Dr. Carney's Talk Back

What's the single best thing we can do for our health?

2011-12-22T18:28:00.000-08:00

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Have a look at this short video. It nicely lays out, in an evidence-based fashion, the case for the "single best thing we can do for our health"...

I've written on this subject before, but nonetheless, it's a subject that's near and dear to me, and in my humble opinion, a simple message that needs to be spread like wildfire in our society...

Enjoy.

http://www.youtube.com/watch?v=aUaInS6HIGo

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Fibromyalgia, Part 2: Treatment and Management

2011-08-24T19:52:00.000-07:00

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As mentioned in Part 1 of this post, there is no magical, quick fix in the treatment of fibromyalgia. Fortunately, symptoms of fibromyalgia can often be effectively managed. Proper management – with the goal of minimizing symptoms and improving overall health – is best achieved with a multi-dimensional approach.

The following is a brief overview of treatments and self-management strategies that may be employed.

Treatments:

- Chiropractic / physical rehabilitation – those with fibromyalgia know, all too well, the tightness and stiffness associated with the condition. This stiffness, especially over weeks – months – years - can compound pain as well as reduce mobility. The skill-set of chiropractors allows us to be well suited to have a positive influence on this tightness and reduced joint mobility.

- Acupuncture – the insertion of very fine needles through the skin to various depths – has some medical research that supports its use in the treatment of fibromyalgia. (Other studies have not shown a conclusive benefit.)

- Massage therapy – can relax muscles and decrease pain. Further, it can help relieve stress and anxiety that is often associated with fibromyalgia.

- Medications – talk to your family doctor about the possible inclusion of certain medications in your management strategy. Medications could include pain killers, muscle relaxants, antidepressants, or anti-seizure drugs. (Certain anti-seizure medications have been shown to help reduce fibromyalgia-related pain).

- Cognitive-Behavioral Therapy – this form of therapy has been shown to play an important role in addressing the stress and negative thoughts associated with fibromyalgia. You may gain stress-relieving strategies as well as the mental strength needed to cope with your condition. It may also allow you to gain a greater awareness of aggravating factors contributing to your symptoms, and what your limits are.

- Support Groups – one of the stresses and frustrations for fibromyalgia sufferers is the feeling that no one understands your pain. It may even feel like those closest to you – friends and family – are not able to understand the persistent pain that you are suffering. It may be helpful to know that there are people out there (many of them) who CAN understand your pain. A simple search on Google will find numerous support groups and online discussion forums for fibromyalgia sufferers. Need a start? Try the National Fibromyalgia Association at: http://www.fmaware.org/

Self-Help Remedies:

- Regular exercise – I can hear fibromyalgia sufferers collectively groaning right now. I know – this is a tough sell. I’ve been told many times from sufferers that exercise increases their pain levels. So why bother? Multiple studies tell us that gradual and regular exercise will, over the long run, lead to a decrease in your symptoms, even if it doesn’t feel that way initially. But keep it simple – stick to low impact aerobic activities like walking, cycling, or swimming. Slowly progress to a faster pace as you feel more comfortable – increase the speed of your walking, or try Nordic pole walking, or pool aerobics. Bottom line – the studies are clear on one point – GET MOVING.

- Reduce your stress -I know – easier said than done – but a worthwhile cause, nonetheless. Have you noticed your symptoms worsen as your stress levels increase? Thought so. There are numerous effective strategies to try, all of which can be effective. If you’re serious about managing your condition, you will have to set aside some time and make a consistent and conscious effort. If you do not have any healthy stress relief techniques, then try something new. How about yoga? Meditation? Breathing techniques? All are good.

- Sleep - Make sure you get enough sleep, and practice regular sleeping habits (such as going to bed and getting up at the same time, and limiting daytime napping). As previously mentioned, tiredness is a central characteristic of fibromyalgia. Regular sleeping habits are absolutely critical for energy, mood, and pain reduction.

Eat well - This just makes sense. A diet that is rich in organic fruits and vegetables, nuts (such as almonds or walnuts), and whole grains all help to strengthen your body’s natural defenses and healing capabilities. In addition, try adding ginger and turmeric (the spice in curries) into your diet as these are fantastic natural healing agents. Reduce your intake of trans-fatty acids by eliminating polyunsaturated vegetable oils, deep-fried foods and vegetable shortening. Eliminate caffeine from your diet.

- Supplements – There is some medical evidence to suggest that calcium, magnesium, and malic acid can be of benefit to fibromyalgia patients.

So there’s a general guideline to help steer you in the right direction. Remember that no single strategy will work miracles for you. Instead, try to incorporate a variety of strategies. I’ve seen many fibromyalgia sufferers, and have witnessed some great improvements in quality of living. Though a painful and frustrating condition, there is hope for fibromyalgia sufferers.

It’s worth repeating – there is hope.

Fibromyalgia: An Overview

2011-07-24T20:39:00.000-07:00

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The following is a common type of case presentation that I see in my office:

An adult between the ages of 20-50, usually a woman, with pain (usually described as aching, or tender, or burning) – but not just pain localized to one area of the body, but rather pain that seems to be all over the body. They may also describe feeling stiff most of the time, often most noticeably in the morning. They are sometimes unable to describe any particular event/occurrence that caused the pain. They often describe feeling tired a lot of the time and have difficulty concentrating. Sleep disturbances as well as feeling down or depressed may be reported. There is usually a lack of desire to exercise (due to the pain and fatigue). Stress, anxiety, and possibly certain weather conditions (cold, or damp) may seem to worsen the pain. There may or may not be a history of headaches, and or irritable bowel syndrome (IBS).

Does this sound familiar to you? Many of us may know someone who fits this profile. One possible diagnosis in this scenario (and certainly there are other possible diagnoses) is that of the condition called fibromyalgia.

An estimated one million Canadians suffer from fibromyalgia.

But, just what is fibromyalgia? In a nutshell, fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain. (By the way – “chronic” for our purposes, means that you’ve suffered with the condition for 3 or more months). Researchers don’t exactly know what causes it, but there are theories that certain events (either recent or from years previous) can trigger its symptoms, such as car accidents, viral or bacterial infections, or the onset of other disorders (for example, rheumatoid arthritis, or lupus). There is some research that suggests a possible connection between emotional stress/trauma (and, in particular, post-traumatic stress disorder) and fibromyalgia. For now, the exact cause remains elusive.

When I perform a physical examination on fibromyalgia sufferers, a pattern emerges. Testing of the mobility of different joints in the body often does not show any large reduction of mobility (although the patient may report feeling stiff). Likewise, strength testing often does not reveal any obvious, significant weaknesses. Neurological testing is usually normal. However, palpatory findings (simply touching different joints and muscles) commonly reveals marked tenderness and soreness. Affected areas may include the upper back, lower back, hips, thighs, rib cage, shoulders, elbows, chest, knees….you get the point. This does not mean that the fibromyalgia sufferer has tenderness in all of these areas, but some of them anyway. The force that I use to touch an affected area of the body is not even close to being enough to harm anyone, yet the patient feels pain or discomfort.

This highlights the difference between hurt and harm. The fibromyalgia sufferer will often feel pain with non-harmful stimuli – such as light touch, or upon performing simple daily tasks. The pain is real – there is no doubt about that point in the scientific literature, and certainly there is no doubt to the patient. However, in these cases, feeling hurt does not accurately indicate that any harm is being done to the musculoskeletal system. Normally, we will experience pain only when some sort of damage is being done to the body – this is the body’s way of alerting us to trouble so that we may attend to it immediately (for example: if you accidentally touch a hot stove, you will very quickly experience pain, which then forces us to respond by quickly removing your hand from danger). The fibromyalgia sufferer will also react to touching a hot stove, but they also react to stimuli and activities that are not harmful to the body (such as light touch).

So why does it hurt then? This question encapsulates the frustration that fibromyalgia suffers experience. To answer that question, I have to get a bit technical. Researchers believe that fibromyalgia sufferers have developed a lower threshold for pain due to increased sensitivity in the brain to pain signals. This is called “central sensitization”. In other words, areas in the brain that are responsible for pain seem to react differently in fibromyalgia patients. Certain chemicals in the brain (called neurotransmitters), as well as the brain’s pain receptors change in these patients, ultimately creating a sort of overreaction to stimuli to the body.

If you feel that you, or someone you know, fit the profile of a fibromyalgia case, it is a good idea to see your health care provider so that he or she can rule out other potential reasons for your pain. They may wish to have blood work, or a urinalysis performed to help eliminate these other potential pain sources. In the case of fibromyalgia, these tests are often found to be normal.

After a diagnosis is made, a plan of management is needed. There is no quick fix in this case, but there is most definitely strategies that can significantly help manage and improve pain and quality of life. In my next entry, we will discuss your varying treatment and self-help options.

Of course, if you have any questions about anything that has been discussed, please do not hesitate to contact me.

Towards good health,

Dr. Michael Carney
B.Sc. (Hons. Kin), D.C., D.Ac., C.S.C.S

Disc herniations - Spinal manipulation vs surgery - a research update

2011-05-25T20:05:00.000-07:00

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I thought that I would share the results of a very interesting study that was recently published. The results challenge the commonly held notion that the solution for lumbar disc herniations (and related sciatica) is surgery.

The study, entitled “Manipulation or Microdiskectomy for Sciatica? A Prospective Randomized Clinical Study” (JMPT, Dr. McMorland, D.C., Dr. Casha MD, PhD, FRCSC, Dr. du Plessis MD, Dr. Hubert, MD, PhD, FRCAC, FACS, 2010) looked at patients who were suffering from sciatic nerve related pain secondary to a lumbar disc herniation, and who were not responding to medical management for at least 3 months.

In this year-long study, patients were randomly chosen to receive approximately 20 chiropractic treatments over the course of the year, or surgery (the standard surgical procedure is called a microdiskectomy). Further, both treatment groups received an additional 6 supervised active rehabilitation sessions and an education program.
After a year, analysis of both groups revealed that 60% of the spinal manipulation group benefited from treatment to the SAME degree as the surgical group. Further, the 40% who did not benefit to the same degree, subsequently underwent microdiskectomy surgery and benefitted to the same degree as the initial surgery group.

So what does this all mean?

Firstly, given that surgery has known risks that greatly exceed those of spinal manipulation, it is apparent that chiropractic treatment is a safe and effective treatment option. It’s also important to note that choosing the non-surgical route does not in any way worsen the outcome of surgery – should that become the treatment of choice later on.

The authors stated “Our research supports spinal manipulation performed by a doctor of chiropractic is a valuable and safe treatment option for those experiencing symptomatic lumbar disc herniation failing traditional medical management. These individuals should consider spinal manipulation as a primary treatment, followed by surgery if unsuccessful.”

As a side note, the authors of this (American) study noted that over 200,000 miscodiskectomies are performed annually in the United States at a direct cost of $5 billion, or $25,000 per procedure. The authors then calculated the total cost of the chiropractic treatments (at $100 per treatment), or $2,100 in total. This is a difference of $22,900 per patient compared to the surgery group, and a system-wide savings of $2.75 billion dollars annually in the U.S. In my opinion, those numbers speak volumes.

As always, I welcome your questions and feedback.

Yours in health,

Dr. Michael Carney
B.Sc. (Hons Kin), D.C., D.Ac., C.S.C.S

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To stretch or not to stretch...

2011-04-06T20:28:00.000-07:00

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With spring upon us, many of us will come out from hibernation and will take to the great outdoors to savor that fresh air and (hopefully) warmer temperatures. Some will walk, some will run, some will bike, and some will work around the yard.

Conventional wisdom has previously been to stretch before and after performing any such physical activities. Although I'm not implying that we are always diligent with our stretching, generally speaking, most people have accepted that stretching can only be a positive thing in conjunction with any physical activity.

More recently, however, there has been some scientific murmurings that stretching may not be all that it’s cracked up to be. A recent review of the larger scale studies related to the effects of stretching, concluded that stretching – be it, before or after exercising – does not decrease the occurrence of injury, nor does it protect the muscles from getting sore.

Huh? I’ll bet that caught a few of you by surprise. It has, most definitely, raised more than few eyebrows in the exercise science community.

So, should we then abandon any notion of stretching?

Not so fast! Okay, so stretching may not decrease injury risk, nor offer the muscles the protection that we once thought it did, but there are still MANY wonderful reasons to keep stretching in your daily routine. Here’s a few:

- Stretching can maintain and increase your flexibility. This flexibility tends to diminish with age.

- Stretching can help enhance your balance and coordination. Again, this can diminish with age.

- Stretching is a known stress and tension reliever (both of physical and mental stress / tension).

- Stretching can improve your circulation.

- Stretching can help correct muscular imbalances and postural problems.

Furthermore, we should all note that the studies that have made conclusions regarding the lack of injury-risk reduction, were studies that only examined a few weeks worth of stretching. Scientists have not yet made conclusions regarding the reductions in risk of injury from stretching over many months or years.

So continue to stretch! Stretch often, and remember to hold a stretch for a minimum of 20 to 30 seconds. Further, be patient. To realize any of the above-mentioned positive effects of stretching, you must stretch regularly – preferably multiple times per day. If you only stretch once in a while, or only hold your stretches for a few seconds at a time, you can expect to see very little benefit. To illustrate this point, think of going for a run; if you run only once or twice, you cannot possibly hope to have significantly improved your level of fitness. However, if you run 50 times, or 100 times, you can expect that the body will have made some positive adaptations that will result in improved fitness. Stretching follows a similar pattern.

To date, studies have determined that the best thing we can do before a work-out is to warm-up. “Warm-up” is not the same thing as stretching. A warm-up can include a 5 to 10 minute walk, or jog on the spot, for example. Its purpose, as the name implies, is to literally warm the muscles up by bringing blood flow to the muscles that we are about to use. By warming the muscles up, we are making the muscles more pliable – more bendable – and hence, ready to be engaged.

Stretching then is best performed when muscles are warmed-up. A light stretch after your warm-up is fine, but is most useful after the physical activity has been performed. Consider this your cool-down, post exercise.

If you like to stretch in the morning – that’s great – just do not stretch immediately after getting out of bed. Instead, get up, and get moving. Walk around the house, or climb the stairs a few times to properly warm up the muscles – and then you may stretch.

Finally, note that that not all stretches were created equal. Some stretches can be potentially harmful to your body, while some can lead to a greatly improved quality of life. Some stretches are better (and more specific) for certain physical activities than others. If you would like a stretching program, or have any questions about your stretching routine, I am here to help. Please feel free to contact me.

In good health,

Dr. Michael Carney
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Tips for Office Ergonomics

2011-03-10T20:20:00.000-08:00

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Some people come to see me because they’ve had a significant (single event) trauma – be it a car accident, a fall, a sporting injury, etc. However, a significant percentage of my patients seek treatment, not because of a major trauma, but because of a gradual onset, “repetitive strain” type of injury.

By “repetitive strain” I am referring to physical tasks performed often over the course of a day, and postures that are sustained for substantial lengths of time that, ultimately, place stress on the musculoskeletal system, gradually leading to strain, pain, and injury. Common pain sites include the upper and mid- back, neck and head (headaches), shoulder pain, and wrist pain (carpal tunnel syndrome).

A few common examples of activities that can lead to repetitive strain include:

- excessive video game playing

- holding a telephone between one’s shoulder and neck

- prolonged length of time looking down (such as while reading or knitting)

In the workplace, the single greatest contributor to repetitive strain injuries is due to the computer. In fact, as we have become more reliant on computers and workplace technology over the past two decades, repetitive strain injuries have skyrocketed. No coincidence. Simply put, the human body was never designed to be sitting at a computer for 8+ hours a day. We’re designed to be active, mobile and physical – not to hold a position for hours at a time. And so it is no wonder that there is a physical toll to be paid for the poor postures adapted in front of the computer.

No, I’m not suggesting you abandon your desk jobs - sorry. I am, however, suggesting a few simple changes to your office set-up that could make your job safer and more efficient.

Keyboard Position: Your upper arms should be able to hang relaxed at your side during computer use. Your elbow joints are at, approximately, 90 degrees. Your hands are in a “neutral” position when using the keyboard or mouse. (In this case, a “neutral” position is such that the hands are in line with the forearms, as opposed to flexed or extended at the wrist.)

Monitor Position: Position it directly in front of you, with the upper half of the screen at eye height. Make sure the screen is approximately 15 inches to 29 inches in front of you. Of course make sure that you are wearing proper corrective eyewear (if needed) to avoid leaning in and straining forward.

Chair: Sit upright and all the way to the back. Place a support cushion or roll against the arch of your low back for lumbar spinal support. Make sure that your chair is adjustable so that you can adjust the height of the seat. The height of the seat should be such that your knees are bent at approximately a 100 degree angle when your feet are flat on the floor. (Stand in front of your chair and adjust the height so that the highest point of the seat is just below your kneecap). If you are shorter, consider purchasing a foot stool to allow for proper knee angle, yet still allowing your feet to rest on a flat surface. Further, adjust the backrest forwards and backwards as well as up and down until it fits the hollow in your lower back.

Telephone: Make sure to use your hand to support the telephone against your ear and alternate sides regularly. Do not cradle the phone between your ear and your shoulder. If you are on your phone a lot, consider using a headset or speaker to reduce strain on your neck and arms.

Document Holders: Get yourself one or two adjustable document holders so that you can look at documents in a more upright position (and closer to eye level) as opposed to viewing documents lying flat on the desk which requires you to hold a physically taxing flexed neck posture.

Task Design: Take a 5 minute break every hour! Get up, stretch, walk! (We’ll discuss some easy, practical office exercises in the near future) Bottom line – no matter how good your workplace set-up is, for better health, you must change position, and move around frequently.

Overall, if implemented, I believe these small workplace modifications could drastically reduce your chances of acquiring future repetitive strain injuries. For those who may suggest that it is not practical for them to modify their work station (I have heard this argument before), I would argue that it is far less practical and far less productive to do your job while in pain.

If you have any questions about this post, feel free to contact me at kawarthatherapeutic@gmail.com or visit us at www.kawarthatherapeutic.com.

In good health,

Dr. Michael Carney
B.Sc. (Hons), D.C., D.Ac., C.S.C.S
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Exercise is best for anti-aging: McMaster Study

2011-02-22T10:29:00.000-08:00

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...thought I would pass this one along to you from the Ottawa Citizen. It's a nice summary of recent findings from a study out of McMaster University regarding a link between anti-aging and exercise.

The results of the study did not surprise me, rather, they add to a growing mountain of evidence regarding the extensive health benefits of exercise to the body. We've discussed health benefits of exercise in a previous post, but nonetheless, further evidence is always welcomed.

Here you go:

http://www.ottawacitizen.com/health/Exercise+best+anti+aging+treatment+study+suggests/4324434/story.html

Is there a better wonder-drug out there than regular exercise? More and more evidence is suggesting - no.

Cheers,

Dr. Michael Carney

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Plantar fasciitis Part 2: Treatment

2011-02-09T19:50:00.000-08:00

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In Part 1 of this entry, I discussed the key features of plantar fasciitis – what exactly it is, the symptoms, the causes, and who is likely to get it. Today I’d like to let you know of your treatment options – including both self-treatment and available professional treatment.

After the diagnosis of plantar fasciitis has been made by a regulated health professional, you will have a few options for professional treatment:

1. “Hands on” manual therapy – different therapists have different techniques –but in essence, all hands-on therapeutic techniques are generally aimed at reducing the tension in the plantar fascia. One specific technique – called Active Release Techniques – has been shown to be quite effective in reducing such tension, and specifically, breaking up “adhesions” and tough dense tissue that develops in the fibers of the injured plantar fascia.

2. Therapeutic Exercises – your practitioner should give you some exercises that are designed to stretch the appropriate tissues. Such stretches should not focus just on the plantar fascia, but also on appropriate neighbouring muscles that may be contributing to your pain and dysfunctional mechanics of your gait. A thorough assessment, not just of the plantar fascia, but of all of the muscles and structures involved in movement, would determine which muscles are dysfunctional, and hence, which are contributing to the plantar fascia problem. Your Achilles tendon, for example, if insufficiently flexible, can lead to an overstress of the plantar fascia during the landing phase of each step. If the Achilles tendon is not addressed (in this example), an underlying contributor to injury is being ignored – and the problem is likely to persist. Further, prescription of some simple strengthening exercises may also be appropriate, as long term physical stress and damage of plantar fascia (and related anatomy) will weaken those tissues.

3. Custom orthotics – if a cause of your plantar fasciitis is faulty foot mechanics (low arches, for example), then orthotics may have a role to play in correcting the faults. Your practitioner can do several things with a custom orthotic than can help – supporting the arch, adding extra cushion to soften the impact of the foot landing on the ground, adding a heel cup which can aid in shock absorption, etc.

4. Night splints – these are worn in bed and allow the foot to remain in a neutral (unstressed) position while sleeping. I managed to find one study (Wapner KL, 1991) which reported significant relief of plantar fasciitis in 83% of patients who used night splints. Granted, some patients don’t like these -they find them annoying to wear, and others find them ineffective. But they are an option that seems to work for some.

5. Ice – as simple as this one sounds, it is not to be overlooked. Simply put – ice is an anti-inflammatory, and plantar fasciitis is an inflammatory condition.

6. Medication – your medical doctor may prescribe pain killers or non-steroidal anti-inflammatory medication. Medication will not provide a solution to the root problem – but it may provide some much needed temporary relief.

7. Therapeutic modalities – such as ultrasound. Such treatment would not be used as a stand-alone treatment – but in combination with other treatment can be quite useful.

Often your health care provider will use a combination of the above-mentioned treatment options…..and fortunately – often they will do the job, and your plantar fascia will heal, and pain will disappear.
Sometimes, however, these treatments will not be enough. Sometimes the pain is too severe, the problem has been present for too long, and the damage is too great for these treatments to be effective. People in this scenario present to the office in despair – they tell me that they’ve tried everything.

Are there any more options?

3 more options remain:

1. Extracorporeal shockwave therapy – this is a relatively new treatment in Canada, but has been used in Europe for years. This is quite an exciting therapeutic option – and scientific research is quite supportive if it. The Journal of Orthopedic Research (2005) found a 90% success rate, for example. That’s encouraging! Shockwave therapy works by sending acoustic shockwaves into the damaged tissue – effectively re-injuring the tissue (on a microscopic level) and stimulating the healing process to kick in. Generally 3-5 treatments are needed for this therapy to be effective. (And to put a personal plug in – we are one of a handful of clinics in Ontario to have this therapy on site)

2. Cortisone Injections – again, this is not to be used as an initial treatment (if at all) – but it is capable of providing significant relief in some (although not a cure). Note that your doctor will not recommend multiple injections because they can weaken your plantar fascia (which can lead to rupture). One study, for example, found 44 ruptures (out of 765 patients) occurred as a result of cortisone injections. (Avevedo and Beskin, 1998).

3. Surgery – clearly, not the option that you want. This is only to be used as a last resort. The procedure is called a “plantar fasciotomy” and involves an incision (usually 3-6 cm) into the plantar fascia to release it. If a calcaneal spur were also present, the surgeon may wish to remove it.

As for self-help options – well, there’s a few things that you can do:

1. Stay off of your feet! Yes, I know, easier said than done. It’s only worth mentioning, however, because each step that you take further aggravates the condition.

2. Apply ice – preferably several times a day for 15 minutes at a time.

3. Gentle massage – using a rolling pin, for example, to massage the plantar fascia can be of benefit (just don’t overdo it – when dealing with an inflamed condition, overdoing it will worsen your pain and only serve to further inflame the tissue.

4. Combine points 2 and 3. That is, try an ice massage. To do this, freeze a water-filled plastic bottle of water, or a water-filled paper cup, and roll it back and forth over the plantar fascia for 5-10 minutes.

5. Gently stretch the plantar fascia, calves, and hamstrings. (Again, the key here is to do this gently – anything more than gentle can cause pain and further inflammation.)

6. Choose proper foot wear. Sorry ladies – high heels are disastrous to the plantar fascia. Wear shoes with a low to moderate heel, good arch support and shock absorption.

Finally, and to re-iterate, the best advice that I can give is to have a health professional perform a full assessment of your painful condition. Let them determine the diagnosis and recommend a proper course of action. You should never feel forced into a treatment plan that you are not comfortable with, but you do deserve to know what your options are so that you can make an educated decision about your course of action.

If you have any questions about this topic, please feel free to e-mail me or contact me at the office. Of course, if you require an assessment and/or treatment, we are happy to serve you at Kawartha Therapeutic Centre.

In good health,

Dr. Michael Carney

Plantar fasciitis explained

2011-01-30T15:03:00.000-08:00

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If you suffer from heel pain, you may have been told by your health care provider (of you may have done your own investigative work via Google) that you have plantar fasciitis.

Those with plantar fasciitis know how debilitating it can be. That sharp, stabbing pain with each step is beyond annoying – it makes it very difficult to lead a normal active life.

In this entry I hope to explain what this condition is, who gets it, and what causes it. In part 2 of this entry, I will explain your treatment options.

The plantar fascia is a thick, broad, rather inelastic band of tissue that runs from your heel bone (called the calcaneus) to your toes. Its purpose is to stabilize the bones of the foot during impact with the ground, and act as a shock absorber for the foot and the entire leg.

I mentioned that this band is “rather inelastic” – what I meant by this is that it doesn’t stretch that much (studies suggest only a few percent) before microtearing (the injury process) begins. Consider this – during running, a force equal to 3 times our body weight passes through the foot with each step. This force brings the tautness of the plantar fascia close to a “danger zone” (where injury occurs) of stress with each step. Repetitive stress of the plantar fascia, and repetitive microtearing can lead to inflammation and injury.

“-itis” means inflammation. Thus, you can probably guess that “plantar fasciitis” is defined as “inflammation of the plantar fascia”.

You should note that plantar fasciitis is by no means the ONLY cause of foot and heel pain – but it is the most common type. Let your health care provider rule out other potential causes of your pain and make the official diagnosis. (Effective treatment, including effective self-treatment depends on a correct diagnosis – otherwise you can make things much worse).

So what causes plantar fasciitis? Well, as mentioned, repetitive stress of the plantar fascia is usually the culprit. But there’s more to it. Some people are more susceptible to injury than others. If you have flat feet, for example, you have greater tension on your plantar fascia even before your feet impact the ground. This means that your plantar fascia is closer to that “danger zone” of tension and stress with each step that you take, and hence, more likely to become injured. But those with high arches are also susceptible to injury. If you are overweight, you are also susceptible to plantar fasciitis, obviously due to an increased force to be absorbed by the plantar fascia. Tight muscles in the leg can also contribute to this injury, because movement (as in walking, running, etc) of the leg depends on the co-ordination and activation of many different muscle groups at the proper time. A disruption in the proper movement pattern can place a greater burden on the plantar fascia – and, you guessed it, can lead to injury. Improper shoes can also be significant contributor to injury, as they can create or enhance faulty foot mechanics, promoting a greater likelihood of an injury scenario. There can be other causes of plantar fasciitis – but I think you get picture.

Finally, who is likely to get plantar fasciits? For starters, if you are over the age of 40, you have a higher likelihood. Sorry - that’s just the simple statistics. Certain occupations and certain sports place a greater stress on the plantar fascia – distance running, ballet, aerobics, and occupations that require a lot of walking or standing on hard surfaces – factory workers, teachers, waitresses – all can increase the likelihood of developing plantar fasciits. And, as noted earlier, obesity as well as faulty body mechanics (low arches, high arches, tight muscles) all contribute.

Since walking is essential to daily activity, plantar fasciitis often does not just “go away on its own”. That is to say, it is very difficult for healing to take place when we are repetitively irritating the already damaged structure. Thus, those with plantar fasciitis can suffer for months to years. That’s the bad news.

The good news is that effective treatment does exist. In my next entry, I will discuss your treatment options.

In the meantime, if you think that you, or anyone that you care about, suffer from this condition, do yourself a favour and have it properly assessed by an expert. Of course, we at Kawartha Therapeutic Centre are most happy to provide a thorough assessment and treatment.

Yours in health,

Dr. Michael Carney
B.Sc., (Hons.), D.C., D.Ac., C.S.C.S

Tips for a Safe Snow Shoveling Season

2010-12-07T10:09:00.000-08:00

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As I write, it’s about -11 degrees Celsius outside, with snow flurries in the air….yes, I think it’s safe to say that winter is upon us.

Although I’d much prefer to associate winter with such pleasures as skiing, skating, hot chocolate, and holiday cheer, there is that sobering reality of the oft dreaded snow shoveling. But more important than being an inconvenience, shoveling can be a recipe for injury. Think about the circumstances surrounding the shoveling experience – IT’S COLD – so our muscles can be cold (unless we’re prepared and warmed up), and furthermore, we have a tendency to rush the job so that we can get back in the house (or get to work) as quickly as possible - so we’re likely to lift more than we should in a reckless manner.

With that in mind, let’s have a safe winter and keep the following shoveling tips in mind:

1. Warm-up. It might sound funny to warm-up before shoveling, but remember, shoveling is exercise. Warm-up before ANY exercise. So, go for a short walk first (5 to 10 minutes will do), or walk on the spot, and get those arms moving. These simple activities will get the blood flowing to your muscles and ready them for physical activity.

2. Dress appropriately. Wear several layers of clothing to keep your body heat from escaping. Cold muscles are muscles that are susceptible to injury.

3. Use good technique! Yes, use your knees and core strength to provide your power to push the snow. Do not, and I repeat – do not – bend at the waist and lift.

4. Minimize lifting and throwing, opting instead for pushing. Snow can be heavy – using the aforementioned good technique that maximizes leg involvement while sparing the back – focus on pushing the snow in a straight line to the side. Lifting and throwing heavy snow puts unhealthy compressive and shearing forces on the low back - do this repetitively – and the back WILL give out.

5. Pick the right shovel. Go for a light-weight push-style shovel. If the shovel is metal, apply a Teflon spray to prevent snow from sticking to it. (Snow that sticks to the shovel will weigh it down and add to the mechanical stress on your low back).

6. Take frequent breaks. No need to rush!!! If you’re worried about being late for work – it’s best to avoid the situation by preparing for it – that is to say, allow yourself extra time if you know that snow is in the forecast. If you’re panicky about being late for work, then you will rush the job, and lift too heavily, too quickly.

7. Keep hydrated. Cold weather can be deceiving in this regard , but the reality is that shoveling, like any exercise, taxes the muscles, and consequently requires hydration for proper functioning of said muscles. Preferably, we should hydrate before, during, and after shoveling with water or juice.

8. Listen to your body. If you experience chest pains or shortness of breath – seek medical attention immediately. If you experience back ache – consult your chiropractor.

When we’re adequately prepared, shoveling can be a safe and beneficial exercise for the body.

I hope you enjoy the beauty of the season.

Yours in health,

Dr. Michael Carney

Laughter is the best medicine

2010-11-28T15:21:00.000-08:00

Did you know that laughter has MANY positive health benefits on your body?

Here's a few:

1. Your immune system. Yes, researchers have found that laughter is associated with an improved ability to fight illness. Specifically, it has been shown that laughter can boost your immune cells, as well as your antibodies (these guys help fight off infections).

2. Blood sugar levels. We don't want these levels to be too high in the blood (high levels are associated with diabetes). Early research has found a link to higher levels of laughter and resultant lower levels of blood sugar. Nice.

3. Blood pressure. In recent studies, Dr. Lee Burk, a psychoneuroimmunology researcher, found immediate decreases in blood pressure following laughter (and, not surprisingly, increases in blood pressure following stressful siutations).

4. Cholesterol levels. Likewise, Dr. Burk and colleagues, over the course of a 12-month experiment of diabetic patients, found increases in HDL ("good") cholesterol and decreases in LDL ("bad") cholesterol in the group of patients who were assigned to the "Laughter Group" of the experiment, with no such changes found in the "Control Group". The "Laughter Group", by the way, was subjected to 30 minutes per day of self-selected comedy television.

5. Inflammation. Among other things, inflammation in our bodies can lead to damage of the endothelium (a protective lining in blood vessels), fat and cholesterol build-up in coronary arteries and ultimately...heart attacks. Cardiologists at the University of Maryland Medical Centre have found a significant link between inflammation and laughter. Sure enough, groups who laughed less were associated with a higher incidence of heart disease.

5. Mood. Laughter helps elevate mood and lower the levels of certain "stress" hormones in the body (namely, cortisol, epinephrine, and dopamine). Chronically elevated, these hormones can have detrimental health effects on the body (including impairing your immune system functioning).

Are you getting the picture?

Now, I'm not saying that laughter is the cure to all of life's ailments. In fact, the researchers of these studies are quick to point out that larger scale studies are needed before drawing any type of conclusions from them. Fair enough.

But perhaps, in addition to making good lifestyle choices (like regular exercise, healthy eating, not smoking, getting enough sleep, for example), we could remember to not take ourselves too seriously. To take time to enjoy the simple things in life. And yes, to laugh a bit more.

With that in mind, have a good laugh watching this bit of hilarity from Ellen Degeneres and David Beckham:

http://www.youtube.com/watch?v=tsuvCozVaRI

You're welcome.

The role of sit-ups in spinal stability

2010-11-21T18:30:00.000-08:00

There’s a common notion in existence that suggests that sit-ups can help stabilize the spine and, therefore, help prevent back pain.

In fact, I’ve had dozens of patients proudly profess that sit-ups are in their daily exercise routine as part of their own self-made back care program.

So the question is – what is the role of sit-ups in helping to prevent back pain?

It’s a good question – an important question. Fortunately, it’s a question that has been well-studied, and answered beyond any reason of doubt. One of the leaders – if not THE leader - in spinal mechanics in the world is Dr. Stuart McGill, a professor of biomechanics at the University of Waterloo.

In Dr. McGill’s studies, it was found that regular straight-legged sit-ups put approximately 3500 Newtons of force (or about 730 lbs) of compression on the spine per sit-up. (By the way, we don’t want to have excess compression on our spines as it will lead to injury). To put those figures into perspective, the National Institute of Occupational Safety and Health has set a limit of compressive force on the spine for any action in the workplace to not exceed 3300 Newtons.

In other words, a single sit-up places more (damaging) compressive force on the spine than the legally maximal limit allowed in the workplace!

In an effort to counter this, some people have recommended substituting bent-leg sit-ups for straight-legged sit-ups, with the theory essentially being that the bent leg will take pressure off of the spine, and will, thus, reduce the compressive force on the spine. Guess what? This was studied too, and the compressive forces were found to be similar to that of the straight-legged sit-ups. Not good.

In spite of these findings, some might counter by suggesting that the pay-offs of working the abdominal muscles outweighs any risk of injury. This is completely wrong for multiple reasons. Firstly, you should note that Dr. McGill and colleagues have measured the muscle usage patterns of various abdominal muscle groups in response to many different abdominal exercises. It turns out that the sit-ups (both straight-legged and bent –knee) are not any better at working the core musculature than other measured exercises. In fact, for some important abdominal muscles, the sit-up exercises are less effective. So the “pay-offs” of these exercises are not even that good anyways.

If we couple the fact that the sit-ups are not especially effective at training the important core musculature with the proven truth that they put an exceedingly high compressive force on the spine, then you understand where I am going with this – sit-ups are bad news. Under no circumstance will I recommend them.

I was recently at a seminar in which Dr. McGill spoke. He reminded the delegates that it’s not so much that the compressive forces of sit-ups on the spine MAY cause an injury, rather, it’s that they, in fact, WILL cause injury. The only question is – when.

At some point, with enough repetitive compressive force is applied to the tissues of the spine, it will give out. Guaranteed.

In future postings I will discuss real “core stability”. I will describe what it is, as well as why it is important and necessary. Further, since I have already shot down the usage of sit-ups in any exercise program, I will discuss some GOOD core exercises – exercises that have passing grades in the scientific literature. These are exercises that will help prevent injuries, rehabilitate existing conditions, help you perform daily tasks comfortably and safely, and enhance sports performance.

Stay tuned.

In good health,

Dr. Michael Carney

Introducing Dr. Stacey Clarke

2010-10-21T10:17:00.001-07:00

We are very proud to announce the addition of Dr. Stacey Clarke to our health care team.

Dr. Clarke has returned to her home town of Lindsay after ten years of university schooling that earned her a Bachelor's degree, a Master's degree, and ultimately, her doctor of chiropractic degree.

In addition to starting having a general chiropractic focus, Dr. Clarke has a special interest in pediatrics, pregnancy, and sports rehabilitation.

Bringing Dr. Clarke into the fold also allows us to offer evening and Saturday services to our patients. We feel that this is a significant advantage to those patients who may have difficulty getting to our office during regular Monday to Friday business hours, or to those who injure themselves on the week-end and require immediate treatment.

We are thrilled to have someone of Dr. Clarke's skill and passion for helping others join our team.

Dr. Clarke is now accepting new patients - please contact the office for a consultation.

In good health,

Dr. Carney

Welcome...

2010-10-21T10:13:00.001-07:00

Welcome to the blog of Dr. Carney and Kawartha Therapeutic Centre.

I'm excited to make this type of forum available to patients, and to the public in general. We are in an age where consumers/clients/patients are seeking greater access to information and, I believe, greater access to their health care providers.

Indeed we are in the age of information. However, with "information" coming at us in all directions, it can be tough to decifer reliable from unreliable information. I won't be arrogant and suggest that I am the ultimate answer to the reliability question - but I do plan on using this forum to provide sound, evidence-based information to questions in the field that I have expertise in.

I will endevour to use this tool to discuss common questions that I hear of in the office relating to health and injuries, as well as topics that you specifically ask me to talk about. So feel free to e-mail me your topics of interest (kawarthatherapeutic@gmail.com). Of course, I cannot answer specific questions relating to YOUR condition, as this would be irresponsible of me to do so without taking a proper medical history and performing a thorough physical assessment. However, I am happy to discuss healthy living concepts and injuries in a general manner, current health trends, nutritional concepts, or any topics in the exercise and fitness world.

If I'm not qualified to weigh-in on a particular subject, I'll let you know.

As mentioned, it is my intention to discuss topics in an "evidence-based" fashion. That is to say, I won't be firing off my 2 cents about a health-related matter if I cannot support it with solid evidence from reputable journals.

I will also use this forum to let you know of any news, events and happenings at the office that may be of interest.

Yours truly,

Dr. Carney