Dr. Kyle: Posture Perfect

You can prevent slips and falls. You can reduce your risk of a motor vehicle accident. You can limit contact sports. One thing that you cannot avoid however, is gravity. If your body and spine are not aligned, the force of gravity will start to wreak havoc on your musculoskeletal system. Making sure we maintain proper posture throughout our work day is critical for longevity in our career. So how do we protect ourselves?

The secret to good posture is maintaining the spines natural curves. When standing, your head, shoulders, hips and ankles should all line up. When sitting, your ears, shoulders and hips should be in line and your buttocks should be at the back of the chair. Sit tall with your chest and head up.

Some tips for creating an ideal posture include:

• Stand tall with shoulders back
• Tuck your chin
• Brace the abdomen
• Squeeze your glutes
• Keep your knees slightly bent

Due to modern day technology, one of the most common signs of poor posture is anterior head carriage. This mean that the head is resting too far forward away from the body. We are not always cognisant of our head posture as we check our smart phones and work on our laptops. The farther our head protrudes forward, the greater the force on our neck. This can lead to chronic neck and upper back pain and lasting postural alterations.

One exercise I recommend to patients to reduce anterior head carriage are chin tucks. These can be done up against a wall or lying flat on your back. You simply bring your chin directly in towards the spine and hold. You can press gently into the wall or pillow to enhance the muscle contraction of your deep neck extensors. Now your spine will naturally carry the weight of your head and allow your neck and upper back muscles to relax. So keep your chin up and your pain levels down!

For more tips and tricks to enhance your posture, visit my Instagram page @drkylearam of email me at drkyle@forwardhealth.ca.

Dr. Kyle: Torn ligament? Maybe not.

Knee pain can come in a variety of presentations. Whether from a sports injury, slip and fall, or out of the blue, no two knee injuries are completely alike. The extent to which tissues are damaged is specific to the patient’s genetics, lifestyle, trauma, and fitness level. A well-trained athlete may be quite high functioning even with a serious tear, while a mild injury may keep a very sedentary person out of commission for several months.

Often times I will hear “hey doc, I think I might have heard a pop and the inside of my knee really hurts!”. My first reaction is to suspect a ligament tear. Once examining the patient further however, orthopedic testing shows stable knee ligament testing, no swelling or redness, and no severe joint line tenderness. So what’s the deal?

Like most soft tissue injuries, ligaments can be damaged to varying degrees. In the clinical world, there are 3 grades of ligament tears. Grade 1 is mild ligament damage, grade 2 is moderate, and grade 3 is severe/ruptured ligament tear. Common symptoms of a complete tear include sudden onset of pain and severe swelling, joint instability, and impaired function. The truth is, disruption of tendon fibers can happen to varying degrees. Think of muscle strains and ligament sprains on a spectrum of structural damage from 0 to 100%. The higher percentage of damage, the longer time it will take to establish preinjury performance levels.

Fortunately, if ligament stability is determined to be adequate by a healthcare professional, a conservative trial of care will often resolve symptoms. Ligaments in the body have the natural ability to heal on their own. Healing consists of 3 distinct phases including the inflammatory phase, the reparative phase, and the remodelling phase. Simply put, fibrotic scaffolding will be laid down so newly formed collagen can connect the severed ends of the tear. It is important to seek proper medical attention so that rehabilitation can begin as soon as possible.

For injuries of this nature, treatment will often begin with controlled range of motion exercises. Other modalities such a laser and acupuncture are helpful for enhancing healing at this stage. As tensile strength of the ligament improves, the joint will be able to tolerate more load. Eventually strengthening exercises will be included into the plan of management and progressed with increasing difficulty.

So if you or someone you know is worried that their knee pain may need surgical intervention, make sure you get it assessed by a medical professional who specializes in musculoskeletal injuries. It may be quite reassuring to know that with the right tools and knowledge the body will be able to heal and adapt on its own.

For more information, please contact drkyle@forwardhealth.ca or visit my professional Instagram page @drkylearam.

References:
Woo SL, Abramowitch SD, Kilger R, Liang R. Biomechanics of knee ligaments: injury, healing, and repair. Journal of biomechanics. 2006 Jan 1;39(1):1-20.