Back At Shovelling

It snowed for the first time this season in Toronto this past weekend so it has most of us searching for those snow shovels we packed away last spring. When you do find them and it starts to snow enough that we have to use them there are several things that we have to remember when we are out there.

Shovelling is just like any other manual labour task or exercise regime. Stretching is key to keeping our muscles moving properly and come away ache and pain free. Stretching your low back, shoulders, hip, and knees both before and after shovelling will go a long way to keep you pain-free this winter.

Stretching
For your low back, place your feet shoulder-width apart and slowly bend down to touch your toes (or as close are you can get them). Hold this position for three big, slow stomach breaths. Walk your hands over to the left leg and foot and hold this position for three breaths. Walk your hands over to the right leg and foot and hold for three breaths then walk your hands back to the centre and rise back up slowly to a standing position.

Stand up straight and roll your shoulders in circles backwards ten times then forward ten times. Next, bring your right arm across your body at the same level as your shoulder and use your left arm to hold it there for three big stomach breaths. Repeat this with the left. Reach behind your head with your right hand and behind your back with your left and try to bring your hands together. Hold this position for three stomach breaths again then switch arms and repeat.

Stand with your feet shoulder width apart and take a long step forward with your right foot. Keep your left knee straight and press your hips forward and down. You should feel a stretch along the front of your thigh and up into your abdomen. Hold this stretch for three big stomach breaths then stand back up and repeat it with your feet reversed.

Stand near a wall and steady yourself with your left hand on the wall. Lift your right foot behind you and grasp it with your right hand. Pull your foot up until you feel a stretch along the front of your thigh. Hold this for three stomach breaths then lower your foot to the ground and repeat with your left.

Shovelling
When you are out there shovelling remember a few things. It is better for your body to push the snow to the edges of the driveway than it is to lift and throw it. If you do have to throw it to get it off the driveway then be sure to lift properly. Keep your back straight and your core tight then bend at the hips and knees to grip the shovel and then extend the knees and hips. Once you are back up straight take steps to turn in the direction you want rather than twisting your low back, and then throw the snow where you want it to end up.

Be sure to take lots of breaks to keep your muscles from getting overly tired. One of the best ways I find to do this is to have some good music playing through some headphones that keeps your bopping along at a good pace but gives you a better idea of the passage of time. Stop every 5-10 songs and give yourself a break. Just stand and take deep breaths or grab a drink of water. The music will also help to keep you in a positive frame of mind which is very good for preventing and relieving pain.

The Ontario Chiropractic Association has an educational pamphlet on shovelling with some good information here.

Stay warm and dry out there this winter and protect your back.

Thanks for reading,
Dr. Ben

Halloween Health Tips

Well, the day has arrived. It is finally Halloween! This night Ghouls, Ghosts, and Vampires will roam the streets looking for sweet things to sink their teeth into. This night is not a great night for health though and more than just the reasons you’re probably thinking of.

Sure there will be tonnes upon tonnes of candy and sugar tonight but I’m going to focus on the more physical and immediate concerns of the night. First off, let’s look at the costumes. We put on some crazy stuff one night a year and sometimes these costumes can be quite cumbersome and restrictive. IT is important to not sacrifice your body for the sake of a good outfit (this holds true on all days of the year too). A restraining costume can increase the probability of falling or tripping, especially if we can’t see our feet. On top of this a restrictive costume can make it difficult to catch ourselves when we fall increasing the risk of injury.

Costumes should also be balanced in their weight. We will be wearing them for a long time with parties or trick-or-treating so it is important to ensure that it will not be a strain to keep them up. If the weight of the costume is more on one side we can hurt back, shoulders, and/or neck. This is especially true if we are drinking alcohol because we could injure our body and take less notice, thus aggravating the injury.

Even if you are not dressing up this year there are certain things to be aware of. If you are taking kids trick-or-treating then be sure that you are ready for a long walk. This doesn’t sound too daunting, but remember what you may encounter on this journey. You can be delegated as the candy carrier and sometimes even the tired child carrier. This definitely makes the trip a lot harder. Be sure to stretch your shoulders, low back, and legs before heading out and when you get home again. Make sure you have good, supportive shoes as well, as these can make all the difference.

With everyone running around it is important to remember how tired the kids and even we can get. Carry a small pack of water bottles and snacks with you to keep everyone full of energy and enjoying the night. Letting kids eat some of their candy while out trick-or-treating still will help them in the short run but the sugar crash that follows will just make it worse. Healthy snacks will keep them going for much longer and make them much less irritable at the end of the night.

Happy Halloween and safe trick-or-treating everyone.
Dr. Ben

The Power of Prevention

Continuing on from last week’s topic a little bit I’m going to hop up on my soap box for a brief moment and talk about something that is really important to me. We all know the worn out phrase, “An ounce of prevention is worth a pound of cure” and probably all roll our eyes when someone says it. But I really want you to sit and think about what it means. It is not just something that our mothers say to us when we are being foolish and could hurt ourselves.

It means that the cure is more work than avoiding the condition, disease, or injury.

It means that prevention is far stronger than the cure.

It means that willpower is better than pain.

Prevention is what we call lifestyle therapy, which primarily means diet and exercise. At this point almost everyone is rolling their eyes again. Sure, you’ve heard it over and over that, “You should eat better and exercise more.” But the simple truth is that these two things can decrease out risk of chronic illness (and even some minor injuries) drastically.

Women who exercise regularly (even just walking) decrease their risk of developing breast cancer (1).

Adults who eat plenty of dietary Omega-3 fats daily decrease their risk of developing Alzheimer’s disease (sorry, no percentage available on this one) (2,3).

People who have fibre from cereal grains and fruits in their diet a reduced risk of developing colon cancer (4).

Regular exercise has been shown to reduce our risk of heart disease at any age (5,6,7).

These are just some of the statistics out there and there is so much more that research has shown us. However, we as a society have gotten ourselves into a rut and it is difficult to get out of it because that rut provides us with easy and cheap fast food and lots of activities and distractions that keep us too busy for exercise.

This path also lends itself to our collective fallacy of, “I don’t feel sick, therefore I am healthy.” We have to stop thinking this and remember that Health is NOT the absence of pain. Health is the optimal functioning of our bodies so that we may perform at our best at all times. Now, I’m not saying that we should all be Olympians. Optimal functioning means that we can meet the basic needs for survival and have plenty of energy and ability left over to rise to any challenge that is presented to us.

Most alternative medicines are based heavily in preventative care. Seeing a naturopath, massage therapist, or chiropractor on a regular basis can help to increase our ability to meet the challenges we face and decrease our risks of certain conditions and diseases even further.

So what is your plan for making your future the brightest it can be? I challenge you to go out and walk for 20 minutes, three days this week and take a look at your meals and make one thing on your plate healthier. Take that first step and see the difference it makes. Changing our habits and lifestyle is an uphill battle but it is far easier than dealing with the consequences of not doing it.

Thanks for reading,
Dr. Ben

References
1. Wu Y, Zhang D, and Kang S. Physical activity and risk of breast cancer: a meta-analysis of prospective studies. Breast Cancer Research and Treatment 2013;137(3):869-882

2. Dacks PA, Shineman DW, and Fillit HM. Current evidence for the clinical use of long-chain polyunsaturated n-3 fatty acids to prevent age-related cognitive decline and Alzheimer’s disease. The Journal of Nutrition, Health, and Aging 2013;17(3):240-251

3. Gillette-Guyonnet S, Secher M, and Vellas B. Nutrition and neurodegeneration: epidemiological evidence challenges for future research. British Journal of Clinical Pharmacology 2013;75(3):738-755

4. Murphy N, Norat T, Ferrari P, Jenab M, Bueno-de-Mesquita B, Skeie G, Dahm CC, Overvad K, Olsen A, Tjønneland A, Clavel-Chapelon F, Boutron-Ruault MC, Racine A, Kaaks R, Teucher B, Boeing H, Bergmann MM, Trichopoulou A, Trichopoulos D, Lagiou P, Palli D, Pala V, Panico S, Tumino R, Vineis P, Siersema P, van Duijnhoven F, Peeters PH, Hjartaker A, Engeset D, González CA, Sánchez MJ, Dorronsoro M, Navarro C, Ardanaz E, Quirós JR, Sonestedt E, Ericson U, Nilsson L, Palmqvist R, Khaw KT, Wareham N, Key TJ, Crowe FL, Fedirko V, Wark PA, Chuang SC, and Riboli E. Dietary fibre intake and risks of cancers of the colon and rectum in the European prospective investigation into cancer and nutrition (EPIC). PLoS One 2012;7(6):e39361

5.Lamina S, Okoye CG, and Hanif SM. Randomised controlled trial: effects of aerobic exercise training programme on indices of adiposity and metabolic markers in hypertension. The Journal of the Pakistan Medical Association. 2013;63(6):680-687

6. Fakhry F, Rouwet EV, den Hoed PT, Hunink MG, and Spronk S. Long-term clinical effectiveness of supervised exercise therapy versus endovascular revascularization for intermittent claudication from a randomized clinical trial. The British Journal of Surgery. 2013;100(9):1164-1171

7. Back DT, Casey DP, Martin JS, Emerson BD, and Braith RW. Exercise training improves endothelial function in young prehypertensives. Experimental Biology and Medicine. 2013;238(4):433-441

Health For Your Career

This week I went to see the Mirvish production of Les Miserables (it was absolutely wonderful and I highly recommend it to anyone who enjoys musical theatre) and it got me thinking about health, as many things do being the health nerd that I am. The performing arts can be absolutely brutal on your body, just like sports, and to have a prosperous career you need to maintain a very healthy lifestyle to meet the challenges that face you.

But this rule does not only apply to performers and athletes. We all need to lead a healthy lifestyle to maintain our career if you think about it. Diet, posture, and activity all play a central role in the deterioration or upkeep of our body. If we sit at a desk all day, hunch by our computer, and get very little activity our body will feel the stress just as quickly as someone who operates a jackhammer all day. This means that our bodies will accumulate damage (“microinjuries”) over time and certain activities will no longer be easy or comfortable for us. This accumulation will limit our ability to do our jobs and could lead to serious disability and potentially losing all ability to work.

Pain, limited range of motion, weakness, numbness, and other downstream effects of these microinjuries all impact our ability to work. So what are we to do about it? Are these effects just an unavoidable by-product of working?

Why not look at it the same way these performers and athletes do? I need my body (and my mind) to do my job so let’s look after my body (and mind) the best that I can so that I can continue doing my job. We hear about so many major league athletes turning to alternative medicine for preventative and injury care but there are just as many performers out there who do the same.

Through prevention we can avoid nasty complications later down the road and keep our ability to work as strong as ever. This will pretty much guarantee a good career (aside from non-health/ability related issues, of course) in whatever field you choose. On top of this, early intervention is key to limiting the impact injuries have on our future ability to work. The longer we put off finding appropriate care the greater the impact an injury will have on our body.

So if you are looking for a long career take good care of your body because it’s the only one you’ve got. Get a little exercise every day, maintain a healthy diet, and make sure you treat your body right with good posture, deep breathing, and a calm, stress-free attitude. Think of yourself as a performer on our own little stage and the lifestyle will follow.

Thanks for reading,
Dr. Ben

Staying Level Headed

When we talk about posture it is generally in terms of front to back discrepancies in the balance but side to side is just as important. A side to side postural imbalance is called Scoliosis. I’m not going to talk about structural scoliosis, where the bones of the spine have developed in such a way that the spine cannot stand vertically. Today I will be discussing functional imbalances that are more common than we think in the general population.

Our side to side movements and balance come solely from our spine and the muscles that run up and down it as well as out from it. An imbalance in these muscles or an outside influence can lead to a curve towards one side or another and this puts a lot of uneven pressure through the joints of the spine.

First of all, those squishy intervertebral discs that we have talked about so many times before will be pushed to the outer edge of this new curve and create uneven pressure on the outer tissue of the disc itself. If prolonged, this pressure will eventually weaken these tissues and increase the likelihood of the intervertebral discs herniating.

The pressure in the joints of the spine also increases the wear and tear they experience which leads to degeneration of the joints and the development of arthritis. The most noticeable and immediate symptom of this imbalance is sore and spasmed muscles up and down the spine. Really muscle spasms and functional scoliosis are a chicken/egg debate that is different for each individual but they definitely go hand-in-hand.

Functional scoliosis can be influenced and/or caused by multiple different factors. The main culprits are bags that are carried on one side like purses, messenger bags, or briefcases. This added weight unbalanced us and puts an outside pressure across the spine. Backpacks on the other hand, when worn on both shoulders balance their weight evenly across the shoulders and low back so that the pressure is vertical and not horizontal. If the backpack is not packed evenly then this protection disappears, of course. This is why it is important to distribute the weight in your pack evenly on both sides.

Our shoes can even be the problem that leads to functional scoliosis. If they wear down unevenly then it’s the same as walking along an uneven surface. This can happen if our gait is off for any reason.

If you think that you have a functional scoliosis take a look in the mirror and really examine how level your body is at all points. Take a good look at your ears, shoulders, and hips as these are generally good indicators of balance horizontally. At our shoulders there is always a little discrepancy because the muscles of our dominant arm will be mildly bigger than the non-dominant one just from frequent use. In fact, we all have a very small mild scoliosis in our upper back which curves towards our dominant arm for this reason. That scoliosis is harmless as the body has adapted to it since childhood and found a balance around it.

So what can we do about it? Really the only help that we can get fixing a functional scoliosis is through rehabilitation and chiropractic care. A chiropractor or physiotherapist can determine if a functional scoliosis is appropriate or the result of an imbalance which should be removed. Through training and manipulation an inappropriate scoliosis and its root cause(s) can be alleviated and resolved. The only thing that we can do at home by ourselves is to make sure that when we work out we stretch and exercises both sides of our body evenly.

So take a good look at the mirror now and then and honestly answer this question, “How level headed am I?”

Thanks for reading,
Dr. Ben

Winging It: Scapular Instability

In the past we have talked about the importance of our posture and our rotator cuff muscles but we really haven’t talked about how they are connected yet. Pretty much everyone can identify their shoulder blade (“Scapula”) but can you say what it is for? It’s a weird flat bone that sits on your upper back and just kind of floats there, but everything in the body has a purpose (except for those wonderful vestigial organs like the appendix). The scapula’s purpose is to act as an anchor to the arm. It holds the ends of the rotator cuff muscles as well as the Biceps, Triceps, and the Deltoid muscles. Now what is the most important aspect of an anchor? That’s right! Stability! Just like our core muscles, our shoulder blades should remain rock solid when we need them but still have some mobility to adapt to changes in arm movement and pressures.

So how can a flat bone be both stable and mobile at the same time? The scapula sits on top of the rib cage with a connection to the collar bone (“Clavicle”) at the front. This connection should not provide mechanical support but only act as a guide for the position of the scapula relative to the rest of the body. The stability of the shoulder blade comes from the muscles that surround it. These “Scapular Stabilizers” pull the boney plate in different directions and lock it down thus allowing it to remain stationary while the prime movers of the arm (Deltoid, Biceps, and Triceps) use it as their anchor.

Posterior (Back) Shoulder Bony Anatomy

Posterior (Back) Shoulder Bony Anatomy

 

Anterior (Front) Shoulder Bony Anatomy

Anterior (Front) Shoulder Bony Anatomy

These Scapular Stabilizers consist of the Trapezius (Upper, Middle, and Lower), Rhomboids (Major and Minor), and Serratus Anterior muscles. Both Rhomboid muscles as well as the Middle Trapezius help to pull the scapula in towards the spine while the Upper Trapezius muscle pulls the scapula up and the Lower Trapezius pull it down and in. The Serratus Anterior opposes muscles by pulling the scapula out and forwards towards the front of the ribs. There are other muscles that attach to the scapula and help to stabilize it but these are the major actors on this stage.

We’re discussing these muscles and their role in shoulder function today because we do not use them correctly. If we were properly stabilizing our shoulder blades they would remain firmly pressed to the back of our ribs but the most common postural pattern in the Western World does not do this. Generally we are slouching forward which rolls our shoulder blades out and forward, around our rib cage. This position puts a lot of mechanical pressure on the joint with the clavicle and causes the Upper Trapezius to bear the weight of the shoulder and arm. Through maintenance of this position the Lower and Middle Traps, the Rhomboids, and the Serratus Anterior all weaken from lack of use and are not able to act upon the scapula as they should. When this happens it is called a “Winging Scapula” because the inner edge of the shoulder blade pops away from the ribs and sticks out like a wing and it means that our scapula cannot provide the stability it needs to. Scapular instability leads to increased risk of injury to the shoulder and arm, specifically the rotator cuff muscles and the Acromioclavicular joint (the joint now under pressure between the scapula and the clavicle).

Winging Scapula

If you have been reading my blog for any amount of time you know that I am all about preventing injuries and reducing the risks we expose ourselves too. So to get out of this problematic position we need to retrain our muscles to hold the shoulder blades in place. There are two fairly simple exercises that can accomplish this. The first we’ve talked about before and I call it the “Pocket Push”. The second is demonstrated very well in the video. The sound is a not great so use some headphones or watch it in a quiet space to hear all the details.

No matter how much some of us might wish for wings to fly, a Winging Scapula is not going to help at all. Tuck in those flat little bones and sit up. It will do your body a world of good.

Thanks for reading,
Dr. Ben

3 Exercises for Healthy Feet

Last week when we talked about finding the best footwear and before that when just talking about foot health in general I touched upon the idea of our feet being weak and unable to support themselves because of the way we’ve treated them. In both those previous posts I mentioned exercises to help reverse this. This week we are going to expand on this and discuss some of those exercises.

Ankle Alphabet
A key component of a strong foot is a strong ankle which requires not only muscle strength but proper mobility. This simple exercise will give us both of these factors in one shot. The Ankle Alphabet is performed by holding your foot (bare is better but it can be done in shoes that do not touch the ankle) just off the floor while seated or lying down. Hold you knee steady and write the alphabet in the air with your toes. All of the movement to do this should come from your ankle and not your toes, knee, or hip. Perform this exercise once a day on each foot writing the whole alphabet out.

Towel Grab
This next exercise helps to get the muscles and tissues on the bottom of our feet moving properly and will decrease tension and spasm. Place a dish towel flat on the floor and, in a seated position, put your bare foot down so that the edge of the towel is under the first knuckle of your toes and your toes are on top of the towel. Keeping your foot in contact with the floor as much as you can, grab the towel with your toes and push it back under your foot. Repeat this process until you reach the far end of the towel. You may have to occasionally lift your foot to allow the towel to move farther back as more is collected by your toes. When you reach the end of the towel smooth it out again and start over. Repeat this process several times on each foot daily.

Plantar Stretch
This next exercise is a little different and can be fairly uncomfortable when first starting out. As we’ve talked about before, tension can build up in the tissues of the bottom of the foot and the Towel Grab alone may not be enough to loosen them again. For the Plantar Stretch you need to be seated with one foot resting comfortably on top of the opposite knee. Take one thumb and place it on the sole of your foot. We’re going to call that thumb the “Pressure Hand” (PH). The other hand should grab onto your toes. We’ll call that hand the “Lever Hand” (LH). Keep your foot relaxed and curl your toes down with the LH. Then push into the bottom of your foot in an area that feels tense (generally around the arch) with the PH. Maintain the pressure on the bottom of your foot and slowly uncurl your toes with your LH. When your toes are fully extended, release the pressure from your PH and curl your toes again with your LH. Repeat this process in a variety of tense spots about 5-10 times on each foot 2-4 times a week.

Chiropractic care is very effective at treating foot problems and helping maintain good foot health. Each foot has 26 bones articulating in 33 joints. So why not see a joint, muscle, and bone specialist for optimal health?

Remember, feet are the foundation of our posture and without a strong foundation a building falls down.

Thanks for reading,
Dr. Ben

Shoes and Our Feet

A while ago I wrote a post about our Feet and Chiropractic Care and today I would like to expand on that a bit. Today we are going to be looking at footwear and their impact on our feet. There are many different types of shoes out there but we will be looking at a few of the more common ones that people wear on a regular basis. For a reminder of proper foot biomechanics take a look back at the original post on feet

The biggest criminal in the shoe world is the high heel. I touched on this briefly last time but let’s go into more detail now. High heeled shoes take the foot, which is designed to spread the weight of the body evenly between the forefoot (toes and arch) and the hindfoot (heel and ankle), and angles it so that all that weight is now on the balls of your feet. The higher the heel, the greater the amount of weight bearing down on this one area. This puts a lot of pressure on the tissues between the bones of your toes. Add to this the restrictive nature of high heeled shoes (trying to maintain some stability) and you have a bad mixture which can lead to a condition called “Morton’s Neuroma”. Morton’s Neuroma is the build-up of scar tissue around the nerves that run between the bones of our forefoot and into our toes. This scar tissue takes up more space than we have available and so squeezes the soft tissues of the nerve and can cause significant amount of pain. The most commonly suggested solution to this problem is surgery where they cut the nerve to kill it and we lose all feeling to that part of the foot and toes. Not the most desirable of situations. Chiropractic and Acupuncture treatments can have a good effect on this condition but are much more effective if caught early.

At the other end of the foot we have the ankle being held in a toe-pointed (Dorsiflexion) position which is not good for it. The pressure that runs down the bones of our shin (Tibia and Fibula) should be transferred through the middle of the ankle joint but instead if pushing down on the back side of the bones. This puts pressure into the closest joints can causes tension in the ankle and hindfoot joints which can cause pain and discomfort. As well, this maintained dorsiflexion put the Garstrocnemius in a shortened position when, as I’ve talked about before, muscles like to reset their default length to the one they spend the most time in. That means that prolonged use of high heels will make it more difficult to bring the ankle through its natural full range of motion and thus make it hard to perform proper biomechanics of walking when not in high heels. Regular stretching and Chiropractic care can help clear up these tension and tight muscle problems.

Flip flop sandals are the next big culprit. They are on almost everyone’s feet during the summer but they are not very good for us. The problem is that we have to work to keep them on while moving around. This means that we grip them with our toes so that they don’t go flying off or twist under our feet. In doing this we eliminate a key part of the gait cycle (the pattern of our walking stride) called “Toeing Off” when we are pushing off with our back foot and our toes are relaxed and extended. This applies to both thong and Berkinstock style sandals. Sandals that strap to our feet around the ankle and will stay on without us actively keeping them there are fine. The gripping action of our toes causes tension along the bottom of the foot and can lead to discomfort and foot problems down the road. Massage, Acupuncture, Physiotherapy, and Chiropractic are all great choices in dealing with this kind of tension.

The next type of shoe I would like to discuss is ballet slippers. These little flimsy slip-on shoes are an interesting conundrum. The provide no support what-so-ever, which is not a bad thing for our feet but the majority of people do not have the muscle strength and endurance to support a barefoot because of the way we have treated our feet in the past. On the other hand we need to challenge our feet to support themselves but in this case the necessity of the shoe trumps our foot’s need. In order to stay on the slipper needs to be snug on the foot from toes to heel, which does not allow for full range of motion of the toes as they splay out and extend back as we are toeing off. So in the end I would say these shoes are not great but are definitely better then high heels by a wide margin.

Men’s dress shoes are much like women’s high heels in their rigidity compared to other shoes out there. They are stiff and do not provide much ability to accommodate the movement of the arch and toes during our gait cycle. A well worn in pair will be more flexible but to get to this point we have to put up with a lot of discomfort and dysfunction in our feet.

At the other end of the spectrum we have athletic shoes. These puppies are designed to be perfect for the foot. They cushion the foot but also allow it to move when it needs to. The only problem with these types of shoes is that they are only designed for one activity. So when doing anything else they are not necessarily what we need. Depending on the sport they can be too restrictive in the ankle or hold the forefoot too tight for everyday life. The only exception that I would say if good for most things is a real running shoe. They are designed for our gait in a wide variety of speeds.

So is all footwear bad? Can we every find something that won’t hurt us? Well, of course we can. The ideal shoe is one that is relatively flat so that the ankle is aligned and weight is spread even throughout to foot. It needs to provide some support as our feet are not used to working by themselves but not too much so that our feet will have to work a little and we can keep them strong. This shoe should also allow for full ankle range of motion and have a flexible enough sole to allow for our toes to extend during toeing off. Make sure to really explore all the aspects of a pair of shoes when buying them so that you don’t regret it later. Of course we can’t limit ourselves completely in our lives. If you have a pair of shoe that you absolutely love you can still wear them but I highly suggest only doing so sparingly. Also, no matter what shoes you wear, we should all spend a portion of the day barefoot so that our feet can move the way they were designed to. Make sure your feet and healthy and happy and the difference in your life will be amazing.

Next week we will take a look at some exercises for the feet which will help to keep us strong and mobile.

Thanks for reading.
Dr. Ben

Thoracic Outlet Syndrome: Posture’s Problem Child

Welcome back to my blog! This is the first post to DrBenRoffey.com so I would like to take a moment and say Thank You for coming by and I hope that you can learn something from what I do here. If you have any questions about what we discuss here or about any aspects of health or healthcare my door is always open. E-mail me at drroffey@gmail.com and I’ll get back to you as quickly as I can.

And now back to our regularly scheduled blogging.

One of the more common conditions that walks into a chiropractor’s office but you don’t hear much about is called “Thoracic Outlet Syndrome” (TOS). This is a condition which is not terribly serious but the symptoms can be very scary and if left long enough can cause become fairly debilitating.

First of all let’s look at what this condition is and what causes it. The Thoracic Outlet is the triangle shaped space between your collar bone, shoulder blade, and the base of your neck. Through this space all of the arteries, veins, and lymphatic ducts travel to and from the chest cavity (Thorax) and out into the arm. These structures are also joined by the nerves from the neck that travel to the muscles and skin of the arm. That is a lot of stuff going through a fairly small area. Thoracic Outlet Syndrome occurs when any or all of the nerves, arteries, or veins become compressed which causes pain, numbness, and or tingling, in the hand and arm

The compression of these structures can happen in several different ways but most are due to poor posture, specifically hunching of the upper back (Thoracic spine), rolling forwards of the shoulders, and the head pushing forward in front of the shoulders. Any or all of these postural positions will stress and strain the muscles around our skeleton and cause them to tense up to hold the weight we are not placing upon them. As the angles of these muscles change and their tension increases dramatically they will push against the nerves at the base of the neck and the arteries and veins exiting and entering the top of the rib cage (the Thoracic Outlet) thus causing Thoracic Outlet Syndrome.

The pain and numbness or tingling associated with TOS can be continuous or episodic in nature depending on the amount of pressure on the structures and they usually have a specific area that they stays within. Most commonly the symptoms are experienced in the hands but over time they may spread into the forearms and even up into the shoulders. People with TOS may also notice a decrease in sensation in the areas affects. If left for a long period of time without treatment muscle weakness can occur in the hand affected.

The exact areas of numbness and tingling and change in skin sensation will be different depending on if it is the nerves, arteries, or veins involved but in general the hand and forearm are the most common areas to experience these symptoms. These symptoms can be mimicked by other conditions such as Carpal Tunnel Syndrome, Herniated Intervertebral Discs in the neck (Cervical Spine), and even active trigger points in the rotator cuff muscles that can refer pain down into the hand and fingers. Make sure you see a doctor to determine the true cause of your pain.

When you go to a doctor they should ask a series of questions and perform a number of tests on you to help determine the nature and source of the problem. Thoracic Outlet Syndrome reacts very well to complementary treatments and therapies including chiropractic, acupuncture, massage, and physiotherapy all have excellent results.

Posture is an extremely important thing in our lives and if we maintain a good posture we can avoid conditions like TOS. So I hate to say it but our mothers were right, “Sit up straight and stop slouching.”

Thanks for reading,
Dr. Ben

Chiropractic and Ribs

(Originally posted on bcotoronto.com on June 6th, 2013)

Chiropractors can adjust any movable joint in the body but the one that people seem to always be surprised at is a rib adjustment. It turns out that most people think that ribs are immobile bones that only protect the chest but there is so much more to them than that.

Ribs to function to protect the organs of the chest and stabilize the thoracic spine but they also play an important role in how we breathe. Our lungs are not muscular organs and so cannot draw air into themselves. It is the responsibility of the diaphragm and the ribs to do this. The diaphragm descends into the abdomen which pushes the ribs out and up in what is referred to as a “bucket handle” motion. This expansion of the chest pulls the lungs out in every direction drawing air in. Relaxing the diaphragm lets the ribs descend and the elasticity of the lungs pushes the air out again.

The ribs are attached to the spine at the back and the sternum in the front. At the spine, the ribs form a joint with the vertebrae which is surrounded but many little muscles. The joint between the ribs and the sternum at the front is slightly more ridged. The ribs end just short of the edge of the sternum and cartilage fills that gap. This does allow some movement as the cartilage is supple and flexible. With these joints as they are the ribs are able to move well and aid in breathing while providing the boney protection to our heart and lungs.

This is, of course, if we are treating our body correctly, which most of us are not. As a society our posture is terrible. We slouch forwards which does not allow out diaphragm to descend as well. This forces us to compensate and use the muscles of the back and shoulders to pull the ribs up to expand our lungs rather than letting them be pushed up by expanding our abdomen. As it happens in all cases of muscular compensation this puts a strain on muscles they were not meant to take. This leads to muscular spasms and pain as well as joint dysfunction in the areas of the spasm. So all these muscles clamping down and holding everything tightly means that the ribs will not be able move properly and hinder breathing. This can be quite uncomfortable and even make breathing painful.

Muscular spasm and improper movement of the ribs will eventually pull the ribs “out” which is not to say that our ribs will fall off but that they will stick out from where they should be. This is not a dislocation but it is a misalignment which can be corrected through adjustment. The adjustment will help to relax the spasm of the muscles, restore proper movement of the rib, and help to improve breathing.

This type of dysfunction is incredibly common and is so simple to reverse. Adjustments paired with postural exercise can restore full breathing capacity and maintain it. This is especially important for people who have difficulty breathing with conditions such as asthma, emphysema, and even smokers.

So make sure your ribs are moving and breathe the fresh air this summer.

Thanks for reading.
Dr. Ben