Lift Light- Lift Right

Whenever those major snowfalls hit this season remember shoveling snow is a serious workout.  A shovelful of snow weighs 5 to7 pounds and considering all the snow you have to move off your sidewalk and driveway – that can easily add up to several hundred pounds.  Lift light and shovel right by following these tips to keep your back in top shape. 

 

1. Don’t let snow pile up – frequently shoveling after every small snow fall will keep the job light and easy
2. Pick the right shovel – use a light weight push type shovel.  If you have a metal shovel spray it will Telfon to prevent snow from sticking.
3. Push. Don’t throw – Always push the snow to the side instead of throwing it.  This way you avoid lifting the heavy snow and prevent any awkward twisting or bending movements. 
4. Bend the knees – if you find you have to lift heavy loads of snow bend you knees and use the power from your legs and arms muscles, while keeping your back straight.
5. Warm up – Before doing any strenuous work-out you need to warm up your body.  Do 10-15 minutes of light exercise, followed by some simple stretches before you start shoveling
6. Take a break – if you feel tired or short of breath, stop and take a rest. Shake out your arms and legs before starting again.  Stop immediately if you feel chest pain or back pain.  If your back pain persists longer than one day after shoveling see your chiropractor.  If you have chest pain that is severe, see a medical doctor immediately.

 

McKenzie Technique – Non Manipulative conservative care

As a chiropractor I do so much more than treat backs.  And I do not adjust everyone’s neck!  Deciding on the proper treatment for a specific patient is a two way street.  The doctor’s side (that’s me) and the patient’s side (you!).   Depending on the circumstances an adjustment may not be the right treatment for that particular day.  In this week’s blog I am going to briefly outline the McKenzie method.  This posting is aimed at the chiropractors following my blog.  It is meant to renew interest in a method most of us have heard of and urge people to do some further research into patient treatment options

Robin McKenzie, a physiotherapist in New Zealand, founded this technique system almost 40 years.  The McKenzie method utilizes a loading strategy with repetitive spine movement or exercises that incorporates the centralization phenomenon.

A McKenzie mechanical assessment of range of motion is done to determine which of three defined syndromes the patient is displaying signs of. Each syndrome is explained below.   When a diagnosis is made treatment is a more active patient-directed approach.   Exercises are usually given in sets 10-15 repetitions and done as often as 1 set per hour.   Patient feedback is important as symptoms change and centralization, the most important factor in treatment, needs to be communicated to the doctor in order for the exercise progression to be advanced correctly. McKenzie method is a non-manipulative conservative measure which can successfully be used by properly trained practionners in both lumbar and cervical complaints. 

Postural Syndrome

The first is the postural syndrome that exhibits neck pain, without physical findings.  The patient demonstrates a full range of motion and an unremarkable examination.  It is thought that normal tissues are placed in a position of prolonged or excessive stretch, with pain ceasing when the offending tension is removed.   Postural abnormalities have been implicated in the increased incidence of pain in an otherwise healthy adult.  Treatment consists of patient education on posture.  A cervical lordosis is to be maintained with the head held over the shoulder region. This generally resolves symptoms and, as there are no functional limitations, no further care is required.

Dysfunctional Syndrome

The second condition is the dysfunction syndrome, whose hypothesized pathoanatomy is adaptively shortened tissue due to scarring or fibrosis of the ligamentous structures in the spine.  This is secondary to trauma, poor posture or degenerative changes.  Overpressure or sustained loading may increase pain at the end range of motion.  The patient exhibits intermittent pain and the symptoms resolve once the stress on the affected tissue is removed.  Therefore, if range of motion were limited in extension, a loading strategy to provoke the dysfunction (ie. Possible repeated extension to end range) would be prescribed.  This is to restore motion to the restricted movement plane, and would generally involve a prolonged course of care of up to a few months. 

Derangement Syndrome

Derangment syndrome is thought to result in an obstructed range of motion.  Symptoms are constant and, on examination, present themselves during and at the end range of motion.  The patient response to testing may result in symptoms that become more of less severe.  A positive response to spinal loading in this syndrome would result in lowered pain intensity, centralization or symptoms, or and increased in range of motion.  This change can occur immediately or after a period of time.  Neck retraction, which has been advocated by McKenzie in the treatment of the derangement syndrome, causes extension of the lower cervical segments and may alleviate the tress of the posterior annulus and thereby relieve pain. 

Sources:

Sundeep Rathore. Use of McKenzie cervical protocol in the treatment of radicular neck pain in a machine operator. JCCA 2003; 47(4):291-297

The McKenzie Institute.  http://www.mckenziemdt.org/approach.cfm?pSection=int

Which mattress is best for my back?

This one is too hard!  This one is too soft!  AAhhh, this is just right  

Waking up in the morning with back pain is tough.  Many people attribute their aches and pains to poor mattress quality. You may be in a situation where you don’t want to trade in that nice, soft comfortable mattress for a hard firm one.   The fact is that for people suffering with chronic non specific low back pain, a firm mattress may not be the best for your back.  In fact, people who already have low back pain are more sensitive than healthy people to mattress firmness, meaning small change in firmness may have big effects on comfort and pain. 

A 2003 study looking at the clinical effects of mattress firmness on chronic non specific low back pain (pain not related to fracture, spondylitis, or systemic processes) found that a medium firm mattress was better than firm mattress on many levels.  After the 90 day study period people who received a new medium firm mattress had less pain in bed, pain on rising and disability than those who received a firm mattress.  Throughout the study patients with medium firm mattress also had less daytime back pain than those with a firm mattress.   That being said, many people in the firm mattress group also had a decrease in pain scores but it was not as significant overall as the medium firm group.

How do I know the firmness?

The firmness of the mattress was rated according to the European Committee for Standardization scale.  The scale starts at 1 (firmest) and ends at 10 (softest).  The firm mattresses in the study were 2-3 and the medium were 5-6. 

There are two main factors that comprise a mattress:

• Support: The coils or inner springs in the mattress provide support for the spine. A mattress should have enough coils to provide adequate support and allow for the natural curves of the spine.
• Comfort: The padding on top of the mattress primarily provides the comfort (thick padding may be called “pillow top”). This is really a matter of personal preference – some people prefer thick padding and some thin.

In general, the higher number of coils and the thicker the padding, the higher quality (and more expensive) the mattress. However, this does not mean that it’s necessary to buy the mattress with the highest number of coils and/or thickest padding. While it is important that a mattress provide an adequate level support for the spine, personal preference and comfort level is the bottom line when selecting a mattress.

Remember this

 Chronic low back pain is a difficult issue to resolve completely and treatment will involve more than a mattress.  Chiropractors are your spinal experts so talk to your chiropractor today about ways to improve the health of your back, including proper sleeping etiquette. 

 

Source:  Effect of firmness of mattress on chronic non-specific low-back pain: randomised, double-blind, controlled, multicentre trial.  THE LANCET • Vol 362 • November 15, 2003

Do your sneakers really fit you?

A proper shoe fit goes beyond just the right size and width.  A major determinant of proper shoe fit needs to be motion control.  Some signs that your sneakers aren’t providing you with the proper support could be pain during or after exercise, excessive wear patterns on the heels, toes or sides of the shoe, holes developing and surprise! people can tell what colour socks you have on and finally if your sneakers in general don’t last you more than 3 months there is something wrong. 

There are 4 simple at home tests that you can do with your sneakers to test the motion control.  (Thank you to Mark Reeves, DPM for the tests and pictures)

1. dish-rag test
2. pinch test
3. fold test
4. shelf test

1. The dish-rag test:  This tests the torsional rigidity of the athletic shoe. It is done by grabbing the sneaker and placing one hand on each end (toes and heel).  Next twist your hands in opposite direction like you were wringing out a dish rag.   Now, do the same thing with a flip flop and see the difference. 

 

2. The pinch test:  Using your thumb and index finger pinch the back of the heel together.  This shows the support from the heel counter.  Having proper support at the heel of the foot is important because that support will carry forward to the front of the foot.

3. The fold test:  This is done to test the flexion stability of the shoe.  Place your shoe flat on the ground now bend the shoe as if your foot was inside and you were going to stand up on your tippy toes.  There should be a natural bending point in the shoes.  Is the bend in the front or in the middle?

4. The shelf test:  This tests the upper stability of the shoe.  Place your new or used runners up on a shelf and look at the heels end on.  Do you see the upper part of the shoe drifting to one side?  Now put two fingers inside the shoe and push side to side.  If there is give in the shoe, there isn’t enough support. 

When you are out buying your next pair of athletic shoes, ask a lot of questions.  If the sales person can’t answer, go somewhere else.  Also you can talk to your chiropractor or podiatrist about the proper shoe fit and motion control for your individual needs.

10 reasons to stretch

Stretching pumps irritants and inflammation away from the muscles, and increase the blood supply and flow of nutrients to muscles and joints.  This process promotes tissue healing and injury repair.  Here are some more reasons why stretching can be beneficial:

1. Reduces muscle soreness after exercise
2. Accelerates tissue healing
3. Improves balance and co-ordination
4. Improves posture
5. Promotes muscle relaxation
6. Boosts your energy levels
7. Relieves back and joint pain
8. Reduces the likelihood of back pain
9. Promotes total body relaxtion and greater sence of well-being
10. Maintains lifelong flexibility

Below are some easy stretches that can be done daily at home.  A comfortable stretch should be held at for 30 seconds.  Do not bounce at the end of the stretches as this can possibly injure the muscle.  Focus on breathing while you are holding the stretch and relax away the stress in your body.

Source:  Ontario Chiropractic Association

How fast should I go? – working out at the right intensity

How fast should I go? The answer is “it depends”.  If your doctor has said you need to start exercising (maybe because of your arthritis, high blood pressure, cholesterol or maybe diabetes) then is it best to start at a moderate intensity level where you can recieve the benefits of aerobic exercise without unnecessarily pushing yourself too hard. 

Ok so you are still asking, how fast should I go? 

There are two simple measures that can tell you this : the “Breath Sound Check” and the “Talk Test”. 

The Breath Sound Check is a way to ensure a minimal exercise level is reached: you should be able to hear your breathing when you perform aerobic exercise. When you can hear your breath you have reached your “Ventilatory Threshold” which is the point where your body is exercises at a comfortable safe level but still recieving the cardiovascular benefits.  The ventilatory threshold is unique and different for everyone.  Those who are less active, can hear their breathing much sooner.  To find your threshold walk briskly or slowly jog for one minute until you begin to hear your breath sounds.  Maintaining an audible breath sound throughout your exercise time means you are at the correct level.

The principle of the Talk Test is simple: you should be able to have a conservation while exercising.  If you have having difficulty talking and are out of breath, you are working too hard and have reached an anaerobic level.  These means your body is burning more oxygen than you are breathing in, slow it down to more comfortable breathing level. 

The Breath Sound Check and the Talk Test are good tools that can be used in combination and provide you with a personalized, yet simple, criteria of the proper work out level for general health and fitness.    So the question you may have is how long should I go?

When starting a new routine, especially for people who have previously been less active or sedentary, it is best to start slow.  Begin with six minutes a day at the Breath Sound Check pace (plus a few minutes leading up to it and slow down) and build your activity level up to 30-60 minutes a day, 4-7 days a week.  Once you become more active you will find you can go longer and faster and still be in the safe Talk Test levels. 

Sources: 

 1.  Goode, R.C., Mertens, R., Shaiman, S. and Mertens, D. (1998).  Voice, Breathing, and control of exercise intensity.  Advances in Experimental Medicine & Biology, 450, 223-229.

2.  Mertens, R., Bell, H.J. and Goode, R.C. (2001). The Breath Sound Check and Exercise at or about the Ventilatory Threshold.  In, Frontiers in Modeling and Control of Breathing. Ed. Poon, C. and Kazemi, H. pp. 375-382.  Plenum, New York