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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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Seasonal Back Pain during Golf? Physiotherapy Winnipeg yourPhysio.com

Again? that seasonal back pain is back…and consecutive golf games are impossible, not to mention your regular league match at any of the golf courses in Winnipeg. One likely culprit; your hip flexors! Yeah, those muscles that lift your knee towards your chest are connected to your back, specifically your lower lumbar spine and pelvis.

During the downswing, the obliques and hip flexors are highly activated, creating a crunch-like position as your hips extend and your pelvis tilts (your belt buckle stays level, pointing forwards) while your chest remains over the ball.

The hip flexors are an important part of your core, working to maintain posture, generate power, stabilize the body, and to decelerate the lower body for efficient energy transfer coming into impact.

Maintaining the quality and function of your hip flexors is very important for maintaining posture through the downswing and impact, especially with the longer clubs, where the greater length of the club’s shaft increases the forces that must be absorbed by the body.

Your hip flexors attach from your spine to your legs.  When they are weak, they are not able to withstand the high forces of the longer clubs and are unable to hold your spine angle.  This results in early extension (loss of spine angle) as the hip flexors lengthen under high loads, resulting in a loss of spinal posture before impact.

 

The Foam Roller Hip Flexor Exercise is a great self-massage exercise that will give your hip flexor muscles (in the front of your hips) a deep and effective sports massage, thus improving the health and quality of your muscle tissue and helping you to perform better.  It will also alleviate soreness and make your muscles feel better.

The foam roller is available at most yoga studios or medical supply stores in Winnipeg; you may even get it covered by insurance! The movement over the roller overloads the muscle tissues through compression, causing your nerves to relax, signalling muscle spasms to shut off, pumping blood and and getting your lymphatic system flowing, to help muscle recovery and regeneration.  You’ll work out those knots (muscle adhesions) in your muscles caused either by inactivity, by the repetitive strain of the golf swing, or by walking a tough golf course.  This will enable you to stretch the muscles back out to their original length, making them more pliable and functional.

Be careful! if the back pain is acute, do not attempt this exercise without first talking to yourPhysio; exercises can be modified and tailored to your injury, and reduce your pain.

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Whether you sit at a computer, shovel snow, lift sandbags or play hockey in Winnipeg, your back pain is probably the result of tight hip flexors

yourPhysio anatomy lesson first; your hip flexors are the dominant muscle in the ‘knee to chest’ action. Anatomically known as your; Iliacus, Psoas Major and Minor, and your Quadratus Lumborum, these muscles are attached to your hip, to your lower back and your pelvis. Consequently, when overused or tight they can reconfigure your lumbar spine, throw out your hip and back, affect your sacro-iliac joint, and change your biomechanics thoroughly.

Even though stretching is essential for all muscle work, it can actually be damaging if not done properly. When you stretch without warming up your muscles, it increases your likelihood of injury, as you are trying to stretch a cold muscle. So before you stretch, make sure you warm up; walk in place, cross-train, and increase the blood flow into your muscles so you can prevent an injury. As a physiotherapist, I do commonly advise patients to hold a stretch for 20-30 seconds, but why? The reason is because our muscles have a protective reflex to avoid over extension or contraction. When you are stretching your muscle, the muscle spindles, which are the components that produce contraction, activate a reflexive pathway which causes them to shorten in order to compensate for the stretch (called the myotatic reflex). This is what causes your leg to kick out when you tap your knee.

Knee Reflex

There are two main types of stretching: dynamic and static. Static stretching is what we just talked about, which is a stretching routine that includes holding 30 second stretches for specific muscles. When using static stretching before a sport that requires you to use specific muscles to initiate specific movements, it is hard to relate static stretches to dynamic activity. This is where dynamic stretching comes in. Dynamic stretching is designed to mimic the actions and movements you are expected to perform during a specific sport. For example, this would include kicking around a soccer ball in warm-up before a soccer game, so your body can get accustomed to activating the required muscles. That way, your muscles can make the necessary preparations to prevent injury, as playing a sport requires many specific dynamic and explosive movements.

Starting blocks

For your hip flexors, I teach a ‘dynamic lunge’; such that your hip flexors, quadriceps and pelvic muscles are used within the stretch. If you add Kegel exercises to this movement, the pelvic floor muscles are activated more and a greater effort can be applied to this core stretch. Remember those pre-natal classes guys? A patient was recently surprised to know that guys can do Kegels too! Guys are equipped with those same pelvic floor muscles and ladies should appreciate these efforts, as do the men!
Overall, stretching is very beneficial for movements involved in a regular day, and those involved in heavy labor, repetitive activity and sports. Therefore, it should be a priority for everyone to incorporate some sort of stretching into their daily routine (after warming up of course!), in order to maintain optimal functionality.  Flexibility is a highly underappreciated component of muscular strength and function, but key to good performance at work, home and recreation.

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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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Winnipeg, have you heard? Sitting is bad for you…solutions by Physiotherapy Winnipeg, yourPhysio.com

Winnipeg, by now you know you probably know that sitting down all day is terrible for you. As computer hardware and software accelerate the ‘web 3.0’, we can do more than ever before from a sitting position. Ergonomics is no longer a foreign word, and our ‘core’ exercises need to be performed everyday!

Who needs scientists to tell you that sitting for even one hour causes the production of fat-burning enzymes to decline a whopping 90%, or that more than four hours of desk time each day raises your risk of a heart attack by more than 100%?

You can feel exactly how crappy sitting all day makes you feel at the end of each workday; though you may be shocked to learn that being a regular gym-goer doesn’t protect you from the harmful effects of all that sitting. Standing up more is scientifically proven to have huge health benefits, but in our digital world it’s not as simple as it sounds. Here’s how to make the switch to an upright workday.

Try the latest DIY option, I have had so many patients describe their attempts at raising their work surface by box, crate, home-made devices, etc. I’m sure you could find the latest ‘how-to-video’ on YouTube to get an idea as to how to produce something for your workstation. Ergonomic clients of yourPhysio.com have purchased electronic and hydraulic ‘sit-stand’ workstations to allow their employees the postural variety that may be necessary for back pain, hip strains or knee sprains. These rehabs require movement throughout the day, and consistent changes in posture is a great place to start.

Invest in an ‘anti-fatigue’ mat, change your shoes every 6-8 months or try an over-the-counter orthotic to replace those worn insoles. You may require a doctor’s note to have orthotics covered by your insurance plan, but it is an employment benefit; so benefit!

Tweak your ergonomics, hire an ergonomic consultant for an hour and learn the proper way, not only how to sit, but how to perform your job so that it will not cause pain. Ask questions about posture, exercise and equipment available to make any task easier and less painful.

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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.

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Active Release, Myofascial Release, Trigger Point release therapies for back pain in Winnipeg by Physiotherapy Winnipeg

You’re back is Achy, You’re neck may be Sore, and You Have No Idea Why…It feels like muscle pain, but unlike a tight hamstring, hip flexor or shoulder that makes you yelp when you stand up, your ache isn’t triggered by a particular movement, and you can feel it in different places at various times. The culprit could be your fascia, that relative “sheet” of tissue, made up of densely packed protein fibers, weaves throughout the entire body, and it binds and supports your muscles, bones and even your organs.

You know how your muscles feel cramped and stiff when you wake up in the morning? After a night’s sleep (or another long period of inactivity, like a car trip or plane ride), the parts of your fascia that wrap around and through your muscle fibers, which are normally stretchy and flexible, can stick together like previously chewed bubble gum. Stretching like a well rested cat in yoga, is a great way to release those sticky fibers at home.

Just today, I’ve recommended a client to work out those overused sore spots with a foam roller. You’ve probably seen people at the gym using these things, which look like pool noodles, to stretch their back, hamstrings and the notoriously tight IT band on the outside of the hips. To start, take an old pillow from home, fold it in half length wise and duct tape it into a hardened roll. It may not provide the stiff surface of a good foam roll, but you can begin slowly, and graduate to harder surfaces later. Sit or lie upon the roll, and when you get to a sore spot that feels like a bruise, pause for 15 to 20 seconds. The discomfort should melt away as the fascia softens and the muscles release. If you feel intense pain that doesn’t dissipate, stop and consider making an appointment with a physical therapist.

Don’t Let the Tissues Get “Crunchy”

If you’ve ever had a shoulder rub and heard something that sounded like crinkling plastic under your skin, that wasn’t your imagination—it was probably your parched, stiffened fascia. The collagen, protein fibers that make up fascia need to stay supple to work properly, and to slide over and under muscles and other inner-body surfaces. One way to keep the fascia hydrated is obvious: drink lots of fluids, especially water. I have had chronic back pain clients change their coffee to water on a 8x per day basis to gain relief from their fascial pain. Another easy (but easily forgettable) way is to make sure we stand up, stretch and flex regularly throughout the day to keep the fascia from locking up. Those pressure points are warning you for a reason!

If you need some foam roll instruction or relative treatment with myofascial release techniques, don’t hesitate to contact me.

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Winnipeg weather can be dangerous too; ice, falls, car accidents, back pain…get Physiotherapy

As the remnants of Sandy linger out East, and people return to their lives, we give thanks for living in the middle, the relative center, on the Prairies. But as our fore-Fathers discovered, Winnipeg weather can be dangerous too; just today another car accident where the conditions and poor preparation cause injury.

Falls can diminish your ability to lead an active and independent life. About one third of people over the age of 65 and almost half of people over the age of 80 will fall at least once this year. There usually are several reasons for a fall. We can help you reduce your risk of falling, and better your performance through Universal design. We can assess your biomechanics at home, on the job or even during sport; like golf, running and curling.

Balance, together with ‘core’ training can enhance your ability to perform, avoid injury, especially like those from falls.

Aging is a natural process that encompasses biological changes that tend to be associated with the development of joint pain or that may limit the ability to work with joint pain.  In addition to arthritic joint degeneration, aging is associated with loss of muscle mass and muscle function.  Functional loss is influenced by changes at the cellular and molecular physiology level.  These changes may reduce joint stability and impair normal joint motion that affect the ability to tolerate specific work postures and repetitive motion.  With a loss in muscle strength, the same level of physical effort places a greater demand on an individual relative to her/his capabilities.

The relationship between aging and joint pain in the workplace is complex and influenced by a number of factors.  For example, national surveys of workers across a wide variety of occupations indicate that not all older workers (50 years and older) report a greater risk of joint pain.  Older workers at greatest risk tend to be in jobs that have high physical demands.  And once an injury has occurred, it may take longer for an older worker to return to work.  In spite of these factors, studies indicate that older workers suffer no decrease in overall job performance.

Osteoarthritis, and the pain associated with degenerative disc disease in the lower back can be alleviated with laser therapy. If you have questions, do not hesitate to contact your Physio.

You can perform at your best when prepared
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Snow, garbage, warm winds and bags of leaves in Winnipeg, need Physiotherapy?

Our first snow fall has come and gone in Winnipeg, unfortunately for those who lost their hydro in the first blizzard of this winter season in Manitoba, it dragged on for 4-6 days. Sounds like our garbage collection woes this October, as Winnipeg introduces the automated, curbside, private company collection, not to mention a shortage of paper bags to dispose of the fall leaves. Snow, garbage, raking leaves, the dreaded fall cleanup can all lead to acute, or even chronic back injuries.

My ergonomic tip for you this fall season; switch the way you do things, especially those repetitive tasks, the raking, the shovelling, switch direction, go from right to left and vice versa. Avoid the pitfalls of the weekend warm winds, get it done, but pace your work and enjoy the time outdoors, stretch occasionally; hands on your hips, bend backwards comfortably and repeat.

Next, we’ll talk about whiplash injuries; what to expect from MPI and driving ergonomics for the ice n snow of winter.