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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

The True Meaning of Multidisciplinary

When navigating the world of healthcare you have probably run into something called a “Multidisciplinary Clinic”. This means that there are multiple different professions working under one roof. The first thing that comes to most peoples’ minds is, “Well, that’s convenient!” but in the end it really isn’t that much better than having all of these professionals working in different locations. Within most multidisciplinary clinics there is just as much miscommunication as there is when they are separate.

The problem lies in the definition of “Multidisciplinary”. When these clinics started popping up they were supposed to be organized efforts to bring together teams of professionals to work together rather than just work next to each other. A truly multidisciplinary clinic will encourage and foster communication and collaboration which benefits the patient much more than one doctor working alone. This has been lost in the healthcare community but is being brought back through multiple different efforts from different groups (one of which, I am proud to say, is the Ontario Chiropractic Association).

The theory behind Multidisciplinary clinics is that doctors working in collaboration with easy communication and access will be able to provide better quality care to the patients. Through this there will be decreased wait times, increased patient and professional satisfaction, and improved prognosis for the patient’s condition. There is a very small body of research that supports these theories at the moment but more is being conducted all the time.

The other aspect of Multidisciplinary team care is knowledge of other professionals’ skill sets. Outside of the specialties within their own professions most healthcare practitioners do not know what other professionals are capable of. Multidisciplinary clinics allow practitioners to get comfortable with other professionals and know where others may be able to treat a patient better than they can themselves. This allows multidisciplinary teams to cover holes in patient care that might otherwise go undiscovered.

It is really important to check out any clinic you go to that promotes itself as multidisciplinary to ensure they embrace the true meaning of the term rather than just working in the same location. If not then you are not getting any extra benefit from it beyond only having to remember one address.

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