The Spinal Column – As Published in the LighthouseNow Progress Bulletin

Dealing with rotator cuff injuries

The rotator cuff is made up of four muscles (supraspinatus, infraspinatus, subscapularis and teres minor) that work together to stabilize the humerus and help with movements of the shoulder.

Shoulder pain, specifically rotator cuff problems, are quite common. Shoulder pain is the third most common musculoskeletal complaint seen in primary care offices. Of all shoulder complaints is it estimated that as many as 65 to 70 per cent of them are related to the rotator cuff.

The rotator cuff can become injured from a trauma (such as a fall on or hit to the shoulder), from acute overload (lifting a load that was too heavy), or from chronic overuse/wear and tear. In the case of an injury developing from an overuse injury or related to degenerative changes, it is possible for the problem to be quietly developing over time while causing little to no pain and then suddenly a relatively simple motion could be enough to initiate the onset of pain.


Diagnosis of where the shoulder pain is specifically coming from can be challenging because of the complex anatomy of the shoulder. Furthermore, where the pain is primarily felt does not always indicate where the pain is coming from. For example, muscles can refer pain to locations away from where the muscle is actually located. The best way to identify what is causing your pain is to have a thorough assessment done by your health care provider.

During the history your health care provider will want to know as much information about the shoulder pain as you can provide. Some information they will be interested in includes: What started the pain, if there was a trauma, had you been doing a lot of work with your arm(s) overhead, when is the pain at its worst, what does the pain feel like, have you lost any range or motion, are you limited in what activities you are able to perform, etcetera.

After the history, a physical examination will be performed to narrow down what tissue(s) and structures are affected. The physical exam will include things such as range of motion testing, observation of the shoulder, muscle strength testing, as well as a variety of specialized orthopedic tests to test specific muscles and specific structures of the shoulder. Your health care provider will then decide if any further imaging is indicated. Often times, if the symptoms are presenting as would be expected with a typical rotator cuff syndrome, imaging will not be done right away. Commonly a trial of care will occur first.


After the history, physical exam and advanced imaging (if needed) are complete, you and your health care provider will decide upon the most appropriate course of treatment. Treatment will depend on what your specific diagnosis is and what your capabilities are. As long as it is safe to do so, your provider will make recommendations about activity level. In general, it is good to keep moving and doing as much as you comfortably can. It is important to maintain the motion and strength you do have, while not pushing yourself too hard and aggravating your condition.

Different treatment options include: medication, heat/ ice, specific exercise, manual therapy, acupuncture, or TENS (transcutaneous electromagnetic stimulation), IFC (interferential current), cold laser therapy, or therapeutic ultrasound. Nutritional supplements may also be recommended.

Medication may be prescribed by your medical doctor to help with pain and/or inflammation. Cold therapy is commonly used for soft tissue injuries to help decrease inflammation and swelling and to decrease pain. The most commonly prescribed method for using ice is to apply the ice to the injured area for 10 minute intervals. Heat therapy is recommended to help decrease muscle tension. Be sure not to leave either on for too long at one time.

Specific exercises will be recommended to you by your health care provider depending on your specific injury and capabilities. Exercises will be given to help you improve/maintain your range of motion, as well as improve muscle function. The aim with rehabilitation exercises is to restore and improve mobility (ability to freely move your arm/shoulder) and stability (making sure your shoulder is in the optimal position both at rest and during movement).


Manual therapy is another treatment approach, which is a hands-on treatment with the goal of restoring proper motion and improving muscle tone. Mobilizations or manipulations may be used to help a joint attain its full range of motion. Soft tissue therapy such as muscle release and massage therapy may be used as well. Manual therapy, when used in combination with exercise, has been found to be very effective in treating rotator cuff syndrome.

Acupuncture is a technique which uses needles at specific points with the aim to reduce pain. Some practitioners may use acupuncture in conjunction with other treatment methods. There are typically two different types of acupuncture, western medical acupuncture and traditional Chinese acupuncture. Your practitioner can help you decide what approach is right for you.

Which type or types of treatment will be the most beneficial for your healing will be determined by your health care provider after a thorough history and physical examination. How quickly one recovers from a rotator cuff injury can vary widely depending on the specific injury, the day-to-day demands of the individual, as well as many other factors. The important thing to remember is to seek treatment as soon as you can, and give the healing process time. Also, please note that this article does not go into discussion of surgical treatment options, which may be indicated depending upon your condition.

 This column is not intended to provide medical diagnosis or treatment. If you have a health concern, see a licensed and regulated health care professional for proper diagnosis and treatment options. Dr. Marilyn Field is a Doctor of Chiropractic who practices in Bridgewater.


Alternatives to opioids for back pain

If you read the newspapers, listen to the radio, or let Google and Facebook inform you about current events, then you are aware of the current opioid crisis. It’s becoming a major issue in both Canada and in the United States. In fact, Canadians are the second highest users of opioids, per capita, in the world.

Although these medications can be very effective at relieving and altering pain in the short term, they have many risks associated with them. The use of opioids can have devastating effects, including addiction and death from overdose.

From my previous columns we know that lower back pain is the most common reason for disability in the world, and often those that suffer turn to opioid medications to relieve their pain. Sometimes, when physicians and patients are at a loss for what to do about chronic back pain, an opioid medication is prescribed.

But in this modern era of health care, practitioners who deal with the public have guidelines that they are strongly recommended to follow. These are usually referred to as “clinical practice guidelines.”

Physicians, chiropractors, and physiotherapists all have such guidelines that are based on years and years of research. But as we learn more about medicine and non-medicinal treatment options, these guidelines change over time.

Recent guidelines in medicine recommend non-opioid treatments over opioid drugs for chronic pain. So what type of non-opioid treatments should be used for low back pain?

In February of 2017 a scientific study was published titled: Non-pharmacologic therapies for low back pain: a systematic review. This review is timely and relevant with the growing opioid crisis facing patients today. There have to be safer and more effective options available to treat pain, than opioids.

Thankfully, the research shows that practitioners can recommend the following nine options: exercise; tai chi; yoga; mindfulness-based stress reduction; psychological therapies; multidisciplinary rehabilitation; acupuncture; massage; and spinal manipulation. There are many safe and effective alternatives to opioid treatment for chronic back pain.

So which treatment option is right for you? In my experience, most people get the most relief from low back pain when they combine several low risk interventions, not just one, or even two. If you exercise regularly in some way, including tai chi and yoga in your routine will help keep your back moving. If you add stress-reduction techniques such as meditation, prayer or mindfulness-based strategies, you’ll likely have even more success.

If you periodically need a health care practitioner to perform some sort of evidence-based intervention, such as spinal manipulation, massage, or acupuncture, then most likely you will be able to live your life with a lot less pain and minimal, or no, disability. Most importantly you will avoid the side-effects and complications that can come from taking opioid medications.

So what type of non-drug treatments don’t work? What treatments are not supported by research or evidence?

The authors of the February 2017 paper stated: “We found little evidence to support the use of most passive physical therapies (such as interferential therapy, short-wave diathermy, traction, ultrasound, lumbar supports, taping, and electrical muscle stimulation) for low back pain.”

The two exceptions are superficial heat and low-level laser therapy, as these treatments have been shown to help relieve pain.

One last thought is that most guidelines do not say what profession is best at treating low back pain. The researchers reviewed what types of treatments are effective and what ones are not.

Many different health care professionals use acupuncture, and many prescribe some type of exercise. Some perform spinal manipulation, and some do all of these.

But if a health care practitioner is primarily using treatments that are not listed in this current research, then they are not practicing modern, evidence-based health care. According to current research, putting sticky pads on your back and sending through an electric current hasn’t been shown to be of any significant benefit, when compared to control groups, where no treatment is done.

Echoing the pharmaceutical tag line on many television commercials: “Ask your doctor if avoiding the use of opioids is right for you.”

This column is not intended to provide medical diagnosis or treatment. If you have a back condition, see a licensed and regulated health care professional for proper diagnosis and treatment options. Dr. Ian Culbert is a Doctor of Chiropractic who practices in Bridgewater


Putting your best foot forward

Today we are going to talk about foot pain, specifically a condition called Plantar fasciitis. Plantar fasciitis is a condition that causes pain along the bottom of the foot, most commonly in the heel.


The plantar fascia is a band that runs along the bottom of your foot. It consists of 3 bands – the medial, central and lateral bands. The central band insets onto a part of the heel bone called the medial calcaneal tubercle. Where this band insets is commonly the first location of pain. The band runs along the bottom of the foot from the heel to the ball of the foot (the metatarsal heads). The plantar fascia’s purpose is to support the arch of the foot.

Plantar fasciitis is when the plantar fascia becomes injured and irritated. Inflammation settles in near the attachment of the fascia to the heel, which commonly results in heel pain when one puts pressure on their foot. This pain tends to be particularly bad with the first few steps in the morning, or when weight bearing again after sitting down for long periods. The pain can be bad enough to cause a limp while walking. Often the pain will decrease as you continue walking, but the pain can increase again near the end of the day, after long periods on your feet. The pain in the foot is often described as sharp, achey, and tight. Pain can also extend along the arch of the foot, and at times into the ball of the foot.


The specific cause of plantar fasciitis is still poorly understood for the most part. However, we do know that there are some common risk factors that make you more likely to be affected by this condition, these include: a sudden increase in physical activity level, reduced ankle dorsiflexion (the ability to flex your foot upwards toward your shin), having a body mass index over 30 (in a non-athletic population), repetitive micro-trauma, and long hours on ones feet.


Fortunately, there are quite a few treatment options when it comes to plantar fasciitis. Which treatment is right for you depends on your particular needs. Home exercises are an important part of any treatment plan, these include things such as: rolling a frozen water bottle along the bottom of your foot (or using a golf or tennis ball), self-massage along the bottom of the foot, stretching and strengthening the calf muscles, along with many other home stretches and strengthening exercises determined by your specific needs.

Manual therapy including soft tissue therapy for the fascia and associated tight muscles, and joint mobilizations/ manipulation have also been found to be helpful in treating this condition. Manual therapists may also use modalities such as ultrasound, or cold laser therapy to help facilitate and speed the healing process. A study from 2014 found that six sesssions of cold laser therapy was significantly helpful in decreasing plantar fasciitis symptoms, and the results held for a year follow up. Taping techniques, such as kineso tape etc., have weak evidence supporting their effectiveness for the treatment of plantar fasciitis, however, that doesn’t mean it’s not worth trying.

There is a lot of strong evidence supporting the use of custom foot orthotics. A study published in 2006 compared the effectiveness of custom foot orthotics verus night splinting (a night splint is a device worn on the foot/lower leg that keeps the ankle flexed 90 degrees towards the shin).

In this study three groups were compared, group A wore the night splint only, group B wore the night splint and custom orthotics, and group C wore only custom orthotics. All participants in this study were between the ages of 20 and 60, and had to have had plantar fascia pain for at least four weeks. They evaluated the success of each treatment using the Foot and Ankle Outcome Score, which evaluates pain, activities of daily living, sport and recreation function, foot and ankle-related quality of life, and other symptoms.

Compliance was measured via daily logs, and a good compliance was defined as the patient wearing the orthotic and/or night splint five days per week. Compliance was found to be slightly higher for the orthotic group versus the night splint group (70 per cent versus 60 per cent).

It is important to note that significant improvements were found in all treatment groups. However, one of the most significant findings of this study was that at the one year follow up mark pain reduction was at 62 per cent for both groups wearing orthotics, and only 48 per cent in the night splint alone group.

Looking at the results of this study really highlights the potential benefit of orthotics; An intervention that individuals are more likely to be compliant with (wearing orthotics) in itself will offer far more benefit than an intervention one doesn’t use consistently. There is also strong evidence supporting the use of custom orthotics that was published in 2008 by the American Physical Therapist Association’s clinical practice guidelines for plantar fasciitis treatment.

For more chronic cases of plantar fasciitis, and cases that haven’t been responding to the above methods of treatment, shockwave therapy is another type of treatment to consider.

A study published in 2008 looked at the effectiveness of shockwave therapy versus placebo in people suffering from plantar fasciitis for at least six months. On average patients in this trial had been experiencing symptoms for two years. Participants had to have tried and failed two pharmacological and two nonpharmacological treatments in the past.

Those in the treatment group received shockwave treatment in three sessions, about two weeks apart. Those in the placebo group, received treatments from an identical looking and sounding machine, but no real treatment was delivered. Outcome measures (total pain score) were measured at baseline, 12 weeks and 12 months.

At the 12 weeks follow-up, patients receiving the real treatment reported a 72 per cent reduction in pain versus a 44 per cent pain reduction in the placebo group. Even at 12 months follow-up the treatment group was doing significantly better than the placebo group (84 per cent decreased in pain versus 43 per cent).

As you can see, there are many options when it comes to finding the right treatment for you. If you have been suffering with plantar fascia pain for a long time, don’t give up. Just continue to seek out different treatment options until you find the right fit for you.

 This column is not intended to provide medical diagnosis or treatment. If you have a back condition, see a licensed and regulated health care professional for proper diagnosis and treatment options. Dr. Marilyn Field is a Doctor of Chiropractic who practices in Bridgewater




After being in a car accident more than 85 per cent of people experience neck pain and often it’s combined with sprains and strains to the back, arms, legs, headaches, psychological difficulties, and even mild traumatic brain injury. The broad, generally accepted term for this type of injury is called whiplash.

Whiplash is defined as an injury to the neck that occurs with a sudden acceleration or deceleration of the head and neck relative to other parts of the body. More simply put, whiplash happens when the head is quickly flung forward or backwards.

A whiplash injury can dramatically disrupt the daily lives of the people who suffer from it. It is associated with considerable pain, disability, and costs related to treatment plus lost time from work. The majority of adults with whiplash report pain in the neck and upper arms that can also include: headache, stiffness, shoulder pain, back pain, numbness, dizziness, sleeping difficulties, fatigue, and impaired mental function, all of which can end up having a negative effect on almost every aspect of one’s life.

What can result is depression, frustration, and difficulty in doing so many of your normal and everyday tasks. There are treatments for whiplash, which I’ll discuss below, but even though the median expected time-frame for recovery is approximately 100 days, unfortunately, about 23 per cent of people report that they are not fully recovered after one year.

Four categories of whiplash

There are four main categories of whiplash, graded one to four. A grade one whiplash involves primarily neck pain, but there is no significant loss of mobility, no significant tenderness, or other obvious abnormal findings. A grade one whiplash is mild. In my experience, most people who experience a grade one whiplash don’t seek treatment because it resolves on its own.

A grade two whiplash involves neck pain and usually several additional symptoms mentioned above. There are abnormal findings such as loss of mobility and significant muscle tenderness. This type of whiplash usually has a significant impact on one’s life. It is also the most common type of whiplash injury that results from a car accident.

A grade three whiplash involves all of the characteristics that are found in a grade two, plus neurological injury, such as numbness or tingling, weakness, or pins and needles that usually travel down into the arms and often to the hands.

Finally, a grade four whiplash involves neck pain with a fracture or dislocation. These types of whiplash injuries are usually discovered in emergency rooms and sometimes in chiropractic offices when x-rays are taken. Thankfully, grade four whiplash injuries are not very common. Most people don’t break their neck, but do experience significant pain and problems.

Treatment options

So what is the best treatment for someone who has a grade one to three whiplash? This question can now be easily answered because in 2016 a major scientific paper was published, titled The Treatment of Neck Pain- Associated Disorders and Whiplash-Associated Disorders: A Clinical Practice Guideline.

A clinical practice guideline is a document that collects all of the best available scientific evidence on a particular topic and then gives doctors and clinicians recommendations on how to best treat their patients. This clinical practice guideline looked at patients with neck pain and whiplash, grades one to three. The target audiences of this guideline are chiropractors and other primary care health care providers delivering treatment to patients with whiplash.

Here is what the guidelines say. For adult patients with a recent (zero to three months) grade one, two, or three whiplash injury, “multimodal care” is recommended over just providing patient education alone.

Essentially,” multimodal” means “many things” such as manual therapy (joint mobilization and other soft tissue/ massage-like treatments); patient education on the type of injury that occurred; advice on ways to cope with pain and speed up recovery; advice on how to manage everyday activities; advice on ways to stay active or modify activity as needed; instructions on self-care, such as what home-based exercises to do and how often to use hot and cold packs.

Dealing with persistent symptoms

There are many things that injured patients can do for themselves, daily, or even multiple times per day to speed up their recovery. Not all these things have to be done in the clinician’s clinic. In fact, many can be done more often, and more cheaply, in the patient’s home.

For patients with persistent symptoms (lasting longer than three months) from a grade one or two whiplash, the same types of advice that I mentioned above still apply, and supervised exercises or instructions on how to best strengthen the neck at home is recommended. This is based upon patient preference and what resources are available.

In other words, a clinician can instruct a patient on specific exercises that can be done at home, and a variety of other homecare procedures such as the application of heat, modifying some daily activities, and continuing to educate the patient on how to best manage this condition, themselves. Or, if a patient prefers, and there are financial resources available, then supervised exercises in a clinic are also an option for patients who suffer from whiplash symptoms for longer than three months.

The guideline also recommended that treatment decisions be based on patient preference and practitioner experience. In Nova Scotia, we are fortunate. If you are injured in a car accident the car insurance company will pay for an evaluation of your injuries by a physician, chiropractor, or physiotherapist. Treatment can also include massage therapy and occupational therapy.

So if you suffer from a whiplash injury, make sure that you receive treatment that is based on current scientific evidence. Advice alone, or just taking medication, is not consistent with current evidence based treatment recommendations. A multimodal approach including manual therapy and advice about self-management and exercise is usually an effective treatment strategy for recent-onset and persistent whiplash injuries.

Your clinician should be regularly monitoring your progress and making sure that your pain is diminishing and your disabilities are subsiding in order for treatment to continue. If you’re not getting better, remember, physiotherapists and chiropractors both treat whiplash. Sometimes patients prefer one more than the other, and sometimes patients get better with one type of treatment faster than other types. Because the last thing anyone wants is to be part of the 23 per cent of patients who still aren’t recovered a year after their injury.

 This column is not intended to provide medical diagnosis or treatment. If you have a back condition, see a licensed and regulated health care professional for proper diagnosis and treatment options. Dr. Ian Culbert is a Doctor of Chiropractic who practices in Bridgewater

For more information concerning whiplash please click the link below:

It may be summer, but your shoulders are frozen

The weather is getting warmer, but today I want to talk about something frozen. Frozen shoulder, or the more technical name for this condition: Adhesive Capsulitis (AC). Shoulder pain (from all causes) affects about 26 per cent of the population. AC affects roughly five per cent of the general population as a primary condition, meaning there was no underlying illness that lead to the development of AC. As a secondary condition, associated with conditions such as diabetes and thyroid disease, AC affects between four per cent and 38 per cent of people.

AC is most common between the ages of 40 and 65, and it is more common in women than men, however don’t let that fool you, men can also be affected by this condition. Also, if you have had AC before, you are more likely to develop it in the opposite shoulder in the future, compared to someone who has never had frozen shoulder. What can be very frustrating for those affected by AC is that there is commonly not a specific mechanism of injury that caused frozen shoulder to develop, it often develops for no known reason.

Sticky shoulders

The term adhesive capsulitis literally describes the condition. Adhesive means sticky, and capsulitis means inflammation of the joint capsule. It is commonly thought that frozen shoulder is caused by the joint capsule of the shoulder becoming inflamed and sticky and thereby limiting movement and causing pain. This is a simplified explanation of what is occurring, but it does a pretty good job at describing the main factors affecting the shoulder. It is important to note here that AC is not a joint inflammation like arthritis and other joints are not affected. AC is considered to be a self-limiting condition, which means if no treatment were to be provided it would heal on its own, however, it can take anywhere from 12 months to two years. Receiving therapy for the shoulder may help to speed the healing process and decrease the pain associated with AC.

Decreased motion

The main symptoms of adhesive capsulitis are pain and decreased motion. The decrease in motion is typically first noticed with external rotation (think turning your arm outwards) and abduction (i.e. your arm is hanging by your side and you try to lift it upwards). There are three main phases of frozen shoulder: the freezing phase, the frozen phase and the thawing phase. The first phase, the freezing phase, is when symptoms begin to become apparent. One will experience pain in the shoulder and a gradual loss of motion. External rotation is the most common first motion to decrease. Many women will describe that it becomes difficult to do/un-do their bra behind their back when this motion starts to become limited. The freezing phase tends to be the most painful of the 3 phases and typically lasts between two and nine months. If one seeks treatment during this phase the main goals are to help decrease pain, as well as maintain as much motion as possible. Mobility exercises and stretches will be given, but strengthening generally will not be the focus at this point. Next is the frozen phase. In this phase motion is at a minimum, but on the positive side, pain is at a minimum as well. This phase will generally last anywhere from four to 12 months. During this phase one wants to focus on maintaining what range of motion they do have, and slowly working to increase it. Keeping surrounding muscles strong and pain free is also important here. The third and final stage is the thawing phase. This is where the motion of the shoulder starts to return and the focus of treatment will be increasing motion and strength as quickly, and as safely as possible. This phase can last five to 12 months. As you can see, adhesive capsulitis can be a long lasting condition that can interfere a great deal with activates of daily living both at work and at home. Seeking treatment early on may help you get through this frustrating condition a little quicker, and with less pain.

How to treat frozen shoulder

Common treatment approaches we use in our office include joint mobilizations, soft tissue therapy, and cold laser therapy; along with home care instructions including mobility exercises, stretches, and strengthening. The cold laser therapy is great for helping to decrease inflammation deep within the shoulder joint, as well as promoting faster tissue healing. By also addressing joint motion/mobility and areas of increased muscle tension with soft tissue therapy, we are able to look at all components of the shoulder and help promote healing of all of the involved tissues. It’s important to note, that just because one is experiencing pain and decreased mobility in the shoulder, this does not automatically mean the diagnosis is adhesive capsulitis. Many other shoulder conditions can present with these symptoms, including many common rotator cuff injuries. If you are experiencing shoulder pain it is always a good idea to get assessed by a regulated health care professional who can then give you an accurate diagnosis and point you in the right direction for the best treatment approach.

 This column is not intended to provide medical diagnosis or treatment. If you have a health concern, see a licensed and regulated health care professional for proper diagnosis and treatment options. Dr. Marilyn Field is a Doctor of Chiropractic who practices in Bridgewater


The dimples of disability

When I talk about dimples I’m guessing that pretty much everyone will think I’m referring to the dimples on our cheeks or chin, that usually appear when a person smiles. They are often what grandparents love to see on their cute little grandchildren.

But the dimples on our face are not the only dimples we have. Many of us have “dimples of venus” that are located just below the belt line at the top of our buttocks. These dimples lie directly over our sacro-iliac (S.I.) joints. The sacro-iliac joints are not commonly known by everyone. We all know where our knees, hips, and elbows are, but the sacro-iliac joints, or S.I. joints as they are usually referred to, are relatively unknown. We have two of them, one on the left, and one on the right. They are between the very bottom part of our spine and our actual hip joints, underneath each bum cheek.

I am discussing our dimples of venus, and more importantly, the S.I. joints that are directly underneath these dimples because the S.I. joints are a very common cause of pain and disability.

When we stand, approximately 50 per cent of our body weight is transmitted through each S.I. joint. These joints also absorb shock when we are walking and running, and by doing so, help to reduce the mechanical stress and impact that would otherwise take its toll on our spines. In order to do their job these joints have to be moving. They are like little shocks that move up and down. But one of the problems with these joints is that they don’t move very much.

S.I. joint pain is usually called lower back pain, hip pain, buttock pain, or pelvic pain. Because most people don’t know that they have S.I. joints, they don’t recognize it for what it is when the pain strikes.

In my experience, many patients with a seized S.I. joint get mis-diagnosed. I have had patients tell me that they were previously told that the cause of their pain is S.I. joint instability and that their S.I. joint is moving too much, so they wear a brace and try to hold the joints tightly together, only making the problem worse. Some patients have been told that their back isn’t strong enough and they must strengthen their core muscles to eliminate their S.I. joint pain. I’ve also had patients that have been told the pain is stemming from a disc in their back, or pulled muscles, or a pinched nerve. As with most things in life, there is more than just one cause for pain. Sometimes an S.I. joint does move too much and it needs to be stabilized. However, in my experience, this is not very often.

Sometimes, chronic S.I. joint pain, that has been present for years and years, may need more advanced treatment. Prolotherapy injections, done by a medical specialist, can help to tighten up an S.I. joint that has become too loose. Certain types of inflammatory arthritis can also inflame an S.I. joint and cause pain, requiring medications to reduce the inflammatory process. And certain pain specialists can inject anti-inflammatory medicine such as cortisone directly into the S.I. joint when other treatment methods aren’t effective. However, the biggest dilemma with this type of treatment is the length of time it takes to get in to see doctors who administer these types of treatment. It can take many months, even greater than a year, just for the initial consultation.

The good news is that for uncomplicated, mechanical S.I. joint pain diagnosis doesn’t require expensive testing such as x-ray, MR, CT scan or blood work. These tests will rule out other more serious causes of pain, but they are rarely needed. In my experience, when a patient is experiencing pain coming from their S.I. joint, in most cases the pain is resulting from a seized joint. And thankfully, there is a very simple, safe, and easy treatment for this condition that is highly effective. When a joint is seized and not moving freely, a very effective approach is to move it until it loosens and can move with ease. It’s that simple. And because loosening S.I. joints is safe, easy, quick, and usually very effective, you may want to try this first, if you suffer from pain and disability, stemming from your dimples of venus.

This column is not intended to provide medical diagnosis or treatment. If you have a back condition, see a licensed and regulated health care professional for proper diagnosis and treatment options. Dr. Ian Culbert is a Doctor of Chiropractic who practices in Bridgewater


Chiropractic care for infantile colic

One might wonder, since babies don’t have back pain (at least not that they can verbally tell us about), why would a baby go to a chiropractor? Well, there are lots of reasons! Let’s talk about one of the more common reasons I see babies in the office: infantile colic.

This is a very common reason for bringing a baby into the chiropractor. Colic, or excessive fussiness, is defined as unexplained and uncontrollable crying in infants up to three months old, it effects roughly 10-40 per cent of babies. Colic has been found to occur at similar rates regardless of sex, type of feeding (breast vs. bottle), gestational age, or socioeconomic status. Colic is considered to be a diagnosis of exclusion, meaning that after a thorough examination by their pediatrician to rule out any concerning causes, if the baby follows the rule of three, the diagnosis of colic can be made. The rule of three is that the crying/fussiness last more than three hours a day, more than three days a week, for three weeks or more. Typically, the crying is at its peak in the afternoon or evening hours. Colic is a selflimiting condition; meaning that it will end if left untreated, usually within six months. However, those can be a long six months for anyone involved!

One possible treatment method for colic involves nutritional changes. If the infant is breastfed there are certain nutritional changes the mother can make that may help to reduce colic in the infant. There have been many studies showing the effectiveness of the mother following a low-allergen diet. Common allergens that a breastfeeding mother may want to avoid include cow’s milk, eggs, wheat, nuts, soy and fish. If the infant is bottle-fed certain types of formula may be of benefit. Be sure to talk to your pediatrician to determine if a formula change is right for your baby.

From a chiropractic perspective there have been many great studies supporting the use of chiropractic care to help decrease symptoms of colic. One study published in 2012 from the Journal of Manipulative and Physiological Therapeutics (JMPT for short), looked at the effect of chiropractic care to help reduce symptoms of colic. This was a blinded study, meaning that the parents of the babies did not know if the baby was receiving treatment or not. Out of 104 infants in the study, 33 were in the non-blinded treatment group (the parents knew their baby was receiving chiropractic care), 35 in the blinded treatment group (the baby was receiving chiropractic care, but the parents did not know if they were or not), and 34 in the blinded, non-treatment group (the parents did not know if the baby was receiving chiropractic treatment or not, and in reality the infant was not receiving chiropractic care). This study found that the greatest decreases in crying time were reported from the parents of the infants in the treatment group, weather the parent was “blinded” or not. That means that when the babies were getting chiropractic care, whether the parents knew if the baby was receiving care or not, their crying time decreased significantly more than compared to the babies not receiving chiropractic care. Another very important finding of this study was that no adverse effects (negative result from the treatment) were reported in either treatment group; thus demonstrating the safety and effectiveness of chiropractic for treating infantile colic.

Another study from the JMPT published in 1999 had very similar results. This study compared infants diagnosed with colic being treated by either chiropractic care for two weeks, or treated with the drug dimethicone. In this two-week period, the infants in the chiropractic treatment group experienced a 67 per cent reduction in crying hours, whereas the infants in the medication group experienced only a 38 per cent reduction in crying time. Numerous other studies and case studies have been published demonstrating the effectiveness of chiropractic care to help with infantile colic, and best of all chiropractic care is very safe for babies. Treatment of a baby is so gentle, it is not uncommon for babies to sleep right through their appointments. The pressure used to treat a baby is no more pressure than you would use to comfortably push on your eye, or explained another way, no more pressure than you would use to squeeze a ripe tomato. If you or someone you know has a baby going through colic, remember that chiropractic care might just help them get through the stage a little faster and a little easier.

 This column is not intended to provide medical diagnosis or treatment. If you have a health concern, see a licensed and regulated health care professional for proper diagnosis and treatment options. Dr. Marilyn Field is a Doctor of Chiropractic who practices in Bridgewater

Do your headaches come from your neck?

I think that most readers of this column will agree that when you have a headache you are not at your best. The bottom line is this: people who suffer from frequent headaches have a lower quality of life than those who don’t.

Unfortunately, headaches happen far too often for many adults. Each day, roughly 16 per cent of the population is suffering from a headache. What’s worse is that three to five per cent of those people suffer from headaches every single day. Seeking treatment for headaches is the third most common reason why patients consult a chiropractor.

But is the pain that you feel in your head actually coming from your head? Or, is it coming from your neck? How do you know?

Unfortunately, you can’t always tell if your headaches are coming from your neck. According to the International Classification of Headaches, a headache that stems from the neck is called a cervicogenic headache. To make life confusing, it states that cervicogenic headaches are “usually, but not invariably accompanied by neck pain.” So you may have neck pain, or you may not, and yet your headaches may be coming from a problem in your neck.

In my experience, necks are a very common source of headaches. There are many different structures in your neck that can cause pain in your head. There are muscles that attach your shoulder blades to the bones in your neck, muscles that attach your neck bones to your head, and muscles that attach your neck bones to your collar bone and chest. A build-up of muscle tension in these muscles can be the cause of these headaches. In addition to muscles, there are seven discs in your neck that can be damaged from car accidents, whiplash injuries, a build-up of wear and tear, and can also contribute to headache pain. The joints in your neck can also get irritated and cause headaches. There are 18 little moveable joints in your neck that allow your head and the seven little bones to turn, twist, bend and rotate. When these joints get inflamed, sore, or partially stuck, headaches are often the result. Another source of headache pain is when nerves in your neck become significantly irritated or pinched. There are nerves that travel from the back of your neck to the back of your head, to the top of your head, to the side of your head, and even to the front of your head, leading to a headache that can occur in one or more of the those areas.

When headaches stem from your neck, often there is a sense of neck pain, stiffness, decreased mobility or a recent history of a neck injury such as whiplash, a fall or jolt to the neck. If you have hit your head hard enough to be diagnosed with a concussion, often you also injure your neck at the same time, and your headaches may actually be stemming from your neck, not from your concussion. But even more common is a gradual build-up of tension, bad posture, immobility (too much Facebook time) that leads to the structures in the neck causing headaches. These are the ones that confuse people the most because they say, “I didn’t ever do anything to injure my neck.”

In 2011, the health care publication Journal of Manipulative and Physiological Therapeutics published evidence that helped to form a national practice guideline titled “Clinical Practice Guideline for the Management of Headache Disorders in Adults.” This guideline stated that spinal manipulation is recommended for patients with cervicogenic headaches. In terms of treatment frequency and duration, the guideline recommended two treatment sessions per week for three weeks. In three weeks there is usually significant relief from one’s headaches. Joint mobilization has also been found to be effective, having eight to 12 treatments over six weeks. Exercises targeting neck muscles have also been found to be helpful at providing headache relief.

The guideline also stated that taking pain-relief medication while having physical, hands-on treatments does not alter the type of physical treatment that can be done. So if you suffer from headaches that come from your neck, using pain medication to provide short-term but also addressing the neck problem that is actually causing the headache, is not a bad idea. Taking a pill is definitely faster, easier and in many circumstances, cheaper. But we also know that long-term use of many medications can create unwanted side effects including damage to our kidneys, liver, and stomach lining. In many circumstances, fixing the physical problem in the neck will provide an alternative to the medication and prevent the need for medication. But in other situations, a combination of both medication and physical treatment may provide the best results.

So if your headaches are stemming from your neck it makes sense to eliminate the source of the pain (the problem in the neck) instead of just removing the symptoms (eliminate the headache by taking medication) without addressing the issue in the neck.

This column is not intended to provide medical diagnosis or treatment. If you have a back condition, see a licensed and regulated health care professional for proper diagnosis and treatment options. Dr. Ian Culbert is a D Doctor of Chiropractic who practices in Bridgewater

Sitting pretty and standing tall

Good posture not only helps you look better, it helps you feel better too. The benefits of good posture range from improved circulation and breathing easier, to less strain and pressure on your muscles and joints. Throughout my previous columns there have been lots of tips related to posture, and this week I’m going to summarize how to assess your own posture and reiterate previous tips on how to achieve good posture.

The key to good posture is maintaining the natural curves of the spine (your natural lumbar lordosis, thoracic kyphosis and cervical lordosis). When the spine is not in its natural position it puts extra pressure on the muscles, ligaments and joints which over time can lead to degenerative changes, aches and pains, and make you more susceptible to injury.

A great way to assess your posture is to grab a friend and do this quick posture assessment on each other. You can also do part of this assessment on your own by looking in a mirror.

1. Look at each other front on. Is one ear higher than the other? Is one shoulder higher than the other? Look at their belt line, is one hip higher than the other?

2. Look at each other from the side. Does the head slump forward so that the ears are coming in front of the shoulders? Are their shoulders rounding forward? Is the curve of the lower back increased causing the belly to bulge forward?

If you answered yes to any of these questions, these are signs that your posture is out of optimal alignment and you would benefit from working to improve it.

Tips to improve your posture

Good posture should look like this: stand tall, shoulders rolled back and down, maintain the natural slight curve in the neck and lower back, shoulders and hips level with each other, and core muscles engaged. Your head, shoulders, hips and ankles should all line up comfortably over top of each other. Your knees ideally are slightly bent (not significantly, but just enough to ensure that your knees aren’t locked), and your feet should be comfortably positioned about hip width apart. This is your guide for good posture; try to maintain this optimal position while you go about your everyday activities.

To really improve your posture it takes time and consistency. Try using some sort of cue to help you remember to check and correct your posture. For example, every time you see the colour red, think, “how is my posture and do I need to correct it?” That way even when you are driving, every time you get stopped at a red light you’ll start to think about and correct your posture. As the old adage goes: practice makes perfect.

The most important tip I can give about maintaining good posture while sitting is to use the chair to your advantage! By sitting correctly in a chair you can use the chair to help support your back and in turn help you sit up straight. When you sit down, be sure to sit all the way back into the chair so that your butt is touching the back of the chair; this will allow the back rest to comfortably support your back while you sit up straight. As your bottom slides forward in the chair, your lower back begins to round and your shoulders droop forward. When you start to notice this happening make sure to straighten up. If you are sitting in an ergonomic chair with all sorts of adjustable parts, take the time to figure out what parts of the seat adjust and move it so it is positioned to your comfort.

It is also important to try to vary your posture every 15 minutes. Sitting in any one position for too long can put extra strain on your spine, muscles and joints. As well, aim to get up every 30 minutes, even just for a quick stretch of standing up, reaching up to the sky, and then sitting back down.

When working on a laptop or smart phone, bring the device to you rather than hunching forward towards it. Use thick books to sit your laptop on to bring it higher so that when you are looking straight ahead you are looking at the top third of the screen.

If you use a backpack, use both straps. Letting it sit on one shoulder will cause you to lean one way or the other and put extra strain on your spine. When using a purse or briefcase, opt for one with a long enough strap that you can sling it over one shoulder and have it rest on the opposite hip. This will minimize the strain on your shoulders and spine. For more information on proper backpack use check out my previous column “Backpacks, purses and bags.”

Working on your core stability will also be a big help in maintaining good posture. Core stability not only includes strengthening the abdominal muscles, but also strengthening the hip and gluteal muscles. It is also important to strengthen the muscles of the upper back; you can strengthen these muscles by doing exercises like rows. Stretching is also very important when it comes to good posture! If your pectoral muscles (chest muscles) are too tight, this can contribute to your shoulders rounding forward. The hip flexor muscles and hamstrings are other areas that can really affect the posture of your lower back.

If you are unsure of what stretches and strengthening exercises you should be doing there is a great app developed by The Canadian Chiropractic Association called Straighten Up Canada.  This is an awesome resource for learning stretches and strengthening moves that will help you improve your posture. And best of all it’s free! If you still feel unsure about how to go about achieving and maintaining good posture contact a registered health care provider and they will point you in the right direction.

This column is not intended to provide medical diagnosis or treatment. If you have a health concern, see a licensed and regulated health care professional for proper diagnosis and treatment options. Dr. Marilyn Field is a Doctor of Chiropractic who practices in Bridgewater


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Migraines: the life-altering head pain

Migraine headache has been ranked the third most prevalent disorder and the seventh highest cause of disability worldwide. A migraine can last for as little as four hours or as long as six days at a time and often prevents people from attending work. Those who suffer from reoccurring migraines often lose large amounts of their income from being unable to work many days. These headaches can have a dramatic affect on one’s social life, as migraine sufferers often have to cancel social functions and dinners due to this disorder’s incapacitating nature.

Migraine is one of the few types of primary headaches. It has two major sub types: “migraine without aura” and “migraine with aura.”

Migraine without aura is a headache that typically lasts four to 72 hours, the pain is usually only on one side of the head, and the pain often pulsates. These types of headaches are normally quite significant in their intensity, being moderate to severe, and are aggravated by routine activities that we have to do each day. To be classified as a migraine there are at least one, and sometimes more, of the following: nausea, vomiting, and/or significant sensitivity to light or sound.

Migraine with aura shares the same characteristics as mentioned above, with the addition of short-lived neurological symptoms that usually occur before the actual headache begins and sometimes occur alongside the headache. An aura is when you see spots, wavy lines, or flashing lights, and the person will often experience numbness or a “pins-andneedles” feeling in their hands, arms, or face.

Medications are a common way for people to manage their migraines and when it comes to pharmaceuticals, there are two main approaches to ease the migraine. One way is to try to stop the migraine once it has begun. These medications are often referred to as “rescue medications” or “abortive medications.” Drugs used to stop a migraine after it has started include: overthe-counter medicines like acetaminophen (Tylenol) and anti-inflammatory drugs such as ibuprofen (Advil) and naproxen (Aleve). There are also prescription medications such as Imitrex, Zomig, and Cafergot, that a physician may prescribe. These medications attempt to cover up the symptoms of the migraine, but don’t go to the head and fix what is wrong.

The second way medications are used to manage migraine is to attempt to prevent the headache from occurring. There are a variety of drugs that can be used including anti-depressants such as amitriptyline; anti-histamines such as cyproheptadine; beta-blockers such as propranolol; and calcium channel blockers such as verapamil. These medications attempt to alter the chemistry of the blood in order to prevent the occurrence of a migraine. They are taken on a regular basis, not just when they feel a migraine beginning. However, we all know that drugs often come with unwanted side effects and many drugs make our kidneys and liver work harder which, in the longterm, can damage both of these necessary organs.

Thankfully, there is current, scientifically-based, researched evidence to support nondrug treatment for migraines. In other words, non-drug treatments have been found to be effective for managing migraines. In 2011, the health care publication Journal of Manipulative and Physiological Therapeutics published evidence that helped to form a national practice guideline titled “Clinical Practice Guideline for the Management of Headache Disorders in Adults.” This guideline stated that spinal manipulation is recommended for patients with recurrent migraines. In terms of treatment frequency and duration, the guideline recommended one to two treatment sessions per week, for eight weeks. This means that in just two months there is usually significant relief from one’s migraines. They are usually less frequent, not as intense, don’t last as long, and in some cases, are absent all together.

The guidelines also recommend that weekly massage therapy targeting the back, shoulders, neck, and head, is recommended for reducing migraine frequency and headache symptoms. When you combine multiple drug-free approaches including exercise, relaxation, stress and nutritional counselling, and massage therapy, relief of migraines is also very likely.

We know that most medications prescribed for migraine do not eliminate the problem. At best, they help sufferers cope. Why then, is the pharmaceutical approach so common? Why has it become so normal to take medication when we are experiencing pain or dysfunction? With a migraine, as with many other conditions, it makes more sense to me to at least try to go to the site of the problem to fix what is physically causing it (ie. a build up of muscle tension, chronic or acute stress, poor posture, reduced mobility in joints, or nutritional triggers) first. Just as a mechanic wouldn’t tell you to put a piece of tape over the “check engine soon” light, maybe we should do the same with our bodies.

My next column in April will address the third and final headache in my series, called “cervicogenic headaches,” which is the fancy way of saying “stemming from the neck headaches.”

This column is not intended to provide medical diagnosis or treatment. If you have a back condition, see a licensed and regulated health care professional for proper diagnosis and treatment options. Dr. Ian Culbert is a Doctor of Chiropractic who practices in Bridgewater

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A pain in the neck (and the arm)

Cervical radiculopathy is a condition where pressure on a nerve root in the neck cases neck and arm pain. This condition, though not as common as a lumbar radiculopathy (causing back and leg pain), can be quite bothersome and affects 85 out of 100,000 people.

The nerves in the neck can be compressed for a number of reasons: from a disc herniation, foraminal impingement and spinal canal stenosis. Not to worry if these words aren’t familiar to you, I’ll explain these a little further below.

First let’s talk about some factors that put you at an increased risk of developing a cervical radiculopathy.

Repetitive heavy manual labour. This doesn’t mean to stop doing manual labour, but just to be cautious and make sure you are using proper form when lifting, knowing what your lifting limit is and getting help when necessary. And make sure to take adequate rest breaks to let your muscles recharge.

Driving or operating vibrating equipment. Be sure to have your car set up ergonomically to help minimize the strain on your neck (and spine in general).

Collision sports. Sports where there are more likely to be blows to the head (like football and hockey) increase the risk of an injury to the neck. Be sure to wear appropriate equipment to protect your body.

Prior injuries. If you have had a neck injury before, statistically speaking, you are more likely to experience another. Don’t worry about it though, just do what you can to keep your neck and spine healthy.

Degenerative joint disease/Osteoarthritis. Sometimes arthritic changes in the cervical spine can leave less room for the delicate nerve fibers in the neck to pass through. This can lead to compression of the nerve root and cause neck and arm pain. However, this is not always the case. Many people have osteoarthritis and experience no pain at all.

How do you know if you have a cervical radiculopathy? Here are some common signs and symptoms that can alert you that something in your neck is in need of attention:

– A deep aching and/or burning pain in the neck.

– Tingling, numbness, and/or sharp shooting pain in the arms.

– You may have had neck pain in the past. Or there could have been a specific injury that seemed to start the pain.

– You may feel you are less able to move your neck in certain directions, and moving in certain ways may aggravate the pain.


Cervical Disc Herniation – the discs are like little jelly doughnuts that sit in between the bones in the neck (between the vertebrae). They primarily act as shock absorbers. When one is damaged, it can become wider, and press on a nerve root in the neck. Nerve roots in the neck send signals of pain, sensation, temperature, etc. down the arms.

Formainal Impingement – there are small openings in the spine that allow delicate nerve fibers to freely pass through. If anything obstructs these areas (degenerative changes or inflammation are two possibilities) and there is increased pressure on the nerve fibers, this is when you may start to experience some tingling in the arms and hands.

Spinal Stenosis – this is when the diameter of the spinal canal narrows and there is less space for the nerve fibers to pass through the open areas of the spine.

Some other important points

Sometimes tingling in the hand and fingers may actually be coming from a source in the hand, such as carpal tunnel syndrome or even Guyon’s canal syndrome; or from the elbow, as is the case with radial tunnel syndrome. There are many nerve fibers running from the neck down to the hands, and there are many areas these nerve fibers can become irritated (such as the wrist, elbow, forearm or shoulder). Sometimes a feeling that is better described as an ache, as opposed to a tingling, can be caused from a tight muscle or joint that is referring pain to another close by area.

Therefore, when you are experiencing symptoms you think may be coming from a cervical radiculopathy, it is important to get a thorough assessment by your healthcare provider to determine the cause of your pain and what course of treatment in best suited for your specific needs.

This column is not intended to provide medical diagnosis or treatment. If you have a health concern, see a licensed and regulated health care professional for proper diagnosis and treatment options. Dr. Marilyn Field is a Doctor of Chiropractic who practices in Bridgewater

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How does aspirin find a headache? Headaches happen far too often for many adults. In fact, they are the third most common reason why patients consult a chiropractor. Each day, roughly 16 per cent of the population is suffering from a headache. What’s worse is that three to five per cent of those folks suffer from headaches daily.

It is not uncommon for folks to try to treat their headache with medication, using various over the-counter pills such as Aspirin (acetylsalicylic acid), Motrin and Advil (ibuprofen) and Tylenol (acetaminophen). But how do these medications work? How do they “find the headache?”

The simple answer is this: pain relievers don’t find pain. They do not travel to your head and then eliminate what is causing the headache. These drugs simply stop your brain from perceiving that there is a headache. It’s kind of like putting a piece of tape over the “check engine soon” light in your car. With the tape on the light you no longer know that the light is on. But if you take the tape off, you’ll see that the light is still on.

So, when you are suffering from recurring headaches, you really only have two options. One is to try to get rid of the symptoms of the headache. Medications can often do this, in the short term. The second option is to try to find and eliminate the cause of the headaches. No one recommends covering your “check engine soon” light up with tape, and I don’t recommend a similar approach for managing headaches.

As I mentioned in my last column, there are two main categories of headaches. Primary headaches are headaches that occur for no specific reason, although there is normally a reason for the headache, it’s just not an obvious one. Secondary headaches are attributed to a specific, underlying cause in the head or in the neck and a headache results because of this. The most common type of primary headache is called a tension-type headache (TTHA).

Tension-type headaches can last for a few minutes to several days, the pain is on both sides of the head, it feels like “pressing,” “tightening” sensations, often described as “band-like” and the pain is usually mild to moderate in intensity. There is no nausea or vomiting and the headaches are not aggravated by routine activities. When a patient is examined by a doctor there isn’t much to find wrong. Blood work, x-rays, CT scans, MRIs, and bone scans are all normal in people who suffer from TTHAs. Unfortunately, like many conditions in healthcare, you just can’t see why these headaches are there. Several patients will feel tender along the muscles in the back of their neck, especially the ones that attach to the head at the top of the neck. The muscles across the tops of the shoulders and shoulder blades can also be tight and sore, but they aren’t always.

TTHAs seem to be caused by chronic stress that results in the accumulation of physical tension. To find relief from TTHAs you have to either cover up the symptoms with medication, or find a way to release the tension and prevent the stress/tension from accumulating again.

A recent chiropractic clinical practice guideline that was published in 2012 stated that the most researched treatment for treating chronic TTHAs is home-based exercise therapy with elastic bands. These are called “low-load cranio-cervical mobilization exercises,” and involve using elastic bands to perform strengthening exercises targeting the muscles of the neck, shoulders, shoulder blades, and upper back. The exciting thing about this type of treatment is that the research recommends that the exercises be performed just 10 minutes at a time, two times per day for six weeks, followed by at least two times per week for the next six months after that. It doesn’t involve expensive equipment, you don’t need a membership to a gym and you don’t have to attend lengthy therapy sessions three times per week.

There are other forms of treatment that address the physical accumulation of stress or tension that cause headaches, but their effectiveness has not been scientifically investigated as well. Frankly, there just isn’t a lot of scientific research that has been done on this very common form of headache. Some other helpful therapies include: massage therapy, muscle-release therapy, stretching, spinal manipulation and electrical therapy such as a TENS machine. Cognitive behavioural therapy and other psychological stress reduction techniques can also help to reduce headaches by helping patients manage stress in their lives.

One last point I want to make is this. It is tempting to “Google” causes of headaches and self-diagnose. However, as any healthcare practitioner will tell you, diagnosing a headache is not as easy. There are multiple causes of headaches and complicating factors. Many people suffer from more than one type of headache simultaneously. Therefore, the only way to make an accurate diagnosis regarding your headache is with a thorough history-taking, physical exam and consultation, from a healthcare professional that is trained in recognizing, diagnosing and treating headaches. My next column in March will discuss migraine headaches, which are the eighth most common reason for disability in the world. Is there a medication that will find that type of headache?

 This column is not intended to provide medical diagnosis or treatment. If you have a back condition, see a licensed and regulated health care professional for proper diagnosis and treatment options. Dr. Ian Culbert is a Doctor of Chiropractic who practices in Bridgewater

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Whiplash — a real pain in the neck!

What is whiplash? A whiplash injury is considered an acceleration/deceleration injury, which means it is an injury that can occur as a result of your head moving quickly in one direction and then rebounding and moving quickly in the opposite direction. This sudden movement of the head can be forward, backward or sideways.

Whiplash itself is not actually a diagnosis, it is a descriptive term used to describe the way the injury occurred. Whiplash is diagnosed as a Whiplash Associated Disorder (WAD), which ranges from a WAD 1-4. Commonly whiplash is caused from a car accident, however it can also result from sports injuries, slips and falls or even from a work injury.

What are the symptoms of whiplash? Sometimes one will not notice symptoms of whiplash until years later, although most commonly symptoms will be two hours to two days after the accident.

The most common symptom of whiplash is neck pain. This pain may be localized to one area of the neck, or it may be pain that moves into the head, arms and even the upper back. Other common whiplash symptoms include: headache, painful and/or limited range of motion, shoulder and upper back pain, and tingling in the arms and hands.

Some people may also experience fatigue, dizziness, pain in the jaw, blurred vision, ringing in the ears, trouble concentrating or sleeping, and irritability.

What structures are injured in a WAD injury? Whiplash injuries commonly involve damage to the nervous system, vertebrae, muscles, joints and/ or ligaments of the spine. The degree of damage to the different structures depends on the extent of the injury itself and will guide which type of treatment is necessary.

How is it diagnosed? Whiplash is a term used to describe a mechanism of injury. The diagnosis of a whiplash injury is termed a Whiplash Associated Disorder (WAD) and is graded on a scale from 1-4.

The most severe form of whiplash involves a fracture or dislocation in the neck; this is a medical emergency and needs immediate medical attention. This type of injury is classified as a WAD 4.

WAD 2 and 3 are the most common forms of whiplash seen in a chiropractors office. With a WAD 2 injury one will experience neck pain or stiffness, as well as decreased neck ranges of motion and some tenderness in the muscles.

With a WAD 3 injury one will experience the same symptoms as a WAD 2 injury, with the addition of neurological signs and symptoms, such as numbness and tingling into the hands/fingers, and/or muscle weakness.

A WAD 1 injury is when one experiences neck pain and stiffness, but has no loss of motion or other physical signs.

During an assessment with a chiropractor a thorough history will be taken to understand how your injury occurred and what symptoms you are experiencing.

What are my treatment options? Whiplash injuries in the WAD 1-3 category are commonly seen in a chiropractors office and there are multiple treatment options available including soft tissue therapy, joint mobilizations and adjustments, laser therapy, advice on home care, as well as stretches and strengthening advice. Your treatment plan may consist of one, all or a combination of these options.

Any time you suspect you may have sustained a whiplash injury you should seek an assessment from a health care professional to assess the extent of your injury, and get guidance on the appropriate course of treatment.

This column is not intended to provide medical diagnosis or treatment. If you have a health concern, see a licensed and regulated health care professional for proper diagnosis and treatment options. Dr. Marilyn Field is a Doctor of Chiropractic who practices in Bridgewater.

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Did you have a headache on January 1?

Were you one of the many (many) folks waking up with a headache the morning of January 1? Obviously, you weren’t alone. Whether it was the loud music, the late bed-time, the celebratory drinks, the dancing and cheering or even all the sugary and rich treats, a New Year’s Eve dance or party can definitely be headache provoking. Hopefully a headache like this is a relatively infrequent event for the readers of this column. I think it’s safe to say that this type of headache is an obvious, activity-induced headache that won’t surprise the person who gets it. But what if you are one of the thousands of people who routinely experiences a headache several times a week? Is getting multiple headaches each week a normal part of life?

On any given day it has been estimated that approximately 16 per cent of the population, (that’s one in six people), will suffer from a headache. Approximately three to five percent of the population suffers from daily headaches. Chronic, re-occurring headaches lead to loss of work and medical expenses adding up to billions of dollars per year. Conventional treatments for chronic daily headaches often involve medications that can be costly and may come with significant side effects while rarely providing complete and lasting relief from the pain. Analgesic medications such as Tylenol, and anti-inflammatories such as ibuprofen, are common over the counter medications used to combat headache pain, but continued high doses combined with long-term use of these readily available drugs can be damaging to your liver, kidneys, and to the lining of your stomach.

I, personally, hate having a headache. It affects my entire demeanour. It’s not like having a sore wrist or a sore elbow that you can kind of leave alone for a while and forget that it’s bothering you. When you have a headache, you know it. You can’t get away from it and if it lasts long enough, a headache will certainly impact your quality of life. It lowers your ambition, productivity and motivation to accomplish sometimes even basic tasks. Headaches often decrease your patience, cause you to lose your temper more easily, and make it difficult to concentrate. Recurrent headaches are linked to depression and are often the reason people don’t get enough exercise or physical activity. Some kinds of headaches can cause nausea, vomiting, and sensitivity to light and sound. If a headache is severe, sometimes all one can do is lie down in a dark room and try to fall asleep.

There is a group of health care professionals called the International Headaches Society (IHS) that has classified how to recognize and diagnose more than 50 different types of headaches. The International Classification of Headache Disorders is the document that explains the characteristics of each headache and helps health care professionals accurately diagnose the many different types of headaches. Although this sounds complicated, all of the headaches can be grouped into three main categories: 1. primary headaches; 2. secondary headaches; 3. headaches that stem from neuralgias and nerve inflammation.

Primary headaches are headaches that occur for no specific reason (although there is normally a reason for the headache, it’s just not an obvious one). Primary headaches are not the result of any other underlying disease or condition. The two most common types of primary headaches are tension-type headaches (sometimes referred to as tension headaches, muscle contraction headaches, or stress headaches), and migraine.

Secondary headaches are attributed to some other underlying cause in the head or in the neck and a headache results because of this identifiable cause. The example that I started with above that involved a headache on the morning of January 1 would be diagnosed as a secondary headache, specifically, a delayed alcohol-induced headache. Other common examples of secondary headaches include headache attributed to fasting;caffeine-withdrawal headache; monosodium glutamate (MSG)-induced headache; and a headache attributed to a whiplash injury. Estimated to be one of the most common types of secondary headaches is what’s called a cervicogenic headache. This type of headache stems from the person’s neck and commonly occurs with mild or moderate neck pain, even without a previous injury to the neck.

The third main category of headaches is not as common. These are headaches related to nerve inflammation and neuralgias. Some of the more common examples of these headaches include: head or facial pain attributed to herpes zoster (shingles); facial pain attributable to multiple sclerosis; and trigeminal neuralgia.

After diagnosing the specific type of headache that is afflicting someone, most of the time the headache can then be sub-classified by how often they occur. “Episodic” headaches are ones that occur for less than 15 days per month. I don’t know about you, but I find it hard to imagine that I could have a headache three days per week and it’s classified as “episodic.” “Chronic” headaches occur more than 15 days in a month. Lastly, there’s a title called “chronic daily headache” given to people who have a headache every single day.

My next three columns are going to talk about three common types of headaches in the general population. First, I will talk about tension-type headaches. Second, I will discuss migraine, which happens to be the eighth most common reason for disability in the world. Third, I will discuss cervicogenic headaches. I will outline the most common causes, risk factors, and the most up to date scientific research on some of the most common treatment options. In my experience, headaches are not well understood by most people. They are often mis-diagnosed (usually by the person, themselves) and they can interfere with one’s quality of life for years. Often, there are solutions for better relief.

This column is not intended to provide medical diagnosis or treatment. If you have a back condition, see a licensed and regulated health care professional for proper diagnosis and treatment options. Dr. Ian Culbert is a Doctor of Chiropractic who practices in Bridgewater.


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Experiencing neck pain?

You’re not alone Neck pain is a common ailment, affecting roughly 11 per cent of Canadians every year. Two out of every 20 people affected by neck pain will find the pain disabling, preventing them from carrying out all the necessary tasks in their daily lives. Some studies have found that women are more often affected by neck pain than men, and neck pain typically peaks between the ages of 35 and 49 and then declines. That being said, however, neck pain is something that can affect anyone, at any age.

Common causes of neck pain include working long hours on a computer, studying, reading or writing with your head down. At this time of year things like baking and spending hours wrapping gifts can also contribute to neck pain! Poor posture, whiplash, or even grinding your teeth in bed can all be common causes as well.

The good news is there are things you can do to help prevent and treat your neck pain. Remember pain is a signal from your body telling you something is not right and you need to do something about it. Looking at pain this way makes it seem like less of a negative occurrence and empowers you to find a way to solve the problem. Your body is always giving you signals telling you if it likes how you are treating it (when you feel good, have lots of energy, are sleeping well) or if it does not like how you have been treating it (pain, headaches, fatigue, stress).

When your body keeps giving you the signal of neck pain here are a few things you can do to help:

Watch your posture. Slouching forward puts a lot of extra strain on the muscles of the neck and can cause pain and headaches. For every inch that your head moves forward, it gains 10 pounds in weight, as far as the muscles in your neck and upper back are concerned. This is because the muscles have to work harder to prevent your chin from falling onto your chest. This common posture often leads to Upper Cross Syndrome, a muscle imbalance problem. The muscles at the base of your skull (the suboccipital muscles) and trapezius muscles along the base of neck, as well as your pectoral (chest) muscles become tight. Meanwhile, the muscles in the front of your neck (deep neck flexors) and the rhomboid muscles (the muscles used to pull your shoulder blades together) become weak. If this posture is maintained over the long term issues can arise such as headaches (from excess strain on the neck and shoulder muscles and subsequent pressure on the suboccipital nerves), an increased thoracic kyphosis (aka a hunch back posture) and even shoulder pain. So what can you do about all this? Practice better posture! To really improve your posture it takes time and consistency. Try using some sort of cue to help you remember to check and correct your posture. For example, every time you see the colour red, think “how is my posture, and do I need to correct it?” When correcting your posture remember to roll the shoulders back and down and imagine a string attached to the crown of your head that is pulling you upwards.

Don’t let technology be a pain in the neck. When you are on your cell phone or tablet, bring the phone up towards you rather than flexing your head forward to look down at it. On the laptop, use books or pillows to elevate the laptop so that when you are comfortably looking straight ahead you are looking at the top third of the screen.

Take stretch breaks. After sitting for 30 minutes be sure to take a break to stretch. One good stretch is to sit on the edge of your chair, have your feet firmly planted on the floor, extend your arms behind you with your palms facing upwards, and gently look up towards the ceiling. Another good stretch is to gently bend your head to the side bringing the left ear toward your left shoulder, so that you feel a gentle stretch in the right side of your neck, hold for 15 to 30 seconds and repeat on the other side.

A few things to avoid. Don’t use pillows that don’t have any support for the neck and try not to fall asleep on the couch or in a chair. Don’t cradle the phone between your neck and shoulder, using a headset or speaker phone can prevent a lot of aches and pains. With the holidays upon us, many people will be sleeping in different beds, to help save your neck bring your pillow from home with you. If your neck pain is persistent and causing you significant discomfort be sure to get assessed by a regulated health care professional. Don’t let the little aches and pains linger for too long, the sooner you can properly address and treat the underlying cause of your neck pain, the better.

This column is not intended to provide medical diagnosis or treatment. If you have a health concern, see a licensed and regulated health care professional for proper diagnosis and treatment options. Dr. Marilyn Field is a Doctor of Chiropractic who practices in Bridgewater

Ian-Spinal Column

The proof is in the pudding

As 2016 comes to an end, so is my series of writing about pain that is associated with osteoarthritis (OA). This is my sixth column over the last six months on this topic. I have discussed what osteoarthritis is, some medications that can help ease the pain, foods that you can eat and foods to avoid to help minimize inflammation, supplements and herbal products that can decrease inflammation and pain, and I’ve discussed movement and exercise to help keep muscles strong and prevent joints from seizing up.

I’ve included many different ways to decrease pain related to OA because unfortunately, there is no magic pill or silver bullet to completely eliminate all OA-related pain in everyone. People who live life with the least amount of pain usually do multiple things to help minimize it. If you’ve been following along over these last six months and you’ve been implementing some of the recommendations and you’re still not satisfied with how you feel, then continue reading, because today I’m writing about one more important topic. Manual therapy done in a health professional’s office can provide a lot of people with pain relief.

Pain that is associated with OA is hard to measure. You can’t see it on an x-ray, and even MRI’s, CT scans, and bone scans can’t accurately determine or predict how much pain a person will be in. And a blood test certainly won’t show how much pain you’re experiencing. Overall, there is no way for someone to measure it, except by asking the patient, “how much pain are you in?”

This does not mean that the pain is not real. Just because you can’t see it, measure it, or predict it with some fancy measuring device doesn’t mean it’s “all in your head.” Pain is a complex thing that is real, causes a lot of disability and frustrates a large portion of our population. With the growing opioid/narcotic drug problem, it’s obvious that people don’t like pain and are always seeking solutions to relieve it.

Many scientific studies, clinical practice guidelines, and healthcare professional organizations recommend manual therapy for pain, especially for low back pain, neck pain and headaches. In many circumstances the pain is at least partially due to some degree of OA. Maybe you have had x-rays ordered by a family physician or an E.R. doctor and when you get the results you are told, “you have arthritis, specifically osteoarthritis.” (If you’ve read my previous columns you will know that everyone over the age of 45 will have at least some degree of OA in more than one area of their body. It’s normal wear and tear.) But having OA doesn’t mean you always have to live in constant pain. Manual therapy, as performed in many healthcare clinics, provides pain relief for many people.

A variety of manual therapies exist and different healthcare professionals tend to use different techniques. Chiropractors, massage therapists, physiotherapists, occupational therapists, and osteopaths are the most common practitioners who utilize manual therapy. It involves hands-on treatments that target muscles, joints, tendons, ligaments, or a combination, to provide improved movement, better function, and as a result, less pain.

But how can a hands-on therapy reduce pain that is related to OA?

When people start developing pain their bodies usually do predictable things to cope. The muscles that are around the painful area become tighter, sometimes to the point of having a muscle spasm. The person also starts to favour the area that is sore, using it less, and as a result it becomes stiffer and less mobile. For example, if one knee is sore, the person often limps, and puts more weight on the nonpainful knee. As muscles become tighter, joints become stiffer, and the person walks differently; the pain starts to spread to other areas. Often it will travel up, or down from the original site of pain. If it’s back pain, it starts to travel down the leg. If it’s neck pain, it starts to cause headaches, or travel down into one of the arms. Often these coping mechanisms end up causing even more pain, problems and disability than the original issue did.

Manual therapy is designed to do three main things: restore proper mobility in a joint, relax tight muscles around the joint, and eliminate the inflammation in the tissues. It assists in the body’s ability to heal faster. Once a painful area is moving better, is less painful, is functioning better, and the patient is not compensating, then most manual therapy practitioners will suggest some sort of exercise to help maintain this. This may involve mobility exercises, stretches, strengthening exercises, or a combination of the three. What exercises are the most effective? The most recent scientific studies say it’s the exercise that patients do consistently, regardless of what it actually is. Unfortunately, reading about exercise is not very effective. You actually have to do it for it to be helpful.

When you have an issue with your teeth, a dentist is the doctor to see. When a medication is necessary, your family doctor will prescribe it. When the arteries to your heart are clogged, a heart surgeon can unclog them. When you have seized joints, tight muscles, and can’t tie your shoes because you can’t bend over, consider seeing a doctor who provides manual therapy. Scientific studies support it. Your neighbour probably already does it. And as the old cliché says, “the proof is in the pudding.” People do it, because it works.

This column is not intended to provide medical diagnosis or treatment. If you have a back condition, see a licensed and regulated health care professional for proper diagnosis and treatment options. Dr. Ian Culbert is a Doctor of Chiropractic who practices in Bridgewater

Marilyn-Spinal Column

Getting a good night’s sleep

A good night’s sleep is essential to good health, and is a very important part of the healing process, whether it be from a physical or emotional injury. However, it can be hard to get a good sleep if you don’t have good sleep posture. We spend roughly eight hours in bed every night, so if your sleep posture isn’t great, that can put a lot of stress on your back and neck. The following are a few things to keep in mind to help ensure a good, healthy night’s sleep.

Find the right mattress

Finding the right mattress can be a challenge. What is comfortable for one person, may cause many uncomfortable, restless nights for someone else. Ideally, your mattress should be firm enough to support the natural curves of the spine, and flexible enough to adapt to your body’s individual shape. For example when laying on your side, your hips should be parallel. If you share a bed it can be hard to find one mattress that is right for both people, but fortunately now there are many mattresses on the market that offer dual support — one side can be firmer or softer than the other so both people get the best support (and sleep) possible.

Invest in a good pillow

A good pillow will support the natural space between your shoulder and head, if you are lying on your side. If you are lying on your back, it will support the natural C-curve of the neck. Your head should not be propped up or stretching to reach the pillow. Imagine good standing posture, this is how your body should be supported by your pillow and mattress when you are lying down. When buying a new pillow, test it out in the store. You may not be able to take a long nap in the store, but laying down with the pillow for a minute or two will give you a good idea if it is the right pillow for you. There are many different materials pillows can be made of, and none are necessarily superior to the other. Some pillow types to try are water pillows, memory foam, microfiber, buckwheat; try out a few and find what works for you.

Don’t sleep on your stomach

Notice there were no tips about a good pillow for sleeping on your stomach? That’s because it is the worst position you can sleep in. It puts a lot of extra stress through your neck and lower back, so it really is best to avoid this position if at all possible. Need help trying to break the habit? Wear pyjamas with a pocket and put a tennis ball in one of the front pockets, it will be uncomfortable to lay on it and prompt you to roll over should you try to sleep on your belly. You can also try propping yourself on your side using extra blankets or pillows.

Suffering with shoulder pain?

Laying on your back can help relieve stress of off your shoulders. If you find side sleeping more comfortable, hug a fluffy pillow so that your arm and shoulder are supported throughout the night. Even if you do not have shoulder pain, try to vary which side you sleep on. Always sleeping on the same side can lead to shoulder pain over the long term. Some people find occasionally switching which side of the bed they sleep on will help them sleep on their opposite side.

Lower back pain?

If you suffer with lower back pain, try putting a small pillow between your legs while sleeping on your side. This will help to maintain optimal alignment of the hips and lower back while you are sleeping. Even if you move around a lot in your sleep and are likely to kick the pillow out of the way during the night, having it there for at least a little while will be helpful. If you sleep on your back, try placing a small pillow under the bend of your knees, this will help reduce the stress on the lower back.

A few other tips

Within two hours before going to bed avoid caffeine, alcohol, and vigorous exercise, all of these things can disrupt sleep. However, it is important to note that regular exercise earlier in the day can be beneficial to sleep. If the only time you have to exercise is within that two hours before bed, my opinion is that it is better to exercise than not to, but be sure to give yourself some time to cool down afterwards.

Avoid watching TV and using tablets/cell phones (anything with a screen), at least half an hour before going to bed. The light of a screen stimulates the brain and can contribute to insomnia.

Establish a clear bed time routine; this will signal to your body that it is time to wind down and relax for the night. This can include things such as washing your face, brushing your teeth, meditating, reading a book (ideally one that isn’t too stimulating), or listening to relaxing music.

Lastly, having a consistent bed time will help to keep your sleep cycle in regular rhythm. I hope you have found these tips helpful and are well on your way to a good night’s sleep!

This column is not intended to provide medical diagnosis or treatment. If you have a health concern, see a licensed and regulated health care professional for proper diagnosis and treatment options. Dr. Marilyn Field is a doctor of Chiropractic who practices in Bridgewater


Ian-Spinal Column

‘If you don’t use it, you lose it’

My last four columns have focused on what you can take, eat, or not eat to help ease the pain associated with osteoarthritis (OA). If you’ve been following along, by now you know there is no magic pill when it comes to completely eliminating OA pain. In order to minimize the pain as much as you can your body needs to do things as well. So let’s talk about exercise and how it can help with pain from OA.

The simple way of putting it is: if you don’t use it, you lose it. Cartilage is the rubbery material that is between all the bones of our bodies and with OA this cartilage starts to break down, wear away and get thinner. When cartilage becomes inflamed, pain results. Think of cartilage as a sponge. It contains fluid that can lubricate the joint, but movement must occur in order for the fluid to get released. When there is movement in the joint, the fluid in the cartilage gets squeezed out, just like when you push on a sponge that is full of water. In your joints, that fluid is called synovial fluid.

Here’s an example to show how your joints get lubricated with movement. When we sleep, we normally don’t move around much. Our joints, especially our knees, hips, and ankles “dry out” as we sleep. When we first get up in the morning and take our first 20 steps, we are usually the most stiff, tight, and “seized” that we will be the entire day. But as we walk to use the washroom, then head into the kitchen to make coffee, and bend over to feed the cat, we are moving our joints and they start to get looser. The cartilage is releasing the fluid that it has absorbed during the night, and in a sense is “oiling” our moveable hinges. It can be summed up with the slogan: “motion is lotion.”

On the flip side, if we get up from bed and walk to the kitchen and sit for a prolonged period reading the paper, then watch TV for an hour, then check our email, then visit our friend and sit while drinking tea (after a 20-minute drive sitting in our car), there is very little “lotion” being released by our joints. As our joints dry out, there is more chafing, friction and rubbing on the cartilage surfaces, which can lead to more pain, dysfunction, and the progression of more cartilage breakdown. If you work in an office 40 hours a week, and spend the majority of your spare time on Facebook, chances are your joints are staying very dry the vast majority of your day.

It is well known that exercise is a very important intervention for patients with non-surgical knee and hip OA. Aerobic exercise (low intensity exercise for longer periods of time, usually greater than 20 minutes), strengthening exercises, aquatic/water exercises, and Tai Chi are beneficial for improving pain and function in people with OA.

There is no scientific proof at this time to suggest that one form of exercise is better than others, however, a combination of general aerobic and specific strengthening exercise is recommended. There are very few times when patients should not exercise when they have OA. One must pick a type of activity that they enjoy, and do the exercises at an intensity and for a length of time that doesn’t increase their pain. Because the optimal exercise dosage is yet to be determined, an individualized approach to exercise is often required based upon that person’s unique situation. The key in the success of exercise therapy is simply choosing an exercise that you enjoy doing and will continue to enjoy doing over time. Some people do better attending a class with a friend and others just like getting out into the great outdoors. It’s also good to know that the effectiveness of exercise is not dependant on how severe the OA looks on an x-ray. Some will get a lot of benefit even when their joint is significantly worn out.

The bottom-line is that becoming more active can help prevent OA from developing, and can make pre-existing OA feel better. So go for a walk. Take exercise classes at the local YMCA, in community centres, church halls, or private gyms. Get a yoga membership. Join a Pilates studio. Swim in a pool. Take aqua-fit classes. Do Tai Chi. Exercise in your basement. Do aerobics in front of your TV. Join a karate club. Sign up for taekwondo. Skate. Row. Swim. Kick box. Play hockey. Play pickle ball. Join the tennis club. Become a member of the curling club. Golf. Run. Play women’s soccer. Do what feels right for you. Just do it.

My next column in December will discuss some non-pharmacological, physical therapeutic interventions that can help alleviate pain that is associated with OA.

This column is not intended to provide medical diagnosis or treatment. If you have a back condition, see a licensed and regulated health care professional for proper diagnosis and treatment options. Dr. Ian Culbert is a Doctor of Chiropractic who practices in Bridgewater

Marilyn-Spinal Column

Preventing pregnancy related back pain

Pregnancy is a wonderful and exciting time in a woman’s life, however it can also be a time of more aches and pain. Roughly 50 per cent of pregnant women will experience back pain at some point during their pregnancy (some studies even suggest as many as 80 per cent will be affected). Many women report that the pain is so significant that it negatively impacts their ability to perform the activities of daily life.

Not surprisingly, back pain is among the most common pain complaint during pregnancy. This tends to be a result of the biomechanical and hormonal changes that take place. A typical weight gain during pregnancy ranges from 25-35 pounds, and a significant portion of this weight is added in the abdominal area. As a result of the growing belly, a woman’s center of gravity shifts forward, which means that the curve in the lower back will increase and added stress will be placed on the joints of the lower back and pelvis. Additionally, as the belly expands, the abdominal muscles also have to expand, causing them to be less effective at stabilizing the core.

From a hormonal perspective, in the third trimester levels of the hormone “relaxin” increase significantly. This hormone allows the ligaments to relax so the pelvis can expand to accommodate the growing uterus. As a result, the muscles of the lower back have to work overtime to keep you balanced; this can lead to back pain, fatigue and discomfort.

For some mothers, these changes will not create any pain or discomfort, however, many others aren’t as lucky. Mothers with a previous history of lower back pain are more likely to be affected by pregnancy related back pain. Fortunately, there are things you can do to minimize the risk of developing these aches and pains, and to manage the pain, should it occur.

The following are a few things one can do to help decrease the stress on the body during pregnancy and help make this special time as comfortable as possible:

Avoid one-sided positions. Be careful getting in and out of the car, swing the whole body around, rather than exiting one leg at a time. Sitting on a garbage bag can help make swinging the whole body at once easier and will help keep the back and pelvis safe.

Try to avoid one leg positions. If you are exercising that is great, however, avoid exercises such as one legged squats. As hormonal changes take place your ligaments will become looser and one legged positions can put too much strain on the pelvis. If you were not exercising before pregnancy, be sure to check with your doctor before starting a new exercise program.

Avoid repetitive motions. Repetitive strain injuries can happen at any time of life, not just during pregnancy, but you will be more likely affected by them now. Therefore, try to vary your tasks frequently.

Watch your posture when lifting. When lifting anything from children to groceries, be sure to keep your back in a neutral position and lift with your legs. Your back is more prone to injury during pregnancy from the hormonal and biomechanical changes that are happening.

Practice good sleep posture. If you are sleeping on your side, place a pillow between your knees to help maintain good alignment of the spine. Also, try sleeping on your left side, this will help to decrease the pressure of the uterus on the large blood vessels in the abdomen and allow for optimal blood flow for both mom and baby.

Support your feet and your back. Wearing good footwear is especially important during pregnancy. Having a shoe with good arch support will help decrease foot fatigue. And avoid wearing high heels, they place extra strain on the joints of the low back, hips and knees.

When sitting use a lumbar cushion to support your lower back. If you have to sit for long periods at work, be sure to take a break at least once an hour to get up and stretch.

To help prevent, and to treat muscle and joint pain, consider adding a chiropractor to your team of maternity care professionals. Chiropractors are trained to identify and correct spinal dysfunctions and muscle imbalances caused by pregnancy. Chiropractic treatment can offer gentle, safe and effective drug-free care to help alleviate the aches and pains associated with pregnancy.

 This column is not intended to provide medical diagnosis or treatment. If you have a health concern, see a licensed and regulated health care professional for proper diagnosis and treatment options. Dr. Marilyn Field is a Doctor of Chiropractic who practices in Bridgewater

Ian-Spinal Column

Hey Doc, does that fish oil actually work?

Many of my patients take some form of fish oil to help decrease their pain or for overall health benefits. Often they take it because their neighbour told them they should. For example, Betty tells John, “I’ve been taking a teaspoon of fish oil every day for the last three months and my knees no longer hurt. You should take it!” So, John buys some fish oil, tries it for three months, and feels no change in his knee pain. He then asks me: “Dr. Ian, does taking fish oil actually work?” Here’s my answer: it depends. It depends on many things.

Fish oil is fat. To make it simple, there are some types of fats that are less healthy (saturated fats) and there are some fats that are more healthy (unsaturated fats). Fish oils contain unsaturated fats. There is a category of unsaturated fat called “essential fatty acids” (EFAs.) “Essential” means our bodies don’t make them, but we need them, therefore, you have to consume them in some way. Omega 3 fats are a sub-type of EFA. They are found naturally in the oils of certain plants and marine life. Flax seeds, pumpkin seeds, and walnuts all contain omega 3 fats. There’s a group of fish called “SMASH” that stands for salmon, mackerel, albacore tuna, sardines, and herring, that contain substantial quantities of this “good fat.”

The benefits of maintaining a diet relatively low in saturated fat and high in omega 3 fats include: reduced inflammation, less pain, improved cardiovascular health, less depression and anxiety, lower cholesterol, and lower blood pressure.

Sounds good, doesn’t it? But how much do I need? Can I consume enough of it in foods to have these positive effects to reduce my pain and inflammation? The simple answer is, no. While it is recommended to consume as little saturated fat as possible, and it’s a good idea to consume as much fish as possible, the chances of us getting enough of these “good fats” to actually have a therapeutic effect is very unlikely.

Thankfully, supplemental forms of fish oils are plentiful. You can buy fish oil in liquid form or in liquid gel capsules. Some capsules are enteric coated so they don’t break apart until further down your digestive tract. There are many different brands and are sold at virtually every pharmacy, health food store, and grocery store. There are some drug interactions, but very few potential side effects, and most people tolerate fish oils very well. Overall, they are considered to be very safe, but as always, it is best to consult your doctor or pharmacist if you are taking any other medications before beginning a regimen of fish oil supplements.

Most importantly when it comes to supplementing with fish oils, not all things are created equal. The main medicinal ingredient in fish oils that helps to reduce pain and inflammation is omega 3 fat. But it goes even further than that. The active ingredients in the omega 3 fat are called eicosapentaenic acid (EPA) and decosahexaenoic aicd (DHA). Simply put, it’s the amount of EPA and DHA that are the magic ingredients in fish oil. Between different brands and manufacturers there can be very big difference between the amount of DHA and EPA that is found in the capsules.

And unfortunately, when it comes to omega 3 fats you get what you pay for. So if Betty is supplementing with 1600 mg of EPA and 800 mg of DHA, for a total of 2400 mg each day, but John purchases an inexpensive supplement that only provides him with 300 mg of EPA and 200 mg of DHA, for a total of 500 mg each day, he’s not going to get the same results. So how much should you take? Again, my answer is: it depends. Recommended amounts vary from a total of 200 0mg each day to 10,000 mg each day. It’s going to cost a lot more to take 10,000mg each day, but it’s also of very little benefit to take just 500 mg if you have pain due to inflammation and osteoarthritis. A common recommended dose for EPA and DHA is a total of 1800 mg-2400 mg daily.

One final note: fish oil is also not the same as cod liver oil, another common supplement that has been taken by many people for years. Cod liver oil has smaller amounts of EPA and DHA and higher quantities of vitamin A and D. However, in order to obtain 1800-2400 mg of total EPA/ DHA taking cod liver oil, the amounts of vitamin A and D you are taking get quite high. If your supplement doesn’t tell you how much EPA and DHA it contains, I’d recommend you choose another brand, where it is provided.

Although they aren’t “a magic pill” you might see a number of benefits from supplementing with fish oils. In a 90-day trial period, you should know if they are helping or not.

This column is not intended to provide medical diagnosis or treatment. If you have a back condition, see a licensed and regulated health care professional for proper diagnosis and treatment options. Dr. Ian Culbert is a Doctor of Chiropractic who practices in Bridgewater.


Marilyn-Spinal Column

Countering the negative effects of too much sitting

The average adult in Canada spends half to most of their day sitting. Whether it’s in our cars, at our desks or at home, we sit more than we don’t and this can wreak havoc on your health. Strong evidence has been found showing the negative effects of too much sitting. In short, research has found the more time you spend sitting, the more likely you are to have health issues.

One study found that women who sat for more than seven hours per day had a 47 per cent higher risk of depression then those who sat for only four hours per day. This study also found that women who didn’t engage in any physical activity had a 99 per cent higher risk of developing depression, compared to women who were active for at least some portion of the day.

To some extent, we can’t avoid a certain amount of sitting during the day. If you have a sedentary job, your job still has to be done (below you will find some tips on how to make sure your workstation is set up as pain free as possible). If you have to drive to work, it’s not an option for everyone to swap out driving the car for a bike ride or walk. However, there are things we can do to help counteract some of the negative effects of chronic sitting. Firstly, we can move more and secondly, we can make sure that when we are sitting we have good office ergonomics (meaning our office space is set up in a way to minimize the chance for injury).

In terms of getting more movement into our day, it is really pretty simple. Just move in any ways you can, in small (or big) doses, on a regular basis. We can’t all ditch our desk jobs, or implement a walking workstation, but we can make more movement a priority.

One study found that a simple five minute walk, for every hour spent sitting, can help significantly reduce the risk of heart disease associated with chronic sitting. Even something as simple as just standing up, ideally every 15 minutes, can help activate the muscles in your legs and get the blood flowing.

The negative health effects of sitting can in part be due simply to poor office ergonomics. How our work space is set up can have a big impact on our health and well-being. If we are slouching, hunched over a computer or book, or just sitting for too long, these things can lead to back pain, neck pain and headaches. If you are someone who sits at a desk job for most of the day these tips can help make your work station a little (or hopefully a lot) less likely to cause you pain;

Don’t cradle the phone between your neck and shoulder.

Do use a headset or speaker phone when possible.

Don’t sit with your legs crossed at the knees. Prolonged cross legged sitting can cause extra strain and tension in the lower back and hips.

Do change positions every 15 minutes. The most important thing to remember about posture if you are sitting most of the day at work, is to vary your posture frequently. Even with perfect posture (hips and knees bent to 90 degrees, feet flat on floor) holding that position for too long can create extra strain on the body.

Don’t strain to reach for things repeatedly while sitting.

Do try to arrange your desk so that important items are within arm’s reach. Keep items frequently needed close by (within an arm’s reach). Items that don’t need to be used as frequently can sit a little farther away.

Don’t have your head flexed forward looking down at the computer screen.

Do centre your computer monitor so the first line of text is at eye level while you are looking straight ahead.

Don’t spend the whole day sitting in an uncomfortable chair.

Do use all of a chairs special features to position the chair in the most comfortable position for you. Ensure your back is supported in the lumbar area, and make sure the chair is the proper height to reduce the pressure at on the back of the knees. Use the arm rests to reduce the stress on the upper body and neck.

Don’t sit for more than an hour without standing up.

Do get up from your chair at least every hour. As mentioned above, any amount of movement you can get into your day will have a positive benefit to your health. If you can, get up and take a short walk, do a few lunges, squats or calf raises, just do something to get moving. If you don’t have time to walk away from your desk, simply stand up and sit back down. The simple act of activating your muscles will go a long way in preventing pain.

Other things you can do to help counteract the negative effects of too much sitting include:

Getting the recommended 150 minutes of physical activity per week during your leisure time. (To put it in perspective, 150 minutes/week is only one-and-a half per cent of your week, and that divides up into about 20 minutes of activity each day, that’s pretty reasonable for most people to attain.) Take the stairs, park farther away, incorporate a mini-stretch and strength routine to do at your desk every hour, and aim to get at least 10,000 steps per day. Some research has found that getting a minimum of 10,000 steps per day can do a lot to improve your health, so dust off the old pedometer or grab your FitBit and start counting those steps. It all adds up to better health in the long run.

This column is not intended to provide medical diagnosis or treatment. If you have a back condition, see a licensed and regulated health care professional for proper diagnosis and treatment options.

 Dr. Marilyn Field is a Doctor of Chiropractic who practices in Bridgewater


Ian-Spinal Column

Natural, non-drug ways to ease the pain

My last column identified different types of foods that we can eat and some foods that we can avoid to help reduce inflammation in our bodies. However, for most people who experience pain due to osteoarthritis (OA) inflammation, simply “eating better” is not going to provide enough pain relief. If you want to avoid pharmaceutical medications and still decrease your pain, then you may want to try some vitamins and supplements that have been found to help.

Here are some that have been researched and may be effective for your pain and stiffness. This is not an exhaustive list of natural anti-inflammatories, but it’s a start:

Vitamin C. Our bodies need vitamin C to produce healthy collagen which is a major component of cartilage. Remember, OA is the process of cartilage wearing out between our bones. The longer you maintain your cartilage, the better. There has been some scientific evidence to say that supplementing with vitamin C can slow cartilage loss. The great thing about vitamin C is that it is very safe, even in quantities as high as 1,000 mg per day.

Glucosamine Sulphate. Some scientific studies have shown that glucosamine sulphate also slows down the progression of cartilage loss. However, other studies have shown it’s not helpful in decreasing pain and it’s important to know that this is not an ‘anti-inflammatory’ supplement. Rather, it helps to make cartilage strong to prevent further destruction and degeneration. Therefore, it can take up to 12 weeks before any improvement is noticed by the patient. Unfortunately, glucosamine sulphate won’t work for everyone, especially if your cartilage is significantly destroyed. The recommended adult dosage is 1,500 mg per day. Diabetics have to be cautious taking it as there is a small possibility that it may increase their blood sugar levels.

 MSM (Methyl Sulfonyl Methane). This is often used in combination with glucosamine sulphate. It reportedly provides sulfur, a vital building block for joints and cartilage, to the body. Recommendations for supplementation amounts range from 400 mg to 6 g per day.

Quercetin. This is a natural supplement that comes from many fruits and vegetables such as red kidney beans, cilantro, red onions, kale, sweet potatoes, cranberries and broccoli (just to name a few). Quercetin has antioxidant and anti-inflammatory effects which can help reduce inflammation. Recommended amounts range from 300-1,000 mg per day.

 Bromelain enzymes. Found in the pineapple plant, bromelain is a group of enzymes that has anti-inflammatory effects. Recommended dosages range from 80-320 mg per day. It should be noted that Bromelain is a natural blood thinner, and therefore should not be combined with pharmaceutical blood thinners such as coumadin/warfarin.

Turmeric/Curcumin. Curcumin is an extract of turmeric, a spice well known for it’s distinctive flavour in East Indian and Thai food, that has natural anti-inflammatory properties. Proper supplementation would involve turmeric extract that has 95 per cent concentration of curcumin. It has been shown to lessen morning stiffness. Recommended dosage of the supplement ranges from 600-1,200 mg per day.

Boswellia. This comes from a group of trees and shrubs that are native to tropical regions of Africa and Asia. It’s another type of natural anti-inflammatory. When standardized to 70 per cent boswelliac acids, it can be used as a supplement to help reduce inflammation at a dosage of 600 mg per day. With less concentration of boswelliac acids, taking up to 1,200 mg per day has been recommended.

 White Willow. This is the bark from the willow tree. Willow bark acts a lot like aspirin, so it is used for pain and inflammation. Its active ingredient is a chemical called salicin that is similar to aspirin. It is also a natural blood thinner, and therefore should not be combined with pharmaceutical blood thinners such as coumadin/ warfarin. A standardized extract containing 15 per cent salacin can be supplemented at a dosage range of 100- 240 mg, daily.

 Ginger Root. The roots of the ginger plant contain chemicals that can reduce nausea and inflammation. Uses include pain relief from rheumatoid arthritis and OA. Recommended dosages will depend upon the percentage of active ingredient in the supplement (called gingerols). When the extract contains 5 per cent gingerols, 150-1000 mg per day has been recommended.

It is extremely important to note that I am not recommending that anyone simply go to their pharmacy or health food store and purchase these supplements without consulting your pharmacist, physician or another regulated health professional. These, like all supplements, are not risk-free and may not be safe for you to take. Some may interact with certain medications and others may be contraindicated depending on what other conditions you have, so it is important to proceed with caution. That said, some companies have combined several of these products into one capsule that can be taken a couple times per day.

This column is not intended to provide medical diagnosis or treatment. If you have a back condition, see a licensed and regulated health care professional for proper diagnosis and treatment options.

Dr. Ian Culbert is a Doctor of Chiropractic who practices in Bridgewater.

Marilyn-Spinal Column

High heels and back health

When wearing high heels it pushes the center of mass of the body forward, and throws the hips and spine out of their normal neutral positions. This puts excess strain through the lower back, knees and hips. This forward center of mass also puts more pressure on the forefoot, and the higher the heel, the more pressure on the feet and back.

Ideally, we would wear flat shoes with good arch support all the time, however there are times when you’ve just got to wear heels! Here are some tips to help make those times as painless as possible:

1. When shopping for shoes, whether it be heels, sneakers or other footwear, it is best to go in the afternoon or evening when your feet have accumulated fluid throughout the day, this will ensure you don’t pick a shoe that feels too tight by the end of the day.

2. It’s not uncommon to be wearing the wrong size shoe, so be sure to measure what shoe size you really are. Always do this standing up, as your foot expands when you are weight bearing.

3. Try keeping your heel height to no more than two inches. As heel height increases, so does the pressure on your feet, knees, hips and lower back; the lower the heel the better. And always make sure you pick a heel height you can walk gracefully in — if you aren’t able to walk comfortably you are more likely to trip and injure yourself.

4. Opt for a wedge heel instead of a stiletto, the wedge offers more support and stability.

5. The fabric of the shoe can make a big difference too. Try to go for shoes that are leather or nylon mesh, these allow for more breathability and flexibility for the feet.

6. Avoid the “break in period” myth. A shoe should fit comfortably from day one, if you need to break it in, it isn’t fitting right. (Yes, with some shoes that are nylon mesh or leather they will stretch over time, and likely that will make them even more comfortable, but they shouldn’t hurt to wear right from the beginning.)

7. Place a cushion under the ball of your foot to help reduce some of the pressure on the forefoot.

8. When you get a chance, take your shoes off ! If you are sitting for a little while, slip your shoes off and wiggle and stretch your toes and feet.

This column is not intended to provide medical diagnosis or treatment. If you have a back condition, see a licensed and regulated health care professional for proper diagnosis and treatment options. Dr. Marilyn Field is a Doctor of Chiropractic who practices in Bridgewater

Ian-Spinal Column

Fueling the fire of osteoarthritis pain

We’ve all heard the saying, “don’t add fuel to the fire.” But have you ever thought that this cliché could be applied to pain and what we eat? In my last column I discussed a variety of drugs that can be taken for pain that’s associated with osteoarthritis (OA). But there can be short-term side effects and there are well known long-term risks associated with taking those drugs. So maximizing non-pharmacological treatment options and preventative strategies should be of interest to anyone experiencing pain stemming from OA.

Pain that is associated with OA is usually due to inflammation. It’s not the actual degeneration of the cartilage, or the growth of bone spurs, or the fact that the bones are getting closer together as the cartilage cushions wear out. It’s actually because there is inflammation at the site of pain. Ironically, inflammation is our body’s way of trying to heal itself. Our immune system is sending certain types of cells to the area to try and remove damaged tissue and heal the joint that has been damaged.

Food can either help us reduce inflammation or it can promote even more inflammation to be produced by our bodies. Certain foods have what are called “anti-inflammatory properties,” and there is some evidence that when these foods make up the majority of our diet we may experience less pain. The list of anti-inflammatory foods is long but some of the main foods include: whole grains, most vegetables, fatty fish (salmon, mackerel, albacore tuna, sardines, and herring), green tea, citrus fruits, cherries, and real juices like pomegranate juice. Let me make this a little easier. For the most part, these foods are the obvious “good for you” foods and are typically very brightly coloured fruits and vegetables.

On the flip-side there are also foods that might promote inflammation in our bodies. It’s kind of like an Olympic athlete taking steroids. Certain steroid drugs allow the athlete to make muscle more easily and they can get stronger in a shorter period of time. If we eat too many foods that help to promote inflammation then we are making it easy for our bodies to create more of it. Some of the important ones in this category include: animal fat, beef, pork, fried foods, sugar, processed snacks, alcohol, dairy, wheat that contains gluten (especially if you are sensitive to gluten or allergic to gluten). There is a category of vegetables called “night shades” that have been linked to creating more inflammation in certain individuals. The most common nightshades include: potatoes, tomatoes, eggplants, chili peppers and tobacco.

I want to make an important point here. I hate to think of labelling any food as being “good” or “bad.” It’s not that simple. It really depends on what your terms of reference are when you ask whether something is good or bad to eat. It doesn’t mean that the pro-inflammatory foods cause problems for everyone. But for people who are in pain every day and experiencing a lesser quality of life due to inflammation you may want to consider eliminating these foods for a while to see if it makes a difference in your level of pain. I have seen examples in my office where a patient with chronic back pain will eat tomatoes (one of the night shade plants) and she will experience a flare-up of back pain within 24 hrs. Sometimes these foods can have a dramatic impact on someone’s pain and other times they will have no impact whatsoever…

Unfortunately, there are not oodles and oodles of scientific papers to prove that the pro-inflammatory foods I’ve mentioned are causing any one person’s pain. But if you are willing to try eliminating some of these foods from your diet, I recommend you do so for three months, and evaluate how much better you feel.

My next column will identify what supplements, vitamins and minerals can help decrease pain caused by inflammation. Stay tuned!

This column is not intended to provide medical diagnosis or treatment. If you have a backcondition, see a licensed and regulated health care professional for proper diagnosis and treatment options. Dr. Ian Culbert is a Doctor of Chiropractic who practices in Bridgewater


Marilyn-Spinal Column

Backpacks, purses and bags — Don’t let them be a pain in the neck and back

Improper use of backpacks can lead to back ache, numbness and even headaches. Nearly 40 per cent of children report back pain at one point or another and many of them attribute this pain to backpack use. It’s not just school-aged children who carry backpacks, many adults use them too and are just as likely to develop back pain from them. Further, back and neck pain can be a result of carrying not just backpacks, but purses, luggage and duffle bags. The good news is that there are a lot of things you can do to help decrease the chance of developing pain from whichever type of bag you carry.

The following are tips to help you avoid a backpack related injury. They’re not only useful for backpacks, they also apply to the use of purses, briefcases, luggage or anything else you use to carry your belongings.

Buying the Right Bag:

Whichever type of bag you buy, use these tips to help pick a good one:

1. When purchasing a bag with shoulder straps, make sure they are thick and well padded. This will help distribute the weight more evenly.

2. Shoulder straps should be adjustable so that they can be fitted to your body.

3. Opt for lighter weight fabrics, like canvas or cotton, rather than leather which tends to be heavier. When buying a designer bag or purse be cautious of ones that have too many studs, gems and fancy additions on them, as these can add a fair amount of weight to a purse before you’ve even started putting your contents into it!

4. Get a bag with multiple pockets. This will help distribute the weight more evenly within the bag. It also gives you more places to put things so that you don’t have to twist, bend and fidget to find what you are looking for.

5. One size does not fit all when it comes to backpacks, bags and luggage. Purchase a backpack, bag or purse that is proportionate to your body size.

6. Stick with small to medium sized bags and purses to help prevent putting too much weight in it. The bigger the bag, the more likely you are to over stuff it.

7. When buying luggage, look for bags that have wheels. This will save your back when you have to walk with it for any distance.

8. When purchasing a purse, a good option is to get a purse that can be worn with one strap across the body, this will help distribute the weight better, and help prevent you from hunching your shoulder up to your ear to stop the purse from sliding off your shoulder.

The Contents – Pack it right:

When packing your bag keep these backfriendly tips in mind:

1. Weigh your bag. Once the bag is loaded and ready to go, weigh it. It should not weigh more than five to 10 per cent of a child’s body weight or 10 to 15 per cent of an adult’s body weight.

2. When packing the bag, put the heaviest items closest to the body and/or at the bottom of the bag.

3. Try to minimize bringing heavy books back and forth to school and home whenever possible.

4. It is better to pack your items into several bags, rather than over-stuff one.

Wearing the Bag:

Keep these tips in mind for carrying your bag:

1. If wearing a purse or one-shoulder bag, be sure to alternate which shoulder it is worn on. Also, if possible, lift the strap over your head and wear it on the opposite shoulder. Wearing or holding a purse or bag on one side can cause you to bend and lean one way more than the other. This can throw off the alignment of the spine.

2. To put a backpack on safely, place it on a table or chair, bend at the knees, put one shoulder strap on at a time and lift with the legs.

3. Wear backpacks with both shoulder straps. If a backpack has shoulder and hip buckles, use them, especially if the backpack is heavy. This will help redistribute some of the weight of the bag onto your pelvis.

4. When wearing a backpack position it so that it is resting between the shoulders and waist. It should not be sagging more than four inches below the waist line and should not rise above the shoulders.

5. If you notice you or your child is hunched forward and/or has rounded shoulders while wearing the backpack, these are signs that it is too heavy. Try to lighten the load.

6. When using luggage that has wheels, take advantage of the wheels and push or pull your bag whenever possible.

7. Try to alternate which hand you use to carry your briefcase or purse with. It may feel awkward at first, but it will help to distribute the stress and strain between both sides of the body, decreasing your chances of developing an injury.

If you follow all these tips, you will greatly reduce your risk of developing pain related to the bags you carry around. If you do experience any pain or discomfort however, consult your chiropractor. Whether it’s offering suggestions about the bags you are carrying or treatment for your body to be at its best, we are here to help.

This column is not intended to provide medical diagnosis or treatment. If you have a back condition, see a licensed and regulated health care professional for proper diagnosis and treatment options. Dr. Marilyn Field is a Doctor of Chiropractic who practices in Bridgewater


Ian-Spinal Column

Treatment for osteoarthritis pain—the medication approach

As our bodies grow older the cartilage in our joints starts to wear away, leading to osteoarthritis. Pretty much everyone will have at least some degree of osteoarthritis by the time they are 45 years old. For some, this normal part of aging doesn’t cause any pain at all. But for millions of people, this process becomes symptomatic and painful in at least some of their arthritic joints. Unfortunately, there is no quick fix, or instant cure, but there are some medications that can be used to help alleviate the pain.

As a chiropractor I do not hold a license that allows me to prescribe medications. However, it is necessary for me to have an understanding of the different types of prescription medications that are used to treat the symptoms of osteoarthritis. I do discuss various treatment options with my patients on a daily basis, and this discussion includes educating them on over the counter (OTC) medications. This column is not meant to diagnose or make any treatment recommendations. Rather, my purpose is to help educate you so you can make a more informed decision about what you want to do.

This column will be discussing medications commonly used to treat osteoarthritis. It is not a complete, exhaustive list of all medications that are available. Your personal decision should be the result of a discussion with your family doctor and your pharmacist. But here’s what I think is important for everyone to know.

There is no cure for osteoarthritis. You can’t take a pill to make it go away or reverse the wear and tear. However, there are drugs that can help alleviate the pain associated with osteoarthritis. I am going to classify the types of drugs into two main categories. The first is analgesics, and the second is anti-inflammatories.

Analgesics are used to decrease pain. They do not alter the condition or reverse physical damage, but they do make it feel better by making our bodies not detect the pain. There are OTC analgesics to be swallowed, such as acetaminophen (Tylenol®), and some that are used in topical creams and rubs like menthol (Deep Cold®). Then there are prescription analgesics that are mostly narcotics, such as codeine (Tylenol 3®), morphine, meperidine (Demoral), hydromorphone (Dilaudid), oxycodone (OxyContin), and fentanyl (Fentora®). I like to think of analgesic drugs like putting tape over the “check engine soon” light on your car. You’re not fixing the problem. You’re just getting rid of the signal that is telling you there is a problem.

Analgesics can provide pain relief while your body attempts to actually heal the problem. However, because osteoarthritis is incurable these medications often have to be taken continuously. And every medication has some risk to it. Acetaminophen (Tylenol®) is one of the safest OTC medications, but it does add stress to the liver and can cause problems when taken for long periods of time, or when taken with alcohol. Narcotic pain relievers often impair someone to the point where it is un-safe to operate a car, motor vehicle or perform many job duties. Nausea, constipation and addiction to narcotic pain relievers are very common side effects. The take-home message regarding analgesics is this: there is always a price to pay for your pain relief. So if you’re not getting much relief, then you may want to reconsider taking them. Always take the least amount that is possible to get some relief, and make sure you know the side effects, and monitor yourself regarding them. When you get that print out from your pharmacist, read it!

The second category of drugs for osteoarthritic pain is a large group of drugs called anti-inflammatories. This category can be broken into two sub-categories. There are steroidal anti-inflammatories that are available by prescription only and are swallowed (like prednisone) and ones that are injected (like cortisone). But more common are the non-steroidal antiinflammatory drugs or NSAID’s. Some are OTC such as Aspirin®, ibuprofen (Advil®, Motrin®) and naproxen (Aleve®). Common prescription anti-inflammatories include higher amounts of ibuprofen and naproxen, diclofenac (Voltaren®), and celecoxib (Celebrex®). There are also OTC creams with anti-inflammatories in them such as Voltaren Emulgel®.

Fortunately, most people will get some relief from their pain when taking an anti-inflammatory medication. Unfortunately, all anti-inflammatories have side effects and the probability of developing side effects depends upon the individual person, the dosage of the drug and the length of time that the drug is taken. Some people tolerate these drugs well while others will experience side effects very quickly. Heartburn, pain/bleeding in the stomach, nausea, ulcers, are just some of the more common side effects. These drugs can raise some people’s blood pressure, and long-term usage of some of them can increase your risk of heart attacks and strokes.

We all want to live life pain free, but we need our hearts to be beating and our brains to be functioning first. So again, make sure you know the risks of these specific drugs. Your pharmacist does an excellent job of informing you of what the side effects of these drugs can be. Talk to your doctor if you start to experience them. And remember: alcohol and anti-inflammatories don’t go well together, as both irritate the stomach lining, so when you take both at the same time you are increasing your risk of damage.

So should you take drugs for pain that is associated with osteoarthritis? It all comes down to the benefit versus risk ratio. If your benefits of taking these drugs outweigh your risks, then the drug may be a good choice for you. However, if the short-term side effects or the long-term risks don’t sit well with you, then maximizing non-pharmacological treatment options and preventative strategies may be of interest to you and your long-term health. That’s what I will be talking about in my next several columns.

This column is not intended to provide medical diagnosis or treatment. If you have a back condition, see a licensed and regulated health care professional for proper diagnosis and treatment options. Dr. Ian Culbert is a Doctor of Chiropractic who practices in Bridgewater

Marilyn-Spinal Column

Pain free driving

Summer is here and more and more people will be heading out for a family road trip. Maybe you have a job which requires you to be behind the wheel frequently. Whatever your reason for spending long hours in the car, it can be a source of back and neck pain, especially if you aren’t using good driving ergonomics.

The way we have our seat, mirrors, and steering wheel  positioned in our car can either be a source of neck and back pain, or it can help prevent it.

The following are some pointers to help you have a pain free drive:

Move the seat forward until you can comfortably depress the brake pedal and accelerator pedal while your hips remain square in the seat. Having to over stretch to reach the pedals can lead to lower back and hip pain.

Raise your seat adequately to give yourself proper vision of the road. You want your seat to be high enough so that you can comfortably see over the steering wheel, but not so high that your head is pushing against the roof of the car.

Reduce pressure on the back of the knees by raising the seat cushion to a comfortable level where the backs of the legs are fully supported. You want to ensure your legs are supported, while at the same time not having too much pressure against the back of the knees, inhibiting proper blood flow in the legs.

Adjust the backrest to fully support the spine, from the buttocks all the way up to the shoulders. If your car does not have adjustable lumbar support consider buying a back rest that will fit on the seat, or even using a small cushion or towel to place in the groove of your lower back to help maintain a neutral lumbar lordosis while you are driving.

Avoid reclining too much, this can cause added pressure on the lower back and neck. If you have your seat reclined too far back, you will end up straining more through your neck and shoulders to grip the wheel.

The steering wheel should be adjusted so that it can be easily reached with a slight bend in the elbows. Be sure that you are not straining to have both hands on the wheel, while maintaining a slight bend in the elbows. This will reduce the strain on your upper back, shoulders and neck.

Adjust the headrest so that the top of the head is level with or above the top of the headrest and as close to the body as possible. This will offer maximum protection in the event of a whiplash type injury situation.

If you are going on a long drive, aim to take a pit-stop every hour. Make sure you get out of the car and stretch. Even just a short walk around your car will help refresh your muscles (and your mind).

This column is not intended to provide medical diagnoses or treatment. If you have a back condition, see a licensed and regulated health care professional for proper diagnosis and treatment options.

 Dr. Marilyn Field is a Doctor of Chiropractic who practices in Bridgewater

Ian-Spinal ColumnTreatment for Osteoarthritis pain—is there a magic pill?

Osteoarthritis, simply put, is the process of cartilage in our bodies wearing out. We have cartilage between the bones in our body that act as shock absorbers and sliders for the bones. Unfortunately, our bodies were not designed to last forever. As our bodies grow older the cartilage in our joints starts to wear away just like the tires on our cars, the soles on our shoes, and the brake pads in our vehicles. For many people this process occurs and causes very little or no pain at all. And yet for millions of people, this process becomes symptomatic and painful. And even those folks who do suffer from painful osteoarthritis may have symptoms or pain in some of their osteoarthritic joints but will not have pain in other osteoarthritic joints. For example, they may have a lot of pain in their right knee but not in their left knee. But if you take an x-ray or MRI scan of both knees they will look essentially the same. So why does one hurt and the other doesn’t?

Most of the time doctors and health professionals actually don’t know the answer to that question. Our bodies are complex and our ability to measure what exactly is causing the pain is challenging. But research is beginning to suggest that it is the joint inflammation (swelling or edema) that may be one of the biggest reasons for pain. Some worn joints become inflamed and produce pain and other joints don’t. Osteoarthritis is an extremely complex condition. It can be tricky to diagnose properly and even more frustrating, it can be very difficult to treat effectively. It attacks certain joints in some people, and other joints in other people. There is no quick fix, or instant cure.

In my clinic I find that most people don’t know the options they have available to them to help relieve some of the symptoms of osteoarthritis pain. Many people that I have treated over the years don’t understand the different types of medications they have tried, or what other natural options they have to treat the symptoms, and they don’t know that a lot of the time they are promoting and aggravating osteoarthritic joints by their every-day behaviours and lifestyle choices.

So, in my upcoming columns I’m going to try to de-mystify this very common, but very confusing condition. I’ll share what I have learned about osteoarthritis and hopefully it will help to explain some of the ways that you can relieve the pain if you are one of the millions of folks who suffer from osteoarthritis. I’ll break the discussion down into three categories.

First, I will talk about the pharmaceutical, or medication approach. There are many different types of drugs to swallow, rub on sore joints, or have injected into sore joints to treat painful osteoarthritis. I will cover the different classes of medications and how they work. I have found that most people don’t know the difference between the many different types of drugs that can be taken, or why your doctor might recommend one and not another. And because you need to speak a whole new language to discuss different types of drugs it makes things very confusing. I will simplify this discussion to make it easy to understand.

Second, I will talk about what can be done from a natural, non-pharmacological approach. This approach will involve some foods that can be eaten, some that can be avoided, and what vitamins, minerals, and non-pharmacological supplements can help. We’ll also look at the role that exercise and other healthy behaviours have in the management of osteoarthritis pain.

The last category that I will discuss will be preventative strategies and steps we can take to help slow the progression of osteoarthritis in our bodies. Unfortunately, many people who suffer from symptomatic osteoarthritis are living a life that has significantly pre-disposed them to develop it. As our population grows older and our healthcare system becomes over-burdened, taking a preventative approach to healthcare is in the best interest of everyone. The old adage that says, “an ounce of prevention is worth a pound of cure” can definitely be applied to many forms of symptomatic osteoarthritis.

As I cover these categories in my future columns I will try my best to describe the benefits, the risks, the costs, and what the current research is saying about effectiveness. And I will tell you right now that there will be no magic little pill; no miracle cure; no slam-dunk physical procedure; and nothing that will work all the time, for everyone, and not have any side-effects. There simply isn’t anything like that out there. But I am looking forward to shedding some light on what can be done to help ease the suffering of many people in this community. Stay tuned for my next column.

This column is not intended to provide medical diagnosis or treatment. If you have a back condition, see a licensed and regulated health care professional for proper diagnosis and treatment options.

Dr. Ian Culbert is a Doctor of Chiropractic who practices in Bridgewater.

Marilyn-Spinal ColumnGolf injury prevention

By now golf season is in full swing, and with that can come many aches and pains. Low back pain accounts for 26 – 52 per cent of golf related injuries. Fortunately, there are steps you can take to decrease the chance of suffering from a golf related injury.

One of the main ways to help reduce your chance of injury is to warm up. It might seem obvious but properly warming up before golf (and many other activities) is commonly over looked. A great way to warm up before a round of golf includes doing some dynamic stretches, such as arm circles and leg swings (helping to warm up the shoulders and hips); followed by a quick series of static stretches.

Try adding the following four stretches to your pre-game routine:

1. Hip Flexor Lunge Stand with your feet shoulder width apart. Step one foot forward into a lunge position. Keep your body upright and back straight. Bend both knees so that you feel the stretch. Do not let your forward knee pass over the ankle of your front foot. Use a golf club to keep your balance. Hold 15 seconds. Repeat twice on each side.

2. Seated Twist Sit on a bench or golf cart with your knees together and feet flat, pointing forward. Reach across the front of your body and grasp the back of the bench or cart. You should experience a stretch in your spinal muscles. Hold 15 seconds. Repeat twice on each side.

3.  Seated Forward Bend Sit on a bench or golf cart, knees bent and feet flat. Place one ankle onto your opposite knee, and relax this leg so that your knee falls out to the side. Slowly bend forward, keeping your back straight. You may gently pull on your bent knee to generate a deeper stretch. You should feel a stretch in your buttock area. Hold 15 seconds. Repeat twice on each side.

4. Side Bending Stretch Stand with feet shoulder width apart. Hold the golf club above your head with your arms straight. Slowly bend to one side, without rotating, until you feel a stretch along the side of your back. Hold 15 seconds. Repeat twice on each side.

If you feel any pain during or shortly after performing these stretches stop and consult your health care provider.

This column is not intended to provide medical diagnosis or treatment. If you have a back condition, see a licensed and regulated health care professional for proper diagnosis and treatment options.

Dr. Marilyn Field is a Doctor of Chiropractic who practices in Bridgewater

Ian-Spinal ColumnCould Superman find your joint pain?

Many of the readers of this column suffer from symptomatic osteoarthritis (OA). How do I know that? Because the majority of the patients who come into my office suffer from some amount of symptomatic OA. I emphasize the word symptomatic because, if you’ve read my column before, you will have learned that the existence of osteoarthritis doesn’t mean you are experiencing pain. And the inverse is true as well. Just because there is no evidence of OA, does not mean that a patient is not experiencing pain. We’ve learned that when it comes to osteoarthritis, x-rays cannot predict the severity or even the source of the pain. Why? Because x-rays can only identify joint wear and tear. X-rays don’t show muscles, tendons, ligaments or bursas, all of which can be a significant source of pain due to inflammation. We know this is true for backs, but is the same true for hips and knees?

In 2014, the scientific study “The Framingham Osteoarthritis Study” was published in the medical journal Arthritis and Rheumatology. The results of this study may surprise you. 24.7 per cent of women reported pain in either hip. However, OA was seen on x-rays in only 13.6 per cent of women, meaning that almost half of the women had hip pain but no OA that could be detected on x-rays. In this study, men were different than women. Only 14.7 per cent of men reported pain in either hip, yet OA was seen on x-rays in 24.7 per cent of men, meaning that a lot more x-rays showed the presence of OA but men did not complain of hip pain. In fact, overall, after x-raying 1,850 hips, only 15.6 per cent of the time did hip pain coincide with the x-rays showing evidence of OA. This is not the only scientific study to show this. There are a lot of people who have hip pain with no detectable OA on their x-rays and there are a lot of people with no pain in their hips who have OA that can be seen on their x-rays.

Knees are not much different. Scientific studies have also found that the association between the amount of knee pain experienced and the amount of OA visible on x-rays is weak. This means that the amount of joint wear and tear in knees does not necessarily match how much pain the person will be in. X-rays simply can’t predict how much pain someone is in. Pain is found on patients, not pictures. This is being discovered again and again through scientific studies for the neck, lower back, hips and knees.

So what does all of this mean? I said earlier that most of my patients present with symptomatic OA. And these folks are in pain – often significant pain. But I just got through telling you that sometimes people can have significant joint wear and tear and have no pain at all. The bottom line is that osteoarthritis is an extremely complex condition and is often tricky to diagnose properly and treat effectively. And it is costly to our health care system. It affects more than twice as many people as cardiovascular disease. Most importantly, if you’re one of the folks suffering from it you know that it significantly impacts your quality of life. Just getting from one side of the house to the other can be painful. You put off going down the stairs to do your laundry because you know it’s going to hurt your knee when you do. You decide you can’t go and watch your grandchildren’s Christmas concert because walking up those steps to the school will make your hip hurt. When you have OA and it is painful, it affects your life … a lot.

So what’s the  difference between OA that is painful and OA that isn’t? That’s what makes it such a complex problem. We don’t always know. But research is beginning to suggest that it is joint inflammation (swelling or edema) that is the biggest culprit.

If health care professionals rely on x-rays to diagnose and treat OA a large portion of patients will be missed and not treated properly. To properly diagnose and treat painful joints, health care professionals should evaluate the patient, not just the pictures of the patient. This means a physical exam that involves testing the mobility of the painful area, the strength, flexibility, and performing provocative tests to find where the pain is coming from. Pain can stem from muscles, tendons, ligaments, bursas, mechanical restrictions between joints, and these structures almost never show up on an x-ray.

So if Superman takes a look at you with his x-ray vision and tells you that “you have joint wear and tear” remember that this is really only a small part of the story. Our joints will gradually wear out, in all of us, if we live long enough. But if you are in pain that means your joints are inflamed and something needs to be done about the inflammation. Thankfully, there are many ways to treat and manage symptomatic OA pain so that you can decrease the pain and improve your quality of life.  That will be the topic of my next column.

This column is not intended to provide medical diagnosis or treatment. If you have a back condition, see a licensed and regulated health care professional for proper diagnosis and treatment options.

Dr. Ian Culbert is a Doctor of Chiropractic who practices in Bridgewater

Marilyn-Spinal Column

Five keys to creating better health

This week’s column might seem a little off topic as it relates to a healthy spine, but these five tips are actually very important to spinal health. Back pain tends to be multifactorial, meaning there are many factors that contribute to developing it. Often in the spinal column we talk about the biomechanics of back pain (how your spine moves and functions), but this week I wanted to share some tips for improving your overall health, which in turn will contribute to having a healthy spine!

These five keys will help you to decrease aches and pains, to improve your energy levels and most importantly, to achieve a greater level of overall health and well-being. When you feel good you are able to do more of the things you love. My passion is health and helping people live well so that they can do more of what they are passionate about.

My challenge to you is to pick one thing that you could do to improve your health and make that change starting today. So without further delay let’s dive into the five keys.

Key #1: Movement

Our bodies are designed to work the best when they are in motion. So whenever you get the chance, move your body.

The current guidelines recommend adults get 150 minutes of physical activity per week. That works out to about 20 minutes per day, which you can break down into 10 minute chunks.

It’s not just structured activity that matters, it’s also important to simply reduce the amount of time you spend sitting each day. Some people even call sitting the new smoking. Over the years, the effects of sitting for a large portion of the day add up and can lead to health problems like weight gain, decreased bone density and increased cholesterol.

The good news is that there are things you can do to help counteract the negative health effects of too much sitting, such as getting the recommended 150 minutes of activity per week, taking the stairs, parking further away and getting off the bus a stop early. Move as much as you can in whatever ways you can. It all adds up.

Key #2: Eating well

The best food advice I have heard is from Michael Pollan, “eat food, not too much, mostly plants;” short, simple and to the point. There are so many fad diets and so many food options out there it can be very confusing. Which diet should I follow? Should I be eating all raw foods? Should I go gluten free? These are all good questions, but the honest answer is that there is no one “right” way to eat. Everyone is different. However, here are a few good guidelines to start with.

Eat lots of fresh vegetables and fruit. One study found that people who ate the most fruits and veggies had a lower risk of all causes of mortality, particularly cardiovascular mortality. With all of the farmers markets starting up, it has become even easier to get lots of fresh and local fruits and veggies!

Decrease refined sugar consumption. Sugar wreaks havoc on the body. From a chiropractic perspective it contributes to inflammation in the body; not only can this create more aches and pains, it can also alter digestion and affect body chemistry, leading to all sorts of health problems.

Avoid “frankenfoods” as much as possible. These are foods that have a long list of ingredients and are really far from being real food. Try eating wholesome natural foods as much as possible, such as fruits, vegetables, nuts, seeds, grains and meats. When eating packaged food aim to eat foods with fewer than five ingredients.

Key #3: Drink enough water

The benefits of being well hydrated range from better looking skin, improved digestion, to fewer aches and pains and increased energy, and that’s just the tip of the iceberg. A good rough calculation of how much water you need is to divide your weight (in pounds) by two; this will give you the ounces of water you should be getting per day. As an example, a 130 lb person should be getting about 65 ounces of water, which is roughly eight cups per day. Obviously this number will vary for each person and will also change if it is particularly warm outside or if you are very active.

Key #4: Set goals and have a plan

There was an interesting study conducted at Harvard in 1979 looking at success and goal setting. They found that only three per cent of the Harvard MBA class had written out goals. They followed up with the students 10 years later and found that the three per cent who had written goals were earning 10 times more than the other 97 per cent of the class combined. That is pretty compelling proof right there that goal setting is important.

If you don’t know where you are going and have some sort of plan on how to get there, your life is much more likely to go in the direction of someone else’s dreams.

Write down your top five goals in life and put them somewhere that you can read them daily. I recommend setting goals around the major areas of your life. Tony Robbins suggests the pyramid of mastery, which consists of seven key areas for creating an extraordinary life. These are: Physical Body, Emotions & Meaning, Relationships, Time, Work/Career/Mission, Finances, Spiritual Sense.

Set goals in all of these areas or just pick a few to start with. When you have clarity on what you want in life, you become more hopeful and energized.

Key #5: Take care of your body before it’s broken

Health is not something that just happens to you, you create health through consistent good choices. Genetics only account for a small percentage of our health or illness; our daily choices have a far greater impact on creating the state of our health and well-being.

By taking care of your body before it is sick or injured you are going to improve your health, have more energy and be able to get the most out of life. We don’t wait until our cars are broken with smoke coming out of the engines before taking them for an oil change, just as we don’t wait until our teeth are rotting to go to the dentist. We should treat the rest of our body the same way.

People under regular chiropractic care have been found to have fewer aches and pains, spend less money on medications and have fewer hospital visits. Chiropractic is safe and effective for all ages from infants to great grandparents. And whether it’s chiropractic, acupuncture, massage therapy, or whichever type of healthcare you benefit from, be sure to take the time to care for yourself before a major health problem develops.

I hope you enjoyed these five tips and have identified one area you can improve on. When we make healthy choices on a regular basis we create a strong, resilient and healthy body.

This column is not intended to provide medical diagnosis or treatment. If you have a back condition, see a licensed and regulated health care professional for proper diagnosis and treatment options.

Dr. Marilyn Field is a Doctor of Chiropractic who practices in Bridgewater

Ian-Spinal ColumnCan we predict who will have back pain?

In my clinic I see patients normally for one of three reasons.  1) They are in pain and need relief. 2) They have had significant pain in the past and now seek treatment periodically to help prevent the pain from re-occurring.  3) They have loss of movement or function of a body part. These problems can affect almost any area: their neck, shoulder, elbow, wrist, finger, hip, knee, ankle, foot, even toe. But the majority of what I see and treat is lower back pain.

Lower back pain is the number one reason for disability in the world. More people are disabled because of lower back pain than any other problem. It affects 80 – 89 per cent of the population at some point in their life. It affects all types of people: young, old, wealthy, poor, overweight, thin, active, sedentary, those who have had significant previous injuries and those who have not.

Lower back pain can affect people with osteoarthritis (OA) and it also affects people without OA. If you read my last column, you will remember that the amount of OA that someone has in their back does not predict how much back pain they will have. This sounds hard to believe but it is absolutely true. This is not just my opinion. Multiple scientific studies provide evidence that there are many individuals with severe OA in their back and they have no lower back pain. Furthermore, with treatment, many individuals will see their back pain resolved, despite the fact that their severe OA remains unchanged.

I will share with you a real  example of this from my clinic. A female in her early 70s consulted me for severe back pain that was travelling from her lower back down her right leg to her ankle. She had been suffering with it for months. Despite anti-inflammatory medication and some therapy she was not improving. She had a CT scan of her lower back and it showed she had severe OA. To be more specific, she had very thin discs in her back, multiple bulging discs, areas where she appeared to have spinal nerves being “pinched” and her spinal canal had become narrow due to the building up of bone spurs on her back bones.

The CT scan report said she had “severe degenerative changes,” which means she had severe OA (also known as severe ‘wear and tear.’) But after just three chiropractic treatments she reported that her back pain and leg pain were both 100 per cent gone. How can this be? Did the treatments reverse her OA? No. Did it remove the bone spurs that had formed on her back bones? Again, no. Did treatment make her discs grow and become thicker? Certainly not. The treatment did none of those things. What the treatment did was loosen up her tight muscles and make her lower back joints turn, bend, move, and slide more gracefully over one another. The result? No pain. She is a perfect example that “age appropriate arthritis” is not the cause of most people’s back pain. It definitely wasn’t the cause in her case, and she is happy now to know this.

In my last column I said that there are some rare occasions when OA does cause back pain. As we’ve discussed, the presence of OA does not always mean the patient is experiencing pain. The OA needs to be inflamed in some way in order to cause pain. In some cases, OA causes narrowing of the spinal canal, which can cause leg pain and loss of strength in the legs. OA may also shrink some other holes or passages in someone’s back where nerves pass through, causing pinched nerves. It may also cause the joints in the spine to get stuck more often which then creates joint pain and stiffness. But you’ll be happy to know that even in a lot of these types of cases there has to be accompanying inflammation in order for the patient to experience pain from it. Many people who experience narrowing of their spinal canal and shrinking of nerve passages still don’t have pain until those structures become exacerbated, aggravated and inflamed. So the actual presence of the structural problem still doesn’t guarantee that there will be pain with it. Inflammation of the spinal joints is what will cause the person to feel pain. But inflammation doesn’t co-exist will OA at all times.

What OA does do is this: it will give people some extra stiffness so that touching their toes is no longer possible. When they get up in the morning they may function like a car does on a – 20 degree morning, it takes them about an hour to “warm-up” and get going to normal. A person with OA in the lower back will also find that they have to take things more easily than they did when they were in their 20s. Instead of piling eight cords of firewood in one day, people with OA in their backs will have to spread it out over a couple of weeks in order to not exacerbate their condition. Instead of doing eight loads of laundry in one day, they will only be able to do two per day. Instead of golfing 36 holes in one day, they will have to limit it to just 18 holes, and maybe only two rounds in a week. But this should not have any significant impact on their life or their activities that they do each day.

So what can predict the amount of back pain someone will have? When someone has mild OA, or severe OA in their lower back, is there a test that will determine how likely they are to develop pain? No, there is no medical test that can predict how much lower back pain someone is in, or will be in one day. As a chiropractor, I can’t predict how much pain someone is in by looking at their lower back x-rays, CT scans, bone scans or MRI’s. In the vast majority of cases, I can’t, and no one else can, predict how much pain that person is in. Doctors find pain on patients, not on pictures.

Please note: This column is discussing specifically lower back pain and OA. This explanation does not apply to all joints of the body. Our bodies are complicated and different body parts react to OA in different ways. Next time I’ll discuss how our knees, hips and necks are affected by osteoarthritis.

This column is not intended to provide medical diagnosis or treatment. If you have a back condition, see a licensed and regulated health care professional for proper diagnosis and treatment options.

Dr. Ian Culbert is a Doctor of Chiropractic who practices in Bridgewater.



Gardening injuries are a common cause of spring and summer aches and pains. All that bending, kneeling, raking and lifting can create repetitive strain injuries to the elbows, arms, shoulders, knees, hips and back. The good news is that there are things you can do to help prevent these types of injuries.

Warm up and cool down. Treat gardening like you would any sport or workout. Take the time to warm up your muscles and joints before heading out with some dynamic stretches like arm circles and leg swings. And when you are done for the day, take the time to do some static stretches to help prevent muscle injuries. Be sure to stretch your arms, wrists, chest, back, glutes, quads and hamstrings. It sounds like a lot, but you can put together a quick little stretching routine in no time. If you are ever unsure of what stretches you should be doing, or how to properly do them, always ask your healthcare provider and they can show you the right moves.

Stay hydrated. Keep a bottle of water near you at all times and be sure to take a water break at least once an hour. Our bodies are about 70 per cent water; some of that water helps to keep our joints lubricated. When you are dehydrated the body can’t do all of its essential functions optimally, and it will leave you feeling tired and make you more susceptible to injury.

Use the right tools. Select tools that are a comfortable weight and size for you. Before buying gardening tools hold them and try the movements you’ll be doing with them. Make sure the handles are the right size and are comfortable for you to grip. Consider investing in a lightweight wheelbarrow if it is something you use a lot. Use a cushion to put under your knees while kneeling. Opt to use the hose rather than carrying around a large, heavy watering can. Use tools that are light weight and have long handles to minimize bending.

Use the right moves. Alternate tasks, and try not to spend the whole day doing one task, in one position. Change it up! Take turns alternating between heavy tasks such as digging, and lighter tasks such as planting. Try to vary your position every 10 to 15 minutes, as well as changing hands when doing repetitive tasks such as digging or raking. It might feel awkward at first, using your non-dominant hand to do some of these jobs, but by switching sides every so often it will help decrease the risk of repetitive strain injuries.

Lift with ease. Anytime you need to lift a heavy load off the ground, get down low, bringing your body close to the load. Bring the item in as close to your body as you can, then use your leg and arm muscles to slowly and safely lift the load. Be sure to breathe while lifting, holding your breath my increase your risk of injury. If the item you are lifting is quite heavy, try propping it ontoits side; and don’t be afraid  to ask for help. Sometimes the safest way to lift something is with a buddy, or not at all.

Regular activity to  stay in shape. It’s important to stay active and get regular exercise all year round. If you have been  fairly inactive over the winter and suddenly spend a day in the yard or garden without spending some time to get in shape before hand, you will be more prone to injuries. So, if this winter did keep you inside and less active, be sure to ease into the yard work. To get your body ready for yard work and gardening season, start with going for a walk every day, or even every other day. Start with the length of time you feel comfortable with, working up to a 30 minute walk every day. And don’t forget to stretch afterwards.

By following these guidelines you can help minimize the risk of developing an  injury while working in the garden and yard this spring. Remember to pace yourself.It’s recommended to take a break  at least once an hour, if not a little more frequently. Take a few moments to move around, stretch, get a drink, or simply  sit and relax. Spread the work out over a few days or weeks; you will still achieve the same great results in the end and your back and body will thank you.

This column is not intended to provide medical diagnosis or treatment. If you have a back condition, see a licensed and regulated health care professional for proper diagnosis and  treatment options. 

Dr. Marilyn Field is a Doctor of Chiropractic who practices in Bridgewater


Ian-Spinal Column

Osteoarthritis (aka wear and tear on your back)

Back pain can strike at any time. It can be severe and disabling. It often occurs again and again. But as I have discussed in my previous columns, most back pain is caused by mechanical problems in the spine. This means that the back is not moving, bending, and gliding the way it should.

Sufferers want to know the cause of their pain. This means they want to see what the cause is. X-rays, CT scans, MRIs and bone scans are used by many health care practitioners, myself included, to hunt down the cause for the patient’s low back pain.

But how often do these costly tests find the back pain? Are they worth the exposure to radiation that comes with them? The reality is they don’t find the pain very often. Eighty five per cent of the time, the imaging test does not find a specific reason for the patient’s back pain. Imaging tests don’t find pulled muscles, as you can’t even see muscles on x-rays. Very seldom do they show relevant inflammation. What these tests normally do find is arthritis. In the majority of these cases, it is called osteoarthritis. Your doctor will most likely call this “age-appropriate arthritis.”

What makes this subject challenging to the general public is that there are multiple words that all mean the same thing and different health care professionals use different words. Many terms are used to describe osteoarthritis of the back — degenerative disc disease; degenerative facet joint disease; degenerative arthrosis; facet arthrosis; spondylosis; degenerative changes; osteoarthrosis; thinning of the discs; disc narrowing; intervertebral disc degeneration; uncovertebral arthrosis; uncinate process arthrosis. These all mean osteoarthritis.

The terms sound scary but are pretty much just part of getting older. Over the age of 40, almost everyone will have some degree of osteoarthritis in their back. CT scans and MRIs make this even easier to see as these images are more clearly defined than traditional x-rays. But what does osteoarthritis mean? Does it matter? Is that why the person has back pain?

Osteoarthritis is the process of cartilage wearing out. Between almost all of the bones in our bodies, there is a rubbery tissue called cartilage. It’s the white, grisly material that you find on the end of a chicken leg. Cartilage acts as a shock absorber between your bones. So in all the joints of your body that move, there is cartilage between the bones. There are just over 200 bones in your body so there is a lot of cartilage.

Cartilage is like the rubber tires on your car. The older your car is and the more miles you drive, the more your tires wear. When you put new tires on your car they have lots of rubber. After 100,000 kilometres and a few years of use, the tread wears thin and there is less rubber on the tire. Our bodies act in a similar way. If you are 65 years old, you will have less “rubber” between your joints than you had when you were 25. Generally speaking, if you have had more birthdays, expect more “wear and tear”, or osteoarthritis. That is why your doctor will say you have “age-appropriate arthritis.” It happens to all of us if we live long enough.

The anatomy of your spine is very important when discussing osteoarthritis. In your back there are two main locations for cartilage. There is cartilage between your back bones; this cartilage is called a disc. There are 24 bones in your entire spine so we have 24 discs between the bones. But the more important cartilage in your back when it comes to back pain is the cartilage between your joints. There are four joints called “facet joints” for each back bone, two on the bottom and two on the top. These facet joints move like the links in a chain each time you move your back. It is these facet joints that are often the cause of mechanical back pain. You have 52 of these facet joints in your entire spine. That’s one reason why spinal problems are so common. There are 52 joints that can cause pain. So when someone is told that they have osteoarthritis in their spine it most commonly refers to the cartilage discs wearing out or the cartilage between these facet joints wearing out, or both.

So when it comes to back pain how much does osteoarthritis actually matter? The quick answer is: very little. The amount of osteoarthritis you have in your back does not predict how much back pain you will have. Dr. Edvin Koshi is a pain specialist in Halifax. He spends his days providing pain relief for complicated back-pain patients. Dr. Koshi has stated that “we know from numerous research studies that there is no correlation between pain and the way facet joints appear on MRI. One can have normal-looking facet joints on MRI with a lot of pain from them. One can also have terrible-looking facet joints on MRI and no pain at all.” When Dr. Koshi refers to “terrible-looking facet joints,” he means that they are full of osteoarthritis. Some folks have backs that are full of osteoarthritis but experience no pain at all, and some folks have backs that have almost no osteoarthritis and yet they suffer from severe pain. In conclusion: osteoarthritis is not the cause of the pain.

This is great news for anyone who has thought that the back pain they experience is directly related to the osteoarthritis that they have. People can find relief from their back pain even though they have extensive osteoarthritis. Just like cars, our bodies wear over time. But just because your tires have less tread doesn’t mean you shouldn’t be able to get from point ‘A’ to point ‘B’ without pain.

In my next column I will discuss the rare occasions when osteoarthritis does affect someone’s back pain. And if the amount of arthritis does not predict how much back pain someone has, then what does? You’ll find out next time.

This column is not intended to provide medical diagnosis or treatment. If you have a back condition, see a licensed and regulated health care professional for proper diagnosis and treatment options.

Dr. Ian Culbert is a Doctor of Chiropractic who practices in Bridgewater.


Marilyn-Spinal Column

Preventing running injuries
As the weather gets nicer day by day, more people will be out pounding the pavement. The last thing you want is a running injury to sideline you just as the nice weather arrives. The following are three very common running injuries and a few things you can do to help decrease your risk of developing these or other injuries.

Plantar fasciitis is pain on the bottom of the foot. It can affect one or both feet. Typically the pain is at its worst first thing in the morning and starts to ease slightly as you walk around.

The solution is to stretch the calves and Achilles tendons after a run. If you find the bottoms of your feet getting sore following a run, try rolling a golf ball length wise under the bottom of your foot. This will help to relax and gently stretch the plantar fascia.

Shin splints typically present as a dull pain in the front of the shin which is made worse with activity and relieved by rest. Some common causes include poor running form, weak muscles, worn-out running shoes, recent changes to the intensity, frequency or surface which one is running on.

The solution is strengthening and stretching the calf and muscles in the lower leg. Good running shoes and orthotics may be helpful as well. Be sure to increase your training intensity gradually.

Runners knee (aka patellofemoral syndrome) presents as pain around the knee that worsens with activity, especially climbing the stairs or squatting. Some also find their knees get stiff after sitting for long periods of time.

The solution is stretching — are you seeing a trend here? — specifically stretching and strengthening the quadriceps and hamstring muscles. Proper footwear is also important.

Here are some more tips to help prevent running injuries in general.

Stretching is very important before and after a run. Some of the major muscle groups to focus on are glutes, quadriceps, hamstrings and calves. Before your run, try warming up with some dynamic stretches such as leg swings. After the run is a great time to do static stretches. Be sure to hold each stretch for at least 15 seconds, and if you feel so inclined, try holding the stretch for longer. Holding a stretch for up to two minutes has been found to be helpful.

A full-body strength program can have many benefits. It will be great for overall health, and as a runner strengthening your core and lower body will help to prevent injuries.

Ensuring you’re wearing good running sneakers, and in some cases a good orthotic, is essential to helping prevent running injuries. In general, look for a sneaker that has good support and cushioning, as well as some flexibility to allow your foot to bend naturally as you run. Keep in mind that everyone’s feet are different and no one shoe will work for everyone. What about barefoot running? That’s a longer topic to cover than we have room for here, but make sure to do your  research before trying it. Some will swear by it, but others will be injured by it.

Increase your mileage gradually. If you haven’t done much running over the winter, don’t go for a 10K run on your first day out. Start small and increase your distance by no more than 10 per cent weekly. For some, 10 per cent per week may even be too much, so try a 5 per cent increase per week instead.

If you are running on a track or sloped surface, make sure you vary which direction you run in, to reduce the risk of developing an overuse injury.

Last, but not least: Listen to your body and rest when you need it.

Following these simple pieces of advice will help you reduce the chance of developing a running injury. If you are developing pain be sure to have it assessed by a registered health care professional. Letting little aches and pains fester can result in  unwanted, and potentially avoidable, long-term injuries.

Happy Running!

This column is not intended to  provide medical diagnosis or treatment. If you have a back condition, see a licensed and regulated health care professional for proper diagnosis and treatment options. 

Dr. Marilyn Field is a Doctor of Chiropractic who practices in Bridgewater


Ian-Spinal ColumnNo matter how hard you look, you can’t see pain.

When we experience back pain we usually want to know why we have it. It’s natural; we’re scared and we need to know what is going on. In this modern era of YouTube, Google and our natural human instinct, most people want to see the cause of their pain. We want a picture of it. Often the first step is to get a set of x-rays. X-rays are relatively cheap for our health care system and they are fairly easy to get at hospitals and some chiropractic clinics. What is the most common result of lower back x-rays?

Usually you get a call from your doctor’s office and they tell you that “you have a little bit of arthritis that is age appropriate. Other than that, nothing else showed up. So you strained your back, meaning that you pulled some muscles.” Naturally, the patient puts two and two together and thinks it must be the arthritis that is causing their back pain and the x-rays showed that they have pulled muscles. But the reality is, rarely is arthritis the actual cause of lower back pain and you can’t see pulled muscles on x-rays. More about this is my next column.

If your back pain doesn’t go away within a reasonable amount of time using common methods such as resting and taking ibuprofen, acetaminophen or muscle relaxers, then the patient often returns to their doctor
and says, “There’s still something wrong with my back. I need an MRI.” This does sound logical as MRI or Magnetic
Resonance Imaging provides a very detailed picture of your back. An MRI picture will show the muscles, tendons, ligaments, nerves, and many other soft tissues of the body. So it stands to reason that seeing all of these structures will help to identify the source of the ongoing back pain.

However, in Nova Scotia and especially on the South Shore, MRI is difficult to get. It can take months, even years of waiting. Furthermore, physicians who order these tests have guidelines set out by medical authorities that they have to follow when selecting which patients should have one. These medical guidelines help to ensure that patients who don’t actually need MRI won’t clog up the system and drain financial resources away from patients who do need the test as an important diagnostic tool. The vast majority of the time you won’t see the source of back pain on an x-ray, a CT scan, or MRI. The bottom line is that you can’t see it because most back pain is due to a functional, not a structural, problem.

In one of my previous columns, I  mentioned that lower back pain can be separated into three main categories. The first two, which include identifiable causes such as a fractured vertebrae, tumour and a pinched nerve, account for fewer than 20 per cent of all cases. The third category makes up more than 85 per cent of all back pain cases and is said to have “no specific, identifiable cause.” It’s important to note that “no identifiable cause” means you can’t see it on an x-ray, a CT scan, MRI, or an ultrasound. This is often referred to as dysfunctional back pain, or mechanical back pain.

If you have dysfunctional or mechanical back pain then subjecting yourself to the ionizing radiation of x-rays and a CT scan and waiting months and months for MRI may solve absolutely nothing. You may be told at the end of all those imaging tests that “you have some arthritis and degenerating discs that are age-appropriate.”

Allow me to use your car as an example. Let’s say you have a 2007 4-door sedan. There is a computer software glitch that is making the car run poorly. It also has 175,000km on it. It starts okay, and runs fine at low speeds, but when you try to accelerate up a hill or reach the speed of 50km/hr, it starts to shake, and there isn’t enough power to get to 80km/hr. Something obviously in the engine is not running properly. So you take your car to the mechanic and he pulls out his digital camera and takes a picture of the front of the car, the side of the car, and the back of the car, and he studies those pictures. He tells you that you have a few scratches around the door handles, there’s some rust in all four wheel wells, your rocker panels are starting to rust a little bit and your tires tread is wearing low. But these are all normal for a car that is nine years old. Yes, all these things are true, but none of these structural deficiencies are the cause of your car’s poor performance.

Because the pictures of the outside of the car didn’t find much, the mechanic decides to do a more detailed look. He opens the hood and pulls out a high power, modern day, very expensive, magnifying digital camera that produces digital images on a computer. He takes pictures of the alternator, the engine’s cylinders, pistons, and all the small parts of the engine. He takes a lot of pictures and then the computer puts these images together and creates a 3-D image of your car’s engine. After studying these computer-generated images the mechanic tells you that your pistons are a little loose, there’s a minimal amount of oil leaking from your cylinders, there’s a small leak in your water pump, and a fair amount of rust on your struts. But again, these are all common for a car that is nine years old and has 175,000km on it. Still, none of these structural “wear and tear” findings explain why your car won’t accelerate past 50km/hr.

In order to properly fix a computer software issue with your car the mechanic needs to listen to what you tell them your car has been doing. Then they will start your car and usually take it for a test drive. They have to experience how it performs and runs. Then they will decide, based on their training, observations, and judgement, what the source of the problem is. The source of many performance problems for a car can be a sensor or a computer software problem. Many are not structural. The mechanic can’t see it. But they will fix your car without ever seeing a structural defect.

To diagnose lower back pain most of the time the MRI is not necessary. It does not mean that the patient is not experiencing pain. It simply means we can’t see it. But we can find the source through other means, and thankfully we can treat the majority of it. Next time, I will discuss what “age-appropriate arthritis” means and how it affects our backs.
This column is not intended to provide medical diagnosis or treatment. If you have a back condition, see a licensed and regulated health care professional for proper diagnosis and treatment options. 

Dr. Ian Culbert is a Doctor of Chiropractic who practices in Bridgewater.


Ian-Spinal ColumnWhat’s causing my back pain?
When patients enter my office for an assessment, they are, almost without exception, experiencing pain. Most commonly, it’s lower back pain. Sometimes the pain is so severe that it is difficult to walk, sit, or stand. Pain like this is not only debilitating, it is also incredibly frightening. It is true that as a chiropractor I help to ease the pain and dysfunction caused by this very common condition, but first I have to identify the cause of the pain and work quickly to alleviate the fear. The most important thing that a patient needs to know is that the amount of pain that he or she is experiencing does not always correlate with the seriousness or severity of their condition. In other words, you may be experiencing severe pain but it is likely that the cause is actually quite simple.

Thankfully, back pain is rarely caused by a serious or disabling condition. According to a recent Clinical Practice Guideline from the American College of Physicians and the American Pain Society, there are three main categories of lower back pain.

The first is the kind of back pain that we are all deeply afraid of. This pain comes from a serious, very specific, identifiable cause, and accounts for fewer than 10 per cent of back pain cases. Back pain that fits into this category includes: a broken or fractured vertebrae, an infection, a tumour or cancer. These causes of lower back pain can often be seen on X-rays, CT scans, MRIs, and through lab testing (bloodwork). It is important to say that while exceedingly uncommon, these are serious cases of back pain that need to be properly diagnosed by a regulated and licensed health care professional because they can progress into long-term problems if not diagnosed quickly.

A second category of lower back pain is when a nerve in the spine, or the spinal cord itself, becomes pinched. Nerves can be pinched by several things, but a common example is when a disc in the lower back ruptures or “herniates” and pinches a spinal nerve. Picture a jelly donut getting squeezed. The jelly in the donut squeezes out of the side. Your discs are similar to the jelly donut. When a disc “herniates” or spills out, the jelly-like material inside can put pressure on a spinal nerve and cause back pain, severe leg pain, numbness, tingling, pins and needles, weakness, and sometimes even difficulty going to the washroom.

Another type of pinched nerve occurs when the spinal cord is pinched. This can be caused by several things including a ruptured disc, a bulging disc, or narrowing of the spinal canal, which is called “spinal stenosis.” This type of spinal cord pinching normally occurs in older individuals, over the age of 55, with significant arthritis and disc degeneration. This second category of back pain is significant, often disables people for many weeks or months, and sometimes requires surgery. But thankfully, like the first category of back pain, this is also not the most common type of lower back pain and makes up fewer than 10 per cent of lower back pain cases.

The third category of lower back pain is the one that affects most of us; in fact, more than 85 per cent of all back pain cases fall into this category. What many patients find most puzzling is that this type of lower back pain is said to have “no specific, identifiable cause.” This does not mean that there is no source of pain, no reason for the pain, and most importantly it does not mean that it is “all in your head.” What it does mean is this: you can’t see the source of the pain specifically on an X-ray, a CT scan, an MRI, an ultrasound, or pick it up on bloodwork. There is no broken bone or tumour or cancer to find. Often the patient reports that they didn’t do anything specific to cause it, rather it just seemed to happen “out of nowhere.” No matter how it strikes the sufferer, whether it is from bending over to tie a shoe, or simply getting out of bed, they often experience severe pain; they can’t move, they can’t sit, they can’t stand, they can’t sleep, and they are miserable. But if they get an X-ray, a CT scan, or slide into the tube for an MRI, and take a picture of where the pain is, no abnormality is found. This kind of back pain is due to loss of function in the spine. It is not structural. You can’t see it, but you sure can feel it. It affects your quality of life, and how you move, lift, breathe, twist, sit, stand and sleep.

The good news is that most types of back pain can not only be managed and treated, they can even be
prevented entirely. Next time, we’ll discuss what can be done to prevent functional lower back pain. Relief is on
the way!
This column is not intended to provide medical diagnosis or treatment. If you have a back condition, see a licensed and regulated health care professional for proper diagnosis and treatment options.
Dr. Ian Culbert is a Doctor of Chiropractic who practices in Bridgewater



Ian-Spinal ColumnPain in the back
It hits you when you least expect it and it seems to come from nowhere. Those affected can be heard saying, “I didn’t do anything! I just bent over to pick up a paper clip,” or “I reached to put my jacket on and my back just buckled”or maybe “I was putting my socks on and it just suddenly went out on me”.

It’s back pain.

For those of you who have not had the  misfortune of meeting me because of disabling back pain, my name is Dr. Ian Culbert. I am a chiropractor in Bridgewater, and I have practiced here for the last 13 years. What I do each and every day is fix backs — old backs, young backs, large backs, small backs. People come to see me when they can’t put their shoes on, or sit down to eat a meal, or stand up straight, etc., etc. And I fix them.

I’m the back-pain guy.

The unfortunate thing is that I can’t fix them all. Sometimes we ignore the warning signs and neglect our back for so long that it can be too far gone for me to fix. That’s the bad news.

But the good news is that the majority of back pain is not only treatable, it is also preventable. Do you know what I have learned from my years of practice on the South Shore, treating back pain, day in and day out? The vast majority of back pain sufferers are responsible for their own back pain. We do it to ourselves. Myself included. Of course, no one ever intends to injure themselves, and there are some exceptions, but most back pain is caused by our lifestyle choices. And if that’s the case, then it is preventable. But it is only preventable if we know why it’s happening in the first place. And that’s where I come in.

Over the next several months my colleague Dr. Marilyn Field and I will share with you many different ways you can prevent disabling back pain. Some of it you will like because some of our suggestions will be easy. But some of our information you won’t like because you probably have habits or commitments that are ultimately hurting you that you don’t want to — or simply can’t — change. But we will share a bunch of facts and statistics, dispel some myths, and educate you on truths. We will share what we know to help you prevent, minimize, or manage your back pain.

Ultimately, our goal is to remain a mystery to you. Hopefully you will never need our services. I’m sure you would rather be on the golf course swinging your driver than hobbling into my clinic with back pain so severe that you can barely walk. I’m confident that you’d rather be in your boat reeling in a 10-pound trout than hearing the timer ‘go off ’, telling you the ice pack can be removed from your inflamed back joints. Your bank account would rather see you attend work than stay at home and not get paid because you can’t drive. Your  grandchildren would rather have you board a plane to visit them than see you stay home, spending your time in my office getting treatment. And you would rather sleep through the night and wake up rested than toss and turn, trying to get comfortable, because of back pain travelling down your leg.

The sad truth is that 80-89% of people will suffer from back pain at some point in their life. And in my experience, this often strikes at very inconvenient times. I’ve seen patients who “threw their back out” lifting luggage out of their vehicle while unloading at the airport to go away on a vacation. Or it strikes the morning that you have a job interview to get to. Or the pain lasts so long that you miss a month’s work and your job doesn’t have any sick leave. You get the point. Back pain is debilitating. It cripples you, your family life, your social life and your work life. It also cripples our economy and productivity.

This column will address the impact back pain has on you, the individual, and our society. So follow along and we will educate, inform, entertain, and help you fit into the 11% of people who never develop significant back pain. Check back next time when we will discuss the many different types of back pain.

This column is not intended to provide medical diagnosis or treatment. If you have a back condition, see a licensed and regulated health care professional for proper diagnosis and treatment options.

Dr. Ian Culbert is a Doctor of Chiropractic who practices in Bridgewater


Marilyn-Spinal ColumnShovel Safe!

It’s that time of year when the dreaded four-letter word keeps popping up, or should I say falling down — snow. As pretty as it is when the trees are all covered in white, it’s not so pretty staring at your driveway covered with the white stuff, knowing it’s on you to get it cleared.

Snow shovelling is a strenuous task and should be treated for what it is: a workout. The good news is that 15 minutes of shoveling snow counts as moderate activity and when done properly can be a good form of exercise. Adults should be getting at least 20-30 minutes of moderate physical activity per day, so during the snowy seasons you can clear your driveway and get your activity in for the day.

The bad news is that injuries due to snow shovelling are quite common. According to the American Journal of Emergency Medicine, these are a few of the most common areas to suffer from shoveling related injuries, from least to most common: heart, legs and feet, head, hands and arms, and the lower back. In fact, the lower back accounts for up to 34 per cent of snow shoveling-related injuries. Fortunately, there are a number of things you can do to help minimize the risk of sustaining such an injury.

First things first, pick the right shovel. Taking the time to pick a shovel that is light-weight and the correct height for you will go a long way to help prevent injuries. If you are using a metal shovel, you can spray the metal with Teflon to prevent the snow from sticking.

Next, take the time to warm up. As stated above, shoveling is a workout and should be treated like one. A proper warm-up helps to decrease the risk of injury. Take a few minutes to do some dynamic stretches such as arm circles and leg swings. These stretches help to get the blood flowing to the muscles and joints you are about to be using. Taking a few minutes to go for a quick walk around the block will also help get your blood flowing and get your heart ready for physical activity.

Don’t let the snow pile up. Going out to clear the snow a few times while the snow is falling, rather than waiting till the storm is over, will help save your back. You’ll potentially be spending a bit more time shoveling, but there will be less to do each time. An individual snow flake doesn’t weigh much, but they pile up quickly and a shovel full of snow can weigh a lot.

Now that you have the right shovel, have warmed up your body and are going out in the middle of the storm, you are ready to start shoveling. Be sure to push the snow, rather than lifting it. When the snow banks start piling up on the side of the driveway, and you have no choice but to start lifting the snow to get it on top of the bank, try this: Start in the middle of the driveway and push half the snow to one side and half to the other. That way you are only lifting half as much.

A few tips for lifting. Be sure to bend at the knees, keep your spine in a neutral position and keep your core braced. Think about someone trying to punch you in the stomach. The way you would reactively tighten your core is “bracing”. This is different from “sucking it in.” When lifting the snow up, try not to twist. Twisting puts added stress on the lower back, increasing your risk of injury.

This next tip can feel awkward at first, but worth it in the end. Use the shovel on both sides of your body. You may feel more comfortable with the shovel on your dominant side, but switching it up will help prevent all the stress from building up on one side of the body.

A few closing tips: make sure to take breaks, drink plenty of water and stretch when you are done. Every 30 minutes, take a brief break to do a few stretches and take a drink of water. When you are done shoveling, be sure to stretch all the major muscle groups you used (your arms, shoulders, back, glutes and legs). Taking 10 minutes to stretch after any type of workout goes a long way to help prevent injuries.

By following these tips I hope shovelling will be less of a pain for you this winter!

This column is not intended to provide medical diagnosis or treatment. If you have a back condition, see a licensed and regulated health care professional for proper diagnosis and treatment options.

Dr. Marilyn Field is a Doctor of Chiropractic who practices in Bridgewater