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.

A muscle cramp is a strong, painful contraction often occurring in the legs, but not limited to. Onset is sudden and lasts from a few seconds to several minutes. When it occurs in the legs, it is commonly referred to as a charley horse.

Night time leg cramps are usually sudden spasms, or tightening, of muscles in the calf. The muscle cramps can sometimes happen in the thigh or the foot, although much less frequently. Unfortunately, cramps often occur just as you are falling asleep or waking up and can be quite disrupting to your sleep.

What causes muscle cramps?
The cause of muscle cramps isn’t always known. Muscle cramps may be brought on by many conditions or activities, such as:

1. Electrolyte deficiency (not having enough potassium, calcium, and other minerals in your blood.)

2. Dehydration.

3. Exercising, injury, or overuse of muscles.

4. Pregnancy. Cramps may occur because of decreased amounts of minerals, such as calcium and magnesium, especially in the later months of pregnancy.

5. Standing on a hard surface for a long time, sitting for a long time, or putting your legs in awkward positions while you sleep.

6. Exposure to cold temperatures, especially to cold water.

7. Other medical conditions, such as blood flow problems (peripheral arterial disease), kidney disease, thyroid disease, and multiple sclerosis.

8. Taking certain medicines, such as antipsychotics, birth control pills, diuretics, statins, and steroids.

How can you stop a muscle cramp when it happens?
You may need to try several different techniques/tips to stop a muscle cramp before you find what works best for you as the cause of cramps depend on varying factors. Here are a few things to try to alleviate them:

1. Stretch and massage the muscle.

2. Take a warm shower or bath to relax the muscle. A heating pad placed on the muscle can also help.

3. Magnesium

4. Drink plenty of water.

5. Electrolyte replacement supplements or drinks.

If the aforementioned tips don’t alleviate the symptoms, consider coming in for an evaluation.

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

Your iliotibial band (ITB) is fascia- a non contractile tissue- meaning it doesn’t have the ability to shorten or lengthen on its own. It relies on the muscles that attach to it so foam rolling your ITB is the same as trying to roll out a piece of paper versus trying to roll out pizza dough. You want to roll out muscles as they act in the same manner as pizza dough; they have the ability to shorten, and most importantly, lengthen. This is the entire point of rolling out an area. What you should be rolling out are the muscles that attach to the ITB; the TFL (tensor fascia latae), gluts, and vastus lateralis (VL).

In order to effectively roll out the vastus lateralis- one of the quad muscles- you want to place your leg on a 45 degree angle to the roller.  Do not place your leg directly on it’s side on the roller (as you have likely done in the past when believing rolling out the ITB was a good idea) as this will just glom the fascia right up against the VL and cause an inordinate amount of discomfort. Foam roll the TFL and gluts by placing the foam roller perpendicular to the muscle you want to roll.

The key to effective foam rolling is to ensure your muscles are already warm; never, never, never roll out a cold muscle! I advise my patients to foam roll after they have exercised and stretched. I suggest doing about 10-15 passes per muscle.

One of the most important tips to remember is to never foam roll an injured muscle.

Why do patients often think they should “roll out their ITB’s” in the first place? If you are a runner, cyclist, dancer, gymnast, or are active in any sports that relies heavily on your legs, you may be prone to ITB syndrome. This may affect your lower back, knees, quads, and the rest of the lower kinetic chain.

Stretching the TFL and foam rolling the aforementioned muscles will go a long way in preventing tight lower extremity muscles and ITB syndrome. If you would like to book an assessment to ensure you are performing optimally, please don’t hesitate to call or email the clinic.

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

Stir the pot – no, not the chili – the exercise that is touted as one of the best core exercises on the planet by Canada’s own top spine researcher Prof. Stuart McGill, should be considered as an addition to your workout routine as soon as possible (after consulting a health practitioner).

Stir the pot puts dynamic strength and stability demands on your core, with muscles such as rectus abdominus, transversus abdominus, and internal and external obliques firing to keep the spine and pelvis in a neutral position while you balance on a Swiss (exercise) ball. One of the key aspects of this exercise is the somewhat unpredictable movements the spine will perform while the body attempts to keep balanced on a unstable surface. Compare this to a plank on the ground (planks are still great!); the ground is not moving, and is not going to move, and your body and spine know this. This forces the muscles to activate, but it is in a predictable fashion. Compare this to an unstable surface such as the exercise ball, which represents a real time scenario of, for example, getting out of a car. Your spine has to bend forward into flexion, rotate, laterally bend, and then extend while standing up straight.

Unless in an acute stage of low back pain, most people don’t think about stabilizing specific muscles to do this motion, instead, they just do it. In dynamic training with “stir the pot”, we attempt to put your core in a situation where it reacts to unpredictable stability demands on the fly, more like a real time situation. Reiterating that planks are a great exercise, as is side planks, superman’s, and a tonne of other core exercises, consider adding “stir the pot” to your exercise routine after consulting your favourite health practitioner at Vitality!

Have a great day and contact myself, Dr. Lucas Tisshaw or Dr. Crysta Serné at Vitality Clinic, to discuss a core stabilization program that is tailored specifically for you.

Sincerely,
Dr. Lucas Tisshaw
Vancouver Chiropractor rand ART Provider

It’s running season! One of the first questions I ask my chiropractor and sports therapy patients is if they do more than a casual jog to warm up when they set out for their run. All too frequently, they sheepishly reply with a “nope“. It is important to start out with a very casual jog to increase general circulation and warm up the body, but you should then transition into a dynamic warm up to isolate stretching specific muscles involved in the run.

Running is one of the most complex forms of exercise in that it uses so many muscles so we want to do everything we can to prevent injuries from occurring!

As mentioned, first start out with a casual jog for about five minutes. Moving in the direction you want to continue with, bring one knee to your chest and raise onto your toe with the other leg. Repeat with the other side. Continue this for about 30 meters. This will warm up your hamstrings and calf muscles.

Next, I like to encourage my patients to perform an inch worm (or caterpillar). It does require putting your hands on the ground so hopefully you don’t shy away from it merely because you might gets your hands a bit dirty!

Start by rolling your head forward and then follow with your torso until your hands are on the ground (if you are feeling a strong stretch in your hamstring, it is ok to start with your knees slightly bent). This is very similar to a rag doll position in yoga, and you then end up in a downward dog. Now, walk your hands forward until you are in an outstretched position; a plank. Stay there for a few seconds and then slowly walk your feet back towards your hands (if you need to bend your knees while doing this- it’s ok!). Roll your torso slowly up and finish with your head so you are once again in standing position. This dynamic stretch really helps warm up the back muscles, the hamstrings, and the quads. Repeat 5 times.

Increase the speed of your jog slightly and do a few shoulder rotations and arms swings in the process.

Lastly, you should do a “spiderman”. It involves a repeat of the rag doll, downward dog, and plank positions. However, this time, you will bend one knee and bring your foot as close to your hand as possible. Hang out there for a few seconds and then bring the other foot up so it is resting beside the other hand. Really engage those gluts and hips and pry your knees as wide apart as they are comfortable spreading. Use your shoulders to aid in the stretch if need be. With a wide stance, slowly roll your torso up, and then your head so you are once again in a standing position. This stretch really helps open up the hips, stretches the groin, and continues to lengthen the lower back muscles.

As you are continually moving in a forward direction and you are constantly moving body parts, you should notice your overall time isn’t being compromised too much!

If you have any questions or concerns, please don’t hesitate to contact the clinic and set up a consultation.

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

Related Articles:
Running Injuries
Running in the Rain
Running and Acupuncture
5 Minutes of Running Per Day
Core, Core, and More Core
Running Shoes

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

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

Related articles:
Care of Head, Neck, and Upper Back
Mouse Placement
Stretches for Upper Back
Neck Pain
Posture at Work 
Work Hacks

Ask anyone who steps into my Chiropractor and Sport Therapy Clinic- I am a HUGE advocate for introducing core exercises into your home care regime. Stretching is important too, but it’s if you don’t have the muscle endurance to keep those joint where they are meant to be, you will find your back health doing a roller coaster ride between healthy and injury prone. Along with maintenance chiropractic adjustments, core exercises are a key ingredient to eliminate low back pain and restore healthy activities of daily living.

Once you have the basics down (pelvic tilt, prairie dog, plank, single leg heel taps, Supermans, etc) you are ready to move on to incorporating the ball into your exercises. The ball adds an extra element of dynamic stability so any core exercise done on the ball should be considered moderate to advance in difficulty. Make sure you are comfortable with where you are on the core strength continuum before initiating any of these exercises.

First, it’s important to remind you the MOST IMPORTANT factor in performing any exercise is technique. If you feel you are struggling with maintaining proper technique, stop, and do a few lesser challenging exercises to build the muscle memory back up. It is OK!- any core exercise is better than none and the last thing you want is to injure (or re-injure) yourself.

Starting, Push up Hold, or Plank Position   (as shown in the feature photograph)

With the exercise ball in front of you, lower yourself down so your stomach is resting on the ball. Now walk your hands forward until you reach a point where you feel your back muscles and abdominals are working; the ball may be at the level of your knees, shins, or feet. As you gain strength in your core, you will find your able to increase the distance between the ball and your hands. Ultimately, you want to end up having only your feet and lower ⅓ of your legs touching the ball.

You should be completely flat with your legs straight. The shoulders should be positioned ever so slightly behind your hands. (*Even in the photograph, I should have my back just a tiny bit less rounded than it is!)

This position in and of itself is a great core exercise- it is considered a bilateral isometric exercise as both sides of the body are working and the muscles are neither increasing nor decreasing in length.

Hold the position until you feel a slight tremor in either your core muscles or arms, and then slowly walk your hands back towards the ball until your stomach is resting on it. Repeat 5 times.

If you are using the position as a starting position only, here are just a few of the multitude of exercises you can perform!

Jack Knife

When doing a jack knife, the key is to keep the knees as parallel with the floor as possible. You want to avoid having your knees pointing down towards the floor. By maintaining an elevated knee position, you are engaging your hip flexors and learning to perform a pelvic tilt at the end of the jack knife. Remember to keep your mouth open or sing a song as this will prevent you from holding your breath.

Repeat 10-15 times and then hold the plank position for as long as you are able to maintain proper technique.

Slowly walk your hands back towards the ball until the ball is once again positioned under your stomach. Take caution when you stand up as the blood may have rushed to your head while performing the exercise, and you may get a very mild dizzy spell. Anther way to dismount off the ball is to one at a time lower each knee/foot to the ground when you are in the plank position.

Pike Up

A pike up is an extremely challenging core exercise as you are not only balancing your feet on the ball but you are also utilizing a fair amount of shoulder and arm strength as well.

Start in the push up position and then roll the ball towards your chest with your feet while pushing your bum into the air at the same time. Once you have reached as high as you can with your bum, slowly return to the starting position.

Repeat 10-15 times.

If you want to increase the difficulty even further, lift one leg straight into the air when at the peak of the pike up.

Step Downs

This is a great unilateral core exercise as you are tapping one toe onto the ground while maintaining the plank position with the other leg on the ball.

Once in the starting position, lift one leg up and slowly lower it to the ground- do not rest your foot on the ground. It is meant to tap and then return to the plank position. Repeat on the other side. You have the option of performing all 10 on the same side before repeating with the other leg, but I enjoy the increased dynamic element when having to alternate between each leg.

Russian Twists

If at any time during exercising you feel pain in any body part, discontinue the exercises, and consult with your Chiropractor. As always, I assume no responsibility for exercises performed without my authorization.

Lastly, it’s NEVER to early or late to start a core exercise program!

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

If you are looking for some variation to your leg workout, look no further.  Bulgarian split squats targets the quadriceps with the gluteus maximus, soleus and adductor magnus working to assist. The hamstring, gastrocnemius, gluteus medius and gluteus minimus all act as stabilizers. As it is done with the rear foot elevated on a bench, it builds lower body muscles without the additional stress on the back found with traditional squats. As a Chiropractor, this is something I am always concerned with so this is one more reason I advocate this exercise!

Why this is referred to as a Bulgarian split squat is unknown to me as the Bulgarian weight lifter never did this exercise! At any rate, it is a fabulous lower extremity exercise but I consider it a moderate to difficult exercise so use caution when attempting it.

The key to this exercise is to have adequately warmed up your body and stretched your hip flexors! Second, and equally important, is the position of your knee to your foot. NEVER allow your knee to migrate in front of the knee. Your weight should ALWAYS be on the heel of the front foot. When performing the split squat your front knee should never move- it should always remain stationary. It is your back (elevated) leg that is doing the majority of the work.

Start by positioning yourself with your back foot on the bench. I do a few hops forward to ensure I am in the key position. If you have never done this exercise before, have a spotter in front and hold onto their hands the first few times you lower down.

 (starting position)

To increase stability, I place my hands on my waist. With the weight through your front heel, slowly lower yourself down until your knee is almost touching the ground. Raise back up with the same tempo as you lowered down with (about 4 seconds.)

Perform all 10-12 reps on the same side and then repeat on the other side.

The position you start with is key so take your time to set up!

To increase difficulty, add a dumbbell to each hand.

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

*Dr. Serné and Vitality Clinic assumes no responsibility for anyone attempting to perform this exercise

Another great core exercise to add to your arsenal. This particular exercise focuses on internal and external obliques, transverse abdominals, and paraspinals.

I would consider this a more advanced core exercise as it takes quite a bit of dynamic stability and control when on the ball.

First, start by grabbing a weight bar you feel comfortable with when holding it straight out in front of you. Place it on your stomach and sit on a ball. Slowly roll yourself out so you are in a supine plank position on the ball. Raise the bar in front of you so it is positioned at chest height but never below your xiphoid process.

While maintaining the bar position, slowly rotate your body to one side. Make sure you are contracting your abs when returning to the starting position as this is equally important in increasing abdominal strength. Repeat on the other side.

Repeat each side 5-10 times.

Always remember to make sure you are breathing throughout the exercise. A tip I offer my patients is to always make sure their mouth is open as this prevents you from inadvertently pursing your lips together.

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

Related articles:
Core, core, and more core

This is a great core exercise geared towards those just starting out and/or anyone who has suffered from any type of sciatic pain, disc pathology, or spinal stenosis. This core strengthening exercise is one of my personal favourites as it can easily be modified to increase or decrease difficulty depending on rehabilitation needs, as well as having the option to make it an unilateral or bilateral exercise.

Although core exercises are a fundamental component of any chiropractic treatment plan, not all core exercises are suitable for every back ailment or condition. If you have back concerns, please consult with your Chiropractor or health care practitioner to ensure this exercise is suitable for you.

Step 1: Start by lying flat on your back. Engage your lower abdominal muscles and perform a pelvic tilt. Place your hands in a triangle shape and position them directly under your sacrum. They should rest in and about the same shape as your sacrum (the triangle bone at the very base of your spine.)

Step 2: Raise both legs and place them in a table top position (both knees and hips should be at roughly 90º angles). The key to having this exercise engage the correct muscles is to ensure the hips and knees are stacked on top of each other or the knees are even slightly angulated away from the torso (as demonstrated in the picture to the right).  If  you allow your hips to be drawn closer to your chest, you will find the exercise much easier as it will not isolating the lower back and pelvic floor muscles.

Step 3: Slowly lower one foot towards the floor while continuing to maintain your hand position under the sacrum. This forces the pelvis into a pelvis tilt, allowing you to properly execute the move without arching your back and increased risk of injury.  DO NOT HOLD YOUR BREATH! Only if you have an extremely strong core, and no current back concerns, should you consider removing your hands and performing the heel tap.

Step 4: Alternate sides and repeat each leg 5 times. It should take about 5 seconds to lower one leg to the floor.

If you would like to increase the difficulty of the exercise, attempt to perform the exercise with alternating straight legs or with both legs lowering simultaneously.

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

*Dr. Serné assumes no responsibility for anyone attempting to perform these exercises without her specific approval.

So what is Kinesiotaping all about anyway?

Kinesiotaping gives support and stability to your joints and muscles without affecting circulation and range of motion. It is also used for preventive maintenance, edema, and pain management.

Kinesiotaping exhibits its efficacy through the activation of neurological and circulatory systems. The Kinesio Taping Method is applied over muscles to reduce pain and inflammation, relax overused tired muscles, and to support muscles in movement on a 24hr/day basis. It is non-restrictive type of taping which allows for full range of motion

Kinesio Tape can be used to treat a variety of musculoskeletal conditions, including carpal tunnel syndrome, lower back strain/pain, knee conditions, hamstring, groin injury, rotator cuff injury, whiplash, tennis elbow, plantar fasciitis, patella tracking, pre and post surgical edema, ankle sprains, athletic preventative injury method, and as a support method.

Kinesiotape structurally lifts the skin and allows the flow of body fluids under the application area, reducing edema, inflammation, and discomfort.

Kinesiotaping simulates human skin in thickness and weight. It has an elastic component that allows a stretch 30-40% beyond its normal length.  Unlike other tapes that restrict movement, Kinesiotape allows for full range of movement while providing support to the muscle.

Kinesiotape is heat activated and durable which allows for a 3-4 day wearing periods This avoids the hassle of applying and removing traditional sports tapes every few hours. It also gives lasting support and pain relief.

Kinesiotape has a 100% high grade cotton, wavy design that enhances comfort and channels out air, sweat, and water.

Kinesiotape is hypoallergenic and latex-free minimizing skin irritation.

If you would like to learn more about Kinesiotaping or would like to book an appointment with Dr. Anstett, please contact [email protected] or call 604.687.7678

Have a great day,
The Vitality Clinic

Although curling may be slightly less popular than ice hockey, it is a favourite among many Canadians, young and old. Curling is sometimes viewed as a sport that is also perhaps less strenuous than others but if you curl, whether as a part of a competitive league or just for fun, you know curling is a great source of exercise (especially in the winter months when walking or summer sports may be less desirable.)

Curling actually requires a significant amount of strength, flexibility, and core stability. Along with the physical demand comes mental acuity and motor control as you attempt to be accurate with the weight, distance, and spin of the rock. While throwing the rock, almost every joint in the body is under load, all this while demanding significant range of motion.

Therefore, the most common curling injuries are musculoskeletal in nature and most often affect the back, knees, and shoulder. These injuries are normally the result of movement involving stress on your joints due to the sweeping motion. This stress is really not surprising when you think about the fact that the stones are made of pure granite and can weigh upwards of 20kg.

Tips to avoid curling injuries:

1. Stretching. This can’t be stressed enough. Heading out onto the rink thinking that the sport isn’t difficult and, therefore, stretching isn’t really necessary will cost you in the end.

A. Warm up your quads by placing your foot on a chair so your knee makes a right angle. Hang out there for 5 minutes while drinking your coffee and then repeat on the other side.

B. Stretch your shoulders by doing a cross the body arm pull. Hold for 45 seconds and repeat on the other side.
C. Stretch your forearms by applying light pressure to your hand when it is at 90 degrees to your arm.  

D. Stretch your lower back by bending over at the waist until you feel a stretch in your lower back and hamstrings- you should never feel a pinch or twinge!

2. Learn the proper technique. First-time curlers: this is for you! Watching a curling tournament on the television doesn’t mean you know what you’re doing. Make sure you get some guidance or head out with someone who can give you some specific points to help you form and refine your own stance and procedure.

3. Wear the right equipment. Jeans may be stylish but they don’t belong on the rink. Wear comfortable clothing; something that allows your joints to move freely. And don’t forget gloves!

If you’ve already curled and didn’t realize how hard it can be on your body, we can help! There’s no need to suffer through pain if you’re already dealing with a curling injury.

Consider having an assessment with one of our clinic Chiropractor’s to get your body straightened out! A chiropractor can help adjust and manipulate misaligned joints that are contributing to pain and bring you relief.

Have fun on the rink,
Dr. Crysta Serné
Vancouver Chiropractor and owner of Vitality Clinic

Winter is here and a large portion of the Lower Mainland population are raising their après drink classes in celebration of the local North Shore mountains, Grouse Mountain and Cypress Mountain, opening up some of the terrain for downhill skiing and snowboarding! Not only are the local mountains open, Whistler Blackcomb has opened up this past weekend and locals and internationals are a buzz in excitement for a hopefully long and prosperous mountain season. The speed and unpredictability of the mountain slopes can result in numerous aches, pains, and serious injuries for skiers and snowboarders. A fall onto any surface from powder to packed snow groomers can result in various areas of discomfort and stiffness. Neck and lower back strains, from mild to severe, are common complaints that can often be put to rest with a few chiropractic appointments. Other common areas that chiropractic and Active Release Therapy (ART) can help with are skiing injuries to the shoulder, thumb, knee, hip, and foot.

Here are a few tips to prevent injuries from occurring in the first place:

Foam rollers and stretching prior to and after hitting the slopes can be great to help loosen up the body but access to a roller and space to do it are not always practical. Grab a lacrosse, ball hockey, or tennis ball and try to dig into those gluts and hips as well as quad and hamstrings. Body weight squats and lunges are highly recommended prior to strapping into skis or a snowboard, as well as jumping down into a downward dog/upward dog routine with a few warrior poses for 3 minutes before hitting the slopes.

Some common winter sport complaints that chiropractic can help rehab and prevent:

Neck and Shoulder:
– whiplash
– cervical strain
– rotator cuff strain
– subacromial impingement
– stiffness between the shoulder blades

Back:
– muscle strains
– disc herniation
– pain with bending over (flexion intolerant low back pain)
– tailbone sensitivity (sacro-iliac joint dysfunction with ligament sprains)

Knee:
– hamstring strains
– meniscus sprain
– patellofemoral pain syndrome

Hip:
– pelvic rotational imbalance
– gluteal strains
– groin pulls
– hip flexor tightness

Wrist and Hand:
– Skiers thumb
– wrist sprain
– joint stiffness
– forearm strain and Tennis Elbow

Interested to find out how chiropractic can enhance your ski season this year by allowing you to spend more enjoyable and pain free days on and off the hill? I will gladly have an in-person or teleconference consultation to discuss how you can benefit from individual treatment plans of chiropractic and myofascial release. Contact us today at 604-687-7678 to discuss your health treatment options and to develop a prevention routine!

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

Related Articles:
Stretching For the Slopes

There are countless physical activities out there, but walking has the lowest dropout rate of them all! It’s the simplest positive change you can make to effectively improve your general health.

Research has shown that the benefits of walking and moderate physical activity for at least 30 minutes a day can help you:

1. Lubricate joints and increase circulation to muscles- essential for patients who suffer from arthritis, low back pain, or chronic muscle strains
2. Strengthen your bones
3. Reduce the risk of osteoporosis
4. Improve your balance and coordination
5. Maintain a healthy weight
6. Reduce the risk of coronary heart disease
7. Improve blood pressure and blood sugar levels
8. Improve blood lipid profile
9. Maintain body weight and lower the risk of obesity
10. Enhance mental well being
11. Reduce the risk of breast and colon cancer
12. Reduce the risk of non-insulin dependent (type 2) diabetes
13. Elevate your mood

The faster, farther, and more frequently you walk, the greater the benefits.

Consider your technique

Turning your normal walk into a fitness stride requires good posture and purposeful movements. Ideally, here’s how you’ll look when you’re walking:

1. Your head is up. You’re looking forward, not at the ground.
2. Your neck, shoulders and back are relaxed, not stiffly upright.
3. You’re swinging your arms freely with a slight bend in your elbows. A little pumping with your arms is fantastic and encouraged.
4. Ensure you’re using your core- your stomach muscles are slightly tightened and your back is straight, not arched forward or backward.
5. You’re walking smoothly, rolling your foot from heel to toe.
6. Plan your routine

As you start your walking routine, remember to:

Get the right gear. Choose shoes with proper arch support, a firm heel and thick flexible soles to cushion your feet and absorb shock. If you walk outdoors when it’s dark, wear bright colours or reflective tape for visibility.

Choose your course carefully. If you’ll be walking outdoors, avoid paths with tree roots, cracked sidewalks, potholes, low-hanging limbs or uneven turf.

Warm up. Walk slowly for five to 10 minutes to warm up your muscles and prepare your body for exercise.

Cool down. At the end of your walk, walk slowly for five to 10 minutes to help your muscles cool down.

Stretch. Again, you should walk for a few minutes to increase circulation (and warm up the muscles), and then do some light dynamic stretches (kicking heels to your bum, bringing your knee to your chest, etc). After you cool down, gently stretch your muscles as well. When you are calling down, you want to engage in static stretches (holding the position for a period of time versus elongating the muscle through moment).

The rule of thumb is you stretch prior to activity to prevent injury, and you stretch after to promote flexibility.

When to Walk

Getting into the activity habit is easiest if you choose a specific time each day. If you are a morning person, consider walking before you go to work or after the kids are off to school.

Not a morning person? A walk on your lunch break will work up an appetite and help your digestion.

Alternatively, if evening is the best time for you, schedule your walk after dinner and evening chores are completed.

The important thing is to decide on the best time for you and try not to allow other things to get in the way.

Look at your walk as an enjoyable break in your day – a time when there are no chores to do or deadlines to meet. Breathe deeply. Look up at the sky, the trees and the rooftops. Smile. Life gets better when you fit in a walk.

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

I feel great! Do I still need to do core exercises?

Yes, yes, and yes! I’m sure yo’ve heard the old adage “if you don’t use it, you’ll lose it.” Well even though you may think you are doing tons of core work when you are at the gym by doing a plank, deadlifts, and some abs, you aren’t working your core enough.

In order to truly maintain your core, you need to do at least 4-6 exercises geared solely on the core- I refer to these exercises as micro-movements. Sure, you’re working your core when you are doing box jumps and squats, but you are doing macro-movements and your core in engaged, not being isolated.

The sole premise for doing core exercises is to increase the endurance of the really small muscles (intrinsic) of the back (multifidus, rotatores, interspinalis, ) so your back doesn’t fatigue as quickly. It is not about power and strength, which is really what squats, deadlifts and back extensions are for. Don’t get me wrong- if you have a healthy back, these are great exercises to incorporate into a well rounded workout routine.

Here are many examples of core exercises you should incorporate into your exercise routine:
Supermans
Plank
Bridge
Single leg Bridge
Reverse crunch
Prairie Dog
Superheroes
Supine Heel Taps
Russian Twist
Ball Core Exercises
Mountain Climbers

There are a plethora of exercises to choose from so don’t limit yourself to just the ones mentioned above. If you want an individualized program based on your back concerns, please book an appointment and we will be happy to design one for you.

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

This particular core exercise is fantastic for anyone with a disc injury (whether it’s a new injury, a flare up of an old injury, or a previously healed one.)  It is also a great starting point for those just beginning a core program.

Start by lifting one arm and the opposite leg into the air (as seen in the picture to the right.)  Hold for 3 seconds and repeat on the other side.  Pay attention to your breathing- make sure you are not holding you breath!  If you are just starting a core workout routine, stay with doing opposite arm and leg raises.  Repeat each side so you end up doing 5-8 holds per side.  After a few days of doing the arm and leg raises, proceed to step 2.

Now lift just your arms and chest into the air.  Hold for 3 seconds.  Ensure your gluts are as relaxed as possible so you work your back and not the butt!

Finally, lift both arms and legs into the air.  Hold for 3 seconds.

Repeat the cycle 3-5 times.  I would recommend doing this series twice daily.  Please consult with your health care practitioner prior to engaging in these exercise to ensure they are suitable for you.

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

A concussion is a traumatic brain injury that alters brain function due to the disruption of the cell membrane of nerve cells. Concussions often result after a blow to the head, but they can also occur when the head, neck, and upper body are violently shaken, such as in a car accident. Historically, people would think of concussions only when there is a loss of consciousness, but most of time there is no loss of consciousness, resulting in undetected concussions. Signs and symptoms include headaches, problems with concentration, memory, balance, pupil changes, nausea, and blurred vision.

Most concussions require rest and time to heal, with a large variance of recovery time between different cases. The best recommendation is to slowly return to sport or physical activity and do not rush back in full force until symptoms are completely gone. Chiropractors are trained to evaluate and recognize concussions as they can go hand in hand with common conditions that people seek chiropractic for: whiplash and sports injuries. During a blow to the head or an accident, it is likely that the cervical spine misaligned and resulted in reduced regular range of motion. This can result in neck, upper back, and shoulder pain that are often present with concussions and can be managed case by case with chiropractic adjustments, joint mobilizations, interferential electric current, and myofascial release technique.

If you or anyone you know “gets their bell rung” or has a known concussion, advise them to stop physical activity and be evaluated by different health professionals, including a chiropractor to help with neck and upper back muscle and joint pain, and tension headaches.

Stay safe,
Dr. Lucas Tisshaw
Vancouver Chiropractor and ART Provider

Regardless of any injuries, I always recommend to my chiropractor and sports therapy patients to implement closed kinetic chain exercises.  This refers to having your feet firmly planted on a surface, whether it be the machine platform when doing a leg press or keeping both feet on the ground when doing lunges.   The reason I advocate not doing walking lunges or leg curls is when you aren’t firmly planted, your muscles can fire incorrectly causing muscular and joint imbalances.

When performing a reverse lunge, as demonstrated in the picture to the right, knee to ankle position is imperative to ensure proper technique and prevent injuries to ankle, knees, hips, and lower back.

I usually ask patients to start out in the position with their knee on the ground.  Once established, they then raise their knee off the ground and perform the lunge.  The back heel always remains raised off the ground and the weight should be dispersed through the front heel.

Ideally, you should do approximately 15-20 per side, switch legs, and repeat.

Please do not perform this exercise if you have an acute injury to your lower body.  Seek out an assessment and treatment before engaging in any exercise involving your ankles, knees, hips, or lower back.

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

A stress fracture is a partial to complete hairline break in a bone, without displacement, due to repeated trauma and with no history of overt trauma.

The bones most commonly affected are:
1. Metatarsals (foot bones)- especially the second one
2. Tibia (shin)
– upper shaft more common in dancers and gymnasts
– lower shaft- more common in runners
3. Fibula- lower 1/3rd above lateral malleolus
4. Calcaneus (heel)

Metatarsal Stress fracture
1. Usually a result of repetitive microtrauma (overuse) from jumping, marching, running, dancing.
2. Bone deformity causing a weight transfer through the bones of the foot
3. Biomechanical faults creating an increased pronation of the foot or foot slap
4. Osteoporosis- women who do not have a regular or any cycle are at an increased risk.

Tibial Stress Fracture
1. Often preceded by “shin splints”
2. Biomechanical faults creating an increased pronation of the foot or foot slap
3. Overuse
4. Osteoporosis- women who do not have a regular or any cycle are at an increased risk.

Generally, patients present with acute pain but they can not determine what initiated the pain. The pain increases in its severity quite abruptly and decreases with rest.

As mentioned, stress fractures often result as an overuse injury in runners, dancers, gymnasts, or athletes involved in jumping or running. Often the athlete engages in impact on hard or uneven surfaces, increases mileage quickly, has a change in routine, or has poor footwear (or none at all.)

Prevention is key!
1. Warm up the lower leg muscles sufficiently
2. Ensure you’re wearing proper footwear whenever possible
3. Gradually increase the mileage or intensity of your training

Treatment
A. Acute
1. RICE (ice massage)
2. Electrotherapy to decrease inflammation (IFC)
3. Hydrotherapy
4. IV therapy
5. Adjustments to correct biomechanics faults

B. Chronic
1. Adjustments as necessary
2. Modify exercise program
3. Isometric and isotonic rehabilitation exercises
4. Ultrasound
5. Orthotics

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

Related Articles:
Running injuries
Plantar Fascitis
Short Leg Syndrome
Shin Splints

By definition, shin splints is a catchall term referring to leg pain brought about by running or jumping.  “Shin splints” in and of itself is not a diagnosis; it is merely a collection of symptoms.

Shins splints fall into three main categories:
1. Strain, tendonitis, or periostitis
2. Stress fracture
3. Compartment syndrome

The most common cause of shin (leg) pain is medial tibia stress syndrome (MTSS). It is a strain, tendonitis, and/or periostitis evolving the tibialis posterior and/or soleus.  Most of the pain is localized to the distal 1/3rd of the medial and posterior aspect of the leg.

The second leading cause of shin splints is due to a tibialis anterior strain. The pain is localized to the anterior and lateral aspect of the leg.

As mentioned, shin splints often results as an overuse injury in runners, dancers, gymnasts, or athletes involved in jumping or running. Often the athlete engages in impact on hard or uneven surfaces, increases mileage quickly, has a change in routine, or has poor footwear (or none at all.)

Prevention is key!
1. Warm up the lower leg muscles sufficiently
2. Ensure you’re wearing proper footwear whenever possible
3. Gradually increase the mileage or intensity of your training

Treatment
A. Acute
1. RICE (ice massage)
2. Gentle stretching program
3. Taping the shin
4. Adjustments to foot and back as needed
5. Electrotherapy to decrease inflammation
6. Gentle soft tissue work

B. Chronic
1. Adjustments as necessary
2. Aggressive stretching program
3. Deep tissue massage
4. Modify exercise program
5. Isometric and isotonic rehabilitation exercises
6. Possible compressive sleeve, or continued taping of area
7. Ultrasound

Next in the series: Stress Fracture

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

In this final article on sports nutrition, pre and post game nutrition is discussed.

Pre-Game Nutrition
What you eat several days before endurance activities affects performance. Your food the morning of a sports competition can ward off hunger, keep blood sugar levels adequate and aid hydration. Avoid high protein or high fat foods on the day of an event, as these can stress the kidneys and take a long time to digest. Empty your upper bowel by competition time.

General guidelines
1. Eat a meal high in carbohydrates.
2. Eat solid foods 3-4 hours before events and liquids 2-3 hours before.
3. Choose easily digestible foods (i.e., not fried.)
4. Avoid sugary foods/drinks within one hour of event.
5. Drink enough fluids to ensure hydration (i.e., 500ml of water 1-2 hours before exercise, and an additional 250ml within 15-30 minutes of event.)

Replenishing fluids lost to sweat is the primary concern during an athletic event. Drink 125ml of water or dilute sports drink every 10-20 minutes throughout competition.

Carbohydrate Loading
To avoid running out of carbohydrates for energy, some endurance athletes like triathletes, long-distance runners, swimmers, and cyclists load their muscles with glycogen by eating extra carbohydrates in combination with doing depletion exercises several days before an event. First, exercise to exhaustion. Your workout must be identical to the upcoming event to deplete the right muscles.
Then eat a high-carbohydrate diet (70-80 percent carbs, 10-15 percent fat, 10-15 percent protein) and do little or no exercise starting three days prior to your event. Muscles loaded with unused glycogen will be available to work for longer periods of time.

Post-Exercise Meal (to replenish muscle glycogen)
All athletes know of the importance of the pre-exercise meal. However, what and when you eat following exercise can be just as important. While the pre-exercise meals can ensure that adequate glycogen stores are available for optimal performance, the post-exercise meal is critical to recovery and improves your ability to train consistently.

What and when to eat after exercise is a common topic among athletes. The general advice has been to focus on high carbohydrate foods in order to replenish depleted muscle glycogen stores. Research has shown that carbohydrate intake within two hours of endurance exercise is essential to building adequate glycogen stores for continued training. Waiting longer than two hours to eat results in 50 percent less glycogen stored in the muscle. The reason for this is carbohydrate consumption stimulates insulin production, which aids the production of muscle glycogen. However, the effect of carbohydrate on glycogen storage reaches a plateau. More recent research has shown that combining protein with carbohydrate in the two-hours post-exercise, nearly doubles the insulin response, which results in more stored glycogen. The optimal carbohydrate to protein ratio for this effect is four grams of carbohydrate for every one gram of protein. Eating more protein than that however, has a negative impact because it slows rehydration and glycogen replenishment. The study found that athletes who refuelled with carbohydrate and protein had 100 percent greater muscle glycogen stores than those who only had carbohydrate. Insulin was also highest in those who consumed the carbohydrate and protein drink.

Protein has other important post-exercise qualities. Protein provides the amino acids necessary to rebuild muscle tissue damaged during intense, prolonged exercise. It also increases the absorption of water from the intestines and improves muscle hydration. The amino acids in protein stimulate the immune system, providing you additional resistance to colds and other infections. If you are looking for the best way to refuel your body after long, strenuous endurance exercise, a 4:1 combo of carbohydrate and protein seems to be your best choice. While solid foods can work just as well as a sports drink, a drink may be easier to digest thus making it easier to get the right ratio and meet the 2-hour window. However, research of the ratio energy drink only yields results in the United States; Accelerade and Powerbar. If you prefer energy gels or other non-protein containing sports drinks, simply add 1 Tbsp of protein powder for every 25 grams of carbohydrate to create the 4:1 ratio.

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

Athletes who want a winning edge require optimal nutrition. When you drink enough water and eat a healthy, well-balanced diet, your body can make energy efficiently and this fuels top performances. You are more capable of making the most of your athletic talents by potentially gaining more strength, power, and endurance when you train. One needs to base their diet on a variety of factors including age, height- weight ratio, and physical condition; and the type of exercise you are doing.

Hydration
Water is the most important factor in sports nutrition. It makes up about 60 percent of body weight and is involved in almost every bodily process. Your body cannot make or store water, so you must replace what you eliminate (i.e., urine, sweat). Everyone should drink at least two liters (eight cups) of water each day; athletes require more. The most important factor in hydration is how much you drink at one time; you may quench your thirst but not sufficiently hydrate your tissues if you drink too much at one time. Maximally, you should drink 500 ml of water per hour to ensure you are hydrating your tissues and maximizing water uptake. Drink plenty of fluids before, during and after sports events to stay hydrated and avoid overheating.

When you workout or compete, especially in hot weather, try to closely match the amount of fluid you drink with the amount you lose to sweat. Cool water is the best fluid to keep you hydrated during workouts or events lasting an hour or less. Sports drinks (i.e., 6-10 percent carbohydrates) are useful for longer events. Most of these types of drinks should be diluted approximately 50 percent with water. Drink even if you are not thirsty as thirst is not a reliable way to tell if you need water. You won’t start feeling thirsty until you have already lost about 2 percent of body weight – enough to hinder performance. Interestingly, if you stop drinking water once your thirst is satisfied, you will get only about half the amount you need.

Some tips for staying hydrated
1. Drink small amounts of water frequently, rather than large amounts less often.
2. Drink cold beverages to cool your core body temperature and reduce sweating.
3. Weigh yourself after working out and drink 2-3 cups of water for every pound lost. Your body weight should be back to normal before the next workout.
4. Pay attention to the amount and colour of your urine. You should excrete a large volume that is nearly colourless. Small amounts or dark coloured urine can indicate dehydration.

Next up in the series: Fuel Sources

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

Most running injuries occur as a result of overuse or inappropriate biomechanics. A good analogy is to think of a pulley system where the rope is your muscle and the pulley is the joint. If you have asymmetry in the way you are pulling on the “rope”, you are not going to be able to glide it over the “pulley” without using excessive effort; it will become more difficult to lift the weight at the end, thus creating friction. This in turn heats up the rope and possibly, SNAP; you now have a tear. If you realign the rope and the way it travels over the pulley, via chiropractic and sports therapy treatments, the ease at which you can pull the weight up is greatly enhanced. One will then find the energy required to complete your run is more efficiently used and your time will improve.

Here is a breakdown of some common running injuries:

Pronation Syndrome
Is a mechanical error whereby the foot is over pronated for too long in the stance phase, not held long enough throughout the phase, or the foot is pronated at the wrong time (i.e. should be supinated.) It is an all too common complaint in my practice! 60-75% of all runners have approximately 90% of their soft tissue problems associated with the foot.  Typically, portion syndrome is an overuse injury as it develops over time, resulting in decreased shock absorption of the foot during the stance, decreased foot stability during the stance phase, and decreased propulsion during the stance phase.

REMEMBER if someone is flat footed, they may not necessarily overpronate.

Treatment of the common conditions causing pronation syndrome depends on the condition causing the pronation.  Such conditions include:
1. Forefoot varus
2. Rearfoot varus
3. Tibia Varum
4. Genu Varum
5. Genu Valgum
6. Tricep Surae contractures

Forefoot Varus
Inversion of the forefoot with the subtalar joint in neutral and the rearfoot parallel with the ground. Requires increased calcaneal eversion to establish full forefoot contact.

Treatment:
a. can not change structural defects
b. adjust fixations, especially of the subtalar joint
c. stretch tibialis anterior strengthen the peroneal muscles
d. pronation control shoe
e. functional orthotics – medial forefoot posting if the condition does not improve with a pronation control shoe.

Rearfoot Varus
Inversion of the rearfoot (calcaneus) when the subtalar joint is in neutral.

Treatment:
a. adjust fixations – talus and subtalar
b. stretch tricep surae (calf muscles)
c. strengthen the muscles involved with inversion
d. pronation control shoe
e. orthotics with medial heel wedge (posting) if the condition does not improve with a pronation control shoe.

Tibia Varum
Congenital error where the distal 1/3rd of the tibia is adducted (curved/bowed medially) in relationship to the proximal tibia causing a varus foot in neutral.

Treatment:
a. Mild: shoe with medial rearfoot and forefoot posting- pronation control shoes
b. Severe: orthotics with varus wedge in rearfoot if not prolonged pronation; medial and posterior wedge if prolonged pronation.

Genu Varum
Inward bending of the tibia (>5° at the knee); AKA bow legged

Treatment:
a. strengthen external tibial rotators
b. stretch internal tibial rotators and hamstrings
c. orthotics with medial posting (varus wedge)
d. adjustments to the knee, hip, foot, and low back.

Genu Valgum
Excessive outward bending of the tibia (15° at the knee); AKA knock kneed.

Treatment:
a. pronation control shoe or orthotics with varus wedge
b. stretch hip extensors, knee rotators, and hamstrings.
c. strengthen hamstrings and quads.
d. adjustments to the hip, knee, foot, and low back.

Tricep Surae Contracture 
Occurs when tight surae complex prohibit adequate dorsiflexion (>5°) at the ankle joint, usually with a flexible flatfoot or valgus rearfoot.

Treatment:
a. avoid high heels
b. strengthen anterior leg muscles and inverters
c. soft tissue work to the leg
d. contrast soaks to calf muscle
e. adjustments to talar, subtalar (posterior calcalneus), and navicular (inferior).

Plantar Fascitis 
Definition: Strain, inflammation and pain associated with the plantar aponeurosis and flexor digitorum brevis at their attachment to the anteroinferior aspect of the calcaneal tuberosity.

Etiology (onset)- Insidious onset quickly becoming chronic in nature with acute exacerbations. Plantar fascia plays an important role in the arch support as it is the “tie beam”.  Plantar fascitis is one of the most common overuse injuries in athletes, especially distance runners, basketball players, and dancers.

Treatment:
ACUTE
a. RICE
b. IFC, U/S or TENS
c. Soft tissue work- MRT and strip and bow
d. adjustments to the posterior calcalneus, medial talus, inferior navicular, and/or low back.
e. heel cup
f. home care: roll golf ball under arch 6-10 times followed by an ice massage.

CHRONIC
a. orthotics control for pronation
b. stretch calf muscles
c. strengthen muscles involved with invertion
d. deep soft tissue massage
e. heel cup

Medial Tibial Stress Syndrome (Shin Splints)
Definition: Muscle strain, tendonitis, and/or periostitis involving the tibialis posterior and/or soleus and presenting with pain along the posteromedial aspect of the middle 1/3rd of the tibia.

Etiology: Repetitive impact and most commonly occurs in runners, aerobic dancers, or other high impact sport athletes.
Contributing factors that will exacerbate this condition:
High mileage
Hard surfaces
Uneven surfaces
Sudden changes in routine
New activities
Poor shoes

Signs and Symptoms:
1. swelling
2. small lumps or nodules along the muscle attachments to the tibia
3. often the patient overpronates as well

Treatment:
ACUTE
a. ice massage
b. IFC, U/S, or TENS
c. gentle stretching
d. gentle soft tissue work of the tibialis posterior
e. adjustments to talar joint and knee
f. change shoes

CHRONIC
a. continue adjusting
b. aggressive stretching
c. deep tissue massage
d. modify exercise program
e. isometric/isotonic rehabilitation

Stress Fracture
Metatarsal Stress Fracture: Often due to repetitive microtrauma; overuse as a result of excessive running, dancing, or jumping. It is a biomechanical fault that causes increased pronation or foot slap. Osteoporosis- remember an amenorrheic (non menstruating) female athlete is at high risk for accelerating this process.

Treatment:
a. rest for 2-3 weeks
b. IFC and U/S- low setting NOT to pain
c. orthotics (usually semi-rgid, shock, or sport)
d. ROM exercises
e. stretching and strengthening of intrinsic foot muscles

Iliotibial Band Syndrome
Definition: Tendonitis along the iliotibial band causing pain along the lateral aspect of the knee.
Overuse: Most commonly due to continuing to run or cycle when symptoms are already present.  Other contributing factors include over pronation, under pronation, poor shock absorption, and uneven surfaces.

Treatment:
a. soft tissue massage- MRT and strip and bow
b. decrease mileage and avoid downhill running
c. orthotics
d. stretch hip abductors, hamstrings, and gluteal muscles
e. strengthen gluteals and other hip abductors

Trochanteric Bursitis 
Definition: Inflammation of the large bursa that lies between the tendon of the insertion of the gluteus maximus and posterolateral prominence of the greater trochanter.

Etiology: friction trauma from muscle hypertonicity and overuse (i.e. running with tight gluteals).  Direct or micro trauma usually resulting from pronation syndrome and/or a medial rotation stance.

Treatment:
a. electrical current for two weeks
b. ice massage if acute
c. soft tissue therapy- gluteals
d. stretch gluteals
e. adjustments to the low back, SI joint, and hip
f. modify activity- avoid hills, stairs, and uneven surfaces

Iliopsoas Bursitis
Definition: Inflammation of the bursa that lays between the iliopsoas muscle and the iliopectineal eminence; it overlies the anterior-medial capsule of the hip.

Treatment: as above

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

Knee pain and injuries, as a result of iliotibial band (ITB) syndrome, can be an extremely painful and frustrating injury that puts a big strain on both the knee and hip joints.

Knee injuries are very common among runners and cyclists. However, they doesn’t usually occur in an instant, like a hamstring strain or groin pull.  It commonly starts off as a “twinge or niggle” and progress quickly to a debilitating sports injury that can sideline the best of us for weeks.

For those who aren’t familiar with ITB syndrome, let’s start by having a look at the muscle responsible for the problem. The iliotibial band is actually a thick tendon-like portion of another muscle called the tensor fasciae latae (TFL). This band passes down the outside of the thigh and inserts just below the knee.

The diagram to the right shows the side (lateral) and front (anterior) view of the thigh muscles. If you look towards the top of the diagram, you’ll see the TFL muscle. Follow the tendon of this muscle down and you’ll see that it runs all the way to the knee. This thick band of tendon is the iliotibial band.

The main problem occurs when the TFL muscle and ITB become tight. This causes the tendon to pull the knee joint out of alignment and rub against the outside of the knee, which results in inflammation and pain.

Causes
There are two main causes of knee pain associated with iliotibial band syndrome. The first is overload and the second is biomechanical errors.

Overload is common with sports that require a lot of running or weight bearing activity. This is why ITB is commonly a runner’s injury. When the TFL muscle and ITB become fatigued and overloaded, they lose their ability to adequately stabilize the entire leg. This in turn places stress on the knee joint, which results in pain and damage to the structures that make up the knee joint.

Overload on the ITB can be caused by a number of things. They include:
Exercising on hard surfaces, like concrete;
Exercising on uneven ground;
Beginning an exercise program after a long lay-off period;
Increasing exercise intensity or duration too quickly;
Exercising in worn out or ill fitting shoes; and
Excessive uphill or downhill running.

Biomechanical errors include:
Leg length differences;
Tight, stiff muscles in the leg;
Muscle imbalances;
Foot structure problems such as flat feet (pes planus); and
Gait, or running style problems such as pronation.

Immediate Treatment
First and foremost, one should have a full examination of their gait and posture to identify any postural misalignments as this may help reveal the underlying cause. This service is offered by both of the Chiropractors in the clinic- Drs. Serné and Tisshaw. They will then provide a treatment plan to correct for any biomechanical faults.

The basic treatment for knee pain that results from ITB Syndrome is no different to most other soft tissue injuries. Immediately following the onset of any knee pain, the R.I.C.E. regime should be applied. This involves Rest, Ice, Compression, and Elevation. It is critical that the R.I.C.E. regime be implemented for at least the first 48 to 72 hours. Doing this will give you the best possible chance of a complete and full recovery.

Ongoing Treatment and Prevention
Although the pain may be felt mainly in the knee, the problem may actually be caused by the muscles that support the knee; the tensor fasciae latae, quadriceps, hamstrings, and the gluteus muscles.

After the initial examination, implementation of a program to include electrical therapy, deep tissue massage, and chiropractic adjustments should be followed. It may be just what you need to help loosen up those tight muscles and restore fluid mechanical movement.

Firstly, don’t forget a thorough and correct warm up will help to prepare the muscles and tendons for any activity to come. Without a proper warm up the muscles and tendons will be tight and stiff. There will be limited blood flow to the leg muscles, which will result in a lack of oxygen and nutrients for those muscles.

Before any activity be sure to thoroughly warm up all the muscles and tendons that will be used during your sport or activity.

Secondly, flexible muscles are extremely important in the prevention of most leg injuries. When the muscles and tendons are flexible and supple, they are able to move and perform without being over stretched. If however, your muscles and tendons are tight and stiff, it is quite easy for those muscles and tendons to be pushed beyond their natural range of movement. To keep your muscles and tendons flexible and supple, it is important to undertake a structured stretching routine.  

The stretch to the right is one of the best stretches for the tensor fasciae latae.

Stand upright and cross one foot behind the other. Then lean towards the foot that is behind the other. Hold this stretch for about 45 seconds, and then repeat it 3 to 4 times on each leg.

Stretching is one of the most under utilized techniques for improving athletic performance, preventing sports injury, and properly rehabilitating sprain and strain injury.  Please don’t make the mistake of thinking that something as simple as stretching won’t be effective.

And thirdly, strengthening and conditioning the muscles around your knee and upper leg will help greatly to reduce the chance of knee injury and knee pain.

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

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

Stretching before any physical activity helps prevent injury and gives your muscles a chance to warm up. Here are some basic stretches for muscles that are used during cycling.

Start off by stretching your neck. Slowly roll your head from shoulder to shoulder. Repeat five times in each direction.

Sitting upright with your back straight, bring the soles of your feet together.  Slowly drop your knees apart. This will slowly stretch your groin muscles. Hold this stretch for about 2 minutes.

Put your feet flat on the floor with your knees bent. Gently pull the back of your head towards your knees to stretch your upper back and neck. Hold for about 45 seconds each time.

Remain in the same position, but straighten one leg out, resting the bottom of your other foot against the inside of your thigh. Slowly bend at the hips and reach toward your outstretched ankle to stretch your hamstring muscle. Hold for about 45 seconds and repeat with the other leg.

Lie flat on your back with your left arm straight out to the side. Bend both knees to 90 degrees and gently let your knees fall towards your right. If you would like to increase the stretch, take your right hand and apply a slight downward pressure to your left knee.  Also, look away from the direction that your knees are, towards your left outstretched arm.  Hold this stretch for about 2 minutes and repeat with the other side.

Roll over and lie on your stomach. Place your hands about six inches to the sides of your shoulders and slightly in front of them. Stretch your lower back by pushing up with your hands and raising your chest off of the ground, try to keep your stomach on the ground. Repeat and hold for about 10 seconds each time.

Stand on one leg and bend the other leg to 90 degrees. Rest it on your bike frame and hold the stretch for 3 minutes. Repeat with the other leg. It may help to also use something to hold onto for balance.

Stand up and bend your knees slightly. Bend at the hips and reach toward your feet until you feel the stretch in your lower back and hamstrings. Hold for about 45 seconds.

Find a solid object such as a wall, tree or car that you can push up against to stretch your calf muscles. Stand a couple of feet away from the object, place your hands against it and one foot forward with the knee slightly bent. Straighten the other leg behind you by keeping the foot flat and bending the ankle. You should feel the stretch in your calf. Hold for about 45 seconds and repeat with the other leg.

Stretch your triceps by standing up with your feet a little farther apart than shoulder width. Point your left arm straight up in the air. Keep your arm up, bend the elbow and reach with your left hand behind your head towards your right shoulder blade. Use your right hand to gently pull on your left elbow. You can stretch other muscles by bending to the right slightly at your hips. Hold for about 45 seconds and repeat with the other side.

Bend your fingers and wrists back gently to stretch each hand. This will help to prevent pain and cramping from braking and holding onto the handlebars.

Enjoy your ride! Also, remember that stretching after cycling will help to increase flexibility.
Dr. Crysta Serné
Vancouver Chiropractor and owner of Vitality Clinic

I have been a sports junkie all my life. I love football, and have been a Patriots fan for years – yes- all the way back to when Drew Bledsoe was throwing the pig skin for them, and Tedy Bruschi was their amazing linebacker. (FYI- Tom Brady didn’t come on the scene until 2001!). Proudly wearing my Bruschi jersey, I can’t wait to watch the season opener on September 7th against the Miami Dolphins. What made today even more amazing was as I was perusing through Facebook, I came across this amazing endorsement for my profession.

Who was it from? None other than Tom Brady! Ahhh, life is good.

Whether a Patriots or Bears fan, here is the full NFL season to check out. 

If you want some great ideas to serve during a football game, check out these football recipes.

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

We refrain from using the word “bath” in our conversation as some individuals detest baths. However, they will “soak” their body knowing it is an effective treatment for soothing sore, achy, and tight muscles and joints.  Home care is an essential component to the services we offer our Chiropractic and Naturopathic patients.

Hydrotherapy can actually be as effective as oral analgesics in treating sore, aggravated muscles and tendons, and may be practiced up to 3 times/day for about 20 minutes.  The athletes among us can attest to the pain relief achieved upon immersing their sore bodies in a warm soak following prolonged physical activity.

Epsom salts, or magnesium sulphate, are a particularly effective adjunct to warm bathing, as soaking in Epsom salt has the beneficial side effect of increasing magnesium levels within the blood, assisting in muscle relaxation. Add 2 cups of Epsom salt to a hot bath and soak for 20 minutes.

If it’s an especially hot day and a warm bath doesn’t sound all that refreshing, fill your tub 1/3 of the way full with hot water, add 2 cups of Epsom salts and dissolve.  Fill the remaining space in the tub with cold water, and enjoy.

Adding essential oils to your Epsom salt soak can take relaxation to the next level – add 5-10 drops of pure organic essential oil to your bath for the following benefits:

Lavender is an antiseptic, gentle muscle relaxant and anxiolytic.  In fact, double blind placebo controlled studies have demonstrated that Silexan, an 80 mg lavender oil capsule, is as effective as lorazepam in improving symptoms of uncomplicated anxiety, and anxiety related sleep disturbance.  We love this powerful botanical.

Teatree also an antiseptic, teatree oil is a good choice if prevention of fungal infections is a top priority.  If you have a tendency towards athlete’s foot, or ringworm, this oil can help prevent infection after exposure (think less than clean gym showers.)

Eucalyptus is anti-inflammatory and analgesic.  Eucalyptus improves the immune system’s response to pathogens, and is effective in treated uncomplicated respiratory tract infections when added to baths or humidifiers and inhaled as steam.

Have a great day, and enjoy your soaks!
Dr. Kaleigh Anstett, Vancouver Naturopath
Dr. Crysta Serné, Vancouver Chiropractor and owner of Vitality Clinic

In the adult, the hip is a very stable joint that rarely dislocates due to heavy ligamentous and muscular support.  However, in an infant it is the most common site for congenital dislocation.

The acetabulum forms the socket the femoral head sits in, creating a “ball and socket” joint. It is comprised of the ilium (posterosuperior), ischium (posteroinferior), and pubis (anteroinferior) bones.

Anteversion refers to an internal rotation of the hip and the toes point inward
Retroversion is when the hip is externally rotated and the toes point outward.

Range of Motion
Flexion- 0-120º
Abduction (ABD)- 0-45º
Adduction (ADD)- 0-30º
Medial (internal) rotation- 0-50º (hip and knee are flexed to 90º
Lateral (external) rotation- 0-40º

Closed packed position- internal rotation with extension and ABD of femur

Ligaments
Fibrous capsule
Iliofemoral ligament-resists extension and internal rotation of the femur
Ischiofemoral ligament- resists extension and internal rotation of the thigh
Pubofemoral ligament- resists extension, external rotation and ABD of the thigh
Ligamentum teres femoris- a flattened band that attaches the fovea capitis femoris to the transverse acetabular ligament
Transverse ligament- an extension of the ace tabular labrum

Muscles
Gluteus maximus- extends and externally rotates hip
Gluteus medius (anterior fibers)- flexion, internal rotation, and ABD of hip
Gluteus medius (posterior fibers)- extension, ABD, and external rotation of hip
Gluteus minimus- flexion, internal rotation, and ABD of hip
Biceps femoris- extension and external rotation of the hip joint
Semimebranosus, semitendinosus- extension of the hip joint and internally rotates the lower extremity when knee is slightly flexed
Sartorius- longest muscle in the body.  Involved in flexion, adduction and external rotation at the hip
Gracilis- ADD and flexion of the hip
Iliacus and Psoas (iliopsoas)- flexion the hip
Rectus femoris- assists with flexion of the hip when hip is flexed above 70º
ADD longus, brevis and magnus- ADD the hip
Piriformis- ABD hip
TFL- ABD and flexion of hip
Quad femoris, gemellus (superior and inferior), obturator (internal and external), piriformis, pectineus- external rotation of hip

Orthopaedic Test
Thomas
Faber
Noble Compression
Ober
Ely’s

Pediatric testing
Ortolani’s- F hip and ABD
Barlow’s
Galeazzi’s (Allis test)
telescoping

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

As a Chiropractor, it is my responsibility to teach my patients so they have the ability to make informed decisions about their health.  Fortunately, it has been my experience patients LOVE to learn about their bodies and health.  Knowledge is power and when you know the “what, why, and how” of your body, it makes it easier to stick to your treatment plan, whether at the office or at home.

I have laid out the information in such a way so any student studying anatomy can easily reference it.

General Anatomy
The ankle and foot are comprised of three important joints:
• tibiofibular
• talocrural, and
• subtalar

Also:
• 28 bones including distal tibia and fibula (not including sesamoid bones)
• 35 articulations
• 29 muscles control the bones and articulations (18 in foot and 11 in the leg)
• 3 arches: medial longitudinal, lateral longitudinal, and transverse or anterior.

Pes planus refers to flat feet (individuals who pronate are often flat footed), whereas
Pes caves refers to a high arched foot (individuals who supinates often have pes cavus).

Range of Motion
End feel – both extremes of plantar flexion (PF) and dorsiflexion (DF) have a firm capsular end feel.
Close packed position of ankle joint – full dorsiflexion and slight medial rotation of the tibia.
Closed packed position of subtalar joint – eversion.
Capsular Pattern – F, E

• Plantar flexion: 0- 50°
• Dorsiflexion: 0-20°
• Inversion: 5°
• Eversion: 5°
• Pronation: 15-30°
• Supination: 45-60°
• ABD: 10°
• ADD: 20°

Muscles
Muscles that dorsiflex the foot: tibial anterior (with inversion), extensor hallicus longus (with inversion), extensor digitorum longus (with eversion), and peroneus tertius (with eversion).
Muscles that plantarflex the foot: tibialis posterior, flexor hallicus longus and flexor digitorum longus (all with inversion.) Pure plantar flexion is achieved with the triceps surae muscle (gastrocnemius and soleus.) Peroneus longus and brevis plantar flex the foot with eversion.

Ligaments
Ligaments are strong, elastic bands of tissue that connect bone to bone. They provide strength and stability to the joint.

Four ligaments connect the femur and tibia:
The deltoid ligament (also called medial collateral ligament for the talocrural joint) provides stability to the inner (medial) aspect of the ankle. It is considered one of the strongest ligaments in the body. It resists rotation, eversion, terminal dorsiflexion, terminal plantar flexion, and AP glide of the talar joint.

The lateral collateral ligament (LCL) provides stability to the outer (lateral) aspect of the ankle. It is made up of the anterior talofibular ligament (associated with first degree sprains), calcaneofibular ligament, and posterior talofibular ligament. Together, they resist rotation, inversion, terminal dorsiflexion, terminal plantar flexion, and AP glide.

The distal tibiofibular joint gains stability from the anterior and posterior tibiofibular ligaments. Together they prevent the leg bones from spreading.

The subtalar joint is strengthened via four ligaments; the lateral talocalcaneal ligament (often sprained along with the anterior talofibular ligament when inversion occurs), medial talocalcaneal ligament, interosseus talocalcaneal ligament, and cervical ligament.

Tendons
Tendons are tough cords of tissue that connect muscle to bone. In the distal leg, the most important tendon is the Achilles tendon.

Orthopaedic Tests
Anterior drawer- tests for ligament laxity of talocrural joint
Talar tilt- tests for ligament laxity of subtalar joint
Eversion stability- Kleiger test
Homan’s (DF)- testing for DVT
Thompson- squeeze calf- tests for DVT
Neuroma squeeze
Fascial rub

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

Superheroes are another core strengthening exercise I often provide my chiropractic patients.  It is a unilateral, isometric stabilizing exercise as it predominately uses one side of the body at time (unilateral) and the muscle neither lengthens nor shortens (isometric.).  Ensure you have mastered the prairie dog before engaging in this exercise as it is the next phase in the series; it requires more dynamic stability because you’re using an exercise ball.

When you have the exercise ball placed in front of you, place both hands on the ball and slowly lower yourself to the ball.  Once your stomach and chest are lying on the ball, remove your hands and place them on the floor in front of you.  Extend one leg out behind you and ensure your knee points directly towards the floor.  Once you have complete control of this position, initiate bringing the opposite arm out in front of you.  Do not let your body jack-knife (pike or fold towards the side of the body with the foot on the ground.)

The key to having the superhero work the appropriate muscles to their maximal efficiency is dependent on maintaining as still a position on the ball as possible.  The quieter the body, the more control your muscles have and in turn the more muscle endurance they are gaining.

This is an exercise geared towards increasing the endurance of the muscle so it should be performed until failure- that is until you can no longer hold the correct technique.  Rest 10 seconds and repeat up to 5 times. Repeat on the other side.

If you currently have low back pain or experience it when performing this exercise, please discontinue the exercise and consult your health care practitioner.  Vitality Clinic and Dr. Serné assume no responsibility.  As always, I advocate coming in for a spinal assessment to ensure your body is working at its optimal efficiency.

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

Related Articles:
Core, Core, and More Core

Heel Pain Caused by Plantar Fasciitis and Heel Spurs

There are many forms of foot pain, but heel pain can be one of the most troubling. The most common form of heel pain in individuals is known as heel spurs or plantar fasciitis. Many resources label them one in the same, however heel spurs and plantar fasciitis are slightly different.

Plantar fasciitis occurs when the long, flat ligament on the bottom of the foot (plantar fascia) stretches irregularly and develops small micro tears that cause the ligament to become inflamed. The pain is described as being dull, aching, or sharp and can be reproduced by flexing the toes upwards (dorsiflexion) and tensing the fascia.

A heel spur is actually a type of bone growth that develops on the outside of the heel bone where the plantar fascia ligament attaches. Spurs may form when the plantar fascia becomes inflamed causing calcification or bone growth. They are often described as having a small hook shape to them, which causes pain by irritating the surrounding soft tissue.

Although the plantar fascia is invested with countless sturdy “cables” of connective tissue called collagen fibers, it is certainly not immune to injury. Middle aged, overweight, and athletic individuals are more prone to plantar problems, as are non-athletic people who spend a lot of time on their feet or suddenly become active after a long period of lethargy. A recent study found that over 50 per cent of people who suffer from plantar fasciitis are on their feet nearly all day.

Plantar fasciitis and heel spurs usually develop gradually. Heel pain may only occur when taking the first steps after getting out of bed or when taking the first steps after sitting for a long period of time. If the plantar fascia ligament is not rested, the inflammation and heel pain will continue to get worse. Other conditions or aggravating factors, such as the repetitive stress of walking, standing, running, or jumping, will contribute to the inflammation and pain. In some cases, the inflamed ligament may not heal because individuals who are developing the conditions do not completely stop the activity aggravating the symptoms.

A number of factors are directly associated with development of plantar fasciitis and heel spurs. These factors can lead to the change of the gait (the way the feet strike the ground), which may cause additional injury. Risk factors for include:

• biomechanical factors, such as decreased flexibility in the foot and ankle, imbalances in muscle strength (muscles in one leg or foot are weaker than the other), abnormal foot mechanics (when stepping down), and tightness in the achilles tendon.
• the repetitive nature of sports activities and improper training.
• sudden increases in weight.
• rapidly increasing the length of time spent on the feet.
• running or walking up steep hills.
• wearing shoes that are worn out.
• wearing shoes that do not have a cushioned sole or enough arch support.
• abruptly changing the intensity or duration of athletic activities.

The traditional remedies for plantar fasciitis include application of ultrasound, stretching and stripping out the calf, chiropractic adjustments to the talar and sub-talar joint, potentially decreasing one’s activities, purchasing better-fitting shoes (with a raised heel and arch support), icing the sore heel, and taking a natural anti-inflammatory. Another common consideration is custom orthotics.

If you believe you are suffering from the above condition, please consider booking an assessment with myself or Dr. Tisshaw.

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

Following up to a blog written last week on why sitting is the new smoking, we will up the ante and state that vigorous running for 5 minutes per day can significantly improve your health. New research not only has compared people who run versus people who do not run, but they have also compared high volume runners to low volume runners and concluded that there are only a small difference in outcome markers between the groups – the point here is that if you only want to exercise vigorously for 5 minutes per day, you are still gaining huge benefits to your health and wellness. This topic was recently written and posted in the New York Times Well Blog. Check out the full article here 

Dr. Tisshaw and Dr. Serné both have experience working directly with athletes and runners to prescreen for faulty movements and injury risk, as well as treating the wear and tear on the feet, knees, hips, and back while pounding the pavement.

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

Not only is stretching important for flexibility, it is CRITICAL for muscle growth!

When you think about improving muscle mass, stretching is probably not the first thing that pops into your head. Were you aware that stretching plays a critical role in building muscle?

Every muscle in your body is enclosed in a bag of tough connective tissue known as fascia. Fascia is important for holding your muscles in their proper place in your body. However, your fascia may also be holding back your muscle growth. Think for a moment about your muscle development; you train them and feed them properly. They want to grow and will grow if given the right conditions, but are you giving them the opportunity? Something may be holding them back; they have no room to grow! Fascia is so dense that it doesn’t allow the muscle enough space to expand when it is proliferating. It is like stuffing a large pillow into a small pillowcase. The size of the muscle won’t change regardless of how hard you train or how well you eat because the connective tissue around your muscles is constricting the muscles within.

The best example of this is the calf muscle. The lower leg is riddled with fascia because of its tremendous weight-bearing duties in the body. It is because of this fascia that many athletes have great difficulty developing their calves.

The solution: stretching. Stretching is one of the most under-utilized techniques for improving athletic performance, preventing sports injury and properly rehabilitating sprain and strain injury. Don’t make the mistake of thinking that something as simple as stretching won’t be effective.
 Using the pillowcase example from above, imagine you can expand the size of the pillowcase by stretching it.  Suddenly, the pillow within has more room and will expand to fill that new space. By stretching your muscles under specific conditions, you can actually stretch your fascia and give your muscles more room to grow. The key to effective fascial stretching is the “pump.”  The best time to stretch to expand the bags that are holding in your muscles is when your muscles are pumped up full of blood. When your muscles are fully engorged with blood (i.e. being utilized), they are pressing against the fascia.  By stretching at that time, you increase that pressure on the fascia greatly, which can lead to expansion of the fascia.

One of the major reasons Arnold Schwarzenegger had such incredible chest development was that he finished his chest workouts with dumbbell flys, an exercise that emphasizes the stretched position of the pectoral muscles. He would pump his chest up full of blood during the workout then do flys, holding the stretch at the bottom of the fly. This gave his chest room to grow to amazing proportions.
Fascial stretching is more rigorous than regular stretching but the results can be amazing. When you stretch hard enough to cause the fascia to expand, you will really feel it! When you are stretching the fascia, you should feel a powerful pulling sensation and pressure as the muscle works against the fascia to expand it.

Be sure you do not stretch so hard that you cause the muscle to tear or cause injury to yourself. You will rapidly learn to distinguish the difference between a good stretch and a bad stretch. You should not feel any sharp pain, just a steady pull.

Hold each stretch for at least 45 seconds to a minute as you must give your fascia time to be affected by the stretch. Stretch hard like this only when you have a fully pumped muscle as you must give your fascia a reason to expand. If your muscles aren’t pumped, just stretch normally.

One set of hard stretching after each set you do for a muscle group, besides the obvious benefits of increased flexibility, can have an incredible effect on the size of your muscles and their further ability to grow. DO NOT continue with any stretch that causes pain to a joint or muscle. If you are unsure of what muscles to stretch, or how to effectively stretch, please call Dr. Serné to set up an appointment.

Remember the take home to today’s discussion- stretch prior to an activity to prevent injury, but stretch after to promote flexibility and hold the stretch for at least 45 seconds.

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

Most individuals see doctors only when they’re sick. As a “back doctor”, I am more interested in ensuring that you stay healthy and injury free, rather than seeing you when you are already down and out. By taking a preventative and proactive approach to your health, instead of a reactive one, you will continue to strive towards the goals you set in your healthy lifestyle to become stronger, leaner, and fitter. So you might be asking yourself how to accomplish this task. By seeing a chiropractor and having yourself assessed BEFORE you’re hurt is the easiest way. We are able to identify potentially problematic areas and treat them so it doesn’t become a concern later in life.

Prevention is the name of the game! Just because you don’t have PAIN, it doesn’t mean the FUNCTION of the joint, muscle, or ligament is optimal. Your back may just be a time bomb waiting to go off.

By seeing a chiropractor at Vitality Clinic, you will avoid the following:

1. Loss of normal position, which leads to restricted movement.
2. Abnormal positioning which may lead to shortened muscle tissue with decreased strength and flexibility, leg length inequalities, as well as to scar tissue development.
3. Continued pressure on nerves; due to the altered alignment this may cause numbness and tingling in the area in which the nerve travels.
4. Swelling and inflammation may develop in the disc, joints, or surrounding tissues.
5. Degenerative joint disease may occur in the affected area leading to bone spurs.

Don’t limit yourself to thinking that chiropractors are just “bone- crunchers”. I pride myself on being trained to care for ALL aspects of the patient’s health, in an attempt to identify what may potentially be the root of the problem. This may include muscle work, orthotics, nutritional supplements, and core stabilizing exercises (prairie dog, planking, and single leg bridge to name a few.)

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

Myofascia is a strong and flexible network of connective tissue that surrounds, cushions, and supports muscles, bones, and organs – right down to the cellular level. Functionally, it forms a continuous web from head to toe.

Fascial restrictions can result from accidents, injuries, repetitive stress situations, surgical or traumatic scarring, and abnormal postures. When these injuries occur, the muscle fibers and the fascia which surrounds it become short and tight. This uneven stress can be transmitted through the fascia to other parts of the body, causing pain and a variety of other symptoms in areas you often wouldn’t expect.

Let’s use an analogy: imagine you are wearing a tight t-shirt and someone was to grab that t-shirt over your shoulder, then twist it up. One can easily see how the t-shirt would get tight, but you would still be able to move the arm. This is a primitive example of what happens with facial restriction. Myofascial Release Technique (MRT) is essentially the process that removes that bound up tissue/t-shirt.

Myofascial Release Technique is the three-dimensional application of sustained pressure and movement into the fascial system in order to eliminate restrictions. It refers to a manual muscle technique both our Chiropractors and Registered Massage Therapists may incorporate into your treatment plan. This technique requires stretching the fascia and releasing bonds between fascia, integument, muscles, and joints – with the goal of eliminating pain, improving posture, and increasing your range of motion.

MRT is an effective therapeutic approach in the relief of cervical pain, back pain, headaches, shoulder injuries, arthritic conditions, sports injuries, fibromyalgia, restriction of motion, and many more conditions. There is even a specific technique called skin rolling which can reduce the effect of cellulite!

What does a Myofascial Release Technique treatment feel like?

The pressure can range from very gentle touch to much deeper pressure. However, the pressure should never be beyond one’s tolerance level and it is therefore very important to give feedback to your practitioner during the treatment. Some people may experience a slight tingling or burning sensation in the skin (this is completely normal and safe). Others may feel a gentle to deep stretch on the area being treated. It can, at times, be quite intense, especially in the case of tissue that is holding a lot of tension and stress. It is normal for individuals to experience slight stiffness and soreness post treatment – usually that vanishes within a couple of days.

MRT is most effective in combination with chiropractic adjustments to the joints involved, whether it be spinal or extremity (ankle, shoulder, wrist, etc). Because each individual is different, the number of treatments required may vary, however a general rule is that you should notice a change in your condition within the first three treatments. Your practitioner will discuss your treatment plan and projected outcome with you during your initial session.

To conclude, MRT, often in conjunction with joint corrections, is a very effective treatment program and can significantly improve many soft tissue and orthopeadic conditions. To see if MRT is right for you, please contact the clinic @ 604.687.7678 to book an appointment.

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

Many people these days spend the majority of their day sitting at a computer, typing or mousing.

In this posture the shoulder joint is held in a position of internal/medial rotation to accommodate the palms of the hands facing downward and engages the muscles between the shoulder blade (on the back) and the shoulder. These muscles help make up what we call the rotator cuff, and after long periods of computer work, they can become very adhered and tight, reducing the mobility of the shoulder or causing pain and stiffness.

When these muscles become chronically tight, they pull on the shoulder blade (scapula), which pull on the muscles of the upper back, giving them extra stain as both muscle groups compete to keep the scapula in position.

So if you have been experiencing pain, tightness or stiffness in upper back or back of the shoulder, try these stretches once a day, and/or come into Vitality Clinic for a massage therapy treatment to relax the muscles and decrease developed adhesions.

I would also recommend these stretches to anyone who has spent long hours working at a computer to maintain mobility and tissue circulation of the shoulder joint.

The first stretch is great as it targets the muscles that are approximated during the time at your desk. Using a towel, scarf, belt, or anything of decent length, bring your arm and hand up behind your head and PULL DOWN with your opposite arm behind your lower back until a pain free stretch is felt. Hold for 1 minute and repeat with the other side. Try it twice a day, especially at the end of the your time at the desk, as it is the inverse position to what you have been holding.

The next stretch can be easily done seated and may be repeated many times throughout the day. Bring your arm across your body and tuck your elbow into the elbow joint of your opposite arm. Use the opposite arm to pull the arm being stretched to the opposite side until you feel a pain free stretch. Hold for at least 30 seconds and repeat on the other side. I would recommend doing this 3 times per day.

Hope that helps and see you soon for a treatment!

Take Care

Sydney Beagle, RMT

Carpal tunnel syndrome (CTS) is a relatively common complaint in individuals that perform constant and repetitive motions of the hand and wrist. This applies to individuals sitting prolonged periods in front of their computers; my “industrial athletes“.  Also, any athlete playing a sport requiring them to repeatedly grasp something while the wrist joint is twisting and turning, are at a high risk of developing the complaint.

Sports that have a high incidence of CTS sufferers include most racquet sports, handball, swimming, body building, rowing, golf, archery, and rock climbing.  However, any sport that involves prolonged use of the wrist and hand can unfortunately cause the condition.

What is CTS?

Carpal tunnel syndrome is a compression neuropathy in which the median nerve becomes entrapped in the region of the wrist. This entrapment means the thumb and the first three fingers, as well as the majority of the palm may become numb. The median nerve also supplies limited movement to the thumb through the “Thenar” muscles (the muscle pad at the base of the thumb) and so the condition normally causes partial paralysis of the thumb.

Anatomy of CTS

As already mentioned, carpal tunnel syndrome is caused by the entrapment and compression of the median nerve. This nerve runs from the forearm to the hand where it branches to supply innervations to the thumb and the first two fingers.

As it traverses the wrist area the nerve passes through the carpal tunnel, which is composed of the carpel bones and the transverse carpal ligament. The carpal bones make up the base and sides of the tunnel so that a semicircular shape or valley is formed. Stretched across this, much like a bridge that crosses the valley is the tough transverse ligament. The median nerve, along with nine tendons that give the thumb and fingers movement, pass through the tunnel and into the hand. The carpal tunnel is a rigid structure and the inner space is fixed and very confined.

Causes of CTS

Carpal tunnel syndrome is ultimately an inflammatory disease and so any job, sport, or pastime repetitive in its actions can cause either the muscles or the tendons crossing the wrist to become irritated and inflamed.

In addition to the median nerve, a set of nine tendons run through the carpal tunnel. When the protective linings, or synovial sheaths, of these tendons become swollen and inflamed this puts excessive pressure on the tendons and median nerve.  This occurs because of the limited amount of space within the tunnel. Other causes of increased pressure occur when the tough transverse carpal ligament becomes swollen or when a bone fracture or break causes edema or the build up of fluids.

When the median nerve becomes compressed because of excess pressure in the carpal tunnel, the nerve signals normally transmitted through the nerve become slowed, which ultimately results in abnormal sensations in the affected hand i.e. numbness, pins and needles or a tingling, burning feeling.

Symptoms of CTS


The majority of the symptoms felt by sufferers of carpal tunnel syndrome are ultimately due to the entrapment of the median nerve. Common symptoms include:

• Weakness in the affected hand which affects grip. Many sufferers find that picking up a bag or opening a door becomes difficult because they can no longer grip with enough force.
• A feeling of numbness in the thumb, fingers (not the little finger) and the thumb-side of the palm. Alternatively some individuals may have a tingling sensation instead.
• Impaired coordination of the thumb and forefingers so that fine movements become difficult.
• Pain in the wrist and hand that can stretch up as far as the elbow. The pain that is associated with carpal tunnel syndrome is not actually caused by the nerve compression; rather it is caused by inflammation or by a bone fracture which in turn causes the nerve compression. Most cases of CTS cause absolutely no damage to the nerve itself and so when the pressure is relieved the symptoms abate.
• Tinel’s sign – this is a diagnostic test which involves tapping the carpal tunnel area lightly to see if a sharp pain is felt. If pain is felt then a diagnosis of CTS is generally given.

CTS Prevention

It is important for athletes to warm up the wrist area before they engage in any serious training so that the risk of developing carpal tunnel syndrome is reduced.

Isometric strength exercises (these are exercises where the muscles are contracted but they do not lengthen) not only warm the wrists and nearby areas up, but they also strengthen the muscles and improve blood flow. Below are a few exercises that will help to strengthen the wrist and reduce irritation.

1. Make a fist with the right hand, palm face up. Using the left hand gently push down on the fisted hand while keeping the right wrist straight.
2. Turn the fisted hand over and again push down gently on the knuckles. Remember to keep the wrist straight.
3. Turn the fisted hand so that the thumb is pointing up and repeat the exercise.
4. Next hold the first two fingers up (like the “peace” sign but with the fingers closed). Draw 5 clockwise circles and then 5 anti-clockwise circles in the air.

These simple exercises should be practiced each day, especially if one of the sports mentioned above are regularly performed. One should avoid extreme flexion as this action doubles the pressure applied to the median nerve.  Extreme extension virtually triples it. Only perform warm up and strength exercises as far as feels comfortable; pushing things too far can result in the very condition you’re trying to prevent.

Because it is often inflammation of the tendon sheaths that cause carpal tunnel syndrome, flexibility exercises that reduce pressure on the tendons should also be practiced. A number of the sports mentioned in the introduction cause the muscles of the forearms to tighten, in turn causing pressure on the tendons. Thus, stretching exercises to reduce tension in the forearms will help to prevent carpal tunnel syndrome.

Interlock your fingers in front of your chest and then straighten your arms and turn the palms of your hands outwards.
Place one arm straight out in front, parallel to the ground. Rotate your wrist down and outward. Use your other hand to further rotate your hand upwards.

Another form of prevention is by using a wrist brace which helps to stabilize the wrist and stop possible overextension and flexion.

CTS Treatment


CTS is a soft tissue injury of the muscles and tendons around the wrist joint and therefore should be treated like any other soft tissue injury. Immediately following an injury, or at the onset of pain, the R.I.C.E.R. regime should be employed. This involves Rest, Ice, Compression, Elevation, and Referral to an appropriate professional for an accurate diagnosis.

It is critical that the R.I.C.E.R. regime be implemented for at least the first 48 to 72 hours. Doing this will give you the best possible chance of a complete and full recovery.

As part of the R.I.C.E.R. regime a night splint that provides support to the wrist and keeps it in a straight line (i.e. the position that applies least pressure to the median nerve) may be useful. Consult with the clinic Chiropractors prior to purchasing any supplemental material to ensure it is necessary. If the symptoms persist, it may be worth while splinting the wrist during the day so there is a lower chance of further aggravating the injury.

The next phase of treatment (after the first 48 to 72 hours) involves a number of mulitimodal chiropractic and sports therapy techniques. The application of ultrasound, TENS, heat, massage, and elbow and wrist adjustments is one of the most effective treatments for speeding up the healing process of the muscles and tendons.

Once most of the pain has been reduced, it is time to move onto the rehabilitation phase of your treatment. The main aim of this phase is to regain the strength, power, endurance and flexibility of the muscles and tendons that have been injured.

Supplements are also commonly prescribed in cases where the pain in the wrist and hand is quite severe. Nature’s Relief is a natural anti-inflammatory supplement often prescribed to combat the effects of carpal tunnel syndrome. It works by reducing the pain and also acting on the underlying cause of the condition, the inflammation.

Enjoy your day,

Dr. Crysta Serné

Chiropractor and owner of Vitality Clinic

A sprain is an injury to a ligament or joint capsule. A ligament is a thick, tough, fibrous tissue that connects bones together. Commonly injured ligaments are found in the spine, ankle, knee, and wrist.

Ligaments are often injured when they are stretched beyond their natural limit (i.e. too far from their normal position) and they lose their ability to stabilize the joint. The purpose of having ligaments is to hold your skeleton in a normal alignment — ligaments prevent abnormal movements. However, when too much force is applied to a ligament, such as in a fall, the ligaments can be stretched or torn; this injury is called a sprain.

A strain is an injury to a muscle or tendon.   Tendons are connective tissue that attach muscle to bone.  Commonly injured tendons are in the shoulder, back and neck, achilles, and elbow.  Strains commonly occur due to repetitive overuse or traumatic injury.

Both sprains and strains are categorized based on the severity of their injury from Grade 1-5.  A Grade 5 sprain/strain is a complete rupture and often requires surgical intervention.

As multimodal chiropractors, we are trained and equipped to treat sprains and strains of any nature.

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

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

Related Articles:
Care of Head, Neck, and Upper Back
Neck Pain and Injuries
Upper Body Stretches
Stretches for Nursing Moms (or anyone else with stiff upper Back)
Mouse Placement
Sleeping Positions to Alleviate Neck Pain
Correcting Faulty Posture
Pillow Talk

Muscle contusions, commonly referred to as bruises, are one of those injuries just about everyone has had at one point or another. In fact, bruises are the second most common sports injury after strains.  Although not considered a serious injury, they often cause mild discomfort and can create discolouration of the skin.

What is a bruise and how do they occur?

Bruises are the result of your body colliding with a solid object, (or a solid object colliding with your body). When this occurs, the soft tissues under your skin (muscle fibers and connective tissue) are crushed but the skin does not break or rupture. When soft tissue is damaged, blood from the ruptured capillaries leaks out under the skin and pools, causing the area to swell and form a red or purplish mark that can be sore and tender to touch. The symptoms associated with bruises are pain, swelling, and restricted movement.

Types of Bruises

Like muscle strains, bruises are usually graded into three categories and these are referred to as: first; second; or third degree depending on their severity. A first degree bruise is the least severe. It is the result of a minor rupture of the capillaries and is accompanied by mild pain, some swelling, and stiffness. There is usually very little loss of function as a result of a first degree bruise. A second degree bruise is the result of a moderate rupture of the capillaries and increased bleeding. There is also increased swelling and pain associated with a second degree bruise, and a moderate loss of movement at the injury site. A third degree bruise is the most severe of the three. A third degree bruise is the result of a major rupture of the capillaries and will result in massive swelling, severe pain and instability around the injury site.

Who Bruises?

Anyone can get a bruise, although people involved in contact sports are most at risk. But why do some people bruise more easily than others? The severity of a bruise can depend on a number of things: how tough a person’s skin tissue is; the general health of the underlying muscles and soft tissue; medications one may be on; or age. Age can be a major contributor because as we get older our blood vessels tend to become more fragile.

Immediate Treatment

The immediate treatment of any soft tissue injury is vital. Proper care and treatment now will go a long way towards a full recovery later. It is likely that most first degree bruises will require very little treatment, however second and third degree bruises should be treated with the following. Without a doubt, the most effective, initial treatment for bruises and contusions is the R.I.C.E.R. regime. This involves the application of (R) rest, (I) ice, (C) compression, (E) elevation, and obtaining a (R) referral for appropriate medical treatment. R.I.C.E.R. forms the first, and perhaps most important stage of injury rehabilitation, providing the early base for the complete recovery of injury. Where the R.I.C.E.R. regime has been used immediately after the occurrence of an injury, it has been shown to significantly reduce recovery time.

R.I.C.E.R.

R: (rest) It is important that the injured area be kept as still as possible. This will help to slow down blood flow to the injury and prevent any further damage.

I: (ice) By far the most important part. The application of ice will have the greatest effect on reducing bleeding, swelling, and pain. Apply ice as soon as possible after the injury has occurred. How do you apply ice? A gel molding ice pack is usually the best. If you don’t have an ice pack readily available, cold water from a tap is better than nothing at all. When using ice, be careful not to apply it directly to the skin, unless you are instructed to do an ice massage.  Placing an ice pack directly on the skin can cause “ice burns” and skin damage. Wrapping the ice in a damp towel generally provides the best protection for the skin. The most common recommendation is to apply ice for 10 minutes on, 30 minutes off every 2 hours for the first 48 to 72 hours.  Be aware that children and elderly individuals have a lower tolerance to ice and cold. A frozen spoon is a great option for infants that may have bumped and bruised themselves. Finally, people with circulatory problems are also more sensitive to ice so if one feels a burning sensation, remove the ice until the area returns to a light pink colour or neutral skin tone. Remember to keep these things in mind when treating yourself or someone else with ice. Obviously, there will be a slight discomfort from the cold, but as soon as pain or excessive discomfort is experienced, it’s time to remove the ice. It’s much better to apply ice for 3 to 5 minutes a couple of times an hour, than not at all. IN some cases, a contrast between heat and cold is recommended, but please ask your therapist befoe applying this method.

C: (compression) Compression actually achieves two things. Firstly, it helps to reduce both the bleeding and swelling around the injury, and secondly, it provides support for the injured area. Use a firm, elastic, and size appropriate compression bandage to cover the entire injury site.  Start wrapping from the point farthest from the heart (distal) and work inward from there (medial.)

E: (elevation) Simply raise the injured area above the level of the heart at all possible times. This will further help to reduce the bleeding and swelling.

R: (referral) If the injury is severe enough, it is important that you consult a professional sports therapist or a qualified doctor (yes, Chiropractors are qualified doctors!!) for an accurate diagnosis. They will be able to tell you the full extent of the injury. Before we finish with the initial treatment and move onto the next phase of the rehabilitation process, there are a few things that you must avoid during the first 72 hours. Be sure to avoid any form of heat at the injury site. This includes heat lamps, heat creams, spas, Jacuzzis, and saunas. Avoid all movement and massage of the injured area. Also avoid excessive alcohol. Any of the aformentioned may increase bleeding, swelling, and pain of your injury.

After the first 48 to 72 hours

First, you must keep active! Don’t listen to anyone who tells you to do nothing. Now is the time to start some gentle rehabilitation. Most of the swelling will have subsided after the first 48 to 72 hours and you are now ready to start light activity. Light activity will not only promote blood circulation, but it will also activate the lymphatic system. The lymphatic system is vital in clearing the body of toxins and waste products, which can accumulate in the body following a sports injury. Activity is the only way to activate the lymphatic system.

Before we move on, a quick word of warning. Never do an activity that hurts the injured area. Of course you may feel some discomfort, but NEVER push yourself to the point where you’re feeling pain. Listen to your body; don’t over do it at this early stage of the recovery.

Next, you now need to start three vital treatments. The first is commonly used by Sports Therapists (and Physiotherapists), and primarily involves increasing the blood supply to the injured area. The aim is to increase the amount of oxygen and nutrients to the damaged tissues. Sports Therapists accomplish this aim by using a number of activities to stimulate the injured area. The most common methods used are ultrasound, IFC, TENS, and heat.

Ultrasound, IFC, or TENS (Transcutaneous Electrical Nerve Stimulation) simply uses a light electrical pulse to stimulate the affected area. While heat, in the form of a ray lamp or heated gel pack, is very effective in stimulating blood flow to the damaged tissues, once you are out of the danger zone of the first 72 hours.

Secondly, to speed up recovery and repair the damage tissue it is vital that you initiate gentle massage the injured area and connecting muscles. While ultrasound and heat will help the injured area, they will not remove the scar tissue and other damaged tissue; only massage will be able to do that. Initially, the injured area may be quite tender, so start with a very light stroke and gradually increase the pressure until you’re able to tolerate a firmer stroke.

Just a few final points before we move on. Be sure to drink plenty of fluid during your injury rehabilitation. The extra fluid will help to flush a lot of the waste products from your body. Also, I recommend you consider purchasing a natural anti-inflammatory and muscle relaxant (both are available at Vitality Clinic.  Topical creams such as Arnica are also beneficial for local relief.

Lastly, gentle stretching should also be included as part of your heat and massage treatment. This will help to regain your range of motion and realign the damaged muscle fibers. While working on increasing the flexibility of the injured area, it’s also important to increase the flexibility of the muscle groups around the injured area. Once your range of motion has returned to normal and movement of the injured area is pain free, you can start to implement some more active rehabilitation techniques like strength work, balance drills and sport specific training be included as part of your heat and massage treatment. This will help to regain your range of motion and re-align the damaged muscle fibers. While working on increasing the flexibility of the injured area, it’s also important to increase the flexibility of the muscle groups around the injured area. Once your range of motion has returned to normal and movement of the injured area is pain free, you can start to implement some more active rehabilitation techniques like strength work, balance drills and sport specific training.

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

This morning habit will leave you energized all day!

Alternating or contrast showers are a simple yet efficient way to improve circulation, stimulate the nervous system, speed healing, modulate immune response and generally improve energy and detoxification.

During your morning shower, turn the water up to a comfortably warm temperature, and remain within the warm water for at least 3 minutes. Following this warm phase, turn the temperature down as low as you can handle, and stay under the cold stream for up to 30 seconds. Following the cold stage, turn the temperature back up, and enjoy the warm water again for 3 minutes, followed by another brief period of cold. Repeat this process up to 8 times, remembering to always end your shower on cold. If time does not permit, simply ending your shower on cold will impart significant benefit.

Contrast showers following resistance training are also an effective way to reduce fatigue and delayed onset muscle soreness.

To summarize contrast showers:

3 minutes hot, alternating with 30 seconds cold, always ending on cold.

Ending on cold has a warming effect on the body, as blood vessels are first constricted, then dilated as the body warms itself.

Please do not practice contrast showers if you are pregnant, have cancer, suffer from cardiac insufficiency, or have diminished peripheral sensation (often associated with diabetes or vascular insufficiency.)

Have a great day,
Dr. Kaleigh Anstett
Vancouver Naturopath

Related Articles:
Heat Versus Ice

Are you aware our resident Registered Acupuncturist, Julianne, offers laser therapy treatments?  Laser light is a great way to enhance any treatment.  Research demonstrates laser affects the mitochondria (the cell’s power house) thereby enhancing the production and synthesis of ATP (the cell’s energy.)  This allows the body to optimize healing and growth.  It does so by “injecting” billions of photons of visible and/or invisible laser light deep into tissue structures.  This chemical energy is utilized by the tissue to significantly accelerate the healing process and reduce pain in the body naturally.

Laser therapy can assist with:

age spots,

acne,

skin ulceration,

soft-tissue damage,

sports injuries (sprains, strains, and contusions), and

arthritis pain.

The healing process increases the strength of healed tissue, reduces swelling, increases blood flow, increases lymphatic activity; reduces inflammation, and increases cellular metabolism which speeds up the repair process.  The results are accumulative.

Call the clinic to book your treatment today!

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

Everyone knows water is essential for life, but do you know how much you are supposed to drink in a day?  The kidneys can only filter water at a certain rate, so my rule of thumb is to drink 500ml per hour to a maximum of 3 litres.  Anything more than 500ml and you’re quenching your thirst but not hydrating your tissues.

If you struggle to drink water as part of your daily routine, here are a few suggestions:

1.  Add lemon or cucumber for flavour

2.  Start with drinking water at room temperature; it is easier to digest and often you can drink more without realizing it.

3.  Always have a water bottle nearby so you get into the habit of continually drinking small amounts throughout the day.

Don’t forget about your electrolytes as you need to make sure they stay balanced in order to aid with water absorption (coconut water is a great source.)

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

When you go out to play golf you’re hoping for a good round. I know I do. How often does your outcome match what you hoped for? Do you usually shoot the scores you had envisioned before you teed off? If not, do you ever evaluate where and how you could have saved strokes and avoided those blow up holes?

Here are 5 easy tips for you to implement immediately that will shave 4-6, or even more strokes off your score the next time you play.

First, you’ve got to put the proper fuel in your body before you leave home. Most golfers don’t give it a second thought. They either don’t eat at all before they leave home or they eat something that is not going to give them the long-term energy they’re hoping for. Whether it’s lunch or breakfast before you leave, you need to consume a complex carbohydrate and a good protein source. This combination will warrant the best use of your energy for the entire round.

• An example for breakfast would be a bowl of quinoa or oatmeal, an egg, and a piece of fruit or a glass of juice. A suggestion for lunch would be a turkey sandwich on whole grain bread with a piece of fruit. Ensure there is a variety of vegetables on the sandwich and avoid mayonnaise or butter.  Consider adding hummus as an alternative.

The second tip is to properly warm up your body before you hit your first ball. So many golfers show up 5 minutes before tee time, take a few putts, and then head to the first tee. Those golfers are potentially headed for a double bogey right off the bat…  A better approach is to give yourself at least 30 minutes before your tee time. First, do some dynamic (movement oriented) stretches to prepare your body to perform. Exercises such as arm circles, partial squats, toe touches, etc. Next, take some half swings with a 7 iron. Now you’re ready to hit some wedges.  With this approach, your hits on the range will be much better, which will build your confidence.

Drink lots of water even before you leave your house. However, only drink a maximum of 500ml of water per hour.  Anything more than that and you’re quenching your thirst but not hydrating your tissues.  Dehydration causes energy loss, lack of focus and concentration,  fatigue, and possibly muscle cramps later in the round.   Also, remember to bring a water bottle with you so you can continue to drink water during your round.

Don’t wait until you feel tension to initiate stretching.  Constantly move your body and stretch your joints while you play. I often see and hear golfers complaining of tight lower backs or shoulders during the round, and especially after when they are in for an appointment.  Think of your body as a machine; if the machine starts to break down – fix it.  You’ll see a big difference in your swing mechanics late in the round.

Snack while you play. I don’t mean the hot dog at the turn with a beer chaser! Bring fruit, nuts, and nutrition bars to eat every 4-6 holes. When you supply your body with the proper nutrients, your energy levels stay balanced and you will avoid those mental lapses later in the round. How many times have you had a good score only to blow up late in the round? I’ll bet more than a couple of times; I know I have.

Now some of these tips you may have been aware of, and maybe a couple of them you haven’t given as much thought to.  Do all of them and your score will show it. The above routine should become part of your golf experience every time you go out and play. This is called pre-game preparation and performance maintenance. You’re an athlete (believe it or not) so treat you body like one!

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

Intramuscular stimulation, or IMS has become a popular method of relieving chronic and acute muscle pain and spasticity. IMS is extremely useful in treating skeletal muscle trigger points, or areas of shorted, contracted skeletal muscle that contribute to pain and dysfunction. Acupuncture needles, as opposed to much larger needles typically used for injections, are inserted directly into trigger points. This direct stimulation of the trigger point often precipitates fasciculation or muscle spasm, and relaxation of the affected muscle, leading to pain relief.

Specifically, IMS is used to treat neuropathic pain, resulting from skeletal muscle “supersensitivity”. According to Dr. Chann Gunn, a pioneer in the method of IMS and pain pathophysiology, supersensitivity is the process by which nerves become over sensitive to stimuli causing an increased perception of pain. “Super sensitive” muscles cannot be seen via medical imaging, and may only be identified via a combination of palpation, and patient history. Some deep muscles that aren’t easily palpated must be assessed via the insertion of acupuncture or IMS needles. If the suspected muscle is not functioning appropriately and contains trigger points, the patient will feel an odd, deep aching sensation. If the muscle is healthy and contracting appropriately, this deep aching sensation will not be experienced.

Once a trigger point has been identified and needled appropriately, the affected muscle will either start to spasm immediately, or tightly grasp the needle for a period of time. This “grabbing” sensation is a result of muscle stimulation and is transient, but is often perceived as a deep intense muscle ache that may radiate to bony attachments. As the trigger point begins to relax, the deep aching sensation subsides. If a muscle contains many trigger points, multiple treatments are often necessary – typically patients see complete relief with 8-10 sessions, but often benefit greatly after a single treatment.

Historically, the needling of muscular trigger points has contributed greatly to the treatment of pain and muscle dysfunction in traditional Chinese medicine. Traditional acupuncturists directly needle what are known at “ashi” points, or points of muscle tenderness and pain, with predictable referral patterns. Traditional acupuncturists will also typically needle additional points with therapeutic properties based on the patient’s presenting concerns and systemic health pattern.

Therapeutic IMS is an incredibly effective adjunct to chiropractic care and massage therapy, and is currently offered at Vitality Clinic.

Have a great day,
Dr. Kaleigh Anstett, ND

It is generally accepted increasing the flexibility of our muscles promotes better performance and decreases injuries. Stretching is regularly included in both warm-up and cool down, with the notion that decreased muscle stiffness allows for increased joint range of motion. However, a number of recent research studies, using athletes in several sports, suggest that pre-event static stretching may actually negatively impact the performance of maximal muscle strength, power and even balance and reaction time. This means static stretching as part of a warm-up leads to greater potential for injury occurring during an event.

The scientific basis of stretching is that it increases the compliance of the muscle tissue for a short period of time. Unfortunately, increased compliance decreases the ability of the tissue to absorb energy and can potentially increase the chance of injury.

The most important aspect of the pre-match preparation should be on active warm-up and sport-specific movements. The goal of a warm-up is to gradually increase the metabolic demands required for running. By doing a progressive warm-up, muscle temperature and blood circulation will increase. More blood flow (and nutrients and oxygen which fuel exercise) to the working muscles helps prevent metabolic by-products such as lactic acid. Improved core temperature allows for increased elasticity of the soft tissue structures improving flexibility and range of motion. Nerve impulses also travel faster at higher temperatures preparing the muscles for increased speed of contraction.

For a runner, this means using movements that target the muscles used in running and taking those muscles through an active range of motion to prepare them for work. These movements will closely resemble what will take place during your actual training.

The following are a few dynamic stretches that can be used as part of your warm up:

1. High Steps Actively warms up the hip flexors and calves while passively stretching the hamstrings, glutes and low back (extensor chain). Begin by stepping forward. As you step forward, bring your knee to your chest – pull it into the chest with your hands. Next step, opposite knee. While doing this move, try to push up on to your toes – as you pull your knee into your chest. Walk yourself forward 15-20 feet/return to starting point.

2. Frankenstein March Actively warms up the hip flexors while passively stretching the hamstrings, glutes and low back (extensor chain). Begin by standing with your arms extended out in front of you. Swing your right leg forward and touch your left hand and return the leg and hand back to starting position and repeat on opposite side – kind of like a skipping motion While performing this move, try to avoid bending forward as you lift your leg and keep your leg soft (not totally straight) while lifting to your hand. Move forward 15 to 20 feet while performing this movement at a moderate pace/ repeat back to the starting point.

3. Back Pedal Simply run backwards over the 15 to 20 feet while over-exaggerating your stride. This helps warm up the extensor chain. Pace is slightly faster than moderate for this movement.

4. Fifty-Percent Sprint/Stride Sprint at 50 percent of your max speed for 15 to 20 feet, moving forward with a slight over-stride. These are just a few, but by adding these exercises to your warm up routine you can help reduce the likelihood of injury.

Static stretching is still fine – AFTER your event. Increasing your flexibility of your muscles is still desired; it’s just the timing of that static stretching. Remember dynamic before, static after!

So if you are in the Vancouver area and would like an individualized warm up program to suit your needs, please make an appointment with either our Chiropractors or Registered Massage Therapists.

Good luck with your runs.

The Vitality Clinic Team

In order to maximize your muscle’s strength while performing any exercise, technique is critical. Here is the ideal position and technique for a bicep curl…

Point #1– The first point to consider is your carrying angle- it is the angle your arms make relative to the side of your body. Let your arms drop naturally by your sides and then open your palms so they face forward. This is your carrying angle; the position you should always perform your bicep curl at as it maximizes the space your bicep tendon has at the shoulder.

Point #2– Never let your arms fully extend at the bottom of the curl. When you fully extend, you lose the contraction and you place more strain on the tendon and joint. Keep your arms at about 160 degrees. You may want to drop your weight down a bit as you should fatigue more quickly keeping the contraction through the entire set.

Point #3- Pay attention to wrist position. They should remain planar (completely in line with your arm) through the entire curl. Often, especially with increased weight, individuals have a tendency to flex their wrists towards their body when performing the curl. Unfortunately, this is making the curl easier and you’ll just end up with really sore forearm muscles.

Point #4– Lower back. Always ensure you have the rest of your body in mind when performing any exercise. Pelvic tilt (belly button tucked under) and keep your knees slightly bent to avoid any unnecessary pressure through the lower back. If you are unsure whether you are rotating your torso or arching your back, stand against a wall while doing your bicep curls. If you notice you were doing either, your trying to lift too much weight so drop down a few pounds.

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

We may have posted this once before on our Facebook page, but as we go in to play offs it seems particularly relevant! This is a great animated short by DocMikeEvans that is not only informative but fun to watch.

Play safe everyone!

Kari

Are you training for a half marathon or marathon this summer? Using running as a cross train or a way to get in shape? These simple tips will help keep you pain free for longer – you just need to look at your feet!  Or rather, your shoes …

If you are running in an older or worn pair of running shoes you are at an increased risk for running injuries. Running shoes lose cushioning, stability and shock absorption over time. One way to prevent these injuries is to know when to replace those old shoes.

Below are some tips and tricks to keep in mind when considering buying replacement shoes.

1. The mileage on your shoes is high. It is a good idea to replace your shoes every 600-800 kilometres. This is somewhat dependent on the surface you are running on, your body weight and running style. Smaller runners can get away with longer, running in rough terrain decreases the lifetime of a shoe, as does heavier runners.

2. You’re feeling pain.

If you’ve been feeling muscle fatigue, shin or calf pain or some pain in your joints — especially your knees — you may be wearing shoes that have lost their cushioning. When you’re feeling pain on both sides — both knees, for example — that’s often an indication that you need new running shoes. It’s also often an indication that you should see your Sports Therapist or Chiropractor to work out the kinks in your lower kinetic chain.

3. Your shoes fail the twist test.

If you hold your running shoes at both ends and twist the shoe, it should feel firm. An old shoe or one that doesn’t have proper support will twist easily, like a dish rag.

4. The soles have worn out.

Soles typically last longer than the shoes shock absorbency and cushioning so if the soles are worn down, then it’s definitely time for new shoes!

5. Newer shoes feel much better.

Some experts recommend that runners rotate two pairs of running shoes. If you get a new pair of running shoes about half-way through the life of your old ones, they can serve as a reference to help you notice when your old ones are ready to be replaced. If you notice a big difference in the cushioning of the newer pair, then it’s probably time to say goodbye to the old ones.

If after replacing your shoes you are not quite healed, a visit to your Chiropractor, ART Provider, and Massage Therapist is a good idea. You may have built up some scar tissue or joint restrictions that need to be released!

Enjoy the weekend,

Dr. Laura Clemenhagen

Chiropractor and ART Provider

Winter is almost here and as promised, here are a few guidelines for hitting the slopes to avoid unnecessary injury.  While skiing and snowboarding come naturally to some, others spend most of their time unsuccessfully negotiating the equipment and terrain.  Whatever your level of experience, either sport can be hazardous and contribute to injury.  Prepare youself for the slopes by minimizing your risk of injury through spinal alignment treatments, sport specific strengthening, and warm up and cool down programs.  This approach will maximize your time on the slopes.

To avoid injury this snow season, consider the following:

“Prehabbing” for the slopes

Begin to incorporate chiropractic treatments and sport specific exercises into your regular exercise routine at least eight weeks prior to the season.  This will promote proper use of the muscles and joints required for your preferred sport.  Strengthen the muscles specific to snow sports (quads, hamstrings, gluts, core stabilizers, and triceps) to reduce the risk of injury and increase your enjoyment and endurance on the slopes.

Look after your back

A neutral spine and strong core are essential for minimizing injury.

Here are a few general stretches of the lower back, hamstring, and psoas and quad.*

Warm up, stretch, and cool down

Before hitting the slopes, warm up like you would with any other sporting activity.  Stretch your thigh, calf, and arm muscles.  Ensure you are adequately warm prior to taking to the slopes (make sure you also do this after each rest break.)  Once you have finished skiing or boarding for the day, remember to cool down, especially if you’re travelling home in a vehicle.  These activities will better prepare your body to avoid injury.

Ski or snowboard within your capabilities

Beginners should take advantage of a ski lesson and not succumb to the pressure of keeping up with experienced skiers/boarders.  Don’t be afraid to rest when you find yourself getting tired.  Fatigue can certainly increase your risk of injury.  Injuries often happen on that last run of the day!

To avoid injury on the mountain this winter, consider booking an appointment to discuss how to best prepare your body and ensure your season is injury free!

Enjoy the week,

Dr. Crysta Serné

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 accepts no responsibility.