Choosing The Right Backpack For Your Children

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

Carrying a poorly designed or overloaded backpack can place excessive weight on a child’s growing spinal column.  This type of daily physical stress can lead to irritation and injury of the spine, joints, and muscles, which can potentially result in postural changes, back pain, and headaches.

 

Parents and children can avoid injury by following these simple rules with respect to choosing, packing, and carrying a backpack.

1.    Pick the correct size:  Choose a backpack that is proportionate to body size and not larger than needed.  The top of the backpack should not extend higher than the top of the shoulder, and the bottom should not fall below the top of the hipbone.

2.    Choose lightweight material:  Select a backpack made of light material.  For example, nylon, vinyl or canvas instead of leather.

3.    Strap it up:  The shoulder straps should be at least two inches wide, adjustable, and padded.  Ensure that they do not cut into or fit too snugly around and under the arms.  A hip strap or waist belt helps to effectively redistribute as much as 50 to 70 percent of the weight off the shoulders and spine onto the pelvis, balancing the backpack weight more evenly.

4.   Padding goes a long way:  A backpack should have a padded back for added protection and comfort.  Pack odd-shaped items on the outside so they do not dig into the back.

5.    Pack it right:  Contents should be evenly distributed, with the heaviest items packed closest to the body.  This reduces the strain, as the weight is closer to the body’s centre of gravity.

6.   More pockets are better:  Choose a backpack that has several individual pockets instead of one large compartment.  This will help to distribute the weight evenly and keep contents from shifting.

7.    Wheels and handles:  Explore other backpack options such as a backpack with wheels and a pull handle for easy rolling.

8.   Weight is everything:  Backpacks should never exceed 15 percent of a secondary school child’s body weight or 10 percent of an elementary school child’s body weight.

9.    Handle with care:  Children should learn to squat or kneel to pick up their backpacks, and use their legs by bending at the knees and not twisting the back when lifting.  Backpacks can be placed on a counter, chair or table before they are put on.  Slinging backpacks on one side of the body may place excessive stress on the joints and muscles of the mid and lower back.

Parents should ask their kids to report any pain or other problems resulting from carrying a backpack.  If the pain is severe or persistent, seek care from a qualified health professional.  For more information, visit www.nhwc.ca.  The author credits the Ontario Chiropractic Association (OCA) in the preparation of this educational information for use by its members and the public.

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 Smoking Does To Your Musculoskeletal 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 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.

Now Offering Clinical Social Work And Counselling

CLINICAL SOCIAL WORK AND COUNSELLING
With Sandra Tocitu, BSW., RSW

Our Clinical Social Work and Counselling services provide a variety of areas of expertise to help individuals and families with matters such as child and adult mental health, depression, anxiety, addictions, domestic violence, child abuse, custody and access disputes, Motor Vehicle Accident (MVA) rehabilitation and chronic pain just to name a few. Recovery is a subjective experience, and depending on the circumstance, a combination of interventions and modalities that best suit the specific needs of an individual can be used during treatment sessions.

In addition to offering clinical counselling and therapy, this service also provides general social work supports that may include but are not limited to connecting individuals and their families to the most appropriate resources in the community, making referrals for their family members to different/other service providers, as well as general navigation of the social system (for example Ontario Housing, Ontario Works, Ontario Disability, court services just to name a few).

Many Extended Health Care (EHC) insurance policies fully or partially cover individuals for Clinical Social Work and Counselling. These services may be specifically covered under "Social Work" or "Counselling".  Please check your policy for details.

Sandra is now accepting new patients.  Please call 519-662-4441, or email: info.nhwc@bellnet.ca to schedule an appointment.

Understanding Bursitis

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

A bursa is a thin, slippery sac found around a joint that releases lubrication called synovial fluid.  Its primary function is to provide cushioning between bone and surrounding soft tissue, such as skin, muscles, ligaments and tendons.  Under normal circumstances, the bursa provides a smooth surface that allows for minimal friction with movement between these structures.

The term "bursitis" refers to any inflammation or irritation of the bursa.  When this occurs, the bursa loses its gliding capabilities, and becomes thickened and swollen.  As a result, the added size of the swollen bursa causes more friction within an already confined space, and the smooth gliding bursa becomes gritty and rough.

There are approximately 160 bursae in the body.  Fortunately, only a handful of them usually develop bursitis. The most common areas to get bursitis include the shoulder, elbow, hip and knee regions.  Less frequently, bursitis may also occur in the wrist, buttocks, heel and big toe.  Symptoms of bursitis include swelling, pain, and tenderness in the affected region.  This may also be accompanied by reduced range of motion and strength which can lead to a significant decrease in physical functioning.

There are several factors that can contribute to the development of bursitis.  Activities that result in repetitive overuse or prolonged and excessive pressure on a body region are a common culprit.  An example of this would be constant overhead lifting using your shoulders or continuous kneeling on a hard surface with your knees.  A bursa can also become injured as a result of a blunt trauma or fall such as slipping on ice and landing on your hip.  Bursitis is more common in adults, especially in those over 40 years of age.  As soft tissues age they become less elastic and durable making them more susceptible to overuse and traumatic injuries.  Other possible causes and risk factors for developing bursitis which may require additional medical management include infection from an opening on the skin surface, rheumatoid arthritis, gout and diabetes.

Conservative self-care strategies for reducing the pain of bursitis should initially involve relative rest from any painful activities and ice application.  Altering or eliminating the situations that contributed to the bursitis is also important.  This may include activity modification such as using the correct technique, tools, and/or equipment.  In addition, taking breaks to relax overworked muscles and joints, and performing exercises to strengthen the body can also be effective.

Bursitis that does not respond to self-care strategies may require professional treatment.  This can include acupuncture and electrotherapeutic modalities to decrease pain, manual and soft tissue therapy to assist in healing, and specific rehabilitative conditioning training for the affected muscles and joints.

If you are having difficulty with a case of bursitis, a qualified health professional can 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.

Understanding Tennis And Golfer's 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 Tennis Elbow (TE) and Golfer's Elbow (GE).  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.

Tennis Elbow (TE) is medically known as lateral epicondylitis and causes the outer part of the elbow tobecome sore and tender.  This typically affects the muscles and tendons that extend the fingers and wrist, and roll the forearm outwards.

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.

TE and GE 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.

As a result, TE and GE 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 TE and GE.

It is important to establish an accurate diagnosis of TE or GE.  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. 

Chiropractors are healthcare professionals skilled in diagnosing and treating muscle and joint conditions such as TE and GE.  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 laser therapy, acupuncture, electrotherapy, 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 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.

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 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.

Tips for Bending With Low Back Pain

By Dr. R. Greg Lusk, DC

Sitting and standing were discussed thoroughly in my last article as they are common activities that trigger low back pain (LBP). Modifying how they are done form part of our daily upkeep of our backs, referred to as spine hygiene, which when coupled with appropriate exercises can help make you more resilient to symptoms. Bending is another frequent trigger for  low back pain and how it can be performed in a more spine sparing or friendly way will form the focus of this article.

If you have or had LBP, it is highly likely that bending is or was an aggravator to your symptoms. Imagine yourself flexing forward to put on socks, stooping to brush your teeth, or trying to pick up that pen you dropped on the floor. Many of you will dread the thought of having to do that when you have LBP. However, you can employ strategies to do this that spare the spine, allowing it to stay in neutral, thereby minimizing pain. Squatting, by moving predominantly at the hips and knees, will allow you to lower yourself without rounding your back. To get even lower you could use a lunging pattern. To perform this move, you stagger your feet one in front of the other and offset side to side, so you don't feel like you're standing on a balance beam. Once again, you move about the hip and knee joints while lowering the rear leg toward the floor, keeping the back straight throughout. From the bottom of this position you can generally reach near the floor with your hand with minimal spine motion needed. Good technique is paramount to minimize stress on the hip and knee joints so symptoms are not produced there, which may be particularly challenging for some of you with a history of injury and or arthritis there. An alternative that may be helpful is referred to as the golfer's lift or pick-up. Similar to the action you'll see a golfer perform to retrieve the ball from the hole, you balance on one leg while you hinge about the hip joint, lowering a hand toward the ground while the free leg extends backward as a counter-balance. Particularly for relatively light items, this is an effective way to get your hand low while keeping your spine neutral and your core tight. Balance may be an issue for some so using your free hand to lean on a wall or hold onto another firmly rooted object will provide another contact point for improved stability in this position.

The stooped (i.e. slightly bent) posture you can observe when someone is brushing their teeth over the sink, gathering laundry out of the washer or dryer, or kneeling to do gardening can also be modified to become more kind to your spine. With these activities we use our arms but really only need the free motion of one hand to be efficient. The other hand, which is typically non-dominant, can instead form a contact point of support on either the vanity counter, the appliance, or ground, while you also hinge at the hips and keep your spine neutral. The support hand now bears much of the load that leaning forward imposes on the spine, which is surprisingly substantial when you consider how much the upper half of our bodies weigh coupled with the multiplying power of leverage.

Good luck employing some of these ideas to bend with increased ease. With low back pain the more we can reduce all of the contributing sources of aggravation the more likely you'll experience decreased symptoms and prolonged relief. This article is for general information purposes only and is not to be taken as professional medical advice.