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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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Canada’s Growing Demand for Ergonomics in Kitchens…for Aging in Winnipeg Place, for the disabled and the post Surgical

As the first Boomers move into their later 60’s, their growing demand for services, for activity and for health has spurred the demand for ergonomics in kitchen design.

Aging in place is a term used to describe a person living in the residence of their choice, for as long as they are able, as they age. This includes being able to have any services (or other support) they might need over time as their needs change.

To be clear: the act of aging in place takes place during a period of time in an elderly person’s life where they can have the things that they need in their daily life, while maintaining their quality of life.

The reason this distinction is important is because many people think aging in place will fix the problems they have in their lives. The only problems that can be fixed while aging in place are the ones that a person has planned for (i.e. finances, health, personal or health care, etc.).

The kitchen has always been a place for family and socializing. Making changes for aging in place in the kitchen space can greatly increase its usability and the safety of those that live there. With home modification, people will no longer have to spend less time in the kitchen as they age.

In a growing trend observed by the brand Smeg, European consumers are opting for compact appliances to give their kitchens a homogenous look and more efficient arrangement of appliances. Will this trend make it to Canada? to the USA?

One of the most popular trends in kitchen design is the demand for ergonomics with more and more consumers choosing a linear look for the placement of their appliances. Smeg, a leading Italian home appliance manufacturer, has observed this trend with a significant growth in the sales of its compact appliance range.

Smeg is the only brand to offer its appliances in two design styles – the classic stainless steel look and the linear look in stainless steel with glass. Both design styles are made in standard sizes and have matching aesthetics to ensure the kitchen gets a clean and homogenous look.

All standard compact appliances are 600mm wide and 450mm high and designed to be easily installed in a bank at midway level (chest or eye level) or under the bench. Smeg’s current range includes convection ovens with microwave, combination/steam convection ovens, dedicated steam ovens, microwave ovens with grill function and built-in coffee machines.

Appliances play a major role in a person’s ability to use and work in the kitchen safely and efficiently. Appliances that do not incorporate universal design, or that are placed improperly, can inhibit this. Select appliances that display information clearly, have convenient functions and are easy to use. Many appliance makers are incorporating universal design principles in their designs, which allow consumers to get a variety of more functional appliances. You should also consider investing in energy saving appliances, which will help you save money. Currently, the most popular placement of any appliance or storage cabinet is at the midway level since it ensures easy and safe access to a range of appliances without the need to bend or stoop.

As in lifting or reaching mechanics, the placement of load or where you interact with that load is of key importance.

Beware of your biomechanics. Know your Ergonomics.

Know yourPhysio Winnipeg!

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Shovelling in Winnipeg’s Extremes; know your Biomechanics, your limitations and your Physio

A great bulletin from the Heart and Stroke Foundation; Snow shovelling may be dangerous for some hearts

Snow shovelling may be dangerous for some hearts. Reports have linked snow shovelling in extreme cold weather to an increased risk of hospitalization or death due to heart attacks. The Heart and Stroke Foundation advises taking extra precautions when snow shovelling during extreme cold alerts, particularly for individuals with a pre-existing heart condition or who are at high risk of heart disease.

Research shows that physical activity helps protect against heart disease, stroke and many other health conditions. It is also an important part of cardiac rehabilitation programs and an important way for heart patients to keep their cardiovascular system strong and resilient.

Extreme weather conditions, such as very high temperatures and humidity in the summer, smog, and cold winter days, can make physical activity more strenuous. Both strenuous exercise and extreme weather independently increase blood pressure, push the heart rate up, and increase blood concentration of fibrinogen, a protein involved in blood clotting. All of these factors contribute to increased heart attack risk.

The Foundation recommends approaching physical activity in extreme weather with caution if you have been diagnosed with heart or blood vessel disease (including stroke, previous heart surgery, and uncontrolled high blood pressure) or if you are at increased risk of a cardiac event because of high cholesterol levels, an inactive lifestyle being overweight, or obese or other risk factors. Speak to your doctor about what is acceptable for your health.

The risks become even greater when vigorous exercise and extreme weather are combined, such as when shovelling snow in sub-zero weather conditions. Studies show that in most people who have died shovelling snow or carrying out some other form of vigorous physical activity in extreme weather conditions, the plaque inside their blood vessels ruptured and travelled to the heart causing a heart attack. The rupture may be caused by increases in blood pressure or changes in vascular tone associated with physical exertion. Plaque is a sticky, yellow substance made up of fatty substances such as cholesterol, calcium, and waste products from your cells.

Here are some tips from the Heart and Stroke Foundation.

Take the time to do a few minutes of warm-up activity like walking to increase your heart rate slowly and prepare you for the activity

Build in frequent breaks from extreme weather activities so your body doesn’t become too strained

Ask for help from family, friends or neighbours if you need to do an urgent task, such as clearing snow, in bad weather;

Wear appropriate clothing and keep water nearby to replace fluids lost through perspiration

Plan ahead. Watch your local weather forecast for smog, humidity, heat and extreme cold alerts and plan for enough time or get help with major tasks like snow shovelling, on those days.

Stop your activity if you experience sudden shortness of breath, discomfort in the chest, lightheadedness, nausea, dizziness, or severe headache and immediately seek medical attention

Snow shovelling in very cold weather has specific risks. Here are some additional tips to help you stay safe during this particular activity:

Don’t continue shovelling just to get the driveway cleared in a hurry. If you’re tired, quit;

Don’t shovel or do any other vigorous activity directly after eating a meal. Your body is working hard enough just to digest the meal; adding vigorous activity on top of that could put too much strain on your heart;

Don’t stoop to pick up the snow; bend at the knees to avoid back problems.

Find out if your community offers programs or assistance for snow shovelling or snow removal (particularly for older adults or those with existing heart conditions)

Play safe Winnipeg; your your biomechanics, your limits and your Physio…

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It’s heavy snow Winnipeg, learn about rotator cuff injuries, the winter cold and shovelling

It’s snowing this morning in Winnipeg; the first heavy blast of winter this season. Car accidents, falls and shovelling injuries are inevitable. Beware of your posture, the load, your balance and fitness level before you ‘shovel for hours’. The shoulder, and its supporting rotator cuff group of muscles are highly susceptible to those strains n sprains of high repetition and little prep.

Rotator cuff injuries are common in all sports and can be career enders for athletes likes quarterbacks and pitchers. But even if you’re just throwing snowballs with the kids or working out to stay fit, it’s important to keep the shoulder joint healthy. Here, physiotherapist Chris Bisignano, answers some of the important questions.

Q1: What exactly is the rotator cuff?

“The rotator cuff is a group of muscles, that act almost like a dynamic ligament. It is comprised of four muscles: the supraspinatus, which is the most commonly injured, the infraspinatus, the teres minor, and the subscapularis. The rotator cuff’s functions are to assist with arm movements and provide stability to the glenohumeral [shoulder] joint.”

Q2: Why does the rotator cuff get hurt so often, and what are the common issues?

Most of the exercises we do actually do not specifically target the RC enough to make a difference to its actual strength.

“Up to 67% of the population will have a shoulder problem at some point in their lifetime, and the rotator cuff is most often the source of the pain. The primary reason for rotator cuff pain is that pinching sensation or ‘impingement syndrome,’ which may be the result of rotator cuff tendon inflammation caused by an activity or trauma. Over time, this can lead to a rotator cuff tear. To make matters worse, evidence suggests that most individuals are likely to experience rotator cuff degeneration by age 40 and rotator cuff tearing by age 60. Thus, in many cases, a seemingly normal exercise session or home-repair project may incite shoulder pain.”

Q3: What kinds of moves should I avoid if I want to stay injury free?

Repetitive reaches with even a simple load can isolate alot of force upon the RC. Movements above shoulder become risky when a joint is not supported well, or even unstable because of weakness.

“Many of the more common gym exercises—such as upright rows and lateral deltoid raises—may lead to rotator cuff injuries. Modifying these exercises to keep the end position of the arms or elbows below shoulder height may help prevent injury.”

Q4: How can I tell if I have a rotator cuff injury?

“Many people already have a rotator cuff injury and aren’t aware of it. Unfortunately, evidence suggests that these individuals will eventually develop symptoms. Early on, if you have pain when reaching overhead—pain located at the tip of the shoulder or the outside of the arm, where the lateral deltoid is located—that suggests a rotator cuff injury. Weakness when reaching the arm out to the side is also suggestive of a tear.”

Q5: How can I prevent a rotator cuff injury?

“Three key measures can be taken to reduce the chances of experiencing a rotator cuff injury.

“First, strengthen the external rotators; specifically by tubing or dumbbell exercises that need to be learned from a professional; these will help restore and maintain shoulder stability and may prevent impingement.

“Second, avoid sleeping on your side with your arm positioned overhead.

“Finally, try to achieve muscle balance—that’s key. Many weight-training routines are inherently biased, creating muscle imbalances that may lead to a rotator cuff injury. Try to perform an equal number of ‘pull’ versus ‘push’ exercises. Moreover, try to replace a few sets of shoulder exercises—such as lateral deltoid raises or shoulder presses—with exercises that strengthen both the deltoids and the rotator cuff, such as prone ‘Y’ or ‘T’ exercises.”

Visit yourPhysio or ask your healthcare provider for specific RC education and exercises.