Top 3 simple phrases to live a healthy life

 

Top 3 simple phrases to live a healthy life

by Dr. John Neal

 

Over the course of practice, I’ve found myself using simple phrases to help in the educating patients to manage their musculoskeletal injuries. These phrases are typically rhyming, short and sweet, and are surprisingly packed full of applicability. As we go through these helpful phrases, you’ll probably have heard them before but not realized how expansive their meanings can be. I hope you enjoy the list as much as I enjoy explaining them to you and to patients for the benefit of a healthy lifestyle!

 

  1. “Motion Is Lotion.”

 

This is number one for the simple reason that it is repeated numerous times in the course of the day. I’m honestly surprised it isn’t painted on the walls of the clinic yet! The benefit of motion is that it is what our bodies were designed for. We are not rocks or stone, we have hundreds of joints, muscles, ligaments, and other connective tissues that help create movement. 

Movement provides information to our brain (via mechanoreceptors in our tissue) to let it know how the body is moving in order to plan for the next movement. This is why we in the clinic look at the intricacies or fine details of our patient’s movement. If movement isn’t occurring in the right place or in the right way, than that provides information to the brain that is a bit muddied which causes following signals from the brain to be less ideal to manage the movement. For example, if your shoulder joint, which has countless degrees of movement, is not able to fully access its potential movement, than other structures nearby will have to compensate. Reasons for a joint to not move the way it is supposed to range from previous injuries causing fibrosis or scar tissue to simply lack of movement in various ranges. For a joint to be healthy, it has to move and move well. Not too much (hypermobility or instability) and not too little (hypomobility or compressed). 

The lotion part of this phrase comes from the fact that movement causes increase of blood flow and synovial fluid dynamics which bring nutrients to the joints and takes waste products away. 

Chiropractors are trained extensively to assess the joints of the body. Historically chiropractic would treat the joints of the spine with adjustments to create various changes in the patient to help promote healing. Our approach to therapy evaluates the patient’s movement and finds where deficits reside and uses a variety of treatments, including adjustments, to restore and train proper joint mechanics to ensure improved health and function of the joint as well as decrease pain. 

 

  1. “Use It Or Lose It.”

 

As mentioned above, joints have the move well in order to remain healthy joints. The same goes for the rest of your tissue in the body. Thus we come to this classic gem of “Use it or lose it”. I’m sure you’ve heard and used this phrase numerous times in a variety of contexts. I’d also bet money that you probably don’t realize how true it actually is when it comes to your physical health! 

Let’s first look at the facts in regards to muscles: After age 30, you begin to lose as much as 3-5% of your muscle mass per decade. Part of this is the fact that the rate of muscle atrophy (wasting) from disuse (10-42 days) can range from 0.5-0.6% of total muscle mass per day. Putting this together, if you remain inactive or sedentary, we are wasting away as we age. As our muscles waste away and we lose the parts of us that produce and absorb forces and stresses placed on the body. Without muscle, that leaves our joints, ligaments, bones, and other tissues high and dry to handle the load. Hence why a simple fall in our later age can become catastrophic!

 

Now for some good news! We’ve touched on the “lose it” part; let’s talk about how we “Use it”. Another popular phrase that works into this conversation is “Nothing wrong with getting strong”! It didn’t quite make the list but it could mean the difference between life or death. Resistance training, lifting weights, pushing and pulling heavy stuff, doing this can make you strong and combat muscle wasting! One study by Vikberg et al (2019) showed that 10 weeks of a body weight based resistance training program produced a 2.8% increase in lean body mass. This was in men and women in their 70’s! There are more studies showing that resistance training improves strength and muscle mass which combats muscle wasting. Muscle wasting leads to being frail. Resistance training twice a week combined with 30 minutes of daily activity, makes you healthier. “Use it or lose it” rings true with your muscles! 

 

What about joints you ask? Let’s get into that. In a 2017 study by Wallace et al, they found that the 2 fold increase in knee osteoarthritis is not primarily due to weight or age longevity. They looked at thousands of skeletons from the early industrial era and from the modern post-industrial era, they controlled for body mass index, age, and other variables, and found that osteoarthritis is more preventable than is commonly assumed. Over this course of history, humans have gone from less physically demanding jobs and have transitioned into a more sedentary lifestyle. With less movement, the joints do not get to BE joints. They don’t get the fluid dynamics needed for healthy capsules that surround the joints as mentioned in the above section. They begin to stiffen and become less and less like the joints they are and more into the surrounding bone tissue. 

 

If you “lose” the joint by not “using” the joint, guess what else you lose? Range of motion? Yes of course, but why? Part of the loss of your ability to move your joints is because the joint structurally changes. HOWEVER, there is another factor involved and it is your brain! The brain understands where your body is in space (i.e. your arms, limbs, joint angles, length of muscle) by mechanoreceptors that sends signals to the brain. These receptors sense mechanical changes (i.e. movement) and tells the brain what happened in order for the brain to know and respond accordingly. This happens constantly and subconsciously in order for you to move, stand, sit, walk, dance, and so on. When you don’t move your joints, than these signals to the brain become less frequent. With less input to the brain (known as afference) than the brain starts to unlearn ranges of movement in order to be more efficient at what your joint is currently doing…which is NOT moving! This is why after we’ve been in school for 12+ years, we’ve seem to have lost the ability to sit with our legs crossed on the ground or be able to do a perfect squat. “Use it lose it” rings true for the joints! 

 

Just like muscles, this can be retrained and restored… to some extent. While the significant changes in structure requires surgery, the neurological and functional changes can be adapted using manual therapy and specific movement training. As chiropractors, our spinal adjustments improve movement of the joints which provides those signals to be sent to the brain. Combining this with rehabilitation exercises, we start to see some awesome changes in joint mechanics! 

 

  1. “Know Your Limit, Play Within It.”

 

Have you heard this one before? I BET you have? I gently borrowed this from the Lotto Max tag line as I found this was an easy reminder to tell patients as I encouraged them to be physically active. The idea here is to know what your limit is. Frequently I get people come into the office because they took up running in the spring and ran 5 to 10 kilometers for a couple weeks after not doing any exercise for months. Sometimes it is a patient who decided to take that extra squat repetition even as form was failing 2 reps ago. We all have physical and mental capacities. These are what we are targeting when we are studying or doing exercise. When the external stresses or “loads” are placed on us, it is up to our capacities to handle them. When Load is greater than our capacity, this is when break down and injury occurs. Our connective tissues have a certain tolerance to load. If the external load is just at or slightly above the current level of capacity, than the tissues will adapt and get stronger if you provide it with the resources (nutrition) and time (rest) to do so. If you do too much too soon and too often, that is a recipe for stiffness, pain, burn out, and injury.  

However, the same goes when the external loads placed on us are far below our capacities. When we aren’t challenged, we waste away (similar to the use it or lose it principle). Think about how much you were able to do when you were in high school athletics. Then came years of desk work, watching television, and lack of exercise. Good luck breaking your personal best time running a 5k! You won’t be able to do it that first week getting back into running but someday you might if you train well.  

 

Finding that happy sweet spot where we get challenged and succeed is where we get to “push” our “limits”. We “play” within our limits in order to encourage growth of our capacities. Using the “overload principle” is a way we grow both physically and mentally. 

 

 

How to wear your face mask like a Pro during the Covid-19 pandemic #sighofrelief

Face Mask Mishaps !

By Dr. Dan

One thing that we can all agree on is that wearing a face mask during Covid 19 SUCKS! As a society, we may not agree on everything, but we can at least come together on the point that wearing something over your nose and mouth is extremely uncomfortable. On top of the physical discomfort of being “strapped in,” there is also a physiological discomfort that many people are experiencing…feeling like they CAN’T BREATHE!

Not only is this a terrible feeling, but it is scary as well, and even panic inducing for some. But fear not my friends, there is a way to mitigate this feeling! It is quite simple to be honest. You need to shut your mouth, stop talking, and breathe through your nose.

Why it happens!

Every person has a certain tolerance to having carbon dioxide build up in their blood (CO2 Tolerance). For most of us it’s quite low because it never gets put to the test. An inability to tolerate CO2 makes us feel like we can’t get enough oxygen in our system. CO2 tells the brain to BREATHE MORE! So what happens when we put a mask over our face? You guessed it! We end up re-breathing part of our own CO2 output, and that increases our blood levels of CO2.

What you can do about it!

Nasal-only breathing is the number one thing you can do to stop your feeling of breathlessness while wearing a mask. When you breathe through your nose you end up slowing down your breathing rate, so you don’t blow off as much CO2. You will also cause your body to release Nitric Oxide (NO) from your nasal tissues. NO is a very potent vasodilator, which allows your arteries to deliver more blood to your tissues, making you more efficient at oxygen delivery, and thus making you feel less breathless.

The second thing you can do when you are wearing your mask is not to talk as much. Talking causes you to produce more CO2, and thus you end up hitting your CO2 tolerance limit faster, decreasing the amount of time you can wear your mask comfortably.

Finally, the last thing you can do is to actually improve your CO2 tolerance with different breathing exercises. One of my favourites is called box breathing:

Inhale for 5 seconds

Hold for 5 seconds

Exhale for 5 seconds

Hold for 5 seconds

Repeat 12 cycles

This technique works because it makes you breathe 3 times per minute, so your body gets used to having more CO2 in your blood. So it doesn’t have the same reaction to CO2 at a later time when you wear your mask. It’s kind of like how the first time it hits 5 degrees C in the fall we all find it cold… but the first time it hits 5 degrees C in the spring we all think it’s warm! Your body gets tolerant to the cold over the period of the winter.  As you practice box breathing every day, your body will get used to CO2. The adaption period is about 2 weeks to see a huge difference, but you’ll notice little differences right away.

I made you a short video so that you can get a better idea of what I’m talking about.

There is also a whole host of other benefits to increasing CO2 tolerance. Check out these links:

Figure out your CO2 Tolerance
-This link also has some more advanced exercises for increasing CO2 Tolerance .

Have Anxiety ? This could help !
– This link to a study showing improved CO2 tolerance can reduced anxiety.

How to Box Breath.
– This link is how to do a 4 count box breathing cycle

If you have any questions about what Dr. Dan is talking about, click here to book an appointment with one of our chiropractors who would love to discuss them with you

We’re open!

Our clinics are now open, and we are ready to serve you!

Our clinics offer Chiropractic, physiotherapy, Registered Massage therapy, Athletic therapy, naturopathy and more.

We’re located in Woodstock, Fredericton, Saint John, St. Stephen, Hampton, Sussex, West Saint John, and Grand Manan!

Our team will be using the absolute top notch PPE and hygiene practices to ensure the safety of our patients during this tough time.

Town Health Solutions administrative team

We are so proud, at Town Health Solutions to have so many amazing administrative support staff!

Faith Allaby-Hourihan (Saint John)

Deb Campbell – Operations consultant

Susan Hunt – Operations Manager (& Hampton front desk)

Tanis Friars (Sussex)

Judy Haley (St. Stephen)

Candace (Woodstock)

Raylene Hayman (St. Stephen)

 

 

Town Health Solutions named one of the fastest growing companies in Atlantic Canada.

For the past two years, Town Health Solutions, led by Dr. Erik Klein, two time Top50 CEO Award winner was named one of the top growing companies in Atlantic Canada.

In 2018, Dr. Klein’s organization was #3,  and in 2019, they ranked #5.

This is a testament to the dedication of the team to serving more people around New Brunswick.

Even though 2020 has been a rough one with the coronavirus, stay tuned for new news on this front as things develop!

Pregnancy and therapy, the interdisciplinary approach

CHIROPRACTIC and PHYSIOTHERAPY DURING PREGNANCY: THE BASICS OF INTERPROFESSIONAL COLLABORATION.

Published in Canadian Chiropractor Magazine in April 2020 by Dr. Erik Klein and Dr. Sarah Mickeler of Westendmamas

The beauty of being a chiropractor that works with pregnant patients is that your patient likely has more medical support for this 9 months of her life, than they’ve had on any other occasion. Treating a pregnant patient is an incredible opportunity to not only give the patient top-notch care via interprofessional collaboration with their primary CARE and allied health team, but it’s also a fabulous opportunity for you to establish alliances with that team, if you haven’t already.

WHO ARE THE KEY PLAYERS DURING PREGNANCY?

  • Obstetricians
  • Midwives
  • Family Physicians (many of them still have delivery rights at hospitals)
  • Pelvic Floor Physiotherapists
  • Massage Therapists
  • Acupuncturists
  • Chiropractors
  • Lactation consultants (in the immediate postpartum)

 

PRIMARY CARE RELATIONSHIPS FOR THE PATIENT

In most provinces in Canada, your patient has a choice of primary care provider (PCP): they may choose a midwife for an uncomplicated pregnancy, or they may opt for an Obstetrician, or, less commonly, their Family Doctor may care for them and deliver their baby. All three routes are covered by our tax dollars.  Midwifery services sit outside the usual provincial healthcare coffers, and for this reason, newcomers to Canada, including undocumented immigrants, qualify for midwifery care for free.  In Canada in 2017, 10.8% of all births were midwife-led births.

Your patient will see their PCP, on average, once a month during their first and second trimester (up until week 27) on average bi-weekly from weeks 28-36 and usually weekly from weeks 36-40 or 41. That’s roughly 14 visits; more if the patient is a high-risk patient, or if any issues are identified during their pregnancy.

ALLIED CARE RELATIONSHIPS FOR THE PATIENT

In addition to choosing your exceptional chiropractic care, your patient may want or require the services of other allied health professionals (AHP).  Each of these professionals is valuable in the lifecycle of your pregnant patient, and while most patients will not require the services of ALL of these professionals, it’s worth knowing what they do.  In addition, it’s important to know who does what so that when you go to build relationships with them, you can be well-educated on their scope of practice, and what would be a great referral for them.

If you approach your potential interprofessional collaborator with an attitude of “how can I help you” you will almost always be very well received.  Just as we don’t naturally graduate with a full contact list of people to refer our patients to, neither do other AHPs.  We are all looking for the best people on our team to help our patients feel their best.  By putting the patient first, you will be able to sleep at night, and I can just about guarantee that the patient will refer back to you because of your integrity, and it’s likely that whoever you referred the patient to will, also.

Some readers may be nervous to make these referrals, for fear of “losing the patient”. However, when it’s done right, you will keep the patient, if they need to continue seeing you, and you will likely IMPROVE your relationship with the patient, increasing their trust in you.   Put the patient first.

 

WHO TREATS WHAT?

For the purposes of this article, we will stick to the top 4 services, other than chiropractic, that a pregnant (or immediately postpartum) person may be interested in accessing.  Many of us will have access to licensed practitioners in all of these designations in either our own city or in neighbouring ones, but if you don’t, that’s ok.  Just do the best job you can with the tools you have.

  • Pelvic Floor Physio
  • Urinary incontinence and dyspareunia at any time in the patient’s life – during pregnancy, 6 weeks after having a baby, 20 years after having the baby, etc.
    • Please remember that any amount of urinary incontinence, even a single drop, is not normal. Common, yes. Normal, no.  Any amount of reported incontinence should automatically trigger a referral to a Pelvic Floor Physiotherapist.
  • Hip pain
  • Pelvic girdle pain
  • Labour prep for a vaginal birth
  • Many, many other issues
  • MASSAGE THERAPIST
  • General aches and pains
  • Edema/lymphatic drainage
  • Stress/relaxation
  • May do infant massage once the baby is born
  • Potentially breast massage postpartum to help with engorgement
  • ACUPUNCTURIST
  • Morning sickness
  • Edema
  • Stress/relaxation
  • Sleep issues
  • Cervical ripening, to encourage a more efficient birth
  • Natural induction
  • Milk supply issues postpartum

 

LACTATION CONSULTANT

  • Latch issues
  • Blocked ducts, mastitis (mastitis should also be an immediate referral to the doctor as it will require antibiotics)
  • Assessments for tongue tie
  • Milk supply issues
  • Pain with breastfeeding

 

HOW TO BUILD THOSE RELATIONSHIPS

Now that you know who else your patients may want or need to see during their pregnancies, it’s time to build those relationships.  The easiest way to do this is to simply send a clinic note to their PCP and AHPs after their first visit.  Make sure to get the written consent of your patient before doing so. If you integrate the consent to share health information with other health care providers into your intake form, simply get their verbal consent to do so.

Make the note short but sweet; get to the point.  Lay out who the patient is, when they came in and why, what you found (don’t bore them with the names of orthopedic tests; they don’t know or understand what they are for), what you are planning to do about it, and how you expect the patient to do.  Let them know that you love working with pregnant patients (if you do!) and that you would love to work together again soon.

If you have a referral pad, send one.  Send some literature about your office (if it’s pregnancy-specific literature, that is).  Send that note out within one week of the patient’s first visit.

The note should, at the very least, go to your patient’s PCP.  Most PCPs don’t have a built-in network of alternative care providers that they already work with, so you sending a note to them will let them know that you do this work, and they will likely remember your name because you took the time to send them a well-written, logical, patient-centered note.  In addition, it opens the lines of communication between you and them.  It will help the patient, because when the patient says “I’ve been seeing my chiropractor for x-y-z” the PCP will be able to say “oh yes, I got their note.  They seem to know what they’re doing.  Is that going well for you?”.  This is good for everyone – you and the patient.

The same goes for any AHPs that you may send the note to.  If, for example, the patient is seeing a pelvic floor physio (or any other allied health professional), send them a note, with the patient’s consent.  Let them know what you’re doing and that you’re open to chatting with them if they feel the need to do so.  Remember that our services are complementary – seeing one practitioner does not negate the need to see another.  The patient can see a pelvic floor physio for their pelvic girdle pain, and ALSO see a chiropractor.  Well all do slightly different things, and we all have value for the patient.  By framing it as “I want to help my patient feel their very best” you can’t lose.

 

WHAT IF YOUR PATIENT ISN’T SEEING OTHER HEALTH CARE PROVIDERS?

If your patient isn’t already under the care of an AHP, you have an opportunity to build community relationships so that you have an adequate referral network for those patients that require referrals. Google “pelvic floor physios near me” or “pregnancy massage near me” or whatnot, and figure out who is doing that work.  Give them a call and ask if they would be open to meeting.  When you meet them, let them know that you work with pregnant patients and that you would like to get to know what kind of work they do so that you can refer to them when the time comes.  Like everyone else, they likely don’t have a large network of people to refer to, and they will remember you when their patient says that they have a complaint. This is good for you, them, and the patient.

If you would like to work with more midwives, go meet them!  Set up a meeting, ask if they would allow you to come chat about what you do during their practice meetings, and go put your face in front of them.  Sponsor an ice cream social (or something similar) in your office for local health professionals to come by and get to know you and your clinic. If they know who you are and what you do, they are more likely to refer to you to help their client feel their best.

 

PUT THE PATIENT FIRST

No matter what, remember to put the patient first.  No one person can be everything to everyone.  Many chiropractors are exceptionally skilled, but you will be hard-pressed to help a patient with their baby’s latching issues, pelvic floor issues, or to help with a natural induction. If you do not feel comfortable treating pregnant people because you do not have enough experience with them, either take advanced evidence-based training for working with pregnant patients, and/or seek out the chiropractors in your network that are comfortable working with them.  Interprofessional collaboration is so important during a patient’s pregnancy – by putting the patient first, you will be able to comfortably make the referrals that will help the patient feel their very best during and after their pregnancy.

The original published article can be found here –> Canadian Chiropractor

 

 

 

 

 

 

 

 

 

 

 

 

Hey runners, what about those shin splints?

Spring time, sunshine and shin splints!

By Dr. John Neal (Woodstock and Fredericton)

Let me tell you a story about a time when I was a little foolish!

I signed up and participated in a Santa Clause 5k run in Kitchener-Waterloo, Ontario! The foolish part was that I decided to run the 5k with a brand new pair of orthotics without first ever wearing them! After the first kilometer, I was quickly feeling an intense burn in the front of my left leg. My shin was on fire! This burn was very familiar to me though as it was muscle fatigue! It was tired due to the change in running mechanics brought on by the foreign object in my shoe: the orthotic! As the body adjusted to this new movement mechanics, I never felt that issue again. However, the same cannot be said for actual shin splints!

Anyone who has actually dealt with shin splints would understand that what I had was not the same thing. Shin splints, known more accurately as Medial Tibial Stress Syndrome, is a condition that is much more serious than a tired muscle. What happens with this condition is a stressful pulling of the muscle from the bone occurs and causes inflammation and pain at the sight of stress. This condition is aggravated and worsened by running or walking with pain during and after the event. This condition is typically a long standing issue as people and athletes usually try to ignore it and hope it goes away. The pain will subside when they rest and take a break from the aggravating activity but the pain usually comes back when they go back to it.

If it does go away and never returns, that’s good! That shows that the healing was successful and you’re all set to continue the activity. In some cases, a person suffering from the condition can get the aggravated muscle successfully treated to decrease the stress on the bone and provide pain relief. However, if the CAUSE of the problem was never dealt with, this condition typically relapses when they try to increase their activity! In my experience, there are multiple causes that lead to the actual tightening of the muscle that pulls on the tibia bone (shin). Whenever I’m assessing people with this condition, I assess the muscle being stressed and then take a step back from the area of complaint and go big picture! It is important to see how the hips, knees, and ankles are working during walking and running. Once you see how they are moving you can get a strong sense of which muscles are over-active and which ones are under-active. This chain of events is typically the reason why one muscle gets stressed and pulls on the bone more than it should; leading to this syndrome!

If you think/know you are dealing with this, be rest assured that there is help for you! A proper course of treatment to correct muscle and joint dysfunction in the movement chain with relative decrease in activity can help decrease the stress and allow for healing and movement mechanics to take effect! As a chiropractor, I love that I can help solve problems like Medial Tibial Stress Syndrome (shin splints) and many more musculoskeletal conditions that hinder people’s life. There is no need for this condition to stand in the way of your activity goals! Whether it is running a marathon, walking the trails, or playing soccer, shin splints are an all-too-common condition that has a relatively simple fix.

Now without knowing your specific biomechanics, training regimen, or functional anatomy, I would like to provide a sample of exercises that are commonly used to strengthen aspects of the kinetic chain that is related to this condition. These exercises may aid you in self-management of this condition because they will address issues that are commonly found in people with Medial Tibial Stress Syndrome (shin splints). The exercises to try are ankle inversions and eversions using a resistance band, as well as glute strengthening exercises!

As well, for the running crowd who want some support NOW, my friend Dr. Erik has a video about how to use athletic tape for shin splints while you continue to run.  Remember, taping without rehab is just a short term fix!

Thank you for reading this article and I hope you learned something new! Please don’t let pain or dysfunction stop you from living the life you want to live! We are here to help you achieve your health and fitness goals. Take care of yourself so you can enjoy your activities this spring! If you have any questions or suggestions on another health topic, don’t hesitate to contact me!

Virtual/video consultations now available at Town Health Solutions!

Due to the COVID-19 pandemic, all of our clinics are closed, however we’re working diligently to provide options for you in your time of need!  We are now offering Virtual/video consultations which will include the following:

We will review your history and discuss your problem face to face via a video conferencing platform.

We will watch you move, and ask you to perform certain tasks for us to assist us with our assessment.

We will review any X-rays, MRIs, or pertinent lab reports.

We will provide you with a clinical assessment of your situation.

For treatment, we will provide you with home manual therapy, and exercise.

We will be using our proprietary exercise software (not available in Canada) to assist you with this.

The fees for this service are purposefully designed to be affordable.

Please enter your information in the Book Online form, selection Virtual/video consultation and we will get back to you as soon as possible.  Alternatively, you can email drerikceo@townhealthsolutions.com

 

 

 

Athletic therapy: moving seamlessly from the sidelines to the clinic

This article was written by Caitlin Marshall, certified athletic therapist; and Dr. Erik Klein and published nationally in Canadian Chiropractor Magazine in February, 2020.

The treatment of elite athletes has come a long way from the “ultrasound and ice mills” to elite teams of performance therapists integrating care to maximize performance and minimize injury under an unrelenting training schedule. While most day-to-day clinicians will never have access to professional, or Olympic calibre athletes, much can be gleaned from how these training programs work, and extrapolated to serve the weekend warrior or everyday patient.

One such training program is ALTIS, headquartered in Phoenix, Arizona. It’s a high performance training centre for both professional and semi-professional track and field athletes. The program has 56 Olympic medals to their credit. For Canada, Andre deGrasse had been training in Phoenix when he won his Olympic bronze medals in the 100m, and 4x100m relay, and silver medal in the 200m against Usain Bolt.

ALTIS offers internship and performance programs for therapists and coaches, and both of us attended between 2016 and 2017. As an organization they place a strong emphasis on education around sport performance, including performance therapy.

Performance therapy involves bringing brief manual and therapeutic interventions directly into the practice setting, allowing for the opportunity to make immediate improvements to movement patterns. It requires collaboration between the coach, therapist, and athlete, otherwise known as the “performance trinity.”

It is very common in many disciplines, including chiropractic, athletic therapy, physiotherapy, and sports medicine to place a high emphasis on technology. There is no limit to how much you can spend attempting to get a leg-up on the competition. While now, most smart phones and computers have built in software that allows you to slow down video, make side to side comparisons, and even make drawings; many national programs are still utilizing heavy technology products such as Optitrack, which costs upwards of $1,000 per meter! However, ALTIS stays true to the manual arts and the KISS principle and the results can’t be argued with.

One of the biggest performance takeaways was the concept of a living movement screen. We had always known that warm-ups were important from an athlete’s perspective, in order to decrease risk of injury and be fully prepared to take on the demands of practice, but we had never thought of them from the perspective of the clinician. Being on the sidelines for a practice provides us with the advantage of observing the athletes we work with. By being mindful and attentive of their individual movement patterns, and understanding the demands of their sport, both the practitioner and coach can pick up on that athlete’s readiness for practice.

If we can detect early on that something in their movement pattern has strayed from their baseline, a therapeutic intervention can assist in correcting the issue. The key is to input a minimal intervention on-site at the right time, and then re-establish the more ideal movement pattern. (Hence, run, treat, run.) This is far and away a more successful approach than the isolated in-vitro approach of the clinic.

These strategies in turn can help prevent potential injury from the movement error, and allows the athlete to be more effective in their training session. Rather than performing a one-time, pre-season functional movement screen, the living movement screen provides a daily assessment for each individual’s motor patterns.

How does this apply in the clinic setting?
One of the major contributors to injury is poor biomechanics. In order to successfully treat and manage the athletes or clients that we work with, it is crucial that we as clinicians have a thorough understanding of the movement patterns needed to carry out their sport, recreational activity, or even their occupation.

If we use a recreational runner as our example, let’s think about how many steps they will take in a 10-km easy run. If they have mechanical deficiencies in how they contact the ground, this will be repeated with each step that they take through their training. It then becomes inevitable that at some point in time tissues are going to break down, and there is a high probability that an injury will occur. As a therapist it is our job to not only assess what is going on statically when they are on our table, but dynamically and in the context of the movement they are trying to perform.

As a clinician, we don’t always have the opportunity to be on the sidelines of the practice, game or race that our clients are participating in. It was important for us to take what we had learned, and modify it in a way that applied to the clinic setting.

This starts with the assessment. Being on the table is an important piece of the puzzle, however, we find the most useful and important information comes from watching the client move in a dynamic manner, having them perform tasks specific to their objective. Their hip may be the site of their pain, however we will not know the cause of their pain simply by assessing that area. Being able to see how each joint interacts with certain movements will provide much more information as to the WHY of their problem. Assessing the individual body part that is in pain has its use, however we must look deeper and take into account that without movement it is impossible to determine where if this is a joint issue, soft tissue related, or does it have to do with poor motor control and dysfunctional movement patterns?

This can be applied to clinical practice as well. Hands-on manual therapy is an exceptionally powerful tool. Regardless of your discipline or techniques you utilize, your mindset to treatment, and the culture of your office or organization can contribute to patient success in a major way.. While technology is immensely helpful in sport and clinic, at the end of the day, our hands on work, and our clinical strategies are what will get us the results we are looking for. The rest just helps fill in the cracks.

For example, a simple strategy to employ for hip pain, is to not just test the hip in a supine position. However test it in a prone position, or standing, or with trunk rotation etc. Of course, the history will guide you, but taking a more ‘in the moment’ approach to a complaint will glean much more sensitive information. If a patient has hip pain after sitting eight hours per day, but testing supine doesn’t reveal much which is often the case, test it while seated. If the individual spends a lot of time reaching for the mouse on the right side, take the scapula or the glenohumeral complex into account and THEN re-test the hip. In more cases than not, adequately replicating a patient’s point of stress will give you insight into how to correct their problem. A March 2016 paper by Cox, deGraauw, and Klein [the co-author of this article] in JCCA found very poor sensitivity in many commonly taught orthopaedic tests. The overreliance on standard static orthopaedic tests can at best render someone a poor clinician, or at worst result in an outcome seriously detrimental to the patient.

The treatment of the athlete and the everyday patient doesn’t need to be THAT different. Great clinicians will be able to move seamlessly between the sidelines and the clinic room, bringing relevant strategies with them.

Catching some Zzzs

This article was written by Dr. Maria Boyle and Dr. Erik Klein and published nationally in Canadian Chiropractor Magazine in November, 2019.

I think we can all agree that there is nothing better than waking up after a restful night sleep feeling rejuvenated, refreshed and ready to tackle what life throws our way.

Good quality sleep puts our bodies into the parasympathetic state – more commonly known as the “rest and digest” nervous system. It is not surprising that during this state our body and mind rest, digest and revitalize to help support healthy brain function.

The World Health Organization and the National Sleep Foundation both recommend seven to nine hours of sleep a night for the average adult. However, 50-70 million adults in the United States are failing to obtain those precious and recommended hours of sleep. In today’s world, it is so easy to access information through social media, podcasts, and magazines. Why are so many of us depriving ourselves of sleep on purpose? Both the journal Sleep Health (the journal of the National Sleep Foundation) and the book Why We Sleep by Dr. Matthew Walker are a few of the accessible resources that should be recognized for those who want to dive into the topic of sleep a little further.

While “hustle” is an integral part of building any successful business, hustling smart and efficiently is key. Getting the right amount of sleep for your own recharge needs to be a part of this plan. Dr. Michael Breus, a leading sleep expert determined that there are four primary chronotypes of sleep patterns.  Which one are you?

The Lion (15% of the population) The Lion is the chronotype that gets all of the attention. These are the folks that wake at 4-5am, hit the gym, and have an abundance of energy early in the day, being most productive during the morning.  The Lions will set meetings first thing. However, there is a down side: They don’t tend to be the life of the party. The cost of waking so early, is a very early shut down in the evening. So schmoozing, networking, family activities and/or recreation tend to take a hit.

The Wolf (15% of the population) The Wolf tends to be a late sleeper, not truly feeling comfortable until about 10am, with their highest productivity during mid-afternoon, hence when they like to meet. Around dinner time, early evening, they’ll be in a lull, but coming to full attention after 8pm, and often not feeling ready for bed until 12-2 a.m. Wolves tend to be judged negatively, often being called lazy. Wolves forcing themselves to wake consistently early will often encounter health issues later in life, as we discuss below. Dr. Erik is a Wolf naturally, although he wakes at 6 a.m. most days, with a lot of self-maintenance to make this happen!

 The Bear (50-55% of the population) The bear wakes with the sun, and starts winding down at dusk. This is the majority of the population.  Dr. Maria is a Bear.

The Dolphin (15% of the population) These are your insomniacs.  Wide awake at night, and fatigued during the day.  These folks have the most difficulty functioning in society and frequently require medical intervention to get by.

Why do we need to sleep?
If it wasn’t as important as eating well, reproducing or being safe from our predators, then why, since the beginning of time have humans been risking all of these vital parts of life to sleep? From an evolutionary standpoint, it does not make any sense to lie motionless and be vulnerable to our prey; however, since the birth of our species, we have been sleeping for at least 2/3rd of our day. While we are dreaming our brain and bodies are going through a series of cyclical patterns to revitalize key components to help us thrive in our conscious state. There is not one stage of sleep that is more important than the other; it is the cyclical process of all stages that is important. Each one of these stages plays its own role to be sure to keep our minds sharp, to translate short term learnings into concrete knowledge, to rest our sympathetic state so that we can go about our day feely less grumpy or “on edge” and to enhance our immune systems so we can fight off infection and illness. The different stages of sleep are classified as:

  1. Light NREM (non-rapid eye movement sleep)
  2. Deep NREM
  3. REM sleep.

How does sleep actually benefit us?
A study out of the University of Rochester Medical Center suggests that while we are in REM (rapid-eye-movement sleep), our brain cells shrink by 60% to allow for the waste system in our brains to clear our metabolic by-product and rehydrate cerebral spinal fluid throughout the brain. It helps to form connections between recently learned information. Sleep allows us to remember and it also has the ability to help us to forget things we may not want to dwell on. This is great news for chiropractors who treat individuals who suffer from chronic pain conditions or those who are receiving treatment following a traumatic event. There have been multiple studies that have been done recently looking at the effects of sleep and psychiatric conditions and many of these studies show clinically significant benefits. If you were to indulge in this topic of sleep deprivation leading to poor mood it makes sense. If we do not sleep well, we are more irritable and when we are more irritable it may be harder for us to create relationships or be happy throughout the day, which can lead to depression.

Effects of sleep deprivation
We have all experienced sleep deprivation. Ever wonder why you get those hunger cravings following a short sleep or the feeling of satiation is just not there? It is due to the fact that when we are not sleeping enough, the hormone that suppresses our hunger is tainted. This can lead to a downward spiral for someone’s health if this is an everyday occurrence.

Another downfall of sleep deprivation is the effect on our mood, or our lack of motivation to do anything physical. When your slumber was not as restorative as it could have been often time we wake up feeling grumpy, irritated and tired, which makes it extremely difficult to motivate yourself – we do not have the energy to be physically active in these states of deprivation. When we sleep less, we move less – and when we move less this increases our risk for developing cardiovascular conditions.

The National Institute of Health recommends twelve tips for healthy sleeping patterns:

  • Stick to a sleep schedule
  • Exercise is great but not too late
  • Avoid caffeine and nicotine
  • Avoid alcoholic drinks before bed
  • Avoid large meals and beverages late at night
  • Avoid medicines that delay or disrupt your sleep
  • Don’t take naps after 3 p.m.
  • Relax before bed
  • Take a hot bath before bed
  • Have a good sleeping environment
  • Have the right sunlight exposure
  • Don’t lie in bed awake
  • Try to align with your chronotype if possible.

As many of you know from experience, a chiropractor plays the role of both an educator and motivator in the lives of our patients and in our community. If the goal is to optimize wellness and performance in the lives of our patients then we are doing them a disservice if the topic of sleep is left unaddressed. Similar to how physical activity and nutrition play a huge role in our patient’s health and recovery, so to does sleep quality. This is one of the easiest ways we can have an impact on our patient’s lives. Sleep is one of the cheapest, most enjoyable forms of healthcare out there.