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. Laura: What is Lymph?

Our lymphatic system is made of fluid from the intestines and our immune fighting cells. It is like the drainage, filter and sewer pipe for the body because it provides immune cell circulation and collects cellular waste. It includes the spleen, thymus, lymph nodes and lymph channels, MALT or mucosal associated lymphoid tissue, as well as the tonsils and adenoids.

Signs of lymphatic back up

  • Fatigue
  • Constipation and sometimes diarrhea
  • Body aches
  • Puffy, swollen areas
  • Sore breasts at onset of period
  • Chronic ear/throat/tonsil issues
  • Cellulitis
  • Sinusitis
  • Cysts, fibroids and adhesions
  • Stiff muscles, frozen shoulder
  • Low back pain, especially early in the morning

How to improve lymph flow

From latin name of a Roman city, Lympha. It means deity of fresh water. Our lymphatic circulation helps our body-water-balance. Lymphocytes are one of the types of white blood cells in the lymph and the complete blood count (CBC) with white blood cell (WBC) differentiation is a way to quantify the lymphatic immune response. 70% of the lymphatic system, and thus your immune response, is wrapped around the gastrointestinal tract. As well there are lymph channels and nodes all through the body.

The lymphatic system doesn’t have a heart to pump it or synapses like the nerve to transact messages. Lymph relies on gentle exercise, light pressure massage or skin brushing and healthy diet. Additionally there are herbal creams and oils that are most beneficial to move lymph.

Get relief from pain, swelling or fatigue

Naturopathic doctors are trained in whole body therapy. Dr. Laura M. Brown, ND has extended training in lymphatic drainage through herbs, lotions, oils, homeopathic and hands on therapies (yours and hers!). Need relief from swelling, pain or fatigue? Call 519 826.7973 or book your appointment online.

Dr. Laura M. Brown, ND is a Naturopathic Doctor, a Certified Gluten Practitioner, a HeartMathCertified Practitioner and is a graduate of Adapt Level 1 at KresserInstitute of Functional Medicine. Essentially, Dr. Brownhelps people better digest their food and the world around them.

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. 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. Phil Shares: 8 Bad Habits That Kill Your Metabolism

You may already suspect your metabolism slows as you age. According to research published in the Public Health Nutrition journal, you’re right. In a review of data on energy expenditure, researchers found simply getting older is associated with progressive declines in basal metabolic rate. On top of that, there are many daily habits that can drain your metabolism even further.

But you don’t have to go down without a fight. Cut out the below habits and watch your metabolism and energy levels improve.

Eating a nutritious breakfast is always a good way to start your morning. Because your metabolism slows down during sleep, eating can fire it up and help you burn more calories throughout the day. According to Rush University Medical Center, “When you eat breakfast, you’re telling your body that there are plenty of calories to be had for the day. When you skip breakfast, the message your body gets is that it needs to conserve rather than burn any incoming calories.”

OK, so it’s about more than just eating something in the morning. If you grab a sugary donut or eat a muffin in the car, you’re setting yourself up to crash later. Instead, choose something with filling protein and fiber like eggs, yogurt and berries or whole-wheat toast topped with peanut butter.

Going from your office chair to your car to your couch can lead to a very sedentary routine. And sitting for extended periods puts your body into energy-conservation mode, which means your metabolism can suffer. According to the UK’s National Health Service, “Sitting for long periods is thought to slow metabolism, which affects the body’s ability to regulate blood sugar, blood pressure and break down body fat.”

Cardio is great, and it can quickly burn calories, but once you’re done running or cycling, your calorie burn quickly returns to normal. When you do HIIT and resistance-based workouts, however, your calorie burn stays elevated for longer as your muscles repair themselves. Per the American Council on Exercise (ACE): “Strength training is a key component of metabolism because it is directly linked to muscle mass. The more active muscle tissue you have, the higher your metabolic rate.” And, according to ACE, a pound of muscle burns an additional 4–6 calories each day compared to a pound of fat.

Protein feeds your muscles, promotes satiety and is an important component to sustaining a healthy weight. Eat too little, and you may have trouble building or maintaining muscle mass — and per the above, we know muscle’s importance to metabolism. Also, protein requires more energy to break down than carbs or fat, so you’ll actually burn more calories during digestion.

One bad night’s sleep is enough to leave you feeling sluggish and impair your cognitive processing. String together several nights in a row — or a lifetime of inadequate sleep — and science shows decreased metabolism and hormonal imbalances may follow.

In a study published in The Journal of Clinical Endocrinology & Metabolism, researchers found drinking 500 milliliters of water (about 2 cups) increases metabolic rate by 30%, and that spike lasts for more than an hour. So, drink water throughout the day to stay hydrated, and you’ll get the added benefit of a boosted metabolism.

When stress levels increase, your body produces a hormone called cortisol. Cortisol leads to increased appetite, makes us crave comfort foods, decreases our desire to exercise and reduces sleep quality — all things that negatively impact metabolism. So, while you can’t always control your stress levels, managing stress can go a long way toward protecting your body’s internal fire.

by Kevin Gray

Shared by Dr. Phil McAllister @ Forward Health Guelph

SaveTagscreating healthy habitslosing weightmetabolism

Dr. Phil Shares: Can You Lose Fat Through Exercise Alone?

Can You Lose Fat Through Exercise Alone?

One of the hardest parts about starting a fat-loss program is knowing you won’t be able to eat a lot of the foods you enjoy. At least, not in the same quantities. For this reason, some people try to achieve their fat-loss goal through exercise alone, hoping they’ll burn enough calories during their workout to make up for poor diet choices.

WHY EXERCISE ISN’T ENOUGH

First of all, exercise tends to increase appetite, says Tiffany Chag, RD, a sports dietitian at the Hospital for Special Surgery in New York. If you’re not paying attention to what and how much you’re eating, you could take in more calories per day than you were getting before you even started your exercise program. “We don’t really realize we’re doing it,” Chag says. Over time, this could lead to stalled results or even weight gain.

HORMONES

In a recent study, a group of lean, overweight and obese women followed an eight-week exercise-only program. Not only did the women see zero fat reduction, but appetite hormone levels increased significantly in overweight and obese participants. These hormonal changes could explain the lack of fat-loss results, according to researchers.

THE CALORIES PARADOX

In addition, exercise only burns a small percentage of calories in the overall scheme of things. A vigorous 30-minute strength session, for example, only burns roughly 223 calories for a 155-pound person, according to Harvard Health. That’s the approximate equivalent of a couple of tablespoons of olive oil or a protein bar.

Granted, exercise — and strength training, in particular — will have you burning calories long after your workout is over, but it may not be as much as you think. “People often get a false sense of how many calories they’re actually burning [during exercise],” says Steve Moore, MS, lead physiologist and health coach with the Penny George Institute for Health and Healing LiveWell Fitness Center at Abbott Northwestern Hospital.

All too often, we assume we’re burning more calories than we actually are, which makes it easier to reach for higher calorie foods. In fact, we can overestimate the calories burned by as much as four times the actual amount, leading us to eat 2–3 times our caloric expenditure from that workout, according to the results of a study published in the Journal of Sports Medicine and Physical Fitness.

In other words, just because the display on the treadmill or elliptical says you burned 300 calories, doesn’t mean you actually did: “Those [machines] are notorious for being wrong,” Moore says.

THE BOTTOM LINE

You might lose fat through exercise alone, but you’ll have far greater success if you pair your exercise with a healthy diet.

In a study published in Obesity, overweight and obese postmenopausal women who followed a combined diet and aerobic exercise program lost more weight over the course of one year than women who followed a diet- or exercise-only program. Still, the women who followed the diet-only program lost significantly more weight than the exercise-only group (8.5% versus 2.4%), and only slightly less than women who followed the combined program (8.5% versus 10.8% for the combined approach).

Don’t think you have to completely overhaul your diet or add crazy amounts of exercise to see results. Set achievable goals, like adding one extra serving of vegetables per day or taking the stairs instead of the elevator, and focus on meeting those goals for a few weeks before adding in other changes, Chag says. “[Your goal] has to be something that’s measurable, but set the bar so low that you can’t fail.”

by Lauren Bedosky

Shared by Dr. Phil McAllister @ Forward Health Guelph