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: 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: Sport Injury Rehabilitation

 

There are many factors to consider before clearing an athlete to return to sport. Time since injury, improvements in range of motion and increases in joint stability are all good metrics to evaluate before giving an athlete the green light.

Many rehabilitation programs focus primarily on enhancing maximal muscle strength. Current research suggests that Rate of Force Development (RFD) may actually be a better predictive factor in determining whether an athlete is ready for sport.

Common athletic maneuvers such as pivoting, jumping and stop-and-starts require rapid stabilization of the joints in the lower limb. This requires almost instantaneous muscle activation to prevent joint displacement and avoid re-injury. Factors such as neural activation, fiber composition and muscle contractile properties influence RFD and the body’s ability to absorb load on the joint. Therefore, it may not matter how strong the muscle is, but rather how fast the muscle can fire.

So how might this change rehabilitation programs?

Most physical rehabilitation protocols help build strength but fail to include an explosive component. Because athletic demands are often variable and unpredictable, it is important for the muscles to be able to react to any situation. Incorporating explosive plyometric exercises and a variation of sport specific drills will improve RFD and prevent future injury.

Take home points for sport-injury rehab:

• Allow sufficient time to for healing process to occur
• Recover full range of motion and flexibility
• Progressively overload the muscle to build strength
• Explosive training to enhance ability of muscle to generate force rapidly.
• Incorporate plyometric and sport specific drills to complement athletic demands.

As always, the best way to stay in the game is to avoid injury in the first place. So don’t wait for the pain to start before implementing an effective strength AND conditioning program.

If you or someone you know is suffering from a sport injury, call and book an appointment today for a complete musculoskeletal assessment!

 

Reference:
Buckthorpe, M., & Roi, G. S. (2018). The time has come to incorporate a greater focus on rate of force development training in the sports injury rehabilitation process. Muscles, ligaments and tendons journal, 7(3), 435-441. doi:10.11138/mltj/2017.7.3.435