Hello all, it is Osteopath John here with todays blog which is going to be on Low Back Pain, an extremely common complaint we see here at Dalhousie Health & Wellness.


There are many misconceptions associated with Low Back Pain and over the last 20+ years there’s been huge advancements in the research for Low Back Pain, however not all of the informations has trickled down to patients.


So let us have a look at a few concepts and ideas, primarily mechanical loading can lead to ‘failure’ of the disc, muscles, ligaments or small joints of the spine. We can use the idea lifting of a box as an example to how the back can be become painful. You could lift one box which is extremely heavy and this could apply an excessive load which the back is unable to handle and this in turn will lead to injury and pain. To try and limit this occurrence health and safety execs, etc set limits on maximum safe lifting loads. However we are all individual and our tissues/discs/joints can all become strained at different levels of ‘load’. So what might be safe for some may be too much weight for others. Repetitive lifting of light boxes, well within lifting limits could actually cause more damage then lifting just one heavy box that is over the recommended limit, continuously carrying a light box could also stress the discs, muscles and joints of the spine. Does this mean that no lifting at all should be carried out? A short answer is no. As with most things in life it is all about finding the right balance for your body. ‘Loading’ our spines can ensure good bone density, muscle growth, and encourage blood flow. Although for anyone that does put mechanical loads through their backs it is important for them to understand the importance of rest. The same idea as when you go to the gym, it is not beneficial, but actually detrimental to work the same muscle groups day in and day out. Allowing periods of rest between lifting/loading of the spine will help to minimize the risk of injuries, there is also research demonstrating even the time of day can have an effect on the pressures put on our disks, it states that earlier in the day the higher the risk of injury. So how come it seems that some people are able to lift heavy objects with poor form every day and seem to be completely pain free? Well these are the lucky ones which have a good balance and endurance of all the muscles of the back/core, as each muscle group will engage in the right order and stabilizes the whole back. This prevents excesive strain through one part of the spine and this ensures that the load is distributed evenly through the back. Think of the muscles as the Guy Wires that all have to have the correct level of tension to keep the spine in its optimal position. Others unfortunately can lift the lightest load just slightly awkwardly and it leads to immense pain. This is indicative of poor posture, muscle imbalance, and can be predisposed by genetics and a history of spinal injuries.
Now even without carrying a box or a load, we have gravity constantly putting forces through our backs, and poor posture, a weak core, and again a history of injuries can predispose us to low back pain without even any lifting involved. In these scenarios even a light strain can be enough to be the ‘straw that breaks the camels back’, and it can be what would seem to be a minimal load such as sleeping awkwardly, bending forward to tie your shoes, etc that lead to a pain that seems completely disproportionate to the movement that caused it. This is classic but demonstrates there was an underlying issue, as our spines should be able to easily deal with these movements/activities etc, without going into spasm.




Ok, let us say we’ve over exerted it and now the back has become painful what next? You book in to see an Osteopathic Manual Practitioner, a Chiropractor or another type of Manual Therapist which is most likely be beneficial. Therapists’ can help to reduce the pressure placed on the spine, muscle, tendons, ligaments and discs. As well as encouraging healing of damaged tissues, here at the clinic we attempt to look further than just the site of pain, attempting to improve biomechanics all through the body so loads and strains are dissipated equally. Exercises maybe prescribed during sessions to help you recover faster, hopefully prevent future flair ups. Core strengthening is often a go to exercise but there are several studies that show core strength has little to do with future low back pain and it is instead endurance of the core muscles that are of more importance.


The time of day should also be considered in regard for exercises, this is due to our disks being more hydrated in the morning and this extra fluid increases the pressure within the disc and therefor stretching down to touch your toes could increase the risk of injury as the disc can be thought of as a “jelly filled donut” and there is more chance of the jelly being pushed out if we put to much strain on the disc too early in the morning. It is also important to re-educate the body on correct form and movement, to assess what is not moving but should be and whats is moving too much. Our body is very good at compensating, so you may have a very stiff spine but are able to bend down and touch your toes easily, all this movement could be coming from hamstrings and hips and it may be dysfunction in the spine might be missed as your visual range of movement appears to be above average. These are just some of the considerations that have to be taken into account for rehabilitation exercises and it shows that a ‘one size fits all’ approach is does not exist. If there is restricted/immobile areas of the spine then other areas have to take extra strain to accommodate them and if there is too much movement then instability can also cause problems.
It is also the same with strengthening, too much in the wrong area can be problematic and not enough strength/endurance can lead to future back complaints.


So it really comes down to in depth assessment, to understand what really is the cause of pain, and then producing a patient specific care plan to address all the issues to hopefully provide you long lasting and effective pain relief!

Call Dalhousie Health & Wellness today to book your individualized plan towards helping solve your low back pain for good!

The philosophy of Osteopathy is based on four basic principles:
• Each structure in the body supports the body’s functions.
• The natural flow of the body’s fluids – lymphatic, vascular and neurological
– must be preserved and maintained.
• The human body is the sum of its parts. Its physical, emotional, social, spiritual, and cognitive systems don’t work independently - they work in harmony.
• When the body has no restrictions, it has the inherent ability to heal itself.
Osteopathic Manual Practitioners recognize a person as an integrated whole. When all of the body’s components are in balance, a person is complete and in total health. Osteopathic Manual Practitioners work to maintain, improve and restore the normal physiological function of interrelated body structures and systems, enhancing the body’s natural ability to heal itself.
Using various manual assessment and techniques and modalities, Osteopathic Manual Practitioners work to identify and ease restrictions, constrictions and pain; reduce swelling; improve tissue mobility; and promote proper function and healing in people of all ages.
~From the Ontario Association of Osteopathic Practitioners website

Sporting Injuries
Having a keen sporting background and interest I am well aware of the strains and forces placed on the body during sports at any level and any age, and understand how Osteopathy can help. Regardless of the area of pain or the onset of the injury we can work through the issues and help your muscles recover faster, increase your flexibility and the range of motion through your joints. See how we can help you raise your game!!!

Non-Sporting Injuries
Even if you do not participate in sports, we can still unfortunately injure ourselves. Whether it be it from lifting something too heavy and hurting our backs, sleeping funny and waking up with a stiff neck to overusing our shoulders gardening. These can all result in pain and discomfort, which will benefit from Osteopathy. We can use a wide variety of techniques to free up our joints and improve tissue healing.

Low Back and Neck Pain
Low back pain and neck pain are probably the most common areas we treat here at the clinic, the spine is of extreme importance for the well being and functioning of the body. Unfortunately lots of things can go wrong with the spine, disk damage, degeneration, nerve irritation, muscle sprains to name a few. See how we can help keep you mobile and pain free!!

Posture
It is a fact that no one has perfect posture, but we can all try and aim to have our bodies functioning optimally to help reduce stress or ‘wear and tear’ on our joints. Having proper alignment of our spine, shoulders, hips and so on can all aid in creating a body with minimal imbalances and therefore more equal distribution of forces such as gravity that are constantly placed upon our bodies.

Degeneration and Osteoarthritis
Osteoarthritis/Degeneration is just a fancy word for wear and tear, it is closely related to posture, past injuries and sports/occupation. It happens to us all to some degree but unfortunately when it becomes more severe it can cause pain and discomfort. Although no manual practitioner can reverse the changes on the bones, manual practitioners can help improve the range of motion, relax muscles and stretch the soft tissues to prevent the rubbing of ‘bone on bone’. Commonly affected areas include the Knees, the Hips, Low back and the Neck.

Nerve Irritations
Nerve irritation or a ‘Pinched Nerve’ as it is often called, is a common occurrence, with symptoms including Pin and Needles, sharp shooting pain and even muscle weakness. There can be a multitude of factors that can cause compression of the nerve, for example it can be spinal disk related, pinched by bones or tight muscles that irritate the nerve as it passes through. Removing the forces that are causing the compression will result in a reduction in symptoms!

Shoulder Pain
I like to consider myself a shoulder expert! It is a fascinating and extremely complex joint. It is amazing as it provides a huge range of motion, allows us to do some many movements, activities and so forth. However with all the complexity and range of motion it leads the shoulder prone to numerous injuries, commonly our ‘Rotator Cuff muscles’ can become torn, inflamed as well as poor biomechanics (hunched shoulders) and so forth can all result in pain, weakness and limited mobility.

Osteopathic Manual Practitioners can treat a variety of aches, pains and health concerns. If you think you could benefit from the help of an osteopath. Call Dalhousie Health & Wellness to book your Osteopathic visit today!

Pain and discomfort are sometimes difficult to recognize and therefore manage in infants, toddlers and children. You know its time to go to the chiropractor when your own aches and pains make their appearance, but how do you know when your baby or toddler may need a visit? How does your chiropractor recognize pain and discomfort in little ones?
In babies crying is used to communicate everything from pain to hunger to discontentment and a whole lot of other things! Therefore crying is not always a reliable signal on it’s own that your baby is in pain. However, if the sound of the cry seems different than usual, prolonged or cannot be consoled with a bottle, diaper change or physical comfort, it may be a sign that something is wrong. Excessive, intense crying- usually beginning around 2 weeks of age, may also be a sign of colic.
Other behaviours your chiropractor may observe or ask you about for infants 0-12 months:
- Disruption of sleeping patterns
- Withdrawing from touch or drawing knees into the chest
- Rigid or tense body positioning
- Inconsolability
- Avoidance of tummy time or certain positions
- Irritability
- Changes in appetite or feeding patterns
- Arching their body
- Different or unusual facial expressions
- Chronic pain can also drain a baby’s energy causing them to become lethargic and unusually
quiet
Fortunately, when it comes to toddlers and children they can often tell us or point to the area that hurts to demonstrate their discomfort. Another way to encourage children to express their pain is to supply a list of words, asking them to use the word that best describes what they feel, such as: “sharp,” “burning,” “aching” . Your chiropractor may use a pain scale with faces to have your child rate their pain, use a doll to point to areas that hurt, and observe their behaviour.

Behaviours your chiropractor will observe or ask about for toddlers & children 1-12 years
- Behaving younger than their age
- Intense crying or yelling
- Favouring a leg or arm, or guarding
- Decrease in activity levels
- Changes in sleep patterns & appetite
- Refusing favourite activities, foods or toy
- Being uncooperative
- Being physically resistive to touch or exam
- Body tension: clenching fists or jaw, stiffness, eye closing, brow wrinkling, frowning - Physical signs such as: dull eyes, flushed skin, fast/shallow breathing, or sweating - Being excessively clingy, asking for hugs and kisses
Untreated or unrelieved pain can take a toll on a baby or child causing issues with sleep, play, social bonding, appetite, sports, academic performance and can make them more vulnerable to pain later in life. Using the signs above as a starting point, your chiropractor can delve further into the cause of these symptoms to help get your little one out of pain. Chiropractic care for babies & children is gentle and effective. Children are also especially responsive to pain reducing techniques which capitalize on their sense of play and imagination- which means we try to keep treatment as fun as possible

Of all the paediatric chiropractic visits, almost two thirds of those are for infants and babies! Chiropractic care for babies is safe, effective and gentle, using about as much pressure as you would to check the ripeness of a tomato. Our sense of touch is one of our first senses to develop, meaning even babies may benefit from manual therapy and therapeutic touch.

​Why would my baby need to see a chiropractor?
Your chiropractor is trained to asses for imbalances, dysfunctions and injuries which may affect your baby’s quality of life. Chiropractors use their skills of palpation to identify areas of injury and restore normal movement patterns. Musculoskeletal irritation or injuries sustained during or before birth are termed “physiologic birth injuries”. Birth is an event full of compression and traction which may contribute to these very common, mild to moderate injuries. Serious injuries are, thankfully, very rare.
Some of the most common symptoms parents report: excessive crying/fussiness, ineffective feeding, refusal of tummy time, irritability with certain positions, only feeding on one side, refusal to turn head and excessive gas or changes in bowel habits.
Births which are at highest risk for injury include: inductions, fast births due to intense contractions, medically assisted (use of forceps or vacuum), breech births, and deflected presentations.

How do chiropractic treatments for babies work?
Research is still fuzzy on the hows of chiropractic treatment and infants. This is due to the fact that it is difficult to conduct ethical research with babies. Hypotheses suggest that, just as in adults, improving the mobility of a restricted joint or releasing a tight muscle promotes physical and emotional comfort while calming the autonomic nervous system.
What are the most common side effects?

Safety is always the number one concern with all our patients- but that goes double for babies and infants! The most commonly reported side effect of treatment is a temporary increase in irritability/crying during or in the time following treatment. This is usually brief and parents typically report a more content and sleepy baby when the irritability diminishes. Most of the babies I treat actually fall asleep during or shortly after treatment.

We also encourage parents to have these symptoms co-managed by their family doctor, nurse practitioner, paediatrician or midwife and to attend their regular check-ups. Working together, your chiropractor can be a valuable part of your baby’s health care team.

The suction and negative pressure provided by cupping can:

✔️Loosen muscles
✔️Encourage blood flow
✔️Relieve back and neck pain
✔️Alleviate anxiety, fatigue, and migraines
✔️Help release toxins

Possible side effects include dizziness, and/or nausea, and thirst. It can also leave round purple/pink marks, or circular “bruises” on the skin. These spots do not actually hurt as they are not real bruises, they are just stagnant blood being pulled to the surface of your skin. Most spots will disappear within minutes, but some spots can last for several days, or even 2-3 weeks depending on the area of the body, and it’s blood flow.
So if you have an event to go to, make sure to tell your therapist and they can avoid areas of the skin that would be exposed.

Including cupping in your massage therapy treatment can be a great tool in helping to increase movement of tissue and fluid. Cups can be used in a few different ways, stationary on a focused area or in motion (stroking sweeps, or gliding). And the intensity level of the suction can be controlled, so if you are someone who prefers a lighter pressure massage, you can still benefit from cupping as well!

Now that you have all this new information about cupping therapy, why not give it a try?!

Call Dalhousie Health & Wellness to book your cupping treatment!

The staff at Dalhousie Health & Wellness know first hand how stressful the effects of COVID-19 have been on our community. We have taken an abundance of precaution to make sure everyone feels safe when we re-open. We have been following the situation closely in order to stay up-to-date on the requirements of our regulating body’s and Ontario Public Health. Our main goal is to keep everyone healthy and safe, but also create an environment where people are comfortable. Our patient care is, and always will be our number one priority. See you in the office on June 16th when the doors to Dalhousie Health & Wellness officially re-open! Until then...

• All cleaning will be done with medical grade cleaner or bleach and water (at a 1:9 ratio)
• All surfaces, doorknobs and treatment tools, treatment tables and any areas touched by practitioners and clients/patients are to be are to be sanitized after each patient visit by each individual practitioner
• All staff are required to have a pair of indoor shoes worn only in office, OR required to wipe the solestheir shoes with medical grade cleaner upon entry
o It is strongly suggested that you leave a pair of indoor shoes at the office
• Practitioners must wash their hands…
o As soon as they enter the office
o Before and after a patient leaves
o Before and after putting a mask on
o Before and after eating
o Before and after going to the bathroom
o Before and after checking a patient out (if reception is not available)
• All practitioners are required to wear a medical grade mask in office at all times
o New masks are required when removed
o Please refer to your regulating body standards of care for how to apply a mask properly
• All practitioners are required to clean ALL surfaces in their room at day end
• All furniture must be off the ground at day end and ready for a morning deep clean by front end staff
• Kitchenette is to be wiped with each use
• We are leaving 10 min between each patient for cleaning
• Patients must wait in treatment rooms until reception is clear (only one person in reception at a time)
• We are now paperless, all practitioners, Doctors and staff will keep notes in our new Jane software
• Front end staff will wipe all surfaces touched by clients after every person leaves the office(Front door handle inside and outside, Reception counter top, POS machine, Bathroom surfaces if used by patients)
A deep clean will be preformed at the beginning of each day
• Vacuum and mop (use 9:1 solution water: bleach)entire office, upstairs and main floor
• Deep clean bathrooms and kitchenette
o Water and bleach solution on all surfaces, toilets and Windex mirrors

• Staff members who have a cough, fever, shortness of breath, runny nose or sore throat (that is not related to a pre-existing illness or health condition) should visit public health and get tested for COVID-19
o The staff member may not return to work until they receive negative COVID test result
• These requirements should be followed until tests results are known and if the staff member(s) tests positive with COVID-19. Negative test results allow the staff member(s) to return to work.
• If a staff member does come to work sick, the following guidance applies:
• Staff who appear to have acute respiratory illness symptoms (e.g., cough, shortness of breath) on arrival to the workplace, or who become sick while at the workplace, should be sent home immediately and asked to maintain at least two meters of distance from other staff and patients while exiting the workplace.
• Sick individuals must follow hand hygiene and respiratory etiquette, as necessary, as they are exiting the workplace.
• Once a sick individual has left the workplace, clean and disinfect all surfaces and areas that they may have come into contact with.

Night pain is a commonly encountered symptom for patients with shoulder injuries. Night pain is of great importance as it disturbs sleep and diminishes quality of life. Good quality sleep is of utmost importance to all of us! Without proper sleep we may be less active during the day, have a lower threshold for dealing with stress and injury, mental exhaustion and even delayed healing.

There are many conditions associated with night pain in your shoulder such as: bursitis, rotator cuff injuries, adhesive capsulitis [frozen shoulder], osteoarthritis and tendinosis to name a few. The cause of pain in these conditions can be divided into three major subtypes: movement related, compression and inflammatory

Did you know that most of us are side sleepers? Often patients tell me that they usually sleep on the side of their injured shoulder. Changing our sleeping position can be very challenging, however laying on the same side as the injury can further aggravate your pain and discomfort. Making efforts to avoid compressing the injured tissues is also recommended as a way to speed up healing times.

Some of my patients report that no matter how little or how much they move around, whether they sleep on their backs or sides, they just cannot relieve their shoulder pain at night! This night time aching that does not seem to be positionally related is the most perplexing and frustrating for patients. Researchers have found that this type of night pain is related to increased blood flow through the arteries of the shoulder suggesting an increase in inflammation.

The best option is always to consult a health care professional for a proper assessment, diagnosis and individualized treatment. Your health care provider may suggest some of the following depending on your specific type of shoulder injury and cause of the night pain:
1. Use a pillow to restrict your movement: If you are concerned about moving in a painful direction or rolling onto your shoulder, placing a pillow behind you may help prevent you from turning over.
2. Avoid sleeping on the side of the injury: Sleeping on your back, opposite side or even using a wedge pillow to elevate your shoulders may relieve some of your discomfort.

3. Perform your prescribed stretches and rehabilitation exercises. A health care professional can prescribe therapeutic exercise to relieve pain, stiffness and improve your range of motion.
4. Icing. Using ice or other anti-inflammatory measures before bed as prescribed can help delay the onset of pain and allow you to fall asleep faster.
5. Avoid any activities which are likely to worsen your pain. Knowing your limits and decreasing overall irritation will also aid in a faster recovery.
6. Practice good sleep hygiene. Try to go to bed at the same time every night. Reduce fluid intake and avoid caffeine, nicotine and alcohol before bed. Turn off electronics at least 30 minutes prior to bed.
If you’re experiencing persistent pain, restricted or painful motion, night pain or shoulder issues which are affecting your quality of life, please make sure to consult your chiropractor, doctor, massage therapist, physiotherapist or other trusted health care professional

Visit your chiropractor for guidance, diagnosis and treatment of shoulder injuries and shoulder pain. Your Dalhousie Health & Wellness team is read to help your shoulder pain!

Dr. Pepper has a special interest in the treatment of children, adolescents and adults with concussion. Much of my time treating concussions is spent answering questions and providing education. Despite the surge in interest, many questions and misconceptions linger around the topic of concussion. The following are some of the most common myths I hear about concussion in my office.

People commonly believe that you need to hit your head to have a concussion and that the harder the hit the worse the concussion. Neither of these statements are true. A concussion can be sustained by hitting your head, but also by a rapid acceleration-deceleration or your head or a coup-countercoup motion. This kind of injury can be produced in a car accident, a fall or even a hit to the body. We also see in practice that the degree of the injury does not correlate well to the number or intensity of symptoms.

Loss of consciousness is not a diagnostic criteria for concussion, in fact it occurs in less than 10% of concussion cases. Although it seems logical that a loss consciousness would indicate a more severe concussion this is also not the case. It is always important to report loss of consciousness to your health care provider but it may not be a reliable indicator in determining if you have a concussion or how severe the symptoms may be.

Sleep is actually vitally important in concussion recovery. This misconception is likely a result of advice that is intended for those with bleeding in their brains. Brain bleeds are very rarely associated with concussion. If the patient has been assessed by a health care professional and a bleed has been ruled out, it is safe for them to sleep. When you sustain a concussion your brain is suffering from an energy crisis and adequate sleep can help restore your brain’s energy. However, daytime sleeping and excessive napping is discouraged, try to get your restorative sleep at night.

Although concussion symptoms may come on right away, they are often delayed. Some symptoms may take hours or even days to appear after the initial injury. In the time following a concussion the brain is more susceptible to injury, this is why we say “when in doubt, sit them out”. Returning to play before a concussion is healed and sustaining a second injury may lead to Second Impact Syndrome which is a very serious complication that causes neurological impairment, brain swelling, coma and possibly death. For more information on this please read up on Rowan’s Law which is legislation designed to protect those with head injuries.

An initial period of complete rest may be recommended for 0-48 hours post injury. Following this, light aerobic activity is highly recommended. Research demonstrates that light activity is

associated with faster recovery than complete rest. Your health care provider will assess your individual case and make recommendations based on your symptoms. Usually a short walk or stationary biking are preferred. As your symptoms improve your health care provider will include rehabilitation exercises and slowly re-introduce you to your previous activities. Incremental exposure to your normal demands will be a critical part of your return to work/play or school plan.