Doctors | Sports Specialist Rehab Centre

Nov 03 0

Cauda Equina Syndrome

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“I just informed my Chiropractor that I’m suffering from low back pain. Why was I asked about my bowel and bladder function?”

As licensed doctors and health care providers, the role of a Chiropractor is not only to figure out (i.e. “diagnose”) the problem a patient may present with, but also to rule out more serious and possibly life altering or threatening concerns.

WIth respect to the acute onset of low back and pelvic pain, one of the most serious concerns is Cauda Equina Syndrome. “Cauda Equina” (literally translates to “horse’s tail” in Latin) is the name given to the tail end of the spinal cord at the level of the low back and sacrum in humans. When this bundle of neurological tissue is compromised (for a number of different reasons) it can not only result in the production of low back and/or pelvic pain (which most patients are aware and mindful of) but also a change in bowel and/or bladder function (often missed by patients in lieu of focusing on their pain). The change in bowel and bladder function could be indicative (along with other features such as “saddle paresthesia”) that Cauda Equina is in progress. If the condition is not adequately addressed, there could be dramatic and possibly permanent life changing alterations in bodily function below the waist. A detailed history and thorough physical exam including orthopaedic testing, neurological assessment and muscle motor function tests can help the attending Chiropractor determine if Cauda Equina Syndrome may be present, necessitating an immediate referral to an Emergency Room.

With the combination of our intense educational framework and thorough assessment tools, Chiropractors can determine if what might appear as “regular low back pain” may, in fact, be a medical emergency. Providing the appropriate referral information and informing a patient of the clinical importance of the event can prevent the patient from experiencing possible detrimental changes for the rest of their life.

For more information how Chiropractors can assess your problems and help you, please feel free to contact our office at 416-385-0110.

Author: Dr. Paolo De Ciantis, B.Sc.(Hons.), M.Sc., D.C.

Jul 28 0

Floss Your Joints

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How often do you brush and floss your teeth?

Every day, right? You know it is important for the health of your teeth, and they go yellow and fuzzy if you don’t. Your partner will tell you when you need to brush your teeth, if you haven’t. But what about your joints? How often do you floss your joints for their health so you can move better and feel your best?

Having a daily mobility routine immediately improves and maintains your joint movement, reduces soft-tissue stiffness and allows for easier access to your active available range of motion (ROM). Everyday, just like brushing your teeth, you need to facilitate movement of every joint to keep it healthy until you are 100 years old. What if I told you that at the age of 70 we could get you back doing the splits again within a year? Yes, your body is malleable!

When you were born, your body was at its most malleable. You can take a baby’s ankles and move them to do the splits in every direction with minimal resistance. Then as we grew up to start walking, running, playing soccer and sitting – we created the range of motion that our body now uses today based on our individual movement patterns and postures. If you don’t use it, you loose it! Those sitting positions restrict and don’t allow you to use your hips and their surrounding muscles and soft tissues to their optimal potential. What does your current ROM look like for your neck, shoulder, hips, ankles?

Your mobility is indicative of your quality of life. Do you have control of the range of motion that you have access to?

I believe in coaching through assisted stretching of Fascial Stretch Therapy in combination with Functional Range Conditioning with the goal of decreasing back pain, injury prevention in athletes, reducing stiffness in older adults and improving the quality of life of every patient on my table. Strength + control + breathe are prioritized as the pillars in order to expand upon usable ranges of motion, articular resilience and overall joint health and facilitate alterations in blood flow parameters as well as relative tissue glide. These principles in your prehab, rehab and training can be a game changer!

If you don’t brush your teeth, you get cavities. If you don’t articulate your joints, you get pain, decrease ROM and even joint degradation. Don’t just move more, move better and feel better!

Author: Adriana Renton

Jul 15 0

Acupuncture Can Help!

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Contemporary Medical Acupuncture

What is Contemporary Medical Acupuncture?
Contemporary Medical Acupuncture, sometimes also known as Neurofunctional Acupuncture or Electroacupuncture, is “a precise peripheral nerve stimulation technique, in which fine solid needles (acupuncture needles) are inserted into neuro-reactive loci, and stimulated manually or with electricity for the therapeutic purpose of modulating abnormal activity of the nervous system.”

How does it work?
There are several mechanisms by which acupuncture works to help patients move better and feel better. Our body really prefers to be in homeostasis, the tendency toward a relatively stable equilibrium between interdependent elements, especially as maintained by physiological processes. When an intervention like acupuncture is brought into the mix, it helps to precipitate the process of maintaining that equilibrium. This commonly happens by either up regulating or down regulating specific cellular processes based on the body’s need to “return to normal”. For example, if a muscle is “tight” or has high neural tension, the acupuncture will aid in reducing that tension.

Is it safe?
In short, YES. Of course, as with all treatments, there are some risks involved. However, in Ontario, practitioners who utilize acupuncture are all regulated healthcare professionals with extensive training in anatomy. Part of the training includes comprehensive discussions on the safest way to needle and how to best avoid any adverse events. Your safety, comfort and health are our top priority!

Does it hurt?
Generally, NO. However, at times, a patient may feel a dull ache or a twitch in the muscle; this dull ache is actually a positive thing and means we are affecting our target in the muscle. If there is ever too much discomfort, it’s important to let your practitioner know and things can be adjusted, or needles can always be removed.

What types of conditions can be treated with Neurofunctional Electroacupuncture?
Electroacupuncture can be used to treat a wide variety of neuromusculoskeletal conditions. Some of the more common conditions that respond well to acupuncture are:
Back pain
Neck pain
Headaches
Tennis elbow
Plantar fasciitis
Shin splints
Shoulder, hip and knee pain
Many more!

Author: Dr. Allie Dennis

Resources:
Elorriaga Claraco A, Fargas-Babjak A. Contemporary Acupuncture for Health Professionals. Handouts Unit 1-5. Fall 2016.

Jul 07 0

Partners in Healthcare

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As a rule, we at the Sports Specialist Rehab Centre recognize that there is no “i” in “team”. A team is always stronger than the individual. With respect to the healthcare of our patients, we apply the same rule.

It is our perspective that no one medical professional is superior to the other. Every healthcare provider, be it a physiotherapist, chiropodist, nurse, dentist, optometrist, family physician, chiropractor, etc. all possess a unique set of knowledge and skills. Their individual knowledge and skill set are developed over a period of years of formal education as well as practical implementation. However, there is a limit to what an individual can do. That said, the great thing about the knowledge and skill set of an individual provider is that when it’s combined with those of complementary healthcare disciplines, it results in a formidable assemblage of expertise. When this expertise is applied to a patient, the patient benefits from an overall healthcare perspective, rather than just a narrow scope from one healthcare discipline.

Moreover, there can be limits to the scope of practice for an individual healthcare provider. For example, a registered massage therapist could suspect a fracture but does not have the ability to order an x-ray. Establishing and nurturing relationships between different healthcare disciplines allows for the circumvention of these limitations so that the patient does not unduly suffer as a result.

In summary, a team based approach allows for an efficient and robust approach to the treatment of a patient. As a matter of practice, we at the Sports Specialist Rehab Centre make it a point to work together within the clinic and externally with other healthcare providers for the benefit of individual patients.

Author: Dr. Paolo De Ciantis

Jun 10 0

Hurt versus Harm

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One question I hear from many of our patients at The Sports Specialist Rehab Centre is “Should physical activity be painful?”. Generally, the answer is “No”.

Physical activity can be loosely defined as a voluntary activity performed by an individual for a specific purpose that leads to movement and force generated from the body. This can include exercise, sports or rehab. The forces generated during physical activity can place stress upon the muscle tissue, joints and supportive tissue. As such, it is common and sometimes expected that during physical activity, there can be some discomfort (i.e. “hurt”). For example, if I am playing tennis, I would expect some minimal discomfort in my wrist, elbow and possibly shoulder. That said, this “hurt” does not necessarily translate to damage of body tissue. However, if a physical activity is ever painful (i.e. “harm”) while being performed, generally, that is not a good sign. This may indicate that you are damaging tissue as opposed to just engaging it. As such, should a physical activity ever become painful, please stop the activity immediately! The age old adage of “no pain, no gain” is not a fruitful one. The pain generated while performing an activity could represent significant trauma to an area and could have long term and far reaching implications.

Everyone’s definition of pain is completely subjective. So you, the individual, become the best judge at deciding when an activity becomes harmful, and not just a bit hurtful. If you should have any questions or questions regarding when an activity is hurtful versus. harmful, please don’t hesitate to contact one of our therapists who would be more than happy to explain!

Be active but be safe!

Dr. Paolo De Ciantis

Jun 13 Comments Off

COVID-19 Policy

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To our valued patients, we have updated our COVID-19 policies and procedures in order to reflect the current change of the COVID-19 pandemic in Ontario and current government and regulatory college guidelines and recommendations.

We kindly ask that any patients who may be experiencing COVID-19 symptoms or who may live with someone who is experiencing symptoms or is confirmed to have COVID-19 to inform our administration staff and to reschedule your upcoming appointment.

Our staff will continue to self monitor for COVID-19 symptoms prior to attending our clinics for in person treatments.

Furthermore, as per current government and regulatory college recommendations, our treatment staff is no longer required to wear protective face masks for in person treatments. As such, should you prefer treatment from a staff member who will wear a protective mask during in person treatments, please inform our administration staff at booking or prior to attending your appointment.

For those experiencing COVID-19 symptoms, please contact the following:

Public Health Ontario: 1-877-604-4567

Telehealth Ontario: 1-866-797-0000

May 26 0

Heat vs. Ice!

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I get this question too many times a day to even count. So, I thought I would spend some time laying out why I might recommend heat for one person and ice for another.

Both heat and ice are helpful tools in pain management. Although there are many theories as to why they work, the research is incomplete and there is still much that is unknown. One main theory for icing, for example, is that the reduction in temperature reduces the conductive ability of your nerve to relay information back and forth, therefore not allowing the ‘alarm signal’ of pain to be expressed as quickly. It is also understood to be helpful for inflammation as blood flow to the area is decreased. Heat, on the other hand, promotes blood flow to the area, which is helpful for healing. Heat activates certain neurotransmitters which blocks the ability for our body to perceive pain.

WHEN TO USE ICE
You have an acute injury (e.g. ankle sprain), within the first 48 hours
Inflammatory conditions (e.g. rheumatoid arthritis, ankylosing spondylitis)
Red, hot, swollen tissue

WHEN TO USE HEAT
Acute low back or neck pain
Chronic pain
Muscle stiffness

HOW TO USE ICE
Make sure the ice is covered or wrapped in a wet cloth, and not against your bare skin to protect from frostbite (I’ve done this before. It’s not fun – I promise!)
Use the 20:20:20 rule – 20 minutes on, 20 minutes off, 20 minutes on. This can be repeated several times a day

HOW TO USE HEAT
If you have sensory issues, be careful not to burn your skin
Heat can be applied much longer than ice and there’s really no guideline – just make sure you are awake and aware of the sensations you are feeling so as not to become injured

Having said all that, each person and each body is different; what works for one person might not work for someone else. So, if you love ice and find it’s super helpful for your chronic pain – GO FOR IT!

As with everything, there are precautions and contraindications to all forms of therapy. Make sure you speak with a regulated health care professional to make sure that ice and/or heat is safe for you before using it.

Author: Dr. Allie Dennis

RESOURCES:
Algafly AA, George KP. The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. British Journal of Sports Medicine. 2007;41(6):365-369. doi:10.1136/bjsm.2006.031237.
Nadler SF, Weingand K, Kruse RJ. The Physiologic Basis and Clinical Applications of Cryotherapy and Thermotherapy for the Pain Practitioner. Pain Physician. 2004;7:395-9.
Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate Medicine. 2015; Early Online: 1-9.

May 19 0

Do I Have a Slipped Disc?

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In short, the answer is NO – our discs don’t ‘slip’.

I often get this type of question from patients with back pain and neck pain so I wanted to take some time and explain what our intervertebral discs are, whether or not they ‘slip’ and why they may sometimes contribute to pain in our back or legs.

⦁ What is an intervertebral disc?

Our spine is made up of 33 vertebrae and the majority of them are separated by intervertebral discs. These discs are made up of two components – the outer annulus fibrosis which is composed of strong connective tissue and the inner nucleus pulposis which is a softer, gel-like material. The disc allows for increased motion in our spine and helps connect each segment together.

⦁ Do discs slip?

Nope! The connective tissue attaching those discs to our vertebrae is very strong and much too stable to cause any slippage. Some things that might occur to the discs over time includes dessication (aka dehydration), bulging, herniations, and other forms of degeneration. These are all very common and the majority of adults will have findings of these things in their spine, regardless of whether or not they are experiencing pain. In fact, it has been studied quite often that degenerative findings in the intervertebral discs have little to no correlation with pain.

⦁ Can discs cause pain?

Sometimes. The most likely reason a disc will cause pain is a disc herniation. Over time, with repetitive stresses on our back the outer annulus fibrosis can begin to tear. If it tears enough, some of the inner, gel-like nucleus pulposis can herniate out of the disc and can irritate the nerve root sitting nearby. The pain can be a result of mechanical compression or chemical irritation to the nerve, or both. This can lead to symptoms along the entire course of the nerve. For example, disc herniations in your lumbar spine, or low back, may cause symptoms down your legs.

So what does this mean for the patient with back and/or leg pain?

Majority of cases of back and leg pain due to disc herniations are self-limiting and will get better on their own. Conservative care (e.g. chiropractic, physiotherapy, massage therapy) can often help you get there faster. There are very few cases where disc herniations can lead to a medical emergency – if you are unable to urinate and/or unable to control your bowel movements, go to the emergency room. Additionally, if you have rapidly worsening neurological symptoms (e.g. weakness, loss of sensation), this also needs to be checked out urgently and more invasive approaches to care may be necessary.

Dr. Allie Dennis

**This is not intended to be a replacement for medical advice. If you are suffering from any of these symptoms, please see your healthcare provider for appropriate management**

May 12 0

Garden Safely This Spring!

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Spring is here! Time to get those gardens flourishing. Gardening can be very hard work with lots of kneeling, bending, twisting, lifting and carrying. It’s important to ensure we keep our bodies and spines healthy and moving well during this increase in physical activity.

The Ontario Chiropractic Association has an excellent acronym to help us remember how to stay healthy while we’re gardening!

HEALTHY BACKS

H – Have the right tools for the task at hand.

E – Ensure you drink plenty of fluids.

A – Alternative between light and heavy jobs.

L – Lift correctly.

T – Take frequent breaks.

H – Heavy loads should be shared.

Y – Your feet should be protected with thick soled supportive shoes.

B – Before you start, warm-up your muscles.

A – Avoid muscle strain, learn the right techniques.

C – Change positions frequently.

K – Kneel to plant and weed.

S – Spinal check-ups can help keep your back healthy.

If you do injure yourself while gardening, or have questions about specific techniques (lifting, bending, etc…) please go see a regulated health professional for a proper assessment, treatment and advice specific to your body. Enjoy the sun! Looking forward to seeing those May Flowers!

Author: Dr. Allie Dennis

Source: http://www.chiropractic.on.ca/wp-content/uploads/Tips-for-a-Healthy-Back-in-the-Garden-Apr17-v2.pdf

May 05 0

What is Fascia?

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Many of you may have heard of the term “fascia” before. Over the last few years, “Fascial Stretch Therapists” (F.S.T) have gained popularity in the fitness and Kinesiology fields. In fact, your Registered Massage Therapist (R.M.T) may have already thrown around the term myofascial release or even suggested incorporating fascial techniques into your hands-on sessions. It’s possible you might have even suffered from a common condition called plantar fasciitis. So, the question remains, what is fascia?

To best explain fascia, try picturing a form of netting, webbing, a sort of glue or bandage. It’s actually a dense sheet, or band, of irregular connective tissue that lines the body wall and limbs, supporting and surrounding muscle groups that perform similar functions. It is strong yet mobile. Picture a spiderweb, intricately interwoven silk threads; this intricate interwoven network runs throughout our entire bodies acting like a web, holding us together.

The appearance of fascia throughout the body can differ greatly, ranging from quite thick, mimicking muscles such as the fascia making up the plantar fascia of the foot; it can also be quite thin and broad such as the thoracolumbar fascia of the lower back. Important to note is that when fascia is tight and inflexible it can pull on other structures within the body, causing tension, pain and decreased range of motion.

Factors that can affect fascia:
⦁ Repetitive movement
⦁ Sedentary lifestyle (little to no daily movement)
⦁ Trauma including surgery or injury (ex. post C-section)
⦁ Postural imbalances
⦁ Inflammation
⦁ Pathology

The benefits of regular body work, or preventative maintenance as I like to describe to patients, is so important in maintaining the health of your muscles, tissues and fascia. Keeping these integral tissues in consideration for your fitness and overall health, and getting manual work done, the fascia will become more pliable, your range of motion will increase, you will begin to experience a decrease in pain and discomfort and it will eventually increase the flow of the lymphatic fluid. This can lead to decreased inflammation and swelling.

Regardless if you are feeling specific discomfort in a particular bodily area, preventative work can be performed. Each individual responds differently to each modality (ex. myofascial release, trigger point therapy, cupping, active release therapy, acupuncture and so on). Whether you see a Chiropractor, Physiotherapist, Acupuncturist, Registered Massage Therapist or Fascial Stretch Therapist, listen to your body!

At your next appointment ask your practitioner about fascial work or try a session with a Fascial Stretch Therapist – I’m sure you will not be disappointed!

Author: Lesley Andress R.M.T

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