Exercises for ageing bones

Are you in or approaching your latter years and are wondering what you can do to ensure your bones stay strong through the next period of your life? As we age it is common to begin feeling the effects of years of ‘life’ on your body. Diseases like osteoarthritis (i.e. degeneration of joints) and osteoporosis (i.e. weakening of bones) are more common in the elderly population. But just because the figures show this, it doesn’t mean these diseases will affect your ability to lead a full and active life.

 

The good news is, there is plenty you can do now to reduce the risk of bone-related problems down the line. Read ahead for a few exercises you can perform regularly to keep you and your bones in tip-top shape!

 

Weight-bearing and resistance are key

It is widely accepted that to increase bone health, we need to stress the bones of the skeleton. The best way to do this is through weight-bearing exercises (i.e. exercises performed in an upright position with our legs impacting the ground). Resistance-type exercises are also beneficial in protecting the skeleton against the effects of ageing. ‘Resistance’’  implies an exercise that is performed against a force acting on the body. A simple example would be to compare walking through your house to walking through strong head-on winds. The wind pushing against the body is the resistance aspect.

When we exercise, forces acting on our muscles help to build strength. The forces placed upon the skeleton through the muscles help to activate special bone-building cells within the bones, and these help to maintain or build strength in the bones depending on the intensity of the exercise. In order to increase bone strength, we need to regularly push our bodies beyond the intensity of simple everyday tasks, like walking.

 

Age is a factor

Now, if you’re worried, we’re going to suggest a new gym membership and intense weight lifting program, then rest easy. There are lots of things to consider, and age (as well as medical history) is a big factor when it comes to prescribing exercise. Someone who is 80 will need a different exercise regime compared to someone who is 55 when it comes to targeting bone health.

 

Exercises to try

The following are simple weight-bearing exercises you could have a go at doing:

  • Walking or jogging uphill
  • Hiking across the countryside
  • Stair climbing or step-ups
  • A friendly game of tennis, badminton or squash
  • Aerobics or dancing

You can add resistance to your exercise program by:

  • Lifting weights (always start light so as to not overload the body)
  • Exercising using cables or resistance bands (again, use light resistance to begin with)

 

Everyone has different requirements, so we suggest giving us a call on (416) 546-4887 or email me at daniel@beachealth.com so we can create an individual a program that is perfect for you.

 

References

  1. Hong, AR. and Kim, SW. 2018. Effects of resistance exercise on bone health. Endocrinology and metabolism. 33 (4). 435-444. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6279907/
  2. Benedetti, MG. et al. 2018. The effectiveness of physical exercise on bone density in osteoporotic patients. BioMed research international. 2018, 4840531, 10 pages. Available from: https://www.hindawi.com/journals/bmri/2018/4840531/cta/
  3. Osteoporosis Australia. 2013. Exercise – consumer guide. [Online]. Available from: https://www.osteoporosis.org.au/sites/default/files/files/Exercise%20Fact%20Sheet%202nd%20Edition.pdf. [Accessed 06 Jun 2020]

Dorsal Scapular Nerve Entrapment

Has one of your shoulders been feeling a bit off lately? Is the neck and mid-back region around the shoulder blade feeling stiff and heavy? If this sounds like you, then you may have a problem with a nerve known as the Dorsal Scapular Nerve (DSN). This is a previously under-diagnosed cause of neck, mid-back and shoulder pain and dysfunction. With advances in technology and the development of knowledge and skills of treating practitioners, it has become apparent that this problem is much more common than originally thought.

Relevant anatomy

The neck is made up of a stack of seven bones known as vertebrae. These are numbered C1-7, where ‘C’ stands for cervical (i.e. the neck region of the spine). The vertebrae are numbered from top (near the skull) to bottom (where the neck meets the back). Between the vertebrae are little holes where nerves run through on their way to provide electrical signals to our muscles and other body parts. Between the 4th and 5th vertebrae, the C5 nerve root lives. The DSN is a little off-shoot of the C5 nerve root which runs from the neck to the back of the shoulder and mid-back.

 

The DSN provides electrical stimulation to three muscles in the neck/shoulder region, all of which attach to the shoulder blade (or ‘scapula’) at one end, and the spine at the other. On its way to these muscles, the nerve pierces through another muscle in the neck (one of the three scalene muscles if you’re really interested!).

 

Muscle function

Two of the three muscles that the DSN supplies help to move the shoulder blade inwards from its resting position, towards the spine. These are the Rhomboid Major and Rhomboid Minor muscles. The other muscle, the Levator Scapulae, as its name suggests, helps to elevate or lift the shoulder blade. The proper functioning of these muscles is important for us to be able to move our shoulder through its full range of motion. Injury or entrapment of the nerve can lead to poor muscle function and subsequently, poor shoulder movement.

 

Signs and symptoms

As previously mentioned, the nerve pierces through one of the neck muscles on its way to innervating the other three muscles. This creates a potential point of entrapment of the nerve and this can lead to signs and symptoms commonly experienced with DSN injury. People with DSN injury may present to the clinic with any or all of the following signs and symptoms:

 

  • Abnormal and/or reduced shoulder movement
  • Pain around the lower neck, upper/mid back and shoulder region
  • Winging of the shoulder blade (i.e. tilting of the blade away from the rib cage)
  • Difficulty with drawing shoulders backwards and together
  • Difficulty with raising the arm upwards to full range
  • Altered resting position of the shoulder blade on the injured side. Due to poor functioning of the rhomboid muscles, the shoulder blade may sit away from the spine compared to the non-injured side.
  • Weakness of the affected shoulder muscles
  • Stiffness in the neck / spine

 

Who does it affect?

DSN injuries are common throughout the general population. People whose occupation puts their posture in a compromising position every day and leaves them open to issues around the neck joints and muscles are particularly susceptible to this issue. It has also been seen in people who lift weights and after car accidents.

 

Treatment

Great news! We can help you get over this issue. Once we’ve been through our assessment and are happy with our diagnosis, we can get to work on you. Yes, this is a problem which primarily affects muscles that drive shoulder movement, but the root of the problem is usually down to poor function of the joints and muscles around the lower neck and upper back. Don’t be surprised if we direct quite a bit of our treatment at the spine. We will provide tight neck muscles with a soothing massage. Stiff neck and back joints will be mobilized and may be manipulated if we feel it is required.

As with most injuries, there is an exercise element to recovery. Poor movement patterns in the spine and shoulder have to be corrected and re-trained over a period of weeks to months. This is to ensure we get to the root cause of the problem and don’t just bandage over the top of it. Strength and stability exercises of the trunk and shoulder will be on your to-do list.

As previously mentioned, your occupation may be driving a lot of these issues. We may suggest changes to your work (i.e. a desk set-up assessment) and other aspects of your lifestyle to ensure you’re hitting this issue from all angles. That way we have more chance that the problem will be resolved permanently.

First and foremost, if you think you have a problem, please get in touch today on (416) 546-4887 or email to daniel@beachealth.com so we can start your journey to recovery.

 

References
1. Snell, RS. 2012. Clinical Anatomy by Regions. 9th ed. Philadelphia: Lippincott, Williams & Wilkins
2. Muir, B. 2017. Dorsal scapular nerve neuropathy: a narrative review of the literature. The Journal of the Canadian Chiropractic Association. 61 (2). 128-144. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5596970/

Pandemic Posture

It has been, and continues to be, uncertain times for many of us as the virus pandemic continues to sweep across the globe. Lockdown has meant many of us have had to batten down the hatches and re-discover what it means to be ‘at home’. We ask you the question “how is your body being affected?” Let us take you on a scan of the body, focus on some potentially problematic areas, and give you some advice to avoid any long-term issues.

Head and neck

First stop is the very top! For all of you that normally head out to the office every day, the pandemic might mean you’ve had to start working from home. Not having your usual desk set up can place a great deal of stress on the neck region. Are you now working on a laptop instead of a desktop computer? Are you sitting on the sofa instead of an adjustable chair? Close your eyes for 30 seconds and hone your thoughts in to your neck. Move it around… How does it feel? Is it tight, restricted or does your head feel heavier than usual? It could be that your new ‘desk’ set up’ is causing some strain in places it doesn’t usually. Think about the effect of having your head looking down at a laptop for 8 hours a day compared to straight up at a monitor set to the ideal height… Your poor muscles must be feeling the strain too. We recommend trying to recreate your office space as close as possible to the real thing. If you don’t have a desk at home, a dining table may be more suitable than sitting on a sofa or armchair. You also need to ensure you are moving your neck and shoulders more regularly to avoid them being in a strained position for too long. Take a break every 30 minutes and move into a different position.

Spine

Our spine sits at the core of the body, and we need good function throughout to ensure our limbs can also function with minimal effort and maximum efficiency. Are you used to an active job and now you find yourself homeschooling the children, or trying to break the day up with a bit of reading, gaming, TV or doing a crossword? Life is suddenly much more sedentary for most of us, so it’s important to avoid getting stiff. Sitting with poor spinal posture for extended periods, day after day can wreak havoc. Our spines curve ‘out in the mid-back and ‘in ’ in the lower back. If we don’t look after those curves carefully by protecting our posture from excessive strains, then we leave ourselves open to sore backs and poor functioning limbs as a result. We recommend avoiding long periods of sitting or lying down. Save it for bedtime! Try some standing spinal twists or bends (gently, of course), go for a walk around the garden, or do a session of yoga, Pilates or simple stretching through the day to mobilize your spine. If you have kids, get them to do it with you. They will enjoy a break from their school work, no doubt.

Hips

Anyone who works in a seated position knows what effect this can have on the hips. Having your hips in a ‘flexed’ or in a seated position for long periods of time can leave your hip flexor muscles tight and short. This decreases your ability to open the body out into a fully straight position, reducing flow of fluids through the central part of your body and leaving the back chain of muscles in a lengthened state, which can eventually result in the weakening of the chain. We recommend lots of upright exercises for this one. Counteract the time spent seated working or binge watching a TV series with some standing-based exercise. Jumps, skipping, walking, running or bridging is a nice way to open those hips and get the blood flowing. Our underlying message through all of this is to move, move, move! You are a movement machine, so regularly start the ignition and go for a spin. Look after yourselves and please get in touch today on 416-546-4887 if you need help keeping your pandemic posture in check!

Winging of the shoulder blades

Do you have, or have you ever seen someone whose shoulder blades stick out on their back and look a little bit like wings? This condition is aptly named ‘winging’ of the shoulder blades.

SCAPULA bone anatomy x-ray scan

Anatomy

Osteopaths love a bit of anatomy! The shoulder blade or ‘scapula’ is a largely flat bone that sits on the back of the rib cage and is an important ingredient in what makes up the various joints of the shoulder. As well as the larger flat part, a few extra lumps and bumps makes for a very odd shaped bone when looked at in isolation. One of the bony protrusions actually makes up the ‘socket’ part of the ball and socket joint in the shoulder. The ‘ball’ part being made from the head of the upper arm bone (aka the ‘humerus’).

Interesting fact… There are 18 muscle attachments on the shoulder blade. It is through fine balancing of these muscles which keeps the shoulder blade stabilized and flush to the back of rib cage and allows us to move our shoulders through an extremely large range of motion. As you can imagine, keeping all of these muscles in full working order takes a bit of co-ordination and with so many players involved, there is room for dysfunction to creep in and movement to become affected. Sometimes the dysfunction is great enough to cause the shoulder blade to flip outwards from the rib cage, and this is what we refer to as ‘winging’.

 

Causes of winging

The causes of shoulder blade winging can be broadly broken down into:

  • Muscular: As we previously mentioned, lots of muscles are responsible for controlling the position and movement of the shoulder blade. Injury to these muscles, or an imbalance in the strength, length and function of the muscles over a prolonged period may lead to this issue. The main muscles involved here are the Serratus Anterior (a muscle which attaches to the ribs and the underside of the shoulder blade), and the Trapezius (a kite shaped muscle which covers the back of the neck, shoulders and upper back… Aka ‘traps’). It’s more complex and there are more muscles involved, but these are the key players when it comes to winging.
  • Neurological: Muscles require a nerve supply in order to move, so if any of the nerves that supply the key players (i.e. Serratus and Traps) are injured, this can stop the muscles from being able to perform their job. Nerves can be injured through entrapment, where something presses on a nerve as it travels from the spine down to the muscle it supplies. Other causes may be from acute traumas as seen with car or sporting accidents where the shoulder takes a direct blow while the arm or neck are suddenly pulled.

Other ways these injuries may come about include prolonged wearing of a heavy backpack, complications following surgery, or as a result of a viral infection that affects the nerve.

 

Signs and Symptoms

The main sign is a shoulder blade that doesn’t sit snug to the rib cage, particularly when trying to move the arm upwards in front of the body or out to the side. Many people with scapula winging feel no pain whatsoever, but this can be a very painful condition if the cause is from a severe nerve injury. Another key sign is the inability of a person to lift their arm above their head.

 

Treatment

The treatment of shoulder blade winging very much depends on the cause. If the shoulder blades are winging because of a muscular imbalance, these are a little easier and faster to rehab. After careful assessment of your shoulder, neck and other spinal movements, we will aim to restore full functioning of the muscles that control the position and movement of the shoulder blades. This might include techniques which aim to lengthen short or tight muscles which are pulling the shoulder blade out of position. If there is a weakness to a particular muscle or group of muscles, we will also prescribe you strengthening and movement re-training exercises which aim to return the shoulder blade to its functional position.

Winging caused from nerve entrapment or injury is notoriously harder to treat. If entrapment of the nerve is caused by muscular tension in another part of the body, or because you’ve been carrying a heavy backpack for too long, then we will work on the relevant muscles and nerves to release the entrapment and pressure. We might also need to adjust how you wear your backpack and how much weight is inside while we focus on improving your physical impairments. Nerve-related injuries can take much longer to resolve. Winging caused by paralysis of the nerve which supplies the Serratus Anterior muscle has been known to take up to two years to resolve. The good news is, most people will make a full recovery in this time with surgical procedures saved only for more complex or unresolved cases. Which if you ask any Osteo, is always the goal!

If you notice winging of the shoulder blades, or difficulty with achieving full shoulder range of motion, then get in touch today on 416-546-4887. We would love to chat to you about your issue in a phone or video consult and get you on the road to recovery as soon as possible.

 

References

  1. Brukner, P. et al. 2017. Clinical Sports Medicine. 5th ed. Australia: McGraw Hill Education
  2. Snell, R. 2012. Clinical Anatomy by Regions. 9th ed. USA: Lippincott Williams & Wilkins
  3. Magee, D. 2008. Orthopaedic Physical Assessment. 5th ed. USA: Saunders Elsevier

Vertigo

Vertigo: symptoms and treatment

Benign Paroxysmal Positional Vertigo (BPPV). In simple terms, a non-serious sudden attack of
dizziness brought on by a change in head position.

What is vertigo?
Vertigo is a type of dizziness where a person experiences the sensation of whirling, spinning or swaying. A person will usually feel that they, or objects around them are moving when they are not. There are several causes of vertigo, with the most common cause being BPPV. Other common causes include Ménière’s disease (vertigo with hearing loss and ringing in the ears) and labyrinthitis (inflammation of the inner ear). The ear is made up of an outer, middle and inner section. The outer ear is the ear that we see on the head and the opening that leads into the head itself. This connects to the middle ear — a small area inside the head which houses the ear bones, connects to the inner mouth and also the inner ear. The inner ear is the section which houses our hearing and balance organs — the cochlea and the vestibular system. It is this most inner section which is involved with BPPV.

What causes BPPV?
The structure of the inner ear is quite complicated. It is a maze of hollow chambers and canals
all connected together and filled with fluid. There are three semi-circular canals which are
expertly positioned to detect movement in the 3 planes that our head can move (nodding up and
down, tilting left and right, and looking left and right). Inside the chambers live tiny crystals
which, when movement of the head occurs, move and send important information to the brain
about what type of movement is occurring. Sometimes these crystals become detached from
the chamber and move into the canals where they can play havoc.
Basically, the crystals move through the fluid which stimulates nerve endings in the canal. The
nerves then send a message to the brain which the brain perceives as movement, even though
the head isn’t actually moving. Because this information doesn’t match with what the eyes are

seeing and the ears are detecting, we experience vertigo. It is one big mismatch of information
which is tricking the brain. And the effect is quite unpleasant!
An attack of BPPV can be brought on by a quick change in head position, when rolling over in
bed, sitting up from lying down, or when looking up to the sky. A recent head injury or
degeneration of the inner ear system can precede episodes of BPPV.

Signs and symptoms
The main symptoms as discussed include a sensation of spinning or swaying. People may also
experience feelings of light-headedness, imbalance and nausea. Attacks will usually only last a
period of a few minutes and may come and go. It is not unusual for a person to have a period of
symptoms followed by a period of no symptoms for months at a time. If symptoms persist for
longer than a few minutes at a time, then it is likely the vertigo is from a different cause.
Some conditions that cause vertigo can also give symptoms of headache, hearing loss,
numbness, pins and needles, difficulty speaking, and difficulty coordinating movements.
Episodes of vertigo may also be much longer or constant. If you experience any of these
symptoms they should be reported immediately as they could be signs of more serious issues,
which will need to be investigated.

Can it be treated?
BPPV is very treatable. Many people with dizziness end up seeing their GP first, but it is
common for a GP to refer these cases to us here at Beachealth for ongoing
management. After a thorough session of questioning and assessment, if we are happy with our
diagnosis of BPPV, then we can get to work right away.
BPPV can affect any of the semi-circular canals mentioned above. For treatment, we need to
first bring on the symptoms. It sounds sadistic, but it is necessary to ensure we resolve the
symptoms for you. Treatment for BPPV consists of a series of head and body movements
where you start seated, move into a lying down position and end sitting upright again. This
series of movements is known as the Epley Manoeuvre and is used to treat the most common
form of BPPV. If the source of the problem is coming from a different canal, then the treatment
will be slightly different.
We then send you away with some general do’s and don’ts. You may have to keep your head
relatively still for the rest of the day (sorry, heavy exercise is not recommended at this stage)
and to sleep propped up for the first night after treatment. We will then organise for you to come
back in within a few days to reassess and if necessary continue with another treatment.

Final comments…

Interestingly, we often get patients come in who think they have vertigo, but in fact, it’s other
structural issues contributing to their dizziness (which we diagnose and treat). That’s why it’s so
important that we have a thorough consultation, to ensure we develop the right treatment plan
for you. If you think you are experiencing vertigo, please come in and speak to us. Osteopaths
are highly trained medical practitioners who can help treat more than you think. Call us today on
(416) 546-4887 to book your consultation.

References:
Vestibular Disorders Association. 2020. Benign Paroxysmal Positional Vertigo (BPPV).
Available from: https://vestibular.org/understanding-vestibular-disorders/types-vestibular-
disorders/benign-paroxysmal-positional-vertigo.
Healthline. 2018. Benign Positional Vertigo (BPV). Available from:
https://www.healthline.com/health/benign-positional-vertigo.
HANDI project team. 2013. The Epley Manoeuvre. Australian Family Physician. 42 (1). 36-37.
Available from: https://www.racgp.org.au/afp/2013/januaryfebruary/the-epley-manoeuvre/

Cranial Osteopathy and Cranio-sacral therapy

Our Osteopathic Manual Practitioners at Beachealth have completed a 5 year double degree university program at Victoria University in Australia for Osteopathy. This qualifies them to practice osteopathy and in Australia under the title of Doctor. The basic training of cranial osteopathic technique is given during the medical degree, but some Osteopaths specialize at post graduate level.

In the 1970’s Cranio-Sacral therapy embraced these osteopathic techniques. However, most Cranio-Sacral Therapists are not Osteopaths, and not all therapists have a background in anatomy, physiology, pathology, diagnosis and biomechanics. Therefore they are unable to offer a valid working diagnosis which is essential prior to application of treatment.

Swift Treatment For Warts

Now available at Beaches Foot Care Centre (@Beachealth)

Treat warts with confidence!

Swift is the pioneering new microwave therapy system for the treatment of Plantar Warts.

How frustrated are you trying to get rid of Plantar Warts? I know that after many years of implementing many different types of treatments, I became tired of not seeing much,  or any progress in resolving this stubborn infection for my patients. In search for the best option available I decided that “SWIFT”  will be my best solution to fight this stubborn viral infection.

What are warts??

Warts are benign skin growth caused by human papilloma virus (HPV). There are many types of warts, and at our clinic we are treating specifically Plantar/ Foot Warts. These are usually found on the soles of feet. Plantar warts often grow into the deeper layer of skin due to the pressure from walking, and standing. Walking around barefoot increases your risk of developing plantar warts.

Warts may spread from person to person by direct or indirect contact, and may also spread from one area of body to another. individuals with weakened immune systems may be more susceptible. 

At “Beaches Foot Care Centre” , I would first assess infection  and together with patient decide on the best treatment option.  Thera are few options we offer, to name a few: the application of blistering medications, wart needling… These treatments are time consuming and often painful, and traditionally warts have been very resistant to most of them. That is, until now.

What is “SWIFT”?

Swift is a new technology, developed in the UK, which has been licenced for the general treatment of skin lesions in Podiatry and Dermatology. Swift uses microwave energy which is delivered through a special probe applied to the skin to treat the affects tissue. After continued research into novel microwave based medical product, success rate spiked significantly.

I am proud to be among very few clinics in Toronto using this new and exciting technology.

If you are suffering from wart infection, do not hesitate to contact me to inquire more information, or make an appointment.

Sincerely,

Lada Milos Lee B.Sc, D.Ch.

Is the Empty Can Test A Good Rehab Exercise?

Over the past couple of weeks, I have been seeing a few more shoulder injuries, all which have started for many different reasons. There have been falls, sports injuries and others which have been there for a long period of time. However, with some of the presentations there has been a common factor and that has been a particular exercise or rehab that has been prescribed.


After spending some time with the clients going through their medical history and working out actions that may aggravate or relieve their pain, we are able to come to a clinical impression, which gives us an ability to determine a personalised rehab plan to the shoulder joint. The shoulder can be a complicated joint as there are lots of different muscles which attach around the area and influence its movement.
While I don’t like to call out another practitioner or say that one exercise shouldn’t be performed, I do believe that there are exercises that are better for people so that we are to strengthen an area while limiting pain.

The empty can/ full can exercise involves taking your arms out to the side (abduction) on about a 45-degree angle and turning your thumbs down (pronation) or as if you are pouring a can out and then turning the can upwards (supination) this exercise is done with weights being held and repeating the pronation and supination action.

This exercise has been proven to target the supraspinatus muscle, which is one of the four rotator cuff muscles. When you pronate your wrist, we decrease the amount of space our shoulder joint has to move and this is one of the many reasons that people may get shoulder pain. So you can imagine that if you have been given this exercise from a healthcare practitioner and you are getting a sharp pain in the front of your shoulder, your desire to perform the exercise is not going to be very good. So how do we target the muscle without placing our shoulder in a painful position?

There are a number of different ways, but to keep it simple, standing external rotations and lateral raises, should be sufficient enough to train the muscles. Each person is different and require slightly different instructions or cues to help them feel the activation of a muscle, but as a general sense these 2 exercises can activate the muscle correctly without putting the shoulder into a position which may cause more impingement pain.

If you think that this could be beneficial for yourself, please don’t hesitate to contact us at the clinic

Written By: Brendan Ashman