Dr. Steven Scappaticci, B.Sc. (Hons.), CSCS, DC, FRCms

In the following 3 part series, I will highlight some of the more common forms of exercise that are out there along with their benefits. As you’re reading through, try and see if there’s a particular type of exercise that interests you. Now before someone comments that I forgot to include circuit training or some other combination, remember that this is just highlighting broad categories of training, a starting point, if you will. If any colleagues are reading this, remember that this blog is meant to educate those who have not studied these topics. 

Part 1: Mobility
            What is mobility training? To answer that question we need to understand what mobility really means. Mobility is one’s ability to actively move and control their body. Mobility and flexibility are often erroneously used interchangeably. Flexibility differs in that it is the amount of passive range of motion a person has. Why is this difference important? Well someone can be flexible but not very mobile.
            For example, think of someone lying on their back with their legs straight on the floor. A therapist comes by and lifts the persons’ leg to about 90 degrees then places the leg back down on the ground. The therapist then asks the person to actively lift the same leg. The therapist notices that the person can only lift their own leg to approximately 45 degrees. Here we see the difference between flexibility and mobility. This person is flexible but not mobile.   
            Now why is this important? Well if the individual in the previous scenario decided to perform some form of activity at the gym, particularly a weighted exercise (i.e. squat, deadlift), they are at a greater risk for injuring themselves. Without the proper “joint-prerequisites”, surrounding joints have to compensate for the lack of mobility, which increases the risk of injury.
            The topic of mobility is important for athletes (as we saw above), however mobility is key for everyone! Mobility is what keeps us feeling young and loose. It is important to maintain our mobility as we age since there is overlap between mobility and independence.          
            The reason Mobility is Part 1 of 3 is because it is the foundation. We often need to relearn how to move before even thinking of adding weight to the equation. Why do we need to relearn how to move? Well picture how an infant moves and how mobile they are (i.e. how they would pick a pencil off the floor). Now think of the average workday for a North American individual – drive to work, sit at a desk for 8 hours, come home to sit and eat dinner and relax on the couch, go to bed and repeat. Our bodies adapt to our environments and when our environments do not require movement or mobility, we lose it!  
            People often ask me, “mobility work? Is that like yoga and pilates?” Programs such as yoga and pilates are great but mobility programs often involve a higher intensity depending on the phase/goal of training.
            A good mobility program is one that hones in on each joint, more so the areas that need greater attention, with the ability to progress to more challenging exercises over time. Find a mobility specialist to help you reach your mobility goals!    
 
Tip: Whether it’s during your warm-up, cool-down, in-between sets, or it is your actual workout, implement mobility work as much as possible, as well as throughout the day.   
 
For more information check out Functional Range Conditioning & www.functionalanatomyseminars.com    
 
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. 

By: Dr. Steven Scappaticci, B.Sc. (Hons.), CSCS, DC

Ever find that you have trouble falling asleep? Maybe when you wake up, you don’t feel rested and refreshed. Here are seven tips to help you get a better night’s sleep! (Note: these are general tips and may affect people differently)
 
1. Exercise Daily          
              Remember as a kid, you’d play outside all day and then come bedtime once your head hit the pillow you fell asleep immediately? How about the phrase, “I slept like a baby”? The more vigorous the exercise during the day, the stronger the sleep benefits – but even light exercise (i.e. walking for 10 minutes a day) can improve sleep quality. It should be noted that some people may have trouble falling asleep if they work out too soon before bed (due to increased metabolism, body temperature, and certain hormone levels). If this occurs, aim to exercise earlier (i.e. at least 3 hours before bed).
 
2. Cut Down On Caffeine                       
         Caffeine affects everyone differently. It may affect some individuals for up to 10-12 hours after consumption. It can contribute to keeping you alert and awake longer than you’d like. Consider cutting down on cigarettes, alcohol, and big meals before bed as well, as these can disrupt your sleep.
 
3. Turn Off Smartphones & Other Electronics                       
              Melatonin is a hormone that helps regulate your sleep-wake cycle. Your brain releases more melatonin when it’s dark, making you sleepy. At night it is suggested to avoid bright screens within 1-2 hours of your bedtime as the blue light emitted by your phone, table, computer, or TV can be disruptive. Also, try skipping on watching late-night television, as these can be more stimulating than relaxing. Try listening to soothing music or audio books instead. If reading before bed, try not to use a tablet that is backlit as they are more disruptive than e-readers.
 
4. Get Into a Routine
                  Going to bed and waking up around the same times each day help set your body’s “internal clock”. Choose a bedtime when you normally feel tired, so you don’t toss and turn.  
 
5. Decrease Your Stress                       
                  The use of relaxation techniques can help to wind down, calm the mind, and prepare for sleep. Some techniques include: deep breathing, progressive muscle relaxation, and visualizing a peaceful place.
 
6. Create A Calm & Relaxing Sleep Environment    
           This can help to calm oneself in preparation for bed. Tips for improving one’s sleep environment include: keeping noise down (e.g. noise from outside or even from within the house), keeping your room cool (~18 deg Celsius), and ensuring that you have a comfortable bed.
 
7. Stay Out of Your Head           
             Ever lie in bed at night and remember something you did long ago? Maybe you wish you could go back and change something. Are these the things that are keeping you up at night? These are unnecessary factors that can prevent you from falling asleep. Try and clear your mind with relaxation techniques to help you get to sleep faster and stop thinking of the past. 
​
            There are many other tips out there but hopefully these help you start to get a better nights sleep. Feel free to progressively include these into your daily life to see what works for you!
 

By: Dr. Steven Scappaticci, B.Sc. (Hons.), CSCS, DC

“Where you think it is, it ain’t” – Ida Rolf
 
            A patient presents to your office with tingling into their right hand. They have spoken to a co-worker that had a similar complaint and after a quick Google search, they are convinced it is Carpal Tunnel Syndrome.
            You understand where they are coming from, but given the complexity of the surrounding structures, you highlight the importance of a thorough physical examination to rule in or out other possible diagnoses.
            Speaking of other diagnoses, when it comes to “hand tingling” there can be a long list of differential diagnoses. The more common differentials include: Carpal Tunnel Syndrome, Pronator Teres Syndrome, Anterior Interosseous Syndrome, Thoracic Outlet Syndrome, Brachial Plexopathy, Cervical Radiculopathy (C6), Diabetic Neuropathy, Ulnar/Radial Neuropathy, Fracture, Tumor/Cyst. The list goes on and on.
            To help narrow down the list of differential diagnoses, a proper history and physical exam are imperative. The patient is a carpenter and tells you that for the last few weeks they have been working many more hours than usual in order to prepare for the holiday season. Their hand complaint is located closer to the thumb and index finger. They find that by midday, they can barely use their screwdriver anymore as the symptoms flare up. (Note: No trauma has been sustained and the patient is otherwise healthy)     
            As you are progressing through the physical exam you note that there is a significant amount of tenderness over the proximal anteromedial aspect of the right forearm. You ask the patient to resist you moving their wrist/forearm and find that there is moderate weakness as you test their ability to pronate (Note: They are able to make the “OK” sign (Pinch Test) with their thumb and index finger with adequate strength). Continued palpation of the pronator teres reproduces their chief complaint. Given the motor and sensory deficits, lack of cervical spine (neck findings), unremarkable health history, and no trauma, you are lead to a diagnosis of Pronator Teres Syndrome. (Note: Tinel’s at the Carpal Tunnel and Guyon’s Cannal were both unremarkable)  
 
            Now this is a fictional and simplistic (although entirely possible) presentation, however the purpose of this was to highlight the importance of differential diagnoses, as well as a thorough history and physical examination.   
            Human anatomy is complex and never as neat as it appears in textbooks. Lets remember that the nerves that supply our shoulders, arms, and hands all stem from our necks, thus one may need to examine along the course of a whole nerve/limb to find the true source of the issue.
            In this particular case, it was the median nerve that was affected, specifically within the two heads of the pronator teres. The median nerve however, arises from the lateral and medial cords of the brachial plexus (thus injury to either one of these can lead to potential symptoms) and enters the axilla (armpit). It continues downwards between 2 muscles (biceps brachii and brachialis) until it crosses the cubital fossa (elbow). The median nerve passes between the heads of the pronator teres as mentioned earlier before travelling between even more forearm muscles and dividing to supply the rest of the forearm and hand.
            If the practitioner in this example had agreed with the patient right off the bat (unlikely) or if they had only focused on the median nerve at the carpal tunnel, it could have potentially lead them down the wrong path with the wrong diagnosis and would have wasted the patient’s time. This emphasizes the quote below that I will end this post with.
   
“Specificity of Assessment = Specificity of Treatment = Specificity of Results”
 Dr. John Saratsiotis
 
(Note: the listing of all specific history findings and orthopedic tests were purposely omitted for this post, as to not give the diagnosis away early on in the blog)      

How to Avoid Poor Workplace Ergonomics!
Dr. Steven Scappaticci, B.Sc. (Hons.), CSCS, DC
 
            In the last century, our society has moved from an industrial setting with physical labor jobs involving variable work settings to post-industrialization with stationary jobs and more sedentary lifestyles. It is not uncommon for most people to get up out of bed, drive to work, sit for 8 hours, come home to relax on the couch, go to bed, then repeat.  
            Nutrition and exercise aside, the focus of this post is to focus on what can be done at work to prevent you or someone you know from developing musculoskeletal (MSK) pain due to the time spent in your work environment. You may spend 8 hours (or more) at your desk, which equates to approximately 2,000 hours a year at your desk, or the equivalent of 83 days!
 
So here’s what you need to know!
 
Overview
            With proper office posture and workspace setup, someone can work for many years without any major residual effects. However, when office posture or workspace design are compromised, many MSK injuries can arise.   
            Some even say that there are 3 stages of ergonomic work-related MSK injuries. These 3 stages are as follows.
Stage 1  - mild discomfort, present while working, but disappears when not working.
Stage 2 - involves pain being present while working and continues when not working but is REVERSIBLE with care.
Stage 3 - pain is present all the time and work is affected. Injury is not likely reversible but can improve (but not to a full recovery).

​SEATED POSTURE

​The image above depicts the “ideal” posture while sitting in a chair. It should be noted that there is no posture that is ideal indefinitely. It is advised that you change your position and posture frequently by adjusting the position on the chair and alternating tasks.

CHAIR SETTINGS
Height - Highest point of seat just below kneecap; Feet should rest firmly on the floor; Distribute weight evenly
Back Support - Lumbar pad should support natural lordosis
Seat Tilt - 5 degrees is recommended
Depth - Use the back support without your knees touching the seat
Width - Shouldn’t apply pressure to your thighs
Armrests - Should be adjusted to elbow height

​WORK SURFACE

The image above shows that the further things are from you on your desk, the less frequently they will be used. The top of your work surface should be at your elbow height. One many need to raise their chair to get to this level. A keyboard tray can be used to bring the keyboard and mouse to elbow height. It is suggested that one should arrange work materials in a semicircle shape. 

​                                                      INPUT DEVICES
Keyboard - Make sure it is in a neutral position to reduce MSK injuries.
Mouse - Same level as the keyboard; Helpful if you switch the side of the keyboard its on

MONITOR

DISTANCE - 60-90 cm away (farthest away as possible) 
HEIGHT & LOCATION - Just below eye level, tilted 15 degrees
Lighting & Glare - 300-500 Lux, Test for Glare, Take regular eye breaks​

            The image above highlights the appropriate set up of your computer monitor.  If you wear bifocals, the monitor should be set even lower. Most offices lighting are set to 1,000 lux. To test for glare, turn off your monitor. If the screen provides reflections, you have glare! Workers should get into the habit of taking your eyes off the screen every few minutes and focusing on something far away. You can also move your eyes up and down, and side-to-side without moving your head. This will help to decrease eye strain. 

Other Accessories
Palm Rest/Support - Keeps wrist in neutral position BUT only use while resting or for short breaks.
Phone - Use a Headset/Speakerphone

Computer and Desk Stretches
            Below are stretches that workers can do every hour. It is also suggested that workers get up and walk around the office whenever they can. 

Reference
Office ergonomics – Guidelines for preventing musculoskeletal injuries. (2010).        Workplace NB.  http://www.worksafenb.ca/docs/officeedist.pdf 

Why you shouldn't fear chiropractic manipulation of the neck
Dr. Steven Scappaticci, B.Sc. (Hons.), CSCS, DC

                  I have had numerous patients present with chronic neck pain and the first thing they say to me is “I don’t want my neck cracked”. They often dislike the “cracking” sound or have heard stories through the grapevine about neck adjustments that make them want to avoid them altogether. I can understand a patient’s concern when it comes to having their neck manipulated. For someone who has never experienced it before, there may be uncertainty as to what to expect, or perhaps they’ve read “horror stories” in an online forum about stroke and chiropractic care.
 
            However, there has been an extensive amount of research conducted regarding neck manipulation and the possible adverse events associated with it, namely stroke. It should be noted that there are no known premanipulative tests that are effective for determining if someone is or is not a candidate for neck manipulation, according to Dr. Pierre Cote, a prominent Canadian researcher. Tests such as Houle’s, Wallenberg’s, and deKlien’s tests, aim to assess the patency of the vertebral artery, often by placing the patient’s head in an extension-rotation position. These premanipulative tests are not valid and have not been shown to improve health, as they do not meet any of the criteria to be implemented in clinical practice (Cote, 1999).     
            So if there are no manual tests, what can chiropractors do to ensure the safest practice measures when adjusting the neck? Well, first and foremost, a proper and thorough history (i.e. DAN questions for all my colleagues) and physical exam, which includes vitals (i.e. blood pressure and pulse) as well as assessment of known risk factors for stroke some of which include: hypertension, smoking, atrial fibrillation, previous transient ischemic attack, and diabetes mellitus (Cote, 1999).
            Dr. Cote emphasizes that a key piece to providing proper care is the explaining and obtaining of the Canadian Chiropractic Association’s (CCPA) informed consent. The consent form states that current medical and scientific evidence does not establish that chiropractic treatment causes either damage to an artery or stroke. What commonly occurs, is the artery is already damaged and the patient was progressing towards a stroke when the patient consulted the chiropractor (as stroke may present as a headache and/or neck pain). This is referred to as a “stroke-in-progress” and can happen whether one seeks care from their medical doctor or their chiropractor. Regardless of the practitioner, it is up to them to do everything they can to rule out the possibility of a stroke-in-progress. The process of obtaining consent allows for the patient to be fully aware of all the risks and gives them the opportunity to ask any questions.
 
            As for the efficacy of neck manipulation, Gorrell & colleagues (2016) conducted a study assessing the effects of two different cervical manipulation techniques for mechanical neck pain (manual manipulation vs. instrument-applied manipulation). The study found that manual manipulation provided improvements in subjective pain scores and neck range of motion at the 7-day follow-up. Interestingly the study demonstrated that not all manipulative techniques have the same effect on outcomes, which can be seen in the results between manual manipulation and instrument-applied manipulation.   
 
            Circling back to my chronic neck-pain patients, I always assure them that if they do not want their neck adjusted, I understand their concern/preferecnes. Although I may recommend neck manipulation and may include it in the treatment plan, I always list them many other forms of care that I can offer them to treat their neck pain some of which include: mobilizations, acupuncture, soft tissue therapy, and rehabilitation. 
 
            I hope this blog has helped to educate the reader and perhaps settle some myths about neck adjustments. If you or someone you know are suffering from neck pain, I encourage chiropractic care to be sought.
 
Dr. Steven Scappaticci, B.Sc. (Hons.), CSCS, DC is a chiropractor at AEGIS MD. He aims to implement a evidence-based, multimodal, functional approach to care. His goal is to work with you to get you feeling better and moving better.  
 
Reference:
 
Cote, Pierre. (1999). Screening for stroke: let’s show some maturity. Journal of the    Canadian Chiropractic Association. 43(2), p 72-74. 
 
Gorrell, LM; Beath, K; Engel, RM. (2016). Manual and Instrument Applied Cervical    Manipulation for Mechanical Neck Pain: A Randomized Controlled Trial.        Journal of Manipulative and Physiological Therapeutics. 39 (5), 319-29.