Nov 28, 2013 / 5:00 am
When a person gets injured or has chronic pain there are many traditional treatments and self-help strategies that are employed to help speed up recovery and reduce pain. Some examples of these would be RICE (Rest, ICE, Compression, Elevation), Non-Steroidal Anti-Inflammatory Drugs and other over the counter medication, topical ointments and visits to the chiropractor, physiotherapist or medical doctor.
Most of the time what gets overlooked, especially in mainstream medicine is the role that nutritional supplementation can play in helping a person both speed up recovery from an injury and help cope with chronic pain. Besides eating an anti-inflammatory, mostly plant based diet there are several nutritional supplements that you may want to consider adding if you are going through injury or pain.
Omega 3 Fish Oil – Omega 3s are considered to be very important for a number of functions of the body and frequently is recognized for its effect on brain function and development as well as cholesterol levels. It also possesses some characteristics that make it an important substance for injury management. Omega 3 fish oil targets pain receptors such as TNF, IL2 and IL6 to reduce pain and also plays a role in reducing inflammation.
Magnesium – I often recommend patients look into magnesium supplementation to help with problems such as muscle cramping, however it also plays a role in pain management. Some magnesium supplements have the problem of not being readily absorbed by the body and therefore being drastically less effective. Magnesium glycinate however is thought to have an absorption rate of over 80% and binds with NDMA which is a prominent pain relieving receptor. Magnesium can also help to improve sleep quality, which in itself is important because a rested body tends to heal much more readily than a sleep deprived one.
Vitamin D – Vitamin D has been a fashionable supplement for several years for a number of cancer prevention, cardiovascular and bone health reasons. It has become perhaps the most important vitamin on the market, especially for us in the Okanagan during our sunless winters. Its role in pain management is that it can help to replenish dopamine levels in the brain. Dopamine and serotonin are neurotransmitters that are important for feeling of happiness and satisfaction. Decreases in these have been linked with depression.
Tumeric & Bromelain – Both of these supplements are great for natural anti-inflammatory purposes and can be very effective in the management of acute injuries. Tumeric and Bromelain (and they often come together in a blended product) are relatively inexpensive, very safe to take and can markedly reduce inflammation levels in the body to help speed up recovery from sprains and strains. It can also be an useful supplement to take post surgery to reduce associated inflammation.
Always consult with your preferred health care provider when considering making changes to your supplementation regime.
Nov 14, 2013 / 5:00 am
One of the most frequent questions that I get in my office on a day to day basis is, “what exercises can I do to strengthen my back?” For me that question is a bit of a heads up that this particular patient probably needs a bit of coaching because what would probably be a better question is, “What can I do that won’t hurt my back?” or “What exercises do hurt my back?” A fundamental premise of achieving good “core strength” to help your back is to actually get it to work less. Having a strong back, despite conventional wisdom is not necessarily what you should be looking for. You should also be wary of trying to improve low back flexibility as that is also unlikely to help with what ails you. Fact: People with low back pain tend to have stronger low back muscles. Why? Because they are putting too much load and movement through their backs, when really the lumbar spine is designed to be used as a stabilizing machine.
In general, I try not to discourage patients from doing certain activities or forms of exercise because A) they might really enjoy it and that is worth a lot and, B) a lot of times any activity is better than none. There is also rarely a hard and fast rule when it comes to exercise and knowledge is constantly shifting as to what is good for us and what is not. However in terms of helping patients become stronger and less prone to low back injury or pain there are a couple of main guidelines that should be followed in helping you select exercises that are appropriate. The key to doing proper core exercises is to have as much muscle recruitment in the muscles considered as the “core” (abs, glutes, obliques etc) while decreasing what’s known as shearing force on the back. So in simple terms do exercises that use lots of muscles, while sparing the back. With that in mind here are a few exercises that you are better off without:
Superman or Lotus Pose
This exercise is a clear violator of the spinal shearing load rule and puts tremendous force through the spine. You will see this exercise promoted all over the internet, in gyms and yoga classes as a back strengthener. I guess it is the exception to the rule that everything on the internet is true. While putting great loads on spine through recruitment of erector spinae group, it also minimizes the contribution of the glutes (which you actually want).
A staple of fitness centres everywhere, this exercise has presumably been around since the Roman empire. That doesn`t mean it is any good. Also falling in the spinal shearing no-no group, enthusiasts of this exercise will often hold a 25-35 pound weight just make the this spine crushing activity even more effective at its job. Also note the locking of the legs, to make sure your glutes (one of the strongest muscles in your body and what you should be using!) are not working at all.
I actually find it hard to believe people still do these. The big problems with sit-ups is the repetitive flexion based movement that is done. It has been well established in this area of researched that one of the easiest ways to damage a spinal disc is to put it through repetitive flexion (moreso with rotation). These are best left as a fond memory of your PE classes.
There are many examples of fine core exercises that you can be doing which both spare the spine and activate a lot of muscles at the same time. Please have a look through some of my previous articles to find examples of safe and back friendly core exercises.
Oct 31, 2013 / 5:00 am
Most patients that I see with complaints of back pain have no idea what is causing their pain. The facts are that back pain is not something that comes one day and is gone forever with a few treatments. Most people with back pain can expect to have repeated episodes. To complicate the matter and frustrate patients even more is the vast majority of back pain is known as mechanical low back or non-specific low back pain (NSLBP). Up to 95% of people fall into this category while less than 5% of people exhibit true nerve root pain. True nerve root related pain such as a herniated or bulging disc (and no discs do not “slip” despite what a local yoga website may tell you) is actually much easier to clinically diagnose than the various entities that exist under NSLBP. It’s called non-specific for a reason.
The bottom line is your back hurts mainly because somewhere along the way you learned to move improperly. The pain did not become evident right away because of this movement and may in fact have take years to present. And despite one singular event such as mowing the lawn or picking up a piece of furniture causing an acute episode of back pain, that event is not to blame in the vast majority of situations. This can be frustrating for a patient, because it seems like a simple event occurred to cause the pain and a simple fix can cure it. Unfortunately it is often more complex than that and while pain relief can hopefully be achieved quickly, to truly improve your pain long term, some retraining and education is in order.
Like I said blaming back pain on one single wrong movement is inaccurate. It is the hundreds and possible thousands of times that you have done that movement (most commonly bending and twisting) that is to blame and finally your back said “enough is enough”. Until you manage to improve your quality of movement, you can be rest assured you will always be at risk of another episode of acute pain. Treating the acute pain through the use of adjustments, soft tissue techniques such as Active Release Techniques and modalities like electrical stimulation can be very helpful to increase your function and get you feeling normal again. That is not the whole solution though. A person with back pain has to remove those movements that cause the pain in the first place. They have to work within what is called their pain free functional range of motion. This is why as part of my first office visit with a patient I will get a patient to show me how they move in terms of getting out of bed, getting into and out of a chair and how they lift. This usually gives me a wealth of information to work on with a patient when I show them how these movements completed incorrectly all their lives are a direct contributor to their pain.
Education is key for the patient. As a practitioner if I can teach a patient alternative ways to move that will spare their back and still allow them to complete the activities they need or want to do, it is incredibly empowering for the patient. This takes time, patience and practice however, because often a patient is relearning new movement patterns to replace ones that they have used for most of their lives.
Oct 17, 2013 / 5:00 am
Thanksgiving is over, the days are shorter and colder, and winter is definitely on its way. Although we are blessed in the Okanagan to be able to pursue outdoor activities virtually year round in our beautiful playground, many of us start looking towards local fitness centres for activity options when fall and winter arrive. Working with a personal trainer is also something that people elect to do to help them achieve their fitness goals.
I am a chiropractor in private practice here in Kelowna with a professional background in human kinetics. I spent many years working as both a personal trainer and exercise therapist in several performance and rehabilitation settings. I no longer do any personal training due to time constraints but my patients are well aware of my passion for exercise and rehabilitation. A serious pet peeve of mine is questionable advice given to a patient by a personal trainer or any other health practitioner for that matter. Although I don’t actively offer personal training, I am still a member of the highest level of fitness certification offered in the country (www.csep.ca) and feel that I am in a pretty good, neutral position to offer some advice on what to look for and what to look out for when choosing a personal trainer.
The first thing you should know is that anybody and I mean ANYBODY can call themselves a personal trainer. You literally have to have no experience, education or certification to call yourself this. This is unlike a professionally trademarked term such as chiropractor or physiotherapist, where there is a governing college and association that specify certain education and examining to be able to use that credential.
Personal trainers can vary from completely uncertified, to weekend certified (such as BCRPA, CrossFit) to some with a 4 year university degree and professional post graduate certification. Now don’t get me wrong, just because someone has a university degree doesn’t mean they will make a great personal trainer and some of the best trainers I know did not complete a kinetics degree. It does however put some legal limits on the type of client that they should be working with.
If you are an apparently healthy person with no significant disease or injury history, then a standard BCRPA trainer could be a good option for you. Their scope is limited to working with “apparently healthy” people. If you do have a significant past, you should be aware that the vast majority of personal training certifications do not have liability insurance that covers working with this population. This is very important, because if you were to get injured or become disabled while engaging in activity under their care (it is rare, but it happens), their insurance would not be valid and therefore your legal options would be significantly reduced. My fitness certification has a policy that covers me for $2 million dollars of liability while working with clients. For a person with a significant medical history, you should clarify with your trainer what they are covered for.
When selecting a trainer, be selective! When they initially meet you, remember that you are interviewing them for a job, not the other way around. Their strengths should meet your goals and if does not appear that they have a lot of background or experience in the particular type of fitness or exercise you are interested in, believe me there are 10 other personal trainers in the area who do.
There are many personal trainers in the Okanagan area that I have had the pleasure of working with. If you are interested in going down this route, feel free to email me at [email protected] and I would be happy to help you out.
Read more Back to Basics articles
- The problem with "making good time" Oct 3
- The ankle-foot complex Sep 5
- Common questions in my office Aug 22
- Are your sources reliable? May 16
- Assessment and treatment of headaches Apr 4
- Simple things with powerful effects Mar 21
- Finding the balance Mar 7
- From injury to performance Feb 21
- Fix your own back Feb 7
- Effect of pain on function Nov 29
- Why is my hand numb? Nov 1
- Mixing pain medication with exercise Oct 18
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