What this means is that we can use a range of different exercise training styles to help with physical function. We can pick things that we like to do and use them to get the results that we’re looking for. You don’t have to do something you hate! 

Can exercise improve my Mental Health? Resistance exercise, aerobic exercise, and stabilization/motor control exercise training resulted in improved mental health following intervention compared with other options. 

​​So this means that you don’t have to do grueling exercise and reach certain milestones to be successful. The studies that this research group was looking at didn’t show much impact on strength with the exercises that were being done. What this means is that you don’t necessarily even have to get stronger to see the improvements, you just need to do the activity. But it probably doesn’t hurt to get stronger either!

​Back pain is one of the most common conditions that affects adults, with 4 out of 5 adults experiencing at least one episode of back pain in their life. While back pain can be quite concerning for most people it comes and goes quickly, resolving within 3-6 weeks. Most back pain is considered mechanical in nature meaning that the source of the pain could be coming from a variety of structures such as muscles, ligaments, joints, or discs. Mechanical back pain is typically caused by putting more strain through that area than it can handle, irritating the tissues and creating pain. This strain can come in the form of lifting something too heavy, too much repetition of the same task, or too much time in a single position. 

People who perform tasks that involve repeated motions, heavy lifting, prolonged sitting or twisting motions may be more prone to experiencing back pain. Taking preventative measures, rather than waiting until an injury occurs, can help reduce incidents of back pain, allowing us to stay active and healthy.

Here are 5 tips for a healthy back:

​1. Sitting with Good Posture: 

The aim is to maintain the natural ‘S’ curve of the spine, so think about:     

• Growing tall

• Lift your breast bone up slightly
• Tuck your chin (like a nod 'yes').
• Gently draw your shoulder blades down and back.
• Ensure you do not over correct, this should feel easy
  ​

To maintain this posture when sitting, ensure your bum is back in your seat. A cushion or rolled up towel placed at your lower back can help to maintain this position.  ​

2. Lifting: Planning and Using Correct Form
​
Taking a second to ensure the path is clear, thinking about where you are moving the object to and getting it close to your body can go a long way in reducing injury with lifting. 

Make sure to bend at your hips and knees to lift, squatting down to the object rather than bending over. The muscles in your legs are much bigger and stronger than the muscles in your back.  
​

Megan Lautner, Physiotherapist.  

In the rough and tumble world of children and adolescents, most will experience some amount of bangs, bruises, scrapes, and scuffs. The vast majority of these are treated with a combination of first aid strategies, rest, and modified activity as required. However, back pain in this age group can sometimes require a bit more attention. This seems to be more likely when we look at the world of organized sport. What I would like to discuss today is what are these situations, and what do they look like? 

Children are not just “little adults” and should not be assessed as miniature versions of an older population. While episodes of lower back pain throughout adulthood is relatively common, it is less frequent in children. As well, children are more likely to have a more specific cause of symptoms than adults, particularly if symptoms persist beyond the norm. 

There seems to be a combination of factors that predispose a young person to an injury of their spine, including behavioural, genetic, and mechanical features. Currently, it is thought that a combination of repetitive stresses and sports that require hyperextension movements can predispose young athletes to higher rates of injury, but this is difficult to specifically determine between sports. Maturity of different parts of the spine develop between 10-15 years of age, which can vary significantly between children, who are usually grouped by age in sport and activity. Up to half of young athletes that experience an extended bout of lower back pain may have the beginnings of a stress fracture. 

​

References

Linton, A.A., Hsu, W.K. A Review of Treatment for Acute and Chronic Pars Fractures in the Lumbar Spine. Current Review in Musculoskeletal Medicine (2022) 15:259-271.

Schroeder, G.D. et al. The role of intense athletic activity on structural lumbar abnormalities in adolescent patients with symptomatic low back pain. Eur Spine J (2016) 25:2842-2848.

Pate, JW., et al. Assessing a child or adolescent with low back pain is different to assessing an adult with low back pain. J Paediatr Child Health. 2022 APr; 58(4):566-571.

Sairyo, K. et al. A review of the pathomechanism of forward slippage in pediatric spondylolysis: The Tokushima theory of growth plate slippage. J. Med. Invest. 62:11-18, February, 2015.

​

​

“An ounce of prevention is worth a pound of cure.” (Benjamin Franklin, 1736)
 
80% of human beings will experience low back pain during their lifetime. And 80% of that eighty percent will have reoccurring back pain throughout their life. It is the leading cause of absenteeism in the work place and it affects our ability to show up in our lives in the way we wish.

As a person who had her first episode of back pain at age 16, I can attest to the fear and anxiety it can cause as well as how it can prevent me from doing the activities I love. So as a sufferer of recurring low back pain and a physiotherapist, here are my top strategies to prevent low back pain.

Humans, by nature,  appear to be more reactive than proactive. Should we choose the latter over the former, we stand to be happier and healthier.

Health is the new wealth so read on and join me in a proactive revolution against back pain!

1. Optimize your posture.

We are designed to have three curves in our spine: two ingoing curves- one in the low back and one in the neck; and a slightly outgoing curve in the midback. When these curves are maintained throughout the better part of a day, we reduce the chance of irritating our spine.

How do we do this Lisa?

I am so glad you asked! My personal favorite way that maintains all three curves is a lumbar roll to support the ingoing curve in our low back which then corrects the curves above. Furthermore, with such a support in place, we are free to concentrate at whatever task at hand, such as

• work,
  
• driving,
  
• reading,
  
• eating,
  
• our favorite program or hobby.
  

​Your muscles get a break too and you will prevent them from getting tired unnecessarily.

2. Microbreaks to move or stretch in the opposite direction.

​Most of us humans in the 21st century are spending a lot of time sitting. So all the more reason to use a lumbar roll!

But this is also a great reason to stretch backwards!

The good news is the investment of time is literally 10 seconds every 1-2 hours during your day. Because sitting and bending forward stress our discs, we need to give them a break and do the opposite arching backwards.

The bonus of this movement is that it stimulates our facet joints at back of our spine, allowing the joints to become lubricated and get adequate nutrition. You know what that means?? You got it! Your joints will be happy and you will prevent the onset of stiffness. ​

3. Use your big muscle groups to lift.

Lifting is not harmful if done properly. Bending at our knees and hips to lower ourselves to pick up heavier objects, reduces the stress on your spine. Doing the golfer’s pick up for light objects is great at protecting your spine also.

4. Breathe deeply!

Do you hold your breath sometimes when you lift or open a heavy door?

​When we breathe, expanding our rib cage and bellies, our brain recruits our core musculature which supports our spine. When our spine receives adequate support, we reduce the risk of injury.

BONUS TIP

5. Stay active!

Even a 15-30 minute moderate paced walk engages our core muscles, especially when we swing our arms.

A 10-15 minute yoga session will help keep your muscles flexible and your joints stimulated.

2-3 sets of 10-15 squats every other day will strengthen your legs and core. Start small and keep it simple and joyful!

​ 
There are no guarantees in life but when I make use of these tips, I feel so much better and I don’t miss out on my life!

Hope you find this helpful and if ever you become a statistic there’s help and hope! Donald Physio can help just give us a call!

~ Lisa Lepage, Physiotherapist

Chronic muscle strain refers to a painful condition resulting from gradual and continuous tension on a muscle.  Though it typically develops over a period of time, its symptoms can occur quite suddenly, and if not managed well it can lead to significant functional limitations in local and even more remote areas of the body. 
 
The upper back and shoulders are among the main areas you can find this condition to occur.
Populations most commonly at risk are those who:​

• Spend hours sitting at a desk or computer, especially if positioned in less than ideal postures (eg. accountants), where unfortunately, accuracy and focus on the task at hand often trump focus on ergonomics.
• Have occupations requiring continuous movements with the arms in a forward position (eg. piano players), leading to overstretching of the muscles over time.
• Have roles requiring positions that are sustained for an extended period of time (ie. dental professionals), leading to increased risk of muscle fatigue.
• Perform heavy lifting, carrying or pulling activities, (eg. student’s heavy back pack, parents and their infants, etc.), which if done repetitively, can set you up for a combination of both overstretching and fatigue.
• Have shoulders being pulled forward by overdeveloped short anterior shoulder-girdle muscles, resulting from an imbalanced upper body strengthening program (eg. power lifters), when often extremely important regional stability exercises can be missed.
• It can even occur by simply adopting habitual postures over a period of time that promotes this type of shoulders rolled forward position (eg. Favoring a sleep posture on the same side for years).

I think it’s safe to say this condition can affect pretty much anyone at one point or another, including myself.

Though definitely not the only muscle that has the potential to be affected in this condition, the trapezius muscle certainly can be one of the most common.  Even if not directly affected, it can at the very least have a significant role to play in the development of chronic upper back and shoulder strain. Two of the main reasons why, may likely be because of the muscle’s size and its location. The trapezius is a large muscle, originating from the base of the skull, throughout the back of the neck, with attachments to each of the vertebra in the entire upper back.  It goes on to attach to the outer third of the collar bone and along the width of the shoulder blade, extending from the tip of the shoulder all the way along the length of its spine.
By way of these extensive attachments, it functions as both a postural and an active movement muscle, used to tilt and turn the head and neck, shrug, steady the shoulders, and twist the arms.  More specifically, the upper trapezius elevates, the lower trapezius depresses, the upper and lower trapezius work together to rotate, and the middle trapezius retracts the scapula, or shoulder blade.

One of the most challenging issues in regards to a strain of the trapezius muscle, is that the underlying weakness which gradually progresses over time, can be present for some time without any or many complaints before it results in significant functional limitations.  Initially, you may feel a local sore spot while in certain positions or while performing certain tasks. Or, perhaps you might first notice it when applying pressure to the areas where the muscle attaches to the vertebrae or shoulder blade. It may appear as an acute pain or tenderness not otherwise obvious with typical daily tasks.  One reason for this development of pain is as a result of repetitive unopposed traction by the muscle on its bony attachments along the spine.  This eventually leads to a point where the tissues have reached their limit, a type of warning system if you will.  With all the research and development in pain science over the recent years however, we know of course that this may not be the only factor, but it is still nonetheless an important one. 

​The good news is that if the onset is relatively recent, simply modifying your posture to gently engage these muscles or resting in a position that supports your upper back can offer relief as it removes the element of continuous tension on the tissues.   However, if adaptive tightness in the muscles through the front of the shoulders has developed, or if significant weakness throughout the trapezius is present in the case of more longstanding symptoms, a simple change in posture may not be enough. 

The best course of action in this case, will require a fair bit more effort, particularly if effective long term management is the goal.  However, the final results will definitely be worth it in the end. 
A comprehensive management plan should include:

• Modifying the position or activity that has caused the pain
• Use of ice or anti-inflammatory medication in cases where pain is of a continuous nature, at least initially where management of the symptoms aids in rest and recovery
• In cases where marked weakness of the middle and lower trapezius is present, regardless of whether opposing tightness exists, a shoulder support may occasionally be indicated to consistently relieve tension on the muscles for a period of time
• A carefully prescribed exercise program that isolates stretching the tight muscles and specifically targets progressive strengthening of the weak muscles, again typically the middle and lower trapezius muscles are the ones in need of strengthening
• re-education of functional movement patterns that have more than likely been altered as a result of pain and muscles learning to compensate over time

​Not only can this type of program assist with management of upper back pain, but it can also help aide in the recovery of several shoulder conditions that can result from the presence of underlying trapezius muscle strength imbalances.  In fact, focus on optimizing trapezius mechanics can be appropriate in the rehabilitation of most rotator cuff conditions.  One study has even indicated complete resolve of chronic elbow symptoms, solely by focusing on resolving underlying strength deficits of the middle and lower trapezius.  Though more research is still needed, what is apparent is that the benefits of adding more focus on the trapezius muscle to your workout routine will clearly outweigh the risks of putting in the extra time.  Enjoy your workout!

If you have any questions regarding this or any other blog posted, please feel free to contact the clinic.  We’re here to help.

~ Elizabeth Stefanyshyn-Alonso BScPT, FCAMPT

​References: 

1. Kendall, F.P., Kendall McCreary, E. & Provance P.G., Muscles: Testing and Function with Posture and Pain, 5th Ed., Lippincott Williams &Wilkins, 2005.
2. Bhatt, J.B., Randal, G., Chavez, A. & Yung, E., 2013, Middle and Lower Trapezius Strengthening for the Management of Lateral Epicondylalgia: A Case Report, Journal of Orthopaedic & Sports Physical Therapy, Vol 43, No 11, pp 841-847.
3. https://www.physio-pedia.com/Trapezius
4. http://www.howtorelief.com/trapezius-muscle-origin-insertion-nerve-supply-action/
5. https://nypost.com/2018/03/05/tech-is-turning-millennials-into-a-generation-of-hunchbacks/

Low back pain is one of the most common ailments people will experience. It is estimated that approximately 80% of the population will experience low back pain at some point in their lifetime.There are many different causes of low back pain but the one we will focus on is lumbar disc injuries.

Lumbar disc injuries involve a large spectrum of severity and can produce multiple different symptoms. Some people will experience only low back pain while others may also experience pain, numbness, or tingling into the buttocks or down their leg. Although disc injuries can be very painful, the majority of them will resolve fairly quickly.

The interesting part of disc injuries is that the pain that is felt is not produced within the disc. Anatomic studies have found that there are no sensory nerve endings within the discs. The back pain that is felt is usually due to irritation of the ligaments that lie on the outside of the disc. Therefore, one of the keys to successful treatment is reducing this irritation of the ligaments.

The disc has two main parts to it – a jelly-like substance in the middle called the nucleus palposus and a series of fibrous rings that contain this nucleus. These fibrous outer rings are called the annulus fibrosus. When a disc degenerates or is injured traumatically, there can be some tearing of the inner rings of the annulus fibrosus. This allows the nucleus palposus to squeeze through the deficit in these inner layers. The end-result is pressure created on the outer rings of the nucleus. If this pressure builds to a high enough degree it can cause the outer edge of the disc to bulge.

A minor bulge can put pressure on the surrounding ligaments, producing low back pain. If the bulge is more significant, then it can begin to irritate the spinal nerve that exits the spinal cord behind the disc. This can lead to intense leg pain called “sciatica”.

Commonly what will happen instead is the release of chemical irritants from the injured disc material. These irritants can contribute to nerve inflammation that will produce symptoms in a leg such as numbness, tingling, weakness, or pain.

The goal of physiotherapy treatment is to reduce the pressure that the nucleus causes on the annulus fibrosus. Treatment may include exercises and hands-on techniques to encourage the nucleus material to move back toward the middle of the disc. A very important part of the treatment plan is education regarding positions or postures that can aggravate the disc injury. Positioning is key to alleviate the pressure within the disc and allow the surrounding tissues to settle down.

When diagnosed and treated appropriately, most disc injuries recover within a few weeks or months
without the need for surgery.