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3 Minutes, 3 Hours, 3 Days   –   July 2017

Health is about movement. it is movement of the body, of the joints, of the blood and all the biological chemicals, neurotransmitters, electrical and mental impulses. Without movement, physically and physiologically, the tissues and cells will quickly breakdown, degenerate and die. Have you ever seen a video of live cells? There is always something going on. Biochemical doors are being opened and closed; the cells’ organelles are taking in energy or excreting byproducts. Your lungs will move continuously and your heart will beat non-stop from the moment of development in the womb until the day you die.

This idea of movement is also essential for the neuro-musculoskeletal system to function well. The nervous system is the master control system in the body. No other system can work without the nervous system functioning properly. Chiropractors have long stated that pressure on the nerves, particularly spinal nerves can and do create a cascade of health issues. Several years ago a study was done to test out this theory. The sciatic nerve of a dog was exposed and connected to a monitor to assess conduction of nerve impulses. All mammals have sciatic nerves. They are big nerves running down the back of your legs, originating in the low back. Al slight amount of pressure, about the weight of a quarter, was applied against the nerve. Within three minutes of continuous light pressure the nerve impulse reduced by sixty percent. That is sixty percent less information, neurotransmitters, and electrical stimulation being properly conducted through the nerve. Within three hours of sustained pressure the nerve began to degenerate and breakdown. This is why the question “how do you feel” is a very poor question to assess how healthy you are, especially in terms of spinal health. You could take any number of painkilling drugs to make you “feel better” but your body is not functioning any better and the nerve conduction is still poor.

Short of an accident, people who experience some type of spinal pain have lived with it for weeks, months or even years before your body finally signals that it can no longer accommodate the dysfunction. The gas tank of health is empty. But, it has been running on less than half a tank for a long while.

A proper functioning nervous system is necessary for muscles to contract which then moves the joints. Without continuous joint movement degenerative changes occur quickly. Whether that be spinal joints, hips, knees, ankles, shoulders, elbows or wrist joints, movement is a must to minimize degenerative changes. In fact, joint degeneration will occur within three days of a joint being immobile, especially weight bearing joints. This is why quite often just hours after hip and knee surgeries, patients’ legs are strapped up to an apparatus to get slow movement in that joint.

So, three minutes, three hours, three days, without movement it does not take long for your body and your health to start to degenerate and eventually die.

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Short Legs and Where to Find Them  –  May 2017

Quite often, during the initial consult in our office, patients will tell me that another health practitioner has told them they have a short leg. What does that mean? Is there anything you can do about it? Should you do anything about it?

Having a short leg or more accurately a leg length inequality (LLI) can be either an anatomical issue or a functional one. Anatomically our legs should be the same length. This means all the leg bones and joints should be more or less symmetrical. An anatomically short leg may be a result of fractures, unequal hip or knee angles (which could be caused during birth or during early development), hip or knee surgeries, congenital malformations, or trauma. Various measuring techniques can be employed some more accurate than others. My clinical estimation is that only about one in ten leg length differences are of anatomical origin. The vast majority of LLI is due to functional changes, the most common reason being torsion or maladaptive motion of the pelvis and lower back. A fallen foot arch or inverted ankle could also cause one leg to appear shorter than the other while standing. Functional LLI are best assessed first with the patient prone (lying face down) and then on standing postural observation. The scientific literature states that up to a 4 mm difference is acceptable while other references suggest as high as 10 mm to be a normal variant. My professional opinion is that even at a 4 mm LLI, some form or compensation will show up along the kinetic chain. That is, everything is connected and you can’t change the other parts.

So is there anything you can do about LLI? Absolutely. But first you must be properly assessed by a health professional who has expertise in spinal and body mechanics. What is the primary cause and what are the secondary compensations? Depending on the diagnosis you may need some form of therapy on the spine, pelvis, hips, knees, ankles, feet or all of the above. Therapies could include spinal manipulation (adjustments), exercises, ergonomic education, soft tissue therapy, or custom made foot orthotics (insoles).

Once you are assessed and it is obvious that there is a LLI, the question then becomes what are the goals of any therapy. Is it to reduce the LLI? Is it to increase the function of the involved structures? How well has the body adapted to the LLI? Heel lifts or foot insoles with an attached heel lift on the short leg side are quite popular. However, one should be extremely cautious about adding any type of heel lift that was not prescribed by a health practitioner who assess the entire body mechanics and not just the foot. Adding a heel lift to a functional short leg is one sure way of encouraging and keeping those pelvic and lumbar torsions and misalignments fixed permanently. That is not what you want. A more thoughtful approach would be to strengthen and promote whole body function and movement. Custom made foot orthotics can be an effective complement to the other therapies. But, only as a last resort should a small heel lift be added on the short side, if necessary, once the body has reached its maximum LLI improvement.

Are short legs real? Yes. The key is to know where to find them and what to do about them.

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Beat Bad Behaviour With A BAP  –  April 2017

As a health practitioner, I have had my share of patient interactions where I am doing all the talking. With my expertise and knowledge in my health field, I can’t wait to share it all with my patients. Not until I see the glazed look in their eyes do I realize that as happy as I might be feeling about “educating” the patient on better health habits, all they heard was “wah, wah, wah, wah…..”. Think of the Charlie Brown teacher speaking scenes. And this is not isolated to just health care workers. Teachers, coaches, parents have all run in to the same challenges.

We all have bad habits, poor behaviours that we would like to change. But behaviour habits do not change intellectually they happen emotionally. Having all the knowledge in the world will not make a difference unless we are motivated to change. We all know smoking is bad for our health yet 20% of us smoke anyway. We understand that anger is not a great approach to conflict resolution, we get angry anyway. We know exercise and good diet are important for our health. We sit all day and overeat anyway. How do you help someone improve or change a behaviour, especially when it can be detrimental to their health or well being? The short answer is you can’t. Only they can change. So then the question becomes how can we support someone in to making changes that they are motivated to make? The answer is by guiding rather instruction or directing.

Psychological researches have devised a method of helping people change behaviours called Motivational Interviewing (MI). MI is a “person-centered counseling method for addressing the common problem of ambivalence about behaviour change.” This is an advanced technique that takes time and practice. A simpler more practical tool which is based on MI is BAP (Brief Action Planning). “BAP is a self-management support tool to help you set goals and overcome barriers to your health. BAP is a simple check list tool, organized around three core questions.” Although designed for use by health practitioners in a primary care setting, it can also be used as a model for behavioural changes in other situations. In guiding someone when using BAP one must be in a spirit of acceptance, non-judgement and empathic. Taking this one step further, we can train ourselves to use BAP and reach our goals. The key is to be honest with yourself about what really motivates you and what you want to achieve. For better results this exercise needs to be written down and then read out loud daily.

1)  Is there anything you would like to do for your health in the next week or two?

The question can be as general or specific as you like. The short time frame helps to focus on smaller goals to achieve quick success. As an example, you can’t learn to run long distances until you are able to walk and you can’t do that until you get off the couch. So your first goal would be not to lie on the couch all evening followed by walking 20-30 minutes per day. The goal needs to be SMART (Specific, Measurable, Achievable, Relevant, Time-bound).

2)  On a scale of 0-10, how confident or sure do you feel about carrying out your plan?

If it is not at least a 7 then modify the plan and address barriers to ensure success.

3)  Would it be helpful to check-in on how things are going with your plan?

People are more likely to follow through on a plan if they have to report back or check-in regularly. This can be with a professional, a friend or self reporting. It allows you to recognize and celebrate success.

A wise statement I once read: “Without realizing it, you either build yourself up or put yourself down all the time. You are actually part of the cause of your own pain, poor self image or of your success.” Find out what motivates you and beat the bad behaviour with a BAP.

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 Sleepy Sleep Sleep

We spend approximately one third of our lives sleeping. With that much practice, especially for a normal biological process, you would think we would all be experts at it. Yet increasingly more and more people look for medical intervention to do something that is a natural part of being human. Why? There are many answers…..actually there is only one answer but how it affects us manifests in multiple ways depending on the person. Modern day society creates an environment of over stimulation either physically, mentally, emotionally or all of the above. What we are left with then is many people who get too little sleep (less than 8 hours for adults and less than 10 plus hours for children and youth) or disturbed sleep (frequent arousal without reaching deep (REM) sleep).

On the risk of oversimplifying, this is what is happening. Our bodies have an autonomic (subconscious) nervous system that is divided into two systems, a sympathetic system (fight or flight, increased heart rate, muscle contraction, increase respiration rate) and a parasympathetic system (rest and digest, decreased heart rate). We are supposed to spend 90% of our time in parasympathetic mode but instead many of us now spend most of our time in sympathetic mode. This means we are always on high alert, always gearing up for a stressful situation. Physiologically this creates increased blood pressure, increased heart rate, shallow quick breathing, tense muscles. None of these states are conducive to getting a good night sleep. To get out of this sympathetic mode we need to prepare for sleep. Preparing for sleep is more than just getting on comfy pajamas and brushing your teeth, although these things are a good first step. We must prepare our mind, body and soul:

Power down:  Just like a computer, we need to shut down all our programs. But this must be done in a timely and orderly way. Scanning your smart phone just before bed only helps to stimulate the brain. No screen time for at least 30-60 minutes pre sleep. Is your mind racing with things you plan on doing tomorrow? Take 5 minutes and make a point form list so that you can shut down the “make sure not to forget” part of your brain. Do you have some unresolved emotions? Start journaling for 10-15 minutes before bed to help sort through them so that your thoughts don’t run like a continuous loop in your brain. Also, no caffeine after lunch.

Release the tension: stretching for 5-10 minutes pre sleep is helpful in reducing back and leg pain during sleep. Pelvic tilts, shoulder shrugs, hamstring and gluteus stretches are just a few great ways to reduce the tension and calm your nervous system.

Too much light:  Ideal sleeping conditions require a cool dark setting. This means blinds on all windows to block 100% of the light. Those little lights from televisions and electronic devices must also be blocked. Even night lights have been shown to be detrimental to children’s development. Blue lights are the worst as long term exposure can actually increase the risk of some cancers.

Not enough oxygen:  Oxygen deficiency is due to external and internal factors. Externally, is there a good air flow where you sleep? Internally is more complicated. Shallow breathing, due to being in the sympathetic state, does not allow for sufficient oxygen. This causes repetitive waking and poor sleep. This is when CPAP machines can be effective. When do most heart attacks occur? In the early morning while you are still sleeping because your oxygen intake is not balanced to your myocardial muscle oxygen requirements.

Clear the Heart:  Meditate or pray. These are not just religious constructs. Give thanks and rid your mind of negativism. Several studies show that negative expression and thought take significantly more energy than positive ones.

Now you are ready for a restful sleepy sleep sleep.

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 Lumbar Spinal Stenosis – A Primer

Arthritis and degeneration of the low back is a fairly common condition in humans. Over time repetitive stresses of daily life can cause wear and tear on the joints, discs and bones of the spine. This type of arthritis is called osteoarthritis. However, not everyone who has arthritic changes in their spine experiences back or leg pain or lack of function. Studies using MRI’s (magnetic resonance imaging) show that there are just as many people with osteoarthritis of the spine who do not experience any pain or dysfunction as those that do. What does this mean? It means that for health professionals who assess and treat spinal conditions the clinical exam is often much more informative and valuable than x-rays or MRI’s.

If we look at this condition anatomically we would say that: extensive arthritic changes leads to thinning discs, thickening of the spinal joints and ligaments, and boney build up of the vertebral bodies which can all cause narrowing of the spinal canals. This can compromise the spinal nerves and spinal cord. If the spinal nerves are affected we call it lateral spinal stenosis. If the spinal cord is affected we call it central spinal stenosis. Often both can be compromised.

Looking at this condition clinically we would call it neurological claudication. Most commonly a person with this condition is greater than 65 years old, has buttock or leg pain and weakness with walking which improves with forward bending or flexion and gets relief with sitting. This condition is dynamic meaning that it changes with posture. So what is actually happening? The decreased space surrounding the nerves creates a back up of venous flow. This in turn blocks spinal fluid which then blocks capillaries (mini blood vessels) which does not allow for oxygen and nutrients to get to the nerves and tissues which then causes numbness and pain in the buttocks and legs. So it is actually not an inflammatory condition. This is why anti-inflammatory drugs often are not effective for those with spinal stenosis.

To complicate things even further, having spinal stenosis is one or more levels of your spinal column does not exclude having other conditions like disc herniations at other levels or hip disease or vascular claudication all of which can have opposing signs and symptoms. This is why it is not a good idea to listen to your friend or neighbour’s advice on what to do. Often certain exercises or movements that work great for one type of back condition are completely ineffective or even harmful for other conditions.

Within 15 years 25% of the Canadian population will be suffering with some form of spinal stenosis. It will be a leading cause of pain, disability and loss of dependence in the elderly. Those with spinal stenosis become more sedentary which further causes a decline in their overall health.

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 Spinal Stenosis – What Can Be Done?

In my previous article (Lumbar Spinal Stenosis – A Primer), I was talking about Lateral Spinal Stenosis. This is an arthritic condition of the spine that will affect 25% of the population in the next fifteen years. It will be a leading cause of pain, disability and loss of dependence in the elderly. In this article we will discuss the therapy options and what research tells us about their effectiveness.

No matter what health issues you have a logical and thoughtful approach would be to start with the most conservative therapies first, as they are generally the safest and have the lease potential for side effects. Conservative therapies start with home care, lifestyle modifications, certain exercises and postural improvements.Next would be therapies such as physiotherapy, massage or chiropractic care. Attempting more aggressive therapies should be assessed for risk benefit ratios before proceeding. However, too often people and health practitioners jump to more aggressive therapies first.

Before starting any therapy you must reflect on your goals. Is it soley to get out of pain? Is it to have better function? If so, what function are you trying to achieve: daily house chores, walking, sporting activities, social activities? As a health practitioner I can guide you on what goals are more realistic and achievable but ultimately it is up to you to set your own priorities and goals. When discussing spinal stenosis one needs to understand that although pain reduction is a desirable goal, most people with this condition will always have a certain amount of pain. A more realistic goal would be to improve and maintain a higher level of function. Functional goals will go a lot further in also reducing other health risks like cardiovascular disease and diabetes than will pain goals.

Scientific literature reviews in 2012 in Spine and also in 2014 by the think tank The Cochrane Collaboration both described effectiveness of various therapies:

  •  NSAIDS (anti-inflammatories), Gabapentin and prostaglandins – not effective because spinal stenosis is not an inflammatory condition.
  • Pain killers like acetaminophen and opiods showed poor results.
  • Epidural injection – no evidence of positive outcomes. Despite this, 25% of all epidurals done are for spinal stenosis.
  • Physical therapy, chiropractic – some positive effectiveness, especially to reduce leg pain but results diminish over time.
  • Surgery – moderate effectiveness to reduce leg pain but no effect on low back pain. Results last 2-5 years and then secondary surgery is often done. No difference in walking, pain or disability scores when compared to conservative therapies.

One therapy which has impressive results in terms of significant improvement in function, is the Boot Camp Program for Lumbar Spinal Stenosis developed by Dr. Carlo Ammendolia DC. This program includes a combination of chiropractic techniques to increase spinal joint function along with specific low tech exercises that the patient learns to do in the office and then continues to do at home indefinitely. It has received several accolades amongst the spinal research community for its effective functional results, its patient centered approach an its low tech, low cost application. There are several local chiropractors who use the Boot Camp Program for Lumbar Spinal Stenosis.

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 What is you SPA? (Self-Perceptions of Aging)

Many people have a pre-determined idea of what they will be like once they get to their senior years. Based solely on their family history and experiences, some may already even be inclined to accept their limited longevity as well. Henry Ford, the founder of the Ford automobile and line assembly, once said “If you think you can or you think you can’t, you are right.”

There has been over twenty years of research by psychologists into this whole topic as it is related to health, longevity and mortality. These researchers wanted to know if a person’s positive or negative attitudes about aging along with their attitudes about their personal health and longevity. Results were impressive. Older adults (70 years old) who had the poorest SPA lived ten years less than those with the highest SPA. This association continued even when taking into account factors like age, physical health, cognitive function and well-being. Another study looked at young adulthood (18-49) and found that a negative SPA was predictive of increased angina attacks, congestive heart failures, myocardial infarctions, strokes and transient ischemic attacks. The general conclusion then is that your SPA becomes a self-filling prophecy. If you think you are going to be in poor health or consider yourself “over the hill” at whatever arbitrary age you have decided upon, then there is a high likelihood that it will happen. However, if you alternatively believe that you will be fit, healthy and live to a ripe old age then your chances are considerably better that that will happen. Of course, this only goes along with your natural desire to do all the right things to get you there.