When discussing bone health, we often talk about proper nutrition. Adequate vitamin D and calcium intake are usually recommended to enhance bone mineral density (BMD). What is not discussed as often is the role of exercise and weight training for increasing bone strength. A holistic approach looking at what we put IN our body as well as what we DO with our body is the key for building stronger bones.
As we age our body experiences several physiological changes. Our hormone levels change, muscle mass declines, and bones become less dense. Low bone density, otherwise known as osteopenia, increases our risk of fracture. Although we can bounce back from a slip or fall in our early years, a hip fracture in older individuals can have detrimental effects on quality of life. The good news is, there are important steps you can take to prevent or slow down the decline of BMD.
Research has demonstrated that healthy individuals and patients with osteoporosis can improve BMD with high-moderate impact activities and resistance training. A few examples of high impact exercises include step classes, jogging, and jumping jacks. Resistance or weight training on the other hand can include elastic band, pully, and free-weight based exercises. To put it simply, the more force you transmit through the bone, the more the bone will remodel and grow! Clinical judgment is needed to determine the intensity of force that each patient can tolerate.
Recent studies have found that high-intensity resistance training and impact training improves BMD and physical function in postmenopausal women. Low-intensity and light-resistance exercise programs are not enough to stimulate bone remodelling and improve BMD. Heavy multi-joint compound exercises such as squats and deadlifts induce extensive muscle recruitment and transmit greater force through the bones. In particular, these exercises will apply force through the lumbar spine and femoral neck, making them stronger and more resilient to fracture. Proper form and supervision are crucial when performing any high intensity or heavy loading activities.
Talk to a primary health care provider about your BMD and if an exercise program for developing BMD is right for you. Not only will exercise strengthen your bones, but it will have profound impacts on many other systems of the body as well. As always, if you have any question do not hesitate to contact me at firstname.lastname@example.org or visit my Instagram page @drkylearam!
Sinaki M. Exercise for patients with established osteoporosis. InNon-Pharmacological Management of Osteoporosis 2017 (pp. 75-96). Springer, Cham.
Mounsey A, Jones A, Tybout C. Does a formal exercise program in postmenopausal women decrease osteoporosis and fracture risk?. Evidence-Based Practice. 2019 Apr 1;22(4):29-31.
An estimated 66% of the population will suffer from neck pain in their lifetime (1). Neck pain is one of the most common musculoskeletal conditions treated by healthcare professionals. Often patients will report pain due to sleeping awkwardly, turning their head too fast, or reaching for something overhead. Whatever the mechanism, neck pain accounts for a significant proportion of sick leave, healthcare costs and lost productivity. Chiropractors have been at the forefront of treating neck pain for decades, and the results speak for themselves.
What does the evidence suggest?
Previous systematic reviews on chronic mechanical neck pain have provided substantial evidence for the effectiveness of chiropractic care. Both spinal manipulation and mobilization have been shown to be a viable option of care as compared to other standard treatment methods (2).
A recent systematic review by Coulter et. al. compared spinal manipulation and mobilization to other active modalities such as acupuncture, massage, and exercise to name a few (3). The study looked at patient outcomes such as pain, disability and health related quality of life (HRQol). They found that many previous reviews regarding non-specific neck pain reported evidence in favor of manipulation and mobilization. Other reviews concluded that manual therapies in conjunction with exercise provided superior results as compared to manual therapy alone (4).
As with many musculoskeletal conditions, it appears that a multi-modal approach is best. At this point in time, there is moderate evidence to support manipulation and mobilization for the treatment of chronic nonspecific neck pain in terms of pain and function. It appears that some movement and active rehabilitation is better for patient recovery then complete rest. More studies are still required to look at the benefits of chiropractic manual therapies long term.
To some, these conclusions may not be overwhelming, but research like this is what continues to carry the chiropractic profession in a positive direction. It is exciting to know that chiropractors and researchers alike are looking into the efficacy and safety of chiropractic care so we can better treat our patients and our community.
If you or someone you love is suffering with lingering neck pain, it may be time to schedule a comprehensive chiropractic exam to get to the root of the problem. As always, if you have any questions please do not hesitate to contact me at email@example.com or visit my professional Instagram page @drkylearam.
1. Cote P, Cassidy JD, Carroll L; The Saskatchewan Health and Back Pain Survey. The prevalence of neck pain and related disability in Saskatchewan adults. Spine (Phila Pa 1976) 1998; 23:1689-1698
2. Bronfort G, Haas M, Evans RL, Bouter LM. Efficacy of spinal manipulation and mobilization for low back pain and neck pain: A systematic review and best evidence synthesis. Spine J 2004; 4:335-356.
3. Herman, P. M. (2019). Manipulation and Mobilization for Treating Chronic Nonspecific Neck Pain: A Systematic Review and Meta-Analysis for an Appropriateness Panel. Pain Physician, 22, E55-E70.
4. Brison RJ, Hartling L, Dostaler S, LegerA, Rowe BH, Stiell I, Pickett W. A randomized controlled trial of an educational intervention to prevent the chronic pain of whiplash associated disorders following rear-end motor vehicle collisions. Spine 2005; 30:1799-1807.
[June 17, 2013, Rensselaer, NY] – Fibromyalgia, a painful condition affecting approximately 10 million people in the U.S., is not imaginary after all, as some doctors have believed. A discovery, published this month in PAIN MEDICINE (the journal of the American Academy of Pain Medicine), clearly now demonstrates that fibromyalgia may have a rational biological basis located in the skin.
Fibromyalgia is a severely debilitating affliction characterized by widespread deep tissue pain, tenderness in the hands and feet, fatigue, sleep disorders, and cognitive decline. However, routine testing has been largely unable to detect a biological basis for fibromyalgia, and standard diagnosis is based upon subjective patient pain ratings, further raising questions about the true nature of the disease. For many years, the disorder was believed to be psychosomatic (“in the head”) and often attributed to patients’ imagination or even faking illness. Currently approved therapeutics that provide at least partial relief to some fibromyalgia patients are thought to act solely within the brain where imaging techniques have detected hyperactivity of unknown origin referred to as “central sensitization.” However, an underlying cause has not been determined, leaving many physicians still in doubt about the true origins or even the existence of the disorder.
Now, a breakthrough discovery by scientists at Integrated Tissue Dynamics LLC (Intidyn), as part of a fibromyalgia study based at Albany Medical College, has provided a biological rationale for this enigmatic disease. The small biotechnology research company, founded by neuroscientists Dr. Frank L. Rice and Dr. Phillip J. Albrecht, reports on a unique peripheral neurovascular pathology consistently present in the skin of female fibromyalgia patients which may be a driving source of the reported symptoms.
“Instead of being in the brain, the pathology consists of excessive sensory nerve fibers around specialized blood vessel structures located in the palms of the hands,” said Dr. Rice, President of Intidyn and the senior researcher on the study.
“This discovery provides concrete evidence of a fibromyalgia-specific pathology which can now be used for diagnosing the disease, and as a novel starting point for developing more effective therapeutics.”
Nerve Endings Come In Many Forms
Three years ago, Intidyn scientists published the discovery of an unknown nervous system function among the blood vessels in the skin in the journal PAIN.
As Dr. Rice explained, “we analyzed the skin of a particularly interesting patient who lacked all the numerous varieties of sensory nerve endings in the skin that supposedly accounted for our highly sensitive and richly nuanced sense of touch. Interestingly however, this patient had surprisingly normal function in day to day tasks. But, the only sensory endings we detected in his skin were those around the blood vessels”. Dr. Rice continued, “We previously thought that these nerve endings were only involved in regulating blood flow at a subconscious level, yet here we had evidencs that the blood vessel endings could also contribute to our conscious sense of touch… and also pain.”
Now, in collaboration with renowned Albany Medical Center neurologist and pain specialist Dr. Charles E. Argoff, the study primary investigator, and his collaborators Dr. James Wymer also at Albany Medical College and Dr. James Storey of Upstate Clinical Research Associates in Albany, NY, clinical research proposals were funded by Forest Laboratories and Eli Lilly. Both pharmaceutical companies have developed FDA-approved medications with similar functions (Serotonin/Norepinephrine Reuptake Inhibitors, SNRI) that provide at least some degree of relief for many fibromyalgia patients.
“Knowing how these drugs were supposed to work on molecules in the brain,” Dr. Albrecht added, “we had evidence that similar molecules were involved in the function of nerve endings on the blood vessels. Therefore, we hypothesized that fibromyalgia might involve a pathology in that location”. As the results demonstrate, they were correct.
To analyze the nerve endings, Drs. Rice, Albrecht, and postdoctoral researcher Dr. Quanzhi Hou, used their unique microscopic technology to study small skin biopsies (less than half the size of a pencil eraser) collected from the palms of fibromyalgia patients, who were being diagnosed and treated by Drs. Argoff, Wymer, and Storey. The study was limited to women, who have over twice the occurrence of fibromyalgia than men. What the team uncovered was an enormous increase in sensory nerve fibers at specific sites within the blood vessels of the skin. These critical sites are tiny muscular valves, called arteriole-venule (AV) shunts, which form a direct connection between arterioles and venules (see diagram).
As Dr. Rice describes their function, “We are all taught that oxygenated blood flows from arterioles to capillaries, which then convey the deoxygenated blood to the venules. The AV shunts in the hand are unique in that they create a bypass of the capillary bed for the major purpose of regulating body temperature.”
A Thermostat for the Skin
In humans, these types of shunts are unique to the palms of our hands and soles of our feet which work like the radiator in a car. Under warm conditions, the shunts close down to force blood into the capillaries at the surface of the skin in order to radiate heat from the body, and our hands get sweaty. Under cold conditions, the shunts open wide allowing blood to bypass the capillaries in order to conserve heat, and our hands get cold and put on gloves.
According to Dr. Albrecht, “the excess sensory innervation may itself explain why fibromyalgia patients typically have especially tender and painful hands. But, in addition, since the sensory fibers are responsible for opening the shunts, they would become particularly active under cold conditions, which are generally very bothersome to fibromyalgia patients.”
A role in regulating blood flow throughout the body.
Although they are mostly limited to the hands and feet, the shunts likely have another important function which could account for the widespread deep pain, achiness, and fatigue that occurs in fibromyalgia patients. “In addition to involvement in temperature regulation, an enormous proportion of our blood flow normally goes to our hands and feet. Far more than is needed for their metabolism” noted Dr. Rice. “As such, the hands and the feet act as a reservoir from which blood flow can be diverted to other tissues of the body, such as muscles when we begin to exercise. Therefore, the pathology discovered among these shunts in the hands could be interfering with blood flow to the muscles throughout the body. This mismanaged blood flow could be the source of muscular pain and achiness, and the sense of fatigue which are thought to be due to a build-up of lactic acid and low levels of inflammation fibromyalgia patients. This, in turn, could contribute to the hyperactvity in the brain.”
Dr. Albrecht also points out that alterations of normal blood flow may underlie other fibromyalgia symptoms, such as non-restful sleep or cognitive dysfunctions. “The data do appear to fit with other published evidence demonstrating blood flow alterations to higher brain centers and the cerebral cortex of fibromyalgia patients” he stated. Senior Research Chair of the Alan Edwards Center for Pain Research at McGill University, Dr. Gary Bennett, commented after seeing the results that “It is exciting that something has finally been found. We can hope that this new finding will lead to new treatments for fibromyalgia patients who now receive little or no relief from any medicine.”
This discovery of a distinct tissue pathology demonstrates that fibromyalgia is not “all in your head”, which should provide an enormous relief to fibromyalgia patients, while changing the clinical opinion of the disease and guiding future approaches for successful treatments.###
About Integrated Tissue Dynamics LLC (Intidyn)
Integrated Tissue Dynamics LLC, located in Rensselaer, NY amid the Capital region’s Technology Valley, provides flexible and scalable pre-clinical and clinical research and consulting capabilities on skin and nerve related chronic pain afflictions in collaboration with the pharmaceutical industry, government agencies, academia, and a network of pain specialists throughout the United States. The Intidyn ChemoMorphometric Analysis (CMA) platform can be used to detect chemical and structural changes in the skin and other tissues related to chronic pain, numbness, and itch associated with a wide variety of afflictions, including diabetes, shingles, complex regional pain syndrome, carpal tunnel syndrome, sciatica, fibromyalgia, psoriasis, chemotherapy, unintended side effects of pharmaceuticals, and others.
How to Support Further Research on Fibromyalgia and Other Types of Chronic Pain
Tax deductable donations to support the research of a nationwide network of pain specialists, which includes Drs. Argoff and Wymer at Albany Medical College, can be made to the Clinical Pain Research Program at the University of California San Diego, an American Pain Society Center of Excellence, by contacting the UC San Diego Office of Development (giving.ucsd.edu; 858-534-1610; specify area of research) or UC San Diego Center for Pain Medicine (anes-cppm.ucsd.edu; 858-657-7072). This network, referred to informally as the Neuropathic Pain Research Consortium, includes top neurologists, anesthesiologists, and research scientists at leading universities and pain treatment centers in California, Illinois, Maryland, Massachusetts, Minnesota, New York, Utah, Washington, and Wisconsin.
Albrecht PJ, Hou Q, Argoff CE, Storey JR, Wymer JP, Rice FL (2013). Excessive Peptidergic Sensory Innervation of Cutaneous Arteriole-Venule Shunts (AVS) in the Palmar Glabrous Skin of Fibromyalgia Patients: Implications for Widespread Deep Tissue Pain and Fatigue.
Pain Medicine, May 20. doi: 10.1111/pme.12139 [Epub ahead of print].
2 people with low back pain attempt 10 minutes of moderate exercise on an elliptical machine. One reports that the pain is better. The other reports that the pain is worse.
What’s the deal?
It turns out that one of the main predictors of stubborn low back pain is hip mobility. You may have heard of the term “hip hinge” before, and this refers to bending at the hips while keeping a neutral spine. Elliptical machines in particular work the gluteal muscles group and keep the spine relatively straight.
When restrictions in the hip develop, the body is unable to “hinge” properly and the low back folds forward to compensate. Over time this repetitive flexion of the lumbar spine causes accumulative stress that is linked to pain!
Could it be serious?
If the pain intensity does not change with alterations in posture, loads and movement, it may not be mechanical in nature. Some “red flags” that may indicate something more serious include:
• Bowel or bladder incontinence
• Numbness in the groin region
• Unexplained weight loss
• Low back pain with fever
• Progressive and constant low back pain
Once these red flags have been ruled out and your back pain has been deemed mechanical in nature, it’s time to develop a plan of management.
What to Do
The first step is to remove aggravating factors. If your back pain is worse bending forward, stop bending forward. If your back pain is worse bending back, stop bending back. To a point. The trick is to find that pain free range of motion and to work within it.
Train the hip hinge! A major part of the process is cueing patients to bend at the hips and not with the low back. This will keep the back straight and reduce shearing forces through the spine.
Next, we train the exercises or movements that take the pain away. For many this involves abdominal bracing to stabilize the spine. A few key exercises include:
• Modified curl up
• Bird dog
• Side plank
The final step is to develop strength and endurance. Try to include exercises that challenge one side of the body at a time. This includes lunges, suitcase carries, and one arm rows.
As always, consult the expertise of a registered healthcare professional before starting a strength and conditioning program. Check out my Instagram page @drkylearam for more videos of exercises to prevent low back pain. It’s time to get you out of pain and back on the elliptical!
Carpal tunnel syndrome is a condition characterized by tingling, numbness and pain in the hand and fingers (particularly the thumb, index, middle and ring fingers). These symptoms are often the result of median nerve irritation in the wrist or forearm.
BLAUSEN.COM (2014). “MEDICAL GALLERY OF BLAUSEN MEDICAL 2014”. WIKIJOURNAL OF MEDICINE 1 (2). – CC BY 3.0.
Why Give Massage Therapy A Try?
Massage therapy as a therapeutic intervention is being embraced by the medical community, it is simple to carry out, economical, and has very few side effects. One area that is being explored is the use of massage therapy for patients who suffer from carpal tunnel syndrome.
Randomized clinical trials have demonstrated that for some patients who suffer from carpal tunnel syndrome there is no significant differences in pain and functional outcomes at six and twelve months when surgical and conservative care are tested (Fernández-de-Las Peñas et al. 2017).
Why Does Massage Therapy Work?
The responses to massage therapy are complex and multifactorial – physiological and psychological factors interplay in a complex manner. Research has looked at both peripheral and central responses elicited by massage therapy treatments.
Massage has a modulatory affect on peripheral and central processes via input from large sensory neurons that prevents the spinal cord from amplifying the nociceptive signal. This anti-nociceptive effect of massage therapy can help ease discomfort in patients who suffer from carpal tunnel syndrome.
The median nerve passes through many structures and it may be exposed to mechanical irritation at many different points (Filius et al. 2017). Prolonged irritation may result in a reduction of intraneural blood flow. In turn, local hypoxia of a peripheral nerve leads to a drop in tissue pH that triggers the release of inflammatory mediators, known as “inflammatory soup”, this noxious substance can disrupt the normal function of nerves. Massage therapy may diminish intraneural edema and/or pressure by mobilizing the median nerve as well as associated vascular structures (Boudier-Revéret et al. 2017).
Carpal tunnel specific work may also involve specific soft tissue treatment to optimize the ability of mechanical interfaces to glide relative relative to the median nerve. Ongoing tissue hypoxia or inflammatory responses lead to molecular signaling that promote the development of fibrosis, this may contribute to further peripheral nerve dysfunction (Fisher et al. 2015). The application of appropriate shear force and pressure impart a mechanical stimulus that may attenuate tissue levels of fibrosis and TGF-β1 (Bove et al. 2016).
The etiology of myofascial triggerpoints are still not well understood, but that does not deny the existence of the clinical phenomenon.
A contemporary view of ‘myofascial trigger-points’ is presented by Shah, this categorizes ‘myofascial trigger-points’ by the a number of measurable characteristics: local and remote inflammation, local acidic milieu, local sensitization, local regions of hypoxia, local muscle stiffness (Shah et al. 2015).
Studies have demonstrated that assessing and treating the infraspinatus muscle may be an effective treatment option for a sub-group of patients with suffer from symptoms that present similarly to carpal tunnel syndrome (Meder et al. 2017).
Structures To Be Aware Of When Treating Carpal Tunnel Syndrome
Systematic reviews have also shown that manual therapy combined with multimodal care can improve symptoms, decrease disability and improve function for patients who suffer from carpal tunnel syndrome (Huisstede et al. 2017). Additionally, a recent randomized controlled trial in the journal Brain found that acupuncture improved the outcomes for carpal tunnel syndrome by remapping the brain (Maeda et al. 2017).
A massage therapy treatment plan should be implemented based on patient-specific assessment findings and patient tolerance. Structures to keep in mind while assessing and treating patients suffering from plantar heel pain may include neurovascular structures and investing fascia of:
• scalene muscles
• costo-clavicle space
• pectoralis minor
• biceps brachii muscle
• bicipital aponeurosis
• pronator teres
• transverse carpal ligament
• anterior interosseous membrane
• palmar aponeurosis
The overexertion of muscles through rigorous physical training and exercise can affect athletes’ performance and increase their risk for injury. In between those strenuous workouts, the body could use some pampering.
Regular massage supports the relaxation and recovery process after workouts, helping to prevent injuries; reduce swelling, muscle stiffness and fatigue; and achieve peak performance. And there are numerous other potential benefits that are conducive to your overall health and well-being. Massage therapy helps to improve muscle flexibility (which helps prevent injuries like muscle pulls and tears) and shorten recovery time as well as relieve muscle tension and pain, a remedy for common issues like delayed-onset muscle soreness. But massage can benefit more than muscles. Tammy Taylor, massage/bodywork team leader and a certified neuromuscular therapist at LifeBridge Health & Fitness, says some research suggests that massage may also help:
Lower anxiety Increase range of motion
Improve your mood
Lower blood pressure
Enhance blood flow and alertness
Massage is good for the body either before, during or after athletic events. Sports massage incorporates Swedish (for improved circulation) and deep tissue techniques, among others. Athletes, or anyone who does strenuous exercises on a regular basis, should speak with a massage therapist about specific needs and concerns in order to determine how often massages are necessary and which techniques are most appropriate.
“Your injury or needs will determine the focus of the therapy,” Taylor says. “Often times, an athlete has a specific area in which they are experiencing pain, limited range of motion, etc. That area, in addition to the supporting muscles and connective tissue, is addressed.”
Taylor adds: “A full body massage at another time, maybe within a week or two, is also very helpful for the whole body compensates for an injury, and an injury heals more quickly when the rest of the body is free of limitations.”
December is one of the most important months for self care
Come in for a massage with Rick, Lisa, or myself.
Enjoy time that is strictly for you.
Let us use our experience to relax your ever-tightening muscles, ease your headache, rejuvenate those neglected feet. While we knead and release your muscles we also remind your body that rest and digest are important aspects of health. The care extends to home when you take an epsom salts bath and fall deeply into a great night’s sleep.
Imagine what checking off your holiday list will feel like when you include a rejuvenating treatment for yourself. Or what it will feel like to serve your guests with your cup of energy overflowing.
Check your benefits, as you may have massage coverage. Many plans are set for the calendar year, so use your 2016 benefits before they expire! Of course, if you have any questions about massage therapy, or you want a gift certificate to treat a friend or family member, just call us at 519.826.7973 or book online.
We have all been there…..we went to the gym and did an endurance cycling class or went for a run and ran the hardest that we ever have and all that we can think about is how sore we are going to be the next day. This muscle soreness is often what deters people from continuing their intense workout routines because they don’t want to be sore the next day. But this does not have to be the case. Having a massage after any workout can ease post workout muscle soreness. Did you know that even a ten minute massage after a training session or workout can improve your rebound time or post work out recovery? Check out this excellent article in Men’s Fitness to see what the research says.
After a period of hard training or exercise there will be an accumulation of waste material and possibly some micro trauma with slight swelling in the muscles. The tissues will also be nutritionally depleted and some may be in need of repair. By stimulating the blood circulation through the strained muscles with massage therapy, all these situations can be helped. The waste is removed more quickly and completely and more fresh blood from the arteries arrives to supply the repair and nutritional needs. There should always be a rest period after exercise to allow the recovery process to take place, and a massage greatly improves the quality and effectiveness of such rest. It is the quality of rest that is the key to effective training and regular massage therapy treatments that enables more endurance workouts at a higher level and with less injury.
By having a massage after your workout the conversation no longer has to be on how sore you are going to be, rather on how good you feel and how much quicker our muscles recovered so that you could duplicate the same workout the next day at the same intensity with no kick back pain.
So the next time your are running in the Forward Health neighbourhood at Preservation Park or at your next cycling class at Movati fitness in Guelph, why not consider working a massage therapy treatment into your workout routine? Kick up the intensity in your workout without the worry of being sore for days later. After all , your massage therapy at Forward Health will take care of that.
Time to get the bikes out of storage and get them ready for the Summer Season ahead.
We invite you to drop by with your bicycles on Saturday May 14th 2016, as we are hosting our 2nd Annual Community Spring Bicycle Inspection and Tune-Up Day
Our own Dr. Phil will be riding the Century Distance for Forward Health, and proceeds will be donated to: The Foundation of The Guelph General Hospital and Rotary Clubs of Guelph. Every Dollar goes a long way to help in this worthy endeavor.
In addition there will be food and giveaways for everyone in attendance.
We’re excited to be teamed up on this day with GORBA (Guelph Off-Road Bicycling Association), Rowe Farms Meats and Speed River Bicycle for the beginning of a season of safe riding, for all ages and abilities.
Location: 951 Gordon Street, in the parking lot.(Gordon Street and Kortright Road)
Date & Time: Saturday May 14th, 2016, from 9am – 12noon
Looking forward to connecting you, your family and friends on this wonderful day.