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Glucosamine, Chondroitin supplements for Joint Pain in Downtown Winnipeg

If you work in Downtown Winnipeg, you experience the ‘hardness’ of your daily commute. It is a ‘concrete jungle’, and the impact on your feet, knees, hips and back can be felt on a daily basis.

We all know someone who takes ‘vitamins’, or some kind of ‘supplement’ with the latest health benefit.

I get asked almost everyday about ‘glucosamine supplements’ for arthritis, joint pain, etc. Those ‘horse pills almost choked me’ exclaimed one patient, ‘how much do I need to take to even notice a difference in my knee pain?’, ‘where can I get those pills that supposedly help my joints?…are common questions in Downtown Winnipeg.

In a 2010 British Medical Journal, one of the most reputable of all scientific journals; an article published this conclusion:

“Compared with placebo, glucosamine, chondroitin, and their combination do not reduce joint pain or have an impact on narrowing of joint space. Health authorities and health insurers should not cover the costs of these preparations, and new prescriptions to patients who have not received treatment should be discouraged.”

So is it fair to conclude that it’s not worth taking glucosamine, and/or chondroitin supplements?

Maybe.

May I present the evidence to people to let them make an informed decision. I have seen patients describe dramatic reductions in pain after taking G&C. If the supplement helps your symptoms it may be worth continuing it, especially if stopping taking it causes an increase in pain. I’ve also seen many report no change and complain about the ongoing cost. 1 or 2 have reported occasional side effects, although these supplements are generally considered fairly safe to take.

Other studies have shown more promising results, with Bruyere et al. (2008) concluding G&C may reduce the need for total joint replacement. It’s worth noting however, that in terms of quality of evidence, a systematic review of multiple research papers is usually considered better evidence than an isolated study. A recent analysis by Lee et al 2010 did show that G&C may slow progression of osteoarthritis (as measured by X-ray change) although it required taking it daily over 2-3 years.

But Sawitzke et al. 2010 found “no clinically important difference in pain or function” when compared to placebo. The Cochrane Review (2009) – Glucosamine Therapy for Treating Osteoarthritis had somewhat mixed results but concluded it may reduce pain and improve function.

Prices of G&C vary a great deal. Most clients speak of Costco having ‘bulk’ prices, while Walmart still has the edge on discount pricing for ‘reasonable amounts’. But physicians I have questioned here in Winnipeg, some at our best sportsmedicine centres, still recommend greater than 1600 mgs per day, over greater than an initial 6 week period to judge the supps usage.

Personally, I have recommended our local Winnipeg stores, like Guerrilla Jacks and Sunrise Health; as there is still nothing like more opinions and education about your health.

So the question you need to ask yourself is, am I willing to spend that much on a treatment that might help or may make no difference to my pain or the progression of arthritis?

Words of caution: If you are planning to take supplements to treat arthritis or other conditions discuss this with your GP or Pharmacist.

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HEAT? Really? Stay Hydrated Winnipeg when exercising this Summer

We Winnipeggers wait so long for summer to arrive that some of us overdo it a when exercising outdoors, especially during unexpected heat and humidity early in the season.

‘Global warming’ is changing the prairie climate, the old models are unpredictable and ‘stormy weather’ is dominating the news.

It takes a while for our bodies to become acclimatized to warmer temperatures and our bodies regulate heat more slowly during hot, humid weather, causing us to overheat that much easier.

Before you head outdoors this summer, take a moment to understand the potential health risks of being active outdoors in extreme heat.

While being physically active has many health benefits, it can increase your risk for heat illness, especially in those with breathing difficulties, heart problems, a mental illness such as depression, hypertension or kidney problems. Even those without any chronic health conditions can be at risk without proper precautions.

In my day, Canada’s ‘food guide’ recommended 8 glasses of water for men and 10, 8 oz glasses for women. Now take into account the daily diuretics we all enjoy, coffee and alcohol, and you must add 2 more glasses for each one of those habits.

Get informed:

• Ask your sports organization or trainer if they have a plan for extreme heat.

• Ask a friend or buddy to watch you during extreme heat; if you suffer from asthma, carry your inhaler with you and make others aware of your condition.

• Modify or reschedule your activities.

• Work out early in the day or in an air-conditioned facility.

• Check the Air Quality Index for air quality conditions.

• Check local weather forecasts so you can plan accordingly.

Keep yourself safe:

• Stay hydrated by drinking fluids and eating raw fruits and vegetables.

• Wear sunscreen and insect repellant.

• Allow your body to recover from heat exposure by sitting in the shade or heading to an air conditioned area.

• Watch for signs of heat exhaustion such as dizziness, fainting, nausea, vomiting, headache, rapid heartbeat and extreme thirst.

• Heat illnesses can lead to long-term health problems and even death. These illnesses include heat stroke, heat exhaustion, heat fainting, swelling of hands, feet and ankles, heat rash, heat cramps and dehydration.

• The most serious heat illness is heat stroke, which can be fatal. Symptoms include a core body temperature of 40.5ºC/105º F, confusion, lack of sweat and unconsciousness. Call 911 immediately if you see someone with these symptoms.

• If you see someone going into shock from heat stroke, move them to a cool place, apply cold water to large areas of their skin and clothing and fan them as much as possible.

More tips for staying safe in the heat can be found at

http://www.healthycanadians.gc.ca/sun.

Stay hydrated Winnipeg, yourPhysio has the healthcare experience you need.

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Consider your back, shoulders, hips when buying your next mattress Winnipeg…some tips from yourPhysio

Many people complain of back pain soon after they get out of the bed. Whether it be a combination of tight muscles, stiff joints or general aches, this is a common complaint at any age in Winnipeg.
Although, many fail to sense the link between the back pain and the bedding that they use, research has shown the influence the bedding can have on causing as well as relieving the stress from a persons back. When we go in search for bedding, we can see lot of varieties which are made in many different ways. Adding to this variety is our personal preference. The mattress should also match the framework of the bed. With all these considerations, the value we give to our health is probably low down in the list or not in the list at all.
The link between the bedding and back pain is associated with the malalignment of our body structures away from its natural alignment. When the spine is kept straight, which is the optimal shape to minimize stress towards the lower back, we can see that the ear, shoulder tip and the hip joint are in a straight line. Even when a person sleeps, this would be the optimal positioning for better stress distribution. In overly soft mattresses as well as in old mattresses, we can see certain body parts sinking more into the mattress than other parts of the body. This will upset the alignment and would either direct more stress towards the back or would not facilitate already stressed back muscles as well as the spine. Therefore, in order to avoid such back pains linked to your bedding, you can do the following:
1. If appropriate, the old rule was to place a piece of plywood to make the mattress more firm
2. Do shopping and choose a mattress which is soft as well as firm; many of the new ‘pillow-tops does this for you
3. Can sleep on the floor or on a firm surface with a soft covering to relieve pressure to the bony points.
4. Make use of a water or air filled mattress which could sooth the existing pain as well as relieve the stress in the whole body.
5. Do gentle exercises or stretching before getting out of the bed. Contact yourPhysio for appropriate exercise plans
6. Do not place extra pillows under your head, some may used behind the back, between or under your legs.
7. Position your bed at a adequate level to ease the work related to getting out of the bed.
When considering the link between bedding and the back pain, simple measures would go a long way in relieving this chronic problem. Therefore, the money that you spend for a perfect mattress would definitely be worthwhile when considering the suffering, the loss of productivity as well as the time you spend on your bed.

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Posture, Form, Biomechanics…all important in Exercise Winnipeg to avoid injury

Winter is knocking at the door Winnipeg, back to your gym routine. You must practice the correct posture, form and biomechanics to avoid injury and the right choice in exercise. As a orthopedic physiotherapist, it is crucial to learn the biomechanics of an exercise first; otherwise injuries are eminent. Ask your trainer, yourPhysio or the gym supervisor for education as to how to perform exercise correctly, and gain the greatest benefit.

Ever tweaked a muscle when working out? Whether due to a loss of focus or chronic poor form, getting hurt when exercising can be a huge setback. Fortunately, weight lifting and cardio needn’t be dangerous if you can keep a few concepts in mind. For this blog post, you’ll learn how to stay safe with some of the more common resistance exercises, with good posture and technique.

Try this posture test: When viewed from the side, an imaginary vertical line should pass through your earlobe, the tip of your shoulder, midway through your trunk, over the bony part of your thigh, and then through both your knee and ankle. If there is any deviation from this alignment, like if your ears are in front of your shoulders or your shoulders roll toward your chest, you are set-up for potential injury.

Aside from maintaining ideal posture, try these technique modifications to avoid injuring yourself during 5 common exercises:
1. Squat:

Don’t let you knees drop inward. This common mistake can be remedied if you actively spread your knees apart. Try to keep your back straight as possible, body weight over your heels such that your center of gravity does not fall forward, potentially injury for knees and hips.

Our advice: Doing air squats with a mini band around your thighs is a good way to train proper technique.

2. Deadlift:

Avoid low back injury by maintaining your natural lumbar curvature.

Our advice: Imagine a broomstick running along the length of your spine; if your pelvis curls off the bottom of the stick during the deadlift, then you’ve lost your lumbar curve.

3. Shoulder Press:

Decrease the risk of shoulder impingement by mimicking the natural plane of shoulder motion.

Our advice: Hold your elbows slightly forward of your chest, rather than directly at your sides.

4. Plank:

Spare yourself unnecessary spinal compression by preventing your head and belly from sagging to the floor. Maintain thoughtful and regular ‘belly breathing’ to elicit a better core effort.

Our advice: Tighten your core and shoulder girdle so that you are one straight line from the top of your skull to your ankles.

5. Running:

Land as softly as possible to decrease impact on your joints.

Our advice: One method to do this is by decreasing your stride length, while simultaneously increasing your cadence.

Remember, none of these exercises should be attempted without proper individual instruction; there is no ‘recipe’ that works for everyone, consult yourPhysio or your nearest sportsmed doctor.

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Core training not just for your abs, improve your sitting posture, prevent back pain by Physiotherapy Winnipeg

We’ve all heard physios, chiros, docs and fitness experts claim that core training is important for overall fitness and health. Health clubs offer core training exercise groups and physiotherapists recommend it for those recovering from spinal injury. Your core is the collection of muscles that stabilize the spine, this includes the hips, pelvis, abdominals, lower back, mid-back, and neck regions of the body. These muscles are extremely important in all sports, so why do so many ‘office athletes’ that basically sit for a living overlook core training?

The reason most people skimp on this vital part of their workout is because the benefits are simply overlooked.

Benefits of core training:

It’s important to note that performing a few crunches is not proper core training. As a matter of fact, I recommend that these be avoided for much of a lower back stabilization program. We simply just do not need any more ‘flexion’ in our daily routine; you sit most of your day!

Since your core involves many different muscles groups, a variety of exercises are needed to ensure you work them all; some exercises to explore include, but are not limited to, lunges, bridges, planks, and crunches. Every patient learns how to properly stretch their hip flexors, the ‘culprit’ muscle that usually guards when the ligaments are sprained in the lower back.

Pilates and Yoga classes are also excellent for strengthening your core muscles while also improving balance and posture. Check out Pilates Manitoba as they are offering 50% off their introductory classes for first-time participants.
When your core is strong, your whole body works better. Core training isn’t just for athletes, it’s for anyone who would like to have their body working at its greatest potential. For anyone just starting an exercise program, be sure to talk to yourPhysio first.

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Steroid injections for back pain can lead to bone loss, beware those with elbow pain, chronic pain, use Physiotherapy Winnipeg

Lately, many patients with chronic pain, including those with back pain, shoulder rotator cuff pain, elbow tendinitis pain or other chronic pain, have been asked by their family doctors ‘if they would prefer corticosteroid injections to physiotherapy?’

A Henry Ford Hospital, in Washington, D.C., study ( http://t.co/W3gj4dJt ) has found that postmenopausal women suffered significant bone density loss in their hip after they were treated with an epidural steroid injection for back pain relief.

Bone density loss after six months was six times greater when compared to the typical bone density loss seen in a year in a postmenopausal woman who doesn’t receive steroid injection, researchers said.

Shlomo Mandel, M.D., an orthopedic physician and the study’s lead author, said physicians should exercise caution prescribing an epidural steroid for select patients, suggesting that multiple injections may compromise bone strength.

“The findings of our study suggest that epidural steroid injections for back pain relief should be approached cautiously in patients at risk for bone fragility,” Dr. Mandel said.

“Physicians who do prescribe them should consider measures that optimize bone health such as calcium and vitamin D supplements and exercise as part of their patient’s treatment plan,” he added.

Back pain is one of the most common medical conditions in the United States, affecting 8 out of 10 people at some point during their lives. As people age, their spine ages with them, causing degenerative changes in the spine.

Patients are typically treated with anti-inflammatory drugs and physical therapy. If symptoms persist, an epidural steroid is often prescribed to alleviate pain and improve function. However, steroid use has been linked to diminished bone quality.

There has always been the link, and the questions concerning steroid injection and tendon or bone deterioration. One of the more famous cases was that of Joe Montana, Hall of Fame NFL quarterback and his elbow tendon rupture following multiple injections. Now there are not many of us that perform at this level, but chronic pain of any type can be debilitating and life altering. Please know your options and be aware of all the side effects associated with longterm medications; the list of side effects may outweigh any medical advantage.

If you are considering steroid injection as a form of treatment; ask your doctor about his/her experience in delivering such a treatment option. An orthopedic surgeon or experienced sportsmedicine doctor would be a wise choice.

Your Physiotherapist should be able to address your concerns about such a treatment option, and he/she should be able to provide treatment relevant to your pain trigger points and the appropriate exercise to assist in your longterm rehab.

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How people choose a Physio, a Doctor, a Chiro, in Winnipeg…for back pain, for health advice, for whiplash

Thanks again to my fellow members at the Winnipeg Executives Association, for the positive feedback and referrals following my 2012 Business Profile presentation; How do you choose your Healthcare Providers? Based on the US pre-election survey by INC magazine…

In reverse order of importance, the top five were:

#5 a great Receptionist.

Oooops, if you have been to my clinical location in the formerly TD Centre, at Portage & Main, you would know that I have been a ‘sole proprietor’ since 1991. Clients know that when they call for an appointment or have any kind of question, that they are going to speak directly with me, the Physiotherapist. Whether it be by phone, text, email or video-chat; I do not hesitate to educate you on the spot and answer the greatest concern in real-time!

#4 your Insurance Coverage.

In Manitoba, you do not need a doctor’s referral to see a Physiotherapist. But, you may need one to be covered by your particular insurance coverage. Manitoba Health only covers physiotherapy treatment if obtained in hospital, and WCB, and MPI, only cover a specific number of treatment sessions. So, beware of your coverage and be proactive in your rehab!

I DO direct bill to most insurance plans, if they do allow this to occur as some plans prefer that the client do it by mail or online, such as Sun Life or ManuLife. Healthcare Spending Accounts are becoming more of the norm with ‘flex’ benefit plans. These accounts are excellent ways to be proactive in your health plan by applying these funds to ergonomic assessment or exercise programs.

Like some other providers, I typically do NOT charge for ‘tray fees’, ‘chart maintenance’, exercise tubing or even for Doctor’s notes.

#3 convenient Parking.

Well…again, we are located in Downtown Winnipeg’s most secure parking complex; the Exchange District Parkade, off Albert Street at #35…my entry is at ground level, directly across from Winnipeg’s best kept secret, parking meters inside a parkade entrance.

#2 convenient Office Hours.

For the approximate 60,000 people working within a 5 minute walk of Portage & Main, the most requested appointment time is between 10am and 2pm, with a normal treatment day from 845am to 530pm in the clinical location.

My research begins at the home office, and ergonomic assessments take me onsite to clients’ work places; from garbage trucks to police cruisers, from bus depots to gold mines, from military helicopters to postal distribution centres, from bank tellers to executive offices, from lumber plants to product warehouses, from grocery clerks to sports professionals, from grain elevators to your cottage kitchen…I’ve worked the day and night shifts, and experienced a huge variety of task conditions.

#1 my Location.

Do you know anyone that works within walking distance of Portage & Main?

Do you know anyone who works in an office connected through the Winnipeg ‘W’ walkway system?

Do you know anyone with a schedule that demands a guaranteed appointment time? …there is no waiting room

I invite you to refer them to our services, for healthcare that may not always be what they expected or even be the best in town, but I will always move them in a direction to make it right for them. Thanks.