Heat Exhaustion vs. Heat Stroke

Heat exhaustion occurs when a person loses too much water and salt due to a combination of extended exposure to the heat and failing to stay adequately hydrated. If a person fails to cool their body temperature, heat exhaustion can turn into a life-threatening condition known as heat stroke. 

Heat stroke is where the body loses its ability to control its internal temperatures and the body no longer has the ability to sweat. When in situations of extreme heat, pay close attention to young children and the elderly as they are at an increased risk of developing heat exhaustion, heat stroke or dehydration.

Staying Hydrated in the Heat
With this hot weather it is important to keep our bodies hydrated as heat related illness can alter our body’s performance and place it under strain to the point that emergency care is required.

Signs of dehydration are: dry mouth, thirst, headache, fatigue, dizziness, light headiness, fainting and infrequent urination.

 Tips to stay hydrated in the heat are:

• Reduce or eliminate the amount of caffeinated, carbonated & alcoholic beverages consumed
• Eat more fruits and vegetables
• Take a reusable water bottle with you and use it throughout the day (if bottle after bottle of water seems bland, try adding a little extra flavor with lemons, limes or fresh berries).
• If you plan on exercising don’t just drink beforehand, hydration should occur long before physical activity
• If you normally don’t, try to include a glass of water with every meal

Nutrition: Vitamin D

Essential for promoting calcium absorption and bone growth, vitamin D helps prevent rickets in children and protects older adults from osteoporosis. Vitamin D also plays a role with immune function and reduction of inflammation.

Pop quiz! Can you name three food sources where vitamin D is naturally present? You can earn bonus points if fish liver oils were the first answer that came to mind. In reality there are very few foods that naturally contain the fat-soluble vitamin D. Small amounts can be found in beef liver, cheese and egg yolks. Most people actually meet their vitamin D needs through sun exposure. When ultraviolet (UV rays) strike the skin this triggers the synthesis of vitamin D. Keep in mind direct exposure to sunlight and UV rays (including tanning beds) needs to be limited as UV radiation is a carcinogen and is linked to age-associated dryness and in more severe cases metastatic melanoma.

Vitamin D is available as a supplement and in fortified foods (cereal flours and orange juices). Research is also indicating that vitamin D may have a therapeutic role in preventing diabetes. Other studies are indicating that vitamin D may help in alleviating symptoms of depression, especially in the winter months. 

Did you know: UVB radiation is not able to penetrate glass, meaning sun exposure through a window does not produce vitamin D? 

Groups at Risk for Vitamin D Deficiency

• Breastfed Infants - Vitamin D requirements cannot be met by breast milk alone
• Older Adults - aged 50+, cannot synthesize Vitamin D as effectively
• Populations with Limited Sun Exposure - northern latitudes or homebound individuals
• Individuals with Fat Malabsorption - since vitamin D is fat-soluble there needs to be some dietary fat in the gut for absorption.

The Shoulder

How the shoulder works!

The shoulder is made up of three bones: the scapula (shoulder blade), the humerus (upper arm bone), and the clavicle (collarbone).

The rotator cuff connects the humerus to the scapula. The rotator cuff is formed by the tendons of four muscles: the supraspinatus, infraspinatus, teres minor, and subscapularis.

Tendons attach muscles to bones. Muscles move the bones by pulling on the tendons. The rotator cuff helps raise and rotate the arm.

As the arm is raised, the rotator cuff also keeps the humerus tightly in the socket of the scapula. The upper part of the scapula that makes up the roof of the shoulder is called the acromion.

A bursa is located between the acromion and the rotator cuff tendons. A bursa is a lubricated sac of tissue that cuts down on the friction between two moving parts. Bursae are located all over the body where tissues must rub against each other. In this case, the bursa protects the acromion and the rotator cuff from grinding against each other.

In order to know if you have injured your rotator cuff you should have it examined by a Doctor of Chiropractic. They will ask questions about your medical history, your injury, and your pain. Then they will perform a physical examination of the shoulder. The physical exam is most helpful in diagnosing a rotator cuff tear. A complete tear is usually very obvious. 

X-rays won't show tears in the rotator cuff. However, the Doctor of Chiropractic may want you to have a shoulder X-ray to see if there are bone spurs, a loss of joint space in the shoulder, or a down-sloping (hooked) acromion. These findings are associated with tears in the rotator cuff. An X-ray can also show if there are calcium deposits in the tendon that are causing your symptoms, a condition called calcific tendonitis. Further studies may include: an ultrasound and/or an MRI.

The shoulder is a joint than can be treated with a combination of many different treatments.  The treatment types are dependent on the injury.  These can include – the Interferential current machine, acupuncture, massage therapy, active release, and chiropractic to restore the joint motion, stretching, strengthening, and modifications to activities.

The shoulder joint is very complex and works with the shoulder blade, neck and upper back to co-ordinate movements.

The rotator cuff is made up of four muscles that ‘cuff’ the shoulder.  These muscles can be injured due to different factors.

 The shoulder
• A complex structure:  3 Bones, 3 Joints which attach it to the mid back and arm, 5 Ligaments, over 30 Muscles, 4 Bursa, 3 capsules.
• 75% of North Americans will experience shoulder problems requiring care at some point.
• The shoulder joint comprises the part of the body where the humerus attaches to the scapula.  The shoulder refers to the group of structures in the region of the joint.

The shoulder joint is made up of 3 bones: Collarbone (clavicle), Shoulder blade (scapula), Upper arm bone (humerus) 

• The bones of the shoulder are held in place by: muscles, ligaments, and tendons.
• Ligaments attach shoulder bones to each other, providing the main stability for the shoulder. The front of the joint capsule is anchored by three glenohumeral ligaments. 
• Tendons are tough cords of tissue that attach the shoulder muscles to bone and assist the muscles in moving the shoulder.
• There are 30 muscles providing movement and support for the shoulder complex. 
• The muscles that are responsible for movement in the shoulder attach to the scapula, humerus, and clavicle. The muscles that surround the shoulder form the shoulder cap and the underarm. 
• The capsule is a watertight sac (soft tissue envelope) that encircles the glenohumeral joint. It is lined by a thin, smooth synovial membrane. 
• Three main nerves begin together at the shoulder: the median nerve, the ulnar nerve, and the radial nerve. These nerves run under the collarbone and are known as the Brachial Plexus before they divide.
• The shoulder movement occurs as a result of all these structures and from the use of the ribs, thoracic spine, neck and even the elbow.  Often unresolved shoulder problems are a result of the other areas involved not being treated.   

Scapular-thoracic motion

• Scapular activity during shoulder motion is critical for normal shoulder function – shoulder moves 2/3 of the movement and the scapula the other 1/3 motion. 
• The scapulo-thoracic motion is the movement between the scapula (shoulder blade) and the thoracic spine. 
• The scapula moves with the shoulder in many daily and athletic activities. Anytime you raise your arm up this motion occurs!
• It is often over-looked in shoulder problems and that is one reason they do not resolve properly.

Success Stories of ART

I developed a nasty case of tennis elbow after a busy weekend of skiing and playing shinny hockey (a sport I had never played in my life but why not now)? After about three weekends during which I could hardly lift my coffee cup, let alone do any chores around the house and forget strength training in my aerobics classes, I decided that it was time to seek help.

Dr. Rodwin was very thorough in her assessment and suggested that I try Active Release Technique. Apparently, my arm and shoulder muscles were quite tight and there was plenty of scar tissue there, which probably led to the stress on the ligaments at the elbow.

Initially, I found the treatments somewhat uncomfortable, and I did experience some tenderness afterward, but Dr. Rodwin was always careful not to give me more than I could tolerate. Within weeks my elbow pain started to go away. Before I knew it, my coffee cup was not a painful lift and I began to resume strength training in my fitness classes.

For several years, though I am quite physically active, I have suffered from muscle pain and muscle spasms that were actually quite extraordinary for a person at my fitness level. I had complained to my doctors many times about it, but to no avail. My potassium levels were normal and no one could figure it out (I wondered if anyone really cared, as I did continue with my active lifestyle in spite of the discomfort and pain). It was becoming impossible to stretch many of my muscles because of tightness and/or cramping. The result of not being able to stretch made the muscles even tighter which was causing more pain in my back and other joints as well. I was afraid that I had some serious illness.

The ART treatments in the lower body were somewhat uncomfortable at the beginning and I did experience bruising which Dr. Rodwin had mentioned was a possibility. She was always accommodating when the bruises were too sore for a treatment. But, the payoff was huge!

I had not had a good run in five years: my left leg had ached every step of the way to the point of my foot dropping and causing me to trip. The pain and foot drop have disappeared! I actually look forward to my runs now, where I was about to give up running completely. I can get out of bed in the morning almost pain free! I can stretch! I had almost given up some of these activities because they weren’t fun anymore. Now, I’m back and feeling great!

Active Release Technique (ART)

ART

If you have ever pulled or torn a muscle or severely injured a muscle group, chances are you have muscle adhesions in that area of your body. Muscle adhesions act like your body’s natural ‘Band-Aid’, as it is a strategy to help repair damage. The downside is that along with other scar tissue, muscle adhesions can cause a person pain and discomfort leading to that ‘old and worn’ feeling. Similar to plastic wrap, adhesions can bind two tissues together, resulting in decreased muscle length and the muscle becoming non-compliant. Cramping of the lower limbs at night is a typical sign of a non-compliant muscle.

Many individuals believe that a few stretches and time will release the adhesions, however; active release technique (ART) offers a much better approach. An advanced massage technique, ART is designed specifically to release and relieve tension found in muscles, tendons and fascia (the muscle covering). ART treatment works by breaking up adhesions and restoring integrity to the soft-tissue. In principle this is achieved by maintaining contact on the adhesion, with the muscle in a shortened position and elongating the muscle along its fiber orientation to break up the adhesion.

Concerns about ART include pain during treatment and treatment length. The sensation patients often experience is one of those “hurt so nice” feelings and significant results are often seen within 3-4 weeks. Once the restrictions have been removed an effective stretch routine plays a role in preventing the return of restrictions.

Treatable Conditions with ART

There are over 500 ART treatment protocols and ART can help with various conditions such as back, hand, wrist, elbow, hip, knee, neck, shoulder and foot pain, as well as injuries specific to sports such as golfing, running, paddling and swimming.

One of the benefits of ART is the quick results it can achieve. When combined with a stretch and exercise routine, muscles, tendons, ligaments and nerve related problems tend to respond well to ART treatments.

All of Back to Health’s health care practitioners are certified in ART, for more information regarding conditions that can be treated using ART click here: Active Release Techniques.

Active Release Techniques Can Help Resolve Many Common Back Conditions Including:
→ Facet syndrome
→ Muscle strains/pulls
→ Arthritis
→ Sciatic Nerve Entrapment
→ Disc Injuries
→ Mechanical low back pain

The Injury Process

Over time repetitive forces on the body accumulate placing strain on muscles, ligaments, tendons, and joints. This process can be amplified when the body already has movement restrictions. As time goes on athletes or active individuals will continue their training regime or daily activities leading to micro trauma. While this may not be aggravating or painful, the individual may experience tightness or a slight discomfort. These tiny damages to the tissue still require repairs and small amounts of scar tissue will be laid down around the site of injury, the body’s normal response to micro-trauma. The issue lies with the repetitive nature of an individual’s activities. By constantly straining/stressing the same areas more and more, scar tissue is laid down at the same tissue sites, eventually building up into an adhesion. At this point you will really notice a difference in muscle function such as pain and joint restriction. If the cycle continues the muscle’s ability to contract may become affected to the point where an individual’s stability can become compromised, such as a runner’s knee.

Traditional approaches to these types of muscle injuries make use of anti-inflammatory medications, rest and ice. Unfortunately these interventions fail to address the underlying adhesions that are binding tissue and restricting movement.

Active release technique combined with stretch protocols is a more active approach to addressing the adhesions, which don’t treat themselves!

Who Can Provide ART Treatment?

Healthcare providers that are licensed to work on soft-tissue conditions and injuries can take ART courses. This includes Chiropractors, Massage Therapists, Physical Therapists and Medical Doctors. Personal Trainers & Physical Therapy Assistants are not licensed to treat soft-tissue conditions and are not able to take ART courses. ART involves over 500 protocols and providers are trained to have an advanced feeling for tissues, including their texture, tension and movement.

Stretch of the Month:

Last month we had an article on Illiotibial Band Syndrome and how it is a repetitive strain injury that can cause problems for runners and cyclists. To avoid ITB tightness it is a good idea to incorporate stretches with a foam roller into your stretching routine, as a foam roller can help to increase flexibility and reduce muscle tension. To perform the ITB stretch:

1. Lie on your right side with the roller just under your hip-bone.
2. Straighten your right leg, support yourself using your arms and if needed, the left leg.
3. Roll from the hip down the outer side of your leg to the knee.
4. Repeat on the other side

Lower Back Pain

primehealthchannel.com

LUMBAR FACET IRRITATION
Reach behind you and feel the centre of your back, just above the buttocks. This is your lumbar spine. Lumbar facet irritation usually is a painful condition affecting the joints. These are responsible for connecting the spine with protection, limiting excessive motion and preventing the vertebrae from locking together.

Patients suffering from lumbar facet irritation usually complain of a well localized low back pain, meaning they can pin-point the exact site of discomfort. The condition is closely related to lumbar facet syndrome—however, patients with the latter also feel referred pain in one hip, buttock or upper leg. Facet irritation often precedes facet syndrome, usually if someone had the irritation treated properly. The onset of lumbar facet irritation is often sudden, occurring after a misjudged movement or while recovering from a bent position. 

These activities may stretch the joint capsules (which protect and support the joints) or jam the facet joints, causing subluxations (restricted motion or abnormal positioning) in the spine and painful swelling. Other causes include poor posture, every day wear-and-tear and trauma to the low back.

Symptoms of facet irritation usually get worse when people sleep on their stomach, work with their arms above their head or rise from a sitting position. All these activities expose the joints to stress that they are not accustomed to, making them more vulnerable to injury and irritation.

Chiropractic is effective for lumbar facet irritation and syndrome. Chiropractors perform a procedure called spinal manipulative therapy, also known as an adjustment, which relieves pain and restores function to misaligned or malfunctioning joints.

Some Back Pain Statistics
• From 2000 to 2004 WorkSafeBC (Workers' Compensation Board) received over 107,000 claims for back strains.
• Back strains account for just over 25% of all WorkSafeBC (Workers' Compensation Board) claims.
• Roughly 30% to 40% of all workplace absences in Canada are due to back pain.
• Back injuries may be caused by a single instance of overexertion or develop as a result of repeated motion over time. Over two-thirds of back injuries are a result of overexer-tion.
• 60% to 90% of the population will experience low back pain in their lifetime.
• More than 90% of lower back pain cases have no specific cause (such as infection, osteoporosis, arthritis, etc
• In the health care industry, injuries due to patient handling (lifting, transferring, or repositioning) account for about 35% of all accepted time loss claims and for about 40% of claim costs.

Some common causes of stress and strain on the spine are:
• Lifting or exerting incorrectly
• Slouching in chairs
• Driving in a hunched position
• Poor posture
• Sleeping on a sagging mattress

Acute back pain is if an episode of pain lasts less than 3 months. Most back pain is acute and goes away with 4 to 6 weeks of treatment.

Recurrent back pain is if acute symptoms come back. Most people have at least one episode of recurrent low back pain.

Chronic back pain is if your back bothers you most of the time for longer than 3 months

Massage Therapy and Low Back Pain
Most people, in their life time, have experienced low back pain. It is one of the most common musculoskeletal disorders of today’s society. Many times, people will suffer through the discomfort, not really knowing that relief is just around the corner! Did you know that the Canadian Medical Association Journal published a study recently about low back pain and massage therapy? The conclusion was that of the people who completed the study, 63% of the people receiving comprehensive Massage Therapy reported NO PAIN after 1 month.

To read more about this study you can go to the Canadian Medical Association Journal web-site and look up the article published in the July 27th, 2000 edition.

Orthotic support for Low Back Pain
Whenever we stand, walk, or run, the lumbar spine and pelvis balance on the legs. If there are leg length inequalities, foot asymmetries, or postural misalignments exist, abnormal forces traveling up the kinematic chain will interfere with spinal (low back) function.

Most low back pain is due to some form of musculoskeletal weakness or failure. A very common source of these problems is imbalances (pronation-shifting inward) at the feet.

The feet make up the postural foundation for the body. Statistical evidence says that at birth most people have perfect feet. By age 20, 80% of humans have developed some type of problem (pronation). By age 40 nearly everyone has some kind of foot condition. Many foot problems eventually contribute to health concerns farther up the kinematic chain, especially generalized back pain.

A major factor in reducing excessive forces on the lumbar spine is often overlooked by health care professionals: the use of external supports (orthotics/heel lifts/ metatarsal pads) to decrease external forces.

Example: If a patient presents with excessive foot pronation/arch collapse, a torque force will produce internal rotation stresses to the leg, hip, pelvis and low back. The result is recurring subluxations and eventual ligament instability affecting the sacroiliac and lumbar spine joints. These forces can be decrease significantly with the use of semi-rigid, custom made orthotics.

Preparing for Hockey Season

It’s that time of year to begin thinking about and preparing for hockey season.  

If you don’t take the time to properly prepare the body for the stress placed on it while playing hockey, then you are setting yourself up for muscle aches and soreness and also pre-disposing the body to injuries.

Your preparation should include the following:

1. Booking a biomechanical assessment with Dr. Barbara Rodwin
2. Preparing yourself through stretching and conditioning
3. Preparing your hockey gear

Ask us at Back to Health how we can help your pre-hockey season!

Is it Normal for my Feet to Hurt after Skating?
When you first skate in your new skates, yes, it is normal for there to be a little discomfort. It is normal to get the odd blister, or a bit of a pain. This discomfort should only affect you the first few times you use your skates. This is the normal process of breaking in a new pair of skates. After your skates are broken in you should be able to skate in them without any pain or blisters.

What happens if your feet hurt every time you skate in them?
If you’ve skated 10+ times and your skates still hurt your feet then there is a problem. Your skates may not fit you properly, or you may have problematic feet that need special attention. You can customize your skates by getting custom orthotics or off the shelf insoles for additional support, or by taking them to a pro shop to get them “punched”. Let’s say you have extra wide ankles, you can get the sides of your skates punched to give you some more room.

Some people only have sore feet with playing hockey and are fine with other sports. In this case we can make a custom orthotic designed specifically for the skate. The make and model is taken into consideration in their design. These are the same skate orthotics that NHL players use!!  

If your feet are hurting with skating, book an appointment with Keri-Lyn Dudgeon to evaluate ways we can help.

Dynamic Stretching and Warm Up: 
Dynamic stretching and warm up refers to a series of exercises geared towards getting the body moving in ways comparable with the demands of a specific sport. Body temperature rises as heart rate is increased allowing the major muscle groups to feel more “loose”, functional, and ready for an intense workout. The primary goals behind performing a proper dynamic warm-up are to improve performance and reduce the risk of injury. This is accomplished by: increasing the core temperature and joint range of motion, activating stabilizers, proprioceptors, and the central nervous system, increasing mental awareness and focus, and improving hockey related movement skills.

INTERESTED IN DYNAMIC STRETCHES, STATIC STRETCHES, PRE-SEASON CONDITIONING, OR STREGTHENING: ASK DR. BARBARA RODWIN

Injuries in hockey occur more commonly in games rather than practices.  Injuries more commonly occur during the final five minutes of a period, and 42% of injuries occur in the third period of a game, usually exhibition and preseason games. This is likely due to the level of competition involved and player fatigue.

Head and face injuries: 42% of injuries
Upper body injuries:     27% of injuries
Lower body injuries:     31% of injuries

Any type of hockey injury can be treated by the health care providers at Back to Health!

Think about your body; it is the most important piece of equipment you have!

Concussions and Hockey
If you have sustained a concussion while playing hockey, book an appointment with Dr. Barbara Rodwin as she is trained to properly evaluate and treat you. Dr. Rodwin is trained in the C.A.T.S. (Cranial adjusting turner style) method of concussion treatment, and has been practising this treatment for 2.5 years. 

Cranial Adjusting Turner Style (C.A.T.S) is a scientifically and neurologically based technique designed to address the cranial misalignments caused by an impact to the head. C.A.T.S practitioners are able to detect and correct any cranial misalignments. They function under the basic principle that if a cranial bone is out of place; put it back into place and restore its function. Certain injuries to the skull can cause the bones to be knocked out of their proper alignment. These misalignments can interfere with an individual’s nerve, fluid surrounding the brain and blood supply to the brain. A misaligned skull can also exert extra pressure on the brain which interferes with the brain’s nutrient and oxygen supply, where pain and altered functions can be a direct result of the added intra-cranial pressure.

Dr. Rodwin has had excellent success using the C.A.T.S. technique in treating patients for concussions. The sooner you seek out treatment, the sooner you will be back playing!