Physio and Acupuncture Talk

Which Patients with Low Back Pain will Respond to a Stabilization Exercise Program?

2008-01-20T22:06:00.000-05:00

When treating patients with low back pain, it is sometimes difficult to predict who may benefit from a lumbar stabilization exercise program. Researchers have come up with a list of prediction rules that can help with a physical therapist's decision. Over time, the overall reliability and validity of these rules will be proven to a greater degree.

These clinical prediction rules include:

- age less than 40
- history of frequent prior episodes, with increasing frequency
- frequent manipulation resulting in short-term dramatic results
- history of trauma or spinal surgery
- pregnancy related lumbo-pelvic pain
- radiographic diagnosis of spondylolysis or spondylolisthesis
- reports of "catching" pain and/or painful arc on forward bending or when lifting
- "thigh climbing" upon returning from forward bending
- general hyper-mobility during passive intervertebral motion testing
- reports of feeling "unstable" in the spine during functional activities or when lifting
- straight leg raise test bilaterally greater than 90 degrees
- positive prone instability test

Hicks, Fritz, Delitto, McGill. Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. Arch Phys Med Rehabil. 2005 Sep;86(9):1753-62.

Pregnancy and Back Pain

2007-04-09T13:48:00.000-04:00

Approximately one half of all pregnant women have experienced low back pain. As a woman progresses through her pregnancy there are many changes that occur affecting her muscular and skeletal systems. An increase in the hormone Relaxin will increase ligament laxity, making the joints of the spine and limbs more prone to strains. As the uterus grows and weight gains progress, there is a shift in a woman's centre of gravity. Simply, she will feel drawn forward by the weight, which will alter her posture. All of these changes can cause pain for some women.

Pregnancy Related Body Changes

The weight of the abdomen will draw the pelvis into an anterior tilt thus increasing the curve of the low back and drawing the head forward. This can cause muscle tension, nerve irritation and strained joints, throughout the spine.

Irritation of the sciatic nerve (sciatica) can occur for several reasons causing pain to radiate from the buttocks down the legs as far as the feet. This can cause protective tone or cramping in the hamstring and calf muscles.

Due to ligament laxity, the pelvis becomes loose in the front at the junction of the pubic bones and in the back at the sacroiliac joints. If the muscles in the area are not strong enough to support the increasing weight and anterior tilt of the pelvis, these joints will be strained. Hypermobile and locked joints are also possible. Pubic pain is localized. Sacroiliac pain is one sided but can cause pain to radiate to the buttock or the leg.

As the abdominal wall and uterus stretch, the inguinal and round ligaments may be strained causing low abdominal discomfort. Their attachment to the pelvic cavity can cause strain and arching of the low back.

A partial or complete separation of the rectus abdominus muscle can occur down the centre of the abdomen (linea alba) as a result of changes in hormones, increase in mechanical stress and weakness of the abdominal muscles pre-pregnancy.

The pelvic floor muscles and fascia are like a sling which support the pelvic organs. These tissues connect to the sacroiliac ligaments and muscles in the hips. As the pressure and weight of the growing uterus increases, stress from the pelvic floor can be referred to the sacroiliac ligaments and hip joints. Organ prolapse and incontinence can also occur if the pelvic floor muscles are too weak to support the pelvic organs.

Pregnancy and the role of Physiotherapy

Physiotherapists are primary health care practitioners and are able to assess and treat your musculoskeletal needs when you are pregnant. They may teach a combination of stretch and strengthening exercises, use postural re-education and manual therapy techniques and assist with pain control. A physiotherapist is an important part of pre and post natal health.

About Shoulder Tendonitis

2007-03-27T21:32:00.000-04:00

What Anatomical Structures are affected?

The rotator cuff is made up of four muscles and their attaching tendons. A tendon is a band of fibrous tissue which connects muscle to bone. The shoulder tendons of the rotator cuff, along with the biceps tendon help to keep the shoulder joint in place.

What is it?

Shoulder tendonitis is an inflammation of the tendons in the shoulder region and may lead to weakening and tearing of these tendons. This can result in pain, tenderness, and weakness in the shoulder.

What causes it?

-repetitive movements
-sports injury
-trauma
-repetitive overhead activity (i.e. from work activities or sports such as tennis, baseball, swimming)

What are the Risk Factors?

-Age (40+)
-Involvement in repetitive overhead work or sports
-Trauma to the shoulder (i.e. fall on an outstretched hand)
-Diseases which may weaken shoulder muscles – gout, psoriasis, or rheumatoid arthritis

What treatment is recommended?

Treatment may include the following
-Rest
-Ice
-Physiotherapy which may include the use of modalities, range of motion exercises, theraband strengthening exercises, stretching exercises, postural education, manual therapy, activity modification
-Medications – anti-inflammatory medications

PHYSICAL THERAPISTS CAN HELP RELIEVE PAIN

2007-03-04T09:12:00.000-05:00

The following is provided by apta.org and is a great reminder for everyone to seriously consider physical therapy to help them relieve their pain:

ALEXANDRIA, VA, December 27, 2006 — In light of proposed sterner warning labels for acetaminophen, aspirin, and ibuprofen by federal health officials, patients may wish to consider the benefits of physical therapist intervention for pain relief from certain conditions, according to the American Physical Therapy Association (APTA).

"Many people are looking for alternatives to the sole use of medication to deal with painful conditions," said APTA President R Scott Ward, PT, PhD. "Pain medication may help you get through periods of severe pain, but it won't always help you eliminate the underlying cause of some kinds of pain. For many individuals, it is the underlying causes such as poor posture and alignment, weak and/or inflexible muscles, or tight joint structures that actually exacerbate the painful condition," Ward explained. "A physical therapist will perform a complete musculoskeletal examination and design an individualized treatment program to reduce pain and improve function."

There are many types of pain and inflammation that can be reduced by physical therapist intervention. For example, chronic pain in the back, shoulder, or knee, or pain associated with certain degenerative diseases such as osteoarthritis, can be reduced with the appropriate combination of medication and exercise. "The physical therapist, in collaboration with the patient and the patient's physician, can help the patient manage his or her health over the long term," explained Ward.

For pain of a "mechanical" origin such as back, shoulder, or knee pain, physical therapist intervention may include therapeutic exercise, manual therapy, and functional training. "The goal of the physical therapist is to reduce pain, improve the ability to perform daily activities, and help the patient return to doing the things he or she likes to do," said Ward. "It is also true that patients may unknowingly contribute to their own pain, such as by exercising improperly or with poor posture, and physical therapists can identify and help to correct those behaviors." Ward added, "Through the use of home programs designed to fit the patient's needs, the physical therapist can efficiently progress the patient's rehabilitation and teach the patient how to prevent a recurrence of the original condition."

For osteoarthritis, a degenerative disease of the cartilage and bone, physical therapist intervention may include exercises for strength, flexibility, range of motion, and the use of devices designed to rest or support the joint, such as orthotics or splints.

Physical therapists, who treat nearly 1 million people every day, work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles. Many insurance policies also cover post-rehabilitation gym programs. "Most people who desire a fitness plan are not athletes," Ward explained. "They are ‘ordinary people' who exercise lightly to moderately. Many have a prior health condition, such as chronic low back pain, that can benefit greatly from physical therapist management focused on increasing muscle strength and endurance, restoring and improving range of motion in joints, increasing cardiovascular endurance, and decreasing muscle and joint pain." The physical therapist individualizes exercise programs based on functional limitations as a result of injury or illness.

For more information on physical therapy or to find a physical therapist near you, please visit www.apta.org/consumer.

The American Physical Therapy Association (www.apta.org) is a national professional organization representing more than 70,000 physical therapists, physical therapist assistants, and students. Its goal is to foster advancements in physical therapy practice, research, and education.

Shoulder Pain Poll

2007-02-03T19:54:00.000-05:00

Myofascial Release

2006-11-27T13:00:00.000-05:00

The Fascial System

The fascial system of the body is composed of connective tissue which travels through the body three dimentionally from the top of the head to the tip of the toes. The tissue binds, separates, connects and defends all other tissues in the body, including nerves, muscle, vessels, organs and bone. Since fascia permeates all regions of the body and is all interconnected, when it is injured and scars, the effects will be transferred throughout the system. Imagine the fascia in your body to be the equivalent of a full body panty hose. The tension in the body (or the pull on the panty hose) could cause pain to be felt by pain sensitive structures elsewhere in the body. For this reason, pain can often be experienced away from the site of the fascial trauma. This trauma could have been initiated by soft tissue or bony injury, repetitive strain, infection, surgical incision or any number of causes that would cause a disruption of the glide of the connective tissue. The fascial system is divided into superficial and deep layers. The deepest of these layers are horizontal thickenings of connective tissue which lie in the pelvis, above and below the lungs and at the base of the skull. Often all four of these diaphragms will become restricted when fascial adhesions occur in any other part of the body.

Unlike muscle, which responds to a relatively firm stretch, the fascia in your body gives way to a very small amount of pressure applied by a therapist's hands. Although it is estimated that fascia has a tensile strength of as much as 2000 pounds per square inch, it will soften and begin to release when a very gentle pressure is sustained over time.

Muscle provides the greatest bulk of our body's soft tissue. Because all muscle ("myo" means "muscle")is enveloped by fascia, myofascial release is a term that has been given to the techniques used to relieve soft tissue from the abnormal grip of tight fascia.

What to expect during a Myofascial Release treatment

Your therapist has been instructed in either indirect or direct fascial release techniques and has a thorough understanding of the fascial system in the body. The type of fascial release technique chosen will depend on where they find the restriction of the fascia in your body. With skilled and sensitive hands, your therapist will apply a three dimentional fulcrum and hold a gentle stretch to allow the tissue to release. You may notice subtle movements or full limb unwinding. There may be a perceived warmth, pulsing, tingling or tissue change in the area the therapist is working or in areas that seem unrelated. You may not perceive anything at all during a treatment but your therapists skilled hands will be able to detect areas of fascial restriction and the associated changes that occur with a release.

Myofascial release is a gentle technique but can have profound effects on the body's tissues. You may not perceive any change after your first session but later that day or even a day later you may begin to feel the effects of the treatment.

Occasionally after a treatment, there is an increase in discomfort for several hours, followed by remarkable improvement. This improvement can be noted during or immediately following a treatment. Sometimes, new pain may be noticed in an area that previously did not seem affected. Sometimes there is a short lived feeling of nausea or light headedness. A temporary emotional change may also be noticed. All of these reactions are normal. The fascial system is changing and adjusting to it's new range of mobility.

It is recommended that after a session you drink a lot of fluids to "flush your system". It is felt that after the release of tight tissue there is also a release of trapped metabolic waste products into the surrounding tissue and blood stream. Drinking fluids will limit the feelings of nausea, achiness and light-headedness after receiving myofascial release treatments.

Osteoarthritis

2006-11-21T11:00:00.000-05:00

Osteoarthritis is the most common form of arthritis and is also known as degenerative joint disease or spondylosis. This condition, which occurs later in life, is a progressive disorder of the joints of the body, specifically the cartilage, which is located at the ends of bones. Over time, the cartilage may wear down and consequently lead to pain and inflammation. The most common areas affected are the hands, hips, knees and spine. Other symptoms may include stiffness, swelling, loss of range of motion, muscle weakness, joint instability, deformities and inflexibility.

Physiotherapy has been shown to help manage these symptoms. Specific stretching and strengthening exercises can help to increase flexibility, decrease pain, improve mobility, increase quality of life and reduce the risk of injuries. Stretching muscles that have shortened and strengthening muscles that have weakened will decrease the load on the joints affected, and therefore making osteoarthritis more manageable. Contact a physiotherapist for more information and to begin a specific treatment program catered towards your symptoms and goals.

Pilates Principles in Practice for Perfect Posture

2006-11-20T15:34:00.000-05:00

Pilates has become a common form of exercise used to improve posture and strengthen and lengthen the spine and extremities. Using some basic principles in your daily activities can help you to gain a more balanced posture.

Neutral Pelvis

Whether doing activities in sitting or standing, it is best to keep the pelvis in a neutral position. This encourages a slight forward curve in the low back (lumbar spine), not a flat back or excessive arch. Strengthening your deep abdominal and pelvic floor muscles can help to achieve this control.

Rib cage Placement

The thoracic spine and rib cage, houses very important organs that control breathing and the circulation of blood. To ensure the best function of these organs and your spine, mechanically it is best to keep the rib cage in line with the pelvis. Stabilizing the rib cage on the pelvis is achieved by drawing the shoulder blades gently down and back on the ribcage. At the same, activate the deep abdominal muscles by gently drawing your belly button up and in towards your spine without holding your breathe. Both a slumped posture and an overextended (or military) posture should be avoided as this will strain the joints and soft tissues of the spine.

Head and Neck Placement

By gently tucking in the chin and reaching the top of the ears away from the tip of your tail bone, it is possible to lengthen the neck and spine. This assists in unloading the small neck joints and encourages an upright posture when performed in conjunction with the postural tips mentioned above.

Shoulder Girdle Stabilization

During arm movement it is important to maintain a stabile shoulder girdle and limit rounding of the shoulders on the trunk and neck. Again, This is performed by gently letting the shoulder blades slide down and back on the rib cage when initiating arm movement.

Leg Posture

In standing, if you look down, it is advised to keep the hips in line with the mid line of the knee and carry the line down through the second and third toes. This guideline may assist with controlling excessive rotations occurring at the hip, knee and ankle joints (for example, being knock kneed or bow legged). It is also best to avoid over extending the knee joint. Gaining proper muscle balance of the legs would ensure better leg alignment.

Principles of posture are commonly addressed during a Physiotherapy assessment. Pilates exercises have become a useful tool for many therapists in reducing muscle imbalances, improving body awareness and developing a healthy posture. Overall, this allows for greater ease of motion with all of your activities of daily living.

Acupuncture for Tennis Elbow

2006-05-17T17:04:00.000-04:00

Tennis Elbow is a common complaint among people aged 25 years to 50 years. It often occurs after repetitive use of the forearm or extension and flexion of the elbow joint, or among those who have a history of exposure to cold and wind. This last group who have had the exposure to cold and wind often develop tennis elbow without any particular activity, leading to symptoms.

Patients' main complaints are pain of the lateral side (outsie part) of the elbow, which is sometimes more painful during extension or rotation of the elbow. Sometimes patients complain of a burning sensation on the outside part of the elbow which is also very tender to the touch. In most cases there is an insidious onset and it gradually worsens over time, sometimes to the point where the pain is unbearable.

Acupuncture is an extremely effective treatment option for this kind of pain. The main Acupuncture points to treat Tennis Elbow are Li11(Quchi), Li10(Shousanli), Li4(Hegu), TW5(Wiaguan), GB34(Yanglinquan) and local Aishi points (tender points). All points are connected to a electroacupunctoscope with a dense disperse setting and the needles are left in for approximately twenty minutes. Usually patients experience significant relief after the first treatment which is an excellent start to the recovery process.

About Chronic Fatigue Syndrome

2006-05-13T09:55:00.000-04:00

Chronic fatigue syndrome (CFS) is an emerging illness characterized by debilitating fatigue (exhaustion and extremely poor stamina), neurological problems, and a variety of flu-like symptoms. The illness is also known as chronic fatigue immune dysfunction syndrome (CFIDS). In the past, the syndrome has beeen called chronic Epstein-Barr virus (CEBV).

The core symptoms of CFS include excessive fatigue, general pain, mental fogginess, and often - gastro-intestinal problems. Many other symptoms will also be present, however they typically vary among different patients. These include: fatigue following stressful activities; headaches; sore throat; sleep disorder; abnormal temperature; and others.

The degree of severity can differ widely among patients, and will also vary over time for the same patient. Severity can vary between getting unusually fatigued following stressful events, to being totally bedridden and completely disabled. The symptoms will tend to wax and wane over time. This variation, in addition to the fact that the cause of the disease is not yet known, makes this illness difficult to diagnose.

Colleagues from the Radboud University in the Netherlands say different factors can predispose people to CFS, trigger the onset of CFS, and perpetuate the syndrome. Some of the factors mentioned, which predispose people to CFS include neuroticism, introversion and inactivity in childhood; however, more research needs to be done in this area. Study authors also say genetics may play a part in the development of CFS, as women are more likely to have CFS than men.

There are a number of things that may trigger CFS, including sudden or severe physical or psychological distress as well as an infection caused by the Epstein-Barr virus. Psychological factors appear to be involved in perpetuating complaints among patients with CFS.

Authors say cognitive behavior therapy, which teaches patients to gain control of their symptoms, and exercise therapy are the only two treatments that show success in treating CFS. There are likely many other ways to deal with CFS and it is recommended that a patient with CFS contacts their local association and/or support group.

Patients often find an equilibrium point at which they can function. As in combating any chronic illness, a positive hopeful attitude is essential.

CFS patients must prepared for a possible lack of acceptance from some from whom support is expected. This may be a shock, but as a CFS patient, when you cannot regularly "go bowling" with the gang, or you increasingly depend on being accommodated at home or on the job, and when you have a condition that your doctor may not certify or that other people have already heard of as "that yuppie disease", then your emotional world will become quite different.

If you have CFS, follow these recommendations:

- Find new sources of support. It will be important to create a new family-and-friends support structure. This can be done through CFS support groups, electronic networking, pen pals, and other means.

- You will need to take the time to create a new self image for yourself, to know that your new physical limitations do not limit you as a person, as a soul, no matter what other people are thinking. And take some advice from those who have traveled this difficult road before you -- consider reading from books like those below:

"The Alchemy of Illness" by Kat Duff, 1993, Pantheon Book, New York. $19
"Recovering from Chronic Fatigue Syndrome: A Guide to Self-Empowerment" by William Collinge, 1993, The Body Press/Perigee, New York. $13.95

"Living With Chronic Fatigue Syndrome" by Timothy Kenny, 1994, Thunder's Mouth Press, New York. $12.95

What should your body fat percent be?

2006-05-07T09:56:00.000-04:00

Body fat percent varies considerably for men and women, and age. However, there are some standards. The minimum percent bodyfat considered safe and acceptable for good health is 5% for males and 12% for females. The average adult bodyfat is closer to 15%-18% for men and 22%-25% for women.

Athletes, typically, find themselves at the low end of this scale. Optimal levels of body fat are much lower for those striving for high level performance. Ranges for professional athletes are quite a bit lower than for the average, healthy individual. Much of this difference can be attributed to the increased lean weight (muscle mass) of top athletes. The impact of body size on performance is one consideration that may correlate with body fat.

While levels of bodyfat seem to be related to performance, body composition alone has never been a great predictor of sports performance. Several studies have suggested that percent bodyfat is inversely related to maximal aerobic capacity and to distance running performance. Lean muscle mass seems to be positively related to performance in sports where the ability to generate maximal force is required (this may help to explain why a lot of those defensive linemen appear to have a high body fat levels). The bodyfat percents for elite athletes vary largely by sport. Clearly, the association between low body fat and improved performance is not precise, and there is little evidence of performance benefits when male athletes drop under 8% and women drop under 14% bodyfat.

Understanding Upper Back Pain

2006-04-28T17:47:00.000-04:00

Upper Back Pain can be just as troublesome as the pain in the lower back or the neck. It can be caused by a variety of factors, ranging from poor posture to improper lifting, especially overhead lifting.

Muscular irritation and joint malfunction have been found to be the most common causes of upper back pain. This can be a result of injury or poor posture. It has been found that people sitting in one position for a long time (for example working in front of the computer) are more prone to suffer from this type of back pain. This occurs especially if the workstation is not set up ergonomically.

Lack of activity or poor strength of our muscles is also a very common cause of upper back pain and can be treated through acupuncture, massage, physical therapy and various types of stretching and strengthening exercises.

Many people will experience upper back pain for years without doing anything about it. Adopting good posture and starting regular strengthening exercises are a must for avoiding the pain in the upper back. Poor posture can lead to weak muscles and a strain in our joints and ligaments and thus cause upper back pain. Osteoporosis, a disease which makes ones bones fragile and weak, a rupture in the spinal disk or any other form of injury can also result in back pain.

Poor posture eliminates the natural, weight-supporting S curve in our back and weakens all the back muscles. In contrast, correct posture - chest out, stomach in, and buttocks tucked under - helps one to restore the S curve in our back. Proper exercises can enable one to rectify one's posture.

A few tips to help you with prevention of upper back pain include: standing with your back to the wall perodically and pushing your shoulders back, tucking your chin in and holding for 10 seconds. Also, make sure that your working chair supports you well as you sit and start exercising your shoulder blade muscles by doing the appropriate arm exercises with free weights. Consult your physical therapist today to start improving your upper back!

What is Frozen Shoulder?

2006-04-24T23:01:00.000-04:00

Also known as ‘Adhesive Capsulitis’, Frozen Shoulder is a condition affecting people generally aged between 40 and 60. Essentially, it is a “painful and stiff” shoulder. It is more common in people suffering from Diabetes Mellitus. Investigations such as certain blood tests and X-rays are normal.

This condition usually lasts between 6 months to 2 years, and can even last longer if not treated.

There are 3 Phases to Frozen Shoulder, each lasting several months:

Freezing: There is increasing pain and stiffness. The patient first complains of a painful shoulder, that ‘feels like a toothache’. This affects the sleep adversely especially when lying on the affected side.Graduallly, it gets more difficult to raise the arm sideway and to touch behind one’s head until it becomes impossible.

Frozen: The pain gradually subsides but the stiffness persists.

Thawing: The movements gradually return. However, many patients do not regain their full range of movement even after many years.

How would I get it?

The cause is uncertain, but there seems to be multiple inter-related causes. Some patients may recall a minor trauma to the shoulder before the onset of Frozen Shoulder. There may be “autoimmune” response by the body’s immune system to attack the injured shoulder tissues. There are also studies that showed that identical twins are more likely to get it if the other twin-sibling has it, suggesting a genetic predisposition. Diabetics are 4-5 x more likely to get it.

Can it be cured?

The condition is self-limiting. Treatment will improve on the range of movement and pain while the body heals itself.

How is it treated?

General Advice: There should be sufficient rest for both the patient and the affected shoulder. Resting the affected arm on a “Collar and Cuff” sling for short periods may help to relieve pain.

Physiotherapy: Heat, and often, Ice Packs will help in pain relief. Exercise that works through the range of shoulder movement will help, if it is conducted regularly and gently. However, this should be done after the acutely painful stage has subsided. One particular exercise is the “pendulum” exercise, whereby the patient leans forward at the hip, hanging the arm down and move it in a stirring movement. Acupuncture can often help relieve the pain and facilitate ROM exercises.

Medications: Oral painkillers such as Paracetamol and Diclofenac will help relieve the pain. Oral steroids are effective too. Occasionally, injection of steroids into the shoulder joint may be indicated.

Surgery: Manipulation Under Anaesthsia, whereby the Orthopaedic Surgeon manipulates the affected shoulder through certain movements while the patient is under anaesthesia. The result is significant pain relief and a possible shortened course of the disease process.
Surgical Release can be done either through an open surgery or an arthroscope.

When should I see a doctor?

There are many causes to shoulder pain and Frozen Shoulder is but one of them. Some of these are potentially serious: Ischaemic Heart Disease, Arthritis, TB, Gallstones among others. It is important to see a doctor if in doubt as to diagnosis of the shoulder pain.

Basic Facts on Whiplash

2006-04-17T21:55:00.000-04:00

Most of the time, whiplash affects the soft tissue in a person's body. Soft tissue consists of:

Muscles
Tendons
Ligaments.

In the days following an impact your neck or back muscles may feel stiff and sore. This may subside within a few days, or may persist.

Injury beyond Soft Tissue

Soft tissues generally heal completely within about 3 months. (Some experts say 3-6 months.) If pain persists beyond this timeframe, the whiplash injury may also be affecting any or all of these structures:

Intervertebral joints
Facet joints
Nerve roots
Interveterbral disks.

Diagnosis

If pain does persist beyond the normal amount of healing time for whiplash (3-6 months), a diagnosis is often made by a doctor as to the exact location and nature of the problem.

Diagnostic tools the doctor might use include: MRI, X-Rays and Injections.

Recovery from Whiplash

Generally, whiplash injuries take no longer than 6 months to heal. There are conflicting views as to how many whiplash patients end up with chronic pain - this varies between 5 and 20 percent.

Most of the time, exercise, patient education (on body mechanics), and physical therapy are enough to cause significant improvements, allowing patients to return to their normal activities of daily living.

Treating Dysmenorrhea

2006-04-17T12:55:00.000-04:00

Dysmenorrhea refers to lower abdominal pain which is experienced premenstrual, during menstration or before menstruation. It occurs most typically in young women two to three years after the onset of menstruation. In severe cases , lower abdominal pain is also accompanied with nausea, vomiting, headaches, dizziness, lower back pain or a pulling sensation in the inner thighs. This is a common health problem for women all over the world.
This health problem is often related to stagnation of qi and blood in the uterus, retention of cold-damp, damp heat in the liver channel or liver qi stagnation and deficiency of qi and blood. The first three are dysmenorrhea of excess type and the last one is dysmenorrhea of deficiency type.

CASE STUDY
Female patient, 28 years of age came to the clinic seeking help from her dysmenorrhea that she has been suffering with most of her adult life but the past three year have been unbearable. This condition has affected her life dramatically. She has taken time off work because of the pain and more importantly it has affected her relationship with her family. Over the years she has tried all kinds of prescription pain killers and over-the counter pain relievers. Finally, a friend of hers recommended that she see a Chinese Medicine Practitioner. She was extremely hesitant at the beginning, but she came to see me on one of her "bad" days. The patient presented with lower abdominal pain, irritability, purplish red flow with clots, alleviation of pain with discharge of clots, restlessness, painful breasts, purplish hue on border of the tongue, and a wiry pulse. This individuals Chinese Pattern was stagnation of qi and blood. Treatment consisted of acupuncture and chinese herbs. Points selected were Li4, Liv 3, CV3, ST29, SP8, and Sp6. The patent medicines Tongjing Wan and Xiao Yao were also prescribed. The patient achieved immediate results after the acupucture treatment. I recommended that she have two treatments every month before her menstruation. After three months her menstral pain has disappeared and she is now living a happy productive life.

Do you have a Painful Knee? - It could be Patellofemoral Syndrome

2006-04-09T09:35:00.000-04:00

Patellofemoral syndrome is a common overuse injury of the knee that often results from exercises involving repetitive movements using a higher degree of knee angle than most other exercises.

This condition occurs via two mechanisms, either when the extensor mechanism of the knee is malaligned or as a result of repetitive microtrauma from overuse. Basically, overuse can cause irritation on the articulation between the patella bone and the femoral condyles, the rounded projections on the femur (commonly called the thigh bone). To make this clear let us take a look at the anatomy of the knee. The patella is a small, round bone, commonly called the knee cap. It is situated within the lower end of the quadriceps tendon and the upper end of the patellar tendon (or ligament). There are two projections at the lower end of the femur that hold the patella in place. Patellofemoral syndrome affects the tracking of the patella within this region. People who exercise excessively may develop this condition by causing microtrauma in the area of patellofemoral joint, which means that through external stresses tracking is compromised.

The pain associated with this condition is probably due to the strain placed on the retinaculum, the structure that holds the patella, often times to the lateral side of the knee, causing inflammation. Inflammation of the soft tissues surrounding the area, along with the irritated, yet highly enervated patella, causes pain. The patellofemoral syndrome is recognized by a dull, aching pain behind or above the knee. Inflicted exercisers often have pain while sitting for any length of time with a flexed knee position. Sharp pain may be observed upon activities that require squatting and climbing or descending stairs. Another common symptom is cracking noises that come from the knee during bending and stretching, called crepitus. Often these symptoms do not appear at one instance but develop gradually, which is characteristic of an overuse injury.

Dealing with Back Pain

2006-04-01T18:58:00.000-05:00

Many people try to ignore their back pain when they first start experiencing it. Often, the pain gradually escalates to a severe level, radiating down the leg and limiting most activities. Many can barely walk. They can't shop for groceries, go to family outings, exercise or even work.

This is the collateral damage of pain. Pain is a noxious stimuli that affects all parts of our lives. When we get stopped in our tracks because of the pain we have, we become 'de-conditioned' both physically and emotionally. It becomes a vicious cycle and a downward spiral.

We all get back aches. That's universal. But most pain, even the most severe pain, goes away in a few days. If the pain lingers -- shooting down your legs, arms getting electrical 'zingers' -- you should tell your doctor or physiotherapist and get it examined.

Years ago, doctors recommendeded that patients go to bed and stay there in order to heal. That's absolutely not the recommendation today. In fact, not moving at all could be the worst medicine.

In order for the joints to clean out toxins, feed themselves and regenerate, they need movement to get nutritious fluids in and out of them. So movement as soon as possible, is very important in helping to reduce back pain.

Poften tend to overdo it, or "underdo" it. People exercise too much and stress their bodies even more. Or they don't move at all. The key is to engage in modest, persistent activity. That may mean just walking a little bit every hour while you're having a back-pain episode, just making sure you're not sitting in a chair or lying down for long periods of time.

The first step toward making movement tolerable is taking over-the-counter medications such as aspirin or ibuprofen. These medications work by diluting the power of the nerve pathway to the brain. For most patients, a couple of days of medication and movement makes the pain goes away.

But for chronic pain sufferers, there can be difficulties sifting through appropriate medications. Most people have a view that drugs, since they are over-the-counter, are nontoxic, with no side effects. That's not the case! These drugs come with a whole range of side effects, particularly if taken in greater than recommended doses or taken for long periods of time.

For example, aspirin and ibuprofen can cause stomach ulcers, increase bleeding and damage kidneys. This can be especially problematic for patients on blood-thinning medications. Tylenol can adversely affect the liver. This, too, can be problematic for patients on other medications that affect the liver, as well as patients who drink large amounts of alcohol.

Morphine-like prescription drugs may be an option for some patients. Vicodin, percocet and oxycontin are all morphine-derived medications. They are the "gold standard" of pain relief, because they're potent and effective.

There are alternatives for those who don't like the idea of being on medication every day. Great examples include Acupuncture and Physiotherapy. Patients can also learn psychological techniques, much like those used by athletes. These powerful psychological tools are not new; Buddhists have relied on them for centuries.
Patients can harness their brainpower to get "really robust effects on their pain and general health that are lasting and can be used most of their lives and may even mean they rarely have to go to the hospital or see the doctor.

Stress does not cause pain, but it can exacerbate it and make it worse. Much of chronic pain is 'remembered' pain. It's the constant firing of brain cells leading to a memory of pain that lasts, even though the bodily symptoms causing the pain are no longer there. The pain is residing because of the neurological connections in the brain itself.

One helpful technique is the 'relaxation response' to change the brain's perceptions of what it is experiencing, and help erase the memory of pain. In order to do this, a person has to break the train of everyday thought.

To do that, two steps are necessary. First is repetition. Patients repeat a word, sound, prayer, phrase or movement, such as yoga or tai chi. Most patients use a prayer they are comfortable with and believe in, such as "The Lord is My Shepherd." Other patients choose general words, such as "peace" "love" or "gentle."

The patient then does a combination of the following: sit up, close their eyes, relax all their muscles, loosen their clothing, shrug their shoulders and roll their head and neck around. Then, they focus on breathing. With each outgoing breath, patients repeat their special word or phrase silently to themselves, letting it drain out with each breathe. They should repeat this for ten to twenty minutes every day.

Often, practicing this relaxation technique regularly will deliver the intended results. Long-term bodily changes occur. Pain becomes less bothersome, and if stress is exacerbating the pain, then this approach can work in the long term and can relieve the pain entirely.

This is often true with tension headaches, and sometimes with back pain.
Scores of techniques can evoke the relaxation response -- meditation, repetitive prayer, yoga, Tai Chi and Chi Gong.

The relaxation response is a physiologic state characterized by decreased metabolism, decreased heart rate, decreased rate of breathing, lower blood pressure and specific changes in brain waves, including the liberation of a substance called nitric oxide, a chemical that relaxes blood vessels. This is a discrete physiologic package that's opposite of the "stress" package called the "fight or flight" response.

Often the pain is still there, but relaxation-response techniques help patients live with the pain and return to normal activities. In some cases, the pain disappears completely.

For more information, please visit one of our clinics, www.albionhillsphysio.com in Bolton and www.queenwestphysio.ca in Brampton.

The Belt Treatment Technique for Tennis Elbow

2006-03-27T09:33:00.000-05:00

If you have not had any luck successfully treating that stubborn tennis elbow condition, consider using the belt technique to mobilize the elbow. This can be done while the patient is in supine lying and arm rested to the side. Wrap the belt around the patient's upper arm, just above the elbow joint crease. Then also wrap the belt around your waist, shoulder/back or top of your buttocks, wherever it may feel most practical to apply force. With one arm, stabilze the patient's lower arm just below the elbow joint line, and with your other arm, while applying lateral force to the patient's upper arm with the belt, apply some traction to the patient's lower arm with your free hand, and ask the patient to either extend their wrist against the resistance from your hand, or to extend the wrist while holding a two pound weight. Repeat this 5 to 10 times. This will often help decrease your patient's tennis elbow pain.

Do You Overeat? Pill for Promoting Digestion

2006-03-21T16:15:00.000-05:00

In today's hectic society, many peoples' diets suffer, causing them to make poor dietary choices, eating in a hurry, eating while stressed and eating late at night. As a result, many people tend to suffer from a technical term called food stagnation ( Indigestion ). Food stagnation is an extremely common pattern in western society. It basically refers to the stoppage of undigested food in the stomach. It results fom stagnation of qi, phlegm and dampness in the stomach which causes stagnation of food matter. If someone experiences distension in the epigastrium and abdomen, nausea, stool with undigested food or diarrhea, belching, bloating, difficulty breathing, aversion to food and more, one is probably suffering from the Chinese Medicine Pattern of Food Stagnation.

Food stagnation is caused when the stomach has taken in too much food at one time or if the stomach has ingested too much cold or greasy food at one time. This often occurs at holidays and special events. This pattern is quite common among the adult population and it is for this reason, one should always have a bottle of the Chinese Patent Medicine "Bao He Wan", translated as Preserve Harmony Pill.

Think of the way you feel sometimes after overeating at holidays and parties. This patent medicine helps eliminate stagnant food and aids in the proper functioning of the digestive organ

The chief ingredient in the patent medicine Bao He Wan is Fructus Crataegi (shan zha), which is very effective in reducing all types of food stagnation, especially meat and fatty foods. The deputies are Massa Fermentata (shen qu) and Semen Raphani Sativi (lai fu zi). Both the chief and deputy ingredients reduce the stagnation of food and drink of all types. The assistants include Rhizoma Pinellia Ternatae (ban xia), Pericarpium Citri Reticulatae (chen Pi) and Sclerotium Poriae Cocos (fu ling). These three ingredients help promote the movement of qi and eliminate stagnation which in turn harmonizes the middle warmer to stop nausea, vomiting and sometimes diarrhea if dampness is present. Two other assistants include Fructus Forsythiae Suspensae (lian qiao) and Fructus Hordei Vulgaris Germinantus (mai ya). Lian Qiao is effective for food stagnation that has transformed into heat which often happens and Mai Ya helps reduce stagnation from grains.
So, the next time you are experiencing the above symptoms because you overate, the best remedy is to take "Bao He Wan".

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Understanding Repetitive Stress Injuries

2006-03-19T21:15:00.000-05:00

Repetitive stress injury (RSI) is a stress-related, cumulative injury resulting from constant, repetitive movements. Awkward angles of movement and insufficient rest periods during work are large factors often contributing to this injury.

Due to the popularization of technology in the workplace, physicians treating someone with RSI must suddenly consider a whole new collection of ergonomic concerns. An effective treatment plan requires the doctor to identify and help the patient change behaviors that initially produced the injury.

We often push ourselves to our physical limits trying to meet impossible deadlines. With the introduction of the computer, we now type faster than ever before. We communicate endlessly on our cellular phones and through email. We rarely leave our workstations for fear of falling behind in the competitive world marketplace. Our bodies are not used to such a non-stop, high speed schedule. The result is an epidemic of repetitive strain injuries.

It is time for education. We must understand our jobs and our job's effects on our bodies. Prevention is the only cure for this pernicious kind of injury. It is time to respect our health at work and do the same at home.

RSI is a cumulative injury - tendons, ligaments, and muscles are worn down over time doing repetitive tasks with few rest breaks. Therefore, the real key to a full recovery goes way beyond being evaluated in a doctor's office and showing up for physiotherapy sessions on a weekly basis. Recovery requires a commitment to long term changes in your attitude and behaviour well after you have healed.

In the physiotherapy clinic, we often address the physiological and psychological changes that can occur with RSI. We then go over flexibility, range of motion and muscle tone. The more the patient understands RSI, the easier it will be to adapt and heal.

If you see signs or symptoms of RSI, take the time to learn how you can prevent further injury and save yourself a lot of time, pain and strife in the long run!

Cupping Therapy

2006-03-13T17:32:00.000-05:00

Cupping is an ancient technique that is widely used by many Chinese Medicine practitioners. It is extremely beneficial in treating local qi stagnation or blood stasis in the channels. Practitioners use an open flame, place it in the cup for a very short period of time than quickly remove the flame from the cup, and immediately places the cup over the selected area that is being treated. This flame exhausts the oxygen in the cup and this creates a vacuum which will cause the skin to draw up into the cup. This technique helps with qi stagnation and blood stasis by encouraging the flow of qi and blood in the meridians.
When the cup is left in place on the skin for a few minutes, blood stasis is formed and localized healing takes place.
Cups are usually left in the same position for a considerable amount of time, while in other instances it is removed quickly and placed elsewhere on the body. Cupping, the technique, is very useful and very safe and can be easily learned and incorporated into your family health practices.

Case Study

Male, 29yrs old came into the clinic suffering from upper back strain. Two days earlier, he was working out at the gym and during one of the exercises ( upright rows ), he felt a pull in the upper back. Pain and discomfort have persisted ever since. After assessing the patient, it was evident that the patient was suffering from muscle spasms in his upper back. Patient had two treatments of cupping therapy and this was enough to cure him completely. In this case, cups were used to draw the qi to the muscles in spasm and disperse the stagnant qi resulting from the spasm. Cupping allowed the meridian affected to open up by encouraging the circulation of qi and blood. Because cupping draws blood to the surface of the body, sometimes minor weals or bruises are left after treatment. This possible consequence was explained to the patient before we began Cupping Therapy.

Disc Herniation and Sciatica

2006-03-11T23:35:00.000-05:00

The disc is a major source of pain within the low back. The dual nerve supply to the disc, involving both regular sensory nerves and those of the sympathetic system, results in more profound, diffuse, and complex pain.

'Slipped disc', 'herniated disc', 'sciatica', 'nerve damage' are terms used interchangeably and often inappropriately when dealing with low back and leg pain.

The disc comprises a tough outer shell (annulus fibrosus) and a soft inner core (nucleus pulposus). A weakness in the annulus fibrosus may allow the nucleus pulposus to bulge outward, while a tear of the annulus fibrosus will permit the nucleus pulposus to actually extrude from the disc.

Herniation often results from the gradual aging of the disc, combined with poor muscle strength and improper body mechanics. Due to the close proximity of the spinal nerve roots to the posterior aspect of the disc, herniated nucleus pulposus material can compress or stretch these structures. This may reslut in pain, typically 'sciatica' or nerve dysfunction with numbness or weakness in the leg. Seventy percent of patients with sciatica recover in 6 to 12 weeks.

Sciatica refers to pain in the leg below the level of the buttock fold. It relates to the sciatic nerve, a large nerve supplying most of the leg with power and sensation that arises from numerous roots in the lumbar spine. If the pain of sciatica is specific, relating clearly to one nerve root, then it is called radicular pain. Often accompanied by numbness or tingling, the pain radiates down the leg to a specific area such as the great toe or the outside of the foot.

If the pain of sciatica is more dull, radiating downward but to a more diffuse area, it is called referred pain. Typically, this pain radiates through the buttocks and thighs, sometimes into the calf.

Nerve root compression and damage can also cause the nerve to malfunction. In this case, there may be loss of the skin sensation in the area supplied by the nerve, loss of power in the muscles it supplies, and loss of reflexes as tested by an examiner. Nerve root dysunciton may or may not be associated with pain. Sciatica does not imply damange, just irritation - the nerve is usually able to recover.

What is Carpal Tunnel Syndrome?

2006-03-06T21:52:00.000-05:00

Carpal tunnel syndrome (CTS) is caused by the compression of the median nerve, which runs through a small channel in the wrist on the palm side. Under normal circumstances, there is very little pressure on the median nerve because the carpal tunnel is inflexible. It is surrounded by bone on three sides and tough ligament on the fourth side.
People with CTS experience numbness, tingling, and pain in the first three fingers of the affected hand (or hands). The pinky finger is usually spared, which often provides a valuable clue in the diagnosis of the condition.

CTS tends to be more prevalent among women than men. Any activities that involve highly repetitive use of the hands, especially flexion of the fingers, can result in CTS. People at risk include those who use computers, as well as carpenters, grocery checkers, assembly-line workers, meat packers, violinists and pianists, and mechanics. Hobbies such as gardening and needlework can sometimes bring on the symptoms, while sports such as rowing, golf, tennis, downhill skiing, archery, competitive shooting, and rock climbing also place pressure on the hand and wrist joints. In addition, the syndrome can be caused by underlying disorders that affect the carpal tunnel, including arthritis, thyroid problems, gout, and diabetes. Finally, pregnant women are at risk of developing CTS.

The nerve compression associated with CTS is due to fibrous bands of tissue that form inside the carpal tunnel, squeezing the median nerve. Although CTS is linked to repetitive stress, the underlying cause—which would explain why some people suffer from it and others don't—is unknown. Newer research has uncovered some of the chemical changes that occur in response to mechanical injury among people who suffer from CTS. Although CTS is technically a non-inflammatory condition (because there is no systemic inflammation and the immune system is not activated), it is characterized by localized increases in many pro-inflammatory chemicals in the tissue of the carpal tunnel itself. Treatment of CTS may include some of the following: stretching, ultrasound, acupuncture, ergonomic changes, wearing of a brace, laser and surgery.

Important Diagnostic Indications in Traditional Chinese Medicine for Treating Pain

2006-02-28T09:23:00.000-05:00

Nature of Pain Traditional Chinese Medicine Pattern Diagnosis

If pain is sharp, stabbing and fixed than Blood Stasis is indicated.
If pain is variable, vague and wandering than L iver Qi Depression and Wind is indicated.
If pain is dull, achy and chronic, then Kidney Deficiency, Cold Damp and Spleen Deficiency
with Dampness is indicated. If pain is heavy, swollen, and fixed, then Dampness is indicated.

Duration of Pain

Acute pain indicates Blood Stasis or Invasion of External Pathogens.
Chronic pain indicates Kidney or Spleen Deficiency with Damp and Blood
Stasis due to repeated strains.

Aggravation of Pain

Cold Weather- Indicates all of the Patterns
Worse in the morning- Indicates Cold Damp
Worse in the afternoon- IndicatesKidney Deficiency
Worse with stress- IndicatesLiver Qi Stagnation
Worse with pressure- Indicates Blood Stasis
Worse with activity- Indicates Deficiency Patterns
Worse after sex- Indicates Kidney Deficiency
Worse with hot weather- Indicates Damp Heat

Amelioration of Pain

Pain that improves with rest indicates Kidney Deficiency.
Pain that improves with exercise indicated Liver Qi Stagnation.
Pain that improves with mild exercise indicayes Blood Stasis.
Pain that improves with heat and mild exercise indicates Cold, Cold Damp, or Kidney Yang Deficiency.

In treating pain with Traditional Chinese Medicine, the goal is not to mask the pain, but to open the channel blockages, eliminate pathogenic influences and to correct deficiencies.The diagnostic indications which have been described above help make a comprehensive analysis of the symptoms and signs of an individual pattern.

Many chronic pain patients become emotionally debilitated, leading to depression, anxiety, panic attacks, insomnia or restless sleep. Traditional Chinese Medicine is very effective to treat these symptoms as well.

Treating Bell's Palsy with Acupuncture

2006-02-25T14:48:00.000-05:00

Bell's Palsy is one of the commonest peripheral facial paralysis that many people experience. When it occurs, most people think that they had a stroke. I t often happens suddenly and mostly after being exposed to cold wind. A lot of people recover spontaneously, however, sometimes the condition lingers and this can cause frustration for many. It falls under the condition of true wind stroke in Traditional Chinese Medicine.
It often occurs mostly in the middle-aged and it usually affects one side of the face. Bell's Palsy usually occurs all of a sudden. The patient experiences numbness and sometimes pain around one side of the face, ear and mouth. The mouth can become deviated, the nasolabial groove can no longer be seen and the facial region is relaxed and strengthless. The patient can't close their eye fully. it is difficult for them to frown, speak and eat. Often, saliva comes out from the corners of the mouth. Sometimes, the sense of taste is lost and the sense of hearing can be hypersensitive.

Case Study
Male, 48years old, came into the clinic suffering from Bell"s Palsy. He worked as a butcher and often walked in and out of the freezer many times a day. Prior to the Bell's Palsy, the patient did catch a cold. The onsetof the Bell's Palsy was sudden and the duration was short. The eyes and mouth were deviated. He had difficulty closing his right eye completely. The accompanying symptoms and signs were headache, discomfort, red tongue with thin white coating and a tight pulse. The treatment principle was to expel pathogenic wind cold and to remove obstruction from the channels. Acupuncture was the pfeferred choice of treatment. Points selected were Bladder 2, Triple warmer 23, Stomach 4 inserted towards Stomach 6. All of these points were on the right side. Large intestine 4, Stomach 36 and Liver 3, all bilateral. The patient was also encouraged to put hot compresses on the right side of his face and he was given some mouth exercises to do to restore the strength back in his facial region. After five treatments with the above point selection, the patient fully recovered.

Living your Best Life with Fibromyalgia

2006-02-23T22:37:00.000-05:00

Fibromyalgia is a disease that can create havoc in a person's life. It is a complex condition that affects people in different ways and is not recognized as a true disease by many doctors. Some people believe it is just a label for a "psychological" condition, however, there is an increasing number of research concluding that there is much more than the psychological aspect to this disease.

Non drug treatments for Fibromyalgia include:

T.E.N.S. (Transcutaneous Electrical Nerve Stimulation) which can alleviate pain in regional muscle groups.

To learn all about T.E.N.S., visit http://www.queenwestphysio.ca/strategies/electrotherapy.html

Exercise Programs

Exercise is very important in keeping the muscles flexible. Designing a daily stretching programs can lead to a more active lifestyle and help reduce overall pain. Pool exerices, especially in a warm pool, are also very helpful because of water being able to take the weight off the joints.

Low impact exercises on the floor comprise another option but it is important not to exceed your capacity. Be careful of personal trainers who do not know about Fibromyalgia as they often can give you a program that is much too difficult for you. Phyical therapists can design a very suitable program for the Fibromyalgia patient.

Physical Therapy

A physical therapist often has a wide selection of hands on techniques that help alleviate pain for the Fibromyalgia patient. In addition, a reasonable strengthening and stretching home exercise program can be smartly designed by a physical therapist.

Diet and Nutritional Supplements

Generally, a very well balanced diet is the most recommended for the Fibromyalgia patient. A magnesium supplement has been found to decrease the tendency for muscles to hurt and should be considered based on your physician's advice. Also, appropriate calcium and multi-vitamin intake may be a great idea to help you deal with this condition.

These are just a few ideas to help manage Fibromyalgia. There are countless others to help deal with symptom flares and the emotional aspect of this disease. Contact your national fibromyalgia association for further information and start helping yourself or loved ones who are afflicted with this disease.

Exercise and Osteoporosis

2006-02-21T09:58:00.000-05:00

Exercise and Osteoporosis - Tips

Osteoporosis is an age related disorder characterized by decrease bone mass and increased susceptibility to fractures. Preventative measures can delay the onset of and considerably reduce existing conditions. Exercise plays a large role in the prevention equation. Below are some tips about exercise concerning osteoporosis:

Exercise for 30 to 40 minutes at least every other day (preferably every day) is very important to increase the natural stimulation for stronger bones. People in all stages of osteoporosis need to increase the strength of their back and hip muscles.
Do not be concerned if as you begin you can only do a few repititions of a certain exercise. It is important to realize that you should have no more pain after you finish than when you begin the exercises.
It is important to learn how to do each exercise properly.

Neck Exercises

Bend the chin forward to the chest. If you feel stiffness or pain, do not force the movement. Gos as far as you can move easily. If pain persists with this or any exercise then you should stop until you talk to your physician or physiotherapist.
Bring the left side of your head toward the left shoulder, then to the right.
Bring the head back as far as possible without forcing any movement. If you feel pain or dizziness, stop until you talk to your physician or physiotherapist.
Turn to look over your right shoulder, then your left shoulder.
When you can do each of these exercises, repeat each exercise 2 times. Then gradually increase this number to 5 and then 10.

Other important areas of the body to exercise include the shoulders, hips, back, knees, wrists, ankles and feet. Stay tuned!

User Training and Education in Ergonomics - The Missing Steps

2006-02-20T12:14:00.000-05:00

Many people would agree that there has been a slow, and often uneven, acceptance of ergonomic products for the office environment in North America since the tools began gaining popularity in the early 1980s. There are many possible reasons: equipment, training and the responses of individuals who may not make a link between their discomfort and workplace equipment.

Using a “discomfort assessment” questionnaire to pinpoint worker complaints can go a long way toward ensuring that people use ergonomics equipment properly.

Two decades ago, height-adjustable workstations and pneumatically adjustable chairs were only available from Europe, where proper accommodation of office staff has been a common practice for more than 30 years. Anyone who has toured offices there, especially in Scandinavia, has probably seen employees sitting in upright postures with fully supported backs, while working at desks correctly adjusted to suit their individual needs. There seems to be a real commitment to implementing an ergonomic office environment.

The same claim cannot be made of North America. Although the company manual may say adjustable workstations are what’s needed, an essential step is frequently missed: the application of an effective implementation program that includes user training and education.

Ensuring that users clearly understand the importance of equipment adjustment - and fitting the equipment to the person - remains a challenge. It’s not very difficult to identify when effective program implementation has either been missed or improperly completed. Usually it is when an employer requests help with a worker who has complained of pain or discomfort.

The employer, in fact, is often surprised that anyone could be experiencing discomfort at all. “We gave them an ergonomic workstation,” they often say, as though they believed checking off that single item constituted a comprehensive ergonomics approach.

Almost invariably, a visiting consultant will find that the employee’s workstation and chair are not adjusted to suit that person’s specific physical requirements. It is not uncommon for the consultant to also discover that none of the other workstations in the surrounding area are adjusted for the occupant - even in offices with hundreds of employees. People are frequently found sitting and working in awkward postures. They are forced to twist, bend, reach and alter their postures in ways that would obviously take a physical toll.

Some companies have found that using an anonymous “discomfort assessment” questionnaire can help identify the frequency of discomfort among employees. The questionnaire may contain the question - “To what do you attribute your discomfort?” - that, when answered, explains why employees rarely complain about the discomfort they experience on the job and why they often do not understand the importance of having properly adjusted workstations and chairs.

The answer to the question is surprising. Although the exact words may vary, the sentiment expressed in the majority of responses is more consistent: people think there is something wrong with them. The perception is expressed in far-ranging comments that have nothing to do with their workstations, their chairs or their monitors. “I have a bad back”, “I suffer from migraines”, “I have bad eyes”, “My mattress must be too soft”, “I think it’s an old college injury,” or “I was in an accident”. They continually attribute their discomfort to anything but the way they sit and work.

Since many people attribute their discomfort to a personal weakness, they would be less likely to complain to their employers about their pain or to properly use their chairs and workstations. Even if workers do believe pain could be the result of improper accommodation of their physical needs, it does not necessarily follow that they would have a clear idea of what adjustments should be made to ease their discomfort. In fact, people are often the architects of their discomfort by unknowingly making the wrong adjustments to office equipment.

For that reason, a demonstration for workers that explains the relationship between a wide variety of discomforts and the way they sit and work has proved very successful. After being shown how adjustments to their chairs and workstations can eliminate the physical demands that cause those aches and pains, employees are asked to return to their workstation and apply what they have learned. The downside is that, as consultants who have used the approach will attest, rarely will an employee correctly determine what adjustments are needed to accommodate his or her specific physical requirements.

The ergonomic consultant must visit the worker in the workstation after the demonstration and must make the recommendations directly to the occupant. The whole purpose of the demonstration is to ensure that occupants will listen to the consultant and follow his or her recommendations. Without the visit, employees will have no idea how they should utilize their chair and workstation, in spite of the recent demonstration.

Both productivity and efficiency can be substantially improved with ergonomic workstations that are properly planned and implemented - mostly by making the work easier to complete and dramatically reducing on-premises absenteeism.

This article was written by our ergonomic associate, Steven Price. He has over 29 years of experience in the planning and implementation of solutions to improve the comfort, well-being and efficiency of employees in the office environment. Services that he can provide include Discomfort Assessments, Workstation Design through Functional Needs Analysis, Comfort Improvement through User Training and Education, plus Risk Assessments for the Industrial Environment. For more information, contact us at (905) 450-7870 or via e-mail at info@queenwestphysio.ca.

The Costs of Discomfort

2006-02-18T00:47:00.000-05:00

Studies show employee discomfort is very common in most office environments, even where ergonomic products are utilized. Discomfort assessments that ask “To what do you attribute your discomfort?” make it clear why employees rarely complain, even when their discomfort is serious. Many attribute their pain to a weakness within themselves, while others are simply reluctant to speak up.

Whether or not they complain, these employees’ discomfort can be very expensive. Surprisingly, employers with low levels of reported discomfort can actually pay a higher cost than others.

Symptoms of improper accommodation include increased anxiety and difficulty concentrating. In office environments where management is not stringent, employees will react to such symptoms and other minor discomfort by frequently leaving their workstations. A specific pain might not become serious. Indeed, it may never become known there is a flaw in the design or use of the workstation.

This phenomenon is called on-premises absenteeism. It can lead to lost productivity and substantial increases in staffing that might otherwise be unnecessary.

Many employees are actually the architects of their own discomfort, through the improper use of ergonomic chairs and components. Pain and discomfort can take months to develop. Employees rarely realize or acknowledge that their improper sitting and working postures lead to the discomfort they experience. This is why, following the purchase of ergonomic equipment, teaching people to correctly use their workstations and chairs remains an essential step.

Ergonomic in name only

Unfortunately, many products purchased to improve working comfort are ergonomic in name only. Some actually cause or increase employee discomfort. In fact, it is not uncommon for ergonomic products to alleviate one discomfort while creating a new one that did not exist before. In some cases, it is just not possible to use the product in the manner for which it is intended and employee discomfort cannot be avoided.

One example is the articulating keyboard support arm. Usually implemented to give employees a posture that prevents shoulder pain while they type, it frequently causes discomfort or makes simple tasks more difficult to complete. This is because most computer users refer to documents or reference materials (such as binders and files) while working or reach frequently to a phone, printer, calculator, etc. All such items must sit on the desk surface—the very surface from which they are pushed away by the articulating keyboard support arm.

The discomfort that results from the awkward postures people assume when trying to reach or use their desk surface can be more serious than the discomfort initially alleviated by the adjustable keyboard arm. Trying to read documents from a greater distance causes discomfort that will only worsen as employees age and their visual acuity suffers.

Many employees will push the keyboard out of the way every time they need to move towards their desk surface. Eventually, they adjust their keyboard to a height where it can be easily retracted, rather than to the height they require to work without discomfort. When discomfort does return, it is usually in a place where it did not exist before.

Articulating keyboard support arms should never be used if they interfere with the ability of the employee to complete his/her work with ease or if they cannot be used properly. They do not save the cost of a properly designed ergonomic workstation—an employee who is prevented from working comfortably and efficiently will always cost more.

This is especially true for employees who complete a substantial amount of desk work that is not computer-related. If the desk surface remains at a fixed height, they will frequently experience discomfort while completing their tasks.

Monitor risers also continue to be purchased, even though their use has been discredited by some of the people who first recommended elevated monitors back in the 1980s (see “Set Your Sights a Bit Lower,” by John Goddard, The Toronto Star, January 31, 2003; and “How Low Should You Go,” by Nicolette Beharie, OHS Canada, April/May 2003).

Determining whether a monitor should be elevated or lowered can be achieved by conducting an eye-motion study. If the worker looks frequently to the keyboard or a document that must sit on the desk surface, then the monitor should be lowered. This does not make the user look down—they are already looking down. Rather, it alleviates discomfort by reducing the distance they have to look up.

Looking down is not an unnatural position. Humans have evolved doing so while using their hands and while walking on uneven surfaces. People throughout the world continue to complete tasks by hand, looking down all day.

Computer use is one of the few functions where looking up can be considered, yet the recommendation to do so has been unique to North America. In Europe, the practice of elevating monitors was never adopted and, in fact, monitors are frequently recessed into the desk surface.

Seating discomfort

Neck pain and discomfort are becoming more common in the office environment and a major cause is deflection of the head and neck, but this has nothing to do with the placement of the monitor. The cause is the improper adjustment of the chair back and the growing tendency for people to lean back while working at their computer. They pull their heads forward and stretch the muscles up the back of the neck unnaturally.

People can reduce or eliminate their neck pain by sitting up straight—a posture on which every typing teacher has always insisted. Unfortunately, some so-called ergonomic chairs simply cannot be adjusted to support that posture. Their occupants are often seen sitting upright with completely unsupported backs, trying in vain to avoid the unnatural working posture of leaning back.

Most of the chairs available in the market today are called ‘ergonomic’. However, when noting the differences in the design of chair backs and their range of adjustment—and not just between manufacturers, but between chair models from the same source—it appears there is a substantial difference of opinion about the average shape of the human back and the manner in which it should be supported. If there were a consensus, then all chair backs would look similar.

Choosing a chair must therefore be a careful process. Employees should never be allowed to choose their own chairs, especially when they are seeking to replace one they think is causing them discomfort. Too often, they pick a chair for all the wrong reasons, including, “It feels comfortable.” Most will choose a chair for its ability to allow them to sit comfortably, rather than its ability to allow them to work comfortably.

In addition, a poorly designed chair can feel more comfortable than the one it replaces, simply by changing the way the occupant sits. All too often, the improvement in comfort is short-lived and back pain returns, but where it did not exist before.

It is not possible for one style of chair to accommodate everyone’s physical needs. The best chair models offer small, medium and large options in the size of their seats and backs and the travel range of their cylinders.

An experienced ergonomic consultant should assist in the determination of the specific chair style for each employee. While it means chairs of employees who leave may not fit their replacements, the cost of an uncomfortable employee is still far greater than the cost of a few new chairs.

Armed and uncomfortable

Chair arms are referred to as ergonomic when they are adjustable. Unfortunately, it is not always possible to adjust them in a way that makes their use practical for the average office employee and they often cause discomfort.

Most employees multi-task or complete work in a manner that requires constant movement within their workstations. Reaching—whether for a phone, file, printer, binder, notepad, calculator and file drawer—is simplified when people can swivel freely in their chairs.

Most employees are provided with cockpit-style or V-shaped workstations, which are intended to make the surfaces and everything they contain easier to access. However, when the work surface, keyboard and chair arms are all adjusted to ergonomically correct positions, they will all be at the same height.

Even with short chair arms, occupants are able to swivel only a short distance before the arms hit something, at which point they must twist, turn or stretch unnaturally to complete their tasks. Articulating keyboard support arms usually make the problem worse, causing further interference with movement.

Employees using chairs with arms often experience lower back pain and strained muscles in other parts of their upper body. Some lower their chairs to allow for freer movement, but experience shoulder pain. Others lower the chair arms instead, but suffer postural problems when using them.

When these factors are pointed out during training and education seminars, 85 per cent of employees on average have asked to have their chair arms removed. That represents substantial costs that can be avoided earlier in the process.

True ergonomics

A workstation can only be considered ergonomic if it properly accommodates both the physical and functional requirements of the occupant.

The functional requirements are less easily identified, so they are rarely taken into consideration. In fact, the purchase of standard, “cookie-cutter” workstations—generally sized to the amount of available space and not the needs of the occupant—has become the norm.

It is often intentional, especially on the part of government, to facilitate what has become known as “suitcase moves,” where employees take only their personal belongings as they are moved between standard, common-design workstations. Unfortunately, these workstations frequently fail to help occupants complete the work expected of them.

The specification of complete adjustability is frequently passed to make it easier to move people than to accommodate their individual needs. Although this does save money on moves and furniture, the increased cost of employees who are not able to work comfortably, efficiently or productively is substantial.

Some offices have staffing levels as much as 50 per cent higher than would be necessary if their employees were provided with the proper tools and they were used correctly. Surprisingly, attention paid to improving individual productivity and efficiency has been slow to find its way out of the industrial and manufacturing environments and into offices.

Many employees are expected to multi-task and planning solutions that accommodate all of their needs can be challenging. To maximize employee productivity and efficiency, workstation layouts should be planned by independent consultants who specialize in functional needs analysis.

This approach rarely results in a plethora of layouts, as they are actually specific to the functions, not the individuals. However, if the process does result in the recommendation of a variety of workstation configurations, then it is the responsibility of the office furniture manufacturers to use the least number of components while offering the greatest degree of long-term flexibility.

This “inside-out” style of planning has been the norm in Europe for decades. It should be completed before beginning the overall design phase and, where possible, before space is allocated or leased.

When employers start insisting on the proper planning and implementation of workstations that accommodate both the physical and functional requirements of their employees, they will finally begin to reap the long-anticipated benefits of office computerization. It is important to note that to maintain those benefits, both the employees and the workstations they occupy must be effectively managed to ensure they remain properly configured and correctly used.

This article was written by Steven Price, our ergonomic associate who has over 29 years of experience in the planning and implementation of solutions to improve the comfort, well-being and efficiency of employees in the office environment. For a professional assessment of your work environment, please contact us at 905-450-7870 or email us at info@queenwestphysio.ca.

Why Stretch?

2006-02-16T13:44:00.000-05:00

Stretching should be part of your daily life because it relaxes your mind and tunes up your body. Once you make stretching part of your daily routine you will start realizing the benefits. These benefits include:
1)Increase range of motion
2) Reduce muscle tension and make the body feel more relaxed
3) Improves coordination by allowing for easier movement
4) Develops body awareness. The more you stretch various parts of the body, the more you focus on them and get in touch with them
5)Prepares you for any type of strenuous activity by signaling the muscles to let them know they are about to be used
6)Helps with the body mind connection so that the body moves for its own sake rather than resisting internal and external influences
7) It feels great!
Learning how to stretch daily will enhance your quality of life by counteracting the negative effects of everyday stress. By taking the time to stretch properly, one will recognize areas of physical tension and will learn to release this pent- up emotions and muscular tightness. Give it a try and make it part of your daily routine.

Pain and Traditional Chinese Medicine

2006-02-15T13:29:00.001-05:00

Every human being will experience some form of pain in their lifetime. Pain is more or less a feeling of discomfort, distention, distress, or agony that is felt throughout the body.Pain can be felt in any part of the body and in Chinese Medicine pain is a major indicator of diagnostic information. There is an ancient saying in Traditional Chinese Medicine that states, "when there is pain there is no free flow of energy(qi)". This basically means that pain is caused by lack of free flow of energy. Something has blocked the free flow of energy. In traditional chinese medicine(TCM), cold, wind, heat, dampness, dryness, fire, blood stasis and deficient energy can all block the free flow of energy.
There are many ways to differentiate the cause of pain. Here are some examples.
1) Pulse and tongue diagnosis are important tools in determining the dominant pattern of the dysfunction.
2) Determining the exact location of the pain, as well as its quality of sensation and current degree of severity is critical.
3)Information on what time of day, specific climates and activities that affect the pain define the pattern even further.
4)Palpation is a essential tool as it reveals a great deal. For example, muscle rigidity indicates local blood stasis.
5)A small area of pain is usually due to a sprain or other trauma, and a larger area could possibly relate to some internal organs such as kidnet yin or kidney yang deficiency.
6)As we age and our reserve of energy is depleted and people generally have a tendency to manifest one of two common patterns in TCM. Those who began with very strong constitutions have a tendency to develop kidney yin deficiency. There painful condition is aggravated by heat and activity. Those who began with weaker constitutions have a tendency to develop kidney yang deficiency. Their painful condition will be aggravated by cold and can be relieved by moderate activity.
7) The lower back is the domain of the kidneys. Most pain, or even a propensity to injury is attributed, at least in part to a kidney yin or yang deficiency.
8) This deficiency may be due to a congenital predisposition or chronis illness and may be aggravated by environmental factors such as cold, wind, damp, heat, as well as internal factors which cause blood stasis or energy(qi) stagnation.
9) This condition can be worsened by lifestyle and physical labour, including heavy lifting, bending, prolonged standing, exposure to cold, as well as , shock or prolonged anxiety.

Welcome to Physio and Acupuncture Talk

2006-02-04T20:46:00.000-05:00

Allow us to introduce ourselves! As a team made up of Registered Physiotherapists and a Certified Acupuncturist, along with other Professionals, our intentions are to discuss a variety of issues related to physiotherapy, acupuncture and massage therapy.

Many questions arise on a weekly basis from both patients and colleagues. Our goal is to educate people on a variety of topics related to our profession. We will cover everything from case studies to general philosophies of treatment. Articles will either be aimed at the general population, rehabilitation professionals, or a combination of both.

Please check us out from time to time and email us at info@queenwestphysio.ca if you have any questions.

Wishing you wellness always.
Regards,
Len, Tom, Irene, Rani, James, and Elena

www.queenwestphysio.ca
QueenWestPhysiotherapy&Acupuncture

www.albionhillsphysio.com