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 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.

Safe Gardening Tips To Prevent Injury

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

Spring is upon us and so is the arrival of the gardening season.  Raking, lifting, digging, and planting can be strenuous activities.  Below are some simple tips that can help you avoid and prevent injury during the gardening season.

1.  Prepare your body for physical activity with a warm-up.  Climbing stairs, marching on the spot, or going for a quick walk around the block are examples of excellent warm-up activities that can completed in as little as five to ten minutes.  Follow this with some gentle stretch exercises such as knee to chest, shoulder, forearm and wrist stretches.  Your muscles and joints will appreciate this prior to being asked to do work.

2.    Use the right tools for the tasks to be performed.  Always make sure that tools are a comfortable weight and size for you.  There are many ergonomically designed tools which are lightweight, with long padded handles and spring action mechanisms that can reduce strain and effort.  Carts and wheelbarrows minimize the need for lifting and carrying, reducing your risk of physical injury.

3.    Proper lifting means bend the knees, keep the back straight and brace!  Use your leg and arm muscles to do the 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.  Avoid twisting and turning by positioning yourself accordingly.  Be sure to lift slowly and smoothly with the load close to your body and do not jerk with your lifts.

4. Alternate activities and change positions.  Once you begin, take turns alternating between heavy chores such as digging, and lighter less physically demanding tasks such as planting, every 10 to 15 minutes.  Avoid prolonged working postures.  Changing hands frequently when you rake, hoe or dig prevents muscle strain and joint stress on one side of the body.

5.   Drink plenty of water before, during and after gardening activity.  Dehydration affects your energy level and physical functioning.  Staying hydrated decreases the risks of cramps and strains, and helps to protect joints by providing lubrication and cushioning.

6.    Preparing for the elements and pacing.  Select comfortable, thick-soled, protective shoes that support your arches to reduce joint pain and aching muscles.  To protect from sun exposure, apply sunscreen, and wear a wide-brim hat.  Wear loose and comfortable clothing.  Work at a safe pace and know your physical limits.  Stop gardening immediately if you feel chest pain or persistent muscle or joint pain.

In the event that you suffer a muscle or joint injury while gardening that does not subside, you should contact a licensed health professional who deals in the diagnosis and treatment of these injuries.  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.

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.

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

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.

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.