COVID-19 Check In

I think we can all agree it’s been a particularly rough 18+ months since the COVID-19 pandemic hit the world. It’s safe to say that we’ve all been affected in some way, whether it be through changes to work, finances, isolation, having to home-school the kids, or worst of all, losing a loved one. We wanted to take this opportunity to check in, say a big hello, and send best wishes to each and every one of you who are taking the time to read this message.

 

HELLO!!!!!! 👋😁

 

We know that lockdowns and isolation come with their fair share of baggage, and people respond to them in different ways. Some people become depressed and anxious at the prospect of not being with their loved ones. Others may enjoy the slowing down of life that a lockdown may bring. Either way, it can easily take its toll on you, whether that be quick, or progressively over a long period of time. Whether you are reading this having recently come out of (or gone into) a lockdown or period of isolation, it’s good to take a step back and have a long and hard think about how you may have been (or are still being) affected by it all.

You may think of us as the people you go to when you have a sore back or neck, and whilst that may be true, we are able to offer so much more than just hands-on and movement therapy. It’s a well-known fact that to be 100% healthy, you need to be physically and mentally well, and have a solid, social environment around you that offers you support.

To try and battle some of the negative effects that may have come about over this pandemic, this little check-in from us is designed to give some prompts about some aspects of life that may have fallen (or are continuing to fall) by the wayside as a result of lockdown. You can take as little or as much as you want from it, but even if you take just one point and act on it, it could make a huge difference to your life.

 

Do you need psychological support?

We’re going right into the deep end with this. Rates of depression and anxiety have increased dramatically during the pandemic, especially in adolescents and young adults. Are you feeling low? Alone? Have you asked your kids if they are OK? You or a family member may need some psychological support. Don’t ignore these feelings. Go straight to your doctor or a local psychologist or counsellor and get the help you deserve, today. We mean it, make this a priority.

 

Are you being kind to your body?

Nutritionally and physically? Diet and exercise are a key part to leading a fulfilling and healthy life. Lockdowns and increasing rates of mental health problems can open doorways to bingeing on fast foods that are extremely comforting, yet incredibly full of unhealthy fats and sugars. Put your foot on the brake and steer yourself away from diabetes and heart disease by cramming your diet full of nutrient-rich plant-based foods including fresh fruits, vegetables, nuts and seeds. We’re not saying don’t eat meat, we’re just saying keep it fresh and clean and predominantly… plant-based.

 

Bingeing on fast foods is one thing, bingeing on TV shows and movies is a growing problem. We love a good show as much as the next person, but as the saying goes… all in moderation. Days on end in front of the flat-screen watching season after season of your favourite period drama may seem appealing, but your body will be crying out for movement. Noticed some pains and pangs creeping in? Feeling sluggish? Get yourself out, in the garden if necessary, and get moving. Squats, lunges, step-ups, jumping-jacks, jogging on the spot and many other exercises can all be performed in a space of about 2-3 square metres! You’ll feel great for it, we promise you that.

 

Lastly… have you been having a lot of coffee and alcohol? Remember, our bodies are 60-70% water. We need to feed our bodies water because we are unable to create it ourselves. Whilst we get some water from the food and drinks we consume, we need to ensure the majority of liquid we consume each day is fresh water. Our tip is to have a reusable water bottle with you each day, sip regularly each hour and re-fill as required. Don’t let yourself get thirsty. If you are thirsty, your body is letting you know you are dehydrated.

 

Are you allowing yourself to relax each day?

There are no rules for this, but we all need to wind down each day. Home-schooling the kids or back-to-back household chores is tiring and demanding on the body. What gets you into your chill-zone? Maybe some calming music, a walk along the beach, a puzzle, reading a fantasy novel, building Lego or colouring in? Whatever brings down the stress levels for you, always ensure you allow yourself to do it, each day. It’s easy to put it off until tomorrow. But don’t. You need it.

 

You may be thinking you have read all of this before, and you probably have. But are you following this advice? It’s well-known information, but many people do not follow this advice. Be different. Be healthy. Be the best version of yourself. And you’ll be truly happy and healthy. Stay strong out there, and as always, be safe.

 

P.s. If you do have a sore back or neck, please get in touch today… (416) 546-4887.

 

References

  1. Hawes, M. et al. 2021. Increases in depression and anxiety symptoms in adolescents and young adults during the COVID-19 pandemic. Psychological Medicine. 1-9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844180/
  2. Harvard Health Publishing. 2020. How much water should you drink? [Online]. Available from: https://www.health.harvard.edu/staying-healthy/how-much-water-should-you-drink. [Accessed 17 Aug 2021]

Imaging and Low Back Pain

If you’ve been alive on planet Earth for any amount of time, chances are you have experienced back pain at some point. 84% of adults experience back pain at some stage of their life according to research. In some cases, pain may come from an obvious source, a fall on an icy surface or a sport related injury. For a lot of people, however, pain can sneak up and appear for unknown reasons.

It’s only natural and logical to want to know why the pain is there and what caused it so you can avoid it in the future and hopefully correct or remedy the current issue. You would imagine that the use of medical imaging, such as X-Ray, MRI, CT scan etc. would be useful in this scenario. But what if the opposite was true. According to research this is absolutely the case for low back pain.

It turns out that imaging the back in hopes of diagnosing a pain causing issue produces many false alarms.

Signs of spine degeneration, including disc herniation are present in very high percentages of healthy people that don’t experience pain at all. These changes seen in imaging (degeneration and herniation) are best understood as just a part of the normal aging process of everyone.

Getting an MRI or X-Ray for back pain can give patients the idea that their back might be broken, crooked, out of place or fragile. When in fact most backs all contain these features. This can produce a lot of fear and prevent people from partaking in activities and exercise and may make their pain worse.

The reality is that low back pain can be greatly multifactorial, and the one or two “abnormalities” (but likely normal changes) found on imaging are just one small factor in a complex situation involving a patient’s habits, beliefs, stress factors, biomechanics, injury history etc. that can contribute to their pain.

Imaging such as MRI and X-Rays can be important and very useful, but it is now recommended that when dealing with back pain, imaging be reserved for severe and persistent back pain where there is weakness in the extremities or where cancer or an infection is suspected.

Osteopaths can help make sense of back pain and explain what might be causing your symptoms. They can help relieve pain through manual therapy techniques and give lifestyle and rehabilitation advice on the best strategies to overcome it.

Speak to an Osteopath today!

 

Written: Jared Cox

 

References

An online investigation into the impact of adding epidemiological information to imaging reports for low back pain
Yasmin Medalian 1G Lorimer Moseley 1Emma L Karran 1

Iatrogenic Consequences of Early Magnetic Resonance Imaging in Acute, Work-Related, Disabling Low Back Pain Barbara S. Webster, BSPT, PA-C, Ann Z. Bauer, MPH, YoonSun Choi, MA, Manuel Cifuentes, MD, MPH, ScD, and Glenn S. Pransky, MD, MOccH

Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations
W. BrinjikjiP.H. LuetmerB. ComstockB.W. BresnahanL.E. ChenR.A. DeyoS. Halabi J.A. Turner,A.L. AvinsK. JamesJ.T. WaldD.F. Kallmes, and J.G. Jarvik

Developing Resilience To COVID-19 Variants

Since the beginning of the Covid-19 pandemic, hospitals, health care workers, nurses, doctors, emergency responders and many others have been overwhelmed and under a great deal of stress. They’ve required our cooperation to limit the spread of Covid-19, prevent unnecessary deaths and to reduce the burden on our health system.

The foremost method of limiting this burden so far has involved social distancing, self-isolation, wearing masks, hand washing and sanitizing surfaces. All of which are valid and important to avoid contact and infection from the virus.  But as Covid-19 variants continue to arise and evade vaccination efficacy, it is becoming clear that this virus may be around longer than we would all hope. Is there anything we can do that will reduce our chances of a serious, medical attention requiring, infection and allow us to get back to normalcy?

My hope with this post is to empower and give individuals a more active role in containing the virus and controlling their health by, first, showing the mechanisms of a viral infection and, second, the many ways lifestyle and dietary choices can help or hinder our response to it.

How does a virus work?

The mechanisms of viral infection.

  1. Implantation of virus at the portal of entry (in the case of COVID-19 this implantation occurs at the mucus membranes found within the mouth, nose and eyes. Specifically the ACE-2 receptors on the epithelial cells of these tissues. 1
  2. After the virus has implanted, it will begin to replicate
  3. Then the virus will spread to target organs (COVID-19 seems to affect the lower respiratory tract however there may also be multi-organ involvement. 2
  4. The virus then begins shedding into the environment and potentially infecting others.3 (For COVID-19 two modes for transmission exist – direct and indirect. The direct method includes transmission via respiratory droplets and aerosols when a person coughs, sneezes, shouts or talks. Indirect modes include transmission via fomites4 (picking up the virus from inanimate objects)

Important note:

  • Transmission through inanimate surfaces appears to be very small, and only in instances where an infected person coughs or sneezes directly on the surface, and someone else touches that surface soon after the cough or sneeze (within 1–2 hours). 5
  • Outdoor risk of transmission of Covid-19 is very low. Research continues to suggest that the vast majority of transmission happens in indoor spaces; recent reviews considering data from several countries found very little evidence of outdoor transmission for SARS-CoV-2, influenza or other respiratory viruses.6,7

There are three factors that affect a virus’ ability to infect and a person and make them sick.
These are;

  1. Accessibility of virus to tissue, (How prevalent is the virus in our environment)
  2. Cellular susceptibility to virus multiplication, and
  3. Virus susceptibility to host defences. 3

Lockdowns, social distancing, hand washing and wearing masks, prevents our contact with the virus and reduces our risk of encountering the virus.

But what happens if we do encounter the virus? Is there a way to make our cells less susceptible to viral hijacking or ensuring our host defences (immune system) protects us more effectively?

It turns out that through our lifestyle and dietary choices we have a great deal of control in ensuring a COVID-19 infection doesn’t result in serious or critical outcome. 8

COVID-19’s Mechanisms

Covid-19 infection can present in a spectrum ranging from mild, moderate to severe illness. In severe cases of COVID-19 the respiratory distress comes not just from how the virus harms the infected, but from an exaggerated response of the individuals own immune system. The pneumonia which accompanies COVID-19 is not directly caused by the virus but rather through fibrosis caused by runaway cytokine storms within the respiratory system. 9

What is a cytokine storm?

Cytokines are a group of proteins that provide intercellular signaling and communication, which controls cell proliferation and differentiation alongside immune and inflammatory responses. The immune system, under normal circumstances, will respond to a pathogen with a regulated and proportionate amount of cytokines to remove the pathogen and restore homeostasis.

 

Failures in the body’s own feedback and regulatory processes are responsible for excessive cytokine production and can result in systemic damage that often outstrips the benefit from a ‘typical’ immune response. 8

The leading cause of death in patients infected with Covid-19 is acute respiratory distress syndrome or ARDS. It is now known that several proinflammatory cytokines will contribute to the occurrence of ARDS. 10

Risk factors for a severe infection

Poor nutritional status as well as pre-existing noncommunicable diseases (NCDs) such as diabetes mellitus, chronic lung diseases, cardiovascular diseases (CVD), obesity, and various other diseases that compromise immune function can increase the likelihood of a severe and fatal infection from Covid-19.

These diseases are characterized by systemic inflammation, leaving an individual pre-inflamed prior to viral infection. The inflammation caused by infection from the virus combined with this systemic inflammation can make a severe and medical attention requiring reaction more likely. 11

How to maintain a healthy well-functioning immune system

The good news is, adoption of healthy lifestyle, and dietary habits can have a considerable effect on improving nutrition status, reducing inflammation and preventing and even improving pre-existing conditions which can consequently safeguard us from severe viral infections.

Vaccines also appear to be more effective in individuals who fall into the normal/healthy body mass index (BMI) range for their body weight and height. 12

 

Below are some easy and effective strategies.

 

Adopt an anti-inflammatory diet
There is nothing complex or new about an anti-inflammatory diet. You don’t need to eat a variety of expensive and exotic superfoods or take a briefcase full of supplements. An anti-inflammatory diet is simply choosing whole foods consisting of whole vegetables, fruits, nuts, seeds and grains, healthy fats and oils, good quality protein sources, and small amounts of healthy treats. This combined with reducing consumption of refined and processed foods, including highly

processed sugar laden foods and beverages, processed meats, refined oils and deep-fried foods will be a huge step in the right direction.

A good example is found in this anti-inflammatory food pyramid.

 

Reduce your consumption of sugar
Poor blood sugar control, not only in people with diabetes, worsens the prognosis and increases the seriousness of COVID-19 infection.

  1. because a spike in blood sugar is accompanied by a large increase in inflammatory mediators.
  2. glycosylation – a process that can be caused by a spike in blood sugar, is needed by the virus to link onto a cellular receptor – this can favor the cellular intrusion of Covid-19, leading to higher severity of symptoms experienced.

Individuals with well-regulated blood sugar (like those who regularly exercise and eat plenty of whole vegetables and fruits) are less likely to have high levels of inflammation and reduced binding capacity for the virus. 13

 

 

Supplement with Vitamin D

Two separate systematic reviews looking at the effects of vitamin D and Covid-19 show that a vitamin D deficiency is associated with increased severity and complications from Covid-19 infection and that optimal levels can reduce inflammatory markers and the negative immunomodul

ation of the inflammatory cytokine storm caused by COVID-19. Both studies recommend acquiring optimal blood levels of vitamin D through supplementation and/or sunlight exposure in order to reduce the severity of Covid-19 infection.14, 15

Make sure you’re getting enough Omega 3
There are various benefits of omega-3 fatty acids and taking it as a supplement might be associated with the prevention of the viral entry by changing the composition of fats in the membrane of our cells. Omega-3 fatty acids, such as DHA and EPA, perform their role by being incorporated in the cell membrane and affecting the clumping of toll-like receptors and thus preventing signals that activate nuclear factor kappa B (NF-κB) a regulator of innate immunity, and help to reduce the complications of COVID-19 by producing fewer pro-inflammatory mediators.16 17

 

Exercise

Being physically inactive greatly increases the risk for severe Covid-19 outcomes, including greater risk of hospitalization, admission to the ICU, and death for adults compared to individuals constantly meeting physical activity guidelines. 18

Respiratory viral infections, such as SARS-CoV-2, cause a systemic inflammatory response that places increased demand and substantial burden on the cardiopulmonary system.
Regular use of exercise positively affects the cardiorespiratory system allowing for greater cardiopulmonary capacity to deal with a respiratory infection and has been shown to diminish the risk for adverse outcomes. Routine exercise has also been shown to improve immune function, reduce the risk of respiratory infections and lower chronic low-grade inflammation. 19

The benefits to exercise don’t stop there. Exercise also helps you;

  • Sleep better 20
  • Manage blood sugar more effectively 21
  • Reduce chronic pain 22
  • Reduce the risk of dementia 23

Exercise doesn’t have to be going to the gym and lifting weights or going to spin class three times a week. Exercise in its most sustainable form can be doing any form of physical activity that you enjoy, such as dancing, gardening, hiking, swimming, cleaning, playing with kids or any kind of hobby that gets you moving.

Try meditating or start a gratitude journal.

In a time where our immune systems need to be functioning optimally the news and information being given by media outlets and our government institutions has been a driver for fear, stress and included instructions (social isolation) that are known to, unfortunately, reduce immune function.24

Meditation, visualization and gratitude practices can be extremely helpful at reducing the stress and fear associated with a global pandemic as well as help combat the negative effects of social isolation.

The isolation caused by repeated and prolonged lockdowns are an unfortunate consequence of the medical community’s strategy to control the virus. Fortunately the negative immune system effects of loneliness and isolation have been proven to be improved by specific meditative practices.25

Meditation has been shown to counteract at least 60% of the inflammatory mechanisms that COVID-19 triggers. This could lower the likelihood and severity of the body’s inflammatory load, diminishing the damage the body takes and accelerating the clearing of the virus.26
Improving the resilience and recovery rates of the sick in quarantine reduces the duration of their stay in the hospital and improving the immune efficiency of the healthy in isolation can reduce their likelihood of requiring hospitalization in the first place.

There are many helpful mediation/visualization apps and programs to be discovered – check out a couple of the options below

 

Get enough sleep

Sleep provides essential support to the immune system. Getting sufficient hours of high-quality sleep enables a well-balanced immune defense that features strong innate and adaptive immunity.

Sleep plays a role in promoting inflammatory homeostasis through its effects on several inflammatory mediators, such as cytokines. Prolonged sleep deficiency can lead to chronic, systemic low-grade inflammation and is associated with inflammatory diseases, like diabetes, atherosclerosis, and neurodegeneration.27

Immune function works in a synergistic manner with our circadian rhythm and sleep/wake cycles, where differentiated immune cells with immediate functions, peak during the wake period and undifferentiated or less differentiated cells peak during the night, when the more slowly evolving adaptive immune response is initiated.28

Implementing new behaviours and changing dietary patterns can be challenging, so start out small. Many small changes can amount to a big shift in your wellbeing.

If you would like more information on how to implement these strategies or have a health concern, contact Beachealth today.

 

Written by: Jared Cox

 

 

References

  1. Lu C wei, Liu X fen, Jia Z fang. 2019-nCoV transmission through the ocular surface must not be ignored. Lancet. 2020;395(10224). doi:10.1016/S0140-6736(20)30313-5
  2. Gavriatopoulou M, Korompoki E, Fotiou D, et al. Organ-specific manifestations of COVID-19 infection. Clin Exp Med. 2020;20(4). doi:10.1007/s10238-020-00648-x
  3. Samuel Baron MF and TA. Viral Pathogenesis. Med Microbiol Bookshelf ID NBK8149. Published online 1996.
  4. Harrison AG, Lin T, Wang P. Mechanisms of SARS-CoV-2 Transmission and Pathogenesis. Trends Immunol. 2020;41(12). doi:10.1016/j.it.2020.10.004
  5. Goldman E. Exaggerated risk of transmission of COVID-19 by fomites. Lancet Infect Dis. 2020;20(8). doi:10.1016/S1473-3099(20)30561-2
  6. Bulfone TC, Malekinejad M, Rutherford GW, Razani N. Outdoor Transmission of SARS-CoV-2 and Other Respiratory Viruses: A Systematic Review. J Infect Dis. 2021;223(4). doi:10.1093/infdis/jiaa742
  7. Weed M, Foad A. Protocol for a rapid scoping review of evidence of outdoor transmission of COVID-19. medRxiv. Published online 2020. doi:10.1101/2020.08.07.20170373
  8. Arena R, Bond S, Calvo IR, et al. Shelter from the cytokine storm: Healthy living is a vital preventative strategy in the COVID-19 era. Prog Cardiovasc Dis. Published online June 2021. doi:10.1016/j.pcad.2021.06.008
  9. Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. Features, Evaluation and Treatment Coronavirus (COVID-19) – StatPearls – NCBI Bookshelf.; 2020.
  10. Ye Q, Wang B, Mao J. The pathogenesis and treatment of the `Cytokine Storm’ in COVID-19. J Infect. 2020;80(6). doi:10.1016/j.jinf.2020.03.037
  11. Zabetakis I, Lordan R, Norton C, Tsoupras A. Covid-19: The inflammation link and the role of nutrition in potential mitigation. Nutrients. 2020;12(5). doi:10.3390/nu12051466
  12. Painter SD, Ovsyannikova IG, Poland GA. The weight of obesity on the human immune response to vaccination. Vaccine. 2015;33(36). doi:10.1016/j.vaccine.2015.06.101
  13. Ceriello A. Hyperglycemia and the worse prognosis of COVID-19. Why a fast blood glucose control should be mandatory. Diabetes Res Clin Pract. 2020;163. doi:10.1016/j.diabres.2020.108186
  14. Pereira M, Dantas Damascena A, Galvão Azevedo LM, de Almeida Oliveira T, da Mota Santana J. Vitamin D deficiency aggravates COVID-19: systematic review and meta-analysis. Crit Rev Food Sci Nutr. Published online 2020. doi:10.1080/10408398.2020.1841090
  15. Yisak H, Ewunetei A, Kefale B, et al. Effects of vitamin d on covid-19 infection and prognosis: A systematic review. Risk Manag Healthc Policy. 2021;14. doi:10.2147/RMHP.S291584
  16. Hathaway D, Pandav K, Patel M, et al. Omega 3 fatty acids and COVID-19: A comprehensive review. Infect Chemother. 2020;52(4). doi:10.3947/IC.2020.52.4.478
  17. Hariharan A, Hakeem AR, Radhakrishnan S, Reddy MS, Rela M. The Role and Therapeutic Potential of NF-kappa-B Pathway in Severe COVID-19 Patients. Inflammopharmacology. 2021;29(1). doi:10.1007/s10787-020-00773-9
  18. Sallis R, Young DR, Tartof SY, et al. Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48 440 adult patients. Br J Sports Med. Published online 2021. doi:10.1136/bjsports-2021-104080
  19. Brawner CA, Ehrman JK, Bole S, et al. Inverse Relationship of Maximal Exercise Capacity to Hospitalization Secondary to Coronavirus Disease 2019. Mayo Clin Proc. 2021;96(1). doi:10.1016/j.mayocp.2020.10.003
  20. Banno M, Harada Y, Taniguchi M, et al. Exercise can improve sleep quality: A systematic review and meta-analysis. PeerJ. 2018;2018(7). doi:10.7717/peerj.5172
  21. Buresh R. Exercise and glucose control. J Sports Med Phys Fitness. 2014;54(4).
  22. Leung A, Gregory NS, Allen LAH, Sluka KA. Regular physical activity prevents chronic pain by altering resident muscle macrophage phenotype and increasing interleukin-10 in mice. Pain. 2016;157(1). doi:10.1097/j.pain.0000000000000312
  23. Ahlskog JE, Geda YE, Graff-Radford NR, Petersen RC. Physical exercise as a preventive or disease-modifying treatment of dementia and brain aging. Mayo Clin Proc. 2011;86(9). doi:10.4065/mcp.2011.0252
  24. Campagne DM. Stress and perceived social isolation (loneliness). Arch Gerontol Geriatr. 2019;82. doi:10.1016/j.archger.2019.02.007
  25. Pandya SP. Meditation program mitigates loneliness and promotes wellbeing, life satisfaction and contentment among retired older adults: a two-year follow-up study in four South Asian cities. Aging Ment Heal. 2021;25(2). doi:10.1080/13607863.2019.1691143
  26. Black DS, Slavich GM. Mindfulness meditation and the immune system: a systematic review of randomized controlled trials. Ann N Y Acad Sci. 2016;1373(1). doi:10.1111/nyas.12998
  27. Besedovsky L, Lange T, Haack M. The sleep-immune crosstalk in health and disease. Physiol Rev. 2019;99(3). doi:10.1152/physrev.00010.2018
  28. Besedovsky L, Lange T, Born J. Sleep and immune function. Pflugers Arch Eur J Physiol. 2012;463(1). doi:10.1007/s00424-011-1044-0

Knee Osteoarthritis

Knee pain in the middle to late decades of life is a common complaint amongst patients presenting to osteopathic clinics across the globe. Osteoarthritis (OA) is a common cause of knee pain in this age group of people. Research suggests approximately 654 million people aged 40 years and over were living with knee OA in 2020 around the world. This comes at an incredible cost to healthcare services worldwide, with figures in the billions of dollars!

What is osteoarthritis?

Osteoarthritis is just one of a number of forms of arthritis… Essentially a disease which affects the joints in our body. OA is the most common form of arthritis, with Rheumatoid Arthritis (RA) being the second most common form. This blog will focus on OA, a potentially debilitating disease that most commonly affects the weight-bearing joints of the body (i.e. the knees, hips and lumbar spine), but can affect any joint in the body where the joint surfaces are covered in cartilage.

The characteristics of OA include loss of the cartilage that covers the ends of bones that come together to form joints. The underlying and surrounding bone, as well as other joint structures (including joint capsules and other tissues) are also susceptible to degenerative changes that ultimately lead to poor functioning of a joint. The process usually occurs over a long period of time, often starting early in life (interestingly with little to no symptoms at all) and progressing into the latter years. The severity of the disease varies from person to person with some people only experiencing mild symptoms throughout their life. Other people experience more severe symptoms and may require joint replacement surgery as a last port of call to ensure they can continue to live their life as pain-free as possible.

Osteoarthritis of the knee can affect either of the two main joint components of the knee… The joint between the ends of the thighbone and the shin-bone (called the tibiofemoral joint), and the joint between the thigh-bone and the knee-cap (called the patella-femoral joint).

 

Risk factors

There are certain factors associated with higher rates of knee OA. These include:

  • Age: Rates of knee OA increase in the elderly
  • Obesity: Rates of knee OA increase with higher levels of obesity
  • Gender: Females slightly out-do the males with this one, being approximately 1.5 times more likely to develop it
  • Trauma: A trauma to the knee can increase your likelihood of developing knee OA
  • Smoking: Smoking is associated with higher rates of knee OA

 

Signs and symptoms

The signs and symptoms of knee OA include:

  • Pain
  • Stiffness
  • Swelling
  • Reduced range of motion
  • Difficulty performing functional movements including squatting and kneeling

 

Pain associated with tibiofemoral OA commonly affects the inside region of the knee first, where the two bones meet at the joint line. Patella-femoral related pain is often felt deep behind the kneecap. Pain will vary from one person to another, and the severity of pain does not necessarily relate to the severity of degeneration. Although if you speak to a person who is about to have a joint replacement surgery (i.e. their joint has degenerated to the point of needing a surgical intervention to keep the person functioning well), they will likely tell you that the pain is extremely debilitating.

Pain and stiffness are regularly felt first thing in the morning and late at night. OA tends to respond well to movement of the joints, and so people often find their pain and stiffness improves once they are up and moving, for it to return once their day has finished and they are relaxing at night.

 

Treatment

So, you’ve been diagnosed with knee OA. What to do? Call your osteo… Ta-dah!!!! Given we are experts in how the human body moves (we study human biomechanics at uni), we’re good at picking up how the body should and shouldn’t move. There are no magic pills for treating OA of the knee, and no practitioner can claim to treat the disease itself, as there is unfortunately no cure for OA. It is a progressive, degenerative disease, but there are ways of stunting the progression of this condition if the risk factors leading to its presence are attacked head on.

Poor movement resulting from daily postural repetitive strain, or an old injury that wasn’t treated to resolution is a big factor in the maintenance and development of OA in the knee. Poor movement or dysfunction occurring in the low back, hip or ankle can all lead to excessive load being placed through the knee joints, which can exacerbate the disease process. This is where we come in. We can watch you move during an assessment and work out what is causing the excessive loads through the knee and put a plan in place to improve range of motion and flexibility, strengthen muscles and return you to (hopefully) pain-free daily activities. We will use a combination of soft tissue manipulation, joint mobilization and progressive exercise programs to restore life to your body. Returning to efficient movement patterns after years of neglect, poor movement and a de-conditioned body part will take time, but with determination from both you and your practitioner, it can happen.

 

As previously mentioned, some cases of knee OA can end up requiring surgical intervention to replace either part of or the whole joint. The good news is, if you do have to go through this process, we have your back (well… in this case, your knee) and can help you through rehab and recovery. Many people who have a knee replacement return to full daily activities and live a long and pain-free life.

Knee pain? What are you waiting for? Call us today on (416) 546-4887 or book online to schedule your appointment.

 

References
1. Cui, A. et al. 2020. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClinicalMedicine. 100587. 29-30. Available from: https://www.thelancet.com/action/showPdf?pii=S2589-5370%2820%2930331-X

  1. Arthritis Australia. 2016. Counting the cost. [Online]. Available from: https://arthritisaustralia.com.au/wordpress/wp-content/uploads/2017/09/Final-Counting-the-Costs_Part1_MAY2016.pdf. [Accessed 09 February 2021]
  2. Centres for Disease Control and Prevention. 2020. Cost statistics: The cost of arthritis in US adults. [Online]. Available from: https://www.cdc.gov/arthritis/data_statistics/cost.htm. [Accessed 09 February 2021]

Lateral Ankle Sprain

How many of us have rolled our ankle and damaged a ligament at some point in our life?! The answer is many of us. Approximately 2 million ankle ‘sprains’ (the word used to describe a ligament that has been over-stretched or torn) occur in the US every year alone, which gives you an idea of how many happen worldwide! Whilst many of these sprains occur in the sporting world, there are surprising amounts that occur in the general population. This shows us that we don’t have to be an elite sportsperson to be at risk of rolling our ankles. It’s an injury that can literally happen to any one of us… Picture Joe Bloggs walking down the street and slipping unexpectedly off the curb. Ouch!

What is a ligament sprain?

Let’s start at the beginning… Ligaments hold bone to bone. Two bones held together become a joint. Ligaments are responsible for providing a joint with stability (along with the muscles and tendons surrounding it), ensuring the bones of a joint do not move away from each other and dislocate. Ligaments are thick, strong bands of tissue that can withstand the majority of the large forces that run through our bodies when we move. Sometimes the force placed upon a ligament is too great for it to withstand, and this is when damage (or a sprain) occurs. Ligament sprains are generally categorized into the following grades:

  • Grade 1: A mild sprain with only damage seen at a microscopic level and no joint instability.
  • Grade 2: A moderate sprain where some, but not all, of the ligament fibres are torn. There may be very mild joint instability (or none) associated with this grade.
  • Grade 3: A severe sprain where all of the ligament fibres are torn leaving the joint unstable.

 

Why is a sprain of the outside of the ankle so common?

The outside (or lateral aspect) of the ankle joint is one of the most commonly sprained regions of the body. The two leg bones (the tibia and fibula) run down the leg from the knee and slot in with the ankle bone, or ‘talus’ (pronounced ‘tay-luss’). The fibula bone runs down the outside of the leg and the tibia runs down the middle/inside of the leg. The very ends of these bones are enlarged lumps (known as malleoli… ‘mal-ee-oh-lie’). You can feel these lumps either side of the ankle. Where the malleoli meet the talus is where the outside (lateral) and inside (medial) ligaments are found. The medial ligaments are much stronger than the lateral ligaments which result in the lateral ligaments being injured more commonly. A simple roll of the ankle can cause an over-stretching or tearing of the ligaments here, depending on the force being placed on the ankle as it rolls outwards. In a normal healthy ankle, the ability to roll the ankle outwards is greater than that of rolling inwards… Another reason why lateral ankle sprains tend to occur more often.

 

Risk factors

One of the biggest risk factors for a lateral ankle sprain is having a history of ankle sprains. If you have done it previously, you are more likely to sprain it again! Other risk factors include:

  • Being hyper-mobile or having excessive range of motion at the ankle joint due to naturally looser ligaments.
  • Playing sports where turning, twisting and pivoting at high speed are a large part of the game (i.e. netball, basketball, football (any form), and racket sports)
  • Being taller and heavier in weight
  • Having wider feet

 

Signs and symptoms

Sometimes when you roll your ankle, the force placed on the ligament is not great enough to damage it. In these instances, you may experience no symptoms at all. For instances where the force is great enough to damage the ligament, you can expect to experience any or all of the following (depending on the severity of the injury):

  • Pain (possibly preceded by an audible click or pop) over and around the affected ligament
  • Swelling
  • Bruising
  • Limping on the affected side when walking
  • Reduced movement of the affected ankle
  • Instability of the ankle joint (i.e. excessive movement) if severe enough

After a severe injury you may not be able to walk immediately. The more severe the sprain, the more likely other structures in and around the ankle may be affected, including the possibility of fracture and/or dislocation (if the force is great enough).

 

Treatment

Most cases of lateral ankle sprains that enter our clinic are mild to moderate in nature. More severe injuries are often dealt with initially at an emergency department (i.e. if it has been necessary to rule out a fracture/dislocation), but may present to our clinic for ongoing management once the acute injury has begun to heal.

The first goal of treatment for lateral ankle sprains is to regain a normal walking pattern, whilst reducing the risk of further injury. This is likely to mean zero participation in your chosen sport to begin with, especially if pivoting and turning play a large part. We will work on reducing pain by massaging the muscles of the leg and foot. We may also need to work on muscles higher up the body, such as your back, glutes, hamstring and quad muscles. Any stiffened joints will be mobilized gently to restore range of motion. Any swelling can be dealt with using drainage techniques of the lower limb.

When normal walking has resumed, you can progressively load the ankle by adding in strengthening, balance, and more multi-directional agility exercises. The end goal for a sportsperson is to return to training followed by full match play. A non-sportsperson will look to return to their normal daily life without pain or dysfunction. A mild to moderate ankle sprain will take approximately 6-8 weeks to heal. More severe injuries can take months.

If you have sprained your ankle and need some help, look no further than your trusty osteopath. Call us today on (416) 546-4887 or book online to book your appointment and begin treatment immediately.

References
1. Mackenzie, MH. et al. 2019. Epidemiology of Ankle Sprains and Chronic Ankle Instability. Journal of Athletic Training. 54 (6). 603-610. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6602402/pdf/i1062-6050-54-6-603.pdf
2. Physiopedia. 2021. Ligament sprains. [Online]. Available from: https://www.physio-pedia.com/Ligament_Sprain. [Accessed 08 March 2021]
3. Beynnon, BD. et al. 2002. Predictive Factors for Lateral Ankle Sprains: A Literature Review. Journal of Athletic Training. 37 (4). 376-380. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC164368/pdf/attr_37_04_0376.pdf

Acne and Acne Scars

Acne forms when a hair follicle becomes plugged with oil or dead skin cells. The most common locations are on the face, forehead, chest, upper back and shoulders. The main causes of acne are excess oil, dead skin cells, bacteria and inflammation. There are many triggers that can cause acne. Hormonal changes especially during puberty or menopause cause more oil production which leads to more clogged follicles. Certain medications can also lead to increased oil production. Diet and stress can also play a huge role in exacerbating acne.

The use of Nanofractional Radiofrequency is an effective treatment for the reduction of acne scars. This service is now provided at Beachealth

Acne can range in severity:

  • Whiteheads, blackheads
  • Papules (Red and tender bumps)
  • Pustules (Papule with pus)
  • Nodules (Large painful lumps under skin)
  • Cystic (Painful pus filled lump under the skin)

Untreated or improperly treated acne can increase the risk of complications. The most common complication of acne are scars. Severe acne can leave long-term scars even after the acne has healed. Another complication is changes to skin color, after the acne has healed the skin may be lighter or darker than the surrounding skin.

There are many different treatment plans available and if you have tried over-the-counter products for a couple of months with no success you should see a professional before your acne becomes too severe or you cause damage to your skin. The professional will make a plan to help control your current acne, reduce the risk of scars or make current scars less noticeable.

All treatments plans are based on severity and medical history. The most common treatments given from a professional will include topical (retinol or antibiotic based) and oral medications (accutane, antibiotics or oral contraceptives). Other common treatments include: light therapy, chemical peels, drainage or injections.

There are many other treatments one should consider under the supervision of a professional. Many lifestyle changes can help such as: diet changes, proper cleaning (too much can cause irritation), avoid irritants, avoid picking and taking certain supplements and herbs.

If you have scars from past acne you can get IPL or microneedling procedures, apply topicals or take certain supplements to improve the appearance of the scars.

Dr. Pace, ND does full intakes to provide you with your personalized treatment plan to control your current acne, he also provides aesthetic treatments to decrease the appearance of acne scars. Book an initial Naturopathic appointment or a complimentary aesthetic consultation with him.

 

 

Best Sunscreen

Which sunscreen should I be using?

We are now entering the higher UV rating seasons and sunblock is a must for all individuals. UVA and UVB are both carcinogenic. UVA penetrates to the mid-dermis layer and causes most of the photoaging issues such as wrinkles, lentigines, telangiectasis, and altered collagen and elastin. UVB penetrates to the base of the epidermis where cells DNA is damaged and potentially causes cancer. UVB is also responsible for those nasty sunburns.

Now how do we select the right sunscreen? I suggest any sunscreen is better than none, but if you have a choice then select wisely.

We have chemical and physical sunscreens:

  • Chemical sunscreens protect the skin by creating a photochemical reaction, it absorbs the UV and transforms it into harmless wave radiation and re-emits it as heat. These have a less cloudy and better appearance on the skin. Roughly 2% of people will see skin irritation due to the chemicals. Also they degrade with sun exposure and need to be re-applied.
  • Physical sunscreens protect the skin by scattering and reflecting the UV rays. The older versions are cloudy and hard to apply, but newer micronized versions apply almost as nicely as the chemical ones. The risk of irritation is much lower and they do not breakdown over time and therefore do not need reapplications as frequently.

 

Every year the EWG (Environmental Working Group) releases a guide that includes most sunscreens and provides the hazards and effectiveness of each. You can log on to their website and search each sunscreen. https://www.ewg.org/sunscreen/ (2021 list comes out soon)

I check out the EWG list every year as some companies change their ingredients. I also like to minimize my chemical burden therefore I choose a physical sunscreen.

 

There are also other things you can do to protect against sun damage:

  • wear UV absorbing clothes
  • wear a hat
  • avoid sun exposure ie bring an umbrella to the beach
  • take supplements that are photoprotective (Vitamin C and E)
  • make sure your current medications are not photosensitizing

 

What can I do if I do have sun damage?

  • again there are supplements that can help repair skin damage (Vit A/C/E, zinc and selenium)
  • topical creams including certain ingredients, timing of these creams matter as some of the creams should not be put on when you are outside (Vit A/B/C)
  • laser treatment to remove sun spots and decrease wrinkles (IPL and Nanofractional radio frequency)

 

If you have any questions regarding prevention or treatment of sun-damaged skin please book an appointment with Matthew Pace, Naturopathic Doctor or Lada Milos Lee, Chiropodist.

 

https://beachealth.janeapp.com/#/aesthetics

Spondylolisthesis

Spondylolisthesis is a spinal condition that in the sports world most commonly affects cricketers and gymnasts, but in reality, can affect anyone! Pronounced ‘spon-di-lo-lice-thee-sis’, it most commonly affects the lowest segments of the lower spine region.

What is spondylolisthesis?

Spondylolisthesis is the slipping forward of one vertebra on another. This most commonly occurs at the L5 segment (the lowest vertebrae in the lumbar spine), which slips forward on the S1 segment of the sacral bone. The runner up? L4, which is also a commonly affected area.

There are a few different causes of this condition, and so it has been classified into different types. There are five categories of spondylolisthesis. These are:

  1. Degenerative: Occurs due to degenerative changes to the spinal facet joints and discs
  2. Isthmic: Occurs due to a bone defect in a part of the vertebrae known as the ‘pars interarticularis’
  3. Traumatic: Occurs following a trauma that results in a fracture of either the spinal facet joints or pars interarticularis.
  4. Dysplastic: Occurs due to a developmental defect of the vertebrae which alters the direction of the spinal facet joints, leaving the segment(s) open to slippage in the area where they are partially held in place by the facet joints.
  5. Pathologic: Occurs secondary to a medical problem such as infection or cancer.

In theory, any process that leads to the weakening of the supportive structures of the spinal segments (i.e. the bones, ligaments, discs, muscles) can lead to abnormal movement of the spine.

 

Grades of spondylolisthesis

Spondylolisthesis is further classified based on the amount of slippage that has occurred:

  • Grade 1: Between 0-25% of the vertebral body has slipped forward on the vertebrae below
  • Grade 2: Between 25-50% has slipped forward
  • Grade 3: Between 50-75% has slipped forward
  • Grade 4: Over 75% of the vertebral body has slipped forward

The most commonly reported grade of this condition is grade one, accounting for approximately 75% of all cases.

 

Signs and symptoms

These vary depending on the cause, but can include any or all of the following:

  • Low back pain, including pain in the buttocks
  • Pain along the back of the thigh which rarely goes lower than the knee
  • Tight hamstring muscles
  • Changes in walking pattern
  • Pins and needles and/or numbness down the legs
  • Bowel and bladder dysfunction (in more severe cases)

If you come to us with low back and/or leg pain, we are trained to work out exactly what is going on based on your symptoms and medical history. We will ask you lots of questions to begin with to dwindle our list of potential diagnoses to just one or two. Then we’ll get you to move and through a thorough movement assessment, will be able to come to a specific diagnosis that we will work with you to treat.

Sometimes we may require the help of imaging to rule in or out spondylolisthesis, depending on the severity of symptoms and how much it is impacting your life. In these cases, we will send you off for an x-ray which can detect this issue.

 

Treatment

Most cases of spondylolisthesis can be managed conservatively, meaning non-surgical options are chosen over a surgical one. When this injury occurs, the instability of the particular spinal segment can lead to many of the signs and symptoms mentioned above. One of the main goals of treatment is to increase stability around the affected area and offload the forces that are acting on the injured area.

We will spend time educating you on the mechanics of the spine. If you understand what is happening to your spine, you will know how to protect it, without adding unnecessary stress to the area. We will also advise on appropriate footwear, as well as standing, seated and sleeping postures. Being obese or overweight is also a risk factor for developing, as well as maintaining this problem. If you need to lose weight, we can help you formulate a plan to get there.

Exercise to increase core stability, as well as flexibility of tight muscles is a very important part of therapy as this will reduce the need for external supports such as braces in the long term. And of course, not forgetting our wonderful hands which will get to work on your muscles and joints to reduce tension and tightness, while increasing range of motion. Our osteopaths can help you manage your spondylolisthesis.

All of the above treatments will help you to manage pain, increase function and get you back to work or sport or gardening… Whatever your goal is! Call us today on (416) 546-4887 or book online at beachealth.janeapp.com if you have low back pain, or even if you already have a diagnosis of spondylolisthesis, and we can help you formulate a recovery plan to get you on the road to better health.

 

References

  1. Chila, AG. et al. 2011. Foundations of Osteopathic Medicine. 3rd ed. Lippincott, Williams & Wilkins: Philadelphia
  2. Tenny, S. and Gillis, C. 2020. Spondylolisthesis. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430767/

Lateral Ankle Sprain

How many of us have rolled our ankle and damaged a ligament at some point in our life?! The answer is many of us. Many sprains occur in the sporting world, but there are surprising amounts that occur in the general population. This shows us that we don’t have to be an elite sportsperson to be at risk of rolling our ankles. It’s an injury that can literally happen to any one of us… Picture Joe Bloggs walking down the street and slipping unexpectedly off the curb. Ouch!

What is a ligament sprain?

Let’s start at the beginning… Ligaments hold bone to bone. Two bones held together become a joint. Ligaments are responsible for providing a joint with stability (along with the muscles and tendons surrounding it), ensuring the bones of a joint do not move away from each other and dislocate. Ligaments are thick, strong bands of tissue that can withstand the majority of the large forces that run through our bodies when we move. Sometimes the force placed upon a ligament is too great for it to withstand, and this is when damage (or a sprain) occurs. Ligament sprains are generally categorised into the following grades:

  • Grade 1: A mild sprain with only damage seen at a microscopic level and no joint instability.
  • Grade 2: A moderate sprain where some, but not all, of the ligament fibres are torn. There may be very mild joint instability (or none) associated with this grade.
  • Grade 3: A severe sprain where all of the ligament fibres are torn leaving the joint unstable.

 

Why is a sprain of the outside of the ankle so common?

The outside (or lateral aspect) of the ankle joint is one of the most commonly sprained regions of the body. The two leg bones (the tibia and fibula) run down the leg from the knee and slot in with the ankle bone, or ‘talus’ (pronounced ‘tay-luss’). The fibula bone runs down the outside of the leg and the tibia runs down the middle/inside of the leg. The very ends of these bones are enlarged lumps (known as malleoli… ‘mal-ee-oh-lie’). You can feel these lumps either side of the ankle. Where the malleoli meet the talus is where the outside (lateral) and inside (medial) ligaments are found. The medial ligaments are much stronger than the lateral ligaments which result in the lateral ligaments being injured more commonly. A simple roll of the ankle can cause an over-stretching or tearing of the ligaments here, depending on the force being placed on the ankle as it rolls outwards. In a normal healthy ankle, the ability to roll the ankle outwards is greater than that of rolling inwards… Another reason why lateral ankle sprains tend to occur more often.

 

Risk factors

One of the biggest risk factors for a lateral ankle sprain is having a history of ankle sprains. If you have done it previously, you are more likely to sprain it again! Other risk factors include:

  • Being hyper-mobile or having excessive range of motion at the ankle joint due to naturally looser ligaments.
  • Playing sports where turning, twisting and pivoting at high speed are a large part of the game (i.e. netball, basketball, football (any form), and racket sports)
  • Being taller and heavier in weight
  • Having wider feet

 

Signs and symptoms

Sometimes when you roll your ankle, the force placed on the ligament is not great enough to damage it. In these instances, you may experience no symptoms at all. For instances where the force is great enough to damage the ligament, you can expect to experience any or all of the following (depending on the severity of the injury):

  • Pain (possibly preceded by an audible click or pop) over and around the affected ligament
  • Swelling
  • Bruising
  • Limping on the affected side when walking
  • Reduced movement of the affected ankle
  • Instability of the ankle joint (i.e. excessive movement) if severe enough

After a severe injury you may not be able to walk immediately. The more severe the sprain, the more likely other structures in and around the ankle may be affected, including the possibility of fracture and/or dislocation (if the force is great enough).

 

Treatment

Most cases of lateral ankle sprains that enter our clinic are mild to moderate in nature. More severe injuries are often dealt with initially at an emergency department (i.e. if it has been necessary to rule out a fracture/dislocation), but may present to our clinic for ongoing management once the acute injury has begun to heal.

The first goal of treatment for lateral ankle sprains is to regain a normal walking pattern, whilst reducing the risk of further injury. This is likely to mean zero participation in your chosen sport to begin with, especially if pivoting and turning play a large part. We will work on reducing pain by massaging the muscles of the leg and foot. We may also need to work on muscles higher up the body, such as your back, glutes, hamstring and quad muscles. Any stiffened joints will be mobilized gently to restore range of motion. Any swelling can be dealt with using drainage techniques of the lower limb.

When normal walking has resumed, you can progressively load the ankle by adding in strengthening, balance, and more multi-directional agility exercises. The end goal for a sportsperson is to return to training followed by full match play. A non-sportsperson will look to return to their normal daily life without pain or dysfunction. A mild to moderate ankle sprain will take approximately 6-8 weeks to heal. More severe injuries can take months.

If you have sprained your ankle and need some help, look no further, our team can help you get back and running. Our osteopaths can help with treatment and rehab, whilst our chiropodist can help out with alignment corrections and shoe recommendations. Call us today on (416) 546-4887 or book online at beachealth.janeapp.com to book your appointment and begin treatment immediately.

 

 

References
1. Mackenzie, MH. et al. 2019. Epidemiology of Ankle Sprains and Chronic Ankle Instability. Journal of Athletic Training. 54 (6). 603-610. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6602402/pdf/i1062-6050-54-6-603.pdf
2. Physiopedia. 2021. Ligament sprains. [Online]. Available from: https://www.physio-pedia.com/Ligament_Sprain. [Accessed 08 March 2021]
3. Beynnon, BD. et al. 2002. Predictive Factors for Lateral Ankle Sprains: A Literature Review. Journal of Athletic Training. 37 (4). 376-380. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC164368/pdf/attr_37_04_0376.pdf

Pain management: Acupuncture and more

Acupuncture can help relieve pains such as: Low back pain, headaches, menstrual cramps, nerve pain, all
muscles and joint pains, fibromyalgia and much more. The needle may be inserted where the pain is and
may be inserted in other points along the body that help treat pain. When the needles are inserted they
cause the release of endorphins which are the body’s natural pain killer. Depending on the type of pain the
needles may be inserted and left in for 20 minutes, in other situations the needles may be manipulated.
The needle would be twisted or could be moved in and out quickly to break up a trigger point.

Electro-stimulation: This is an add on to acupuncture, a small current is passed through the needles or
beside them with pads. The frequency is adjusted to a threshold that is comfortable but also therapeutic.
The run time of this method is around 20 minutes. This option is not painful but may be uncomfortable
for some.

 

Moxibustion: This is also an add on to acupuncture, heat is applied to the area. This can be done with
infra red lamps or with burning moxa. This increases temperatures which increases circulation to the area.
This is great for pain management or circulation issues. Again this is a none painful treatment.

 

Cupping: Although sometimes used with acupuncture, most treatments with cupping are done before or
after an acupuncture treatment. A suction cup is placed on the skin, and either kept in place or dragged
along the skin. This is a great options for releasing muscle tension, it also increases circulation.
If you are interested in any of these treatments please contact Beachealth and Dr. Pace ND can answer
any of your questions.