply the inside, front, or outside parts of the thigh, or the inside of the shin and foot.  Therefore, if that is where your symptoms are, you do not have "sciatica".  Furthermore, the sciatic nerve is the power source for the muscles on the back of the thigh (i.e. hamstrings) and all muscles of the shin and foot.
If you do have symptoms in the correct area(s) the question still remains - "Where is the source of irritation?"  Frequently, where you feel symptoms (i.e. the leg) is not where the problem is and often pain relieving efforts are directed at the smoke but not the fire.  Often a nerve root in the back is the site of irritation and this is more properly named a radiculopathy.  This could be due to spinal disc degeneration and resulting arthritic changes (a.k.a. stenosis), a disc bulge/herniation, or slippage/excessive movement between vertebrae (spondylo-listhesis).  Sorry for the tongue-twisting mouthful!  In each case, the management of symptoms could involve aspects that are quite different.  For instance, disc bulges often respond best to exercises where you bend backward whereas relief from stenosis symptoms usually occurs by bending forward.  This illustrates why "sciatica" as a diagnosis doesn't really cut it while something like "L4/5 Disc Bulge with a right L5 Radiculopathy" is much more informative.  Furthermore, this doesn't even consider the fact that muscles and joints, namely the sacro-iliac (SI) joint or hip joint, other soft tissues (e.g. bursae), or irritation to the sciatic nerve and its branches along its path, can refer symptoms into the leg as well.
Differentiating the cause of your "sciatica" is empowering as it clarifies what activities you should refrain from or participate in, providing you with a sense of control over your symptoms. 
This article is for general information purposes only and is not to be taken as professional medical advice.

Monday, November 14, 2016

2016 Record Reader Award Results

The results of the 2016 Record Reader Awards were recently published and...


New Hamburg Wellness Centre was awarded the following:

  • Favourite Massage Therapy Clinic - DIAMOND

  • Favourite Chiropractic Clinic - PLATINUM

  • Favourite Alternative Medicine Clinic - PLATINUM

Thank you for your support.  We are extremely proud and honoured to have received your nominations and votes for the last three years in a row!

Come visit us at 338 Waterloo Street, Unit 9 in New Hamburg.
New patients are always welcome!

Tuesday, November 8, 2016

Treatment & Prevention Of Whiplash Injuries

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

The unique forces generated during a motor vehicle collision (MVC) cause more than 100,000 whiplash cases in Canada each year.  This article will specifically focus on the treatment and prevention of whiplash injuries.

The term WAD (Whiplash Associated Disorder) is used to describe a range of injuries that can be attributed to whiplash.  This may include:  neck pain, whole body muscle pain/ache, jaw pain, referred arm pain, shoulder or other joint pain, mid back pain, low back pain, headaches, dizziness, and tinnitus.

WAD Grades 1 and 2 represent the majority of whiplash cases and are amendable to conservative management.  Early treatment and consultation can greatly improve the recovery process and prevent future complications and chronic pain.  Effective treatment strategies may include: pain controlling modalities such as electrotherapy and acupuncture to help facilitate and promote activity and functioning; manual and soft tissue therapy to assist in the healing of injured tissues; education on how to safely re-integrate into activities of daily living; and rehabilitative exercises that may include range of motion, flexibility, strengthening, and balance/coordination training.  An independent home exercise program should also be provided.

The goal of treatment is to get the injured individual back on their feet and up to their normal level of activity.  The majority of people with WAD Grades 1 and 2 experience no significant disruption to their normal activities of daily living.  Some may experience a temporary disruption to their normal activities, but usually improve after a few days or weeks.  Occasionally, symptoms may persist over a longer period of time.  A return to normal activities of daily living may be assisted by active treatment and rehabilitative exercise prescription as described above.

Included below are some tips that may help prevent a MVC and/or whiplash injury (courtesy of the Alberta College and Association of Chiropractors):

1.    Drive defensively.  Always anticipate the actions of other drivers.

2.    Wear your seatbelt at all times.

3.    Make sure your headrest is positioned properly, that is, the top of the headrest should be no lower than the top of your ear.  If more than one driver uses the car, remind each other to always check the headrest height.

4.    Never operate cell phones or other electronic equipment while driving.

5.    When road conditions are poor (i.e. icy, wet, dark, or crowded), slow down accordingly.

6.    Be sure your car is always in good working order, particularly your brakes, tail lights, headlights, and directional signals.

7.    Engage in regular physical activity consisting of cardiovascular, strength, and flexibility training.  This will help keep your body strong and offer some protection in the event your are involved in a MVC.

If a whiplash injury is interfering with your activities of daily living, consider chiropractic care.  A chiropractor can prescribe appropriate conservative therapy, rehabilitation and self-management strategies specifically for you.  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, November 4, 2016

Understanding Whiplash Injuries

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

Whiplash is a common injury that can be experienced following a motor vehicle collision (MVC).  There are more than 100,000 whiplash cases in Canada each year.  The unique forces generated during these collisions can stress biological tissues and result in pain and decreased functioning for those affected.  This article provides a review of whiplash specifically focusing on the mechanics of injury, the associated symptoms, and general guidelines for the evaluation of any accompanying injuries.

Although rear-end collisions are the most commonly reported mechanism of whiplash injury, an injury may also occur following side and head-on collisions.  The forces generated from these types of impacts thrust the head (and to a lesser extent the entire body) back and forth, much like a snapping whip.  Injury results because the body is unable to compensate adequately for the speed of head and torso movement from the acceleration forces generated at the time of impact.  This will put stretch, compressive and shear stresses on biological tissues such as muscles, ligaments, joints and nerves.  As a result, this can generate pain symptoms, and affect range of motion, strength, coordination, and balance.  The onset of whiplash symptoms may immediately follow a MVC or may gradually develop over the first 24-72 hours.  A later onset of symptoms does not necessarily indicate a more serious injury.

Neck pain is frequently associated with whiplash injuries.  However, the whiplash mechanism may also cause injury and symptoms that include: whole body muscle pain/ache, jaw pain, referred arm pain, shoulder or other joint pain, mid back pain, low back pain, headaches, dizziness, and tinnitus.  The term WAD (Whiplash Associated Disorder) encompasses all of these potential symptoms and is commonly used to grade the degree of injury present.  Of the four Grades of WAD, Grades 1 and 2 represent the majority of whiplash cases.

Evaluation of whiplash injuries should include a proper medical history, along with a physical examination consisting of inspection, palpation for tenderness, range of motion, strength, neurological, orthopaedic and functional testing.  Signs of serious injury, such as fracture, are usually evident in early assessments and may require further diagnostic testing such as x-ray, CT scan, or MRI.  Chiropractors are healthcare professionals skilled in the diagnosis and treatment of whiplash injuries and are commonly involved in the management of WAD.

When an individual sustains a whiplash injury, injured tissues can become stiff and weak when they are not used, which can further exacerbate pain symptoms.  Therefore, a return to daily activities after whiplash injury is extremely important for successful healing as extended rest may prolong recovery.  Healing and a return to daily activities may be facilitated with active treatment and rehabilitative exercise prescription.  Join us next month when we specifically take a closer look at the treatment and prevention of whiplash injuries.  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.