​Low back pain is one of the top three causes of disability in the world.  An episode of acute low back pain will affect about 80% of us at sometime in our lives, and is one of the top reasons for time loss at work.  According to the Canadian Chiropractic Association, it is estimated that the medical costs in Canada related to low back pain  ranges between 6 and 12 billion dollars annually!
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Causes of Back Pain
Low back pain is a complicated, multi factorial problem that often involves a trauma or long term additive stressors.   There is a strong correlation between sedentary lifestyle, obesity, and heavy repetitive labor with increased risk of low back pain. 
All of these factors involve the spine being weak and therefore more susceptible to injury when placed under a sudden load or repetitive stress. The best way to prevent this is to strengthen your spine.

1. Planking 
Planking is a great way to strengthen the back of your body including the hamstrings, butt, back extensors and neck extensors, while engaging your core. Beginners should try to hold the pose for 30 second intervals, and more advance people can hold the pose for over a minute. 
To do a proper plank, you must: 
1. Keep elbows, feet, and knees shoulder-width apart.
2. Keep spine parallel with the floor while holding yourself up on your elbows and toes.
3. Keep head in-line with your spine so that your head doesn't drop.
​4. Breath steadily throughout the hold of the plank. 

2. Pelvic Tilts
This exercise targets the lower back and abdominal muscles. Pelvic tilts can be done while laying on your back, sitting or standing. The easiest way is to do them on your back, laying on a firm surface. 
1. Lie on your back with your knees bent and the soles of your feet on the floor. In this neutral position, the natural curve of your lumbar spine will lift the lower back slightly off the floor.
2. Exhale and gently rock your hips toward your head. As you do this, you'll feel your lower back pressing into the floor.
3. Stay here for a few breaths. When you're ready, inhale and return to your neutral position.
Try to feel the stretch in your lower spine when doing both movements to achieve the tilts. Don't forget to breathe!

3. Back Bridges
This is the movement that fires up your butt muscles.  It is a great core activating exercise that is easy to do. 
1. Lay on your back with your knees bent to 45 degrees and your feet on the floor.
2. Place your arms out at 45 degree angles.
3. Tighten your stomach muscles and raise your butt off the floor until your spine is straight.
4. Squeeze your butt muscles at the top of the move and hold for 5-10 seconds.

4. Back Extensions​
Extensions combine the movements associated with the pelvic tilt and the back bridges. Once again, this works on pelvic mobility and strengthening the muscles of the back. 
1. Lie on a mat on your stomach and straighten your legs behind you. Place your elbows on the ground and slide your shoulders down.
2. Lift your upper back, pressing your hips into the mat. Keep your head and neck neutral. Hold for 30 seconds.
3. Lower to starting position. For a deeper stretch, put your hands on the floor underneath your shoulders. You can also make it harder by placing your hands against your body.

6. Cross Crawls
The cross crawl maneuver works the upper and lower body while helping with balance and body muscle control.
1. Go onto your hands and knees.
2. Keep your spine neutral with a slight arch in the low back.
​3. Slowly raise your right arm and left leg till they are parallel with the ground. Make sure you keep your spine flat and that you don't rotate your spine to raise a hip or a shoulder
​4. Lower your arm and leg and then do the same with the left arm and right leg
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​Back pain will affect almost all of us at some point in our lives. Visit our office and get a thorough exam of your spine and learn what you can do to eliminate and prevent your back pain.  Our Chiropractic and Massage therapy teams are trained to evaluate and treat low back pain conditions. ​
Activity fact: Performing movements  that require you to use the opposite lower and upper extremity (like the cross crawl), actually increases activity between the right and left side of the brain, causing better brain activity and communication. 

COVID-19 has caused a lot of changes in society and one of those is people are now working from home. We are away from our ergonomic designed desks at work and have moved to the ill equipped kitchen table or couch.  This has left people with increased headaches and neck pain.  However, there are many things you can do to help prevent these symptoms.  

Location, Location , Location

The number one thing that you need to consider when setting up your work  station at home is where you are going to work.  It is important that you find a desk with a good chair that will provide support for your spine. It looks so inviting to curl up onto the couch, or even in bed, with your laptop.  Poor postures in these locations will cause gradual strain on your muscles and joints and then pain in the long run. 
Not everyone has a desk with an office chair at home so the next best thing is your kitchen table. Often the kitchen table is higher than the average desk and there will be more strain put on your shoulders, especially when using a lap top. Try to find a taller chair that will raise you up. 
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Setting up Your Work Station

Recognizing that there will be limitations to what you have at home, the following are some basic rules that you can follow when setting up your work station:
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1. Have an adjustable chair so that you can move the height to have your thighs parallel with the floor, your feet flat on the floor, and your elbows supported 
2. Use a foot stool if your feet don't touch the floor
3. Your desk height should be 28 to 30 inches tall so that your elbows are flexed at 90 degrees
4. If you are not using a lap top, your keyboard and mouse should be placed on the same level and so that your elbows are at 90 degrees 
5. When using a desktop monitor your screen should be about an arms length away and the top of the screen should be level with your eyebrows 

Get up and Move

A past blog post sited that sitting is the new smoking. It is proven that prolonged sitting is not good for our health.  One of the advantages of working from home is you can get up anytime and get moving.  It is recommended that you get up from sitting every 45 minutes and spend 5 minutes moving around.  A lot of people are finding they are more productive  working at home because they are not interrupted as much, they don't have to commute, and they can enjoy their lunch hour and breaks more.  With this said, you actually have more opportunity and more time to get up from your work station when working at home. Some tips to help motivate you to get moving are:
1. Set a timer to remind you to get up
2.  Make a schedule of activities that you can do on your breaks including, a short walk, basic stretches, yoga, and body weight exercises
3. Make a goal to get moving, write it down, and reward yourself for your efforts
4. Don't use your breaks for social media.  This just keeps you sitting more!

Try Standing When Working 

Standing work stations are becoming common place in the work force. These allow workers to get up from their desks and help fight the health risks of sitting.  Research shows that they are beneficial but are not good if used all day. Standing in one spot for long periods can put excess stress on your knees and low back. It is recommended that you should stand 30 minutes to one hour for every 2 hours of sitting. 
Most of us will be working at home with a lap top and this allows you to move to different locations including to a spot where you can stand.   

Working from home has its challenges when you don't have a proper desk.  Avoid the temptation to curl up on the couch with your laptop, set up a good work space, and keep moving during the day.  These tips should help you avoid tension building up into your neck and shoulders. 

Activity fact: You should wash your hands with soap and water for a minimum of 20 seconds to help kill any viruses.  Singing the alphabet song at a slow pace while washing should accomplish this. 

The Patella, commonly known as the knee cap, is an essential bone in the knee joint that acts as a fulcrum for our quadriceps, (the thigh muscles), to help gain mechanical advantage for extending your lower leg.  The patella is roughly triangular with the apex of the triangle articulating with the femur bone and it is the largest sesmoid bone in the body.  It is equipped with some of the thickest cartilage on this inferior surface.  The knee cap is stabilized within the grove of the two femoral chondyles with the balance of the musculature and ligaments around it.  This is largely made up of the quadriceps muscles. When there is trauma or a muscular imbalance at the patella, pain occurs.

Symptoms of Patellofemoral Pain Syndrome (PFPS)

PFPS can affect everyone with women and young adult athletes being affected the most. The main symptom of patella-femoral syndrome is pain under or around the knee cap but other symptoms include:

-pain going up and down stairs, (usually more descending stairs)
-pain squatting
-pain kneeling 
-swelling around the knee cap
-knee pain when getting up after sitting for a period of time
-grinding or popping when moving the knee
-increases pain with activities that involve jumping or running

Causes of Patellofemoral Pain Syndrome

Trauma can be a cause of PFPS when  a person falls directly onto the knee and drives the knee cap into the joint.  This causes injury to the cartilage under the patella and joint irritation.  Gradual onset of PFPS is the most common presentation.  There is no one common cause of the condition but often an imbalance of knee cap musculature is at the root of the problem. 

Common aggravating factors to this include:

-Over use of the knee joint when the knee musculature isn't capable of handling the stress
- repetitive exercise that causes an imbalance of musculature around the knee. (example: cycling can build up the lateral leg muscles greater than the medial ones)
- weakness in the hip and back muscles causing an imbalance down the mechanical chain
-Increased pain when playing sports on hard surfaces 
-Certain body types with an increased angle at the knee are more prone to PFPS
-Flat feet or other foot conditions
-improper footwear or changing footwear can flare up PFPS

Treatment of Patellar-Femoral Pain Syndrome

Initial Treatment
Inflammation should be initially managed if you have a flare up around the knee cap that involves pain and swelling.  The classic RICE method should be used:
R- Rest. Decrease or eliminate the aggravating activity
I -Ice. Place ice on the knee in intervals of 15 minutes an hour (don't place directly on skin)
C- Compression. Lightly wrap the knee in a compression bandage, leaving a hole for the knee cap.  Ensure that it doesn't cause more pain when wrapped
E- Elevate.  When you are able, elevate your leg when resting throughout the day.

Medications
Initially, the use of anti-inflammatory medication is appropriate for those who can take them.  They should not be used for over 2 weeks without consulting with your doctor. 
 
Therapy
Conservative care is the appropriate treatment as surgery is rarely needed.  A thorough examination of the leg, hip and back musculature is needed to asses if there are any weakness in the biomechanical chain.  Secondly the feet should be checked to see if there is extra force being placed on the knee due to improper foot mechanics.  
Initial therapy may include modalities such as ultrasound, current, TENS, massage and adjustments to the hips and spine.  It will be determined if you have an imbalance in the musculature and an exercise program will be implemented. 
Common exercises for PFPS include:
a) Stretches
-quad stretch (heal to bum)
-calf stretch (foot up the wall or hang heal over a step)
-hamstring stretch ( sitting toe touches with a straight leg)
- IT band and glute stretch ( sitting with knee bent and pull the leg across the body)

b) Exercises
-shallow wall squats
-glute exercises including clam shell, side leg raises and rear leg extensions
- sitting leg raises with no weight
- lay on your back and lift your leg off the floor 8 inches and hold for 20 seconds
- stand on one leg and slightly bend your leg and hold for 10 seconds

These are some common exercises prescribed and may be different depending on the cause of the imbalance.  Always remember to stop if the exercises hurt, warm up before and cool down after exercising.  

Pay attention to knee pain around the knee cap when it starts.  Listen to your body and get an examination to see if you are starting to develop PFPS.  Find the imbalance and correct it and therefor stop  any progression of chronic knee pain. 

Activity fact: long-term studies have found that runners have less incidence of knee osteoarthritis. One study that followed runners and nonrunners for 18 years found that, while 20% of the runners developed arthritis during that time, 32% of the nonrunners did!

Whiplash is a term to describe a sprain/strain injury to the neck caused by a significant jarring to the spine and stretching of the tissues.  This term is commonly used when describing a neck injury in an automobile accident but can also be applied when the neck is injured in sports, a fall, or other trauma. The over-extension and/or  flexion of the neck causes the muscles, ligaments, joint capsules, and tendons to be stretched beyond their normal capabilities and tissue injury occurs. 

Symptoms

Whiplash associated disorders (WAD) have  been categorized  into four categories based on the severity of the signs and symptoms:

1. Grade 0- you do not have any symptoms or physical signs
2. Grade 1- you have pain and discomfort  but no physical signs
3. Grade 2- you have pain and discomfort with physical muscle and joint signs
4. Grade 3- you have physical signs and neurological changes
5. Grade 4- You have neck complaints with fracture or dislocation

Often whiplash symptoms to not appear till the next day or sometimes 2-3 days after the injury. The most common symptom is neck pain and the intensity of symptoms vary widely between patients correlating with the severity of the injury.  

Common symptoms can include:

-neck stiffness
-headaches (common at the base of the skull)
-trouble sleeping
-mid back and low back pain
-change in range of motion of the neck
-muscle fatigue (worsening throughout the day)
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More severe symptoms include:
-dizziness
-blurred vision
-ringing in the ears
-Arm pain or numbness
-depression
​-difficulty with concentration or memory
-difficulty swallowing
It is important to seek medical attention if you suffer from any of these more severe symptoms after your injury. 

Treatment of Whiplash

It is important to seek treatment if you suspect you have suffered a whiplash injury. You must seek medical attention if you have endured a significant trauma to your spine or have sustained a head injury.  A medical doctor will examine you and order imaging, such as x-ray, if they feel it is needed. 
Once any serious problems have been ruled out, a proper assessment of the spine and the surrounding structures will ensure a quicker recovery and help to avoid any long term development of a compensation pattern that can lead to osteoarthritis later on.  In grade 2-4 WAD injuries, there is a risk of causing hyper-mobility of the neck joints due to the fact that the stabilizing tissues (ligaments and muscles) are over stretched.  This can cause the muscles of the neck and mid back to tighten up and be chronically irritated as well as the joints to have too much movement.  Over time these problems can lead to arthritis in the spine. 

Initial treatment of whiplash should include applying ice and using over the counter anti-inflammatory medications to help manage the pain and swelling. This should be done over the first 2 or 3 days. It is important to maintain movement and to keep active.  Research shows that prolonged rest or wearing a neck brace to prevent movement can prolong recovery. 
It is important to start regular treatments to the neck and mid back. Most grade 1 and 2 whiplash injuries will resolve within 4 to 6 weeks.  Grade 3 and 4 whiplash injuries, all though rare, can take much longer depending on the structural damage to your neck.  
Treatment guidelines for neck pain due to whiplash  outline that the best practice is to initially seek regular weekly care over a 6 week trial, involving home exercises and stretches.  Multi-modal care has been proven to be the best.  This involves combining therapies including: deep tissue massage, spinal adjustments, short term use of muscle relaxants, yoga, range of motion exercises and stretches. For more information visit: https://www.ccgi-research.com/guidelines.

Keeping Active

Again, it is important to keep moving and doing your normal activities of daily living.
It is not recommended that you sit around and do nothing.  Being active with minor pain will not cause tissue to be damaged. 

Some tips to help with this are:

-Avoid prolonged sitting postures with anterior head positioning
-Avoid contact sports
-Avoid long rides in a vehicle
-Periodically stretch and move around throughout the day
-Avoid lifting heavy objects, such as groceries 
-Adjust your pillow to maximally support your neck during sleep
-Make sure you focus on your recovery not the whiplash
-Make sure you seek care if you feel your mental health has been affected by the injury
-Choose low impact exercises such as walking, swimming, or biking
​-Shorten exercise routines as muscles will fatigue faster