Chiropractor's Blog

Giving Vertigo a Spin…

Posted by Dr. Jennifer Viveiros, DC
Chiropractor

Have you ever suffered from vertigo or persistent dizziness? What exactly is vertigo? What are possible causes and treatments?

Vertigo is a symptom rather than a condition – the experience of dizziness characterized by a false sense of movement or a feeling of spinning. Vertigo can arise due to problems with the vestibular system – which is controlled by the cerebellum (in the brain stem) and is responsible for coordination and balance and can be affected by different factors.

Some causes of vertigo are:

1. BPPV (benign paroxysmal positional vertigo): BPPV is a condition where the calcium crystals in the inner ear become dislodged and move into the semicircular canal. Your Health care professional can use various techniques to treat the vertigo/dizziness depending on the cause. BPPV can be treated using repositioning techniques such as Epley’s manoeuvre, Semont’s manoeuvre, cranial therapy etc.

2. Headaches and Migraines: Can affect cranial and sub occipital nerves, which relay information to the cerebellum. Headaches, depending on the origin, can also be effectively treated with manual therapy techniques such as spinal manipulation, soft tissue therapy/remedial massage and acupuncture.

3. Cervical spine dysfunction: Restrictions in the upper cervical joints can disrupt biomechanical feedback from the muscles and soft tissues as well as healthy nerve function in the neck. Mechanical pressure on the upper cervical nerves results in neck pain, headaches and various forms of dizziness since the upper cervical nerves report back to the cerebellum. Cervical dysfunction causing restriction in neck movement and neurological symptoms is effectively treated with various chiropractic techniques including spinal manipulation, deep tissue massage, cranial therapy and acupuncture and more.

4. Ear infection: Vertigo can result in inflammation and swelling inside the ear, which can affect feedback to the vestibular nerve.

5. Inflammation of the vestibular nerve: Inflammation can arise from various causes including bacterial or viral infection. If infection is suspected it is best to consult your medical practitioner to assess and treat the cause of the infection

6. Meniere’s disease: Dizziness and vertigo can also be triggered by Meniere’s disease – when fluid builds up in the ear with an associated sensation of ear “fullness”, hearing loss, and tinnitus (persistent ringing in the ears)

7. Acoustic Neuroma: Another possible cause for dizziness and vertigo is an acoustic neuroma. This is a noncancerous tumor that forms on the nerve that connects the inner ear to the brain.

Your chiropractor can examine and help diagnose the cause of any of these symptoms and offer treatment options on how you can get back to a healthy functioning state. If you think you’re experiencing symptoms of vertigo, the team at Wellington Healthcare in downtown Toronto is well-equipped to help!

Chiropractor's Blog

Plantar Fasciitis and Disorders of the Lower Kinetic Chain:  Are you Getting Off On the Right Foot?”

Posted by Dr. Chris Taylor, DC
Chiropractor, Clinic director

As a chiropractor in downtown Toronto, I see an incredibly wide assortment of injuries and conditions – low back, neck pain and headaches, sprains, strains, tears, fractures, acute injuries, chronic conditions, postural issues and everything in between. Of all the weird and wonderful things I see, one particular intersection of personal and professional interest lies in mechanical issues of the foot and it’s effect on the rest of the “lower kinetic chain” – that is, the muscles, bones and joints of the foot, ankle, shin/calf, knee, thigh and hip. In an ideal biomechanical world, the foot contacts the ground (whether standing/walking or running) and experiences “reaction forces” that are dissipated by or distributed over the appropriate structures in the foot, ankle and leg.

If everything works as designed, these reaction forces are appropriately managed (the shock effectively absorbed) because each link of the chain is pulling its own weight. BUT – what if there is a weak link, and that link is the one that starts a chain reaction?

Consider this: the human foot and ankle contains 26 bones, 33 joints and more than 100 muscles, tendons and ligaments. For a comprehensive review of foot anatomy click here.  When walking, the foot experiences 1-2x one’s bodyweight in reaction force during each step.

Quicken the cadence to running and the force jumps to 3-7 x bodyweight. Check out this link for more insights.Given the immense volume of force that a foot typically experiences each day, it’s vitally important that the foot functions ideally in order to avoid overuse and injury to the rest the joints and muscles in the kinetic chain.

One of the primary underlying issues, in my humble opinion, that results in lower body overuse injuries is a chronic “deconditioning” of the dynamic stability of the foot over time.  The vast array of intrinsic muscles that help to maintain and support the structure of the foot often become “lazy” over time due to persistent use of footwear – preventing the foot from being naturally stimulated during interaction with the ground (i.e. during a step) and often putting it in an artificially supported position.

This deconditioning response causes foot musculature to become weak, inactive and/or inhibited, thereby negatively affecting the function of the foot’s natural support mechanism.  Think about what might happen to your other muscles if they were keep in an immobilized state – ever worn a cast for ~6 weeks?

One of the more common foot conditions is called “plantar fasciitis” – a very painful irritation on the sole (bottom, or “plantar” side) of the foot, near the inner aspect of the heel. It occurs when the plantar fascia (or “plantar aponeurosis”), a thick band of connective tissue, tugs on its attachment to the underside of the heel bone, causing tissue damage, pain and inflammation. Check out: https://www.health.harvard.edu/pain/plantar-fasciitis. The fascia becomes stressed (and stretched) during over-pronation – or excessive collapsing of the medial longitudinal arch – of the foot.

Over-pronation also causes abnormal stress on the tibialis posterior muscle, whose tendon runs under the inside of the foot, supporting the arch like a stirrup.  Excessive stress and strain on this muscle can lead to a painful condition on the inside of the shin (tibia) called medial tibial stress syndrome (MTSS). Check out this link.

MTSS is the precursor for postero-medial shin splints and, if severe enough, can develop into stress fractures of the tibia.  Over-pronation also commonly has a role in the formation of bunions, stress fractures in the foot, arthritis at the base of the big toe (or “hallux”), patello-femoral pain syndrome (pain at the knee cap), iliotibial band syndrome, hip and low back pain and a host of other issues up the kinetic chain.

So how does one stop over-pronation from occurring?  There may be a simple, straight forward answer to this question and it lies in addressing the root cause of the problem: a deconditioned foot with poor dynamic stability.  Since the foot is the “gatekeeper” – the first line of defence against the constant onslaught of reaction forces – if we can “recondition” it’s intrinsic capabilities, we can improve function and allow it to direct force into the appropriate tissues.  This can be achieved in a few simple steps:

1. Consult a qualified health professional (chiropractor, physiotherapist, etc) to have your feet properly assessed.

2. Wear bare feet as often as (realistically) possible.  This will help your foot function improve through providing better tactile feedback and by stimulating support muscles naturally.

3. Perform a series of exercises on a daily basis aimed at working the intrinsic muscles.  For an example of an intrinsic foot exercise program, click HERE.

Foot issues and other problems of the lower kinetic chain are exceptionally common in the general population. If you live or work in the downtown core of Toronto and these problems sound familiar to you, or if you’d like more information, our team at Wellington Healthcare would be happy to help!

 

Chiropractor's Blog

Preventing Headaches With Chiropractic Care

Do you, or someone you know, suffer from chronic headaches?  There are many classifications of headaches – understanding which type affects you is the key to successful management.  Literature suggests that the most common type, by far (~90%), is classified as “tension” or “tension-type.”   In physical medicine or manual therapy circles, this kind of head and neck pain is commonly referred to as a “cervicogenic” headache.  As the suggests, the source of this pain is located in the cervical spine (otherwise known as the neck) – commonly in the sub-occipital region at the base of the skull.  Pain results due to one of several mechanisms:

1. Mechanical pressure/irritation of the nerves that exit the suboccipital area and supply the scalp with sensation.

2. Referred pain from the structures in the neck – muscles, joints and other soft-tissues.

3. Pain that results directly from the structures in the neck as a result of poor posture, overuse, postural strain and other organic mechanical causes.

Chiropractic care is a safe and effective approach to managing this exceptionally common problem.  A combination of joint mobilization & manipulation and soft-tissue therapy (muscles, fascia, etc) can quickly resolve symptoms and improve the #movement and function of the neck.  Postural and ergonomic recommendations can also help to alleviate the environmental cause of the problem.

Chiropractor's Blog

Learn About Lower Crossed Syndrome

Do you sit for most of the day and have a tight, sore back?

Lower Crossed Syndrome is a common functional adaptation associated with long term seated posture. Muscles that oppose each other in the body tend to shut off when their opposing partner is working (ie. the lumbar Erector Spinae which extend the low back and the abdominals which flex it). This allows the muscle in question to perform its action without opposition.

In LCS, the hips are flexed for long periods of time leading the body to get used to them in a shortened position. This postion can be mistaken for the psoas muscle (hip flexor) being active, causing the opposing muscles, the glutes, to become chronically inhibited (or “weak”). This “opposing pairs” situation occurs in a few places (see diagram), leading to a series or chain of muscle imbalances that robs the low back and pelvis of stability and proper function. This can lead to excessive wear and tear, tissue damage, and ultimately, PAIN!

lower-crossed-syndromeChiropractors and Physiotherapists can easily address this condition and develop a treatment plan to improve it. Massage therapy can also assist in dealing with the tight muscles that occur as a result.

If you sit for long periods during the day and have back pain as a result, book an appointment with one of Wellington Healthcare’s trained professionals (Chiropractor, Physiotherapist or Massage Therapist) to have your issue properly assessed!

Chiropractor's Blog

Snap, Crackle, Pop!

In my last post I took aim at trying to dispel an old chiropractic myth that bones or joints somehow end up “out” of place and need to be physically realigned via joint manipulation.  We have already established that this is not literally the case – but what about that satisfying (or terrifying for some!) crunch, click, pop, or crack that results from a chiropractic adjustment/manipulation?  Isn’t that the result of a misplaced bone slotting back into its correct location?  Sorry to be the bearer of bad news, folks, but no – it’s just an air bubble.  Let me explain.

Most joints in the human body are considered “synovial” joints because they are encapsulated and lined with a special tissue that creates fluid when moved or distorted. This fluid ends up inside the joint cavity and acts to lubricate and nourish the inside of the joint.  Because there is no direct blood supply to the inner aspect of the joint, synovial fluid also contains gasses and nutrients to keep the joint healthy from the inside.  So, in essence, we’ve got an enclosed capsule filled with a mixture of fluid, gasses and nutrients.  Still with me?  Good.

Okay, now let’s go back to high school science class.  At a certain atmospheric pressures, gasses can exist dissolved in fluid.  However, when that pressure changes (ie. increases during a joint manipulation or adjustment) the substances tend to like to separate into their more pure forms – fluid with fluid, gas with gas.  And, because the entire system is sealed within the joint cavity and there isn’t anywhere for the pressure to escape, increasing pressure to the point of a cavitation (or “pop”) – the formation of an air or gas bubble when it separates from the fluid – is quite simple when applying a specific amount of force from an external source (in this case a chiropractor or physiotherapist).  Recent MRI studies of joints being “cracked” have actually confirmed this phenomenon.

Phew!

So, considering the above information, can excessive knuckle “cracking” give you arthritis?  Likely not.  Creating pressure in your knuckles to the point of cavitation does not cause bones to rub or excessive wear and tear at the joints in question – it just annoys your parents!

Chiropractor's Blog

The Lego Effect: Dispelling a Chiropractic Myth

 

“Is it out, doc?!?”

This age-old chiropractic question, or something similar, is posed to me quite frequently in my busy downtown Toronto practice.  Is a bone out of place?  Have the 2 sides of a joint shifted out of “alignment?”  I am always a little baffled at how I should approach the response – do I answer accurately, and launch into a biomechanical or evidence-based anatomy & physiology lesson?  Do I side-step, or deflect, the question because the “correct” answer is one that requires a) too much time to properly explain and b) might not interest the patient in the least?  Or do I politely oblige, despite the semantic inaccuracy, because I know that it’s not really the terminology that matters, but more that a sound therapeutic approach will be applied?

The truth is, “it” (referring to a bone/rib/vertebra/joint) isn’t “out” of place.  It never was and never has been (In fact, if it was literally out of place the person would likely be in the ER and not at Wellington Healthcare). All too often, it seems, people have the idea that the human skeleton is akin to a giant structure comprised of miniature lego blocks that a chiropractor can “click,” “pop,” or “crack” (more on this topic in a future post) back “into place.”  I can only assume that this notion was born out of more antiquated chiropractic models or concepts and, due to simplicity of explanation, has been perpetuated for many years in the chiropractic field.  Again, the truth is that this view of the human body is entirely too elementary and, in essence, literally false.

Let’s take the human skeleton for instance – a wonderfully complex network of 24 vertebral bones (33 including the sacrum and coccyx) and soft tissues that, in any one vertebral joint, are supported by a vast array of strong ligaments, spinal muscles and intervertebral discs, not to mention the shape of the vertebrae themselves.  These structures combine to support, stabilize, and control the relatively small amount of movement that occurs at the articulation between 2 vertebrae – not to mention collectively house and protect the spinal cord.  The gross movement of the spine as a whole is a result of the combination and coordination of these relatively subtle individual motions, making the structure an intricately complex, fluid and interconnected system of moving parts – NOT, as it seems many people think, a series of individually functioning bones that shift and slide into and out of place at will.

When an individual experiences mechanical back pain, the type that a chiropractor, physiotherapist or massage therapist treats on a daily basis, it is generally a result of an injury, irritation or damage to one of these structures – ligaments, muscles, joint capsules or surfaces, fascia, etc. – which results in a chemical reaction that stimulates nerve fibres, culminating in the perception of pain.  In many cases, the body will also attempt to protect itself with a reflexive tightening (or spasm) of the local muscles and tissues surrounding the injury in order to avoid further damage.

When considering a manual therapeutic approach to this type of injury, let’s say a chiropractic manipulation and/or one of many soft-tissue techniques, a therapist typically aims to achieve a few goals:

1) decrease the nervous system’s protective response to the injury
2) promote more efficient healing of the injured tissue, and better structural quality of that tissue
3) decrease pain and inflammation
4) improve the biomechanics of the injured area through decreasing muscle tension and increasing synovial fluid production in the affected joints.

Now, obviously, this brief explanation is not a completely comprehensive overview of the body’s response to therapy – however it does illustrate the complexity of mechanical injuries and the subsequent approach taken by an appropriately trained therapist.  The take home point is this:  when you are experiencing pain that interrupts your ability to function normally, have the issue assessed by someone that understands your body’s fundamental biomechanics and can formulate a sound approach to fixing your problem.

Oh, and leave the Lego to the romper room ;)