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.

Dr. Phil Shares: 3 Common Walking Myths, Busted

3 Common Walking Myths, Busted

When it comes to exercise, walking doesn’t always get the respect it deserves — and it’s time that changed. Before buying into the idea that walking isn’t a worthwhile workout, learn the truth behind these three common walking myths.

There is a great feeling of accomplishment when your fitness tracker buzzes to signal you hit 10,000 steps. But Carol Ewing Garber, PhD, professor of movement sciences at Columbia University, believes it might be an arbitrary target.

Yes, there are studies that show walking 10,000 steps per day is associated with lower blood pressure and improved glucose tolerance but the idea of walking the equivalent of five miles per day could feel overwhelming to new exercisers.

“[Walking 10,000 steps] will result in health benefits,” Garber says. “But it should be noted that … there is benefit even with small amounts of walking and the benefits increase with the more steps you walk each day.”

Garber suggests aiming for 150 minutes of moderate-intensity exercise each week instead of setting a step count goal.

If you want to count steps, consider this: Walking an additional 2,000 steps per day — even if your current step count is minimal — helps lower body mass index and boost insulin sensitivity, according to research published in the journal BMJ.

Leslie Sansone, fitness expert and creator of Walk at Home Workouts is adamant: “Walking works for weight loss!”

A slow stroll around the block isn’t going to move the needle on the scale (although it does burn more calories than binge watching legal dramas). To lose weight with a walking workout, Sansone suggests high-intensity interval training or HIIT.

Picking up the pace — without breaking into a run — at regular intervals during your walk has a major impact on weight loss.

In one small study, researchers at the University of Virginia found that overweight women who logged three 30-minute, high-intensity walks and two moderately-paced walks per week for 12 weeks lost six times more belly fat than women who went for a slow stroll five days per week. A second study found that varying speed burned up to 20 percent more calories than maintaining the same pace.



Incorporating HIIT into your walking workout is simple, according to Sansone. After a 5-minute warmup walk at a slow pace, walk at a brisk pace for 30 seconds and then a regular pace for 4 minutes. Repeat the interval four times. End with a 5-minute cooldown walk.  

“Walkers have so many choices to get fit and stay fit for life,” Sansone says.

Walking can be a “gateway exercise” that helps new exercisers improve their cardiovascular fitness and stamina to transition to running but not all walkers want to run — and that’s OK.

“Walking is a good exercise for everyone,” Garber says.

study published in the journal Arteriosclerosis, Thrombosis and Vascular Biology found rates of hypertension, high cholesterol, heart disease and diabetes were lower for regular walkers than runners.

While a walk around the block is a good start, maximizing the benefits of a walking workout requires logging sufficient time in your sneakers. Garber suggests focusing on distance, duration or calorie expenditure (all viewable on your fitness tracker) noting that it’s the amount of exercise that counts — for both walkers and runners.

“If you start fitness walking today, you will instantly feel better and know you’re doing something good for your body, mind and soul,” Sansone says.

by Jodi Helmer

Shared by Dr. Phil McAllister @ Forward Health Guelph

Dr. Phil Shares: Screen Time Negatively Affects Children’s Health

Screen time is quickly becoming one of the hottest topics for parents, healthcare practitioners, and educators. How much screen time should children and adolescents be allowed per day? Does screen time include the time spent on laptops to complete homework and reading assignments for classes? At what age should children begin to use screens? When is an appropriate developmental timeframe to buy your child a phone? Does the use of screens increase the risks of behavioral disorders and sleep problems in children and adolescents? The list of questions goes on and on.

Unfortunately, many of the answers to these questions are simply unknown at this time and some, honestly, are personal choices that each family has to make for themselves. Truly, there is no denying that the digital age is here to stay; screens are all around us, from televisions to smart watches, from iPods to smart phones, from tablets to laptops, there is literally a screen for everything. In 2017, 98% of homes in the US with young children had a mobile touch-screen device compared to 2011 when only 52% of households had such technology.1

Globally, the availability and usage of mobile touch-screen devices by children are at astonishingly high rates:1

  • In Australia, children under 2 years are reported to have an average weekly screen time of 14.2 hours, while those between 2-5 years old average 25.9 hours
  • In France, 78% of children were using a mobile touch-screen device by 14 months of age and 90% of children by 2 years of age
  • Across five countries in Southeast Asia, 66% of children between 3-8 years of age are reportedly using their parents’ mobile touch-screen device, while 14% of children already owned their own devices
  • In Britain, 21% of children aged 3-4 years of age are reported to own their own device

Interestingly enough, part of the dilemma of creating set guidelines on screen time in children is that there are various groups with sometimes competing and conflicting interests in this subject. Educational and tech focused organizations encourage the use of screen time for educational advantages and for enhanced benefits to long-term career and financial goals as children grow into adults. On the other hand, public health officials warn of the potential detriment to young minds and their still developing behaviors.

What is screen time displacing?

There are a variety of reasons cited by experts for keeping screen time to a minimum, particularly in young children.

Take for example the CDC, which states that children between the ages of 8-10 spend, on average, 6 hours per day in front of screens, including 4 hours of TV viewing.2 In children ages 11-14 this number skyrockets to 9 hours per day with approximately 5 of those being TV watching.2 Finally, in teenagers aged 15-18 the number of hours per day in front of a screen averages 7.5 with 4.5 being in front of a TV.2 These numbers are startling high when one realizes the activities which are NOT taking place when this much screen time is involved.

For instance –

  • Mentally and physically supportive health benefits which come from engaging in physical activity such as organized sports, neighborhood pick-up games, the unorganized activities of exploring and using imaginative play alone and in groups, and the quiet, downtime children and adolescents need to regroup and restore their bodies and minds
  • Social aspects of cultivating relationships with physically present individuals, learning how to read and empathize with emotional cues and needs, developing problem solving skills alone and in groups
  • Interconnectedness and responsibilities that come from supporting the family and local community networks through chores, volunteering, and taking part in events
  • Restful sleep and downtime to restore brain and body
  • Reading and engaging in learning opportunities not involving screens or directed education/learning
  • Mindful, present, and nutritious eating time with family, so as to avoid passive overconsumption of nutrient void foods

All of the above suffer when screen time overtakes the activities of unplugged healthful daily life.

Screen time duration impacts wellbeing

A study looked at the effects of screen time in 40,337 children and adolescents in the US between 12-17 years of age.3 For the purpose of this study, screen time included cell phones, computers, electronic devices, electronic games, and TV. The amounts of time spent on screens was compared to an array of psychological wellbeing measures.3

Results from this study found that the wellbeing of children and adolescents did not differ significantly (except in curiosity) between those spending no time on screens and those spending 1 hour or less per day on screens.3 However, after exceeding 1 hour of screen time, the risks to wellbeing increased– the researchers explained that increased screen time (> 1 hour/day), “was generally linked to progressively lower psychological well-being. In terms of relative risk (RR), high users of screens (≥ 7 hours/day) carried twice the risk of low well-being as low users (1 hour/day).”3 The low wellbeing measures included not staying calm (especially among 14- to 17-year-olds, RR 2.08), not finishing tasks (RR 2.53), not being curious (RR 2.72), and having less self-control and emotional stability.3 High users of screens compared to low users were described as more difficult to care for, while twice as many high (vs. low) users of screens had an anxiety or depression diagnosis.3 It was found that the effects of high screen time use on wellbeing was generally greater in adolescents than in children.3

Beyond psychological wellbeing, increased time spent on screens is also associated with increased risk of cardio-metabolic diseases and being overweight.4 It comes as no surprise that longer duration of reading and doing homework is associated with higher academic achievement.5 High use of screen time has also been linked to worsening sleep patterns in children and adolescents.6 In a review of 67 studies published from 1999 to early 2014, it was found that screen time was adversely associated with sleep outcomes (shortened duration and delayed timing) in children and adolescents in 90% of the studies.6  Knowing that restful and adequate sleep, particularly in children and adolescents, is associated with lower obesity risk, better psychological wellbeing, improved cognitive functioning, and lower risk-taking behaviors, it is important that the detrimental effects that screens have on sleep be minimized in this developing population.7

Managing & modeling healthy screen behaviors

A quick peak at the leading organizations’ recommendations on supporting healthy screen time in children and adolescents reveals similar guidelines across the groups which can be broken into 3 key areas:.

1. Model appropriate screen behavior. Modeling appropriate screen behavior begins with parents, guardians, caretakers, and educators. The authors in a BMC Obesity publication concluded that, “Mothers’ and fathers’ media parenting practices were associated with children’s screen time. Interventions aimed at reducing children’s screen time should address both mothers’ and fathers’ media parenting practices.”8 Screen time habits discussed in this article included, among other factors, screen use by parents during meal times.8

2. Limit screen time and limit to age-appropriate content. The American Academy of Pediatrics recommends the following guidelines:9

  • For children younger than 18 months, avoid use of screen media other than video chatting. Parents of children 18-24 months of age who want to introduce digital media should choose high-quality programming, and watch it with their children to help them understand what they are seeing.
  • For children ages 2-5 years, limit screen use to 1 hour/day of high-quality programs. Parents should co-view media with children to help them understand what they are seeing and apply it to the world around them.
  • For children 6 years and older, place consistent limits on the time spent using media, and the types of media, and make sure media does not take the place of adequate sleep, physical activity, and other behaviors essential to health.

Some researchers and practitioners recommend limiting screen time to 2 hours/day after age 5, not including educational screen time such as what is used for school, studying, and work-related screen interactions.10

3. Encourage face-to-face interactions and physical activity on a regular basis. Be intentional about daily “screen-free” time, particularly during mealtime, conversations, play time, family time, and bedtime. Support daily exercise for all children and adolescents being especially cognizant that sedentary screen time does not become a part of a child’s habits before the age of 5.11

Citations

  1. Straker L et al. Conflicting guidelines on young children’s screen time and use of digital technology create policy and practice dilemmas. J Pediatr. 2018;202:300–303.
  2. CDC. Screen time vs lean time. https://www.cdc.gov/nccdphp/dch/multimedia/infographics/getmoving.htm. Accessed December 18, 2018.
  3. Twenge JM et al. Associations between screen time and lower psychological well-being among children and adolescents: Evidence from a population-based study. Prev Med Rep. 2018;12:271-283.
  4. Braig S et al. Screen time, physical activity and self-esteem in children: the Ulm birth cohort study. Int J Environ Res Public Health. 2018;15(6):E1275.
  5. Carson V et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth: an update. Appl Physiol Nutr Metab. 2016;41(6)3:S240-265.
  6. Hale L et al. Screen time and sleep among school-aged children and adolescents: A systematic literature review. Sleep Med Rev. 2015;21:50–58.
  7. LeBourgeois MK et al. Digital media and sleep in childhood and adolescence. Pediatrics. 2017;140(2):S92–S96.
  8. Tang L et al. Mothers’ and fathers’ media parenting practices associated with young children’s screen-time: a cross-sectional study. BMC Obes. 2018;5:37.
  9. American Academy of Pediatrics. AAP announces new recommendations for children’s media use. https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/American-Academy-of-Pediatrics-Announces-New-Recommendations-for-Childrens-Media-Use.aspx. Accessed December 18, 2018.
  10. Mayo Clinic. The Mayo Clinic Minute. https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-minute-how-much-screen-time-is-too-much-for-kids/. Accessed December 18, 2018.
  11. Canadian Paediatric Society, Digital Health Task Force. Screen time and young children: promoting health and development in a digital world. Paediatr Child Health. 2017;22(8):461–468.

Bianca Garilli, ND, USMC Veteran

Shared by Dr. Phil McAllister @ Forward Health Guelph

Dr. Kyle: Building Stronger Bones

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 drkyle@forwardhealth.ca or visit my Instagram page @drkylearam!

Reference:

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.

Dr. Phil Shares: What You Need to Know About Going to a Chiropractor

What You Need to Know About Going to a Chiropractor

The chiropractor. A lot of people swear by chiropractic treatments as the only way they get relief from back pain, neck pain, headaches, and a host of joint problems. Others aren’t so sure about this holistic wellness discipline. Regardless of what camp you’re in, allow us to demystify this type of care for you.

Chiropractors Train as Long as MDs Do

That’s right, a Doctor of Chiropractic (DC) studies for four years of undergraduate and four years of chiropractic school, using similar books that MDs use for study, says Scott Bautch, DC, president of the council on occupational health for the American Chiropractic Association. Chiropractors must also pass a licensure test and take continuing education courses to stay abreast of the latest trends in their field and maintain their credentials.

Chiropractors Can Help with Overall Wellness

People mostly see chiropractors for pain relief, but it’s becoming more popular to see a chiropractor for general wellness. “Chiropractors are increasingly becoming overall wellness advisors — advising patients about their eating , exercise, and sleeping habits,” Bautch says. Since chiropractors focus on the health of the nervous system, particularly the spinal cord, they are treating the entire body. Therefore, they are addressing both acute injuries (such as low back pain), as well as general, chronic issues (such as fatigue).

The First Appointment Will be Really Thorough

Chiropractors use comprehensive intake screenings to learn not just about what ails you, but also to get a complete picture of your overall health (hence the “holistic” descriptor). This will include health history questionnaires as well as functional and neurological assessments to see how your body moves, how well you can balance, etc. The doctor may also take x-rays. Finally, there will be a discussion about cost and course of treatment.

This thorough first appointment was experienced by New York City resident Karl Burns. In a tennis game, Burns swung his racket too forcefully and injured his low back. He was referred to chiropractor Cory Gold, DC. “At first, I thought, ‘I’ve never been injured before, I don’t need a voodoo doctor,’” says Burns. “But Dr. Gold and I immediately gelled. After many tests and questions, he told me, ‘Your treatment plan will be three times a week for a couple weeks, then two times a week for a couple weeks, then once a week — this is not a lifetime injury.’”

You’ll Likely Be a Regular, Initially

In most cases, people see chiropractors for acute injuries (like throwing your back out) or chronic conditions (like headaches), so it may take a few of weeks of multiple visits to stabilize the problem. After a few weeks of multiple treatments per week, treatment tapers gradually to once per week, then once per month for maintenance, until the spine is able to stay in alignment without the chiropractor’s adjustments. The course of treatment and length of time until stabilization vary from person to person.

That said, visits are often quite short — an average of 15 to 20 minutes — of hands-on manipulation. “Chiropractors aren’t trying to fight an internal battle against infection the way medical doctors are,” says Burns. “The treatment consists of much smaller movements and adjustments to your body and alignment of the spine.” Burns points out that he experienced pretty significant pain relief from the get-go. “Every time I walked out of there, I felt amazing,” he says. “The benefits are instant and can be perceived better [than with conventional doctors].”

You Won’t Be a Patient Forever

There’s a general belief that chiropractors want to make you reliant on them, but Bautch and Burns believe otherwise. “There are three phase of care,” Bautch says. “Acute — let’s get you functional; corrective — let’s adjust you so that it doesn’t happen again or as frequently; and then maintenance — maybe down to once a month.” Indeed, this is what Burns experienced — but he also learned the hard way the importance of self-maintenance. “Chiropractors take the approach of ‘let me teach you how to fish,’ not ‘let me just give you the fish,’” says Burns. He, like most patients, was given exercises to compliment and maintain his recovery — and he only ran into trouble again once he stopped doing them. “If I skip my exercises, sure enough, my lower back gets tight,” Burns says.

BY: Amy Roberts

Shared by Dr. Phil McAllister @ Forward Health Guelph

Dr. Phil Shares: How Much do You Really Need to Walk to Shed The Pounds?

How Much do You Really Need to Walk to Lose Weight?

Regardless of age or fitness level, a dedicated walking program coupled with proper nutrition can be an excellent way to lose weight. To do it right and reach your goals, you’ll need to make sure you’re walking far enough, at the right intensity and paying attention to your diet.

Here’s what you need to know and how to get started:

WALKING DURATION AND WEIGHT LOSS

According to the American College of Sports Medicine (ACSM), individuals should aim to participate in a minimum of 30 minutes of moderate-intensity exercise per day or 150 minutes per week. While this can help you get on track in terms of cardiovascular fitness and combating other health conditions, if you’re looking to lose weight, you’ll probably want to do a little more.

For individuals who are obese and trying to lose weight, or anyone looking to keep the weight off, the ACSM recommends bumping this number up to 200–300 minutes per week (3.3–5 hours). Breaking this down, a one-hour walk 4–5 days per week will be sufficient to achieve your weight-loss goals. Any additional time you spend exercising on top of this adds to your overall calorie burn and fitness level.

WALKING INTENSITY

Not all walks are created equal. It’s important to make sure your heart rate reaches a moderate-intensity level during your walk. According to the Centers for Disease Control and Prevention (CDC), moderate-intensity exercise is defined as an activity that raises the heart rate to 50–70% of your maximum heart rate.

If you decide to up the intensity — either by adding resistance training in the form of weights or including short periods of running — exercising at a vigorous activity level (70–85% of your maximum heart rate) requires the duration of your walk to be cut in half to achieve the same benefits. In other words, a 60-minute moderate-intensity walk is the same as a 30-minute walk/run at a vigorous intensity level.

The most accurate way to measure intensity level is to use a heart rate monitor, but you can also keep track of perceived exertion. On a scale of 0–10 (0 is sitting, 10 is the highest exertion possible), moderate intensity is a 5–6, and vigorous activity begins at 7.

TRACKING MEALS

Calculating and recording your daily steps, mileage, time and exercise intensity is all important when you’re trying to lose weight. But the last part of the equation — nutrition — is equally crucial. Logging your food intake with MyFitnessPal as well as your workouts can help you get a more accurate picture of the quantity and types of foods you’re consuming. That way you can make informed decisions regarding smarter portion sizes and where you can cut excess calories to find a healthy deficit that allows you to lose weight and keep it off.

THE BOTTOM LINE

Start by walking a little more than you normally do each day until you can do an hour or more 4–5 times per week. If you keep to a brisk pace and pay attention to your nutrition, you’ll set yourself up for effective weight loss.

by Marc Lindsay

Shared by Dr. Phil McAllister @ Forward Health Guelph

Dr. Kyle: Manipulation and Mobilization for Neck Pain

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 drkyle@forwardhealth.ca or visit my professional Instagram page @drkylearam.

References:

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.

Dr. Phil Shares: Do This Daily For a Healthy Spine

Do This Daily For a Healthy Spine

If you’ve ever hurt your lower back, you know how much it can affect your life. Whether you’re getting up from a chair, carrying groceries or hoisting a barbell overhead, your lower back is involved in nearly every movement.

While lower back injuries should be treated with the help of a doctor or physical therapist, many cases of lower back pain can be avoided with simple exercises that strengthen the core muscles and teach proper movement of the spine. Stuart McGill, PhD, professor emeritus at the University of Waterloo and the world’s premier authority on spinal health, designed exercises to build a healthy spine.

McGill’s research has been pivotal in helping people understand core training for a healthy spine should focus on stability exercises like planks. Movements that bend the spine like crunches and situps, could even contribute to lower back injuries if performed incorrectly or too often. McGill’s “big three” exercises can be combined into a daily routine that requires no equipment and can be done at home or in the gym.

If you’ve been injured and your doctor has cleared you to work out again, or if you’re perfectly healthy and want to give yourself the best chance to keep your spine pain-free, try these three simple exercises to start building a more resilient spine for all of life’s activities.

MCGILL CURLUPS

Back pain can often be traced to two simple culprits:

1. The lower back itself moves too much.
2. The joints around the lower back (e.g., hips and upper back) don’t move enough.

The McGill curlup teaches you to stabilize your lumbar spine (lower back) using your abs, while moving through the thoracic spine (upper back). The act of pushing the lower back into the floor is how you properly “brace” your abs, so remember how that feels because you should be using it for just about every other exercise you do.

The move: Lie on the floor, face up to the ceiling. Bend one knee until your heel is flat to the floor, a few inches away from your butt. Keep the other leg straight and dig the heel of that foot into the floor, pointing your toes to the ceiling. Place your hands under your lower back and actively push your lower back into your hands to engage your abdominal muscles. Bring your chin toward your chest but keep your head on the ground. Continue to push your lower back into the floor to gently lift your shoulders off the ground. Make sure not to curl your chin toward your chest or let your lower back leave the floor. Perform all your reps on one side, then repeat on the other side.

Sets and Reps: 2 sets of 5–10 reps per side, holding each rep for 3–10 seconds (hold each rep longer to make these more challenging)

BIRD DOGS

The McGill curlup teaches you how to brace your abs, now it’s time to put that stability to the test with bird dogs. This teaches you how to move your arms and legs around a solid core position without moving from your lower back.

The move: Start on your hands and knees with your hands directly under your shoulders and knees directly under your hips. Flatten your back by bracing your abs much like you did with the curlup, but instead of pushing your lower back into the floor, tighten your abs as if someone is about to punch you in the stomach. Reach out with your opposite arm and leg until both limbs are parallel to the floor. Be careful not to arch your lower back — imagine keeping your leg long and low. Repeat with the other arm and leg, making sure to brace your abs on every rep.

If you feel like a fish out of water when doing bird dogs because you’re not quite coordinated enough yet, try them with just your legs first. Once you’re able to lift your leg parallel to the floor without arching your lower back, add in your arms, too.

Sets and Reps: 2 sets of 5–10 reps per side, holding each rep for 1–5 seconds (hold each rep longer to make these more challenging)

SHORT SIDE PLANK

Curlups and bird dogs mostly work your ab muscles on the front of your body: the rectus abdominis and transverse abdominis. But we can’t forget the important oblique muscles, your “side abs.” The short side plank builds strength in your obliques to prevent unwanted twisting and side bending of the spine.

The short side plank resembles a traditional side plank but leaves your bottom knee on the floor for added stability. Think of it as a more user-friendly side plank so you can learn how to properly use your obliques to support your spine.

The move: Lay on your side with your bottom elbow and leg on the floor. Bend your knees until your upper and lower leg form a 90-degree angle. Tuck your bottom elbow tight to your side, squeezing your bottom fist. Lift your bottom hip off the ground while leaving your bottom knee and elbow on the floor. Pull your shoulders back and squeeze your glutes to keep a straight line from your head to your knees. Inhale through your nose and exhale through your mouth for the duration of the exercise. Repeat on the opposite side.

Sets and Reps: 2 sets of 5–10 seconds per side. Even though 10 seconds may seem quick, exhaling forcefully (like you’re blowing up a balloon) can make even just 10 seconds seem challenging.

by Tony Bonvechio

Shared by Dr. Phil McAllister @ Forward Health Guelph

Dr. Kyle: The Facts On Foam Rolling

Foam rolling or self-myofascial release is a common technique that is used to reduce the sensation of muscle soreness. It is most often performed by placing a foam roller on the ground and rolling a particular muscle out using your bodyweight to compress the tissue. This has been used extensively in the past decade as a form of muscle recovery pre or post workout.

Is foam rolling all its hyped up to be?

I have recently come across some not-so-hot reviews on foam rolling and its effects on muscle recovery and performance. Before coming to any conclusion, I decided to consult the latest research.

Here is a short list of the potential Pros and Cons of foam rolling to help you decide for yourself:

Cons:

• Foam rolling can apply excessive pressure to the tissue. Too much pressure can cause muscle and nerve cells to rupture. Foam rolling with small diameter rollers or lacrosse balls can exceed tolerable cell pressure (1).
• Foam rolling will not break down scar tissue. Scaring is produced by strong fibrotic connections between cells that can withstand forces produced by self-myofascial release techniques.
• Foam rolling has little effect on increasing mobility and may even increase pain in the process.

Pros:

• Rolling can speed up recovery. Extended foam rolling sessions can increase blood flow to the area and enhance nutrient exchange and clearing of cellular debris.
• Reduces inflammation and causes draining of lymphatic pooling.
• Foam rolling may have minimal positive effects on sprint times and overall athletic performance (2).
• May increase proprioception (joint position sense) immediately prior to exercise (3).
• Foam rolling releases tightness. Sustained external pressure stimulates the nervous system to decrease muscle tone.

Remember, this is just the tip of the iceberg. There are tons of information out there on foam rolling, some good and some not so good. Much of the research I read showed conflicting results making it difficult to draw conclusions. Here is a list of my best recommendations:

• Keep it light! Gentle-moderate pressure will generate positive stimulus without causing cell damage.
• Target specific areas of muscle stiffness to enhance recovery and decrease muscle tone.
• Foam roll after your workout to decrease inflammation.
• Supplement foam rolling with stretching, corrective exercises, muscle activation and soft tissue therapy techniques.

Have questions? Visit my Instagram page @drkylearam or email me at drkyle@forwardhealth.ca for more information!

https://www.instagram.com/drkylearam/

References:

1. Gonzalez-Rodriguez, D., Guillou, L., Cornat, F., Lafaurie-Janvore, J., Babataheri, A., de Langre, E., … & Husson, J. (2016). Mechanical criterion for the rupture of a cell membrane under compression. Biophysical journal, 111(12), 2711-2721.

2. Miller, K. L., Costa, P. B., Coburn, J. W., & Brown, L. E. (2019). THE EFFECTS OF FOAM ROLLING ON MAXIMAL SPRINT PERFORMANCE AND RANGE OF MOTION. Journal of Australian Strength & Conditioning, 27(01), 15-26.

3. David, E., Amasay, T., Ludwig, K., & Shapiro, S. (2019). The Effect of Foam Rolling of the Hamstrings on Proprioception at the Knee and Hip Joints. International Journal of Exercise Science, 12(1), 343-354.

Rick Shares: Fibromyalgia is not all in your head, new research confirms

Researchers discover a rational source of pain in the skin of patients with fibromyalgia

INTEGRATED TISSUE DYNAMICS (INTIDYN)SHARE PRINT E-MAIL

IMAGE
IMAGE: THIS SCHEMATIC ILLUSTRATES THE ORGANIZATION OF BLOOD VESSELS AND THE REGULATION OF BLOOD FLOW (ARROWS) IN THE PALM OF THE HANDS. ARTERIOLE-VENULE SHUNTS ARE SMALL MUSCULAR VALVES THAT CONNECT…view more CREDIT: FRANK L. RICE, PHD, INTEGRATED TISSUE DYNAMICS LLC
[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].

Posted at the National Library of Medicine (PubMed): http://www.ncbi.nlm.nih.gov/pubmed/23691965

A description of this study for the general public can be found at: http://www.intidyn.com/Newsroom/article-0008.html

For further information, contact:

Dr. Frank L. Rice, PhD 
frankrice@intidyn.com 
866-610-7581, ext. 102 
©2013 Integrated Tissue Dynamics (INTIDYN)