Dr Notley's Spot on Health

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 said 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 hold 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 pushed 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.

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.

Go here to read more

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!

Go here for more

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

Happy New Year Wishes 2012

2012-01-01T21:03:00.000-06:00

HAPPY NEW YEAR!

I would like to extend my best wishes to you and your family for 2012.

These are my wishes to you:

Continued or improved health through appropriate diet and exercise.
Rekindled relationships that have been lost with your friends or family.
Your life will be blessed and prosperous; more success at work, with your marriage, with your kids, etc.
That you will not have to see me at my Chiropractic clinic as much or at all.

Dr Notley
Chiropractor and Athletic Therapist at Downtown Chiropractic and Gelley Chiropractic in Winnipeg

Santa Clause at Risk for Back Pain

2011-12-23T10:59:00.001-06:00

From Wikipedia

Just for fun, I started to think about whether or not Santa Clause would have back pain. Based on my knowledge as a Chiropractor and Athletic Therapist, as well as my experience of treating back pain these are my thoughts.

I feel for Santa, he has a very important job to perform once a year. Thankfully, Santa has his elves helping him make all the toys for the boys and girls. It was smart of him to delegate some of the work. If he had to do all the work himself he would likely experience repetitive strain injuries in his wrists, elbows, shoulders, neck in addition to his lower back.,/p>

Sadly though, in the case for lower back pain, the odds are against Santa. Approximately 80% of people will have suffered from back pain at least once in their life. The reoccurence rate is also high amongst those who have had a previous back injury.

Here are some of the risk factors for back pain that Santa possesses.

Smoking

Years ago Santa was a smoker. Just check out this Google search for images of Santa smoking. Smoking is one of the risk factors for back pain. People who smoke tend to experience degenerative disc disease of the spine. Santa may not be smoking now but the damage to his spine has already been done. We have to assume that Santa doesn't smoke now but he may be hiding it since he knows that it would be bad for his image as smoking has become less socially acceptable. In addition, smoking is associated with chronic pain which is often experienced by those who have had a back injury.

Overweight

It is rather evident that Santa is overweight. Every time he laughs his belly jiggles like a bowl of Jello. The extra weight he carries places added strain onto all of his weight bearing joints, including his spine and the intervertebral discs between his vertebrae. This added strain can lead to an intervertebral disc derrangement/herniation and possibly lead to sciatica down his leg. With his extra weight in his belly his spine needs to extend backwards so he can stay upright. This can cause abnormal compression onto the joints between the vertebra causing what is known as facet syndrome.

In addition, with Santa being overweight he may be suffering from Metabolic syndrome which has also been associated with lower back pain. Metabolic syndrome is linked to Type II diabetes. Considering all of the cookies that Santa consumes on Christmas Eve he likely has Type II Diabetes (He may want to learn how exercise can help with diabetes). Santa may also want to consider better eating habits and read this great weight loss success story by my friend Kymberley (She has now lost 80lbs!).

Age

Typically disc herniations occur around 25 and 45 years of age. Santa has been around for a long time. His origins begin back in the 4th Century. That would make him very old. One might assume that he is from a lineage of Santa Clauses and if that is the case, the white beard likely places him in his 60s or later. At this age we are more concerned about arthritis of the joints or even stenosis of the intervertrabal foreamen where the nerves exit the spine. Arthritis of the spine has sometimes been called "grey hair of the spine". It is a natural process and thus it is highly expected to be found in Santa's X-rays.

Inactivity

It is quite evident that for most of the year Santa is inactive. He likely has not performed any core exercises to aid in protecting his back and he likely doesn't have the muscular strength or endurance to perform his job without fatigue. You would think that he needs considerable strength to hold the reins of his flying reindeer and to climb up the chimney after leaving from a house. Inadequate core strength and fatigue results in poor technique and can increase the chance of hurting your back. The problem with having to work only once a year is similar to the weekend warriors who only play on the weekend and do not exercise any other time of the week. Weekend warriors are often the ones who get injured.

Uneven lifting

Santa has to carry a heavy sac of toys. Carrying a sac over one shoulder (likely the same shoulder all the time because of our tendency to be one side dominant) places excessive strain on one said. This would likely result in muscular imbalance and ultimately back pain. He should follow the advice of a Chiropractor and use a backpack to evenly distribute the weight across both shoulders

Long sitting followed by heavy lifting

Truck drivers are often at risk for back pain one of the reason is due to the long sitting. They are even more at risk for a lower back injury if they go for long sitting to lifting activities. The intervetebral discs are more at risk for injury at this time. In addition, if Santa lifts with poor technique he is further risking himself for injury. Many people with back pain have poor movement patterns. One of the poor patterns is flexing forwards at the spine rather than at the hips. Since Santa appears to be an inactive individual we can assume his movement patterns may be faulty. He needs to learn how to hip hinge.

Stressful job

Stress is another risk factor for back pain. Santa likely gets very stressed with his job. He has billions of letters to read and he has to watch over every child making sure they are naughty or nice. The naughty kids must make him want to pull his hair out (I wonder if that is why he wears that hat all the time). For most of the year his job must be pretty thankless. As Christmas Eve gets closer he has to make sure everything is perfect. In addition, he has a deadline that can't be extended. He has to get presents to all the boys and girls before they wake up. If he doesn't they won't be very happy. He should try mindfulness meditation to help with his stress.

Conclusion

As you can see the odds of Santa having back pain are very high. Thankfully a number of these risk factors can be controllable while others are completely out of his control. I highly suggest to Santa that he should seek out some help in managing his weight, developing his core, and developing his strength and endurance. There are great Chiropractors, Athletic Therapists, Personal Trainers and Physiotherapists out there who can help. In addition he may want to try massage, Active Release Techniques, or acupuncture to help manage the back pain. With a good team of healthcare providers you can manage your back pain more effectively.

Do you have any of these risk factors for back pain and do you have back pain? If so you may want to become proactive in your health seek out a health care professional that you can trust and start your New Year on the road to recovery.

I hope you all enjoyed this fun blog. Have a Merry Christmas!

Dr Notley

P.S. Hey Santa, if your back is hurting on Christmas Eve and you need to see a Chiropractor or Athletic Therapist in Winnipeg I have a table at home. You know where I live.

Chiropractic Care: A Firefighter's Testimonial

2011-12-07T22:21:00.001-06:00

I would like to share with you a testimonial by one of my clients. She sent this email to me this past week.
Lindsey is a very impressive athlete and Firefighter. Check out her accomplishments for 2011. Note that she has competed in a variety of fitness challenges.

I've been getting treated by Dr. Notley for a couple of years now. With the number of sports I do, not to mention my job, I need to be ready to go at all times. Dr. Notley makes sure that I am. I had knee surgery in 2010 and I've come back to have a breakthrough competitive season. Dr. Notley has been an integral part of my success.

Thank you!

Lindsey Ingram BPE, CSCS

FirefighterStrength and conditioning coach

Here are Lindsey's Results for 2011

2nd place team firefighter division, stair climb race, Dallas TX
2nd place La Coupe olympic weightlifting competition
2nd place, tall and masters categories, MABBA figure novice show
1st place age group St. Malo triathlon
8th place age group Warrior Dash Minnesota (36th out of 4,374 overall)
7th place age group National triathlon championships
1st place Regional Firefit competition
2nd place National Firefit competition
3rd place World Firefighter Combat Challenge
3rd place co-ed tandem World Firefighter Combat Challenge

Lindsey trains people out of CrossFit 204. If you are looking for someone to train you check out the website.

Thank you for your email Lindsey
Dr Notley

Dr Notley's December 2011 Newsletter

2011-12-06T23:06:00.001-06:00

Winnipeg feels like it is colder than usual this December. If you have found the time away from preparing for Christmas then stay inside, grab something warm to drink, sit down (don't slouch) and enjoy this month's Newsletter.

Improve your mental health. Get up and get moving!

From the blog of the people at ParticipAction this is an interesting article on exercise and mental health: "I recently completed a fascinating course on the subject of exercise and sport psychology. I’ve long been a believer in the importance of regular physical activity for physical, mental and emotional health… but some of the research I reviewed in the course was so interesting that I wanted to share it."

Click here to check out the information

Back Pain: It is not always typical

http://drnotley.blogspot.com/2011/11/back-pain-it-is-not-always-typical.html
As a Chiropractor, I treat a number of people because of back pain. I have a number of patients who come in figuring they have typical lower back pain (disc derrangement, facet syndrome, sciatica, mechanical lower back pain) and most times they are correct. But there are those situations where it isn't typical. One of the atypical situations that I have seen is lower back pain due to cancer. Though this is a rare occurence (about 1% of all back pain), and this post isn't meant to scare you if you have back pain, early recognition of cancer is crucial for your future health. Click here to learn more about the important features to recognize that your back pain is not typical.

Tips on Minimizing the Risk of Back Pain While Shoveling

As winter approaches I start to see more people seeing me for their back pain as a result of shoveling snow. Check out these tips on how to prevent back pain from shoveling.
http://drnotley.blogspot.com/2010/11/tips-on-minimizing-risk-of-back-pain.html

Technique. Technique. Technique.

I am a stickler for proper form. Building strength with a poor foundation will result in poor overall performance and an increased chance of injury. Check out this video. My understanding of this video is that they were people at a seminar for training strong man moves. It is obvious that the weight they were lifting was too much for their technique. There were a few times that I cringed watching this video.

Plank It

From the people at DailySpark: The plank, according to many experts, is by far one of best exercises we can do to help strengthen our core--the muscles that support our back and abdomen. And because there are many different variations in performing this exercise, they also help strengthen our hips and pelvic floor, as well as our shoulders and arms. Click here for more.

The plank is a great way to strengthen your core aid in improving your performance in sports and the treatment of back pain. you can also take a look at my blog posts on how to make the plank harder (Front Plank New Challenges and Front Plank Exercise More Challenges) and how to make the plank easier.

MRIs and the lower back controversy

As a Chiropractor lower back pain is one of the most common problems that I see at my Winnipeg offices. A number of my patients come to me with an MRI report in hand and it's findings. These findings can give us some good information about our patients in conjunction with a full history and physical examination. On its own, the results of the MRI may result in an improper diagnosis. Click here for more.

Have a Merry Christmas

Dr Notley
Chiropractor/Athletic Therapist in Winnipeg since 2000

Active Release Technique: Continuing Education

2011-12-05T22:23:00.001-06:00

As many of you know, I am Certified Active Release Techniques (ART) Provider. If you do not know what Active Release Techniques is, in brief, it is a soft tissue release technique (muscle, nerve, fascia) that I use in conjunction with my other forms of care (spinal manipulation, acupuncture and corrective exercises). I have a number of athletes in Winnipeg who seek out my care because I am an ART provider.

ART is a highly respected technique, especially by the people who train for the Ironman. These athletes beat up their bodies day in and day out to prepare to compete at an Ironman competition. In addition, many if not all of the NFL football teams have ART providers on their staff. These athletes experience acute injuries and repetitive strain injuries and ART can be great for these problems but this technique is not just for athletes; it is just as effective for non athletes as it is for athletes.

Yearly, to maintain my certification, I need to attend one of the courses provided by the people at Active Release Techniques (ART). What I enjoy most about attending these seminars is that it improves my skills. I learn something new every time I go and I get better at treating my patients. I recently attended an ART Spine seminar out in Las Vegas, Nevada. Since many of my patients have spinal related injuries this is an important seminar to attend.

In addition to helping you with your back and neck pain the techniques I learned from this seminar will help you with your:

Headaches
Shoulder pain
Hamstring pain
Groin pain
Hip flexor pain
Numbness/tingling in the arms and legs

If you are experiencing any of these problems feel free and email me to find out if ART may be right for you.

Dr Notley

Active Release Provider since 2006

The MRI and Lower Back Pain Controversy

2011-11-27T21:00:00.001-06:00

As a Chiropractor lower back pain is one of the most common problems that I see at my Winnipeg offices. A number of my patients come to me with an MRI report in hand and it's findings. These findings can give us some good information about our patients in conjunction with a full history and physical examination. On its own, the results of the MRI may result in an improper diagnosis.

I found an old research paper titled, Magnetic Resonance Imaging of the Lumbar Spine in People Without Back Pain, written in the New England Journal of Medicine, July 1994. Here are the highlights of what they found after looking at the MRIs of 98 people between the ages of 20 and 80:

64 percent of the images had one lower back intervertebral disc abnormalities and 38 percent had abnormalities at more than one spinal level.
The prevalence of disc abnormalities increased the older the person was.
67% of those over 50 years of age (27 people) had disc abnormalities
27% of those under 50 years of age (71 people) had disc abnormalities
Those who exercised more were more likely to have a disc abnormality.

When is it appropriate to have an MRI? I found this on the Spine Health website

After 4 to 6 weeks of leg pain, if the pain is severe enough to warrant surgery
After 3 to 6 months of low back pain, if the pain is severe enough to warrant surgery
If the back pain is accompanied by constitutional symptoms (such as loss of appetite, weight loss, fever, chills, shakes, or severe pain when at rest) that may indicate that the pain is due to a tumor or an infection
For patients who may have lumbar spinal stenosis and are considering an epidural injection to alleviate painful symptoms
For patients who have not done well after having back surgery, specifically if their pain symptoms do not get better after 4 to 6 weeks.

So what does this make you think?

These are the thoughts that go through my head about this.

Based on these findings, is the MRI necessary in many of the people who come through my door? Have these patients been appropriately sent for an MRI.
Are Primary Care Providers (Medical doctors, Chiropractors, etc) referring patients for MRIs for the wrong reason; using it as the gold standard for the diagnosis of lower back pain?
How does a MRI finding of disc abnormality affect our patients? I have had patients label themselves with a disc herniation and explain that is the reason why they never get 100% better. Based on this paper could the MRI findings be negatively affecting our patients and be a reason for their chronicity.

Patients need to be educated that their MRI finds are not a diagnosis on it's own. When the history, examination and imaging (MRI) all point in the same direction then that is when a diagnosis can be made.

Until next week, take some time to take care of your spine.

Dr Notley

Chiropractor and/or Athletic Therapist in Winnipeg since 2000

Back Pain: It is not always typical

2011-11-20T22:37:00.001-06:00

As a Chiropractor, I treat a number of people because of back pain. I have a number of patients who come in figuring they have typical lower back pain (disc derrangement, facet syndrome, sciatica, mechanical lower back pain) and most times they are correct. But there are those situations where it isn't typical. One of the atypical situations that I have seen is lower back pain due to cancer. Though this is a rare occurence (about 1% of all back pain), and this post isn't meant to scare you if you have back pain, early recognition of cancer is crucial for your future health.

In healthcare, the term Red Flags are key parts of a history/examination that puts the chiroprator, athletic therapist or any other healthcare professional on high alert. In the case of cancer, the following are red flags when you have back pain.

History of cancer
Unexplained weight loss >10 kg within 6 months
Age over 50 years or under 17 years old
Failure to improve with therapy
Pain persists for more than 4 to 6 weeks
Night pain or pain at rest

Alone, each of these characteristics of back pain may not indiciate cancer but combined they increase the chance that cancer may be the underlying cause of your back pain.

If you are sitting there hoping your back pain will get better on its own and you have several of these Red Flags then you NEED to go see your doctor as soon as possible.

Dr Notley
Winnipeg's only dual credentialed Chiropractor and Athletic Therapist

P.S. Patients need to know that when a chiropractor sees a patient for the first time or even if they have been a regular patient , but with a new presentation, a history and examination must be performed. Chiropractors are responsible for diagnosing and referring their patients when appropriate. If you come into my office don't expect to come in and just be cracked.

Dr Notley's November 2011 Newsletter

2011-11-12T23:35:00.001-06:00

Welcome to this month's newsletter. It is a compilation of articles that I found over the past month that I felt were of interest to you. In addition, you can find links to my last three blog posts.

I hope you are doing well and that at least one of these articles will help you in your goals of improving your health or aiding you in your recovery from injury.

Squat technique
by Dr Spina

"On past posts I have discussed the topic of performing the proper squat in the context of conditioning:
However, as important as performing proper squats in the gym is for strength development, I cannot stress enough the importance of teaching proper squatting technique to patients suffering from chronic knee pain, hip pain, or who are undergoing post surgical rehab on the pelvis or lower limbs. This post outlines some of the key points that should be emphasized when teaching the standard bodyweight squat to lay persons/patients." Click here for more

Strength training vs functional training
By Dr Liebenson

"To strengthen a muscle requires that the muscle is trained at or near it’s maximum threshold. To do this muscles are isolated and the body is stabilized so maximum force can be generated. Strength training works best when movement occurs in only one plane."

"In contrast, functional training integrates many muscle groups with the body not stabilized. Functional training works best when movement is unconstrained, thus requiring multi-planer stability."

Check out this blog by the doctor who wrote the book on back care, Dr Craig Liebenson

A guide to pull ups

One of the toughest body weight exercise, in my mind is the pull up. Check out this video on learning how to perform the pull up.

Janda's postural crossed syndrome
By Coach Peter Rouse

This is one of the most common syndromes I see in my Winnipeg Chiropractic practise. If you have neck pain, headaches, shoulder pain, lower back pain or piriformis syndrome. As a Chiropractor we are trained to see these postural patterns. Do you suffer from these problems? Is your posture like the ones found in this blog??

I hope you have enjoyed these articles if you found these interesting check out my most recent blog posts:

Recent Back Injury? Early Safe Core Training

Running Injuries and Nutrition

Back Pain and Driving

Dr Notley
Winnipeg's only dual credentialed Chiropractor and Athletic Therapist

Recent Back Injury? Early Safe Core Training

2011-11-06T22:01:00.000-06:00

You may have read my recent blog, Back Strength: Four for the Core, regarding my top four exercises for core training. These exercises are intended for those who have had a recent injury, but are now in the subacute stages, or they have no previous core training.

This weekend, I attended a seminar by Dr. Craig Liebenson. Dr Liebenson wrote the book on back care. I know that's a saying but he seriously wrote the book. One of requirements was to read a few chapters of his book Rehabilitation of the Spine: A Practitioner's Manual, 2nd ed. Through my reading I found a table that further explained the benefits of the exercises that I give. It also adds another exercise that I often use with my patients, the alternating dog pointer. It compares these exercises with more conventional exercises.

When you are in a subacute stage it has been recommended that loads placed on the spine above 3000 Newtons should be minimized. So based on this criteria let's compare the exercises.

McGill Crunch Vs Sit-ups

The McGill Crunch results in 2000N on the spine while the Sit up (knees bent) is 3350 N while the straight knee sit up results in 3500 N of load on the spine. Similar muscle activity is places on the muscles. If you perform the sit up on the ball version you will be placing 4000 N of load on the spine.

Side plank on the knees vs Side plank on the feet.

I typically start most of my chiropractic patients with the side plank on the feet. The loads placed on this exercise is 2600 N. A number of my patients are unable to perform this exercise so I make it easier by performing the side plank on the knees. The loads placed on the spine with this exercise is 2000 N.

Alternating Bird Dogs vs Prone superman

The alternating bird dog, when performed results in 2000N places on the spine while the prone superman exercise more than doubles the load on the spine with 4300 N.

Conclusion

It is evident that when starting out a strengthening program for the core, especially when in the subacute stage or with beginners, choosing an exercise that places less load on the spine is a better choice to prevent re-aggravation of the previous injury or result in a new injury.

I hope you enjoyed this.

Dr Notley
Treating muscle and joint injuries in Winnipeg as an Athletic Therapist or Chiropractor since 2000

P.S. After this past weekend course I will be adding back into my repertoire the Dying bug which has a much greater connection to the squat that I had ever thought of before.

Running Injuries and Nutrition

2011-10-31T11:00:00.000-05:00

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?

When reviewing the research on running injuries I stumbled upon this research paper, Fat Intake and Injury in Female Runners, which may be one reason for injuries in female runners who run greater than 20 miles/week. Here are the highlights of what I learned from reading this research paper:

Energy availability between 20–30 kcal/kgFFM/d has been found to impair bone formation due to a sharp decline in the osteocalcin. This increases the chance of stress fractures.
2 previous studies have found an association between fat intake and stress fractures.
A study that followed elite adolescent runners for a period of 3 years found that mean energy intake and fat intake decreased over the follow-up period while stress fracture incidence increased.
In the study they found that the foot/ankle the most common site (40 % of injuries), followed by the knee (19 %) and the hip (16 %).
Stress fractures/stress reactions, iliotibial band problems, and tendonitis were the most common injuries.
Injured runners consume significantly (p < .05) less total fat and obtain a lower percentage of total calories from fat than non-injured runners and consumed significantly lower amounts of the fat soluble vitamins A and K
Daily fat intake in grams was the single best dietary predictor of injury
Using daily fat intake they were successfully able to classify 64% of the subjects as subsequently injured (1) or not injured.
The odds ratios revealed that runners consuming less than the commonly recommended 30% of total calories from fat were 2.5 times as likely to sustain an injury compared with runners consuming 30% or more.
Another intriguing explanation for the correlation between fat and injury involves polyunsaturated fatty acids (PUFA), which are know to play a role in inflammation. Deficient intake of n-3 PUFA could contribute to an enhanced inflammatory response and increase injury severity (injured runners did consume significantly less PUFA in this study

This is a very enlightening research study. It may explain why I see many of my clients having re-occurring injuries. So if you are a female runner, and you get injured often, one possible ways of preventing injury is to analyze your diet. Are you getting enough healthy fats in your diet? Are you getting around 30% of your calories from fat?

I had a curious thought about this research, "Could a woman who is attempting to lose weight be increasing her chance of injury, especially if she is reducing her fat intake?"

I hope you found this interesting

Dr Notley

The only dual credentialed chiropractor and athletic therapist in Winnipeg

Back pain and driving

2011-10-24T11:00:00.000-05:00

I was recently asked, on twitter , the question , "Is it bad for your back to be sitting and driving for long periods?" As I recall, this question was asked by someone who commutes for about two hours each day (one hour each way). When I started searching for information on this subject most of the research was on truck drivers, bus drivers or farmers. The research most often was centered around sitting and whole body vibration while driving.

Here is what I learned from my research. You can read the abstracts at the end of the post.

Vibration produced while driving affects the spine by exciting a 4-6-Hz resonance on the lower back. The motor nerves in the lower back fire causing muscle contraction and ultimately fatigue. This leads to greater stress on the spine and intervertebral discs.
Sitting alone is not associated with risk of developing lower back pain
Sitting along with the exposure of whole body vibration and awkward sitting increased the risk of lower back pain four fold.
Helicopter pilots are the greatest risk for lower back pain.
Awkward posture is independently associated with the presence of lower back pain and/or sciatica
Sitting for more than half a workday, in combination with WBV and/or awkward postures, does increase the likelihood of having LBP and/or sciatica, and it is the combination of those risk factors, which leads to the greatest increase in LBP.
A constrained, seated posture, in combination with exposure to whole-body, jolt/vibration can impose significant stresses on the posterior intervertebral disc and can lead to back muscle fatigue.
Of the seven reports, one showed increased frequency of lumbar prolapse in occupational drivers, and six showed low back pain to be more frequent in whole-body vibration-exposed groups. Only two out of the four articles reporting on dose, showed a dose-response association.
One study that looked are more than just driving and found the following: Lower back pain is associated with poor mental health and belief in work as a causal factor for low-back pain, and with occupational sitting for > or =3 hours while not driving. Associations were also found for taller stature, consulting propensity, body mass index, smoking history, fear-avoidance beliefs, frequent twisting, low decision latitude, and low support at work. They found little evidence of vibration being a factor.
Strong evidence exists for manual materials handling, bending and twisting, and whole-body vibration as risk factors for back pain.

Conclusion

What I learned from this research is that no matter how strong or in shape we are our spine is at risk when driving. It is even worse off if you are sitting with poor posture and if there are long exposure to whole body vibration. In addition, these are not the only factors. There are also psychosocial factors that also influence the likelihood of having a back pain. So if you sit with poor posture, drive for long hours daily, have poor mental health, smoke, are over weight, and you are tall you have an increased chance of having back pain because of driving.

So how can you prevent this? A few thoughts that pop into my mind as I read the research are as follows:

Sit with good posture.
Use a back support to aide in maintaining good posture
Get out frequently to stretch your back. This may not be possible in all situations
Eat well, exercise, manage your weight and don't smoke
Drive a vehicle with functioning suspension seating

I hope you found this interesting

If you have any questions feel free and contact me

Dr Notley

Winnipeg's only dual credentialed Chiropractor and Athletic Therapist

Abstracts

Association between sitting and occupational LBP.

Eur Spine J. 2007 Feb;16(2):283-98. Epub 2006 May 31.
Lis AM, Black KM, Korn H, Nordin M.

Abstract

Low back pain (LBP) has been identified as one of the most costly disorders among the worldwide working population. Sitting has been associated with risk of developing LBP. The purpose of this literature review is to assemble and describe evidence of research on the association between sitting and the presence of LBP. The systematic literature review was restricted to those occupations that require sitting for more than half of working time and where workers have physical co-exposure factors such as whole body vibration (WBV) and/or awkward postures. Twenty-five studies were carefully selected and critically reviewed, and a model was developed to describe the relationships between these factors. Sitting alone was not associated with the risk of developing LBP. However, when the co-exposure factors of WBV and awkward postures were added to the analysis, the risk of LBP increased fourfold. The occupational group that showed the strongest association with LBP was Helicopter Pilots (OR=9.0, 90% CI 4.9-16.4). For all studied occupations, the odds ratio (OR) increased when WBV and/or awkward postures were analyzed as co-exposure factors. WBV while sitting was also independently associated with non-specific LBP and sciatica. Vibration dose, as well as vibration magnitude and duration of exposure, were associated with LBP in all occupations. Exposure duration was associated with LBP to a greater extent than vibration magnitude. However, for the presence of sciatica, this difference was not found. Awkward posture was also independently associated with the presence of LBP and/or sciatica. The risk effect of prolonged sitting increased significantly when the factors of WBV and awkward postures were combined. Sitting by itself does not increase the risk of LBP. However, sitting for more than half a workday, in combination with WBV and/or awkward postures, does increase the likelihood of having LBP and/or sciatica, and it is the combination of those risk factors, which leads to the greatest increase in LBP.

Vibration of the spine and low back pain.
Clin Orthop Relat Res. 1992 Jun;(279):49-59.
Pope MH, Hansson TH.
Abstract

There are now many studies suggesting a positive relationship between both low back pain and spinal degeneration and exposure to whole body vibration. Such relationships appear to be particularly marked in drivers of tractors, earth-moving equipment, and trucks. There is a tendency toward a greater incidence of complaints as exposure increases. Vibration affects the spine by exciting a 4-6-Hz resonance that is related to the biologic "soft spring" between S-1 and the seat. The muscle nerves fire sequentially under vibration and fatigue. In animals, vibration exposure leads to pronounced creep, increased disk pressure, and changes in the levels of neuropeptides in the dorsal root ganglia.

Mechanical stress reduction during seated jolt/vibration exposure.

Semin Perinatol. 1996 Feb;20(1):54-60.Wilder DG, Pope MH, Magnusson M.
Abstract

The risk of experiencing low back pain is associated with mechanical factors. Anatomic factors, such as advancing pregnancy, can also place extra mechanical stress on the lower back. Mechanical factors, such as those related to the workplace, can be minimized by ergonomic interventions. A constrained, seated posture, in combination with exposure to whole-body, jolt/vibration can impose significant stresses on the posterior intervertebral disc and can lead to back muscle fatigue. Interventions that reduce the jolt/vibration magnitude and duration of exposure will decrease the mechanical work performed on the intervertebral disc. Such interventions range from jolt/vibration isolating seats and vehicle cabs, to decreasing exposure time and maintaining simple supported postures during ingress and egress. Improvements in seat configuration can reduce the intervertebral disc pressure and the strain on the posterior disc.

Case-control study of low-back pain referred for magnetic resonance imaging, with special focus on whole-body vibration.

Palmer KT, Harris CE, Griffin MJ, Bennett J, Reading I, Sampson M, Coggon D.Scan J Work Environ Health 2008 Oct;34(5):364-73. Epub 2008 Oct 14.
Scand J Work Environ Health. 2009 Jan;35(1):80. Harris, E Claire [corrected to Harris, E Clare].

Abstract

RESULTS:
Strong associations were found with poor mental health and belief in work as a causal factor for low-back pain, and with occupational sitting for > or =3 hours while not driving. Associations were also found for taller stature, consulting propensity, body mass index, smoking history, fear-avoidance beliefs, frequent twisting, low decision latitude, and low support at work. However, the associations with the six metrics of whole-body vibration were weak and not statistically significant, and no exposure-response relationships were found.
CONCLUSIONS:
Little evidence of a risk from professional driving or whole-body vibration was found. Drivers were substantially less heavily exposed to whole-body vibration than in some earlier surveys. Nonetheless, it seems that, at the population level, whole-body vibration is not an important cause of low-back pain among those referred for MRI.

Whole-body vibration and low back pain: a systematic, critical review of the epidemiological literature 1992-1999.

Lings S, Leboeuf-Yde C. Int Arch Occup Environ Health. 2000 Jul;73(5):290-7.

Abstract

RESULTS:
Twenty-four original articles concerning the association between whole-body vibrations and the lower back were retained for use. The quality of the papers was mostly low, but improved with time. Only seven articles passed our predetermined quality criteria. Of the seven reports, one showed increased frequency of lumbar prolapse in occupational drivers, and six showed low back pain to be more frequent in whole-body vibration-exposed groups. Only two out of the four articles reporting on dose, showed a dose-response association.
CONCLUSIONS:
Despite the lack of definite evidence, we found sufficient reasons for the reduction of whole-body vibration-exposure to the lowest possible level. If new knowledge is to be produced, good prospective studies with repeated measurements of exposure, analyses of work postures, and clear definitions and subgroupings of low back pain are needed. Other research in this field should be given up, and the resources used for more important issues, as the size of the problem of whole body vibration is probably on the decrease because of the technical prophylactic developments that are already in progress.

Low back pain among farmers exposed to whole body vibration: a literature review

Med Pr. 2011;62(2):187-202.
[Article in Polish] Solecki L.

Abstract
A literature review was performed for the years 1990-2007. It covered reports addressing the problems associated with the prevalence of low back pain and musculoskeletal disorders among farmers. In addition, the anticipated relationship between low back pain and whole body vibration in farmers was evaluated based on 12 reports for the years 1987-2009. The review confirmed that the prevalence of back pain is significantly higher in farmers exposed to whole body vibration than in the control group (not exposed to vibration). The frequency of back pain is related with whole body vibration, as well as with prolonged sitting position, wrong body posture and physical work load (especially lifting and carrying loads). The prevalence of these symptoms increases with the increased vibration dose and duration of exposure. Disorders in the lower section of the spine were associated with age, accidents (concerning the back), cumulative dose of whole body vibration, and overload due to wrong body posture. Long-term exposure affecting the whole body is harmful to the skeletal system (degeneration of the spine). The results of the study suggest that the repeated or constant exposure to mechanical shocks may increase the risk of low back pain. The investigations confirmed that there is a dose-response type of relationship between exposure to whole body vibration and pain in the lumbar section of the spine.

Low back pain disorders and exposure to whole-body vibration in the workplace.

Semin Perinatol. 1996 Feb;20(1):38-53. Bovenzi M.

Abstract
Occupational exposure to whole-body vibration (WBV) and postural stress in a driving environment may contribute to an increased risk for low back pain (LBP) disorders. In two epidemiological studies of bus drivers and tractor drivers, LBP disorders were found to be associated with age, back accidents, cumulative WBV dose, and postural overload. A review of the literature showed that the exposure-response relationship for WBV and injuries to the lower back is not fully clarified. There is a shortage of information on the health risk from WBV in female workers. Because it is estimated that several thousand women are exposed to intense WBV in the workplace, the health effects of WBV on female reproductive organs and vertebral column should be carefully investigated.

Whole body vibrations and low back pain

Ugeskr Laeger. 1998 Jul 13;160(29):4298-301. [Article in Danish] Lings S, Leboeuf-Yde C.

Abstract
Whether exposure to whole body vibration (WBV) in transport vehicles and moving machinery constitutes a health risk is unclear. The literature on this subject is vast, but most is of limited scientific value. A recent review covering the literature up to 1992 has been used as a basis for a further search concerning the period 1992-1996. Fifty-three articles were found: 14 epidemiological studies, 15 human laboratory experiments, four animal experiments, seven field studies and 13 reviews. Almost all epidemiological studies yielded insufficient information and had methodological shortcomings. Of the reviews, only three were critical. Experimental data support the hypothesis that WBV can have a negative effect on the spine. Epidemiological studies have shown drivers to have an increased prevalence of low back pain, probably in a dose-related fashion. Hence, it is likely that long-term exposure to WBV can contribute to back disorders. Present studies do not allow for a quantitative specification of the association between exposure and effect.

Physical load during work and leisure time as risk factors for back pain.

Scand J Work Environ Health. 1999 Oct;25(5):387-403.
Hoogendoorn WE, van Poppel MN, Bongers PM, Koes BW, Bouter LM.

Abstract
This systematic review assessed aspects of physical load during work and leisure time as risk factors for back pain. Several reviews on this topic are available, but this one is based on a strict systematic approach to identify and summarize the evidence, comparable with that applied in the clinical literature on the efficacy of intervention for back pain. A computerized bibliographical search was made of several data bases for studies with a cohort or case-referent design. Cross-sectional studies were excluded. A rating system was used to assess the strength of the evidence, based on the methodological quality of 28 cohort and 3 case-referent studies and the consistency of the findings. Strong evidence exists for manual materials handling, bending and twisting, and whole-body vibration as risk factors for back pain. The evidence was moderate for patient handling and heavy physical work, and no evidence was found for standing or walking, sitting, sports, and total leisure-time physical activity.

Dr Notley's October 2011 Newsletter

2011-10-16T09:00:00.000-05:00

Welcome to this month's newsletter. I hope you are enjoying our extended summer in Winnipeg. This is a collection of some of my favorite blog posts or internet finds that I have read/written over the past month. I hope you enjoy.

Exercise: getting started without the 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.

Check out this blog post that I made for a recent talk for a TOPS Weight Loss support group

5 Reasons Active Release Techniques is Better

My Chiropractic patients know that I don't just crack their spine and send them on their way. I also treat them with a technique called Active Release Techniques (ART). The intent with this technique is to break up scar tissue and adhesions in muscles, ligaments, tendons and fascia to help restore normal movement and function. I often ask what makes these technique more special than other massage techniques. Check out this blog post by a fellow chiropractor to learn why he thinks ART is better than others techniques.

Back pain: Four for the Core

The core muscles include all those muscles that attach to the pelvis. This includes the glute muscles, hip flexors (iliacus, psoas major and rectus femoris), groin muscles, the hamstrings, abdominal muscles (rectus abdominus, internal and external obliques and transversus abdominus, the quadratus lumborum, multifidii muscles and the erector spine. The core muscles are important for stabilizing the lower back and hips. It is also important for transferring the force generated by the hips to the shoulders in activities like throwing a ball. These are the four core exercises I suggest people start with.

Research Based Healthy Eating

A picture is worth a thousand words, and that’s why nutritionists use symbols and shapes to answer the question, “What should I eat?” For nearly two decades, the U.S. government distilled its nutrition advice into pyramids. These efforts didn't accurately show people what makes up a healthy diet. Why? Their recommendations were based on out-of-date science and influenced by people with business interests in the messages the icons sent. This year, the U.S. government scrapped its MyPyramid icon in favor of the fruit-and-vegetable rich MyPlate—an improvement, yet one that still doesn't go far enough to show people how to make the healthiest choices.

Check out the rest of this post by the researchers at Harvard

Video: Understanding pain

I treat a number of people who have chronic pain. Many of these people have gone through test after test after test with nothing found. What I try to have them understand is that their initial injury has long since healed the problem they are having now is the pain. Pain is an experience interpreted by the brain. Not that their pain is fake, it is real, it is just not as a result of the problem at the location of pain. Check out this video to further understand pain and how to deal with chronic pain. I love this video.

Being Healthy While Pregnant

As many of you know my wife is pregnant. It seems that now that she is pregnant I am seeing more pregnant women walking around and more pregnant women coming into my office for treatment. I am even seeing more tweets about pregnancy and exercise lately too. My wife, before she was pregnant had managed to loose over 40 pounds over the last year. She did this through good eating and being more active. My wife's hope is to get back on track with her weight loss after the baby is born. Here is some advice from an active women who continued to be active during her pregnancy. She gives advice to all the new moms on how to eat and be active during pregnancy, how to deal with stretch makes and how to get back in shape after pregnancy.

I hope you enjoyed the newsletter.

Dr Notley

Winnipeg's only dual credentialed Chiropractor and Athletic Therapist

Get in Shape without Injuries

2011-10-06T11:30:00.000-05:00

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.

What does it mean to be in shape?

Being in shape can be either individually defined or defined by achieving a pre-determined standard. A pro hockey player has to be in a different type of shape than a marathoner. In addition, we don't have to be in the same type of shape as the pro athletes to consider ourselves in shape. The problem with a pre determined standard is that we push ourselves to achieve that goal possibly more rapidly than our body is capable of achieving which leads to the body breaking down and injuries happen.

So how can you get in shape without getting hurt?

Here are some of my tidbits of advice on preventing injuries.

Play Safe

Simply put, exercise in an environment that you can control. Make sure the surface you are exercising on is clear of debris, the surface is even and you have adequate gripping for your feet (surface/shoes). If you plan to go on a bike ride choose a safe route rather than one in high traffic or on a challenging off road path (not that off roading is a bad activity, it's more of a safety issue). Many people get hurt because they don't watch where they are going and what they are doing. Be aware of your surroundings.

Be Well Rounded

We tend to do the things we like to do and neglect the things we find are difficult, boring or tedious. This can result in imbalances and repetitive strain. For example, the body builder may be very strong and has big muscles but if that is all he does he may not have the flexibility to move those muscles through a full range of motion. The aerobics instructor may be able to exercise for 90 minutes but can she carry the 30lbs bag of dog food to the house?

When it comes to being in shape, developing a program that addresses the different aspects of being in shape; muscular strength, muscular endurance, flexibility/mobility, aerobic endurance and anaerobic endurance helps you to be able to handle a variety of physical feats.

Start by taking one or two categories of fitness, as you develop a habit for exercising, then add another category of fitness. Most people getting in shape would do well with developing aerobic endurance/muscular endurance along with flexibility and then adding the other aspects of fitness as they become more fit. This gives you variety, lessens repetitive strain and helps with the monotony of performing the same program over and over.

Start slow and go slow

When starting an exercise program we have a tendency to push ourselves harder than our body is capable of handling. We want to get in shape now and we will push ourselves to achieve it. We buy DVDs of the next greatest workout program guaranteed to loose weight. We jump full into the program only to discover our body is not yet ready for that type of program. You may not have the physical ability to perform the exercises, your technique may be horrible or your body fatigues too quickly and
you get hurt. Start with the basic of all exercise, walking, biking, basic stretching, body weight exercises and then slowly increase the volume, intensity or complexity of the activity.

It is generally accepted that increasing your volume or intensity of exercise, every week or two, by 10 percent is a safe approach.

Eg. Lifting weights by increasing only the volume:

Week one: 1 set of 10 repetitions - total 10 repetitions
Week two: 1 set of 11 repetitions - total 11 repetitions
Week three: 2 sets of 6 repetitions - total 12 repetitions
Week four: 2 sets of 7 repetitions - total 14 repetitions
Week five: 2 sets of 8 repetitions - total 16 repetitions
Week six: 3 sets of 6 repetitions - total 18 repetitions

You have to remember that getting in shape does not have an end point. Once you are in shape you can't just stop, you have to continue to maintain. Take it slow and you will still achieve your goals.

Technique Technique Technique

Don't perform any exercise if technique is poor. It is better to build your body on a strong foundation than on a weak foundation. It is better to perform 5 high quality repetitions than it is to perform 10 poor quality repetitions.

Also, performing exercises that require you to be quick but alters your technique should be avoided until technique is perfected. If you need to cheat to complete a repetition or if your movement becomes faulty, stop. Find someone who is trained in recognizing poor movement (personal trainer, athletic therapist, some chiropractors, and some physiotherapists). It is better to pay for this service now than when you have to pay for help in the healing process of your injury.

Eliminate Imbalances

Injuries can be the result of joint immobility, muscle inflexibility, poor muscle motor control or poor strength. Having someone assess you to discover these imbalances may help prevent further injury. Don't over work the show off muscles (chest, arms, quadriceps), this causes imbalances. I often recommend a two to one ratio of exercise between the show muscles (front) and the opposing muscles. Don't perform the same mode of exercise over and over, this causes imbalances and repetitive strain. Change it up.

Stretch the Tight Stuff

For the general public and for athletes these are the most common muscles that I find that are inflexible:

Suboccipital muscles
Chest/pectoralis muscles
Piriformis muscle
Hip flexors
Calf muscles

These muscles are often a problem in those who have jobs that require them to sit for long periods of time or with those with poor posture.

Don't over stretch muscles that are already flexible. This may lead to hypermobility which can be another cause of injury.

Strengthen/Activate the Weak Muscles

Muscles I find that are typically weak are as follows:

Deep neck flexors
Rhomboids and trapezius muscles
Serratus anterior
Core muscles (glutes, abdominal muscles etc)
Tibialis anterior (shin muscles)

Get Balanced

One of the leading cause of falls in the elderly is poor balance. Balance, or proprioception, tells our brain where our body is in space which then helps the muscles around our joints to help keep up upright. Training with dumbbells or one legged activities helps develop proprioception.

A good way to start developing your balance is by, each morning while your brush your teeth, stand on one foot when you brush the top row of teeth. When you brush the bottom row, switch to the other leg. As you get better at this, and you can stand without wavering, then close your eyes. As you improve, then other more challenging activities can be added.

Learn to Hip Hinge

Back, knee, ankle and foot pain may be a result of poor motor control at the hip. I see this in many injured people. Poor squatting technique and poor lifting techniques is often a result of poor movement at the hips. In the case of lifting injuries the back flexes more than the hips thus causing more strain on the back. Many people can't complete a full squat without knee pain. Often, this can be associated with poor movement at the ankle and at the hip.

Vary your Volume and Intensity

In the art of strength and conditioning, strength coaches develop programs in the attempts to improve performance but also to prevent over training. This type of training approach is called periodization. In essence, it is a program that has changes in either volume of work or the intensity of the work. Over the course of a training period, say 6 weeks, you would see throughout the week the intensity/volume change. One day would be harder than average, another day may be lighter and another might be average but by the end of that training program the athlete is capable of performing more work or work at a higher intensity. Training at high intensity all the time can wear down the body and cause injury or overtraining.

Recognize Overtraining

The signs of overtraining are as follows:

Difficulty sleeping
Elevated heart rate
Getting sick more frequently
Unable to accomplish workouts you used to perform
Fatigue, lack of interest to work out, depression
Decreased appetite
Weight loss
Increased rate of injury

I suggest monitoring your heart rate every morning upon waking. Monitoring yourself now will allow you to see your heart rate decrease as you get in shape. If you are overtraining or you are coming down with a cold your morning heart rate may be approximately 10 beats a minute higher than normal.

Don't Exercise Through the Pain

Pain that persists after a warm up, worsens throughout the workout or results in increased pain after a workout should be avoided. Working through the pain may only result in being out of commission for a longer period of time.

If you can, reduce the volume and intensity of your exercise by at least 50%. If pain still persists then seek treatment. In the meantime, as you heal, choose different exercises that do not cause pain.

Reduce the Stress on the Joints

Every time we run/jog there is a significant increase in force on the body (about 2 to 3 times your body weight. Our joints have to be able to withstand these forces or else they are going to get damaged. If you have joint pain or want to prevent joint pain chose exercises that are less stressful on the joints. Speed walking is far better on the joints and actually burns more calories. Other exercise methods are exercising in the pool (pool running) or using a stationary bike or elliptical. As your conditioning
improves as well as your strength then it may be possible to increase the stress on the joints, depending on the reason for joint pain.

Eat Well

Though many people exercise at the same time as restricting calories we need to adequately fuel our body so that it can refuel and repair our body. Recent research has even found that those who restrict their fat consumption below 30% tend to have a great change of injury. If you are looking at building muscle to help with weight loss then ensuring adequate protein in your diet is important. Amino acids are the building blocks of muscle.

Take a Break!

Even the best athletes take a break from time to time. We get stronger and more fit when we rest. Constant training prevents you from recuperating therefore having days of rest or light activity can help you improve and prevent injury. Every six to eight weeks take a break and just go for a light walk, lift some light weights, do some light yoga.

Conclusion

Remember, not all injuries are preventable. When starting take it slow, be well rounded, work on imbalances, perform with excellent technique, vary your workout and every once in a while take a break.

Getting in shape is not a race and you don't win because you get there first. You win because you get in shape and become healthier.

I hope this keeps you safe as you start your exercise program.

If you have any questions feel free and ask/

Dr Notley
The only Chiropractor/Athletic therapist in Winnipeg

Ask the Chiropractor: Common Exercises

2011-10-03T18:21:00.000-05:00

I am often asked what my most common exercises are for my patients depending on their ailments. I decided to put this list together for you. Make sure you check out my most common stretches as well.

Deep neck flexors

Neck retraction

The deep neck flexors are at the front of the spine, immediately infront of the vertebrae. These muscles are often weak and inhibited after a motor vehicle accident. They are also inhibited and deconditioned if you sit or stand all day with your head forward infront of your shoulders. These muscles are associated with a flattening of the cervical spine (loss of it's natural backwards curve) or a reversal of the cervical spine (forwards curve; kyphotic). The neck retraction exercise to help stretch out the suboccipital muscles helps to activate the deep neck flexors as well. Another more challenging exercise for the deep neck flexors is the quadruped neck retraction exercise (note: arm is behind back only to show movement of neck). You can build on this exercise by adding resistance by using tubing draped over the head and held by the hands). You can also work on the neck retraction followed by turning the head as in this video.

Rhomboids and Trapezius muscles

The rhomboids are often over looked. It is rather easy to over look then because they are found on our back side between our shoulder blades. These muscles are often inhibited by inactivity and are cause of rounding of the shoulders. Poor activity of these muscles means poor mechanics at the shoulder which can lead to shoulder injuries such as impingement syndrome or shoulder bursitis. To train these muscles I perform T's and Y's. My favorite piece of exercise equipment to perform these two exercises on the TRX suspension trainer, but you can also use elastic exercise tubing.

Serratus Anterior

Serratus anterior is found on the side of our ribcage and travels up into our armpit and attaches to our shoulder blade. One of the jobs of this muscle is to hold the shoulder blade against our ribcage. Weakness of these muscle leads to our shoulder blades popping up off of our rib cage as we do a pushup. Another job this muscle has is to aid in abducting out shoulder blades as we raise our arms over head. Any weakness or dysfunction in this muscle can cause a movement dysfunction at the shoulder which can lead to shoulder injuries. The scapular pushup is an excellent way to start training this muscle. If you can't perform it on the floor then try performing it against a wall or with your elbows on a bed/bench. Check out this video as well

Four for the Core

As mentioned in my previous blog post, the plank, side plank, bridge and the McGill crunch are my four preferred exercises to give to my chiropractic patients. Check out my Four for the Core here

Tibialis anterior (shin muscles)

The muscles at the front of the shins are responsible for lifting the foot up. They are also responsible for aiding in maintaining the arch in the foot while walking or running. strengthening these muscles so they can handle the repetitive strain of long walking or running is important for preventing walking/running injuries such as shin splints. Perform this exercise by standing with your back resting on the wall and feet out from the wall. The further away from the wall you are the harder the exercise will be, especially if you have a shoe with a heel. With the body straight, lift toes up off the ground.

Make sure to take a look at my blog post on starting exercise and preventing injury.

Dr Notley
Treating necks, backs, headaches, and other musculoskeletal injuries as a Chiropractor/Athletic Therapist, in Winnipeg, since 2000.

Back Strength: Four for the Core

2011-09-25T16:41:00.000-05:00

The core muscles include all those muscles that attach to the pelvis. This includes the glute muscles, hip flexors (iliacus, psoas major and rectus femoris), groin muscles, the hamstrings, abdominal muscles (rectus abdominus, internal and external obliques and transversus abdominus, the quadratus lumborum, multifidii muscles and the erector spine. The core muscles are important for stabilzing the lower back and hips. It is also important for transferring the force generated by the hips to the shoulders in activities like throwing a ball. These are the four exercises I suggest people start with:

Plank

Planks develop the front side of the core. It prepares you for performing full pushups. It can be challenging. Watch the video to see how the exercise is performed.
If you can't perform the full plank there are ways to make the plank easier.
There are also ways to make this more challenging.

McGill Crunch

Regular crunches tend to flatten/flex the lower back placing added stress on the discs between the vertebrae. Since the discs are often injured with flexion movements minimizing repetitive flexion an effective way at minimizing injury. This exercise a way to prevent excessive loading of the spine but also strengthen the abdominal muscles. Watch this video to see how the exercise is performed.

Side plank

This exercise strengthens the side of the core along with the supporting shoulder. The side of our body is often neglected in strengthening. Research has found that those who can't hold this position for 1.5 minutes were more at risk for having back pain. Read how the exercise is performed or just watch the video.
Here are some other more challenging ways to train the side plank.

Bridges

This exercise activates the gluteal muscles which are often a inhibited because we sit on chairs all the time. The common term for this inhibition is call gluteal amnesia. I often find this in people who have jobs where they sit for long periods of time and when they are unable to perform a hip hinge (behind at the hips rather than at the back when bending forwards). Watch the video or read how the bridge is to be performed.

The bridge has also been shown to activate the transverse abdominus which is important in spine stabilization.

If you have any questions feel free and email me, message me on twitter or on facebook

Dr Notley
Serving Winnipeg as a Chiropractor/Athletic Therapist since 2000

Ask the Chiropractor: Common Stretches

2011-09-18T17:10:00.000-05:00

I often am asked by my Chiropractic patients in Winnipeg, "What stretches do you recommend?"

These are the most common muscles that I find to be tight in my Chiropractic patients, as well as, my favorite stretches to help release tension and improve flexibility in these muscles.

Suboccipital Muscles:

The suboccipital muscles are located at the base skull/top of the neck. They have a tendency to be a source of pain locally and a source of headaches. They are often a problem because many of us tend to slouch. If you slouch and you have to look at a computer screen your head has to extend backwards (relative to the neck) to be able to see the screen. This causes the muscles to be perpetually under contraction. To stretch these muscles perform the double chin exercise.

This is also a great exercise for those who have a cervical disk herniation or derangement. If you have neck pain that hurts when you perform this exercise but the pain decreases as you repeat the exercise this is an excellent exercise for you.

This is also one of the stretches I get for people who need to work on their posture.

Chest/Pectoralis Muscles:

The chest muscles are made up of two different muscles, pectoralis major and pectoralis minor. Pectoralis major is the big chest muscle that we can see. Pectoralis major goes from the sternum/ribs and crosses the shoulder. Pectoralis minor is found deep to pectoralis major and goes from the ribs to the shoulder blade (scapula). When tight pectoraliss major rounds the shoulder inwards. Pectoralis minor, when tight pulls the shoulder blade up and over the rib cage. Both of these muscles can affect the mechanics of the shoulder. Tightness in these muscles is also associated with neck tightness. These muscles are often inflexible while the muscles in the mid back are weak; an imbalance occurs. The likely reason is that we use the muscles in the front of our body so much and do very little activity for the upper backs muscles. Performing the stretch while squeezing the shoulder blades together will help with the inflexibility of the chest muscles and will help with activating the muscles of the middle back. Try out this corner stretch.

The Piriformis Muscle:

The pirfirmis is often sources of tightness in the back side of the hip. The piriformis often can be a source of pain in the buttocks or causing pain down into the back of the thigh. It may also be a cause of "sciatica"-like pain pain. The piriformis muscle travels through the same hole in the pelvis that the sciatic nerve travels through. Myofascial muscle tightness can affect this nerve and cause similar pains as that of true sciatica. Click here for a full description of the piriformis stretch.

Hip Flexor Muscles:

Sitting for long periods of time shortens the hip flexors. The hip flexor muscles attach onto the spine as well as the pelvis. This can alter the function of the spine as well as the pelvis this can result in problems in the lower back as well as the hamstrings. The kneeling lunge is my favorite exercise to give for inflexible hip flexors.

If you have a job that requires you to sit for long periods of time or you are bent over a lot during your sporting activity (hockey players and cyclists)) then this stretch is for you.

Calf muscles:

Wearing shoes that have a heel constantly keeps our calf muscles in a shortened position. In addition, having a job that requires us to sit all day causes our calf muscles to be shortened. Now, considering being a runner who runs several miles, the calf muscles get over used and at the same time are inflexible. This may explain why people develop different types of tendonitis such as Achilles tendonitis. In addition, tight calf muscles will affect the mobility of the ankle so when you squat you will have a faulty movement pattern which can lead to injuries at the knee. Try performing this calf stretch with your lead leg both straight and bent.

I hope you found these exercises useful

Dr Notley

Dr Notley's September 2011 Newsletter

2011-09-11T20:58:00.001-05:00

Hey everyone! Welcome to Dr Notley's September newsletter! I hope you have had a great summer. Here in Winnipeg we have had a beautiful summer; hot weather, little to no rain, no mosquitoes and no signs of fall yet. The summer continues to be great, for my family, because on our oldest son's birthday we discovered that we will be adding one more (I hope only one more) to the Notley Clan!

This newsletter has a little bit of everything:

Headaches? Consider Exercise and Manipulation
Are You In Shape?
Core Training: Back Pain Rehabilitation and Rowing Exercises
Physical Training Can Substitute Effectively as Second "Medication" for People Diagnosed with Depression
Physical Activity Throughout Life Yields Measurable Benefits as We Age

Enjoy!

Headaches? Consider Exercise and Manipulation

Do you have a headache? Do they keep coming back? Are they starting to become more intense and more frequent?

It's frustration to have to deal with a headache. At work, you become less effective and efficient. So what can you do for yourself to help with headaches?

Are You In Shape?

I asked this question on twitter recently, "What is the definition of 'being in shape'?"

Check out this blog post to discover what others have said and what my thoughts are on what it is to be in shape.

Core Training: Back Pain Rehabilitation and Rowing Exercises

Core training is a very common word in both the fitness/sports performance industry and the back rehabilitation industry. The reason for training the core is to improve stiffness and stability of the spine. Stability is defined as, how well the spine can maintain or recover from a change from its original position. The greater the ability to coordinate muscle contraction to keep the spine stable results in greater stability. The importance to core training for back care is that "individuals with higher muscle activation had a higher "margin of safety" in terms of stability than individuals with lower muscle activation." But how can a person who has had back pain train their core without over stressing the spine?

Physical Training Can Substitute Effectively As Second 'Medication' For People Diagnosed With Depression

Exercise can be as effective as a second medication for as many as half of depressed patients whose condition have not been cured by a single antidepressant medication.

UT Southwestern Medical Center scientists involved in the investigation, recently published in the Journal of Clinical Psychiatry, found that both moderate and intense levels of daily exercise can work as well as administering a second antidepressant drug, which is often used when initial medications don't move patients to remission. The type of exercise needed, however, depends on the characteristics of patients, including their gender.

Physical Activity Throughout Life Yields Measurable Benefits as We Age

The benefits of physical activity accumulate across a lifetime, according to a new study published in the October issue of the American Journal of Preventive Medicine. Researchers in England and Australia examined the associations of leisure time physical activity across adulthood with physical performance and strength in midlife in a group of British men and women followed since birth in March 1946.

I hope you found this informative.

Until next time, don't sit still, get up and move!

Dr Notley
Winnipeg's only dual credentialed chiropractor and athletic therapist

Headaches? Consider exercise and manipulation

2011-09-04T22:50:00.000-05:00

Image via Wikipedia

Do you have a headache? Do they keep coming back? Are they starting to become more intense and more frequent?

It's frustration to have to deal with a headache. At work, you become less effective and efficient. So what can you do for yourself to help with headaches?

One of my most favorite problems to treat are headaches. By far, the most common form of headache that I encounter is a cervicogenic headache; a headache that originates from the bony or soft tissue structures of the neck.

When treating my patients, I strive to provide them with the tools to help them help themselves. As much as my methods are effective, being able to treat yourself is so much more empowering. I recently found an article that has shown how only a few minutes a day of exercise can help reduce the frequency of your headaches. Check it out.

Effect of brief daily exercise on headache among adults – secondary analysis of a randomized controlled trial
by Lars L Andersen, PhD, Ole S Mortensen, PhD, Mette K Zebis, PhD, Rigmor H Jensen, DrMedSci, Otto M Poulsen, DrMedSci , Scand J Work Environ Health – online first. doi:10.5271/sjweh.3170

The researchers in this paper took 198 office workers who had frequent neck/shoulder pain as well as headaches. The office workers were broken up into three groups. One group performed 10 weeks of resistance training using elastic tubing for 2 minutes, 5 days a week. Another group worked out for the same number or days and weeks for 12 minutes. The third group, which received weekly health information, were the control group.

The exercise group performed progressive resistance "neck/shoulder" exercises. Sadly, after sending an email to the research group to determine which exercises were performed, I never received a response.

The researchers found that the intensity and duration of headaches remained the same regardless of the intervention. What did change was the frequency of headache. Both the exercise groups showed a significant decrease in frequency of headaches relative to the control.

To some this might not sound too impressive. Do all that work just to experience the same intensity and frequency of headache. I decided to look at see what other research is finding.

Effect of Neck Exercises on Cervicogenic Headache: A Randomized Controlled Trial
Jari Ylinen, MD, PhD, Riku Nikander, PhD, PT, Matti Nykänen, MD, PhD, Hannu Kautiainen, BA and Arja Häkkinen, PhD, J Rehabil Med 2010; 42: 344–349

These researchers too 180 female office workers with chronic, non-specific neck pain. The women were broken down into three groups

Strength Group: Performed isometric, dynamic and stretching exercises. The neck flexors were strengthened by pushing a theraband while seated, forwards, obliquely towards the right and left and backwards. Shrugs, shoulder presses, bicep curls, bent-over rows, flyes and pull-overs were performed at the highest load possible for 15 repetitions.

Endurance Group: Exercised the neck flexors by lifting the head up while laying on their back. They performed three sets of 15 repetitions. Shrugs, shoulder presses, bicep curls, bent-over rows, flyes and pull-overs were performed at starting and 2kg for 3 sets of 15 repetitions.

Both exercise groups also performed trunk and lower limb exercises exercises for one series (repetitions not mentioned). Stretching was performed for the neck, shoulder and upper extremities after the workout. Workouts were performed for 45 minutes, 5 days a week.

Control Group: Performed aerobic exercise 3 times a week for an half hour and were given written information on the stretches which were given to the exercise groups.

The researchers found that neck pain reduced the most in the strength group (69%) and similar results in the endurance group (60%). Upper extremity pain decreased the most in the endurance group (70%). Headaches decreased in intensity 69% in the strength group, 58% in the endurance group and 37% in the controls.

A Randomized Controlled Trial of Exercise and Manipulative Therapy for Cervicogenic Headache
Gwendolen Jull, PT, PhD, Patricia Trott, PT, MSc, Helen Potter, PT, MSc, Guy Zito, PT, Grad Dip Manip Ther, Ken Niere, PT, Mph, Debra Shirley, PT, BSc, Jonathan Emberson, MSc, Ian Marschner, PhD, and Carolyn Richardson, PT, PhD

Two hundred participants with cervicogenic headaches were recruited for this research paper. The participants were randomized into 4 groups.

Manipulative therapy group: This group received joint mobilizations and/or manipulation depending on clinic findings.

Exercise therapy group: The exercise group was trained to perform neck retraction exercises while laying on their back trying to flatten their neck against the floor. They were also taught to squeeze the shoulder blades together while laying face down. These exercises were performed twice daily. These muscles were also taught to be performed while in a seated position.

Combined therapy group: This group received both neck manipulation and exercises.

Control group: No intervention performed

Intervention was performed over 6 weeks with 8 to 12 treatments during this time

The researchers found after 12 months of following the participants that all intervention groups showed significant improvements in headache intensity and frequency and intensity immediately after treatment. The combined therapy group showed a significant improvement in headache duration even after 12 months. Seventy six percent (76%) of the intervention groups achieved greater than 50% improvement while 35% of them managed to experience complete relief. The combined group were 10% more likely to have a good or excellent result.

Conclusion

Based on these papers, there is evidence that manipulation and exercise help with reducing the duration, intensity and frequency of headaches. Results differ depending on the research. There appears to evidence that a combined approach may result in more effective treatment.

I hope you found this informative.

Dr Notley

Chiropractor and Athletic Therapist of Winnipeg

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Headaches? Consider exercise and manipulation