Neck Pain – Vitality Clinic – Chiropractic and Sports Therapy

Direct Billing for Blue Cross and Green Shield

Fri, 09 Mar 2018 18:25:38 +0000

If you have Blue Cross or Green Shield as your Extended Health Provider, we will now submit claims on your behalf.

Please don’t hesitate to contact the clinic to learn more about this service.

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Now Is The Time!

Thu, 07 Sep 2017 18:04:36 +0000

Happy Thursday Everyone!

Now is the time of year when routines take shape again and patterns emerge. If you haven’t sought out Chiropractic care, now is a perfect time to take those first steps.

Have a great day,
Dr. Crysta Serné
Chiropractor and owner of Vitality Clinic

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Standing Versus Sitting Desks

Sat, 25 Feb 2017 17:45:55 +0000

We all remember the hype and excitement as the idea of a standing desk verses a sitting desk would presumptuously be the ‘end-all, be-all’ for our sitting related diseases and overuse injuries. Sure, sitting was once coined as ‘the new smoking’ and is related to obesity, heart disease, and an array of posture related injuries, but what about the effects of standing? Haven’t we learnt “too much of anything is never a good thing?” What about the excess stress on our joints and circulatory system from being on our feet all day? Was there even evidence to support the notion standing was in fact preferred over sitting, or better for our bodies at all? Are we just addicted to this dramatic polarity in life where we swing from one extreme to the next? It has been nearly three years since the boom of standing desks made their way into office conversation and the results are trickling in. It seems, once again, we may have gotten a little ahead of ourselves.

So what if I sit?

First, let’s review your posture when sitting… Starting at the floor, your feet are planted lightly on the ground, knees at a 90 degree angle, sit-bones (ischial tuberosities) supported and tilted slightly back, and your spine straight with your core lightly engaged. Your arms are in front of your body perhaps resting on the keyboard or desk, shoulders are back, and your head is in a neutral position with your chin parallel to the floor. Great…. Now hold that for 8 hours a day, 5 days a week, and see how your body responds! Unless you have given yourself to the Himalayan Mountains as a Tibetan monk whose devoted their life to sitting and mediation for 10-12 hours a day, every day, then I give you roughly 10 minutes before your muscles and joints begin to fatigue and you slouch. Holding an ergonomically correct posture for that duration is near impossible! However, when fully supported, sitting is the ideal position for precise and repetitive work. UCLA Ergonomics states that sitting is preferred “when visually intensive or precise work is required, the activity is a repetitive nature, longer tasks are completed, and when everything can be placed within easy reach.” But even if you do manage to maintain a supportive posture while sitting, some unavoidable perils are still going to create havoc on your health. Catch 22, am I right?

Anatomically, sitting causes a shortening of the muscles at the front of your hips- your hip flexors. Which, combined with a weak core, will create an imbalance affecting all parts of your centre of gravity. This most commonly leads to back and/or knee pain. When you stand after sitting for a long period of time, the hip flexors stay shortened and pull your hip bones and pelvis towards the floor. This creates an increased lower back curvature (hyperlordosis), a stretched and weakened core, and uncomfortable tension placed on your knees. Let’s not forget about the headaches and upper back pain created from slouching in front of a computer screen all day!

Additionally, the health concerns related to sitting (obesity, heart disease, and early death) are present enough in our culture they still raise a constant concern. Sitting creates digestive issues, slows down fat metabolism, increases bad cholesterol, and requires little to no energy. It’s no wonder we are desperate for the golden ideal that will rid us of all our problems!

So what if I stand?

Someone must have said, “Okay… So, if sitting is bad, why don’t we just do the exact opposite all day and see if that works!” Sounds legitimate enough, and seems to make sense, right? Plus, standing desks look great! They are modern, space efficient and, to the benefit of those in the business of selling them, crazy expensive! So, they must be great!

Granted, standing will burn 150 calories/hour compared to the easy 112 calories that sitting gets you. It requires more energy, but does this mean that by standing all day we are going to avoid the negative health concerns like obesity, heart disease, and musculoskeletal injuries? Standing, according to UCLA Ergonomics, is ideal for “jobs which include construction workers, highway flaggers, medical personnel, painters, electricians, plumbers, loggers, firefighters, plant inspectors, and maintenance personnel.” So, where does “office work” fit into all of that?

It seems the studies for standing desks were mostly done after the initial craze, and they came to the conclusion it would be the better solution for stand up desks to be used all day long (versus sitting desks). Recent studies are now concluding standing all day gives you an increased risk of atherosclerosis due to the additional load on the circulatory system. This leads to heart concerns, varicose veins, and swelling of your ankles and knees. It also creates a considerable amount of added pressure on our joints (specifically the ankles, knees, and lower back) which in turn may cause pain, swelling, and decreased range of motion.

Additionally, the ergonomics required for a standing desk are just as (if not more) specific as traditional sitting desks. Standing fixates your posture which increases wrist extension. This often leads to individuals leaning on their desk, causing an increase risk of carpal tunnel syndrome or a tendonitis. Even if the positioning is perfect, you are still at risk for developing overuse injuries, and painful and long lasting conditions.

So, now that we are all confused and on the same page…what can be said for certain when comparing standing verses sitting? I say a sweet compromise and a little personal responsibility is in order!

How about we compromise?

Both sitting and standing desks have advantages and disadvantages; this seems obvious.

The completed research indicates constrained sitting or standing for long periods of time are straining and that ultimately, alternating work postures are preferred. Our bodies thrive when faced with variety and movement. This increases the levels of work performance, reduces risks of musculoskeletal injuries, and improves comfort. Intuitively we know what is best for our bodies. When we are sore from sitting for too long, we take a big cat-like stretch and move our joints. If we have been standing for too long, we often reach forward and stretch out, or perhaps squat down to loosen up our hips.

Let’s combine the sitting and standing, and add in those specific movements. If we broke it up into periodic intervals during the day, preferably 5 minutes every 20-30 minutes, we would see an increase in energy levels, decrease in overuse injuries, a stronger circulatory and lymphatic system, and an increase in work productivity. This theory is supported by Cornell University Ergonomics Online and they go on to add that, “simply standing is insufficient. Movement is important to get blood circulation through the muscles, and movement is FREE!”.

Set a timer to go off every 20 minutes, increase your water intake, download a ‘movement’ app- whatever works for you! Stand up and stretch your arms, waist, legs, hips, and back. Walk around a little bit, do a couple squats or wall sits to get your blood flow moving. Deep breathing and an intentional focus on relaxation is also key!

So, I believe we can call this one a tie. Both sides can identify improvements necessary to counteract the negative effects, and we can all admit we can add a little more intentional movement into our days. Think of it as a giant ‘reset’ button you can manually push every 20 minutes! Your body will thank you for it!

Have a great day,
The Vitality Clinic Team

Check out Reviews.com’s list of the BEST standing desks by clicking here.

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Headaches and Acupuncture

Mon, 06 Apr 2015 17:57:51 +0000

Many people suffer from ongoing headaches and having acupuncture treatments are a great way to treat them.

Headaches can be triggered for many reasons however, an imbalance of hydration fluids, stress, trauma, joint and muscle imbalances, and diet are usually the culprits.

Living in a fast paced environment we are easy to have an imbalance of the autonomic nervous system, specifically the parasympathetic nervous system, which governs our response to stress. Regular acupuncture treatments to harmonize the nervous system and can help bring back balance in your body and mind to reduce and eliminate headaches.

Acupuncture treatments have been shown to stimulate the immune system. Acupuncture also affects the circulation, blood pressure, secretion of gastric acid and the production of red and white blood cell. Acupuncture also stimulates the release of a variety of hormones that help the body to respond to injury and stress.

Many people would assume that inserting a needle into the skin would be painful. However, a variety of sensations such as warmth or pressure may be felt as the energetic sensation of having acupuncture differs from pain. Clients often comment that my treatments are pleasant and relaxing, like pressing the restart button.

Have a wonderful day, and remember to hydrate throughout the day to plump up those blood vessels.

Julianne Petersen
Vancouver Registered Acupuncturist

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The Sphinx Stretch

Fri, 03 Apr 2015 17:55:43 +0000

This upper back mobilization can be complemented with neck stretching, upper back stretching, and other mobilizations such as the cat-cow. The sphinx mobilization is very similar to the cat-cow lumbar mobilization, but it targets upper back stiffness (thoracic spine) and neck stiffness (cervical spine). It is great for helping with poor posture and to fix neck pain.

Start on the floor in a position on your hands and knees. In the sphinx position, your hands will be on the ground directly in front of your knees so that your wrists are in contact with your knee cap. Drop your buttock to your heels. Start the mobilization by slowly arching your upper back up, similar to the “cat” movement in cat-cow.

While you arch your back, push the ground with the outside part of your palms and feel your shoulder blade muscles contract, while your shoulder blades slide laterally along your back. Retract your chin so that you are looking at your knees. Most of the movement is supposed to come from your upper back and low neck. This is the first half of the mobilization (as demonstrated by the picture on the right).

The second half of the mobilization starts by trying to push your sternum towards the ground; this is a ‘cue’, you’re not actually going near the floor. The cue is trying to force you to get as much mobilization from the upper back as possible. As you slowly bend through your upper back, start to look upwards in your neck, while keeping it relatively straight. When at full extension, hold this pose for 5 seconds and repeat the first half.

Do this mobilization 10 times in a row, take a break, do some upper back stretches, and repeat the mobilization again.

If you have any questions, please do not hesitate to contact the clinic for consultation.

Have a great day,
Dr. Lucas Tisshaw
Vancouver Chiropractor and ART Provider

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Neck Stretch

Mon, 30 Mar 2015 19:05:08 +0000

If you work at a desk, you’ll want to do this stretch.

This stretch pays particular attention to the levator scapulae muscle, upper fibers of the trapezius muscle, and cervical paraspinal muscles.

Pay special attention to your hand placement and where you are looking when doing this stretch.

1. First, place your right hand behind your back and rest it palm side out against your left lower back.
2. Next, turn your head as far as it’s comfortable to your left.
3. Now look down towards your left hip.
4. With your left hand, place it on the back of the head as close to your neck as possible and GENTLY provide an additional stretch.

This should feel good and NOT painful in anyway.

(as shown from the back)

Once you have been in this position for 30-45 seconds, slowly remove your hand and with your neck still flexed (eyes facing the floor), move your head so it is positioned directly in front of you (chin to chest position). Now lift your chin and give your shoulders a little shake. By going through this motion versus directly from the position it was held, you are sure to prevent your muscles from reacting in any way.

Repeat on the other side, and as often as you want.

Have a great day,
Dr. Crysta Serné
Vancouver Chiropractor and owner of Vitality Clinic

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Back Pain and Pregnancy

Fri, 20 Feb 2015 21:14:29 +0000

Back pain during pregnancy is unfortunately an all too often occurrence. Typically, women gain between 25 and 35 lbs during the course of the pregnancy and this weight, along with the change of centre of gravity, puts a lot of sprain/strain on the ligaments and joints in the lower back. Another reason for increased back pain may be a result of the hormone, relaxin, as it’s main purpose it to relax joints, ligaments, and muscles as your body prepares for birth.

Low back pain is one of the most common areas to have pain occur. However, you may also experience it in your upper back, between the shoulders, and neck during your pregnancy or once you begin nursing your little one.

One of the best tips I can offer is to start seeing a Chiropractor before you even get pregnant! Set your body up for success by ensuring your muscles and joints are aligned (balanced) before all the wonderful changes that accompany pregnancy occur. As you progress throughout the pregnancy it’s nice to have a health practitioner team supporting you every step of the day. It’s also very helpful to have a Chiropractor who works closely with a Registered Massage Therapist, and Naturopath as these services may also come in extremely handy. This is in conjunction with you visiting your GP (OB/GYN), midwife and/or Doula throughout your pregnancy as well.

The treatment you receive from your chiropractor will change as your body changes during the course of the pregnancy. This should be discussed with you at almost every appointment.

There are also quite a few things you can do on your own to alleviate any discomfort you may be experiencing. Here’s a few:

1. Posture

You should always be mindful of maintaining a neutral posture, but even more so when pregnant. As mentioned, when your baby grows your center of gravity shifts forward. To avoid falling forward, you may compensate by leaning back which can strain the muscles in your lower back and contribute to back pain during pregnancy.

Keep these principles of good posture in mind:
1. Stand up straight but not so rigid you take on a military posture.
2. Work on your pelvic tilts so your not thrusting your pelvis forward.
3. Keep your shoulders relaxed and lowered. In colder weather, make sure you wear a scarf to avoid hiking your shoulders closer to your ears.
4. Keep your knees slightly flexed.

When you stand, consider a stance where your feet are just a bit wider than your shoulders (tripod stance). This allows for a more even weight distribution. If you must stand for long periods of time, rest one foot on a low step stool, and take time for frequent breaks.

Maintaining good posture also means sitting with care. Choose a chair that supports your back, or place a small pillow behind your lower back.

2. Exercise

Maintaining a level of physical activity throughout your pregnancy is highly beneficial! It keeps your muscles strong, joints lubricated, and blood flowing. I wouldn’t recommend an exercise you are not already engaging in (with the exception of an aqua class) and I would encourage you to check in frequently with your health care practitioner. If you are getting tired or pain occurs, stop immediately and speak to your Chiropractor.

3. Stretch

Not all stretches you performed prior to pregnancy are advised so please consult with your health care provider first. You may want to consider joining pregnancy specific classes, such as a pregnancy yoga class. It also provides you an opportunity to meet other momma’s to be!

4. Hot and Cold Therapy

Depending on the nature and location of your pain, heat, ice, or a contrast of both may be indicated. Speak to your Chiropractor to find out which option is most suitable for you.

5. TENS unit

A TENS unit is designed to alleviate pain. It is extremely useful and safe (when properly directed on its use) for low back pain. It is also HIGHLY RECOMMENDED to have one for when you are in labour. We sell them at the clinic and the cost is often reimbursable back to you if you have an extended health plan.

6. Sleep

Make sure you are receiving adequate and restful sleep. It is recommended you sleep on your side as much as possible. Consider investing is a body or pregnancy pillow to help you achieve the good night’s sleep you and your baby need.

Here are sone related articles:
Sleep Hygiene
A, B, Zzz’s of Sleep
Stretches for Nursing Mom’s

Have a great day,
Dr. Crysta Serné
Vancouver Chiropractor and owner of Vitality Clinic

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Magnesium

Fri, 16 Jan 2015 18:58:23 +0000

As a Naturopath working in a busy sports medicine and sports therapy clinic, I see many patients with sore, stiff, achy muscles. Many patients have been lead to believe that muscle pain and tension are normal facets of aging that should be expected, and that popping over the counter pain relievers is ok in moderation, and necessary to achieve a pain-free existence.

For many of my patients, additional factors contribute to muscle pain and when addressed, impart significant relief. More often than not, simple nutrient support is required, and often includes vitamin D, B vitamins and Magnesium. Without sufficient magnesium, muscles are unable to fully relax, lending to chronic muscle tension, trigger points and pain.

When patients explore their own symptoms, they often recognize that other muscles in their body are chronically tight and unable to relax as well, this is where high blood pressure and constipation enter the picture.

Your blood vessels contain smooth muscle that contract and relax, contributing to your body’s intricate ability to control blood pressure. If your blood vessels aren’t able to full relax due to reduced magnesium, blood pressure goes up.

Similarly, when magnesium stores are low in the muscles of your intestines, constipation ensues as these muscles remain contracted, and are unable to fully relax and function appropriately during bowel movements and normal digestion.

Additional presentations associated with low magnesium include migraine, cluster or tension headaches, insomnia, asthma, arrhythmias, depression, ADHD, premenstrual syndrome and osteoporosis.

Addressing micronutrient deficiencies before they develop into major health concerns is by far the most cost-effective and preventative approach.

Not sure if you are suffering from low magnesium?

Common signs include tired, stiff muscles, infrequent bowel movements (less than 2 daily), high blood pressure, headaches and difficulty sleeping.

If you’d like to see whether magnesium is a good option, try it! Unless you suffer from diarrhea, kidney disease, or have a sensitivity to magnesium, supplementing is safe in the dosage schedule outlined below:

Take 1 capsule daily, before bed for 3 days. If after 3 days, you aren’t having 2-3 bowel movements daily, increase your dose to 1 capsule 2x daily. Continue to increase your dose in this fashion until you achieve 2-3 bowel movements daily. It is fine to take the magnesium in 3 divided doses over the course of the day, ideally with food. Magnesium capsules are available in doses ranging from 50 mg-1000mg, although lower dosed capsules are the most useful, as they allow the most sensitive dose titration. At Vitality Clinic patients are prescribed NFH Magnesium bisglycinate, containing 150 mg of elemental magnesium.

If you are able to find it, magnesium bisglycinate is the most effective form of oral magnesium when it comes to improving tissue stores. With time, as your magnesium status improves, you’ll likely need to lower your daily dose to avoid loose stools. If you’re unable to find magnesium bisglycinate, magnesium citrate is suitable. However, the body tends to excrete magnesium citrate much more readily.

Additionally, try to increase magnesium containing foods in your diet. Greens such at spinach, kale and collards in addition to beans, nuts and whole grains are good sources. Although increasing dietary magnesium is a great idea, many people find their need to supplement decreases, but is not eliminated entirely.

Correcting low magnesium can be an incredibly simple, yet effective tool in managing a myriad of health concerns. Sore, tired muscles really are the tip of the iceberg!

Have a great day,
Dr. Kaleigh Anstett
Vancouver Naturopath

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Points to Consider When Choosing a New Mattress

Wed, 26 Nov 2014 22:41:25 +0000

So you’re thinking about purchasing a new mattress, but you are wondering about which one is best suited for you. This is a topic of conversation I have on an almost daily basis with my chiropractic patients. I don’t claim to be the expert on mattresses, but I do know a lot about backs and back health.

Here are a few things to consider:

1. Mattresses should be replaced every 8-10 years.

2. Size- Deciding to go with a Queen or King sized mattress can mean the difference of a few hundred dollars so it is an important decision. If you are a tall individual, a King is a must as you need to ensure your legs don’t hang off the end of the bed! You don’t want to always have to resort to sleeping on the diagonal. Do you share your bed with a loved one… including your furry friends? If so, the extra room may be necessary.

3. Firmness– For the majority of my chiropractic patients, I advocate a semi-firm mattress; it’s the half way point between medium and hard. Far too often mattress are purchased too soft because they initially feel more comfortable. Unfortunately, they often don’t have the coil count to support the weight necessary, especially if there is more than one of you in the bed.

4. Coil count– most semi firm mattress have a coil count between 800-1000.

5. Pillow Topper– PLEASE do not purchase a mattress with a pillow topper attached! This will SIGNIFICANTLY reduce the life span of the mattress as the material will break down over the years due to different pressure points of your body. Your hips and pelvis region are heavier than your legs and your head and shoulders are heavier than your chest so the pillow topper will start to form this shape. You end up with lumps, bumps, or rolls. If you purchase a mattress you feel is a bit too firm, consider buying a pillow topper as an add-on. The second point to consider is if you purchase a mattress with a pillow topper attached, you forfeit the ability to flip your mattress. Rotating and flipping your mattress periodically is essential for maintaining it’s life span.

6. Comfort- All things considered, you still need to make sure you receive a decent night’s sleep! If a mattress hits all the points listed above and felt super comfortable in the store but you are constantly tossing and turning (even after the appropriate break in time), you may need to choose a different mattress. Most stores realize you aren’t going to be able to determine whether the mattress is truly the right one for you by lying on it for 15 minutes in the store so most have a great exchange policy. However, be sure but to check with the store on their particular exchange/return policy prior to making this investment.

7. Pillows– choosing a pillow is equally as important as the mattress yourself. I’ve recommended the same pillow for 14 years as I feel it is the best on the market. Why you ask? It is the only pillow I have found that provides the perfect amount of support and it allows you to sleep both on your side and on your back.

I can’t stress enough how important a good mattress (along with maintenance chiropractic care ) is to help maintain a healthy back!

Have a great day,
Dr. Crysta Serné
Vancouver Chiropractor and owner of Vitality Clinic

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Best Sleeping Position For Neck Pain?

Sun, 02 Nov 2014 15:17:58 +0000

I get asked all the time: what is the best sleeping position? Usually the best sleeping position is lying on your back! But many people cannot seem to get comfortable or fall asleep while lying flat on their mattress so they end up side lying or face down. With proper support to the neck, lying in a side posture position can be a great choice to complement chiropractic care with ongoing neck stiffness. With adjustments and exercise prescription during the day, and a well rested spine and supporting muscles at night with proper sleeping postures, pillows, and a mattress, you can start looking forward to saying “goodnight to neck pain and stiffness”.

To discuss neck stiffness and sleeping positions, or to discuss low back pain and the best sleeping positions to take stress of the spinal joints and musculature, call us for a consultation. The most optimal sleeping position is different for all body types and differs depending if you are currently in discomfort or if it is for preventative measures!

These 5 tips are taken from an article from Harvard Health Publications:
1. Try using a feather pillow, which easily conforms to the shape of the neck. Feather pillows will collapse over time, however, and should be replaced every year or so.

2. Another option is a traditionally shaped pillow with “memory foam” that conforms to the contour of your head and neck. Some cervical pillows are also made with memory foam. Manufacturers of memory-foam pillows claim they help foster proper spinal alignment.

3. Avoid using too high or stiff a pillow, which keeps the neck flexed overnight and can result in morning pain and stiffness.

4. If you sleep on your side, keep your spine straight by using a pillow that is higher under your neck than your head.

5. When you are riding in a plane, train, or car, or even just reclining to watch TV, a horseshoe-shaped pillow can support your neck and prevent your head from dropping to one side if you doze. If the pillow is too large behind the neck, however, it will force your head forward.

Read the full article here

Have a great day and sleep well,
Dr. Lucas Tisshaw
Vancouver Chiropractor and ART provider

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Have You Recently Been In a Motor Vehicle Accident?

Thu, 02 Oct 2014 14:50:23 +0000

Often, individuals are unsure of when to start Chiropractic care once they have been in a motor vehicle accident. This brochure provided by the BCCA may help one decide what steps to take. After the Crash Brochure

If you have additional questions, or would like to book an appointment, please contact the clinic.
You may also contact the Chiropractors directly if you have any additional questions. [email protected] or [email protected].

Have a great day,
The Vitality Team

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Scarves Are Not Just a Fashion Accessory

Sat, 20 Sep 2014 14:21:53 +0000

It is the time of year when we all pull out our array of scarves or pashminas. As a Chiroprctor, I advocate the use of them for more than just their fashion statement.

When you are chilled, people have a tendency to migrate their shoulders up around their ears. This creates mucsle tension and joint fixations. Scarves help keep the neck warm and the shoulder in their rightful position!

Keep warm and have fun shopping!

Have a great weekend,
Dr. Crysta Serné
Vancouver Chiropractor and owner of Vitality Clinic

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TENS (Transcutaneous Electrical Nerve Stimulation)

Mon, 08 Sep 2014 13:40:39 +0000

A significant number of my chiropractic and sports therapy patients already have a TENS unit at home or end up purchasing one from me as it can be a valuable adjunct to the services I provide at the clinic. I purposefully did not go into detail about what specific conditions you should use the TENS for; it is very important you seek out your health care provider to give you specific instructions pertinent to your individual health needs. Further, the embedded article goes into detail about the machine parameters and mechanism of action. It is quite lengthy but if you have a TENS unit, the material will be very beneficial to you.

TENS is a method of electrical stimulation, which primarily aims to provide a degree of pain relief (symptomatic) by specifically exciting sensory nerves. It can be used in several different ways, each being best suited to different pain relief mechanisms. Success is not guaranteed with TENS, and the percentage of patients who obtain pain relief will vary, but would typically be in the region of 70%+ for acute pains (strains, sprains, contusions, etc) and 50%+ for more chronic pains (fibromyalgia, chronic fatigue, osteoarthritis, etc). The technique is non-invasive and has few side effects, when compared with drug therapy. The most common complaint is an allergic type skin reaction (about 2% of patients) and this is almost always due to the material of the electrodes, the conductive gel, or the tape employed to hold the electrodes in place.

TENS Treatment setup – typical applications

1. Traditional TENS (Hi TENS)

Usually use stimulation at a relatively high frequency (90 – 130 Hz) and employ a relatively narrow pulse width (start at about 100 µs). The stimulation is delivered at normal intensity – definitely there but not uncomfortable.

It is suggested that in order to reach deeper lesions, the pulse duration should be increased.

2. Acupuncture (Lo) TENS

Use a lower frequency stimulation (2-5 Hz) with wider (longer) pulses (200-250 µs). The intensity employed will usually need to be greater than with the traditional TENS – still not at the patients’ threshold, but quite a definite, strong sensation.

3. Brief Intense TENS

This a mechanism which can be employed to achieve a rapid pain relief, but note, some patients may find the strength of the stimulation too intense and will not tolerate it for sufficient duration to make the treatment worthwhile.

The pulse frequency applied is high (in to 90-130 Hz band) and the pulse width is also high (200 µs plus). The current is delivered at, or close to the tolerance level for the patient – such that they would not want the machine turned up any higher. In this way, the energy delivery to the patients is relatively high when compared with the other approaches. It is suggested 15 minutes at this stimulation level is the most it would normally be used.

4. Burst Mode TENS

As described above, the machine is set to deliver traditional TENS, but the Burst mode is switched in, therefore interrupting the stimulation outflow at rate of 2 – 3 bursts/second. The stimulation intensity will need to be relatively high, though not as high as the brief intense TENS.

Electrode placement

Target the stimulus at the appropriate spinal cord level (appropriate to the pain). Usually start with the electrodes either side of the involved area. You can use other stimulation points so long as the TENS activates the sensory nerves that enter the cord at the same neurological level. One can therefore employ nerve roots, the course of the appropriate peripheral nerve, motor points, trigger/acupuncture points, the same dermatome, myotome, or scelerotome. If the pain source is vague, diffuse, or particularly extensive, one can employ both channels simultaneously, and some health care professionals use a cross over technique in an attempt to increase the intensity of the stimulation.

TENS parameters and mechanism of action

If you have a TENS unit and would like a greater understanding of it’s applications, please consider booking a consultation with one of our Chiropractors.

Have a great day,
Dr. Crysta Serné
Vancouver Chiropractor and owner of Vitality Clinic

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Rehabilitating Neck Injuries

Fri, 25 Jul 2014 14:11:13 +0000

Most non-traumatic conditions that produce neck pain can be managed by chiropractors, with physical/sports therapy to augment rehabilitation. One key role the chiropractor can often play is to reassure the patient that the injury is not serious. After, the goal of immediate treatment is to minimize pain and inflammation with recommendations of natural anti-inflammatory supplements, natural muscle relaxants, application of TENS, interferential current (IFC), icing, and in some cases immediate manipulation. The chiropractor will perform an examination to determine if manipulation is clinically warranted at the onset of treatment. Rehabilitation to recover lost function should address the entire kinetic chain and include an aerobic component. Return to play must be gradual. Some injured or aging patients may have to cut back on activity or cross-train to maintain an active lifestyle.

The primary care practitioner must have a rational approach to non-traumatic neck and associated upper-limb pain during all phases of rehabilitation management: acute, recovery, and maintenance. Early pain control combined with appropriate rehabilitation techniques and followed by a gradual return to activity is the key in safely putting patients where they want to be: back in action.

Immediate Treatment

General guidelines A specific diagnosis of non-traumatic neck pain is sometimes difficult to make, especially if the pain is localized. Therefore, the chiropractor’s key role can be in assuring the athlete the problem is not serious. If the patient has normal strength and reflexes and a history consistent with mechanical pain, he or she can be told with confidence that no significant herniated disk or nerve injury exists, and that resolution or control of symptoms is expected without surgery or other invasive techniques. Even in the setting of a herniated intervertebral disk with radiculopathy, aggressive conservative care frequently prevents the need for surgical intervention (5).

Management of neck pain is divided into three phases: acute (immediate), recovery/correction (manipulation/rehabilitation), and maintenance (return to play) (6.) In the acute phase, the goal is to minimize pain and inflammation. Initial treatment of acute injuries consists of manipulation, hydrotherapy, electrotherapy, and a 4- to 6-week course of anti-inflammatory drugs, most preferably natural sources, such as Nature’s Relief, or similar compilations consisting of Bromelain, Boswelia, Devil’s Claw, Tumeric, and/or Ginger. Further, frequent self-administered ice packs to the painful area for 10 to 15 minutes, and home stretching within the “vulnerable ROM.” The patient should discontinue activities that aggravate symptoms.

Manual therapy is a valuable empiric adjunct to other measures during both the acute and recovery phases of treatment. Whether high-velocity manipulation, passive mobilization, muscle energy technique, or fascial release is used, the athlete may find that pain decreases and range of motion improves faster with manual therapy, above all else.

A patient who recovers full and painless range of motion within a few days to a week can return to sports without limitations or further treatment.

Radiculopathy. In the athlete who has a cervical radiculopathy, a more prompt referral to physical therapy is warranted, in addition to the measures described above. Cervical traction, postural exercises, gentle cervical mobilization, and education are a few of the early measures a therapist might employ to help diminish radicular pain.

If the patient does not have any resolution of symptoms within 2 to 4 days of rest, ice, anti-inflammatory supplements, or if the pain prevents participation in physical therapy, referral to another health care practitioner may be warranted.

Chronic injury. In degenerative cervical pain syndromes, the initial treatment for exacerbations has some similarities to the acute pain treatment. Cervical manipulations and a short course of anti-inflammatory supplements may be used for periodic flares. In addition, moist heat applied before activity and ice packs after may also provide symptomatic relief.

Some athletes acknowledge their chronic condition and merely seek suggestions about modifying their activity. A 60-year-old male swimmer who has a degenerative disease, for example, can turn his head to the uninjured side during the crawl or switch to the back stroke to prolong the “life” of his neck. Education about mechanics such as proper form, posture, and exercises is greatly enhanced by a knowledgeable chiropractor, especially one who also specializes in sports therapy.

Rehab and Recovery

As pain and inflammation are being controlled, the athlete is advanced to the recovery phase of rehabilitation, where the goal is to recover lost function. Physical therapy is appropriate for any athlete who has acute neck pain and is slow to recover, or for a patient who has chronic neck symptoms but has never had a thorough physical therapy evaluation and treatment. The primary principle that the chiropractor and/or therapist should understand when treating neck pain is that of the kinetic chain (6.) The essence of this principle is that a functional and/or biomechanical deficit or injury anywhere in the musculoskeletal system can lead to injury elsewhere in the system.

For example, a tennis player who has poor thoracic and lumbar mobility and abnormal scapulothoracic and glenohumeral (shoulder) mechanics will stress her cervical spine more often during serving and overhead shots as she tries to maximize her reach and power. This can result in a cervical overuse syndrome. Thus, the physical therapist must address rehabilitation at all appropriate levels of the kinetic chain for a successful outcome. Cole et al (8) provide a more detailed description of kinetic chain rehabilitation in sports-related cervical spine injuries.

The patient should also work on aerobic conditioning during the acute and recovery phases because maintaining overall fitness will facilitate return to activities. Aerobic exercise can include stationary biking, brisk walking, using a stair-climbing machine, or some other non-impact activity. Upper and lower extremity strengthening and stretching should also be maintained, provided the exercises do not exacerbate the cervical condition. If at any time during the acute or recovery phases the athlete does not respond as expected, he or she should be referred to a specialist for further evaluation.

Returning to Activity

Few things are more frustrating for an athlete than to be out of sports because of an injury, but one of them is re-injury as a result of a premature return. To minimize the chance of re-injury, the athlete is promoted to the maintenance phase of rehabilitation only after certain criteria have been met. The goal in this phase is to ensure a graduated return to sports while maintaining the gains made during the recovery phase.

For the athlete who periodically has neck pain only in connection with an acute injury, one goal is pain-free cervical range of motion before full return to sports. On the other hand, an athlete who has a chronic cervical pain syndrome, such as degenerative disk disease, and who sustains a flare-up or superimposed neck injury, will return to full activities when he or she reaches the “familiar” level of pain. Cervical rotation and lateral bending should approach symmetry, with right and left values within about 10% of one another. The range of cervical flexion and extension cannot be compared with values from an uninjured side, so clinical judgment based on normal ranges of motion must be used.

Motor strength of the neck muscles, another return-to-play criterion, is difficult to quantify in the clinician’s office, but a good qualitative attempt should be made. The patient should offer strong, pain-free cervical resistance to the examiner’s hand in flexion, extension, lateral bending, and rotation. Rotation and lateral bending should be relatively symmetrical side to side. Extension should be more powerful than flexion. Return to full athletic participation should be delayed if a gross side-to-side discrepancy is noted.

In patients who have cervical radiculopathy, the examiner should note side-to-side differences in extremity range of motion and strength. The involved limb should be pain-free in motion with no further dysesthesias, and have at least 80% to 85% of the range of the uninvolved side. Motor strength in the myotome of the affected limb should have recovered to at least 75% of that of the opposite side before the patient begins a gradual return to sports (6).

The athlete should resume his or her sport at a level or intensity that allows pain-free participation, then increase the time, distance, weight, number of throws, etc, by approximately 10% each week. For example, if the 60-year-old swimmer mentioned previously had swum 30 laps per session prior to a flare of his symptoms, he might start at 15 laps and increase by 1.5 to 2 laps each week until he reached his previous level. If the patient’s symptoms return at any point, he or she must drop back to the previous pain-free level and continue working on strength, flexibility, and good mechanics before attempting to advance. A qualified coach can be invaluable in helping many athletes develop proper technique, which will facilitate injury-free participation.

Modifying Behaviours

Whether the patient is a recreational or professional athlete, at some point aging may dictate an alteration in activity. Some patients by the age of 30 or 40, many by the age of 50, and most by the age of 60 will have to spend more and more time working to maintain neck flexibility and strength for sports that require significant cervical movement.

For the young athlete who finds cervical injuries occurring more frequently, or the older athlete who has chronic cervical pain, the chiropractor must ensure that appropriate radiologic studies (usually plain radiographs) have ruled out a serious problem, and that the rehabilitation program has been pushed to its maximum benefit. If a complete and well-rounded exercise program is not preventing or minimizing neck pain during sports, the athlete must consider other options. These may include tolerating a certain amount of discomfort or taking periodic breaks of 1 to 3 months from a sport to allow the neck to recover, much as a professional athlete does during the off-season.

Maintenance cervical adjustments, sports massage, IMS and/or acupuncture are a valuable adjunct to control pain for most patients. These treatments, however, should serve to compliment an active rehabilitation program, not replace it.

Another reasonable approach would be to help the patient understand the ideas of conservation (cutting back intensity and/or frequency to improve longevity) and cross-training. For example, our swimmer with chronic neck pain who swims freestyle 5 days a week for 30 minutes may benefit from mixing the backstroke into his routine, limiting sessions to 20 minutes 3 days a week, and working out on a cross-country ski machine the other 2 days. The use of alternative training techniques will allow injured or aging patients to maintain an active lifestyle.

References
1. Cantu RC: Sports medicine aspects of cervical spinal stenosis. Exerc Sport Sci Rev 1995;23:399-409
2. Torg JS (ed): Athletic Injuries to the Head, Neck, and Face, ed 2. St Louis, Mosby Year Book, 1991
3. Torg JS: Cervical spinal stenosis with cord neurapraxia and transient quadriplegia. Clin Sports Med 1990;9(2):279-296
4. Wiesenfarth J, Briner W Jr: Neck injuries: urgent decisions and actions. Phys Sportsmed 1996;24(1):35-41
5. Saal JS, Saal JA, Yurth EF: Nonoperative management of herniated cervical intervertebral disc with radiculopathy. Spine 1996;21(16):1877-1883
6. Kibler WB: A framework for sports medicine: evaluation and treatment. Phys Med Rehabil Clin North Am: Sports Medicine 1994;5(1):1-8
7. Travell JG, Simons DG: Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore, Williams & Wilkins, 1983
8. Cole AJ, Farrell JP, Stratton SA: Cervical spine athletic injuries: a pain in the neck. Phys Med Rehabil Clin North Am: Sports Medicine 1994;5(1):37-68

Have a great day,
Dr. Crysta Serné
Vancouver Chiropractor and owner of Vitality Clinic

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Neck Pain and Injuries

Sat, 19 Jul 2014 16:46:08 +0000

Neck pain or related upper-limb pain can be very disabling for active patients, young and old. The broad differential includes such conditions as strain, sprain, disk injury, radiculopathy, carpal tunnel syndrome, ulnar neuropathy, and degenerative shoulder disease. Approxiamtely 70% of diagnosis’ can be made solely based on history and physical exam findings. It is essential to determine whether the pain is localized or radiating. Localized neck pain generally points to muscle strains, ligament sprains, and degenerative facet or disk processes. Pain that radiates into the upper limbs frequently stems from nerve involvement. Unless significant trauma has occurred, diagnostic images are not warranted unless they are likely to change treatment.

The typical active person takes neck movements for granted until pain limits activity. Fitness clubs and physical therapy facilities are filled with people striving to develop an increased strength and/or flexibility in their upper and lower limbs, as well as in the abdomen. Often the neck is frequently neglected when it comes to preventing and rehabilitating injuries.

The cervical spine is one of the key links in the kinetic chain of physical motion. It controls head movement and, therefore, a person’s ability to direct his or her organs of sensation. When bone, muscles, or nerves of the neck region are damaged, activities ranging from sedentary to record-setting are disrupted. The chiropractor, therefore, must have a rational approach to diagnosing patients’ common neck and associated upper-limb syndromes so that appropriate treatment can be initiated.

Muscle strains usually resolve within a few days to a couple of weeks, ligament sprains may take up to a couple of months, and disk injuries or herniations with radiculopathy can take up to 6 months for full recovery. Chronic pain beyond 6 months is likely associated with a degenerative process; the intervertebral disk, bone, or ligament, or from subtle mechanical instability caused by faulty posture or biomechanics.

Pain that increases with activity or within a few hours after activity, but settles down with rest or a change in position is commonly referred to as mechanical pain. Pain that persists or worsens despite rest and treatment, pain that persists around the clock, or pain that worsens at night raises suspicion for a metabolic or neoplastic condition or for psychosocial factors that prolong recovery. It’s important, therefore, to inquire about recent fevers, weight loss, or history of carcinoma; the resulting information might suggest the expeditious use of appropriate lab tests and imaging. Questions about recent personal stresses, worker’s compensation, or third-party liability cases may also provide useful information.

Location. It is essential to determine whether the pain is localized or radiating; therefore, knowledge of the anatomic region is essential. Localized pain generally points to muscle strains, ligament sprains, and facet or disk (degenerative) processes, although these structures commonly radiate pain to the periscapular or upper trapezius area as well (5,6). Pain that radiates into the upper limbs frequently stems from nerve involvement, although myofascial pain radiation patterns occur occasionally. C-Spine Anatomy
The cervical spine is made up of seven vertebrae. C-1 articulates with the occiput of the skull above and with C-2 below. The atlanto-occipital joint primarily allows flexion and extension, while the atlanto-axial articulation primarily provides rotation. Vertebrae C-3 through C-7 allow for varying degrees of flexion, extension, lateral bending, and rotation. Flexion centers on C-5 and C-6 and extension on C-6 and C-7, which is why degenerative changes and spine injuries most commonly occur at these levels.

Intervertebral disks are found from C2-3 and below and are subjected to significant deformation during flexion and extension. Disk degeneration may be painful in its own right, while herniation can lead to compression of the nerve root (radiculopathy) or spinal cord (myelopathy.) Eight pairs of cervical spinal nerves exit bilaterally through the intervertebral foramina. Each spinal nerve is named for the vertebra above which it exits; for example, the C-6 nerve exits above the C-6 vertebra. Therefore, a herniated disk or significant foraminal narrowing at the C5-6 level will most commonly involve the C-6 nerve. The exception is the C-8 spinal nerve, which exits between the C-7 and T-1 vertebrae.

The posterior aspect of the cervical vertebral articulation contains the facet joints, which are true synovial joints, while a bony lip off the lateral margin of the upper vertebral body forms the uncovertebral joint with the vertebra below. Both joints are subject to degenerative changes that may produce pain with cervical extension combined with lateral bending and rotation. Hypertrophy of these joints may affect the surrounding anatomic structures, including the spinal cord, nerve roots, and exiting spinal nerves, as well as the vertebral artery and the sympathetic rami.

The muscles of the neck are divided into four major compartments: anterior (flexion), posterior (extension), and the lateral groups (lateral bending). The posterior muscles are the strongest group and most likely to be the source of pain in conditions resulting from poor posture, in which these muscles are chronically contracting to hold the head upright. The weaker anterior and lateral muscles are involved more in whiplash type injuries in which they stretch suddenly.

Upper cervical nerve injuries are relatively rare and refer dysesthetic pain to the head (C-1, C-2), the neck (C-3), and the upper trapezius region (C-4). The C-5 nerve transmits pain to the shoulder and lateral arm, and occasionally the radial forearm. The C-6 nerve pattern is very similar but invariably includes the radial forearm and thumb, and occasionally the index finger. The C-7 nerve refers pain to the posterior arm, dorsal (occasionally ventral) forearm, and the index and middle fingers. The C-8 nerve classically radiates pain to the medial arm, ulnar forearm, and the ring and little fingers.

Additionally, evidence indicates that the lower cervical nerve roots, disks, spinal longitudinal ligaments (5), and facet joints (6) refer pain to the scapular region. Along with myofascial pain trigger points or biomechanically induced muscle strains, these structures are the common origins of scapular and periscapular pain.

Other differential diagnostic considerations for referred pain include thoracic outlet syndrome and ulnar neuropathy, in which pain refers to the medial arm, forearm, and ring and little fingers, similar to a C-8 radiculopathy. Thoracic outlet syndrome typically will involve more proximal pain as well, such as in the axilla or scapula. Carpal tunnel syndrome characteristically causes dysesthesias in the thumb and first two fingers, and sometimes pain up the arm as high as the neck, thereby mimicking a C-6 or C-7 radiculopathy. Shoulder degenerative joint disease or acromioclavicular, subacromial, or rotator-cuff pathology may be confused with a C-5 radiculopathy.

Reflex sympathetic dystrophy is frequently associated with fractures or even minor trauma to the upper extremity. Pain from brachial plexus injuries or neuritis radiates to multiple dermatomes and myotomes in the arm and forearm, although patients characteristically have little neck pain. Finally, with the increasing incidence of cumulative trauma disorders related to the workplace, many “weekend warriors” complain of vague symptoms in their neck and upper extremities that they attribute to their sport but that actually result from overuse the other 5 days a week.

Characteristics. The quality or intensity of the pain may give clues to its origin. A muscle, ligament, or disk may give rise to sharp pain acutely, and more of a dull, aching sensation in the sub acute or chronic period. Pain of bone and joint origin may refer through the sensory portion of the motor nerves (sclerotome), and is described as a deep or boring pain. Electrical, numbing, tingling, or shooting sensations generally describe neurogenic pain, while throbbing sensations have been attributed to vascular causes.
In an acute injury, muscle guarding can occur as a protective mechanism, however, its long-term presence is usually the sign of a deeper pain generator (disk, bone, nerve root irritation.) The “spasm” is the muscle’s attempt to stabilize the neck and prevent painful motion.

Aggravating and alleviating factors. Finally, asking about aggravating and alleviating factors can further define the pain generator. Combinations of flexion, extension, or lateral bending with rotation that cause localized neck pain may point to muscle, ligament, discogenic, and/or degenerative bone pain. Pain primarily with neck extension is frequently due to compression of the posterior elements, including the facet joints. If pain radiates into the upper limb, a nerve root is usually involved. In an athlete age 50 or older, foraminal stenosis is common; in the younger athlete a discogenic source is more likely. Relief of symptoms with cervical traction generally points to a discogenic or disk-space-narrowing process.

Recumbency usually alleviates mechanical pain, although nocturnal pain with dysesthesias in the arms or hands raises suspicion for thoracic outlet syndrome, carpal tunnel syndrome, or shoulder impingement. Morning pain and stiffness is often seen with osteoarthritis. Pain with overhead activities that radiates into the upper extremities may stem from thoracic outlet syndrome or shoulder impingement. Pain toward the end of the activity or end of the day is associated more with a degenerative process or chronic overuse syndrome. Relief usually comes from rest and preventative chiropractic care.

References for Neck Pain and Injuries

Have a great day,
Dr. Crysta Serné
Vancouver Chiropractor and owner of Vitality Clinic

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Correcting Faulty Posture

Fri, 27 Jun 2014 17:40:28 +0000

Posture is essential to the position of the body in space. Optimal posture is the state of muscular and skeletal balance that protects the supporting structures of the body against injury or progressive deformity, whether at work or at rest. Correct posture involves the positioning of the joints to provide minimum stress on the joints of the body. Conversely, faulty posture increases stress on the joints. This increased stress can be compensated for by strong muscles, but if they are weak or the joints lack mobility or are too mobile, joint wear and modification can occur. As well, damage and changes to the surrounding tissues can occur. Posture can also involve the chain link concept of body mechanics in which problems anywhere along the body chain can lead to problems above or below that point.

For example, knee pain can arise from pelvic joint disorders. Without good posture, your overall health and total efficiency may be compromised. Because the long term effects of poor posture can affect bodily systems (such as digestion, elimination, breathing, muscles, joints, and ligaments), a person who has poor posture may often be tired or unable to work efficiently or move properly. Even for younger people, how you carry yourself when working, relaxing or playing can have big effects.

Did you know that just fifteen minutes reading or typing when using inappropriate biomechanics will exhaust the muscles in your neck, shoulders, and upper back?

Causes of Poor Posture
The causes of poor posture can be divided into two categories: positional and structural. Structural causes are basically permanent anatomical deformities not amenable to correction by conservative treatments.

Positional causes of poor posture include:
• Poor postural habit for whatever reasons the individual does not maintain a correct posture
• Psychological factors, especially self esteem
• Normal developmental and degenerative processes
• Pain leading to muscle guarding and avoidance postures
• Muscle imbalance, spasm, and contracture
• Respiratory conditions
• General weakness
• Excess weight
• Loss of proprioception – the inability to perceive the position of your body in space

Physiology of Posture
Posture control involves static and phasic reflexes. Static reflexes involve sustained contraction of the musculature while dynamic, short term phasic reflexes involve transient movements. Both types of reflex are integrated at various levels in the central nervous system (CNS) from the spinal cord to the cerebral cortex and are largely affected through extrapyramidal motor pathways. Postural reflex patterns from reflexes, such as the stretch and withdrawal reflexes, result in a coordination of many joint movements and combinations of muscle actions. These include contraction of prime movers, synergists, and stabilizers, along with the necessary relaxation of antagonists. These muscles are regulated for contraction intensity, speed, duration, and sequential changes in activity. The integrative pattern of posture is predominantly automatic and unconscious, resulting from the incessant shifting of weight (postural sway.) Postural corrections are continually mediated by the myotatic stretch reflex. Posture is further mediated by the visual, labyrinthine, neck righting reflexes, and by the interplay of joint reflexes. While the control of posture is primarily controlled by various reflex mechanisms, there is also extensive input from the higher centers of the central nervous. Therefore, posture to some extent can be relearned (corrected) just as it was learned in the first place. What does perfect posture look like?

Normal Posture
Perfect standing posture is when the following are properly aligned:
• The points between your eyes, chin, collarbone, and midpoint between your ankles
• From the side, you can easily see the three natural curves in your back
• From the front, your shoulders, hips, and knees are of equal height
• Your head is held straight, not tilted or turned to one side
• From the back, the spinous processes of your spine should be in straight line down the center of your back
Obviously, no one spends all day in this position. But, if you naturally assume a relaxed standing posture, you will carry yourself in a more balanced position and with less stress in your other activities.

Poor Posture
When you have poor posture, the body’s vertical position is out of alignment and the back’s natural curves become distorted. Head forward or slouched posture:
• Rounded shoulders
• Head forward, rounded upper back
• Arched low back
• Protruding buttocks
• Chest flattens
• Abdominal organs sag, crowding and making more work for your heart and lungs
• Seen often in women who have osteoporosis in later years

Military Posture:
• Head pulled back
• Shoulder blades tightly pulled back
• Arched lower back
• Knees locked (hyperextended)
• Minimizes the spinal column’s ability to be a shock absorber for the body
Slumped sitting posture:
• Upper back humped or too rounded
• Head forward
• Rounded lower back

Tests for Postural Faults
The Wall Test- Stand with the back of your hand touching the wall and your heels six inches from the baseboard. With your buttocks touching the wall, check the distance with your hand between your lower back and the wall, and your neck and the wall. If you can get within an inch or two at the low back and two inches at the neck, you are close to having excellent posture. If not, your posture may need professional attention to restore the normal curves of your spine.

The Mirror Test- (Anterior View) Stand facing as full length mirror and check to see if:
1. your shoulders are level
2. your head is straight; no chin deviation; ears are level
3. the spaces between your arms and sides are equally spaced
4. your iliac crests and hips are level
5. kneecaps face straight ahead
6. a 5° foot flare is shown
7. arches are not flat
8. there is no Achilles deviation, and
9. no evidence of scrunching of the toes

Check for the following:
1. head is erect, not slumping forward or backwards; no anterior head carriage
2. chin is parallel to the floor; no hyperlordosis
3. shoulders are in line with the ears, not drooping forward or pulled back,
4. stomach is flat; neutral spine
5. knees are straight, and
6. pelvis is neutral (slight anterior tilt)

Correcting Postural Faults
A patient’s postural faults must be accurately diagnosed before they can be effectively corrected. Examination and diagnosis should include the following:
• observation of the patient as they sit and move about
• measurement or estimation of the deviation from the ideally erect postures using plumb lines, inclinometry, and posture guides
• three dimensional analysis
• spinal segmental alignment
• flexibility tests
• muscle length and strength tests

The importance of muscle testing to postural analysis can not be over-emphasized. Also, much of the specific therapy in posture correction relies on muscle tightness and weakness found during the examination.

Conventional Corrective Therapies
Five main modalities are employed in the conventional treatment of faulty body mechanics and hence postural faults: chiropractic treatments; hydrotherapy; soft tissue work (MRT); and stretching and strengthening exercises. Shortened agonist muscles must be stretched before the antagonist muscle can be optimally exercised to increase their strength, or vice versa. Depending on the condition, manipulation may also be required to release and accompanying fixation.

Orthotics
Often postural faults are the result of a leg length discrepancy; either functional or structural (anatomical.) Correction of functional shortness involves a number of factors. First, correction of any structural faults has to be made to allow for the normal weight distribution and normal functioning of the joints and muscles involved. This is done by correcting any muscular imbalances (right vs. left and front vs. back) that become apparent. Adjustments allow all joints to function under a proportionate weight distribution which is essential as they are the holding elements for muscles. Lastly, orthotics are prescribed to maintain any structural discrepancy remaining.

Article submitted by Dr. Crysta Serné
Vancouver Chiropractor and owner of Vitality Clinic

(original article provided by Dr. Weatherall at http://www.advancechiro.on.ca.)

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Care of Head, Neck, and Upper Back

Mon, 23 Jun 2014 15:53:01 +0000

When you are experiencing discomfort in the neck, upper back, head, and/or shoulders, ordinary activities which you have taken for granted become a source of irritation. Therefore, it is important for you to be aware of the basic principles of good care.

General Advice:

1. Balance activities with rest. Change positions and take short rest periods often. Slowly increase activities over a period of time.
2. Use ice or contrast treatments to help alleviate muscle tension and increase circulation. Moist heat applied to the muscle is the next best alternative for non-acute problems.

Sleeping:

Avoid sleeping on stomach

A. When sleeping on back:

1. Use a Therapeutica© pillow or towel rolled under neck
2. Elevate your legs by placing one pillow under the knees.
3. Attempt to quiet the mind; when our minds are active, so are our muscles. Focus on deep breathing.

B. When sleeping on side:

1. Lay head on a pillow large enough to fill from one ear to shoulder(neck should lay 90 degrees to shoulder.)
2. Place a pillow between the knees and ankle to support the hips and sacroiliac joint.

Standing or Sitting:

1. Keep the chin tucked in, shoulders back and relaxed, abdomen tightened, maintain the hollow in the back, and knees slightly relaxed. REMEMBER: head over shoulders and chin level!
2. Avoid bending head backwards into extreme positions.
3. Avoid pushing the head forward (think of an apple between the chin and chest)
4. Sit and stand, pretending a string is pulling up from the back of the head.
5. When sitting, have support in the small of the back.

Working:

1. Perform all work with hands as close to the body and elbows at your sides.
2. Avoid holding arms overhead or at shoulder height
3. Pull the seat forward and hold onto the bottom of the steering wheel when driving.
4. Place your work surface high enough so that it is not necessary to bend over your work.
5. Change your work position often to avoid stiffening of weight bearing joints.
6. Avoid lifting. If you have to lift, keep your back straight, stoop with knees bent, keep the close to you, and then lift with your legs.
7. Check your alignment several times throughout your work day. Keep your head over your shoulders.

Remember the rule of 90°; ankles, knees, hips, elbows, shoulder, and chin should all be 90° to the floor.

Should you wish to book an appointment with one of our Chiropractors, please call the office.

Have a great day,
Dr. Crysta Serné
Vancouver Chiropractor and owner of Vitality Clinic

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Pillows

Fri, 20 Jun 2014 17:31:37 +0000

When determining what pillow would be best suited for you, consider your own sleeping position. Contoured pillows can be very useful if sized appropriately for your neck and back sleeping is your primary sleeping position. NEVER purchase a contoured pillow if you ever find yourself on your side as it will create an inappropriate fulcrum on one side of the neck.

If you sleep on your side, your pillow should be firm enough not to allow the head to drop below the shoulder you are sleeping on. Ideally, one should have their neck at 90 degrees to their shoulder.

Of course, stomach sleeping should be avoided for a number of biomechanical/postural reasons.

For 14 years, I have recommended one pillow brand- Therapeutica. It allows you to sleep on your back and on your side, and they come in a variety of sizes.

Should you want to consider purchasing one, you need not be a patient of the clinic to do so. If dispensed by a Chiropractor, they are often covered under extended health plans.

Have a great day,
Dr. Crysta Serné
Vancouver Chiropractor and owner of Vitality Clinic

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Upper Body Stretches

Tue, 27 May 2014 22:45:22 +0000

Here are my three FAVOURITE stretches for the upper body. Although they are generic, they should not be performed with out speaking to your health care provider first. Please DO NOT attempt these stretches if you have shoulder, neck, or upper back pain that has not been diagnosed!

Wall Angels

This is a great stretch and strengthen exercise as it stretches your anterior shoulder and pectoralis muscle, but it also helps strengthen rear deltoids and rhomboids. This is vital for proper joint mobility and spine alignment.

Ensure that when you are doing this stretch, your feet are not right against the wall as this does not allow your back and buttocks to rest flat against the wall (you do not want your back to arch, but rather keep its natural curvature.) I stand about a foot away and then lean back, with my knees slightly flexed.

Once you’re in this position, if you want to challenge yourself further, slide your arms up against the wall to the end up straight overhead. Always keep your wrists and elbows firmly against the wall throughout the entire movement.

Eagle Pose

I am only offering the arm component of this yoga pose but do recognize their is a leg componenet to make it a true “Eagle pose- Garudasana”

Open your palms. Cross your left arm to your right. Raise your right arm with your hand stretching towards the ceiling. Bring your palms together as close as possible, depending on your flexibility. Your fingers should be pointing upwards. Make sure you don’t let the shoulders migrate up. To increase the depth of the pose, slowly raise your elbows towards the sky- you should feel it in the posterior aspect of the shoulder, tricep, and across your upper back.

Yoga Mudra

This is a great stretch for the anterior shoulder, bicep, pectoralis, and back. Once seated on your heels, exhale, place your arms behind your back, and interlace the fingers together. Draw the shoulders away from the ears and squeeze the shoulder blades together to press out through the sternum. Inhale and arch the chest up towards the ceiling. Keep the chest open as you exhale and hinge at the hips, lowering the forehead down to the floor (optional). Lift the arms up as high as you can keeping the palms press together if possible.

The above stretches can be modified to your individual needs, so please ensure that speak to your health care provider prior to attempting any of them.

Enjoy!
Dr. Crysta Serné
Vancouver Chiropractor and owner of Vitality Clinic

*If you have an injury, or have never attempted to perform these stretches before, please consult with your health care provider. Vitality Clinic and Dr. Crysta Serné assumes no responsibility.

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What to Expect At Your First Chiropractic Visit

Sat, 24 May 2014 21:30:42 +0000

As we so often receive calls from new patients setting up their first chiropractic appointment, we thought a breakdown of what you can expect during your initial consultation and treatment would be helpful.

History and Symptoms
In preparation for the chiropractic consultation, an individual will be asked to fill out forms that provide background information about their symptoms and condition. Once your forms are completed, the chiropractor will go through them with you, asking specific questions in order to gain a thorough understanding of your background and the specifics of your complaints.

The types of questions your chiropractor is likely to ask you include:
1. When and how did the pain start?
2. Where is it located?
3. Is it a result of an injury?
4. What provides relief?
5. What aggravates the discomfort?
6. Description of the discomfort
7. Have you experiences other sensations- numbness, tingling, or weakness?
8. General activity levels
9. Sleeping position

Patients are also asked to provide information on family medical history, any pre-existing medical conditions or prior injuries, and previous and current health providers and treatments.

The Chiropractic Exam
A complete chiropractic exam will then be performed. In this examination, you will undergo a postural evaluation, global and specific range of motion tests, segmental joint evaluation, orthopaedic tests specific to the area in question, and a complete neurological examination.

The goal of these tests is to establish:
● Range of motion of the affected part
● Muscle tone
● Muscle strength
● Neurological integrity

Diagnostic Studies to Supplement the Chiropractic Exam
Based upon the results of the history and chiropractic exam, diagnostic studies may be helpful in revealing pathologies and identifying structural abnormalities that can be used by the chiropractor to more accurately diagnose a condition. Diagnostic studies are not always necessary during the chiropractic exam, and the practitioner will discuss if they are clinically warranted prior to administering.

The most common diagnostic studies during chiropractic exams include:
SEMG (surface electromyography)- a muscle scan
X-ray exam
MRI (Magnetic Resonance Imaging) scan
Other laboratory tests

Our clinic performs muscle scans, but x-Rays, MRI scans, and more extensive imaging studies will be referred to an outside centre.

Patient Diagnosis after the Chiropractic Exam
History, physical examination, and any diagnostic studies lead to a specific diagnosis. Once the diagnosis is established, the chiropractor will determine if the condition will respond to chiropractic care.

Our Chiropractors will explain a patient’s:
Diagnosed condition
Individualized chiropractic treatment plan (or other treatments)
Anticipated length of chiropractic care

For more on chiropractic treatment plans following diagnosis, see the next section of this article.

Chiropractic Treatment Plan
Most often, our Chiropractors begin treatment during the patient’s first visit.

● Chiropractic treatment recommendations may include some, or all, of the following:
● Adjustments to key joint dysfunctions
● Modalities to improve soft tissue healing and pain control, such as ultrasound, electrical stimulation, and traction
● Exercises to improve muscles balance, strength, and coordination
● Patient education to improve posture and motor control
● Other treatments such as ART, massage, heat/cold application, and nutraceutical recommendations.

Goals of the Chiropractic Treatment Plan
The chiropractor will establish specific goals for a patient’s individual plan for treatment:

Short-term goals include reducing pain and restoring normal joint function and muscle balance.

Long-term goals include restoring functional independence and tolerance to normal activities of daily living.

To reach these goals, a specific number of chiropractic visits, such as 1 to 3 chiropractic visits/week for 2 to 4 weeks, may be prescribed and followed by a re-examination by the Chiropractor.

We look forward to meeting you,

Dr. Crysta Serné

Vancouver Chiropractor and owner of Vitality Clinic

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Chiropractic Isn’t All About the “Crunch”

Sat, 24 May 2014 21:08:53 +0000

Many individuals thrive on the sound they hear when they seek out chiropractic treatments; they feel robbed if they don’t hear it. However, the high velocity low amplitude adjustment that renders that cavitation, or sound, is not for everyone….. The hard part is having the chance to speak to the patient about their options before they come in. A lot of patients don’t seek out Chiropractic care because they don’t like the thought of hearing that sound, or want their neck or body moved in a particular way. It doesn’t have to be like that! I have found that an overwhelming number of patients utter these words at some point in their treatment plan; “if only I had come to you sooner!” It is both a source of frustration and a challenge to me because I want to be able to help individuals but I can’t have a living room chat with everyone to try and change their perspective on Chiropractic and the level of care that I can provide.

Case In Point

My mother’s friend was at the house seeking out answers to questions he had about his particular condition. He was never fully informed of why he was having such excruciating back pain when he visited a previous health care Practitioner, nor was given a diagnosis. I sat down with him for an hour and explained the anatomy of the area in question and the cause of his concerns. I questioned him as to why he never sought Chiropractic care and he went into a long diatribe about how his wife had seen someone but he was nervous and wasn’t sure it was for him. He then exclaimed that as a result of talking to me, I changed his attitude about Chiropractic and more importantly, gave him some very needed optimism that he could recover from his ailments. Unfortunately, I can not reach everyone this way…

When you first seek out treatment from a Chiropractor, it is usually for one of a few reasons. Mostly, it is due to feeling of being “out of alignment, stuck, or locked,” that causes you discomfort, pain, or lack of mobility. During the initial assessment, I perform an extensive examination and history. Before a treatment is EVER rendered, I will determine what treatment options will work best for you and talk to you about them; your comfort level is one of the most important elements when rendering an adjustment. Let me explain what a high velocity low amplitude (HVLA), or manual, adjustment is. I personally find that it one of the most useful techniques for most patients, as it creates the largest change in the joint over a relatively short period of time. The most important factor though, is ensuring that the muscles are relaxed and you can deliver the adjustment quickly. The other chiropractic techniques I implement are useful, but I find that they take longer to yield the same results. Activator is a mechanical tool that looks a lot like a leather puncher. It has a nice rubber stopper on the end that with the force of the coil, causes the joint to move, with out ever rendering a sound or having the patient in an “awkward” position. Activator is also very useful for small joint like the fibular head, or some of the ankle or wrist articulations. In addition, it is an EXTREMELY useful tool to use on patients that are apprehensive or don’t like hearing any sound.

The drop table technique is a very useful to tool to use as it takes the muscles out of play so the patient is always relaxed. I find the drop piece very useful for hips, pelvis, shoulders, and stubborn low backs. These techniques, combined with soft tisue therapy, stretches, strengthening exercises, modality work, supplement recommendations, and home care advise are all taken into consideration when developing a specific treatment plan.

Once again, chiropractic CAN be for everyone. It is just a matter of understanding your needs and comfort level. I hope this allows you to have an open mind when perhaps making a decision to visit us.

Have a great day,
Dr. Crysta Serné
Vancouver Chiropractor and owner of Vitality Clinic

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