Blog of Dr Notley Winnipeg Chiropractor

Jon Engum: Mobility and Flexibility

2012-05-27T22:58:00.002-05:00

This weekend I attended another continuing education course provided by the Musculoskeletal Study Group of Manitoba, a group of like minded practitioners (Chiropractors, Athletic Therapists and Physiotherapists) who are seeking to always learn more to improve their clinical skills.

http://www.extremetraining.net/

We brought in Jon Engum, a Master RKC (Russian Kettlebell Certified) instructor to teach us about improving mobility and flexibility in our patients. We spent 4 hours learning how to use strength and developing space in the body to improve our mobility and flexibility in all body movements.

We saw extremely inflexible people being able to touch their toes just by performing some simple methods. We learned ways to improve the depth of your squat and to improve the mobility in your thoracic spine (all you golfers out there). We even saw one exercise that helped to improve the strength of a martial artist's kick by performing an exercise that looked to be focused on improving shoulder mobility.

It was an extremely wild, sometimes uncomfortable, enlightening experience.

After one of these courses I always seem to bring home a few extra tools to use on my patients

Dr Notley
Athletic Therapist/Chiropractor in Winnipeg since 2000

P.S. If you see me on Monday you see me walking different. I am sure part of me will be a little sore; but it's a good kind of sore.

P.P.S. If you would like to learn more about improving your flexibility and mobility check out the following link (affiliate) that has Jon Engum teaching the information
Beyond Stretching: The Seminar 5 DVD Set: Discover How Pavel’s 5-Step,Neuro-Software Upgrade System Can Rapidly DEBUG the Hidden Blocks That Are KILLING Your Performance

Exercise of the Week: Lifts & Chops

2012-05-20T16:56:00.001-05:00

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953333/

When discussing core training I often start my clients off with performing my Four for the Core exercises. These are great exercises in developing static holding endurance of the core muscle. They have also been cited as producing low spinal loads which makes them safer on the spine. What these exercises lack is movement of the limbs; this would make it more life-like.

The lift and chop exercises place us into more life like positions as well as take our upper body through common motions that people often use in sports and in jobs that require physical work.

The lift and chop exercises take advantage of what are known as PNF patterns. PNF, proprioceptive neuromuscular facilitation, is often thought of as a method of stretching but it is also a method of strengthening. These movements take the upper extremity through a diagonal pattern across the body, which requires a reflexive response of the core muscles to appropriately contract to stabilize the body.

One of the problems I always have had when training people to "activate their core" is that by telling them what to do the activity becomes more conscious rather than unconscious. Unconscious activation of the core is obviously more life-like. Just think of what it would be like if we had to consciously think about activating our core especially if we were running a marathon. As we have seen in previous posts on core training, it is possible to unconsciously activate the core even in those who are experiencing back pain by using suspension straps.

Watch the video to learn how to perform the lift and chop exercises . To learn more about the science/theory behind lift and chop exercises check out this research paper. You will note in the video that the exercise is used with a single handle. You can also perform this exercise with a stick attached to a pulley system or elastic tubing. If you want you can purchase a TRX rip trainer. (This is an affiliate link. I do use this product for these exercises)

Lift and chop exercises are first to be performed in what are known as transitional position:

High kneeling - Kneeling on both knees with the hips extended and knees together Tall kneeling creates challenge to balance reactions in front and back directions (anterior/posterior directions)
Half kneeling - A kneeling lunge position with the kneeling knee directly below the hip. The kneeling knee and the opposite foot should be approximately 6 inches apart and directly in front of each other.

It is recommended that you start by performing each of these exercises in the kneeling positions first once you have mastered the Four for the Core exercises. Choose a weight or tubing resistance that will allow you to perform approximately 8 to 10 repetitions. Perform the lift and chop with each kneeling position to discover which movement that you find is most difficult or where you can't do as many with good technique.

Once you discover which is the most difficult position to perform then this is the movement to practise. This is your weak link in your core. Some recommend performing this for 5 to 10 sets of one repetition while others recommend 5 sets of 5.

Once these positions are perfected then you can graduate to standing positions such as:

Standing position - feet wide or feet narrow
Split position - One foot in front of the other.
Single leg stance.

Give these exercises a try. Did you have any imbalances between the left and right side of the body?

Dr Notley

Chiropractor and/or Athletic Therapist in Winnipeg since 2000

P.S. If you want to read more about lifts and chops check out these articles:

http://www.dynamicchiropractic.ca/mpacms/dc_ca/article.php?id=55838
http://www.cshnq.org/images/file/Core%20Training%20Webinar%2008-05-09.pdf
http://www.painlasercenter.com/uploads/CS_chop__lift.pdf

Dr Notley's May 2012 Newsletter

2012-05-08T23:14:00.000-05:00

This past month has been a very busy month for me and it has become even busier with the addition of a new member of our family. We had a daughter on April 27th. If you want to learn more check out the post, She's here! Welcome to the Family

After checking out my beautiful daughter (biased father) check out some of the interest articles I have found or posted over the past month.

All About the Squat
by PrecisionNutrition.com

Squatting is a fundamental human movement pattern that involves nearly every muscle in the body. It’s handy for picking stuff off the floor, going to the bathroom, and just hanging out on a traffic cone.

And thanks to exercise science, data show that squats are excellent for building strength, power and mobility. Full squats can help counteract many of the chronic musculo-skeletal problems we face today, such as weak glutes, hunched back, weak torso, etc.

If a person can perform a full depth squat with their own bodyweight, they’re probably a fairly fit person.

This post is definitely worth if you have ankle, knee, hip or lower back pain.

Understanding chronic pain

Pain is one of the primary reasons athletes and others come to my office. To most, pain is a result of an acute injury or due to a repetitive strain. Once the tissues have healed and the repetitive strain has been reduced tissues are generally fully healed within 3 to 6 months. But for some people pain persists beyond this point. This is known as chronic pain.

The responses of trunk muscles to perturbations before and after Active Release Technique® of the hip flexor

Active Release Technique is one of the techniques that I perform on my patients. It is well known in the Triathlon, Ironman and Marathon circles. The hip flexor muscles in these athletes are often a problem Check out the effect Active Release Technique has on treating the hip flexor muscles

Shoulder Problems? Try the Kettlebell Armbar and Serratus Anterior Press

Two exercises I have added into my repertoire of exercises for improving the stabilization of the shoulder blade are the Kettlebell Armbar and the Serratus Anterior Press . The intent with these exercises is to improve the shoulder blades ability to stay still as the muscles of the shoulder (rotator cuff) are active t move the shoulder. If you have shoulder pain these two exercises may be ones that I will add to your exercise program.

No Time to Exercise? Are you Sure
by blog.participaction.com
If you have ever had the excuse that you do not have the time to exercise then this is the article to read. Great tips on how you can incorporate exercise into your life.

I hope you enjoy your May

Dr Notley
Chiropractor/Athletic Therapist of Winnipeg

She's here! Welcome to the Family

2012-04-29T21:36:00.003-05:00

Over that past 8 months I have been telling my patients a story about my oldest boy. Just before his 4th birthday my wife picked up a pregnancy test. He saw her picking it up and asked, "What's that mommy?" She explained, "It's to find out if we have a baby in my belly." He responded with, "You have two. One named Kira and one named Kadi."

You would think that this was just a flippant response but my oldest son has been known to have said other things that have ended up being true.

An ultrasound was performed and we found out that there were to amniotic sacs. Sadly, one of the sacs was not developing. We asked him which one went to heaven and he said, "Kadi". I then asked him when she was going to be born. His response was, "April 29th."

So as this month neared an end the reality of the baby coming on the 29th became more in the forefront of my mind. As last week was nearing an end my wife started to not feel well. We headed to the hospital and an induction was scheduled. After nearly 24 hours of labouring my wife was sent for a C-section.

At 8:32pm, on April 27th, Kira was born. She was the biggest baby we have had. She weighed in at 4000g (8lbs 13 oz) and she was 22.5 inches long.

Welcome to the world Kira.

Daddy......... Dr Notley

P.S. Kira was the name we gave her before my son even mentioned her name.

P.P.S. Yes, we had her name made long before she was a reality.

Exercise of the Week: Kettlebell Armbar

2012-04-21T22:10:00.002-05:00

In the past I have talked about improving the scapular stabilizers of the shoulder to aid in treating those with shoulder injuries (Bicipital tendonopathy, rotator cuff tendonitis/tendonopathy, shoulder impingements). Our shoulder's primary responsibility is to be a mobile joint while the scapulo-thoracic "joint" is supposed to be stable. The mobility and function of our shoulder joint improves when the scapula is stable.

This is like building a house on marsh land versus a house which is built on rock. The house that has a poor base of support will result in the house shifting (scapular stability) and result in doors not closing properly (the shoulder moving poorly). One way of discovering if you have poor scapular stability is by performing a pushup and watching what the shoulder blades do. If they wing out away from the body then there is poor stability.

Here is one exercise I have been starting to recommend some of my patients, especially those who enjoy training for Crossfit, called the arm bar. What I like about this exercise is that it requires the scapula to be stable as the shoulder has to be strong as it moves into different angles of horizontal adduction/abduction.

Making sure you are able to squeeze the shoulder blades fully ensures that there are no scapular movement restrictions which may affect the stability of the scapulae. I often find myself using Active Release Techniques on the serratus anterior muscles and pectoralis minor muscles to improve this mobility.

If you use a kettlebell and place it in the bottoms up position this results in you needing to grip the kettlebell more. From what I have been reading from different sources increasing grip results in an increase in activity of the scapular stabilizers. Note: I need to find out if this is research based.

Give this exercise a try and tell me what you think?

Dr Notley
Treating sports injuries and spinal injuries as an Athletic Therapist/Chiropractor since 2000

Understanding Chronic Pain

2012-04-13T09:23:00.000-05:00

Pain is one of the primary reasons athletes and others come to my office. To most, pain is a result of an acute injury or due to a repetitive strain. Once the tissues have healed and the repetitive strain has been reduced tissues are generally fully healed within 3 to 6 months. But for some people pain persists beyond this point. This is known as chronic pain.

The frustrating part for many of these patients is that they want to find a physical or structural answer for their pain. Many request, or demand, expensive methods of imaging, such as MRIs and CTs, in hopes of finding the answer. Disappointingly, most of the time the results are normal. They are normal because the injured tissues have healed and the pain is not being produced by the tissue but by the brain. Pain is produced by the brain in all cases, acute or chronic pain. In the case of chronic pain, the brain is the problem and not the body.

"In the case of chronic pain, the brain is the problem

and not the body"

In the past, Doctors would explain, "The pain is in your head". From the doctors point of view they are correct but when said that way patients think the doctor is saying, " You are faking it. Your pain is not real".

Your pain is far from fake. It exists. Even though I can not even imagine what your pain feels I know it exists because you experience it. I know how intense it is because I ask you to rate it between 0 and 10 (10 being the worst pain you have ever experienced). Sadly, we have no way to image the brain to show you that it is producing your chronic pain.

"Your pain is far from fake.

It exists."

Take 5 minutes to watch this video from Youtube which explains chronic pain and how to get over it. I have highlighted some treatment tips, from the video, which may help you towards your goal of becoming pain free.

Video Notes:

To treat chronic pain we need to retrain the brain and nervous system
The treatment of chronic pain is complicated
Medication only helps to a limited extent. An "active form" of care is more beneficial
It is okay to use meds to help you cope, in the beginning but they should then be slowly tapered until they are no longer used.
Surgery is rarely the answer.
Consider how your thoughts and emotions affect your nervous system.

Pain alters your mood and increases your stress levels.
Use methods to help wind down the activity of your nervous system, decreasing your stress, improving your well being and reducing your pain

Consider the role of diet and lifestyle. What is your nutrition like? Do you smoke? What is your alcohol consumption like? Do you exercise?
Look into the deeper meaning of your pain and its surrounding personal story. What was going on around the time your pain developed? A worrying period of life can be associated with a worsening pain period. Recognizing deeper emotions may also help with pain.
Consider your physical activity and function. Start with activities that your body can do. Do not start with exercises that cause a fear of potential injury so that the brain doesn't try to protect the body by producing pain.

"Realize that the pain you are experiencing

does not mean you are causing harm to your body"

Many people with chronic pain fear doing any activity at all out of fear of being hurt again. This often leads to disuse and deconditioning. This ultimately leads a decrease in overall well being and further pain. In addition, realize that the pain you are experiencing does not mean your are causing harm to your body. Remember, the tissues have already healed.

I hope this gives you a better understanding of chronic pain.

Dr Notley
Treating athletic injuries and work injuries as an athletic therapist/chiropractor since 2000

Dr Notley's April 2012 Newsletter - For the Runners

2012-04-06T15:43:00.000-05:00

This is a special newsletter geared towards all the runners, old and new, who are lacing up their shoes this month and enjoying the outside. One of the most common patient that I treat is the recreational/competitive runner. Here are some great articles that may help you prevent or treat your running injuries.

Get in Shape without Injuries

So you want to get in shape but you haven't exercised in years, or maybe ever. Getting started is a daunting task and you are motivated to get moving, which is great, but you are also worried about getting injured which would put your goals on hold.

Why Should You Stretch

In my Chiropractic offices I often have patients come see me because they are in pain. One of the tools that I use to treat these people is stretching. These are the reasons that I feel stretching is important.

Active Release Techniques and the Treatment of Running Injuries

Running injuries can be caused by many different factors, such as, poor running mechanics, a rapid build up of mileage, muscle imbalances, poor foot wear, or running through the pain. Even with good technique, appropriate training plan and proper footwear runners are still going to be affected by repetitive micro-trauma resulting in repetitive strain injuries.

Barefoot running: Should you or Shouldn't you

What do you wear on your feet when you run? Shoes of course! But do you really need shoes? The vast majority of people would say, "Yes, of course!" In Winnipeg half the year is winter running on snow and ice would not be very fun. But there are those who are ditching their shoes all together and training barefoot or in minimalist shoes (. The main reason for training barefoot, by barefoot runners, is often because it helped the person with their plantafasciitis, achille's tendonitis, knee pain, ITB pain, hip pain, or lower back pain. Proponents for barefoot running indicate that our feet are meant to respond to the surfaces that they encounter and this form of running results in less force on the body. Conventional shoes allow for cushioning and protection from the ground and weakens the muscles in the feet. Running barefoot strengthens the foot.

Plantarfasciitis: Self Myofascial Release with a Twist

One of my treatment philosophies for my patients is that is it important to provide them with the tools to take care of themselves. When it comes to plantar fascia pain using a ball (golf ball, lacrosse ball, spikey ball) have all been helpful in caring for the tightness in the foot. You can see a video of this here.

Special Guest Posting: Power Running on Active Release Techniques

Power Running is an article written by Vic Keller and James Slade. Vic is an active referrer to my Gelley Chiropractic office in St. Vital and Downtown Chiropractic Centre in Downtown Winnipeg. They wrote this article for the Manitoba Running Association.

Running Injuries and Nutrition

I treat a number of running athletes ranging from recreational runners to competitive tri-athletes/marathoners. Often I am treating them for repetitive strain injuries. Many of these runners are female. I can often explain their injuries due to poor running mechanics, muscular imbalances, previous injuries, volume of training etc. Often I can successfully treat them using Active Release Techniques, acupuncture, manipulation and appropriate stretches or corrective exercises but sometimes they just keep getting injured throughout their training season. What is causing this?

Dr Notley
Treating sports injuries and spines as an Athletic Therapist/Chiropractor in Winnipeg since 2000

Chiropractic Manipulation: Not just for the back

2012-03-30T12:37:00.000-05:00

Evidence is fairly strong when it comes to the effectiveness of joint manipulation for the treatment of acute and chronic neck and back pain. When people think of a Chiropractor they think of someone who is good at treating back and neck problems. When it comes to injuries to the shoulders, elbows, wrists, hips, knees, ankles and feet an Athletic Therapist or other health care provider may be considered first.

From my experience Chiropractic care, along with soft tissue release (ie. Active Release Techniques) and corrective exercises can be effective for a number of injuries to the extremities. My questions this week are, "What does the evidence say abut the effectiveness of joint manipulation for various extremity problems?""Would seeing a Chiropractor for these conditions be a good idea?" I found a research paper that reviewed a number of extremity conditions, along with other spinal conditions, and ranked them based on quality of the evidence. Here is a quick summary of their findings.

High Quality Evidence

Evidence is considered high if there are consistent results from well designed and well conducted studies. There has to be at least two randomized trials.

None of the conditions the researchers had studied exhibited high quality evidence . If there was high quality then an evidence informed doctor would be able to say that this form of care is effective for the condition.

Moderate Quality Evidence

Evidence was considered moderate if there is sufficient data leading to that conclusion but their confidence is less due to the number, size or quality of each study, inconsistency of findings between the studies or lack of coherence in the chain of evidence.

The researchers found that manipulation/mobilization was positively effective for pain between the shoulder blades or scapular dysfunction and hip osteoarthritis. High grade mobilization is positively effective for adhesive capsulitis/frozen shoulder. The use of manipulation/mobilization along with exercise is positively effective for knee osteoarthritis, patellofemoral pain syndrome, tennis elbow and plantar fasciitis.

Based on these findings an evidence informed doctor would say these are effective treatments for the conditions listed.

Low Quality Evidence

Evidence quality is low due to several factors. There may be a limited number or power of studies. There may be important flaws in the design or methods of the study. There may be unexplained inconsistency between higher quality trials or their may be gaps in the chain of evidence.

Rotator cuff pain, carpal tunnel syndrome, ankle sprains, morton's neuroma hallux limitus all have favourable outcome using manipulation or mobilization, in the research, but the quality of the evidence is low.

Based on this information use of manipulation/mobilization would be an effective alternative in the absence of an effective alternative.

I hope you found this interesting and that if you are suffering from any of these conditions

Dr Chris Notley
Winnipeg Athletic Therapist/Chiropractor since 2000

P.S. A great response to the paper I read was from a very well respected Chiropractor, Dr Scott Haldemann. He describes how he uses evidence informed care with his patients. This is a great way to treat my patients. You can read that response here.

Exercise of the Week: Cat-Camel

2012-03-16T16:06:00.000-05:00

To prepare your spine for your work day or if you are suffering with acute lower back pain one of the exercises that I recommend is the cat-camel exercise. This is not an exercise that is intended to be a stretch or to seek greater range of motion. It is more of a mobility exercise.

It has been found that by performing this exercise as little as 5 to 8 cycles is enough to reduce spine viscosity (improving motion) as well as "floss the nerve roots as they exit out of the lumbar spine.

Dr Notley
Chiropractor and/or Athletic Therapist in Winnipeg since 2000

Dr Notley's March 2012 Newsletter

2012-03-15T12:24:00.002-05:00

I hope you are doing well. Here are some of the articles I'd like to highlight to you. They are either blog posts I posted this month or articles I felt to be worth sharing to you.

Myths About Back Injuries

I discovered an interview, on YouTube, of Dr Stuart McGill, a highly respected researcher in the study of spinal biomechanics. He is at the forefront of understanding the effects of exercise and movement on the spine. Learn what he has to say about back injuries. Click the title for more.

Improve your hip mobility

Your hip is a ball and socket joint. It is designed to be a mobile joint allowing the joint to move in all directions. A lack of mobility in this joint may be an indicator of a hip pathology (ie. osteoarthritis) but may also be a cause of lower back pain and knee pain.  Click the title for more.

My knee is aching so it is going to rain
by Tasha Stanton @BodyInMind.org

I remember being amazed by my uncle. He has arthritis in his knees and as a small child I was fascinated by his ‘psychic knees’. And by ‘psychic’ I am really describing the situation where he would look at me and knowingly state, “It’s going to rain…my knees are aching.” And then it would! How did his knees know? What aspects of weather could possibly be influencing his knees? Pressure? Humidity? Overall temperature? The dreary knowledge that if it rains he won’t get the crops in?  Click the title for more.

Choosing a Pillow? Which is best?

I am often asked by my neck pain and headache suffers, "What is the best type of pillow to use when sleeping?" I've always been of the opinion that the pillow depends on the person and the problem they are experiencing but is this what the research says?  Click the title for more.

Fruit is Not the Devil
by Rocofit

All too often when someone decides to lose body fat the first thing they are told is cut back the fruit.
People have now become paranoid that fruit will make them fat! How has this come to be? Fructose, the sugar in fruit, is the culprit and what the fat loss experts love to pick on. The truth is, fructose causes spikes in your blood sugar levels which in turn can lead to weight gain and possibly diabetes, but is fruit to blame?  Click the title for more.

Plantar Fasciitis Self Myofascial Release with a twist

One of my treatment philosophies for my patients is that is it important to provide them with the tools to take care of themselves. When it comes to plantar fascia pain using a ball (golf ball, lacrosse ball, spikey ball) has been helpful in caring for the tightness in the foot. Here is my version but with a twist. Click the title for more.

Barefoot Running: Should you or shouldn't you?

2012-03-06T10:02:00.000-06:00

What do you wear on your feet when you run? Shoes of course! But do you really need shoes? The vast majority of people would say, "Yes, of course!" In Winnipeg half the year is winter running on snow and ice would not be very fun. But there are those who are ditching their shoes all together and training barefoot or in minimalist shoes (. The main reason for training barefoot, by barefoot runners, is often because it helped the person with their plantafasciitis, achille's tendonitis, knee pain, ITB pain, hip pain, or lower back pain.

Proponents for barefoot running indicate that our feet are meant to respond to the surfaces that they encounter and this form of running results in less force on the body. Conventional shoes allow for cushioning and protection from the ground and weakens the muscles in the feet. Running barefoot strengthens the foot.

The skeptic in me started to question. Is there really a difference when running with or without shoes? Do injuries occur less often while training barefoot?

Is there a difference in running style?

So I did a search on pubmed using the terms "barefoot running" and "barefoot running injuries" . This is what I discovered about barefoot running verses running with shoes:

Those who run without shoes tend to land on their forefoot versus their heel (with shoes).
Barefoot runners have shorter stride lengths
Barefoot running has an increase in stride frequency.
Vertical ground reaction forces are lower in barefoot runners

There seems to be a natural change in running style when going from shoes to barefoot. It stands to reason, striking your heel down onto a hard surface would be much more stressful than landing on the forefoot and absorbing the force with the feet and calf muscles.

Do injuries occur less often?

When it comes to injuries there doesn't appear to be any research that shows an actual reduction in injury rate. There was one interesting article that found a reduction in pain in those with chronic anterior compartment syndrome. The two individuals in this study showed improvements with training barefoot and performing rehab exercises intended to prepare them for barefoot running. All other reports were more anecdotal evidence. I also saw a case report of a person who developed a metatarsal stress fracture as a result of running barefoot (abstract only).

In my Chiropractic practise I have had patients report to me of there injuries improving while running barefoot. I have also seen patients who develop Achille's tendonopathy/tendonitis as a result of running barefoot.

Conclusion

There appears to be some logic to the argument of running barefoot. The resolution of symptoms in runners' injuries may be a result of changes in running mechanics thus placing less stress on the offended tissues. The shoes that these runners were wearing, though intended to help, may actually be causing the problem. Weakening of the foot musculature may be the result of many of the foot, ankle, knee, hip or back ailments that runners experience. Therefore, at this point in time, I recommend some barefoot training inserted into a running program. This will give the muscles of the feet an opportunity to train and strengthen.

To prepare yourself for barefoot running, start with walking around your house barefoot. Try walking as if you are sneaking across a floor that squeaks; "tip toe across the floor". Progress to light jogging on grass for short distances. Increase your volume and speed as you see fit. You can also work on skipping and making sure to land on the forefoot; both one leg and two leg skipping. You may also want to consider strengthening up the feet musculature with towel crunch exercises and stretching your calf muscles more frequently.

If you have any questions feel free and ask.

Dr Notley

Sport and Spine Injury Care in Winnipeg

Readings:

Running Barefoot or in Minimalist Shoes: Evidence or Conjecture? - great article providing information on preparing for barefoot running. If you need help finding it just email me.
Running Barefoot or in Minimalist Shoes: Evidence or Foot strike patterns and collision forces in habitually barefoot versus shod runners
Effects of forefoot running on chronic exertional compartment syndrome: a case series.
The rise of barefoot running

Exercise of the Week: Plantar Fasciitis Self Myofascial Release with a Twist

2012-02-22T23:48:00.000-06:00

One of my treatment philosophies for my patients is that is it important to provide them with the tools to take care of themselves. When it comes to plantar fascia pain using a ball (golf ball, lacrosse ball, spikey ball) have all been helpful in caring for the tightness in the foot. You can see a video of this here.

Here is the twist you can try at home. Take a plastic bottle, preferably one that has a smooth and straight shape, like a 1L P3psi bottle and fill it with water. Freeze the water over night. When you are ready to use it get an old wool sock, wet it, and place it on your foot. Then perform the same moves, as the video, on the bottle. The reason for the wet sock is so that the cold can penetrate deeper.

You can also do the same thing with hot tap water using a metal water bottle. The heat penetrates through the metal very easily. Make sure you wear the wet sock to prevent burning yourself and so the moist heat will penetrate deeper into the body.

Give this exercise a try but be careful, especially with the hot water, I don't want to hear you burnt your foot while trying it.

Dr Notley
Chiropractor and/or Athletic Therapist in Winnipeg since 2000

P.S. Be careful don't burn your foot.

Choosing a Pillow? Which is best?

2012-02-20T15:06:00.001-06:00

I am often asked by my neck pain and headache suffers, "What is the best type of pillow to use when sleeping?" I've always been of the opinion that the pillow depends on the person and the problem they are experiencing but is this what the research says?

So what is the best pillow? Is it the chiropractic pillow? Is it a regular pillow? Does the material matter? Rather than sticking with my own opinion, I decided to see what the research had to say regarding the subject. Take a look at the end of this blog to read the research papers I found. I used a pubmed search using the search term "neck/cervical pain and pillows".

Highlights of the research papers I read:

The rubber pillow performed better than subjects' own pillow in most instances. Subjects' own pillow performed similarly to foam and polyester pillows, and there is no evidence that the use of a foam contour pillow has advantages over the regular shaped pillows. Feather pillows should not be recommended.
From a patient's perspective, neck support is an important part of a comprehensive physiotherapy program. Most participants preferred the more rigid support of a Shape of Sleep pillow.
The results suggest that the ARCP (Align-Right (roll-shaped) cervical pillow) has clinically important beneficial effects on the neck pain severity of most chronic neck-pain sufferers.
The water-based pillow was associated with reduced morning pain intensity, increased pain relief, and improved quality of sleep. The duration of sleep was significantly shorter for the roll pillow.
The ideal pillow should be soft and not too high, should provide neck support and should be allergy-tested and washable. The pillow that included two firmer supporting cores for neck lordosis received the best rating.
The opinion was that an ideal pillow should be soft and with good support for the neck lordosis. A specially selected and individually tested pillow with good shape, comfort and support to the neck lordosis (curve in the neck) can reduce neck pain and headache and give a better sleep quality.

Impression

It is evident that not many articles are available to review. From what I see, there is no specific pillow that is best for everyone. The conclusion of the last article provides the best advice, "a specially selected and individually tested pillow" is best. Therefore, try different pillows, those that support the neck, until the best results are experienced.

Dr Notley

Chiropractor/Athletic Therapist of Winnipeg since 2000

Articles

Pillow use: the behaviour of cervical pain, sleep quality and pillow comfort in side sleepers.
Gordon SJ, Grimmer-Somers K, Trott P.
Man Ther. 2009 Dec;14(6):671-8. Epub 2009 May 7.

Abstract
A random allocation single blind block design pillow field study was undertaken to investigate the behaviour of cervico-thoracic spine pain in relation to pillow use. Participants (N=106) who reported preference for side sleep position with one pillow were recruited via a telephone survey and newspaper advertisement. They recorded sleep quality and pillow comfort ratings, frequency of retiring and waking cervical pain and duration of waking cervical pain while sleeping for a week on their usual pillow, polyester, foam, feather and rubber pillows of regular shape and a foam contour pillow. Analysis was undertaken comparing sleep quality, pillow comfort, waking and temporal cervical pain reports, between the usual pillow and the trial pillows, between pillows of differing content and foam pillows of differing shape. This study provides evidence to support recommendation of rubber pillows in the management of waking cervical pain, and to improve sleep quality and pillow comfort. The rubber pillow performed better than subjects' own pillow in most instances. Subjects' own pillow performed similarly to foam and polyester pillows, and there is no evidence that the use of a foam contour pillow has advantages over the regular shaped pillows. Feather pillows should not be recommended.

A comparison of three types of neck support in fibromyalgia patients.
Ambrogio N, Cuttiford J, Lineker S, Li L.
Arthritis Care Res. 1998 Oct;11(5):405-10.

Abstract
OBJECTIVE:
To determine the effectiveness of 3 types of neck support for patients with fibromyalgia (FMS) and their preference for the type of support.
METHODS:
Thirty-five patients with FMS chose the order of application and used each type of neck support for a 2-week period, followed by a 2-week washout. The same schedule was repeated a second time. The neck supports included a Shape of Sleep pillow, two neck ruffs with one standard pillow, and a single standard pillow. All subjects received a physiotherapy treatment and educational program in the home. Outcome measures included visual analog scales (VAS) for neck pain and quality of sleep, the Fibromyalgia Impact Questionnaire (FIQ), and a neck and shoulder pain distribution diagram.
RESULTS:
Analysis using Friedman's 2-way analysis of variance revealed no significant differences in any outcome measure, although there was a trend towards improvement in the FIQ and VAS neck pain and quality of sleep scores for some patients. Most participants (62.9%) preferred the Shape of Sleep pillow, 20.0% preferred cervical ruffs with one standard pillow, and 17.1% preferred a single standard pillow.
CONCLUSIONS:
The results of this study are inconclusive due to the small sample size. However, from a patient's perspective, neck support is an important part of a comprehensive physiotherapy program. Most participants preferred the more rigid support of a Shape of Sleep pillow. Further research into the efficacy of the use of neck support in people with FMS is warranted.

Before/after study to determine the effectiveness of the align-right cylindrical cervical pillow in reducing chronic neck pain severity.
Hagino C, Boscariol J, Dover L, Letendre R, Wicks M.
J Manipulative Physiol Ther. 1998 Feb;21(2):89-93.

Abstract
OBJECTIVE:
To determine the effectiveness (at the 0.1 level of statistical significance) of the Align-Right (roll-shaped) cervical pillow (ARCP) on neck pain severity and headache/neck pain medication use in chronic neck pain subjects.
DESIGN:
The design was a "before/after" (i.e., a "pre/post" trial).
SUBJECTS:
Twenty-eight subjects, 25-45 yr of age with cervical spine pain of biomechanical origin of > 2 on an 11-point ordinal pain scale.
OUTCOME MEASURES:
The primary outcome measure was severity of morning and evening neck pain. The secondary outcome measure was daily quantity of analgesics ingested. The data were analyzed descriptively and inferentially for clinically and statistically significant pre/post intervention differences.
METHODS:
Eligible subjects who successfully finished a 2-wk baseline data-gathering period by mailing in two properly completed diaries each received a pillow and four more diaries (to be filled in over the subsequent 4 wk). Three repeated-measures analyses of variance were performed using the Bonferroni-corrected level of statistical significance of 0.03. Ninety-five percent confidence intervals (for paired-samples mean differences) were also calculated for those pre/post differences that seemed descriptively clinically important.
RESULTS:
The clinically and statistically significant reductions in neck/shoulder pain severity in this sample of chronic neck pain subjects suggest that the ARCP is an effective therapy for target populations with the same profile as this sample. Patient characteristics predicting suitability were not studied in this project.
CONCLUSION:
The results suggest that the ARCP has clinically important beneficial effects on the neck pain severity of most chronic neck-pain sufferers. Further randomized clinical trial research comparing the ARCP with other commonly used cervical pillows is recommended.

Cervical pain: A comparison of three pillows
Robert A. Lavin, MD, Marco Pappagallo, MD, Keith V. Kuhlemeier, PhD
Archives of Physical Medicine and Rehabilitation Volume 78, Issue 2 , Pages 193-198, February 1997

Abstract
Objective: To compare three pillows with regard to pain intensity, pain relief, quality of sleep, disability, and overall satisfaction in subjects with benign cervical pain. The three pillows evaluated were the subjects' usual pillow, a roll pillow, and a water-based pillow.

Study Design: Subjects used their usual pillows for the first week of this 5-week randomized crossover design study. They were subsequently randomly assigned to use each of the other two pillows for 2-week periods.

Patients: Forty-one subjects with benign cervical pain syndromes and free of cognitive impairments.

Main Outcome Measures: Visual analog scale (VAS), Sleep Questionnaire, Sickness Impact Profile (SIP), and a satisfaction scale rating the pillows.

Results: The water-based pillow was associated with reduced morning pain intensity, increased pain relief, and improved quality of sleep. The duration of sleep was significantly shorter for the roll pillow. Overall SIP findings showed a significant advantage for the water-based pillow over the roll pillow and standard pillow.

Conclusions: Proper selection of a pillow can significantly reduce pain and improve quality of sleep but does not significantly affect disability outcomes measured by the SIP.

Neck support pillows: a comparative study.
Persson L, Moritz U.
J Manipulative Physiol Ther. 1998 May;21(4):237-40.

BACKGROUND:
Special neck support pillows claiming to improve rest and reduce neck pain are currently being advertised.
OBJECTIVE:
To test whether neck pillows have any positive effect on neck pain and quality of sleep compared with usual pillows and, if so, to find the optimal characteristics of such a pillow.
METHODS:
Thirty-seven hospital employees and 18 neck patients were asked to test six neck pillows with different shapes and consistency randomly over the course of 3 wk, to grade them according to comfort and to describe the characteristics of an ideal pillow.
RESULTS:
Thirty-six of 55 persons found the pillows positively affected sleep and 27 of 42 found that they positively affected neck pain. The ideal pillow should be soft and not too high, should provide neck support and should be allergy-tested and washable. The pillow that included two firmer supporting cores for neck lordosis received the best rating.
CONCLUSION:
A neck pillow with good shape and consistency and with firm support for cervical lordosis can be recommended as a part of treatment for neck pain.

Neck pain and pillows – A blinded study of the effect of pillows on non-specific neck pain, headache and sleep
Liselott Persson
2006, Vol. 8, No. 3 , Pages 122-127 (doi:10.1080/14038190600780239)

Neck support pillows are widely used in patients with neck pain to reduce pain and get better quality of sleep. To test whether specific neck pillows have any effect on neck pain, headache and quality of sleep in people with chronic non-specific neck pain and to find the optimal characteristics of such a pillow, 52 patients with chronic neck pain tested four different pillows (three specially designed neck pillows and one normal pillow) with different shapes and consistency randomly over 4–10 weeks. The patients graded them according to comfort and described the characteristics of an ideal pillow. The effects of the pillows on neck pain, sleep quality and headache were stated on a questionnaire. Forty of the 52 patients found a positive effect on the neck pain, 24 of 31 (77%) reported a positive effect on night's sleep and 19 of 31 (61%) a positive effect on headache. There were no differences in graded comfort between two of the specially designed neck pillows and the “normal pillow” in the test. The opinion was that an ideal pillow should be soft and with good support for the neck lordosis. A specially selected and individually tested pillow with good shape, comfort and support to the neck lordosis can reduce neck pain and headache and give a better sleep quality.

Exercise of the Week: Hip Internal Rotation

2012-02-15T22:59:00.000-06:00

Your hip is a ball and socket joint. It is designed to be a mobile joint allowing the joint to move in all directions. A lack of mobility in this joint may be an indicator of a hip pathology (ie. osteoarthritis) but may also be a cause of lower back pain.

Hip internal rotation is a common problem I see in patients. A lack of hip internal rotation has been associated with osteoarthritis. In addition, if the lack of range of motion is only on one side it is associated with sacro-iliac pain. If there is pain on both sides it has been associated with lumbar (lower back) pain.

So how can we increase range of motion?

Here is a new exercise I have just discovered that I would like you to try. The concept is to activate the core, which should be stable, to allow for the hip to move on its own.

Tell me what you think. Leave a comment.

Dr Notley
Chiropractor and/or Athletic Therapist in Winnipeg since 2000

Myths About Back Injuries

2012-02-12T22:26:00.001-06:00

I discovered an interview, on YouTube, of Dr Stuart McGill, a highly respected researcher in the study of spinal biomechanics. He is at the forefront of understanding the effects of exercise and movement on the spine. I have mentioned his research before in this blog.

The information mention in this video is too good to not share with you. I spent the time to transcribe everything that was said in the video and posted it here. If you have the time to watch the video you can check it out here.

Myth #1: Back Injuries are rare

Most people will not get through out life without some element of back pain impinging on their activity.

Myth #2: You need a flexible back

Statistically, those who have more range of motion in their back have a greater risk of back disorders in the future. So having a flexible spine is not protective. In fact, it's quite the opposite. The muscles of the legs, arms, shoulders and hips are designed to create force throughout a range of motion resulting in movement. Muscles of the spine, or core, or torso are designed to do quite the opposite; they stop movement

Myth #3: To avoid injury, you need a strong back

Having a very very strong back is not really preventative for a back injury. What turns out to be important is the endurance.

Myth #4: Bend your knees when you lift

Proper lifting mechanics require you to actually lift with the hips, not with the knees. Otherwise, you will just end up with knee arthritis.

How do you do that?

Refer to video:
We are going to slide our hands down our thighs and go down a little bit more to grab the basket and slide it up your thighs and pull your hips through. (He is describing the hip hinge)

Myth #5: Suck in your belly to work your core.

This idea of drawing in your belly to activate a muscle called transverse abdominus when you are performing exercise is highly problematic and it's a myth. When you measure the role of that muscle and the ability to stabilize the spine you do not want to suck it in; you simply stiffen the abdominal wall.

How do you do that?

So the stir the pot exercise requires the feet to be quite wide, she's stiffening controlling through this part of her spine (abdominal region). And now she's just going to swirl her elbows around in circles we call this exercise, stir the pot.

How else? (2:05)

(Patient in quadruped position) We are going to spend time to flex the spine and extend your spine. Finding that neutral position here which is lowest stress for her back. At that point she stiffens her abdominal wall. Then she is going to extend opposite arm and opposite leg moving about the hips and the shoulders; hold that posture for about 10 seconds. We release the cramp? by having her sweep the floor with her knee and hand and back out again. All motion taking place only at the hip and shoulder

How do you train harder?

So we are going to increase the value of this exercise. She's going to make a fist and co-contract and stiffen her arm all up through her back which brings up her upper back here. Then she's going to challenge the different neuromuscular components in her back by drawing squares with her arms and legs.

Myth #6: Sit-ups/crunches give you a six pack.

(Describing the crunch) What she's doing is flexing her spine like this, stressing the posterior part of the annulus (intervertebral disc) which eventually if she does enough of them will cause the damage that we see here; namely a disc bulge.

What should you do instead?

We'll shift her to a different style of curl-up. Put her hands in the small of her low back to support her low back so it doesn't flatten to the floor. And she will straighten one leg. And she is just going to up, just unweighting her head and shoulders; not too much. The motion is hardly moving at all. And we will bring up the elbows (off the floor) and she is very stiff through this region (abdominal region) here. She'll count to ten and slowly put her head and shoulders down and rest and then release the contraction.

Can you avoid injury by not exercising?

Optimal back health doesn't come from doing nothing. It comes from doing the perfect optimized amount; not too much and not too little.

If you want to learn more about back care check out Dr Stuart's Website. This is not an affiliate link.

I hope you enjoyed

Dr Notley
Chiropractor/Athletic Therapist in Winnipeg since 2000

Exercise of the Week: Stir the Pot

2012-02-08T22:29:00.000-06:00

The stir the pot exercise is an excellent exercise that facilitates the anterior chain of the body (the front side of the core). It is an exercise I give to my back pain patients and shoulder injury patients. One of the reasons I like it is that it makes training more interesting rather than simply performing the plank. Another reason is that it incorporates core stability with arm movements; which is much needed. Many times we see core instability that results in shoulder injuries. Throwing athletes with poor core stability end up using their arms to throw rather than transferring the forces from their legs through their core to their arms. This leads to shoulder injuries. In addition to activating the core it also activates the shoulder blade stabilizers (rhomboids, trapezius and serratus anterior).

If you feel confident with your plank exercise then grab a theraball and give this exercise a try. Leave a post if you have any questions or comments

Dr Notley
Sport and Spine Care

Dr Notley's February 2012 Newsletter

2012-02-05T22:21:00.000-06:00

I hope you have all enjoyed January. Winnipeg has been absolutely beautiful. It was so unseasonably warm that it felt like spring rather than winter.

I would like to remind you of two things about this month. Valentine's Day is on the 14th just in case you haven't bought your special someone something and February is Heart Month. Valentine's Day is meant to show the one we love that they have our heart and Heart Month is to remind use that we need to love our heart. We need to take care of it by staying active, reducing stress, and with healthy eating.

Enjoy the Newsletter.

New Blog Feature!

I have added a new feature to my blog. Every week I will add a new exercise for you to learn. Many of these exercises are ones that I give to my chiropractic patients. Just check click on the "Exercises" tab at the top of the page; Or just click here.

My Volunteer Experience: Frostfit Games at Crossfit Winnipeg

This past month I volunteered my services as a Chiropractor, Athletic Therapist and Active Release Techniques provider at the Frostfit Games at the new Crossfit Winnipeg. For those of you who have not heard of Crossfit this is what it is.

Chiropractic at the Super Bowl
from Chiropractic Economics
As the New England Patriots and New York Giants prepare to play on the biggest stage of all for football fans -Super Bowl XLVI - the Foundation for Chiropractic Progress (F4CP) points to the role of the team Doctos of Chiropractic in optimizing functionality, endurance and overall conditioning.

I'd also like to point out that these Chiropractors also use the technique that I perform on my patients and athletes, Active Release Techniques. Click here to learn more

Back Care: McKenzie Extensions

One of the most troubling conditions, for my lower back pain patients, is when they experience symptoms down their leg (commonly known as sciatic). One of the reasons for this is a result of irritation to the nerve root at the spine. A possible reason for this is due to a herniated disc bulging out against the nerve root.

Mckenzie extensions might be able to help you. Click here to learn more

Knee Stability Audit

By Dr Brad Cole

Your knee is the trash can of your lower extremity. It collects all the garbage of poor stability and starts causing pain. It is painful during or after activity because of improper use. While poor movement drives inflammation and pain, proper movement is like massage for our joints.

Do you have knee pain? are your knees stable? Check this out

Have a great month!

Dr Notley

Chiropractor and Athletic Therapist in Winnipeg

Exercise of the week: Overhead squat facing wall

2012-02-01T22:36:00.000-06:00

This week I'd like to introduce to you the overhead squat while facing the wall. This is one of the exercises that I had recently recommended to some of the people at Crossfit Winnipeg. The reason I prescribed the exercise to them was to help them with improving their mobility in their thoracic spine. This was one of the reasons for their shoulders being a problem when they performed the overhead squat.

I like this exercise because it seems to reflexively help with the extension of the thoracic spine during the squat. You don't have to think about it to experience movement in the mid back.

Not only will improving the thoracic mobility help with the shoulders but it will also lessen the stress on the lower back. I also like this exercise because it teaches us to use our hips during the squat and since the wall gets in the way it prevents our knees from moving too far forward.

If you have any questions or comments feel free and post.

Dr Notley
Chiropractor/Athletic Therapist in Winnipeg

Crossfit Winnipeg

2012-01-29T23:01:00.001-06:00

This weekend I volunteered my services as a Chiropractor, Athletic Therapist and Active Release Techniques provider at the Frostfit Games at the new Crossfit Winnipeg. For those of you who have not heard of Crossfit this is what it is.

I had the opportunity to meet some great coaches/athletes such as Wendy Novotny, Rich Thomas, Brad Sarna, Lindsay Ingram and others from Crossfit Winnipeg and Crossfit 204.

Crossfit requires both a physical and technical component to perform the exercise programs provided by the coaches. As fatigue sets in technique is of utmost importance. Since I take technique seriously when it comes to lifting weights my eyes were focused on how the competitors were performing each exercise. Some performed technique beautifully, while others, well, lets just say, not so beautifully.

The Overhead Squat

The most common problem I treated for the athletes was shoulder pain. This is likely due to the fact that a number of the exercises required the shoulders to be over head, for an extended period of time, and under a significant load. An example of this is the overhead squat. The most common position to have the shoulder dislocated is when the shoulder is abducted away from the body and externally rotated. This places a considerable amount of strain on the front of shoulder joint.

When I look at an athlete with shoulder pain I look at mobility and strength of the shoulder joint, the mobility of the shoulder blade as well as the mobility of the thoracic spine. All have to be moving optimally and with adequate strength. If an athlete can't extend their thoracic spine far enough their shoulders have to rotate further back therefore adding more strain on the front of the shoulder.

If the athlete's pain was in either the front or the back of the shoulder one of the most common muscles that I found to be hypertonic was the subscapularis muscle. This is one of the rotator cuff muscles that helps to protect the front of the shoulder. I also found many of these same athletes had restricted thoracic rotation/extension to the same side as the shoulder.

Active Release Techniques worked fabulously to help release the hypertonicity of the subscapularis muscle. In addition to treating this muscle, I also provided those who had problems with thoracic mobility with exercises such as ones I mentioned before in a previous blog.

Treating Crossfit athletes, and other athletes, requires an understanding of the movements they perform, the common errors that occur in their training/competition and understanding that the source of their pain is not always the cause of their pain. All aspects of movement (mobility, strength, motor control, core activation etc) need to be addressed to tease out the athlete's problem.

I would like to thank Tania at Crossfit Winnipeg for inviting me to take care of the competitors. I would also like to congratulate her on a successful Crossfit Games in a superb facility.

Dr Notley
Treating athletes as a Chiropractor/Athletic Therapist since 2000

P.S. Make sure you read the disclaimer at the bottom of this post.

Exercise of the Week: Hip Hinge

2012-01-25T23:37:00.001-06:00

The hip hinge is not an exercise to increase strength or build flexibility. It is an exercise to activate our hips to flex. When I watch people bend over to lift up a box, change a baby or to brush their teeth one of the most common errors in movement that I see is that they bend at their lower back rather than at their hips. There may be a number or reasons why this is occurring but one possible reason is poor motor control.

The hip hinge exercise, with a broom stick is a great method to help improve the ability to use the hips. Being able to move better at the hips means less strain on the lower back and on the knees. For athletes, it will help improve their squats and deadlifts. The gluteal muscles are powerful muscles, not using these muscles can seriously limit your athletic ability or your ability to perform your job if you have a job that involves heavy lifting.

How to Perform the Hip Hinge

Get a broom stick from your closet or a hockey stick and place it behind your back. One hand holds the stick at the lower back and the other hand holds the stick at the neck. The back of the head, mid spine, and sacrum should be in contact with the stick. Then unlock your knees and push your buttocks backwards to allow you to bend forward. The knees are allowed to bend but not so much that it becomes a squat; no greater than approximately 20 to 30 degrees. As this is performed the mid back will extend and lose contact with the stick; this is desirable. What you should not see is the neck or sacrum lose contact with the stick. If you are performing this correctly you should feel as though you can wiggle your toes without falling.

Give this activity a try before working performing squats, deadlifts or kettlebell swings.

Are you able to perform this exercise? Are you having troubles with it?

Dr Notley
Chiropractor/Athletic Therapist in Winnipeg since 2000

Back Care: Mckenzie Extensions

2012-01-22T22:58:00.002-06:00

One of the most troubling conditions, for my lower back pain patients, is when they experience symptoms down their leg (commonly known as sciatic). One of the reasons for this is a result of irritation to the nerve root at the spine. A possible reason for this is due to a herniated disc bulging out against the nerve root.

Most disc injuries are a result of flexion (forward bending) and rotation. Herniated discs typically are found on the back of the disc and tending to be on one side over the other. I liken the disc of the spine as a jelly filled doughnut. The outer layers are tough and fibrous (unlike a doughnut); imagine it like an onion with multiple layers. The inner portion is gelatinous. If you take a jelly filled doughnut and smash it with your fist the jelly squirts out the area of least resistance through the hole where the jelly was injected (that's why your first bite should be where the hole is so you don't squirt someone). In the case of a disc herniation the gelatinous portion pushes in the direction where the outer layers have been weakened. This can cause a bulge to the disc. If large enough this herniation can affect the nerve.

It would stand to reason that moving in the opposite direction would help squish the bulge back into the centre and therefore reduce irritation on the nerve root and the symptoms down the leg. This is called centralization. Robin Mckenzie, a therapist from New Zealand, popularized the use of back extension exercises for back pain and has been reported to have success in reducing patients' symptoms. Though I am not trained in the Mckenzie Method, here are some extension exercises that I give my patients. I have found success with people performing about 10 repetitions, holding for 10 seconds each repetition. This can be done when symptoms occur or periodically throughout the day. I do not recommend these exercises if they increase symptoms.

I recently found a research article which found evidence of a disc bulge being reduced. This research paper used porcine (pig) spine to examine the effects of repeated extensions on disc bulges. Just so you know pig spine (the neck region) is very similar to a human's lumbar (lower back) spine.

This is what the researchers found:

Repeated pure extension or extension with side flexion (depending on the location of the herniation) after disc prolapse was found to redirect the displaced portions of the nucleus back to the central part in a number of discs.
The frequency of repeated extension was one extension per second (1 Hz)
The number or repetitions were at least 900 repetitions.
The specimens that did not respond to reversal testing had prolapsed to a greater extent (more volume posteriorly and closer to the outer annulus) than those that did respond

Based on this finding we can see that not all people will respond to this treatment. We have to remember that even if we reduce a herniated disc it may not be the reason for the back pain. We already know that there are people sitting reading this post who have a herniated disc but no back pain.

I often suggest these exercises especially for those who are involved in jobs that result in activities with repeated or sustained flexion or rotation. I have even used it as an ounce of prevention.

Dr. Notley

Winnipeg Chiropractor/Athletic Therapist since 2000

P.S. Based on this information I will be changing how I use this exercise. I will be seeing how repeating extensions every 1 second and increasing the number or repetitions will result in improvement in my patient symptoms. I'm always learning and willing to change based on what the research says.

Exercise of the Week: Pallof Press

2012-01-19T21:40:00.000-06:00

This week I would like to introduce to you the Pallof Press. This is one of those core exercises that look simple to perform but can be a great challenge in preventing spinal rotation. Having the ability to keep the core stiff allows energy to be transfered from the hips to the shoulders in activities like throwing a ball, and ultimate frisbee or taking a slap shot in hockey. The lack of ability to resist rotation increases the stress on the spine such as the discs and the joints during those same activities. This can lead to back injury and back pain.

Check out a video of the Pallof press here

The physics behind the pallof press is based on levers. The longer the lever the more rotation will be produced therefore more need to resist that rotation.

How to perform the Pallof Press:

You can use a pulley system, tubing, or trx rip trainer to perform this exercise

Stand facing perpendicuar to the pulley.
Grap the handing with both hands and close to your body
Step away from the pulley to lift the weight, or to add tension to the tubing/TRX Rip Trainer
Straighten arms out in front of you until they are straight

Make sure that there is no hip rotation or shoulder rotation while holding the end position for a few seconds.

Variations

There are different ways to challenge yourself with this exercise. Try these:

On your knees
Kneeling lunge position
Standing with legs wide
Standing with legs narrow
Standing in the athletic stance
Standing on one leg

Give this exercise a try next time you work on your core but make sure that you have good posture. Your shoulders and head should be back and there should be a slight arch to the spine.

Enjoy the exercise.

Dr Notley
Forever learning Chiropractor/Athletic Therapist

Protect the Spine: The Kettlebell Carry

2012-01-16T00:06:00.000-06:00

If you have read this blog before, I have expressed my personal interest in using the Kettlebell as an exercise tool and for back conditioning. Sadly, finding research on this piece of equipment is few and far between. I got lucky recently when I found a research paper by Dr Stuart McGill (One of the leading researchers in spinal biomechanics) . The paper is titled, "Kettlebell swing, snatch and bottoms-up carry: Back and hip muscle activation, motion, and low back loads".

The part of the research paper, that I want to talk about today, compares the core musculature activity while performing the kettlebell carry in the rack position and the kettlebell in a bottoms up position. Both of these carry positions were compared to the muscular activation of the core during normal walking.

Kettlebell Rack Position Carry

Kettlebell Bottoms Up Carry

The Findings

Dr McGill discovered that muscular activations of the core were significantly greater with the bottoms up carry. In addition to this, the joint compression and shear forces to the spine were greater with the bottoms up carry as well.

It is believed that the increase in muscular activation is due to an increase in core stiffness as a result of an increase in required grip strength. To keep the kettlebell vertical requires more grip strength than to keep it in the rack position. I've tried this position and it can be very difficult to hold.

My Thoughts

It is interesting to note that there is a difference in core activity even though the weight is the same. What does this mean for you to help you take care of your back?

If you are in the process of rehabilitating your lower back then this would be a challenging, fun, way to progress your conditioning of the core musculature without increasing the weight load.

For those who have back pain, which is influenced by the amount load on the spine, you may need to look at how you hold objects in your hand. Holding objects in various positions or holding different sized objects that increase the need for grip strength, while walking, will affect the muscular activity of the core as well as the load on the spine.

I hope you found this interesting.

Dr Notley

Taking care of back pain in Winnipeg since 2000

Exercise of the Week: RKC Plank

2012-01-11T22:23:00.000-06:00

I discovered this exercise recently on-line so I decided to forward it on to you. I have talked about the plank in a number of my posts. It is one of the core exercises that I use for my Chiropractic patients who have poor motor control of the anterior portion of the body and it is often a part of my back care exercise program.

The RKC plank, video by Bret Bontreras, is a new twist to the basic plank. The only different between it and the basic full plank is that there is added contraction of other muscles.

The client is asked to clench there buttocks, contract their quadriceps, attempt to externally rotated the arms and at the same time attempt to bring the elbows and toes to each other. It is an interesting concept to an old exercise. I would love to see someone like Stewart McGill analyse this exercise and compare to the basic plank.

Give it a try. What are your thoughts?

Dr Notley
The only Chiropractor/Athletic Therapist in Winnipeg

Dr Notley's January 2012 Newsletter: Helping You Get Healthy

2012-01-08T16:16:00.000-06:00

Happy New Year to you all!

This is the time of year that so many of us are starting our new year's resolution. Weight loss or improved fitness is one of the most often resolutions that are made. Sadly, around 80% of resolutions are doomed for failure. To help you with goals here are several articles that may help you along the way.

Weight Loss and Getting Healthy Success Story - An Interview

As you may know, I am on Twitter (@DrNotley). I meet many interesting people on there and see many people who have had successes in their goals of loosing weight and getting healthy. One such individual is Kym (@kymberley76). Kym is a true success story and she should be applauded for her transformation. She did it the old fashioned way; hard work and good nutrition.

Click here for her interview.

Getting the Motivation towards Achieving Better Health

I am sure you have been told that you need to make a plan on how you are going to eat (meal plans) or exercise (workout plans) to a serious attempt at getting healthy. You can have the best plan in the world created by the best Chiropractor, Athletic Therapist, Personal Trainer or Nutritionist but you will fail miserably if you do not have the motivation to stick with it.

Motivation is the "things" that induce you to act a certain way. Motivation is involved in every aspect of our life; work or play. Without motivation you will not continue pursuing your goals. Be aware that some forms of motivation are better than others though especially when it comes to healthy living.

Click here for more

The 10 Rules of Healthy Living
a post from LiveStrong.com

Years ago, I used to start planning my New Year’s resolutions almost a little too early. At the time, I was either too young or too naïve to realize what I was really doing: Procrastinating. I may have seemed ambitious, but I was spending so much time looking toward the future that I completely ignored the present. As a result, I was taking two unnecessary steps back before beginning my journey forward.

Read more here.

12 Essential Tips for Healthy Eating

Throughout my years in health care as a Chiropractor, Athletic Therapist and a Strength and Conditioning Specialist, these are the top tips, in no particular order, which I have found to be excellent pearls of wisdom. I have simplified the tips because it is better to keep your diet simple than complex. Remember; do not get caught up with the fads at the time. Keep it simple. Do your best to follow the Canada food guide.

Read more here

Get in Shape without Injuries

You may be motivated to get in shape and you have the gym membership but you won't be able to get in shape if you get hurt. Take a look at these tid-bits of information of minimizing the chance of getting hurt as you start your exercise program.

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Top 10 Lessons for 2012
From Precision Nutrition

Get in the best shape of your life faster, do it the easy way, and make it last.

The guys at Precision Nutrition know their stuff and they can show their results. This is a must read. Make sure to take a look at the video as well!

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I hope you have a wonderful rest of they year and you are able to reach your new year's goals

Dr Notley
Proudly serving Winnipeg as a Chiropractor/Athletic Therapist since 2000