After a brief hiatus from blogging, I’m back this week to discuss the HIP! First, some important background information. The hip joint is a complex, integrated system of muscle, joint and bone and in recent years, doctors and therapists have changed the way to diagnose and treat problem related to the hip. Two key questions emerged: 1) why was there such a high prevalence of well-​conditioned athletes straining or tearing their abdominal and groin muscles? and 2) why were so many older folks losing their hip function and needing hip replacement surgery?

A newly understood source of hip pain is called femeroacetabular impingement. This is where the head of the femur (a ball shape), can’t move around smoothly because of bony bumps on the femoral head resulting in excessive friction in the hip socket. The result is that it forces people to move differently often affecting one’s midsection in particular and hence straining the abdominal and groin (adductor) muscles and making them more susceptible to tearing. Over a prolonged period of time, impingement can tear the supporting labrum (a fibrous cartilage ring around the hip socket), leading to bone-​on-​bone contact and arthritic processes to occur…and in the worse case scenario the need for a hip replacement.

Patients come into our Richmond Hill chiropractic clinic with hip pain problems all the time. The acute hip injuries are easy to diagnosis because they are often associated with a recent traumatic incident due to an activity. Groin pulls, hip pointers, bursitis and sacroiliac joint sprains seem to be most common.

The chronic hip pain problems typically require more investigation. These are the ones where the patient complains of ongoing pain that is dull or achy and deep within the hip joint. It is sometimes more sharp depending on what he/​she does and there is usually limitations in hip range of motion. It is complicated because it involves looking at the 27 different muscles that control the hip and assessing what limitations exist and are provoking the pain.

In the end, what I will usually find is that there are 1 to 3 key hip muscles that are tight and inhibited in function which causes an imbalance within the integrated hip system. The muscles themselves could be the pain generator or the excessive pulling of the tight muscles may cause excessive pressure within the joint capsule and cartilage structures. The result is the aforementioned femeroacetabular impingement. Properly ‘releasing’ the inhibited muscles will often quickly restore movement of the hip as well as alleviate the pain.

So what can you do to keep your hips healthy? Try these Self-​Defense Tips…

1. Don’t sit in a position where your hips are lower than your knees for prolonged periods. In particular, most people do not have their office chairs adjusted properly to account for this. As well, if you drive alot, the design of most car seats promotes this bad sitting posture. Why is it so bad? It puts your hip flexors in a contracted state for too long, causing it to tighten up and result in either front of the hip pain or even low back pain.
2. Don’t cross your legs. Crossing your legs in a Figure 4 position causes a outward twisting pressure on the hip. Meanwhile crossing on thigh over the other causes an inward twisting pressure. Both are bad so don’t do it. I know…old habit die hard.
3. Sleep with a pillow between your knees to put your hips in neutral alignment. This way the top hip is not twisted inward while you sleep.
4. Add some stretches to your hip flexors, glutes, piriformis and adductors to your exercise regimen. The majority of people only know to stretch their quads and hamstrings. Add the others for a more complete approach to flexibility for good hip health. See your chiropractor, physiotherapist or trainer for some good stretches.

Like I always say, Prevention is the best medicine!

If you know anyone who has ever had a hip replacement surgery, you’ll know how crappy it is…be proactive now and save yourself the aggravation later!

Dr. Keith

It’s estimated that over 80% of the Canadian population will experience at least one episode of back pain in their lifetime. Are you one of those 80%? If not, count yourself lucky because clearly the odds are stacked against you! However, if you have been proactive with proper ergonomics while sitting, standing and sleeping and working on strengthening your core muscles, then keep on doing what you’re doing!

For the rest of us who haven’t been so fortunate, now is the time to get started on avoiding future occurrences of low back pain. I’ve encountered many patients who don’t begin to smartly address their back issues until the second, third or even fourth bad back pain episode. There are a lot of simple things you can do to reduce your risk for low back pain and a trip to your local Richmond Hill chiropractor! Here are a number of tips to keep in mind:

1. Avoid leaning forward from your hips and lock your knees while doing standing activities like washing dishes, brushing your teeth, ironing, etc.
2. Avoid twisting your trunk while bending and lifting. For example, we often bend-​twist-​lift with unloading laundry, picking up children, hauling suitcases, shovelling snow, gardening…sound familiar? As much as possible, turn your whole body around so that you face whatever you need to lift directly. And avoid lifting with your back muscles.
3. When lifting big and heavy objects, lift with your hips and legs, not your back. Instead, make sure you keep your back straight, bend at the knees and keep the heavy object close to your body.
4. Perform an abdominal brace whenever you lift. This is where you tighten your ab muscles…imagine someone is about to punch you in the stomach. Reflexively, you would contract your abs and bear down for the impact. Do the same thing while lifting because it will stabilize your spine and protect it from injury.
5. Avoid carrying suitcases or heavy shoulder bags which stress one side of the back. Invest in some good rolling suitcases and backpacks. They’re great back savers. Who ever finally thought to put those rotating roller blade wheels on the bottom of suitcases should be awarded a Nobel prize!!!
6. When travelling on a plane, train or bus, use a small pillow or rolled up towel and place it behind your low back to help support the normal curve of your spine. You can use the rolled towel also in the car or office…you don’t have to buy a special Obusforme back support to achieve the similar result.
7. Don’t stay sitting or standing in the same position for long periods. You need to take short, frequent breaks to get the circulation going and the muscles moving.
8. Consult a chiropractor, physiotherapist, massage therapist or qualified trainer to determine the best core stability exercises for you. This will involve strengthening weak muscles and stretching tight, inhibited ones. And contrary to popular belief, situps are NOT good for your back! Try planks and side bridges instead.
9. Get off the couch or get away from the computer! Try to exercise 30 minutes a day. Do something you enjoy and become more active!

As always, Prevention is the best medicine!

Helping you prevent low back pain…Dr. Keith

When we look at issues affecting the elbows, wrists and hands, we’re mostly talking about overuse injuries. When you use a computer mouse, screwdriver or tennis racquet for hours on end, you forget to use the leverage of the whole upper body. As a result, you find that the muscles of the neck and shoulder get fatigued and tense from lack of movement while the smaller muscles in the forearm tire out from performing repeated small movements without a break. In the last two weeks, I’ve had a male computer programmer and avid female tennis player come to me for treatment for repetitive stress injuries to the elbow and forearms.

You’d never think that clicking on a computer mouse or typing on a keyboard would be so ‘hazardous’ to your health. In fact, you usually don’t realize it until the muscles in your forearms have been pushed over the edge into irritation and inflammation. At this point, even turning a doorknob, holding a coffee cup or pulling laundry out of the washing machine causes you to wince in pain.

Within the confined space and area of the forearm, there are about 20 different muscles to control flexion, extension and rotation (pronation/​supination) of the wrist. Plus a whole bunch of nerves and blood vessels. That’s a recipe for something getting compressed and triggering pain and dysfunction. If you want to take a proactive approach to avoiding common problems like tennis/golfer’s elbow (tendonitis/​tendinosis), carpal tunnel syndrome and DeQuervain’s syndrome, follow these self-​defense tips:

1. Adjust your computer desk to accommodate you better. When you are typing, you should be able to keep your wrists straight and your elbows bent at 90 degrees. Most desks are set too high so you can either place your keyboard on your lap or get a sliding keyboard tray.
2. When you’re typing or doing housework or repairs around the house that involve alot of wrist movement or gripping, take breaks as often as possible. Every 30 minutes should be the bare minimum.
3. With any type of work, whether you are carrying groceries or using a screwdriver, keep your arms in as close to your body as possible. The further out that you extend your arms, the more stress you end up putting on the elbow and wrist while exerting strength to perform the activity.
4. If you have any current hand/​wrist nerve problems, wearing a splint when sleeping is a good idea. This is because most people sleep with their wrists curled up which causes more compression on nerves and blood vessels in the wrist.
5. If you are a regular tennis player or golfer, you should get frequent technique tuneups from a teaching pro. Minor adjustments to your swing or stroke can help prevent injuries. Or possibly the racquet or clubs you are using are wrong for you. A pro will be able to assess that for you too.
6. If you lift weights regularly, make sure you balance out any arm flexor exercises (eg. bicep curls, wrist curls) with extensor exercises (eg. tricep extensions, wrist extensions). Injuries very commonly occur because there is an imbalance between opposing muscle groups.

Injuries can be avoided or minimized and now you have some more tips to get you started. But it all boils down to you actually doing them! Otherwise I may be seeing you in my Richmond Hill office for treatment on your elbow or wrist some time soon!

Prevention is the best medicine!

Dr. Keith

As mentioned last week, “An ounce of prevention is worth a pound of cure.” Continuing with my blog series on ‘Self-​Defense Tips’ for different parts of the body, this week’s post deals with your shoulders.

All the joints in your body represent a trade-​off between stability and mobility. In the shoulder, it is clear that mobility is the primary characteristic. Humans can move the shoulder easily in every direction. This movement is achieve through a beautiful engineering design which involves 18 muscles and 3 bones. But the price we have to pay for this freedom of movement is instability. In fact, of all the joints in the body, the shoulder has the greatest risk of dislocation. It is the intricate weave of connective tissue and muscle around the shoulder, that helps this joint glide and rotate without falling out of the socket!

You may have heard of the rotator cuff…a group of four muscles and tendons that surround your shoulder joint that are critical to the multidirectional movement and stability of the shoulder. The large majority of shoulder injuries are either directly to the rotator cuff or are caused secondarily by a poorly functioning rotator cuff. Tears to the cuff are common during extreme activity. In middle age, rotator cuff injuries are mostly due to wear and tear of repetitive motion. If you have a major tear, it will need to be surgically repaired. Otherwise, tears can be rehabilitated with passive therapies like low intensity laser in combination with addressing muscle dysfunctions in the neck, upper back, chest and shoulder areas.

The following are your key Self-​Defense Tips for Shoulder Health:

1. Have your posture checked. Gradual rotator cuff damage occurs if you have bad posture because the slouched position that many people have actually reduces the clearance for one of the tendons in rotator cuff. This causes the tendon to be repeatedly irritated with various shoulder movements.
2. Avoid doing too much overhead activities. Anything that requires you to reach above your head alot will cause repetitive stress injury to the rotator cuff. Things like volleyball, baseball, tennis are sports that commonly cause shoulder problems. Occupations like electricians, drywallers, carpenters, etc. which require alot of daily overhead work also are at great risk for injury. They key is to vary your activities as much as possible. And make sure you stretch and strengthen related muscles to counteract the negative effects of overhead work.
3. Avoid sleeping with your arm overhead…this is like combining the bad effects of #1 and #2.
4. For any strenuous activity, keep your arms as close to your body as possible. The further outstretched your arm is from your body, the greater the instabiliy of the joint and the greater likelihood of injury.
5. Avoid barbell bench presses and shoulder presses when working out at the gym. The solid bar limits the natural movement of the shoulder compared to dumbbells. Plus, the classic press exercises all put your shoulder joint in the most dangerous and harmful position. There are better exercises that will help prevent shoulder injury while still allowing you to get a good workout!
6. If you regularly carry any sort of bag (purse, briefcase, backpack, etc.), make a conscious effort to switch shoulders periodically. Most people have a regular habit of carrying bags only on their dominant side. Over the long term, you will develop muscle imbalances that will eventually result in pain and injury to the shoulder as well as neck and back.

If you need preventative or rehabilitative treatment for shoulder pain, we are here to help in Richmond Hill!

You’ve heard the saying: “An ounce of prevention is worth a pound of cure.” Are you willing to do the little adjustments in life to affect your positively affect your health or pain problem? My next series of blog posts will be called ‘Self-​Defense Tips’ for different parts of the body. But don’t just read them…APPLY IT! Today, I give 8 tips to defend against developing chronic neck pain.

1. Don’t tilt you head down when you read. Don’t adjust your head position to the material, adjust the material to you. Try to keep your head in a neutral position. One of my chiropractic patients recently said to me…”Who actually does that??”. And he’s right, most people don’t and that’s the point! We’ve all developed bad habits since our childhood and it take a conscious effort to reprogram our brain and body.
2. When you watch TV at home, make sure that your couch or chair is directly facing the TV. Most of the time, we arrange our furniture to make the room look nice but is functionally terrible! Can you imagine going to the theatre and watching a 2 hour movie with your head cranked to the left because the screen wasn’t directly in front of you? You’ll need to see your chiropractor immediately the next day!
3. When travelling by plane or train, bring a small pillow for better neck support. You’ve seen these passengers. You probably were one at some point! Head is down to their chest or extended backward with their mouths open (and drooling). Embarrasing….AND bad for your neck.
4. Don’t sleep on your stomach; stick with lying on your side or on your back. If you have been doing it all your life and you feel there is absolutely no way you can change your habits, at least alternate the side that you turn your neck to. Also your pillow should support your head and keep it in neutral alignment.
5. Don’t bend your neck down to look at your keyboard. I think laptop computers and the advent of smartphones and iPads are going to keep chiropractors in business for many years to come!
6. Set up your computer monitor so that you can look at it without tilting your head up or down. Typically, most people have their monitors too low on their desk. A good rule of thumb is to have the top frame of the monitor at eye-​level. You can put a few books or an old Yellow Pages directory under the monitor to prop it up.
7. If you spend a lot of time on the telephone or cellphone, invest in a headset. Do not cradle the phone receiver between your ear and your shoulder. You’re just asking for neck pain or cramps.
8. Take frequent, short work breaks. Yes, I know that some of you have tons of work to do or get really in the zone and hate breaking your concentration. But these breaks will pay huge dividends to your mental and physical health. Move around to get the blood flowing. Performing a few head circles or rolling your shoulders is a good start.