Tips

It’s National Physiotherapy Month!

It’s National Physiotherapy Month! With May being National Physiotherapy Month, it’s only appropriate that we focus in on this amazing profession, and highlight the many benefits and strengths a physiotherapist offers their patients. Physiotherapists, like medical doctors and chiropractors, are primary care practitioners (PCPs). This means that one does not need a referral to see one – anybody can book in with a physiotherapist at any time should they have the need. Specifically, physiotherapists focus largely on the movement & functional abilities of their patients – identifying barriers to recovery/improvement, and helping to overcome them through rehab strategies, manual therapy, and education.

Why should I see a physiotherapist?

Patients traditionally seek a physiotherapist following an injury, invasive surgery, or as an aid in combatting chronic pain. To that end, physiotherapists are effective at treating complaints as minor as a pulled muscle, to as complex as post-operative spinal surgery. Perhaps less-commonly known, physiotherapists can also aid in non-musculoskeletal conditions as well including lung problems such as asthma, disability resulting from cardiac (heart) problems, pelvic issues including bowel & bladder problems (including those related to childbirth), and neurological conditions such as Parkinson’s & multiple sclerosis. The expertise of physiotherapists also extends into pediatrics; many childhood conditions can be improved or even resolved through physiotherapy! Postural problems are very common in children of all ages – usually related to long hours of sitting in school or lugging around a backpack heavier than necessary. Compound these issues with inevitable growing pains & you’ve got a child who would greatly benefit from the eye of a physiotherapist.

What can I expect from HCC physiotherapists?

On your first visit to any practitioner at HCC, the practitioner will work with you on developing a detailed clinical history or your condition. Additionally, a physical examination will also be performed, in order to help rule in or out the many possible conditions of the human body. Once our physiotherapists are confident in their findings & the specific needs of you or your loved one, they are capable of administering & educating on the diagnosis responsible for your condition. Following this, they will create a treatment plan best suited to your needs. Physiotherapy treatments at HCC use a combination of manual therapy and exercise science. Different techniques such as Myofascial Release Technique (MRT), Proprioceptive Neuromuscular Facilitation (PNF) stretching, Trigger point therapy, Thermo/Cryotherapy, Low Level Laser Therapy, Therapeutic Ultrasound & Acupuncture are all different manual therapy modalities that the physiotherapists at HCC may rely on. Additionally, a variety of exercises with focuses on postural modification, cardiovascular endurance, muscular strength, or spinal stability will be demonstrated, taught & prescribed. Just as important as the manual therapy & exercise components of treatment, physiotherapists are also experts as identifying potential causative agents of different patient conditions. This is where the idea of Lifestyle Modification & education is incorporated into treatment. Methods such as stress management, activity modification, and maintaining a healthy mindset can all play a profound role in recovery time & patient prognosis.
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Time to Get Walking!

Spring is here – Time to Get Walking!

Spring is here – Time to Get Walking!

Now that spring is here and we can start enjoying the outdoors again, one very simple but effective lifestyle change that we can introduce is walking. All physical activity including walking is important because it gives us energy, it decreases our stress, it makes us stronger and prolongs our independence. It can also help prevent chronic diseases. Walking is both an accessible and low impact form of physical activity with many great outcomes. Here are some of the many benefits you can receive by introducing walking into your routine.
  1. Increased fitness: regular walking daily or multiple times a week will involve your whole body, this includes your muscles and your cardiovascular system. With regular walking you are less likely to suffer from a fall due to increases in strength, flexibility, and range of motion. A reduction in falls leads to a reduction in your risk for fractures. Studies have also shown that participants in walking programs have improvements in quality of life and clinical scores in arthritis pain.
  2. Blood pressure and cardiovascular health: studies have shown that walking alone can lead to a statistically significant reduction in both diastolic and systolic blood pressure. This in turn can decrease your risk of coronary artery disease, stroke, and transient ischemic attacks.
  3. Maintenance of body weight: your weight reflects the balance between what you take in during the day and what you expend. With regular walks at a brisk pace, you expend energy and burn calories, this along with a healthy balanced diet can help maintain your weight.
  4. Improved mental health: when you walk, especially in a pleasant environment, you can experience a reduction in both depression and anxiety. People who walk regularly also experience better sleep quality and duration.
When you start walking the best thing to do is walk however feels natural for you, keep a comfortable pace for yourself as you start. Keeping good posture in mind is important as well. Keeping your head and spine straight to ensure that you are not leaning forward or backward as this will decrease pressure on your joints and help keep your shoulders and arms relaxed letting them swing naturally. Of course, you can look down to avoid obstacles but try to not look down for too long. When it comes to breathing this should also feel as natural as possible. It should be regular and steady. Avoid holding your breath or forcing yourself to take deep breaths. Slow your pace to catch your breath if needed. More of a good thing is always better, walking more regularly will allow for the good effects to accumulate. Taking long breaks in between walking sessions will lower the cumulative effects. There is no specific warmup needed before walking but starting at a slower pace to allow your body to work through the range of motion needed and stretch your muscles before speeding up to a moderate/ brisk pace is advised. Treatment methods and exercises/modification When it comes to walking, footwear is a very important aspect to consider. You don’t need to go out and buy any fancy walking shoes, anything that you can walk comfortably in for an extended period will do. Hiking shoes can be heavy and inflexible so should only be worn if you plan on walking on rough terrain. Shoes designed specifically for running are meant for a forward bent body, when walking up straight this could change the distribution of stress on your legs and low back. Your walking shoes should fit comfortably and allow you to wiggle your toes. They should support both your heel and the arch of your foot. Walking shoes do not need to be ‘broken in’ so ensure that they are comfortable in the store, or don’t buy them. Helpful tip: buy shoes at night as your feet swell by the end of the day and what may feel comfortable in the morning might not be by the end of the day. When it comes to clothing once again, the goal is to be comfortable. Layers are the best option so you can add and take off as you walk depending on your pace. Inner layers should provide insulation and moisture wick technology to help keep your skin dry. In cold, winter weather be sure to add a hat and gloves to contribute to thermal comfort. On hot summer days protect yourself from UV exposure by wearing lightweight clothing that covers enough skin, wear a hat and sunblock as well. Water intake is incredibly important while walking to replenish the fluids you are losing, hydration is key! Introducing walking into your life can be quite simple, start slow and build up with time. The weather is warming up, the flowers are blooming and it’s a great time to start! If you have any questions or would like some more advise on how to get started, please don’t hesitate to ask us here at Halton Chiropractic Clinic.
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Upper Cross/Student Syndrome

Upper Cross/Student Syndrome

What is it/Why does it happen?

As a society, we sit. We sit at our kitchen tables while eating, and couches while watching tv. We sit in our cars during our errands, or at the movies for entertainment. Most notably, we sit in our schools for our learnings, and at our desks for our work, We sit so much, that surely it can’t be terrible for us, right? Well, the association between sitting and low-back pain is rather well documented at this point. Muscular imbalances between our stretched-out gluteals & shortened psoas may lead to a myriad of joint restrictions, strained spinal discs, and other biomechanical issues. However, that’s just the tip of the iceberg. What about our upper backs, and our necks? Rare do we sit, without our attention being held by something infront of us. Phones, laptops, movies, shows, food, or perhaps company across the table – these things grab our attention as we focus on them. As we become more and more focused on whatever our distractions are, it’s not uncommon to begin experiencing a forward-head posture – where we unconsciously ‘lean in’ to whatever it is we’re focusing on. This forward-shift in location of our 11lbs head (equal weight to a bowling ball, by the way) then must be supported by our neck & upper back musculature, until we become aware of our postural issues and correct ourselves until we become focused again. This cycle eventually leads to what we term as “Upper-Cross Syndrome”, which has also earned the nickname “Student Syndrome”, for being very common in the student population.

What should chronic-sitters expect?

Upper-Cross Syndrome is extremely prevalent in both the student & desk-worker populations. Patients are usually first made aware of it as a gradual onset of dull, achy pain along the back of their necks & upper back. If left unaddressed, this dull ache exacerbates into difficulty sleeping, headaches, or carpal-tunnel like numbness/pain in the arms and hands.

Treatment methods and exercises/modification

The good news here is that Upper Cross Syndrome – like other postural-based issues – have an excellent prognosis (recovery) with chiropractic & multidisciplinary care. In these scenarios, both a passive and an active component of treatment are essential to obtain maximum relief, quickly! Osseous Manipulation (Chiropractic Adjustments) should be at the forefront of treatment for Student Treatment. Adjustments to the neck & upper back help to restore proper biomechanical movement & functioning to the targeted areas, as well as provide immediate relief from feelings of constriction & tightness. Following this, incorporation of massage or other soft-tissue therapy to target the neck and upper back musculature compounds the relief. These two things alone are sufficient to eliminate the symptoms of Upper Cross Syndrome within a short treatment session! Following these treatments, incorporating a few simple exercises/stretches into a patient’s daily routine will help to prolong the relieving effects from adjustments, or delay the onset of discomfort from poor posture: Treatment methods and exercises/modification Brügger’s Exercise, shown above, is a simple exercise that stretches the most commonly affected muscles of those with Upper-Cross Syndrome. It can be incorporated into the work routine near-seamlessly, as it’s done from a seated position. Begin by sitting at the edge of your chair & tuck your chin in, as if nodding “yes”. Rotate your arms & shoulders out from your body; turn your palms forward, and then further out to your sides. Pull your shoulder back, while protruding your chest forward. Hold these position for as long as you feel a healthy stretch! Treatment methods and exercises/modification A second, highly-recommended exercise helps to improve the mobility of the spinal joints in the upper back, specifically referred to as your “thoracic”-spine. Shown above, the “Cat-Camel” exercise involves slowly transitioning from the top position, to the bottom position, and back. Begin from a quadruped (on all fours) position, with your head & buttock up, stomach & chest lowered. From here, begin slowly “pushing your upper-back up to the ceiling”, while lowering your head & rounding your low-back. Once you have gone as far as you can, hold for the stretch, and then slowly return to the original position. Repeat. If a person experiencing Student Syndrome begins with these treatment methods, they will notice significant improvement and progress towards complete recovery. However, the issue with many postural-based syndromes is their tendency to reoccur without consistent intervention! Remember to take regular movement breaks from your work/studies, and consult with your healthcare provider regarding potential ergonomic alterations to your workplace.
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Sleep Hygiene

The Importance of Sleep Are you one of the lucky people who fall asleep as soon as your head hits the pillow, or do you toss and turn endlessly before falling asleep? If you’re the latter stick around and learn some helpful tips that will help you catch some z’s before you know it! Did you know that 1 in 4 people experience difficulty sleeping? This doesn’t just mean that they can’t fall asleep, it also includes trouble staying asleep, waking up early, daytime sleepiness, sleeping too much or having restless sleep.

The Importance of Sleep

Having adequate and restful sleep is important for your physical and mental health. Sleep is an essential function that allows you to recharge and stay alert, without it you have trouble concentrating, thinking clearly and processing memories. Lack of sleep has also been linked to a higher risk of developing certain diseases and conditions including obesity, type 2 diabetes, high blood pressure, heart disease, stroke, and poor mental health.

The Science of Sleep

The average adult needs 7-9 hours of sleep per day. We have an internal ‘body clock’ that controls our sleep cycle and runs on a 24-hour circadian rhythm. After we wake up, we get increasingly tired as the day goes on until we reach our peak tiredness at bedtime. This rhythm is affected by many things including hormones and light. The Science of Sleep There are 4 stages that we cycle though as we sleep, the first 3 stages involve non-rapid eye movements. The first stage is light sleep and is the transition phase between being awake and asleep. This is when we relax and our body beings to slow down. Our heart rate, breathing rate, brain waves and eye movement activity decreases. This should last several minutes. As we enter stage 2 or deep sleep, our bodily processes continue to slow down, and our temperature will decrease. This should be the longest of the four stages in our sleep cycle. The third stage is what sets us up to feel refreshed and alert the next day, this is the stage that our body will be at its most relaxed. The fourth and final stage in our cycle is our rapid eye-movement stage. Our heart rate, breathing rate, blood pressure and eye movements all start to increase in activity. This is the stage that dreaming takes place. We cycle through these 4 stages repeatedly through the night until we wake up. Each stage lasts between 90-120 minutes. Now that we know more about sleep and why it’s so important let’s talk about sleep hygiene.

Sleep Hygiene

Sleep hygiene includes our environment as well as our habits and improving both aspects can lead to higher-quality sleep. Here is a list of ideas to help you start improving your sleep hygiene.
  1. Create a comfortable sleep environment. This includes a supportive mattress and pillow, comfortable bedding and room temperature, minimal noise, and light. Light scents like lavender can also create a calming state for sleep.
  2. Creating a relaxing routine before going to bed can help you fall asleep more easily. Figure out what puts you in a calm state of mind and do this before bed. This can include listening to music, reading a book, stretching, meditating, etc. Limiting bright lights and electronics during this time will help increase the production of melatonin and decrease mental stimulation.
  3. Keeping a consistent routine will give your body clues that’s it time for bed. This can be as simple as putting on pajamas, having a cup of tea and brushing your teeth. Doing this around the same time every night is important as well. This consistency should continue into your morning routine, waking up at the same time everyday helps create a regular sleep cycle.
  4. Do not stay in bed tossing and turning hoping that sleep will find you! Get out of bed if you don’t fall asleep within 20-30 minutes. Try your relaxing night routine again and then get back in bed when you become tired.
What can you do during the day that will help you sleep better at night?
  1. Being active! Something as simple as going for a walk, especially in the afternoon or early evening can lead to more restful sleep.
  2. Avoid caffeine, alcohol and smoking within 4 hours of bedtime.
  3. Limit napping as this will interfere with your 24-hour sleep cycle.
  4. Restrict bed use for sleeping. Watching tv, reading, working, studying etc. keeps your mind active and will get in the way of sleep.
  5. Getting natural light throughout the day helps set your bodies internal clock.
It isn’t required that you follow everything on this list but starting small and being consistent will help you build healthy sleep habits that will pay off in the long run. Be patient with yourself and remember that stressing about sleep doesn’t help you sleep!
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Kidney Health & Pain Referral

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. Anatomy & Function

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 Issues resulting in perceived 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!
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February – “Heart Month”

Heart Month 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. Healthy Eating 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. Physical Activity 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. Stress Reduction 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!
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“Disc Slips” & Herniations

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. Anatomy 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 Stages

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. Disc Herniation Symptoms & Diagnosis

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.
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Fall Prevention

Fall PreventionDid 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:
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