Dr. Steven Scappaticci, B.Sc. (Hons.), CSCS, DC, FRCms As a chiropractor, I’ve seen people recover from many injuries. It doesn’t matter if the issue is acute or chronic, if it’s their back or their foot; I’ve seen not only improvements in symptomatology but more importantly resolution of pain & restoration of function. What baffles me is that with results like these why aren’t more people utilizing chiropractic care as the utilization rate in Ontario continues to hover around 10% with the nations utilization rate being only slightly higher. Here are some of the top reasons I’ve found that people aren’t seeing a chiropractor for their musculoskeletal (MSK) aches & pains (note: these are not ranked in any particular order).
The first reason surrounds the UNAWARNESS from the general public. Let me explicitly highlight that it’s not their (the publics) fault. It cannot be expected that the average person is reading the newest research that is, believe it or not, strengthening the evidence of chiropractic care for certain MSK issues. Let me ask you this, do most people know that chiropractors treat more than just necks & backs? Do people know that chiropractors utilize many tools (e.g. acupuncture, soft tissue therapy, laser…etc.), more than only adjusting? Do people know that there are chiropractors out there (like myself) who spend more than 3-5 minutes with a patient? Patients don’t know, what they don’t know. For some they’ve only been exposed to “other” chiropractors who may practice differently, leaving the patient wanting more. The unfortunate thing is when patients paint all chiropractors with the same brush; we’re not all the same (both a ‘pro’ & a ‘con’ for the profession). My recommendation is for patients to ask questions! Make sure they’re comfortable with the treatment they’re going to receive. Another reason is the COST. For a little over a decade chiropractic care has been delisted from OHIP covered services. Simply put, going to a chiropractor in Ontario is not like going to your medical doctor and “swiping” your OHIP card to cover the cost of the visit. People now have to find another means of paying. For the fortunate, they have extended health coverage through their employer (however even this is becoming less common) but there are a percentage of people without benefits who are left to pay out of pocket. But let me ask you a question, what is your health worth to you? What is more important, spending money on your health or spending money on “wants” like the newest toys, cigarettes, and fast food? Addressing the issue (that being pain & dysfunction) in it’s infancy (i.e. the acute stage) will be more cost effective in the long run compared to not getting treatment and having aches & pains linger until the issues are chronic or lead to other health effects. I’d recommend prioritizing what is most important to you but I caution you to put anything before your health. Lastly, I cite APPREHENSION as a reason you’re not seeing a chiropractor for your MSK complaints. In a 2017 article in the Canadian Chiropractor, Mari-Len De Guzman cites from a 2017 Canadian Chiropractic Survey that there still seems to be a “low trust-level from the public or medical community” towards chiropractors. Why is this? Is it because there is a fear of being adjusted, fear of having to “go forever”, and/or fear of lack of value (i.e. very short appointments). I see this with new patients, particularly from physician referrals as the patient is seeing me because their medical doctor advised them to. I don’t blame the patient though; rather I take it as an opportunity to educate them on what I call ‘The New Age of Chiropractic Care’. Gone should be the days of the “revolving-door” system of chiropractors seeing patients & the cookie cutter approaches for care. I’d recommend finding a chiropractor who comes highly recommended. One who will sit down with you & answer all of your questions until you are satisfied. In a world where research & technology is advancing at an exponential rate, how come our society isn’t healthier? Our health is the key to independence. And to stay independent you must feel & move well. If you are in (or near) the Niagara Region, I would love the opportunity to speak with you further about how we can work together to get you feeling your best & how my approach is different than the rest!
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Dr. Steven Scappaticci, B.Sc. (Hons.), CSCS, DC, FRCms
Who’s better? Michael Jordan or Lebron James? Which came first? The chicken or the egg? Who was more influential? Biggie or Tupac? So many great debatable questions but one debate that may exist between strongmen & yogis is, which is more important? Mobility or strength? As you read this, you may already have your mind made up based on your personal preferences but let’s not forget that the answer may vary depending on a person’s needs and/or age. Lets take a deeper look, shall we? What does mobility really mean? By definition mobility is the amount of 'active range' a person has when looking at a specific joint. This differs from flexibility, which is the 'passive (assisted) range' a person has. Mobility is a key piece to evaluate when it comes to movement, whether it’s in a gym setting or even just around the house. What makes mobility so important is that it is often the limiting factor when it comes to any movement. For example, someone can be super strong but if they want to perform a squat but only have 90 degrees of active hip flexion (mobility) but at the bottom of their squat the weight helps them get to 100 or 110 degrees of hip flexion, is that safe? Can they control themselves at the bottom of that squat? Isn’t mobility more important than strength here? Now one thing that is outside of a gym setting that shows the importance of mobility is the relationship that mobility has on our independence as we age. Seniors, assuming adequate visual and mental states, will require their mobility to be sufficient to be ambulatory as the years go on. Is it realistic for someone in their late 70’s to all of a sudden start working on their mobility and then feel young again? Probably not! What is more likely to happen is that each year their mobility will be less and less than the year before. If you don’t care about a gym setting, the relationship between mobility & age-related independence and it’s effect on quality of life should be enough to highlight its importance. But can someone really move if they don’t have the strength to do so? Isn’t strength more important? Some people spend a lot of time in the gym setting with specific training schedules aimed at improving their strength & hitting new personal records (PR) over time. Strength work can be a little more fun than mobility work. I mean its tough to get a PR for your mobility work. But once again, not everyone has the drive for strength in a gym setting. The more muscle mass you accumulate throughout the early stages of life the better you are at having muscle left when you’re in your 80s. The loss of muscle mass is known as sarcopenia & it will affect everyone over time. Strength training can help us build a nice reserve but more importantly help maintain & improve muscle mass as we age (as well as aid in bone mineral density). Having strength as we age also contributes to independence in the later years of life. Are someone’s legs strong enough to get the off the couch or off the toilet at 78? Are someone’s arms strong enough to push a vacuum? If Olympic lifting is not your thing, weight training for future independence should be enough motivation to put down the remote & pickup a dumbbell. So which is more important? Mobility or strength? Perhaps you’ve made up your mind. Maybe you’re thoughts have changed since reading this article. As it was alluded to earlier, the answer may vary from person to person depending on their age & needs. But regardless, everyone’s independence becomes more and more valuable as we age; and mobility & strength are both closely linked with long-term independence. Can you really have one without the other? For any questions, please contact Dr. Steven Scappaticci at drscapp@gmail.com Dr. Steven Scappaticci, B.Sc. (Hons.), CSCS, DC, FRCms As the spring weather is soon upon us, we will start to dust off of our bikes and baseball gloves. After such a long and blistery winter, there will be great desire to get outside and get moving!
Much like a machine that needs a tune-up after sitting for a while, our bodies are very similar. We can’t expect to jump back into running or playing softball if we spent the majority of the winter months cooped up inside. We may think we are still in last season’s “playing form” but there are changes in our strength and conditioning that we may not be aware of. Let’s take the example of someone in their early 30’s who is gearing up for yet another rec soccer season. In their mind, they may still think they are in their 20s and can play well without the proper due diligence of training & warming up. However, taking into account their lack of strength & conditioning in the off-season, they are perhaps at an increased risk for an injury. A hamstring strain, a sprained ankle, or even one of the common knee injuries may be sustained causing the individual to miss time from activity and address the issue. This is a simple, yet classic example but scenarios such as this exist in all sports. Even more interesting is how injuries can happen during spring-cleaning as well. Yard work, garage cleaning, and gardening may put demands on your body that you’re just not ready for at this point in the year. Lifting soil or trays of flowers can cause discomfort regardless if it’s a one-time thing or a repetitive movement. Proper treatment aimed at common musculoskeletal issues is always beneficial if something may arise, but why wait until something happens? Some work prior to activity targeting the muscles and joints is key! Whether it’s a soft tissue treatment, an acupuncture session, or mobility work, there are many options to get your body performing its best! Don’t wait until it’s too late! Lets work together today to get you moving and feeling your best today! Call or Book Today! By: Dr. Steven Scappaticci, B.Sc. (Hons.), CSCS, DC, FRCms Sciatica is a condition that has been around since ancient times [1]. Anywhere from 2-40% of people will experience sciatica at some point in their lives, depending on how sciatica is defined [2]. How do we define sciatica? Does the pain have to be down the whole back of the leg to the foot? What is the pain goes halfway down the back of the leg? How about just into the buttock? That’s the biggest point of this blog, the fact that sciatica is given to any pain down the back of the leg. But is it possible to have posterior leg pain and not have sciatica?
Sciatica is commonly characterized by pain down the back of the leg, particularly due to irritation of the sciatic nerve. The issue with this is that there are a number of conditions that can send pain to the back of the leg. In order to understand this we must review some basic anatomy. The sciatic nerve originates from the lumbar and sacral plexuses (network of nerves in the low back) to form the sciatic nerve proper deep within the gluteal muscles at the piriformis muscle [3]. It travels down the back of the leg and then divides further behind the knee (popliteal fossa) into two subsequent nerves (tibial nerve & common peroneal nerve) which then go on to supply the lower leg and split again [3]. Not accounting for any anatomical anomalies (such as the sciatic nerve piercing through the piriformis muscle) this is the general make up in all humans. We can see from this brief description how far the sciatic nerve courses from the low back to the lower leg & how many structures it engages with. This leads us into the long list of potential causes for sciatic-like symptoms. Starting within the low back, a patient can experience Lumbar Facet Syndrome/Irritation, in which the affected facet joint becomes irritated and can send pain into the lower back & buttocks. Speaking of joint referral (which is a form of sclerotogenous pain referral) the sacroiliac joint can also become irritated from a variety of sources and refer pain into the buttocks and posterior thigh as well. Circling back to the low back, any space-occupying lesion such as a disc herniation or tumor could be a source of sciatic-like symptoms as well. Their presence will disrupt the space surrounding the nerves & cause irritation. Similarly, nerve roots in the low back can become irritated, without the presence of a space-occupying lesion, in the case of lumbar radiculopathies and generate similar pain presentation into the buttock and posterior thigh. A more prevalent condition that can cause pain down the legs in older individuals is Lumbar Stenosis. This is where the spinal canal decreases in size and contributes to neurogenic claudication (which is obviously different from vascular claudication) highlighted by pain down the back of the legs. Moving away from the low back & osseous pelvic structures, we find ourselves deep within the pelvic musculature at the piriformis muscle. This muscle lies in close proximity to the sciatic nerve and in a very small percentage of cases the nerve actually passes through this muscle. A somewhat controversial, yet often talked about diagnosis is ‘Piriformis Syndrome’ where irritation of the piriformis muscle causes irritation of the nearby sciatic nerve. However, given this line of thinking, the sciatic nerve could be irritated by the close proximity of any irritated muscles, namely the hamstrings, posterior gluteus minimus, gluteus medius, gluteus maximus, and even muscles of the pelvic floor [4]. When some of these muscles surrounding the hip are involved, hip issue/pain can be ignored if the practitioner solely focuses at the sciatic like symptoms. As an interesting aside, the term “side-atica” is a presentation where pain is generated down the outside of the leg particularly by the gluteus minimus muscle, specifically the anterior fibers, according to Travell & Simons. Although this muscle garners most of the attention, there are a number of other lateral hip muscles that can cause this presentation as well. Some may say this discussion is splitting hairs but others may disagree and say that it is imperative to have a tissue-specific diagnosis. How frustrating would it be to treat locally at the site of pain (i.e. the posterior thigh) only when the real issue may be at a different site, the low back as an example. Specific diagnoses lead to specific treatments and specific outcomes! Now how does one treat the issue of sciatic-like pain? Well like many answers nowadays, it depends! There are many factors to take into consideration. What does the research suggest? What are the patient’s preferences? What does clinical experience point to? Is a referral or further imaging necessary? There are many questions and sometimes it’s not a black & white answer. What’s important is finding a practitioner who understands these things and will work with you to get you moving and feeling your best! References: [1] Ropper, AH; Zafonte, RD (26 March 2015). "Sciatica". The New England Journal of Medicine. 372 (13): 1240–8. doi:10.1056/NEJMra1410151. PMID 25806916. [2] Valat, JP; Genevay, S; Marty, M; Rozenberg, S; Koes, B (April 2010). "Sciatica". Best practice & research. Clinical rheumatology. 24 (2): 241– 52. doi:10.1016/j.berh.2009.11.005. PMID 20227645. [3] Drake, Richard L.; Vogl, Wayne; Tibbitts, Adam W.M. Mitchell; illustrations by Richard; Richardson, Paul (2005). Gray's anatomy for students. Philadelphia: Elsevier/Churchill Livingstone. ISBN 978-0-8089-2306-0. [4] Travell & Simons Myofascial Pain & Dysfunction The Trigger Point Manual Vol 2 Dr. Steven Scappaticci, B.Sc., CSCS, DC, FRCms The squat! Some love it, while some don’t but we all know it. Regardless of your stance on the squat exercise, it is one of the most functional exercises a person can do. Some individuals train for specific sporting events or for weight loss, however how about just training for regular life? Have you ever watched a toddler pick something up off the ground? Do they bend with straight legs? Do they ever have a hand on their back to help support them? NO! They squat down! This is a movement some take for granted, as many adults cannot properly move like this. Squatting regularly will make a world of a difference when you’re 80 years old and trying to get up and down on the toilet! Many variations exist when it comes to squatting. From the classic back squat, to the much more challenging overhead squat, there are various types to challenge your whole body. Some other common variations include: front-squats, goblet squats, cossack-squats, pistol squats…the list goes on and on. How many of us actually squat with true perfect form? The answer is essentially zero, especially as our reps/sets & weights increase. A “good squat”, when it comes to “form”, consists of utilizing multiple joints within the whole lower body, as high up as the lower rib cage/abdominals to as low as the foot (obviously!). This can be something people lack as they are not mobile in one area of their body and they have to compensate by using surrounding joints. In order to squat properly, one must have the proper “joint prerequisites” to do so. This means that adequate ankle dorsiflexion, knee flexion, hip flexion, lumbopelvic control…etc. are all required, and then some! Starting with the basics, one must brace and control their spine. What this means is that things need to be held tight but allow for controlled motion. Ideally we would like our low-backs to be very stabile during the squat via our “core”. At the same time we want to be able to control our spines during the motion. Often times people experience uncontrolled lumbopelvic motion at the bottom of their squat, and experience pelvic-tilting, often referred to as “butt-wink”. We also want to avoid any flaring of our ribcage or hyperlodosis of our lumbar spine. The whole movement should be initiated by “sending the hips back”, a phrase said very often by coaches in gyms. This helps to keep the knees from sheering forward significantly, which is often a culprit of pain in the front (anterior aspect) of the knee. The hips are a significant (but not the only) contributor to achieving squat depth. Sticking with the knees, it is important to keep the knees inline with the feet (which are usually turned out to help the hips move) or “out” and prevent them from caving inward. This will help to get those glutes nice and worked as well as prevent any pain on the inside (medial aspect) of the knee. Continuing down the chain, we want our ankles to move well for us (via dorsiflexion) so we can get down into the squat and not have the whole movement relying on the knees and hips to get us lower.
Previously, we talked about the knees caving in as we squat, which can also happen due to foot arch collapse. It is important to have strong intrinsic foot musculature to help prevent arch collapse and potential injury. It should be noted that there are a number of other factors that haven’t even been touched upon yet. Things like proper breathing technique and upper body joint prerequisites required for many of these squat variations, however these prerequisites vary for each type of squat (think shoulder flexion requirements for front squats vs. overhead squats) thus will not be described in detail here. So after all of this, perhaps a more complex movement than you may have initially thought, we see that the squat is an intricate maneuver yet the key to keeping your lower body moving well. After all, when it comes to mobility…if you don’t use it, you DO lose it! Interested in learning more? Perhaps you’d benefit from some mobility work? Get treated today! Call (905) 682-3447. By: Dr. Steven Scappaticci, B.Sc. (Hons.), CSCS, DC, FRCms Acupuncture is a treatment modality that has been around for centuries. With origins dating back to China in 100 BC, acupuncture now comes in many forms. The most popular form is that of Traditional Chinese Medicine (TCM). Having said that other types of acupuncture do exist, namely Contemporary Medical Acupuncture, Japanese Superficial Acupuncture, and the lesser known Cosmetic Acupuncture, just to name a few. Needles can be stimulated manually or electrically with or without the use of co-interventions such as moxibustion, herbs, and physical therapy.
This blog will not compare or make claims as to the efficacy of each one; rather it will focus on the scientific rationale that exists for Contemporary Medical Acupuncture – the method I practice, in an attempt to explain to the reader how acupuncture works. Regardless of the type of acupuncture practiced, all acupuncture ideologies use very fine needles. The quickest summation of the action of acupuncture, particularly Contemporary Medical Acupuncture is, “peripheral nerve stimulation with fine solid needles (with or without electricity) to induce physiological changes on the activity of the nervous system & its effectors, for therapeutic purposes” (McMaster Contemporary Medical Acupuncture, 2016). But what does that even mean? Before we answer that, we must understand that any pain we experience, whether it be emotional or physical, is experienced in the brain. Pain is in the brain! If we could control our brains, we could control our pain – obviously a feat much easier said than done. However, this is a good segway into the concept of Neuromodulation, which is the ability of the nervous system to regulate some of its own activities in response to external (exogenous) or internal (endogenous) stimuli. The body is the master compensator, meaning if it has trouble with a particular function, it will find the path of least resistance to perform that action in a different way. An example is when walking, if an individual cannot send their leg forward far enough while keeping their leg straight, the body may compensate by rotating the trunk to help move that leg even further. Why and how these things happen are not always fully understood at the neurological level, as we only know a small fraction of how the nervous system works and its capabilities. But back to the brain! In order to understand pain, we must first understand how the brain interprets pain (Note: I tried to explain things simply, with some extra information in parentheses). All pain that is sent to the brain (via afferent signaling) starts via pain receptors (nociceptors) that are found all over the body. Within our bodies, we have two main nerve types that carry pain information to the brain – C Fibers (diffuse & dull pain) as well as A-Delta Fibers (sharp pain) (Audette & Ryan, 2004). When there is a site of injury there is inflammation and a release of chemical substances in the tissues that can activate these pain receptors (nociceptors). Specifically, substances such as: Histamine, Protons, Bradykinin, & Substance P all act as pain receptor irritants. When the threshold for peripheral pain receptors becomes lowered, individuals become hypersensitive to pain (Hyperalgesia) (Audette & Ryan, 2004). When those peripheral fibres (i.e. in the arms, legs…etc.) relay the information to the back of the spinal cord (i.e. dorsal roots at multiple surrounding segmental levels) the signal actually crosses to the other side of the spinal cord before the signal is sent to the brain on the other side of the body (via lateral spinothalamic tract to the sensory cortex on the opposite side of the body) (Audette & Ryan, 2004). So for example, if your left elbow hurts, that sensation is actually interpreted by the right side of the brain! Isn’t that cool? Now when someone sprains their ankle, there’s often swelling and bruising present and the signs of injury and inflammation are obvious. But what happens when a patient complains of that left elbow pain but when you look at their elbow you do not see those classic signs of inflammation? Well this brings us to the topic of Neurogenic Inflammation, which essentially means that there are substances (listed above) that are lingering due to the trauma that are causing that pain, despite to overt signs of swelling & bruising. This along with some cellular (histological) changes in the tissue cause pain such as this to exist. So how do we neuromodulate to decrease pain signaling? It is important to target neuro-reactive sites. These sites generate signals to the brain (neural sensory afferent input) that elicits neurological responses with therapeutic value. These sites can be found everywhere throughout the body in sites such as: neuro-vascular bundles, motor points (this is a big one!), muscle-tendon junctions, joint capsules & ligaments, and more. As per my education and training, a three level approach is often best when treating pain. First, treating the Local peripheral tissues (i.e. the affected shoulder, elbow, knee…etc.) is essential. Next the Spinal Segmental (spinal cord) levels that supply the affected area are targeted. So if someone were having shoulder pain, it would be beneficial to not only insert needles in their shoulder but also insert needles in the muscles of the neck (at the levels of C4, C5, & C6) as these spinal levels supply the joint, muscles, & skin. Lastly, it is important to target what are called Supra-Spinal level. These are points used in the distal limbs (i.e. hands, feet) to attempt and affect the areas of the brain that deal with chronic pain and emotion. Skipping over the biochemical nature of the resultant physiology involving acupuncture for simplicity sake, some of the goals of an acupuncture treatment include: increasing blood flow to the tissues (perfusion), increasing strength of the muscles (strength), improved joing awareness (proprioception), and decrease pain signaling (nociception) (McMaster Contemporary Medical Acupuncture, 2016). All of these contribute to decreased pain and improved function. For some who are reading this blog, it was all brand new information. It is a very large topic, as there were some aspects I didn’t touch upon. For others it may be a refresher of pre-existing knowledge. Regardless, I hope you can take a few things from it. If you have any questions or comments, I would love to hear from you! References Joseph F. Audette, Angela H. Ryan. The role of acupuncture in pain management. Physical Medicine and Rehabilitation of North America 2004;15:749-772 McMaster University: Contemporary Medical Acupuncture Program. (2016). Written By: Dr. Steven Scappaticci, B.Sc. (Hons.), CSCS, DC, FRCms
Do you ever have one of “those” mornings? The one where nothing goes right and you get off to a bad start? Maybe you hit snooze one too many times, took forever to pick out what to wear, spilled your coffee, or got stuck in traffic? Generally these tend to occur on Mondays but the remaining days of the week are not immune to it either. It is mornings like these that set up the rest of the day to be a struggle. These are the kinds of mornings where just one cup of coffee won’t do! Wouldn’t it be great if by 8 or 9am you had accomplished so much and felt good about your day? I know for me it does! What helps me feel this way is a morning routine (also referred by some as a morning ritual). Something as simple as accomplishing a few things in the early hours of your day can have a profound impact on your mood and the rest of your day. The great thing is that your routine could include anything. It doesn’t have to be super complicated, just as long as it includes a few tasks to help start your day on a productive note. Things that your morning routine can include are: going to the gym or working out at home, going for a walk around the neighborhood, making your bed, packing a healthy lunch, flossing…etc. The list can literally go on and on. Some would even say that what you do is not even as important as simply just doing a few things. It doesn’t matter if your routine includes running 10km and then prepping a gourmet lunch versus making your bed and flossing your teeth. The principle is the same. Having a somewhat structured morning allows for tasks to be completed and gives you a sense of accomplishment before even going to school or work. If you’re in your mid-twenties and single your routine may differ from someone who is in their mid-forties with two children but you would both have a routine. But age does not matter! In fact, those children can have their own routine too. Sure it may not involve going to the gym at 6am, but if they made their bed, packed a nutritious lunch, and maybe did one educational thing before catching the bus (i.e. educational flashcards) they would be off to a way better start than someone in their cohort who gets to school half asleep. Parents can incorporate their children in their routine as well so both are feeling accomplished. What is my routine you ask? Well my alarm is set for 6am, and I’ll admit I hit snooze a time or two (or three) but I am at the gym for 7am. After getting my butt kicked for an hour by a vigorous workout, I head home and enjoy my reward, two espressos (my only coffee intake for the day). If time permits, I will catch up on the sports world by watching a little Sportscentre before getting cleaned up, packing a lunch, and off to work. So before even stepping into my office, I’ve gotten my recommended daily exercise, made my bed, and packed a healthy lunch. These are small but important victories. This also frees up some time later in my day. For example, by going to the gym before work, I free up time at night where I would have normally gone to the gym. To fill this time at night, I can read, cook, spend time with family & friends, or simply relax and reflect on a productive day. Similarly, you can have routines for other parts of your day as well. Maybe when you get home from work, you feel unproductive. Perhaps incorporating a evening routine will make you feel more productive. Things like, organizing/cleaning one room of your house each night, doing 30-60 minutes of yard work each night (weather permitting), meal prepping for tomorrows lunch. Once again, the list goes on. Now you may be thinking that this is going to get boring really quick! To do the same thing day in and day out with little variation can get boring. I completely understand. And for those of you who feel this way, I suggest alternating your routines. Have a different routine for different days of the week. Make it simple by doing tasks ‘ABC’ on Mondays, Wednesdays, & Fridays and complete tasks ‘XYZ’ on the other days. Similarly, you can have different routines based on the seasons. In the summer, you can spend more time outside doing different things before/after work than you would do in the winter. Variability is possible and within your control! A morning routine can be the difference between starting your day with a sense of accomplishment and enthusiasm versus a grumpy mood and the need for a third cup of coffee. It makes a difference, believe me. I encourage you to try it for a month and let me know what you think! We all have 24 hours in a day, how you choose to use them is your choice. No excuses! Dr. Steven Scappaticci, B.Sc. (Hons.), CSCS, DC, FRCms
Gone should be the days of those stereotypical appointments. The appointments where the chiropractor walks-in, asks how you’re doing, “cracks your bones” from head to toe, and walks out within 2-3 minutes. Although there are some patients that may be fine with that, others feel that they are not getting the care they need or value for their money. I have found this out many times, somewhat anecdotally, when asking about a patient’s previous chiropractic experience. Now we are seeing clinics that offer various lengths of appointments ranging from 15 minutes to 1 full hour. Of course the price changes with each increase in duration but let’s not forget that you are investing in your health, arguably the most important aspects of our lives. Historically, chiropractors have been seen as the healthcare professional to seek when one is experiencing neck or low back-pain. However chiropractors should not be limited to solely spinal complaints. With an extensive knowledge of the musculoskeletal (MSK) system, chiropractors treat essentially all joints and surrounding structures. Chiropractors are often seen as MSK specialists, so next time you sprain you ankle, don’t think that a chiropractor can’t help you. Today’s graduates are applying a multimodal approach to care, which is great to see. Taking the previous framework of primarily adjusting and also incorporating modalities such as soft tissue therapy, acupuncture, laser therapy, and rehabilitation just to name a few. Similarly, less and less chiropractors are sending every patient for X-Rays or putting the patient on yearlong treatment plans. It is these changes in patient treatments that improve the patient experience, the reputation of chiropractors, and in turn build and/or strengthen relationships with other health care professions such as medical doctors and physiotherapists. This may have had some influence on the increasing shift of chiropractors working in multidisciplinary settings. I enjoy spending time with my patients. I feel it gives practitioners the opportunity to listen/learn from the patients and really hone in on an area or even target multiple areas/issues. It also allows for practitioners to use all the “tools in the toolbox” from soft tissue therapy to acupuncture, effectively implementing a multi-modal approach to care. My tip for you (the patient) is to ask as many questions as possible. Ask how the chiropractor treats and what services are offered. Do this to see if treatments meet your needs/expectations. In closing, chiropractic care is going in the right direction. Better treatment durations for patients, better utilization of treatment modalities, and less stereotypical “tactics” being used. All contributing to the most important factor – better patient outcomes! Dr. Steven Scappaticci, B.Sc. (Hons.), CSCS, DC, FRCms is a chiropractor in St. Catharines, ON. He aims to implement a multi-modal, evidence-based, patient-centered approach to care. His goal is to work with you to get you feeling better and moving better. Dr. Steven Scappaticci, B.Sc. (Hons.), CSCS, DC, FRCms Part 3: Aerobic Training The third and final part of my 3-part series on exercise focuses on aerobic training, commonly referred to by many as “cardio” (although there are variations and combinations). To have everyone on the same page, aerobic exercise commonly refers to any activity that causes the body to require oxygen for its metabolic processes. Generally exercises that are carried out for extended periods of time are regarded as “aerobic” (e.g. running) where as exercises that are shorter in duration are categorized as “anaerobic” (e.g. strength training). Of course when intensity of exercise changes, so may these processes. It should be noted that both aerobic and anaerobic processes are active at any given time. The Canadian Society for Exercise Physiology (CSEP) has physical activity guidelines for multiple age groups. In the majority of these age groups, there are recommended amounts of aerobic exercise that individuals should be obtaining. The majority of the population (those ages 18-64) should be attaining a minimum of “150 minutes of moderate- to vigorous-intensity aerobic physical activity per week, in bouts of 10 minutes or more”. This may sound like a lot but lets simplify things. This means that over a span of 5 days, it would only take 30 minutes/day. And to make things simpler, you don’t necessarily have to do all 30 minutes at once; it can be broken up into two 15-minute sessions (perhaps before work and before dinner) or even three 10-minute sessions. The activity could be anything from a brisk walk to going for a run. I know going on the treadmill for 30+ minutes may not be everyone’s preferred method of aerobic training, so try and find what works best for you. For me, I prefer to partake in sport-specific activities such as playing weekly ice hockey or basketball at the gym. Everyone can spare 30 minutes in their day. Skip that extra half-hour of TV and go to the gym. Or if you really can’t get out of the house, invest in some form of equipment (e.g. treadmill, elliptical, or stationary bicycle), it will pay off in the long run!...no pun intended The health benefits are numerous, in that there is a reduced risk of: premature death, heart disease, stroke, high blood pressure, certain cancers, type 2 diabetes, osteoporosis, and obesity. For those who have stayed with me through this entire 3-part series, first off I thank you for doing so. I hope you’ve learned a thing or two, been motivated to improve your current habits or encouraged someone else to improve their lifestyle. To end this blog I will leave you with the following quote: "What if there was one prescription that could prevent and treat dozens of diseases, such as diabetes, hypertension and obesity? Would you prescribe it to your patients? Certainly." - Robert E. Sallis, M.D., FACSM, Exercise is Medicine® Task Force Chairman For more information, please visit http://www.csep.ca/home Tip: Try to make it sport-specific (i.e. biking, soccer, tennis…etc.) or with young ones to get your daily dose of aerobic exercise. Note: Consult with a health care practitioner before starting any new exercise regime. Similarly, if you have any joint pain, get examined/treated before putting that joint through any form of training. Dr. Steven Scappaticci, B.Sc. (Hons.), CSCS, DC, FRCms Part 2: Resistance Training Whether it’s training with body-weight, resistance bands, or free weights/machines, the benefits of resistance training are bountiful. Gone are the days where resistance training (commonly referred to as weight training) was seen as something solely for the Arnold Schwarzeneggers of the world. Almost everyone can benefit from weight training in one way or another. Before getting into more detail, I want to express the importance of mobility training that I highlighted in Part 1 of this 3-part series. Being able to control your joints when moving is essential before loading those joints from an external source such as a resistance band or free weight. Interestingly enough, weights such as kettle bells can often be used in the progression of mobility work, which is the perfect segway into our topic of resistance training. As mentioned above, there are many ways to provide resistance to your body movements. Using your own body weight is a great way to master the movements that are needed for a particular exercise (i.e. squat) as well as being beneficial for warming up. Resistance bands and free weights provide additional load and stress multiple periarticular structures. It is important to know where to start and what your body needs before jumping into “Clean & Jerks”. There are numerous health benefits that are associated with resistance training. Len Kravitz, Ph.D., has nicely summarized the adaptations and health implications of resistance training. Specifically, Dr. Kravitz mentions favorable adaptations involving muscle fiber size, muscle strength, bone composition (more on this below), body composition, heart rate & blood pressure, lipoproteins, and glucose metabolism. A number of these are important in preventing chronic diseases such as: cardiovascular disease & diabetes mellitus. The Canadian Society for Exercise Physiology (CSEP) has physical activity guidelines for many age groups. In a majority of these age groups, resistance training is included. It provides an increase in muscle mass and bone density for those that are still developing (i.e. 18 years old), while maintaining muscle mass and bone density for those who are older (i.e. 40 years old). Even more important is the incorporation of resistance training for the elderly, as it helps to prevent muscle loss (sarcopenia) as well as bone loss (osteopenia). In fact, when those who are diagnosed with osteoporosis are given a type of exercise to try and keep their bones healthy, the exercise they are given is weight-bearing exercises. Overall, the benefits of resistance training are important to your health. You don’t have to be the one lifting the most weight in the gym, just as long as your body is challenged a bit. Tip: When starting out, it may be beneficial to work with a personal trainer, strength coach, or an experienced partner. Note: Consult with a health care practitioner before starting any new exercise regime. Similarly, if you have any joint pain, get examined/treated before putting that joint through any form of training. |