Author - halton-chiropractic

Did you know that back pain, doesn’t always come from your “back”? While many cases of back pain can be attributed to your back structures, there are cases where issues with internal organs can be perceived as back-pain. The organs most commonly responsible for this unique situation are by far your kidneys!

Anatomy & Function

Our bean-shaped kidneys are essential organs each made up of ~1,000,000 tiny structures referred to as “nephrons”. These nephrons are responsible for ‘sorting through’ our circulatory system’s blood, filtering out waste products to be eliminated and keeping beneficial ions/water within our body. The waste products are then condensed & stored in the bladder until nature next calls.

Kidney Issues resulting in perceived back pain

Kidney pain (and resultant back/flank pain as shown above) can occur for any number of reasons. Two of the more common causes kidney stones, or infections. If these kidney issues can cause back pain as a symptom, then how do we differentiate between mechanical back-pain, and kidney-referred back pain? Kidney-referred back pain is often felt higher-up, and deeper than true, mechanical (low) back pain. It may be felt on both sides, underneath your rib cage. Kidney pain is also often constant, without much relief being provided by changing of your position. Other signs that your back pain is mechanical include flare-ups during certain activities/movement (like bending forward), relief with rest, muscle aches, and potential ‘shooting’ down a leg. However, indications of potential more-serious kidney issues include fever, full-body aches and significant fatigue. Ultimately, treatment of your kidney pain is dependent on the exact diagnosis of your kidneys. Your chiropractor is able to differentiate mechanical & kidney-referral based back pain, and exact diagnosis can be made through urinalysis & imaging such as ultrasound or a CT scan.

Permanent Kidney Damage

When kidney-related issues remain unchecked, damage to the tiny nephrons within our kidneys may occur. This damage is often permanent. The integrity of our kidneys is measured by their current level of function. “Glomerular Filtration Rate” – shortened to GFR – is the term used when testing and observing kidney function. The true test for GFR is complex, requiring ingestion of a chemical which is then looked for in passing urine. The alternative is a relatively accurate estimation through looking at levels of a molecule called “creatinine” within the bloodstream. GFR is typically seen on a range from greater than 90 (considered to be “normal”, or high-functioning) to less than 15 (considered kidney failure). The lower your GFR number, the more compromised your kidneys are. A patient’s GFR may fall based on a variety of factors, including normal aging, stress, poor diet, lack of exercise, trauma, infection etc. As a patient’s GFR falls, a doctor would recommend diet modification around avoiding foods high in molecules considered ‘difficult’ for the kidney to filter – specifically Sodium, Potassium & Phosphorus – alongside moderate amounts of cardiovascular exercises.

Kidney-friendly diet ideas

The best diet is one that you can stick to! That being said, in the case of kidney health there are definitely “eats” and “try-not-to-over eats”. Firstly, make efforts to limit your salt intake! Read the label on purchased goods, avoid cooking with salt, and when eating out request no added salt to your meal. Limit your consumption of: dark sodas, processed meats, bananas, avocados, oranges/orange juice, cured/pickled foods, potatoes, rice, snacks like chips/pretzels/crackers, red meats, chicken skin. Something to note is that some of these “limit” foods include foods that are otherwise healthy and nutritious. However, people on a kidney-cautious diet should know that many healthy food choices are high in elements that they should limit – such as potassium in bananas. Consider including: Cauliflower, blueberries, cranberries, skinless chicken breast, cabbage, bell peppers, arugula, pineapple, shitake mushrooms, sea bass, egg whites, garlic, olive oil, onions. These foods can be considered to be lower in levels of potassium & phosphorus (while still containing some, ofcourse).

Conclusion

Our kidneys are our friends! They are essential to filtering our blood and education regarding maintaining their health can prolong an active, healthy lifestyle. The most direct method to maintaining kidney health is diet modification – be sure to consult with a registered health practitioner when creating a diet plan right for you!

It’s February and that means that it is Heart Month and here at Halton Chiropractic Clinic we want to bring attention to the importance of cardiovascular health! Heart disease affects more than 2.4 million Canadians over the age of 20, which is why making choices like eating well and being physically active to reduce your risk is so important. Up to 80% of premature heart disease and stroke can be prevented by healthy eating and being physically active. There are many ways to reduce your risk - let’s start by talking about healthy eating.

Healthy Eating

A healthy diet can reduce your risk by improving your cholesterol levels, reducing your blood pressure, managing your body weight, and controlling blood sugar. Canada’s Food Guide gives us a great idea of what a balanced and healthy diet looks like. Increasing your intake of fruits and vegetables is one of the most important changes you can make! They are full of nutrients, vitamins, minerals, and fibre. These keep you full for longer and help you maintain a healthy weight. Canada’s Food Guide says that these should take up at least half of your plate each meal. Whole grains also keep you full longer and help maintain a healthy weight by being full of fibre, protein, and B vitamins. Make sure that these fill a quarter of your plate instead of processed and refined grains. The last quarter of your plate is filled by protein and there are way more options than just chicken, pork or beef! Protein filled foods include legumes, nuts, seeds, tofu, soy, fish, shellfish, eggs, milk, yogurt, etc. Protein helps maintain our bones, muscles, and skin. There are many more habits that you can do each day to help your cardiovascular health, such as choosing water over sugary drinks, eating smaller, more frequent meals, and making a meal plan each week to avoid going for unhealthy, potentially more “convenient” food.

Physical Activity

The benefits of being physically active are endless! It can reduce your risk of heart disease and stroke, it helps prevent and control risk factors like high blood pressure, high cholesterol, type 2 diabetes, osteoporosis, cancer, and obesity. It can also reduce stress levels, increase your energy, improve your sleep as well as improve your digestion to name a few! Not to mention that increasing your physical activity levels can help improve your posture and balance and make stronger muscles and bones. How much physical activity do you need? Canada's Physical Activity Guideline suggests that we all get 150 minutes of moderate- to – vigorous physical activity per week. Carving out larger chunks of time in your day to be physically active can be difficult but we can break down the 150 minutes in shorter bursts of just 10 to 15 minutes a day. For example, take a 10-minute walk during your lunch hour or take 20 minutes to walk around the block after dinner. Some examples of light effort activity include walking, easy gardening, and stretching. Moderate effort can include brisk walking, biking, raking, and swimming. Vigorous effort includes aerobics, basketball, faster swimming, hockey, and jogging. It can be difficult in the middle of winter to think of many activities that you can do inside and outdoors, here some examples, bowling, dancing, ice skating, mall walking, hockey, snowshoeing, stretching and yoga. With Ontario opening back up, so do the possibilities! It's much easier to stay on track when you enjoy doing the physical activity so take your time to try out different activities and find something that's going to work for you!

Stress Reduction

Lastly, let’s talk about reducing your stress. Stress is the body's response to a real or perceived threat, this response can include a racing heart, tense muscles and sweating. There is a strong link between heart disease, stroke, and stress. Stress causes your heart to work harder, it increases your blood pressure, and it increases the sugar and fat levels in your blood. These can all become risk factors for clots, which lead to heart attacks and strokes. Therefore, it is important to recognize and understand your stress. Examples of major stressors include, losing a loved one, changing your job, moving, traffic jams, work pressures, etc. Once you've identified what your stressors are it's important to create a goal to reduce your stress. Our goals can include physical and behavioral coping skills like physical activity, yoga, breathing, resting and a healthy diet. It can also be thinking or mental coping skills like problem solving and meditation. Personal and social coping skills are also one way to deal with stress and this can include spending time with family and friends, developing new hobbies and personal interests, and enjoying the outdoors. Your cardiovascular health can be impacted by so many decisions that you make every day. This can be overwhelming, but a great place to start is by making small changes every day that lead you on a better, healthier path. Happy Heart Month from everyone here at Halton Chiropractic Clinic, we're looking forward to seeing you this month!

Whenever a patient injures their low back, a common thought is that a “disc has slipped”. It’s entirely possible that our patients are correct in their diagnosis – although the term ‘slipped disc’ is a bit of a misnomer. The reality of disc herniation is a little more complex than simply ‘slipping’.

Anatomy

First off, let’s discuss the anatomy of our spinal ‘discs’. Our spines are made up of 24 vertebrae, each stacked on top of the other, separated by “intervertebral discs”. The discs themselves are comparable to that of a “Jelly Donut” you could grab from your local coffee shop. That is to say, they are composed of 2 layers – an outer, fibrous layer referred to as the Anulus Fibrosus (this would be the pastry component of the donut) & an inner, jelly-like layer referred to as the Nucleus Pulposus. A true ‘slipped disc’, or disc herniation, occurs when the inner Nucleus Pulposus extrudes out from within the outer Anulus Fibrosus. In keeping with our Jelly-Donut metaphor, have you ever bitten into a Jelly donut, only to have the filling spill/burst out the side? That’s a disc herniation! As well, apologies if we’ve gone and put you off of donuts with this comparison.

Disc Herniation Stages

The above comparison describes an end-stage herniation, or sequestration. Disc herniations occur in stages or progressions, degeneration -> Prolapse -> Extrusion -> Sequestration. Symptoms may begin as early as the degeneration stage, although are more commonly found from prolapse onward. Extrusion describes the act of the Nucleus Pulposus ‘extruding’ out of the Annulus Fibrosus layer, and sequestration implies that the nucleus pulposus has completely exited the disc, and is free-floating within the spinal canal.

Disc Herniation Symptoms & Diagnosis

Perhaps counter-intuitively, the stages & progression of a disc herniation does not dictate the type of symptoms experienced (although there is possibly a correlation with the severity of those symptoms). Instead, the expected symptoms will vary based on the location of the disc herniation relevant to the surrounding structures. Discs typically herniate in one of 4 possible areas, and each would make itself obvious based off of the group of symptoms the patient is experiencing. As well, the most common ‘levels’ of disc herniation are at L4-L5, & L5-S1 – either at the very bottom of your spine, or just above that.

Central

This location occurs when the Nucleus Pulposus herniates straight back into the spinal cord. Patients with a central herniation will experience numbness and pain down the back of both legs, into the feet and may also lose bowel/bladder control. This is to be considered a medical emergency – patients should head to an ER immediately for surgical intervention or risk paralysis.

Posterolateral/Sub-articular

Just to the right-or-left of a central herniation, subarticular herniations do not impinge directly onto the spinal cord, but rather the small, ‘ventral’ (“from-the-front”) nerve fibers coming directly off of the spinal cord. Patients with sub-articular herniations may not experience numbness, but are more likely to have muscle weakness at the affected level. Patients with a subarticular herniation at the L4-L5 levels will have their L5 ventral nerve root affected – this would be tested for by having the patient walk ‘on their heels’ on the affected side. If the subarticular herniation is located at the L5-S1 level, the S1 ventral nerve root would instead be affected – patients wouldn’t be able to walk on their toes on the affected side.

Foraminal

All nerves in our body exit from our spinal canal and travel throughout our body. The passageways from which these nerves exit our spine are referred to as the “intervertebral foramen”. As such, a Foraminal herniation impinges right within that small exit-passageway. Patients would experience the same motor weakness as in sub-articular herniations, with the numbness/pain of central herniations occurring on the affected side only. These are perhaps considered the ‘classic’ disc herniation.

Far Lateral/Extra-foraminal

These herniations hurt. Outside of our spinal canals & just next to our vertebrae exist our “Dorsal-root Ganglia” – groups of Nerve cells who’s literal function is to transmit sensory information – including pain – to our brains. Extra-foraminal herniations may push right into these ganglia, and therefore patients will report much higher severity of perceived pain, yet have much better muscle strength over other herniation locations.

Treatment

Both conservative and surgical solutions exist for resolution of disc herniations. With the exception of central disc herniations, an argument could be made for beginning patients with a conservative, non-invasive course of treatment prior to surgery. The goal of conservative treatment is to return the Nucleus Pulposus to the confinement within the Annulus Fibrosus through the use of negative pressure (movement is essential to this). Our discs are closed systems, or vacuums. In this line of thought – being able to ‘gap’ the space between our vertebrae results in the Nucleus Pulposus being more readily resorbed into its proper location. With conservative care, the average patient could expect to see 50% improvement within 6 weeks, with 90% of patients having full resolution of symptoms after 3 months. A conservative treatment plan consists of chiropractic manipulation, mobilization & Extension-based (leaning backward) exercises in the ”McKenzie Protocol”. Massage Therapy would assist with pain relief during acute flare-ups, and continued chiropractic or physiotherapy care help to prevent recurrence once symptoms have abated.

Conclusions

Disc Herniations aren’t the most common cause of back pain, but are one of the more common concerns of patients. Depending on the progression and location of the herniation, patients may experience symptoms ranging from intense pain, to mild weakness, or nothing at all. Bowel or bladder dysfunction – that is loss of control or difficulty urinating or defecating – in combination of numbness or pain down both legs are signs of a central herniation and is a medical emergency. For all other types of disc herniation, a non-surgical approach is effective for up to 90% of patients, with the best conservative treatment being a multi-disciplinary approach. Vizniak, N. A., Fairweather, L., Murray, N., Hussain, S., DeLapp, D., Eni, G., Davidson, T., & Hedrich, T. (2022). Evidence informed orthopedic conditions. Professional Health Systems Inc.

Did you know that falls are the leading cause of injury among older Canadians? That’s a scary thought – it’s easy to think that injuries are from ‘more serious’ causes like motor vehicle accidents or in the workplace, but that’s not necessarily true. 20-30% of seniors fall once or more each year, which results in 95% of annual hip fractures. Importantly, half of these life-altering falls occur within the home space. These are some scary facts, but we are here to give you information on common risk factors for falls, and importantly strategies to avoid them. Knowledge is prevention, and prevention is the best medicine! There are many different risk factors that could increase the likelihood of experiencing a dangerous fall. So many so, that they are typically categorized into one of 4 different types. Each person faces their own unique combination of risk factors: Biological risk factors are those related to the natural aging process and existing health conditions. Some of these are modifiable through lifestyle modification/treatments:

• Acute Illness: fever, nausea, dizziness, infections (UTIs), as well as the medications prescribed to treat these conditions
• Balance and Gait Deficits: biomechanical, sensory and cognitive changes
• Chronic Conditions: neurological, diabetes, arthritis, cardiovascular, etc.
• Cognitive Impairments: dementia and delirium can increase your risk by 2-3 times due to its ability to affect how you anticipate and adapt in situations
• Low Vision: increases your risk by 2.5x
• Muscle Weakness: reduced physical activity and endurance has been shown to be the most important risk factor, increasing your risk of falls by 4-5x

Behavioural risk factors are the actions, emotions, and choices of the individual. Most of these are manageable with proper planning ahead & open discussion of alternatives:

• Assistive Devices: are they properly maintained, are you comfortable using it?
• Fear of Falling: 34% of people over 65 have a fear of falling and due to this they decrease their levels of physical activity
• Footwear/ Clothing: shoes design, long clothing
• Previous History of Falls: strong predictor
• Inadequate Diet: dehydration, malnutrition
• Medications: older adults taking 3-4 medications are at a higher risk of falls
• High-Risk Behaviour: climbing ladders, leaving clutter in the way in walking paths

Social and Economic risk factors are the connection between social determinants and one’s level of disability, development of chronic conditions, longevity, etc.

• Social Networks: studies show a positive effect between strong family networks and lower fall rates
• Socio-economic: low education and health literacy

Environmental risk factors are those associated with the physical environment. These are perhaps the ‘easiest’ to modify, given proper planning ahead and careful observation:

• 40-60% of all falls are related to environmental hazards
• Factors in the community: poor stair design, lack or lighting, handrails, uneven pavement
• Factors in the living environment: throw rugs, electrical cords, cluttered floors, bathtubs, etc.
• Weather and climate: wet and icy surfaces

Now that you know some common risk factors that lead to falls, we will go over the different interventions that can help prevent them! The #1 intervention for preventing falls is exercise. This includes balance and gait training, strength training, Tai chi, etc. Studies have shown that exercise leads to a lower rate of falls, a lower number of fallers, a lower rate of fall related fractures and a lower rate of falls requiring medical attention. Having a mobility assessment done and problem solving on removing physical activity limitations can be a good place to start on your exercise journey. Fitness and exercise class orientations can also be a good way to become comfortable with this. As well, you can always come into Halton Chiropractic Clinic to learn different balance and strength principles and exercises from our chiropractors in a safe and controlled setting so we can set you up for success in your daily life. Another important step to take would be reviewing the medication you take with your pharmacist and family physician. It is important to learn about the different reactions you may experience with these medications and get advice on risk factors related to them. Nutritional assessments will also be an important factor to ensure that all the elements needed to help prevent and avoid falls – that is, your mind & your muscles – have the necessary energy requirements to function properly. Also, don’t neglect your water intake! A nutritional assessment can help problem solve, manage, and screen for any deficiencies and provide you with advice going forward on diet and supplementation. Having an environmental and assistive technology review is also a very helpful tool to prevent falls. A home assessment can point out potential trip hazards and provide recommendations to keep you safe. Reviewing all assistive devices and technologies regularly to ensure you are using them correctly and are comfortable will ensure that they are providing the support you require. There many factors that need to be considered to keep you safe & reduce the rate of falls. Please, call the clinic and book into see one of our chiropractors for a free consultation who would be more than happy to discuss this with you further. Stay safe! The Halton Chiropractic Team References:

• Public Health Agency of Canada [Internet]. Ottawa (ON). [cited 2021 Nov15]. Available from: https://www.canada.ca/en/public-health/services/health-promotion/aging-seniors/publications/publications-general-public/you-prevent-falls.html#facts
• Public Health Agency of Canada. Seniors’ falls in Canada: second report [Internet]. Ottawa (ON): Public Health Agency of Canada; 2014 [cited 2021 Nov15]. Available from: http://www.phac-aspc.gc.ca/seniors-aines/publications/public/index-eng.php
• Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K, Clemson L, Hopewell S, Lamb SE. Exercise for preventing falls in older people living in the community. Cochrane database of systematic reviews. 2019(1)
• Hopewell S, Adedire O, Copsey BJ, Boniface GJ, Sherrington C, Clemson L, Close JC, Lamb SE. Multifactorial and multiple component interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. 2018(7).