Articles for the Month of July 2013

Signs of a Stroke

(Originally posted on bcotoronto.com on April 18th, 2013)

Stroke is an extremely important topic in chiropractic and so it is incredibly important that chiropractors know how to identify a stroke when it is in progress. It is also important for you as the general public to be able to identify a potential stroke because the sooner someone suffering from a stroke is taken to a hospital, the better their prognosis will be.

There are some commonly known tools for identifying strokes out there but I would like to repeat them here because everyone should know them. They are easy to remember because they start with the same three letters as Stroke. STR.

S stands for Smile. A stroke almost always affects one side of the brain and so on side of the face will experience weakness in the muscles that allow us to for expressions. A person suffering from a stroke will have a lop-sided smile or even a smile on one side and a drooped, limp lower lip on the other.

T stands for Talk. As the person you suspect of having a stroke to speak to you. It doesn’t matter what they say just that they are trying to form words. The muscles of the tongue are mirrored down the middle and like the muscles of the face one side gets its nerve supply from one side of the brain and the other side gets it from the other. Add this on to the already weak lips and you can’t form words properly. It will sound as if the person is slurring their sentences.

R is for Raising Your Arms. Like the muscles of the face and the tongue, the muscles of the body are mirrored down the middle and each side gets their nerves from one half of the brain. So shrugging their shoulders or raising their arms above their head would be difficult on one side for someone having a stroke. This is, of course, assuming that they could perform this task previously.

So those are the three common “Public Education” signs of stroke that people usually know because they are posted in your office first aid room or all over the internet in chain e-mails. The one other symptom that people generally know about is numbness along one side of the body but this can’t really be tested in an observable way.

There is a lot more to a stroke than just these signs and symptoms. I would like to walk you through a little bit so that you will be able to identify more of these signs and help people get to the proper care they need.

The brain is very organized and so different functions are located in different, distinct areas. So when a stroke happens, only the areas that immediately surround the bleeding artery or vein will be affected. While muscle control is the most common area to be effected it is by far not the only one. In some cases people are still able to speak clearly and move without difficulty.

In general, one of the signs that doctors look for in identifying a possible stroke is patients complaining of the “Worst Headache of their Life”. Of course, this statement is prone to exaggeration so you need to be careful not to jump to conclusions on this one. If you are concerned, ask them to clarify.

During a stroke essential senses can be compromised like balance, vision, smell, or hearing. Generally this means an increase signal from these senses rather than a loss of sense such as blurred vision or seeing auras, smelling a scent that is not there, or a ringing in the ears. Any one of these alone could be a number of different things but probably not a stroke, although they should still be evaluated by a doctor. When in combination they become truly concerning.

Nausea & vomiting are also commonly associated with conditions influencing the brain. When these symptoms occur without provocation always take that person to the emergency room.

So if you think that someone near you or even yourself is experiencing a stroke, start with the STR questions and then add to them with what you have learned here today.

Thanks for reading,
Dr. Ben

Chiropractic Poster

(Originally posted on bcotoronto.com on April 11th, 2013)

So this week has been kind of busy for me. I’ve been running around getting ready to start with my first Corporate client and one of the tasks I have been working away on is a poster for presentations and health fairs. So I thought I would share with you my work.

Enjoy (click to enjoy the full sized pdf, approximately 24 x 30 inches)

Health Fair Poster – Reformat

All the pictures (with the obvious exception of my handiwork) are from Ontario Chiropractic Association material intended for use by members of the association.

Thanks for reading,
Dr. Ben

What Is A Hamstring?

(Originally posted on bcotoronto.com on Mar 27th, 2013)

Concluding the theme of March: Anatomy and Ergonomics, we will be discussing Hamstrings and their important role in the body. The hamstrings are a group of large muscles that run down the back of the leg from the bottom of the pelvis to the knee. They are the primary knee flexors and help our gluteus muscles with hip extension. The Hamstrings include the Biceps Femoris, Semimembranosus, and Semitendonosus.

Biceps FemorisSemitendinosusSemimembranosus

So why are they so important? Well, as I said before they are the primary movers in knee flexion which is an incredibly important movement. Just try walking or jumping without bending your knees. Even sitting for that matter would be difficult. Needless to say we use our Hamstrings every single day to move around so any injury to these muscles will significantly impact our activities during the day.

Hamstring strains are very common among athletes but also among the general population through slipping on ice or missing the curb of the sidewalk. Improper stretching or not stretching at all before exercising is also an extremely common way to injure your hamstrings. So we need to ask, why is this muscle group so easily strained? It is because the Hamstrings are chronically tight and short in the average population.

When a muscle is tight it does not have the ability to react properly and smoothly to changes that are force upon it. With respect to a slow, gradual change this is not a problem but fast changes, like missing a step or running without a warm-up, can strain the muscle. Muscles can be tight for two main reasons; overuse (as with Tennis Elbow or rotator cuff injuries) and postural pressures.

In the case of chronically tight Hamstrings postural pressures are generally the cause, unless you are an athlete but even then they can be part of the contributing factors. The Hamstrings cross two joints, the hip and the knee and just like our hip flexors, if we keep the muscles shortened for a long period of time they will think that length is the appropriate default. Sitting for long periods of time, where the knees a bent, will shorten the Hamstrings. Add to this leaning back into the chair which rolls the top of your pelvis back and brings the bottom forward and you have an even shorter muscle.

Standing posture is also important in Hamstring health. Slouching causes the low back to bow backwards and rolls the top of the pelvis back and the bottom forward and down, once again causing the Hamstrings the shorten.

As with any other muscle, the key to healthy Hamstrings is stretching, proper posture, and keeping moving. There are lots of ways to stretch the Hamstrings but these generally reaching down and touching your toes which many people find uncomfortable and difficult. So I’m going to share with you a different stretch that is a little easier for those of us, myself included, who are not all that athletic.

Lie on your back on a flat surface that you can comfortably stretch out on. Take a bath towel and fold it along the width to make it thinner but still the same length. Hook one heel in the middle of the towel and grab the ends of the towel in your hands. Pull your leg up, flexing and the hip and keeping your knee straight, until you feel the stretch along the back of your leg. Hold firmly onto the towel with both hands and resist as you push your heel into the towel as if trying to bring your heel back down to the floor. Your foot should not move during this push. Maintain the pressure for the length of 3 big belly breaths. Relax the pressure from your leg and gently pull your leg further up with the towel until you meet tension and feel the stretch in the back of the leg again. Hold this stretch for a count of 3 big belly breaths then push into the towel again. After 3 belly breaths of pushing relax and pull your leg towards you more. Repeat this process one more time until you have pushed and stretched 3 times each. After this push your heel back into the floor one last time and only resist this pressure with the towel half as much as you had before. This should allow your foot to slowly come back to the surface you are on. If you feel your Hamstrings are tight do this every morning for each leg and see the difference it will make.

So remember. Sit up straight, move often, and stretch daily.

Thanks for reading,
Dr. Ben

What Is A Knee Cap?

(Originally posted on bcotoronto.com on Mar 21st, 2013)

Our knee cap (“Patella”) is a funny little bone. It is what is called a “Sesamoid” bone which means that it is a bone suspended within a tendon of a muscle. These sesamoid bones develop in areas where tendons rub over bones as they are stretched by the movement of a joint. They take the pressure and friction off of the tendon and for a joint with the bone they are against instead. This is what the patella does with the Quadriceps muscle and the Femur. The back side of the patella is covered in cartilage just like the any other joint and glides through a depression in the Femur called the “Patella Groove”.

Anterior Knee Bony AnatomyLateral Knee Bony Anatomy

Just like any other point, the Patellar-Femoral joint is susceptible outside pressures and because it is not held securely by ligaments these pressures can lead to significant dysfunction. This can lead to a condition called Patellar Tracking Syndrome (PTS). This is most commonly caused by an imbalance in the quadriceps muscles which pull the patella up through its groove as the knee straightens. The muscles of the quadriceps attach to the patella from three different angles and so if one side pulls harder than the other the Patella will be guided out of the groove.

Anterior Knee - The Quadriceps Muscles

Sit in a chair and keep an eye on your knee cap as you slowly straighten your knee. If the patella moves to one side of the other this indicates an imbalance in the strength of the quadriceps. If left unchecked this deviation in movement can cause extra wear and tear on the cartilage underneath the patella and eventually lead to arthritis and pain.

Before reaching the point of full-blown arthritis the cartilage may become inflamed to the point of causing pain and swelling beneath the patella. This is called Subpatellar Chondritis and can cause a significant amount of grief and get in the way of our activities.

So what can we do about this? Well, the most common muscular imbalance in the quadriceps is a weakness in the Vastus Medialis Obliqus (VMO) which causes a lateral (towards to outer side of our leg) shift in the patella out of its groove. The VMO is important in the last little bit of knee extension and so to strengthen it we take it through this activity.

Sit on a flat raised surface like a chair or bed and straighten your knee as much as you can (if you can bend your knee backwards, only extend the knee to be straight and not more). Bend your knee approximately 5o then slowly extend your knee to be straight again. Repeat this 5-10 times at least once a day. This will help to strengthen the VMO and balance out the side-to-side pull on the patella.

It is possible to have an imbalance in muscular strength in the quadriceps due to other reasons like injuries to nerves and scar formation, in which case significantly more therapy and care is needed and exactly how much should be determined by your healthcare professional. We can also injure our patella directly in other ways, but why not do a little work now to prevent the injuries we can?

Thanks for reading,
Dr. Ben

What Is A Pulled Groin?

(Originally posted on bcotoronto.com on Mar 14th, 2013)

Continuing our look at the hip, we will be discussing “Pulled Groin” injuries this week. Of course you are now asking, “What does the groin have to do with this hip Dr. Ben?” Well, that’s what we are here to explore. In sports it is incredibly common to hear about an athlete with a Pulled Groin injury but who runs or skates or jumps with their groin? This misrepresentative nomenclature comes from the pain associated with the injury.

A “Groin Injury” is actually a simple strained muscle of the inner thigh. This strain occurs high up the thigh where the muscle attaches to the pelvis on a region called the “Ischiopubic Ramus”, which as you can see in the picture below, is very close to the genitals. This proximity leads to a lot of referred pain into the groin, specifically the testicles and the labia in men and women respectively. Thus the name.

The Pelvis and Femoral HeadsThe muscles involved are a group called the Adductors and two muscles called the Gracilis and the Pectineus. There are three Adductor muscles called the Adductor Magnus, the Adductor Longus, and the Adductor Brevis. Do you remember the Thigh Master from those commercials in the 90’s (it’s actually still around)? These are the muscles that it was targeting.

The Adductor Brevis and Gracilis MusclesThe Adductor Longus and Pectineus The Adductor Magnus Muscle

So if this is just a simple strained muscle what does that mean for healing this kind of injury? Well, initially we should take it easy and ice the injured area. This will help to reduce the inflammation and swelling. After approximately a day and a half we should switch this up and use heat to relax the tight muscle and increase the blood flow in the area. As well, we should lightly stretch the muscle. This will help to get the muscle to relax as well as increase its ability to contract properly again.

The first stretch we should attempt is a butterfly stretch. Sitting upright on a flat surface (a soft surface like a pillow or mattress might be easier when first trying this stretch), place the bottoms of your feet against each other. Let your knees lower towards the floor and put a light downward pressure on them. Hold this position for several deep belly breaths and then release the pressure on your knees and raise them up again. Repeat this stretch 2-3 times in a set and do 2-3 sets in a day. The closer your feet are to your pelvis, the greater the stretch will be so start with your feet farther out and work them in until you find where your comfortable spot is.

The second stretch is a side lunge. This stretch should not be attempted until we are well on the road to recovery as use of the adductors is necessary to get out of the stretching position and this will hurt a lot if tried too early into recovery. So when you feel like you can manage it stand with your feet flat on the floor and standing straight in a neutral posture. Keep the foot of your injured leg on the floor and with the opposite foot take a large step out to the side. Bend the knee of the uninjured leg and lower your body weight over that leg. This should put you in a position where your injured leg is sticking straight out to the side and the rest of your body is squatting over your other leg. Hold this position for several deep belly breaths and then raise yourself back up to a standing position by straightening your knee and bringing the foot you stepped out with back in. Repeat this stretch 2-3 times in a set and do 2-3 sets in a day.

If you are an athlete you can generally introduce strength training into your recovery when you can perform these stretches without pain.

Thanks for reading,
Dr. Ben

What Is A Hip Flexor?

(Originally posted on bcotoronto.com on Mar 7th, 2013)

One of our most important areas of movement is our hips. They are the main powerhouse movers while walking, working in conjunction with all the thigh muscles (which really involve the hip anyway). Everyone knows about the Gluteus muscles and even a few of the other big movers that make up our bums, but how many people can name what lies on the other side of the hip joint and helps us swing our leg forward?

This main mover is called the Iliopsoas (“Ill – eo – so – as”) muscle. It is made up of two muscle bodies coming together into a common tendon. They are the Iliacus and the Psoas muscles. The Iliacus muscle is a broad, flat muscle that attaches to the upper rim of the pelvis and sits on the inside surface of the pelvic bowl. This ends up making it look like a big fan and gives it the ability to pull on the femur (thigh bone) from many different angles.

The Iliacus MuscleThe Psoas muscle is actually two thick bands of muscle fibres (Psoas Major and Psoas Minor but we’re just going to refer to it as a single Psoas muscle for the ease of the description) that attach to the sides of the lumbar vertebrae. Its length and girth allows these two bands to pull on the femur with quite a bit of strength.

The Psoas MuscleAs the Iliopsoas, these two muscles work together to flex the hip joint and bring the leg forward. They are important in walking, running, sitting, swimming, and really any activity that requires the use of our legs. This grouping of “Hip Flexors” is one of the “Prime Movers” in our body which are responsible for making the large movements of our limbs and body as a whole.

This Hip Flexors are important for another reason too in this day and age. As a society, we sit much more than is good for us. The body, when in any posture for long periods of time, will adapt to that position as the default. This means that when we sit all day and our hips are flexed at a 90 degree angle, the Iliopsoas is shortened and our brains make that new length the default position for the muscle. So when we stand up again, we straighten out our hip joints but the Iliopsoas is no longer long enough and so this pulls our pelvis and lumbar spine forwards.

This creates an over extension of the lumbar spine which pushes the joints that the back of the spine together potentially causing low back pain and decreasing the size of the holes where nerves leave the lumbar spine potentially causing nerve pain that may travel into the leg. More commonly, the Iliopsoas will be a source of pain itself which can cause pain in the low back, pelvis, and genitals.

None of these situations are pleasant and there are two simple things that we can do to make sure they don’t happen; move and stretch. Get up from your desk every 15-20 minutes and stretch your hips and low back (and while you’re at it your shoulders and neck too) and walk around a little bit. This stimulation will keep the blood flowing through the body of the muscle and keep it limber and the appropriate length.

Remember. An ounce of prevention is worth a pound of cure.

Thanks for reading,
Dr. Ben

Corporate Health

(Originally posted on bcotoronto.com on Feb 28th, 2013)

Ergonomic Pain DiagramWith companies like Google stepping up and creating amazing employee health centres in their offices with massage and gyms and health bars why don’t we see more companies following suit? Well, that’s because most corporations think that the cost is too great, but what is the true cost of not taking care of employee health? Let’s explore this idea today.

Pain impacts your work and productivity as an employee. The most obvious way your pain impacts your employer is having to miss work for doctor’s appointments and time off to recuperate. Sure musculoskeletal disorders (MSD) and pain are not the only reasons to take time off work but they definitely do contribute to the total. According to a research study performed and published by The Work Foundation in 2011, ~32.5% of the American workforce took time off work because of the most common MSD (defined as Back pain, Neck pain, and Upper Limb pain) in a two week period1. For a small company of 300 people, that comes out to be ~195 days a year lost due to MSD (Assuming an average of 2 days off/employee/year). Just imagine what that would be for a company of thousands.

Now if we assume an average annual salary of $60,000 and two weeks of vacation a year then we can actually break this down and give this MSD impact a financial cost to the company. For our little 300 employee firm that would be in the neighbourhood of $50,000 per year. Once again, imagine what that would be for a large company.

Before musculoskeletal pain reaches the point where people admit to themselves that they need to take time off or work to recover, it is already impacting their work. Pain sensation decreases our ability to focus and work, both as a distracting factor as well as interrupting our physical ability to perform tasks as simple as sitting at a desk, typing, lifting, or writing by hand. When surveyed , 20% of the American workforce admitted to losing productive time while at work due to MSDs such as headache, arthritis, and carpal tunnel syndrome2. The researchers determined the average number of hours each condition impacted productivity and when we apply these averages to our poor little employer again they lose over 270 hours of work to pain weekly. For a larger corporation this will be in the thousands.

Putting this in financial terms again this costs the company approximately $430,000 a year to MSD given our previous assumptions about salary and vacation time. So in the end our little 300 person agency is losing almost $500,000 a year. A big company like a bank or a brokerage firm would be losing millions.

Along comes our favourite little hero, complementary and alternative medicine. How do we in the CAM world fit into this picture? Well, MSDs are our bread and butter (despite most of us being gluten and dairy free). Chiropractic, Massage, Acupuncture, and even some Naturopathic techniques are superb at treating these conditions. Of course, you know that we don’t only focus on acute pain, we promote prevention of these potentially debilitating conditions. This is not even taking into account how much Naturopathy and Acupuncture can help other conditions outside of the MSD realm.

So you tell me what the true cost of not taking care of employee health is. If you believe in the benefit of preventative medicine, why not discuss it with your supervisor and present it in these terms. You might get more (or any) of the cost covered if your company knows that it will benefit too.

Thanks for reading,
Dr. Ben

Reference List
1. McGee, Bevan, and Quadrello. Fit For Work? Musculoskeletal Disorders and the Canadian Labour Market. The Work Foundation 2011
2. Stewart WF, Ricci JA, Chee E, Morganstein D, and Lipton R. Lost Productive Time and Cost Due To Common Pain Conditions in the U.S. Workforce. Journal of the American Medical Association 2003. 290;2443-2454.

Making a Healthy Meal Easily

(Originally posted on bcotoronto.com on Feb 21st, 2013)

You come home after a long day of work and feel drained and completely lacking in creativity. It is so easy to order a pizza or Thai or anything else you don’t have to cook for yourself but you know that none of it is really healthy. Those of you who know me or even just follow our facebook page know that I’m a bit of a foodie. I love good food and am willing to take on a culinary challenge just to see if I can do it but I definitely feel the same way when I get home after a long day.

So how do we avoid this situation? There are several tricks that we can use to maintain our healthy eating habits on our laziest and busiest days. The first is to fall in love with your slow cooker. Slow cookers are amazingly helpful and save so much time. You can fill it up the night before and turn it on when you leave for work in the morning. By the time you get home it will be a beautiful pot of delicious food waiting for you. If you are uncomfortable leaving something producing heat in your home while you are away you can always cook it overnight and just warm it up slightly when you come home from work. Most slow cookers are even large enough they can make enough food for multiple meals. This especially works if you know you are going to have a long day beforehand.

It is also very helpful to have a handful of “Go-To” recipes that you can basically make in your sleep. This allows you not make yourself get creative but still have a healthy meal. Just make sure that your Go-To’s are not only easy but actually healthy too.

Over a weekend or when you first get groceries and are putting them away, take some time and do the chopping and dicing that we all find tedious. This will make it much easier to put together meals when you are tired and it may even save you space in your fridge. Cut up things like carrots, broccoli, and potatoes that do not have much liquid in them. They will keep longer than veggies with lots of fluid like tomatoes and cucumbers.

One of the most common things people do when they are feeling lazy and tired is pop a frozen dinner in the oven and not worry about making something themselves. Well, these frozen meals are full of preservatives and additives which we know are no good for us so this is no better than ordering in. Why not make some meals yourself when you do have time and freeze them to be thawed and re-heated as needed? They may not stay as long in the back corner of your freezer as those from the grocery store but they are certainly healthier and probably taste better too. You can make casseroles, shepherd’s pie, burritos, and pretty much anything you can think of.

You can even throw something simple together and pop that in the oven when you get home. This takes a little creativity but only a small input of time. Fish and chicken are very easy this way and even potatoes. You could also season the meat and fish before hand and stick them in the freezer to just pop them in the oven when you need it.

One of the best tips I can give you is to know your spices. A good combo of spices can change a bland, boring meal into something exciting and new. This does take some experimentation and time to learn what you like and what goes well together but you can develop some “Go-To” spice combos that you really like and can use on different dishes.

Picking the right foods is also very important to making a good meal. If we are just going to have pasta with butter then we might as well have ordered a pizza. At least that might have veggies on it somewhere. Our nutrient dense foods are what we want to focus on, like our dark, leafy greens, and a variety of colours. Vegetables provide the complex carbohydrates which give us the satisfied feeling of fullness that we all crave.

The last tip I’m going to leave you with is to daydream. Start thinking about your dinner sometime in the early afternoon and this will help you get excited about what you have and what it’s going to taste like. It will also cut down on the amount of creativity that is required after your brain has called it quits for the day.

Here’s an example of a simple meal that I would throw together on a lazy day;

Baked Salmon
1. Preheat the oven to 400 degrees.
2. Place a cut of salmon (this also works with a white fish too) in the middle of a large piece of parchment paper or aluminum foil.
3. In a small bowl combine 2 tsp of chili power and 1 tsp black pepper. Rub this mix onto the top surface of the fish.
4. Cut a whole lime into slices and lay them in a single layer on top of the fish. Wrap the fish in the paper or foil and roll up the exposed edges to enclose the fish in a pouch.
5. Place the fish in the oven and check it after 10 minutes. Sometimes a thicker cut requires more time than this.
6. Serve without the lime slices on top.

While the fish is in the oven prepare the rest of the meal

Spiced Rice
1. Place an appropriate amount of rice (~1/4 cup per person) in a medium pot.
2. Add 2 tsp turmeric, 1 tsp onion powder, 1 tsp ginger powder, a tsp of dried cilantro, and a pinch of salt.
3. Add water (twice the amount of rice) to the pot, cover and put on medium heat.
4. Allow to cook until all the water is gone.

When the fish is done it’s time to work on the veggies

Blanched Asparagus
1. Take a handful of asparagus (this also works with green beans too) and break off the bottom parts of the stems that are stiff and fibrous.
2. Lay the remaining asparagus in a frying pan with about a ¼ inch of water in it.
3. Put on medium heat.
4. Remove the asparagus from the water when a fork slides easily into the veggies but still meets a little resistance.
5. Run cold water over the asparagus to stop the cooking process.
6. Drizzle with olive oil.

Enjoy,
Dr. Ben

Barriers to Exercise: The Weather

(Originally posted on bcotoronto.com on Feb 14th, 2013)

The weather is cold and dreary. The sun has set by the time we get home and hasn’t risen yet when we’re leaving for work. Who really wants to get out and exercise at a time like this? Wouldn’t it be better to hunker down with a good book and a cup of tea? Well, this is the question that most people ask during this time of year and then again in the rainy parts of spring and summer and once again in the sweltering hot days of summer. The weather outside is one of the biggest barriers to exercise we have and sometimes the easiest excuse we have to not get off the couch. It feels good to think that we really would be outside getting some exercise and fresh air if only it wasn’t so ugly out there.

I’m not saying that you have to go outside in a blizzard or thunderstorm to get your exercise. That’s just crazy. Especially when you are starting out, inclement weather can make exercising absolutely miserable. When you really get going and the pleasure of the workout outweighs the feeling of running in the rain or cold the story changes but that’s not what we are talking about today.

The cold and rainy weather can make it difficult to exercise even if you want to get outside. There are puddles hiding edges in the pavement, ice lurking under a patch of snow, and many other treacherous elements waiting to take your feet out from under you.

So with the miserable weather and the dangerous conditions why not head to where you can run or bike or weight lift inside. A gym! Well, gym memberships can be very expensive and gyms are not always the easiest places to get to, especially when the weather is against you.

“Well, I guess that means we should just give up and become one with the couch, right?” Wrong! We can work out at home! “But Dr. Ben, I don’t have expensive equipment to run or bike on!” That doesn’t matter. You can have a great workout at home without any equipment. In fact, for most equipment-less cardio workouts you don’t even need free weights. “But I don’t have any space!” You’ve probably got more than you think. You don’t need more than 5 square feet of space to get your heart racing and burn calories. Even less is needed from some workouts you can find. So move that coffee table reclaim your routine during the bad weather and the good.

If you need that little extra boost to get yourself motivated still, try an interactive workout program that helps you track your progress such as the Wii Fit or sign up for Fitocracy. You can also make it a family thing and include everyone. It’s a great way to teach the kids good habits for the future.

It is important to remember that every little bit counts. Getting up and making your heart pump is a good thing and doing it once a week is still more than you were doing before. The great thing about building a good habit is that it grows and grows the longer you do it. So if you do it once a week for a couple of weeks you will find it easier to start moving twice a week and then later on three times.

To learn how to do a proper cardio workout without equipment all you need to do it type that into Google and see what pops up. Here are a few of the links that I thought were good when I did that.

http://www.fitsugar.com/Cardio-Workout-Home-Equipment-Necessary-1503511
http://www.self.com/blogs/flash/2012/03/no-equipment-at-home-cardio-bo.html
http://www.fitnessblender.com/v/article-detail/Full-Body-Workout-without-Weights-At-Home-Cardio-Workout/6t/

And if you are more of a video person rather than reading about exercises you can do the same thing in YouTube.

http://www.youtube.com/watch?v=biiXlQHjt-g
http://www.youtube.com/watch?v=a7DhBAACn0k

So you have all you need to get started already. Good luck and happy exercising and as always, thanks for reading.
Dr. Ben

How to Help Epicondylitis

(Originally posted on bcotoronto.com on Feb 7th, 2013)

Tennis and Golfer’s Elbow are exceedingly common injuries. We hear about them on the news and in life all the time but they are another one of those things that is only really a vague notion for most people. Tennis Elbow and Golfer’s Elbow, called Lateral and Medial Epicondylitis respectively, are characterized by aching pain that can become sharp with movement and is generally accompanied by a feeling of heat in or around the elbow.

The elbow acts as a starting point for almost all of the muscles of the forearm, wrist and fingers with only a few exceptions. Our ability to bend our wrist and move our fingers actually originates in our elbow. In fact, all the muscles that move our fingers and wrist backwards start from one fairly small point (the lateral epicondyle) and the same is true for the muscles moving our fingers and wrist forward (the medial epicondyle). These sites are called the “Common Origin” of these muscle groups and when they get inflamed this large mass of muscle can cause significant pain and this is the cause of epicondylitis.

Bony ElbowMedial and Lateral epicondylitis are injuries where inflammation generally rises from overuse of the muscles. Any of the muscles can trigger this because they are all so closely associated at the elbow. It is a common misconception that these are only sports injuries. Muscular overuse can arise from any repetitive activity even if it does not involve exertion or strength. Activities where grip strength and fine motor skills of the fingers are involved commonly result in epicondylitis, such as manual labour jobs with hand tools, administration staff at a keyboard all day, or hobbyists building models or electrical circuits. It is also possible to have epicondylitis arise from a direct trauma to the elbow like with a fall or other injury but this is less common than repetitive strain.

Tennis and Golfer’s elbow can be quite debilitating but they do not have to be. Epicondylitis can be treated fairly easily in most healthcare settings and even at home. If you break the condition down, the two main components are inflammation and muscle spasm. To reduce inflammation, attack it with cold to slow down the chemical reaction of inflammation and acupuncture, naturopathy, and massage, as well as ultrasound are extremely good at reducing inflammation. Anti-inflammatory foods like turmeric, dark berries, and ginger are excellent additions to this effort.

To deal with the muscle spasm, chiropractic, massage, and gentle stretching are your best friends. For Medial Epicondylitis place the palms of your hands together and bring them close to your chest like a stereotypical prayer position. Then slowly lower your hands, bringing your wrists further into an extended position while keeping your palms pressed together. You should feel the stretch travelling up from your wrist (or even the fingers) into the elbow along the front of your forearm.

Forearm StretchFor Lateral Epicondylitis the stretch is a bit more involved. Hold your arm out in front of you and flex your wrist. Then twist your wrist so your fingers are pointing out to the side (your fingers should travel below your wrist, not above it) and gently pull it further into this twist and flexion with your other hand. You should feel the stretch travelling up from the back of your hand into the elbow along the back of your forearm. Remember, while stretching take long deep breaths to help get the most oxygen possible into the muscles to help them relax.

Mills StretchSo you can see that Epicondylitis need not be a pain in your life. There are many routes to healing this condition.

Thanks for reading,
Dr. Ben