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Dr.Crystal Draper

Toronto Chiropractor


by Crystal
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Breastfeeding Posture: Finding the Right Fit for You and Babe!

Breastfeeding is truly an art form. There are so many moving parts while learning to master this new skill. Mothers want to be sure their babe is latching properly, that they’re getting enough milk and that they’re comfortable. During this time, moms lose sight of their posture and can end up with some aches and pains of their own.

Musculoskeletal pain is common among moms who breastfeed while sitting or lying in bed. Usually the pain is mild and experienced in the neck, shoulders and back. But, there are ways that mom can make it easier on herself while still providing comfort for her little one.

Here are some posture tips to ensure everyone is comfortable!

The Cradle Hold

  1. This position is when you sit with baby lengthwise across your abdomen with your elbow (on the same side as the feeding breast) supporting baby’s head and hand supporting their bottom. Your other hand supports your breast.
  2. In this posture, you want to lay pillows on your lap to raise your baby up to appropriate nipple height. This will prevent you from hunching over in attempts to bring your nipple to baby. Instead, bring baby to nipple.
  3. For additional comfort, sit in a chair with supportive armrests and rest your feet on a stool to help elevate the little one and to avoid leaning down towards them.

The Cross-Cradle Hold

  1. This position differs from the Cradle Hold in that you support your baby with your opposite arm (to the feeding breast). For example, if you’re feeding on your left breast, use your right arm to support baby’s body and head. Your left fingers support the left breast.
  2. Similar to the Cradle Hold, you want to lay pillows on your lap to raise your baby up to appropriate nipple height, sit in a chair with supportive armrests and use a stool to rest your feet.

The Clutch or Football Hold

  1. As the name suggests, you position the baby like a clutch or football tucked under your arm.
  2. In order to remain comfortable with this hold, you want to sit upright with your back and shoulders well-supported.
  3. Place a pillow on your lap, towards the side of your hip and baby on the pillow facing you.
  4. Tuck baby’s legs and feet under your arm (like a purse or pigskin) and bend them slightly at the waist.
  5. Place your hand under the babe’s neck for support. Once they begin sucking, you can place a pillow under your hand so you are both supported.

Reclining or Side-lying Position

  1. This position is comfortable for feeding during the night but requires many pillows for support. You want to place several pillows behind your back, a pillow under your head and shoulders, and another one between your bent knees to ensure you maintain a neutral spine. An additional pillow should be placed behind baby as well.
  2. You are then going to lay baby facing you with their mouth aligned to your nipple and their head cradled with the hand of your bottom arm. Or, cradle the head with your top arm, tucking your bottom arm under your head, out of the way.
  3. If you need to bring baby closer to your breast, use a small pillow or blanket to prop them up. Neither of you should be straining in order to connect with one another.

Laid Back Position

  1. Similar to the side-lying position, this feeding position also requires the use of lots of pillows as good posture and support is crucial.
  2. You want to lie flat on your bed and elevate your head and shoulders slightly with pillows.
  3. Place your baby’s face down onto your stomach with their cheek to your breast.
  4. Again, make sure that neither of you are straining. If you are, tweak the position by using pillows or blankets for support.

The general idea with all of these positions is comfort and support for both mom and baby. If you are leaning in towards your baby, you will end up with a sore neck, shoulders and back, poor latching and sore nipples. All of these outcomes are going to make your breastfeeding experience a more difficult one for you both. So, use pillows, blankets, and stools, whatever you need to ensure comfort, support and an all-round positive bonding experience with you and your little bundle of joy!

Disclaimer

The advice provided in this article is for information purposes only. It is meant to augment and not replace consultation with a licensed healthcare provider. Consultation with a Chiropractor or other primary care provider is recommended for anyone suffering from a health problem.

References

Mbada, C.E. Is Baby-Friendly Breastfeeding Mother-Friendly? Journal of Women’s Health Physical Therapy. 2013; 37(1):19-28.

O’Brien, T. The Best Breast Feeding Positions for Mom and Baby. Parents. <http://www.parents.com/baby/breastfeeding/basics/the-best-breastfeeding-positions-for-mom-and-baby-/> (visited March 13, 2014)

Positions and tips for making breastfeeding work. Baby Center. <http://www.babycenter.com/0_positions-and-tips-for-making-breastfeeding-work_8784.bc> (visited March 21, 2014)

Smith, R. Breastfeeding Positions. Shird Inc. 2013.


by Crystal
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To Crack or Not to Crack, That is the Question: Is Chiropractic Care Safe in Pregnancy?

Musculoskeletal pain is very common in pregnancy, especially low back pain, as we learned in Low Back Pain and Pregnancy: Growing Pains. However, many expectant moms are confused about what to do about their pain. They don’t want to take medication and are unsure if it’s safe to see a Chiropractor while pregnant. As a result, most moms do nothing and just live with the pain. But, they don’t have to! Chiropractic care, including the adjustment (spinal manipulation), is a highly safe and effective evidence-based treatment for mommy’s-to-be.

The Research

Clinical studies have demonstrated a high level of safety for Chiropractic treatment in pregnancy. Most studies have found very few adverse effects of spinal manipulation, especially for the treatment of low back and pelvic pain in pregnancy.  Those that were identified consisted of mild and short-term events such as a temporary increase in pain following treatment. These side effects are not isolated to the pregnant population, but can be general effects of Chiropractic treatment or manual therapies in anyone.

However rare, more serious adverse effects of spinal manipulation in pregnancy have been reported with neck adjustments. This is thought to be a result of the hormonal changes of pregnancy. With the release of relaxin in pregnancy, there is an increase in joint laxity, increasing the susceptibility to injury.

Making Safe Choices

With these cautions in mind, your Chiropractor will perform a careful and thorough history and physical examination to ensure safety and assess for possible contraindications to treatment.  If contraindications are present, other treatment options can be explored by you and your practitioner, including acupuncture, gentle mobilizations and massage therapy, to name a few.

Most importantly, of the potential concerns that have been identified, none affect your growing babe! There is reassurance in knowing that safe and effective treatment options exist during pregnancy and that pain relief is possible. Please talk to your Chiropractor or health care provider to discuss treatment options most appropriate for you and your one on the way!

Disclaimer

The advice provided in this article is for information purposes only. It is meant to augment and not replace consultation with a licensed healthcare provider. Consultation with a Chiropractor or other primary care provider is recommended for anyone suffering from a health problem.

References

Khorsan, R. Manipulative therapy for pregnancy and related conditions: a systematic review. Obstetrical and Gynecological Survey. 2009; 64(6): 416-427.

Oswald, C. Optimizing pain relief during pregnancy using manual therapy. Canadian Family Physician. 2013; 59 (841-842).

Stuber, K. Adverse events from spinal manipulation in the pregnant and postpartum periods: a critical review of the literature. Chiropractic & Manual Therapies. 2012; 20: 8 (1-7).


by Crystal
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Don’t just sit there! It’s hazardous to your health!

We all know that too much sitting is bad for us, and we have previously discussed the Power of Movement. But, The Washington Post sat down with four experts to explain the many things, from head to toe, that go wrong in our bodies after those long hours at a desk and in front of the TV!

Disclaimer

The advice in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed healthcare provider. Consultation with a Chiropractor or other primary care provider is recommended for anyone suffering from a health problem.


by Crystal
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Joint Health: 6 Tips to Keep You Moving!

Joints form the connection between bones. Most joints are mobile, allowing the bones to move, and allowing us to move. However, with damage or injury, they can be what slows us down and stiffens us up. Here are 6 tips on how to keep your joints healthy and you moving!

  1. Get moving! One of the best ways we can take care of our joints is to get moving. Exercise strengthens the muscles that support our joints protecting them against the risk of strain or injury. Dr. Laith Jazrawi, Chief of the Sports Medicine division at NYU Hospital for Joint Diseases, suggests nonimpact forms of exercise including pilates, yoga, moderate weight lifting and swimming, which firm up your muscles without jeopardizing your cartilage.
  2. Proper posture! You want to maintain a neutral spine position to avoid abnormal stress on the muscles and joints, which can lead to muscular imbalances, injury and degeneration. To encourage this posture, have an ergonomic assessment at work and use a backrest support at your desk.
  3. Maintain a healthy weight! Carrying around extra pounds adds load to your joints increasing the risk of degeneration. Organize a group of family or friends that exercise together and swap healthy meal ideas!
  4. Eat well! Another way to promote healthy joints is by eating a well-balanced diet with less bad inflammatory foods. This means less processed and fried foods, which promote inflammation and pain. Instead, replace these bad foods with good wholesome foods such as fruits, veggies, whole grains, nuts and fish. These good foods help to decrease inflammation in our bodies and joints.
  5. Proper Supplementation! If you are unable to get essential nutrients from from diet alone, there are some supplements that can be taken to aid in joint health.
    • Omega-3 fatty acids – Decreases inflammation of the joints.
    • Boswellic acid – Helps to maintain joint health and flexibility.
    • Calcium – Helps to promote and reduce bone loss.

    If you already suffer from arthritis pain, the following supplements have been shown to help manage symptoms.

    • Turmeric – Reduced arthritis joint pain, inflammation, and stiffness related to arthritis.
    • Glucosamine – Helps to ease joint pain in cases where degeneration has begun.
    • Bromelain – Decreases arthritis joint pain and swelling, and increases mobility.
  6. Listen to your body! If you experience pain, seek care. Practitioners including Chiropractors, Physiotherapists, Massage Therapists and Acupuncturists can help promote and maintain joint health.

Disclaimer

The advice in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed healthcare provider. Please speak to your doctor or pharmacist before taking any supplements as they may interfere with medications and always consult with your health care provider before beginning any exercise program.

Joint Tips on Well.ca


by Crystal
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A Letter from Dr. Draper – Relocating Practice

Dear Valued Patients,

I am excited to inform you that after 3 years at 360 Health Care and 3 ½ half years at Mississauga Wellness, I am relocating my Chiropractic practice as of December 1st, 2013.

After careful consideration and with great enthusiasm, I have decided to join the team at Balanced Body Active Health Care at 260 The Esplanade (at The Esplanade and Berkeley Street). I will begin seeing patients there beginning on December 3rd, 2013. In my new Corktown/St. Lawrence Market location, I will be joining an outstanding group of Chiropractors and health care professionals who provide a truly collaborative approach to patient care. By joining Balanced Body, my patients will gain access to practitioners who provide optimal physical and manual therapy in an evidence-based, holistic way that promotes healthy living.

In addition to my new Corktown/St. Lawrence Market location, I am pleased to announce that as of December 4th, 2013, I will also be available at the Liberty Clinic at 657 Yonge Street Suite 200 (at Yonge Street and Charles Street). This is also a great team of health care providers that have a common vision for integrative medicine, and provide a greater range of services to meet your health care needs.

I realize that change can be difficult but the staff and I hope to make the transition as smooth as possible for you. I have included all the details regarding the new locations, including address, phone number and office hours below.

Appointments can be booked by contacting:

Balanced Body Active Health Care

260 The Esplanade

Toronto, ON M5A 4J6

(T): 647-352-6377

(F): 888-477-6307

www.balancedbodyahc.com

Tuesdays: 11am-7pm

Thursdays: 11 am-7pm

Saturdays: by appointment only

 

Liberty Clinic

657 Yonge St., Suite 200

Toronto, ON M4Y 1Z9

(T): 416-591-1123

(F): 888-436-7190

(E): info@libertyclinic.com

www.libertyclinic.com

Mondays: 11am-7pm

Wednesdays: 11am-7pm

Fridays: 11am-7pm

*Please note these hours will be carried out in full as of January 6th, 2014.

With my expanded availability and hours, I am delighted to be able to continue to accept new patient referrals at both practice locations. If you know of anyone who may benefit from Chiropractic or Acupuncture services, please feel free to pass along my contact information or refer them to my personal or clinic website.

It has been a pleasure working with you and getting to know you and I look forward to having you join me at my new practice locations! Your medical files will be making the journey with me, ensuring a smooth transition for you. If you should have any questions or concerns, please feel free to contact me at any time.

 

Yours in health,
Crystal

Dr. Crystal Draper

BAS, DC, ART Provider, Acupuncture Provider

dr.crystal.draper@gmail.com

 


by Crystal
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Ouch! Should I Heat or Ice?

One out of every seven Americans are affected by musculoskeletal injuries and disorders, so a good question to ask is, should I ice it or heat it?

Cryotherapy or the use of Ice

Cryotherapy is defined as the therapeutic application of any substance to the body that removes heat from the body, and results in decreased tissue temperature. This decrease in tissue temperature causes the following responses:

-       Decrease in blood flow to the tissue by constricting the blood vessels

-       Decrease in tissue metabolism

-       Decrease in oxygen use

-       Decrease in inflammation

-       Decrease in muscle spasm

Thermotherapy or the use of Heat

Conversely, thermotherapy is defined as the therapeutic application of any substance to the body that adds heat to the body, resulting in increased tissue temperature. This increase in tissue temperature causes the following responses:

-       Increase in blood flow to the tissue

-       Facilitates healing by supplying protein, nutrients, and oxygen at the site of the injury

-       Increase in tissue metabolism

-       Increase in tissue elasticity (more stretch)

General Rule of Thumb: Ice a new injury and heat an old one.

Ice a new injury

Cryotherapy is used when you have just suffered an acute injury, for example, an ankle sprain. With this injury there is pain, swelling and occasionally bruising in the area. Therefore, you would want to apply an ice pack and follow the 10-10-10 rule where you apply ice for 10 minutes, remove for 10 minutes, then reapply for 10 minutes. Remember to place a towel between the ice pack and your skin.

An ice pack is the most commonly used modality of cryotherapy, however vapo-coolant spray, ice massage or an ice bath can also be used.

Heat an old one

Thermotherapy is used when you have a chronic condition such as a stiff neck and shoulders. Applying a heat pack for 20-30 minutes in this case will help loosen the muscles by increasing blood flow and elasticity.

While the most common application is a heat pack, alternatives include a hot water bottle, an electric heating pad, or a hot bath/shower.

The exception to this rule is acute low back pain. Based on our general rule of thumb, we would reach for an ice pack in this acute situation. However, both a recent clinical practice guideline from the American College of Physicians and the American Pain Society and a recent Cochrane review recommends the application of heat in the case of acute low back pain.

Thermotherapy and Cryotherapy are useful adjuncts to conservative treatment including chiropractic care, acupuncture, exercise and patient education when used appropriately. If you have experienced an injury or suffer from chronic pain, please talk to your Chiropractor or healthcare provider.

Disclaimer

The advice in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed healthcare provider. Consultation with a Chiropractor or other primary care provider is recommended for anyone suffering from a health problem.

References

Chou, R. Diagnosis and Treatment of Low Back Pain : A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine. 2007: 147: 478-491.

French, S.D. Superficial Heat or Cold for Low Back Pain. Cochrane Database of Systematic Reviews. 2006: 1; CD004750.

Garra, G. Heat or Cold Packs for Neck and Back Strain: A Randomized Controlled Trial of Efficacy. Academic Emergency Medicine. 2010: 17(5); 484-489.

Nadler, S.F. The Physiologic Basis and Clinical Applications of Cryotherapy and Thermotherapy for the Pain Practitioner. Pain Physician. 2004; 7: 395-399.

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by Crystal
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Western Medical Acupuncture: What is the “point”?

There are two main approaches to acupuncture: Traditional Chinese Medicine Acupuncture and Western Medical Acupuncture.  Knowing the difference between the two is an important factor in deciding which will be the most effective course of treatment for you.

Traditional Chinese Medicine Acupuncture

Acupuncture originated in China centuries ago and is encompassed in the practice of Traditional Chinese Medicine (TCM).  TCM refers to pathways that traverse the body called meridians and collaterals; 360 points exist along these 14 meridians.  These pathways carry qi or ‘life energy’ from the various organs to the surface of the body and help to regulate yin and yang, the two opposing forces that keep the body in balance.  According to TCM, pain is thought to result from a blockage or stagnation of qi, and by the insertion of the acupuncture needles the normal flow of the body’s energy force is restored.

Western Medical Acupuncture

Western Medical Acupuncture (WMA) is an adaptation of TCM acupuncture.  It is based on similar techniques as TCM but forgoes the metaphysical concepts such as yin/yang and the circulation of qi.  Instead, the foundation of WMA is built upon the understanding of anatomy, physiology and pathology.  Due to its medical foundation, WMA is mainly used to treat musculoskeletal (MSK) pain.

Chronic MSK pain is the most common reason individuals try WMA.  Research shows that the following pain conditions respond well to WMA:

  • Chronic low back pain is the most prevalent
  • Chronic pain affecting the neck and shoulders
  • Chronic tension-type and migraine headaches
  • Knee osteoarthritis
  • Temporomandibular joint pain syndromes
  • Fibromyalgia
  • Lateral epicondylitis pain
  • Dysmenorrheal
  • Chronic prostate and pelvic pain
  • Obstetric labor pain
  • Postoperative pain
  • Pain from irritable bowel syndrome
  • And nausea

TCM vs. WMA

The main difference between TCM acupuncture and WMA is the explanation of how they work.  As we mentioned previously, TCM acupuncture functions by balancing the flow of qi to decrease pain and/or disease.  WMA functions through neuromodulation, which is just a fancy word to say regulation of the nervous system.  Therefore, the main therapeutic effects of the needling technique are achieved through stimulation of the nervous system. This stimulation occurs at a few different levels, the central and peripheral nervous systems.

The central nervous system (CNS) is comprised of the brain and the spinal cord.  At this level of the nervous system, acupuncture causes the release of hormones (opioid peptides and serotonin) to induce pain relief.  The peripheral nervous system (PNS) includes all of the peripheral nerves outside of the central nervous system.  This part of the nervous system experiences the local effects of acupuncture.  For example, when the needle is inserted at a point, it stimulates the nerve fibers in the affected muscles to improve the local nutritious blood flow, facilitating healing.

Similarities between the two approaches exist in technique.  Both use the insertion of fine sterile needles and the same classical points.  However, WMA may include additional local points in trigger points of muscles outside of the traditional points.  In both practices the duration of needling is variable ranging from very brief exposure up to 20-30 minutes and the number of needles used during a treatment can range 12-35.

What to expect at a WMA treatment

A health care practitioner, including your medical doctor, chiropractor or physiotherapist, will perform a medical examination complete with a thorough history and physical examination in order to come to a diagnosis.  From this diagnosis, the practitioner confirms that the symptoms are suitable for treatment with acupuncture.  Next, the practitioner will have you assume a comfortable position, most often lying on your stomach or back.  They will insert needles locally into the affected tissues and/or segmental points along your spine that are linked with your presenting condition.   Additionally, extrasegmental or general effects points may be included, particularly in hands and feet.  You will lay still with the acupuncture needles in for up to 30 minutes.

Acupuncture is generally a well-tolerated form of treatment.  Most individuals experience no pain during the insertion of needles or during treatment.  If discomfort is felt, it is a “twinge” upon insertion or a “dull ache” sensation at the insertion point. In regards to recovery, some individuals require 6-8 sessions before an improvement in symptoms is noticed while others may feel a response within 2-3 sessions.  Response to acupuncture treatment is variable between individuals.

If you have any questions about acupuncture treatment in general, or if it is the right treatment for you, please talk to your Chiropractor or healthcare provider.

Disclaimer

The advice in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed healthcare provider.  Consultation with a Chiropractor or other primary care provider is recommended for anyone suffering from a health problem.

References

Cheng, K.J. Neuroanatomical characteristics of acupuncture points: relationship between their anatomical locations and traditional clinical indications. Acupuncture in Medicine. 2011; 29(4): 289-294.

Eshkevari, L. Use of Acupuncture for Chronic Pain: Optimizing Clinical Practice. Holistic Nursing Practice. 2005: 217-221.

Kelly, R.B.  Acupuncture for Pain.  American Family Physician. 2009; 80(5):481-484.

White, A. Western medical acupuncture: a definition. Acupuncture in Medicine. 2009; 27(1): 33-36.

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by Crystal
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The Power of Movement: Why sitting is the new smoking!

Over the last century the physical, economic and social environments in which we move through our day has dramatically changed. We have changed our ways in the workplace in the form of communication, transportation, and entertainment. Now we primarily work at desk jobs, send emails, tweets, Facebook messages or texts, drive to work and relax by watching television or playing Xbox. These changes have significantly reduced the demands for physical activity while increasing sedentary or sitting behaviors. To date, it is reported that about 60% or more of adults’ waking hours are spent sedentary. We chose to believe that these changes have increased our overall efficiency and productivity, but everything comes at a cost.  That cost is compromised metabolic health (relating to metabolism or the breakdown of food and its transformation into energy) and premature mortality risk. So we must ask ourselves, is it worth the risk?

Some interesting statistics:

-       According to a Canada Fitness Survey, Canadians who spend the majority of their day sitting have significantly poorer long-term mortality outcomes than those who sit less.  Interestingly, this sitting time-mortality relationship is apparent even in those individuals who are physically active, and is stronger among those who are overweight or obese.

-       Each one-hour increment in TV time is associated with an 11% and an 18% increased risk of all-cause and cardiovascular disease mortality, respectively.

-       There is an 80% increased risk of cardiovascular disease mortality in those watching four or more hours of TV per day, independent of traditional risk factors such as smoking, blood pressure, cholesterol and diet.

The best way to keep your risk at bay is to break the sedentary cycle. Research shows that after just one hour of sitting the production of enzymes responsible for burning fat declines by as much as 90%. Extended sitting (beyond one hour) has additional negative effects including:

-       Slowing the body’s metabolism

-       Increases our waist circumference

-       Encourages obesity

-       Decreases our HDL/good cholesterol levels

-       Increases chance of type 2 diabetes

-       Increases chance of cardiovascular disease

-       Increases chance of breast cancer

-       Increases chance of colon cancer

Even meeting the recommended public health guidelines on physical activity doesn’t protect us from the deleterious effects of prolonged periods of sitting.  We can understand an increased risk for those who are sedentary and physically inactive, but what about those with high sedentary time but still maintain physical activity? For example, consider an ‘active couch potato’, an adult who bikes or jogs to and from work but then sits at a desk all day and spends several hours watching television at night.  What is their risk?  Unfortunately, the particular metabolic consequences of the time spent sitting at their desk and watching television are adverse enough to still put this population at risk. This powerful finding reinforces the importance of breaking the inactivity cycle.  It has been shown that having a higher number of breaks in sedentary time beneficially affects waist circumference, body mass index, triglycerides and glucose levels, benefits all worth making the time for.

So lets make a move…

Breaking up the sedentary cycle is the most protective mechanism, so incorporate movement and activity into each day.  Instead of taking a ‘smoke break’, take a ‘walk break’, take the stairs instead of the elevator, park your car at the end of the lot, and do pushups during commercial breaks.  Every little bit helps to break the cycle.  Talk to your Chiropractor or healthcare provider to determine what activities are appropriate and safe for you to begin and get moving!

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed healthcare provider. Consultation with a Chiropractor or other primary care provider is recommended for anyone suffering from a health problem.

References

Burns, D. The Public Health Challenge of Obesity: Is it the New Smoking? Journal of Community Nursing. 2009; 23(11): 4-9.

Merchant, N. Sitting is the Smoking of our Generation. Harvard Business Review. 2013.

Owen, N. Too Much Sitting: The Population-Health Science of Sedentary Behaviour. Exercise and Sport Science Reviews. 2010; 38(3): 105-113.

Thorp, A. Deleterious Associations of Sitting Time and Television Viewing Time with Cardiometabolic Risk Biomarkers. Diabetes Care. 2010; 33(2): 327-334.

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by Crystal
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Temporomandibular Disorders: Click, Click, Ow!

Chew, click, chew, click… Ever experience that uncomfortable clicking sound when chewing gum or food? The temporomandibular joint (TMJ) can cause this sound when you open and close your mouth or chew. If this sound is associated with pain and/or limitation of movement of your jaw, you may have a TMJ disorder.

Anatomy of the Temporomandibular Joint

The temporomandibular joint (TMJ) connects the mandible (the bone of the lower jaw) to the temporal bone (the bone at the side of your head). There is a joint on each side of your head, just in front of your ears.

The TMJ is an important and complicated one. It controls the movement of your jaw, allowing you to talk, chew and yawn. So is it important? Yes! It is also a complicated joint because of its movement.  The TMJ combines a hinge action along with sliding motions.  To keep these motions smooth, the parts of the bone that interact are separated by a small soft disc.  This disc absorbs the shock and allows for smooth movements while opening and closing your mouth and chewing.

Temporomandibular Conditions

Temporomandibular disorders (TMD) is a collective term to describe a group of conditions that cause pain and dysfunction in the jaw joint and the muscles that control jaw movement. TMD can be caused from a multitude of problems, including arthritis, injury, or muscle dysfunction from clenching or grinding your teeth.  The conditions generally fall into three main categories:

  1. Myofascial pain, which is the most common. This involves pain or discomfort in the muscles that control jaw function. These muscles can become fatigued from overwork if you habitually clench or grind your teeth. Additionally, individuals who experience a whiplash injury are prone to develop TMD.
  2. Internal derangement (disruption within the internal aspect) of the joint. This involves a displaced disc, dislocated jaw, or injury to the bone, which causes abnormal mechanical loading throughout the joint.
  3. Arthritis. This is a group of degenerative or inflammatory joint disorders that can affect the cartilage in the TMJ. These include arthralgia, osteoarthrosis and osteoarthritis.

In many cases, the cause of TMD is not clear because a person can suffer from one or more of these conditions at the same time.

Signs and symptoms of TMD

  1. The most common symptom of TMD is pain, tenderness or stiffness of your jaw, specifically in the muscles of mastication (chewing muscles), and/or your jaw joint.
  2. Difficulty or discomfort chewing.
  3. Uncomfortable bite.
  4. Uneven bite, because one or more teeth are making premature contact, or a change in the way the upper and lower teeth fit together.
  5. Painful clicking, popping or grating in the jaw joint upon opening or closing of your mouth.
  6. Locking of your TMJ, making it difficult to open or close your mouth.
  7. Aching pain in and around your ear, radiating pain in the face, jaw or neck.
  8. Headache.

Who is affected with TMD

TMD most commonly occurs in people 18-45 years of age and is two times more prevalent in women than in men.  Individuals who were born with a deformity of their facial bones are more likely to develop a TMD because the mechanics of their jaw and how their teeth come together are altered. Lastly, those who have rheumatoid arthritis, fibromyalgia, chronic fatigue syndrome or sleep disorders are more susceptible to TMD.

Diagnosis of TMD

TMD is usually diagnosed based on symptoms and clinical presentation. Your chiropractor or healthcare provider will gather a detailed history including medical and dental history, and perform a thorough physical examination including the head, neck, face and jaw. Imaging studies may also be recommended.

Treatment of TMD

  1. First and foremost is education. Know your symptoms, what aggravates them, and what your treatment options are.
  2. Eating soft foods to avoid aggravation.
  3. Avoiding extreme jaw movements such as wide yawning, loud singing and gum chewing.
  4. Ice to help control any pain and inflammation in the area.
  5. Learning techniques for relaxing and reducing stress to help decrease clenching and grinding.
  6. Gentle jaw stretching and relaxing exercises that may help increase jaw movement.
  7. Chiropractic care and/or acupuncture to help decrease pain, and increase function and range of motion.
  8. Use of a stabilization splint or bite guard.
  9. If these conservative treatment options are unsuccessful, over-the-counter pain medications or anti-inflammatory medications are alternatives.

If you are suffering from TMJ pain, please talk to your Chiropractor, Dentist, or healthcare provider to establish an appropriate treatment plan for you.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed healthcare provider. Consultation with a Chiropractor or other primary care provider is recommended for anyone suffering from a health problem.

References

Barkin, S. Temporomandibular Joint: The Role of Arthroscopic Surgery and Arthrocentesis. Journal of the Canadian Dental Association. 2000; 66(4): 199-203.

TMJ Disorders. National Institute of Dental and Craniofacial Research. Online. http://www.nidcr.nih.gov/OralHealth/Topics/TMJ/TMJDisorders.htm

Wadhwa, S. TMJ Disorders: Future Innocations in Diagnostics and Therapeutics. Journal of Dental Education. 2008; 72(8): 930-947.

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by Crystal
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Low Back Pain and Pregnancy: Growing Pains

As if there are not enough growing pains during pregnancy, we have to add back pain to the list. Back pain is a common complaint of mothers-to-be with 50-80% of women reporting back pain during pregnancy and 50-75% during labour.

It is the most common musculo-skeletal problem during pregnancy causing mothers-to-be pain in the low back (low back pain – LBP), pelvis (pelvic girdle pain – PGP) or both. The discomfort most commonly starts between the fifth and seventh month of pregnancy, however, some women can experience the pain as early as 16 weeks and for the odd few within the first month.

Predisposing Factors

There are multiple factors that can predispose women to back pain during pregnancy. First off is previous lumbar (low back) problems or chronic pain conditions. Women with existing histories are more likely to develop back pain during pregnancy. They also have a greater chance of experiencing back pain during a subsequent pregnancy and have more severe, long lasting pain. This pain literally comes back to bite you in the butt, and back. 

Activity also plays a role in pregnancy-related back pain. As they say, everything in moderation. The same goes for activity during pregnancy. Women with an inactive lifestyle have an increased risk of developing back pain during pregnancy, as do those with a mostly active or physically demanding lifestyle. Therefore, moderation wins with moderate activity being the safest bet for battling the growing pains during pregnancy.

Another risk factor includes increased body mass index, which is a formula used to calculate body fat (Note: to calculate your BMI, you take your weight in kilograms and divide by your height in meters squared (BMI = weight (kg)/height (m)2). According to Health Canada, the classifications for BMI are as follows:

BMI Category (kg/m2)

Classification
< 18.5 Underweight
18.5 – 24.9 Normal Weight
25.0 – 29.9 Overweight
30.0 – 34.9 Obese Class I
35.0 – 39.9 Obese Class II
> = 40.0 Obese Class III

In order to decrease the risk of experiencing pregnancy-related low back pain, the optimal classification for your BMI is ‘Normal Weight’.

Lastly, women who are younger in age, and those who have had multiple pregnancies have an increased chance of experiencing LBP and/or PGP during pregnancy.

Causes

With pregnancy many changes in the body occur to make room for your growing baby. Many changes mean many possible causes of back pain. Most times the cause of back pain is multifactorial including a combination of mechanical and hormonal factors. These factors contribute to decreased integrity and stability in the back and/or pelvis during pregnancy.

Mechanical 

Mechanical changes include:

  • Weight gain
  • Change in loads
  • Center of gravity
  • Body mechanics

During pregnancy women typically gain between 20-40 pounds. This weight gain contributes to postural changes because as the baby grows, so does mommy’s tummy. To make room for the baby, mom’s abdominal muscles need to stretch, and in doing so, lose their ability to maintain proper posture. To compensate, the lower back musculature is stressed to support the increased weight of the torso leading to low back pain.

Mom’s growing belly also causes weight to be projected forward. This creates a change in load by altering mom’s center of gravity. Consequently the pelvis tilts forward and increases the curve in the low back. This forward movement increases the forces through the joints of the low back and forces the muscles in the front of the hip (namely, the hip flexors/iliopsoas) to work harder creating a muscular imbalance and low back pain.

The last postural change that occurs is one that maintains the mommy-to-be’s balance after the shift in their center of gravity. In order to compensate, pregnant women rotate their legs outwardly (externally rotate) and ‘waddle’ to give them a wider base of support and overall more stability. In doing so, the piriformis muscle (located in the buttock region, attaching to the sacrum and greater trochanter) remains in a contracted state and contributes to the pelvic pain experienced during pregnancy.

Hormonal

There are also a few hormonal culprits that contribute to back pain in pregnancy.  The most notable is relaxin. Relaxin is a hormone that is produced in increased quantities by the ovaries during pregnancy. This hormone is responsible for relaxing the joints in the pelvis by increasing ligament laxity so the baby has room to pass through the birth canal. But, by increasing the movement in the pelvis, it makes the joints less stable and increases the forces going through them contributing to the pelvic pain experienced during pregnancy.

Similar to the mechanical changes that occur during pregnancy, these hormonal changes also lead to pain and dysfunction.

Diagnosis

Back pain in pregnancy is usually diagnosed based on symptoms and clinical presentation. This is largely due to the lack of available safe tests during pregnancy.  Imaging studies such as x-rays are too harmful to the fetus and are therefore avoided, leaving a detailed history and thorough examination. Physical examination can help distinguish pain coming from the low back versus the pelvis via several tests and maneuvers and examining the musculature. Your chiropractor is trained to perform this examination and diagnose your pregnancy- related back pain.

Treatment

Despite the high incidence of pregnancy-related back pain, only about 50% of women actually seek care from their health care provider. This is because most women assume that back pain is a “normal” part of pregnancy and they just grin and bear it. But there are many successful treatment options for mothers-to-be experiencing LBP and PGP including:

  1. Conservative treatments such as Chiropractic care, Acupuncture and Massage to help reduce pain and increase function.
  2. Yoga to work on breathing and relaxation allowing physical and emotional stress relief.
  3. Postural and abdominal strengthening exercises to strengthen the abdominal, back and pelvic musculature. Mothers-to-be who engage in moderate strengthening exercise benefit in a multitude of ways including: improved abdominal strength, less weight gain, shorter and easier labors, fewer medical interventions, less fetal distress, faster recovery, more energy, fewer mood swings, more restful sleep, and more effective stress management.
  4. Postural pillows to help maintain proper posture and decrease pain.
  5. Heating pads to relieve back pain.
  6. Stabilization belts to provide stability and decrease laxity in the pelvis by pressing together the joint surfaces.
  7. Comfortable footwear to provide a stable foundation. Sorry and sad to say ladies but bye-bye heels.

If you are experiencing back pain during your pregnancy, please talk to your Chiropractor or healthcare provider to discuss treatment options and exercises that are appropriate for you.

Disclaimer
The advice provided in this article is for informational purposed only. It is meant to augment and not replace consultation with a licensed healthcare provider. Consultation with a Chiropractor or other primary care provider is recommended for anyone suffering from a health problem.

References

Dumas, G.A. Fatigability of back extensor muscles and low back pain during pregnancy. Clinical Biomechanics. 2010; 25(1): 1-5.

Gutke, A. Predicting Persistent Pregnancy-Related Low Back Pain. Spine. 2008; 33(12): 386-393.

Health Canada. Food and Nutrition: Body Mass Index Nomogram. 2012. Online. <www.hc-sc.gc.ca>.

Mogren, I.M. Low Back Pain and Pelvic Pain During Pregnancy: Prevalence and Risk Factors. Spine. 2005; 30(8): 983-991.

Nash, J.V. Low Back Pain and Pelvic Girdle Pain in Pregnancy. Integrated Health Care Practitioners. 2012; 63-67.

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