Headaches are one of the top five reasons people seek care at my office. It is estimated that over 25% of the population is affected by headaches and they can be a major cause to days lost at work. The most common type is the tension headache, accounting for around 90% of all headaches.  Chiropractic care is a great solution to those annoying tension headaches that are related to muscle and joint pain. Causes of tension headaches include lack of sleep, stress, muscular strain, and joint tension.  Strain to your spine from prolonged sitting and screen time is also a common contributor.     However your headaches might be caused by something other than your back and neck:

Medication

Medications can often be a cause of headaches.  The unfortunate thing is a lot of medications used to treat headaches can actually be the cause of them.  Anti-inflammatory, pain, and migraine medications all can cause a rebound headache effect. Rebound headache is a medication overuse headache that occurs when you use headache medications multiple times in a month and when you stop using them your body reacts with withdrawal symptoms.  This can happen with both prescription and over-the-counter medications.  Common examples include: Aspirin, Acetamenophen, Ibuprofen, Naproxen, sleeping pills, Codeine, medications that contain caffeine, and migraine medications that contain Triptans.  If you are worried about having rebound headaches you should always consult your doctor before making any medication changes. 
Many other medication can have side effects that cause headaches.  It is very good practice to always research the side effects of every medication that you take and also talk to your pharmacist to see if there could be drug interactions when taking multiple medications. 

Sinus Pain

We have all had a bad cold and felt the pressure from a head full of mucus.  A true sinus infection has the following symptoms:
- often involves pain over the frontal sinuses above the eyes and over the cheek bones
-frontal headache
- Pain occurs when applying pressure over these areas 
-post nasal drip often causing coughing
-teeth/jaw pains
-discolored nasal discharge (often green or bright yellow)
-bad breath

Sometimes sinusitis can linger after the cold symptoms disappear or the sinuses can be inflamed due to allergies.  Frontal headaches from this can mimic tension headaches.  to determine the difference, try the following:

-pain with pressure over the eyebrows, cheek bones, or the bridge of the nose means sinus pains, not tension headache. 
-a headache that is provoked by bending forward looking at the ground means a possible sinus headache, not a tension headache.
-a headache that can be correlated with an allergy season (example rag weed season)
​-headaches with post nasal drip can mean chronic sinusitis

Dehydration

We often don`t realize how little fluid we take in. We should all be drinking our 8 glasses of water a day but often we drink 2 glasses of water, 4 cups of coffee, and maybe a pop.  This results in drinking  fluids that dehydrate us more than helping us to keep hydrated.  Add some exercise or a hot day and you are at risk of a headache from dehydration.  Children and Elderly are most at risk for dehydration as well as people with kidney disease.  Headaches from dehydration are usually located around the head and can be pounding or pulsating.  They are different than sinus headaches as there is rarely facial pain. They are associated with other signs of dehydration including: a dry mouth, dark urine, decreased urination, diarrhea, or vomiting.  

Can your mental health be linked to your back pain? This is starting to be a topic that is being investigated by many researchers as chronic back/neck pain affects 1 in 10 people in the world and mental health problems are directly linked. Global burden of disease studies are showing this direct linkage to back pain and mental health problems. 
Research is showing that in order to help someone with chronic back/neck pain you also need to address their mental health. 

What the Research is Telling us:
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A 2016 study in the General Hospital Psychiatry Journal, used information from the World Health Survey (set up by the WHO),  and looked at health statistics for 43 low to middle level income countries, including: India, China, Brazil, Russia, Ghana, Pakistan, Vietnam, Philippines, and Kenya.  The survey included over 190,500 participants from around the globe and looked at what health problems are occurring in these populations.  The study found that there was an average prevalence of 35.1% for back pain and 6.9% for chronic back pain. Some countries had a back pain prevalence of over 50%, including Brazil, Bangladesh,  and Nepal. The study found that there where links to an increased risk in back pain including: smoking, alcohol consumption, older age, female sex, low education, low income, and living in an urban setting.  
The most striking statistic was the relationship between mental health and back pain. If patients had any type of depression or psychosis, anxiety, or sleeping problems, there was a much higher prevalence of some form of back pain or chronic back pain. In fact, all types of mental ailments were associated with >2 x higher odds for developing some type of back pain.

Other notable findings included:
- the higher a person rated their stress the stronger correlation to back pain 
-patients with a psychotic disorder (including  Schizophrenia) had a slightly over a 2 fold increase in back pain and chronic back pain
-patients with sleeping disorders also had a two fold increase in the odds of having back pain
-depression is directly linked to chronic back pain rather than acute back pain

What can be Done?

It is very apparent that a practitioner must address a patients mental health along with back and neck pain.  This is especially important when dealing with disabling or chronic back pain.  However, there are lots of tools that the patient can use to help their own fight against mental health and associated pain. 

The Spine:
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Back/neck (combined) pain affects slightly over 80% of the population at sometime in their life. It is the number one causes of time off work and contributes to the greatest cause of disability in the world. 
Chronic pain naturally makes a person want to be sedentary. Often people have fear that using their back joints and muscles will cause further damage and disability.  In the vast majority of cases this is not true.  The body has an amazing ability to heal itself to ensure the nervous system, encased by the spine, is safe from harm.   Treatment guidelines from the Canadian Chiropractic Association for chronic low back pain, and chronic low back pain with sciatica,  states that the most effective treatments include conservative care including home exercises and stretching. Gone are the days of prescribing bed rest for back pain.
Chronic pain can cause a negative cycle where the patient is fearful of exercise, this causes further weakening of the spine, which in turn causes more pain. The best treatment is to find a health care provider that can start you on the correct path of exercises to help combat your chronic pain. 

Your mental health:

​By age 40, about 50% of the Canadian population will have or have had a mental illness.
Everyone knows someone that has been affected by this.  Being active is the number one thing you can do to change your overall health and it is no surprise that it helps your mental health too. Many studies have shown that simple activities such as walking are more effective in treating depression and anxiety than taking conventional medications.
​Amazing chemical changes occur in our brain when we exercise.  Physical activity immediately boosts the brain’s dopamine, norepinephrine, and serotonin levels—all of which affect focus and attention, improves mood, and brain circulation. In this way, exercise works in much the same way as medications such as anti-depressants, relaxants,  Ritalin and Adderall. Exercise helps balance out these neurotransmitters and give us an overall improved positive attitude.
Exercise also promotes improved circulation and chemical changes in the brain that promote growth of nerve cells. This has direct impact for people with ADHD due to improved memory, mental clarity, and overall mood. Studies suggest that a tough workout increases levels of a brain-derived protein (known as BDNF) in the body, believed to help with decision making, higher thinking and learning. 

Conclusion:
Chronic back pain and mental illness are directly linked and need to be co-managed together when treatment occurs.  Find a health care provider, like a chiropractor, that can provide you with professional advice on treatment of your spinal pain. The next step is to get active! Keep your spine strong and your mind clear with regular exercise.

Activity Fact:  Neepawa hosts the Miles for Mental Health run every year to raise money for local support groups and to raise awareness for mental health.  

The US weight loss industry is estimated to be a $66 billion dollar industry. There is a hundred different types of diets to try and even more new exercise trends that claim to shed the pounds off. We now even have apps that can track every step we take and calorie taken in. Weight loss should be simple: take in less calories, burn more calories and the weight should fly off and stay off.  However, this is not the case.  70% of Americans still remain overweight or obese. A UCLA study has shown that slightly more than 80% of successful dieters end up gaining all their weight back in two years!
Scientists are studying weight loss and trying to find out what is the best way to lose weight and how to keep it off.  

Exercise and Weight Loss

Exercise is essential for weight loss but also for a healthy body and mind.  Many studies show that it has multiple benefits including: better mental health, better brain health, better muscle and bone health, and helps to prevent aging.  Muscles need energy, through calories,  to function.  They are essentially calorie furnaces for the body.  There is no one ideal exercise that works for everyone.  Research is now showing any kind of exercise is beneficial for weight loss, with walking being the most successful among people who are able to keep the weight off.  Michele Olson, PhD, professor of physical education and exercise science at Auburn University at Montgomery, Alabama says "Data shows that to lose weight with exercise and keep it off, you don’t need to run marathons. You just need to build up to five to seven workouts a week, 50 minutes each, at a moderate intensity, like brisk walking or Zumba." This is proven through many studies with the point being that you need to make being active on a regular basis, an essential part of your weight loss plan.  
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Strength training with high intensity interval training is very time effective and helps to build muscle mass and therefore add more tissue to burn calories. It also causes hormones and enzymes to be produced by the body that positively affects your metabolism causing the body to function more efficiently.  It also eventually effects various hormones in your body that also are connected to losing weight.   

Diet and Weight Loss

Weight loss and the commercialization of dieting started to take off in the 1960's.  Since that time we have seen many different diets and debates come and go.  From the Grapefruit diet, Atkins diet, low-carb, low-fat, keto, and calorie counting, we have been told what the magic fix is to shed those pounds. 

Understanding what it is about a given diet that works for a given person is the unsolved mystery of weigh-loss science.  Hall, a researcher from the National Institutes of Health, has been studying weight loss for many years and has found that when you take a group of people and randomly assign them to a follow a low-carb diet or a low- fat diet and follow them for a few years, what you tend to see is that average weight loss is almost no different between the two groups as a whole.  But within each group , there are people who are very successful, people who don't lose any weight and people who gain weight. 
People lose weight, but often gain it back. However, there are those that keep it off. What is it that helps keep weight off?  The common factors of over 10,000 people researched that have kept over 30 pounds, or more, off for over a year or longer are:
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1. They eat breakfast every morning and it helps to control insulin and jump start metabolism
2. They exercise every day for a total of 60 minutes, sometimes all at once or in intervals
3. They watch less than 10 hours of TV a week
4. They check their weight on a scale at least once a week to help monitor their gains
5. They have a meaningful goal behind them. Such as avoiding disease or want to live longer to spend time with their family. 
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Research is showing that there is not a specific diet or eating style that is perfect for everyone.  A balanced diet with lower carbohydrate levels, 30% protein intake, and lots of fruits and vegetables is very appropriate. Staying away from trans fats and sugary foods helps to keep your insulin sensitivity functioning properly, therefore avoiding weight gain and cravings. 

The Answers to Weight Loss
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1. Weight loss is about changing bad habits into good habits- We eat something sweet after supper every night, we order gravy with our fries, we order a sugary drink when eating out.  These are all examples of habits that we don't even realize we do.  You must take time to recognize your bad habits and replace them with good habits.  This also is appropriate for exercising.  The book "The Power of Habit" by Charles Duhigg is a great read for discovering what habits are and how to change them. 
2. Have a higher purpose for losing weight- Find a reason why you want to lose weight beyond wanting to look like a super model. Be healthy for your family, be healthy to slow aging and you will have more time with your children, be healthy to fight cancer or cardiovascular disease. 
3. It takes several tries- like quitting smoking, it takes many tries to change habits! Don't give up if you aren't losing weight or if you gain it back. 
4. Not one method works for everyone- as mentioned before, there is no magic exercise or diet to losing weight.  Different methods work better for different people. You must try different methods to see what works and this will involve gains and losses. 
5. There are multiple reasons for not being able to lose weight- losing weight isn't from one simple reason.  Psychological reasons, example stress eating, is a major cause of weight gain, hormonal imbalances, medications, the wrong diet, sitting too much, and many other factors can all contribute to weight gain. Evaluate and make changes to help these factors.   
6. Like What you Do- It is obvious we don't want to do things that we don't like and it is the same with diet and exercise.  Find healthy foods you enjoy and find exercises that you look forward to doing. 

Weight loss is not as simple as eat less and burn more. ​So what is better to concentrate on, Diet or Exercise?  The answer is both are important. However, you can never out exercise a poor diet.  Start by evaluating your habits and slowly make changes. It takes time.  Avoid fads and stick to your plan. 
 
Activity fact- On average there is 16 calories in a spoonful of sugar. If you put a teaspoon in your coffee everyday, and drink two cups a day, you are consuming 11,680 calories a year! 

Osteoporosis is a  condition where a person has low bone mass due to loss off bone or the lack of production of bone, or both. It is a condition known as the "silent thief", as the condition can progress over years undetected and when a fracture occurs, and it is too late to get treatment. According to Osteoporosis Canada, it is estimated that 2 million Canadians are affected by osteoporosis with 1 in 3 women and 1 in 5 men suffering from an osteoporotic fracture in their lifetime. 
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Risk Factors for Osteoporosis

The government of Canada public health lists the following risk factors: 

Younger adults (age < 50 years):

• Fragility fracture (breaking a bone as a result of a minor accident)
• Long term use of glucocorticoids such as prednisone
• Hypogonadism or premature menopause (age < 45 years)
• Having other disorders strongly associated with rapid bone loss and/or fracture such as rheumatoid arthritis, malabsorption syndrome, and primary hyperparathyroidism.

Older adults (age > 50 years):

• Being 65 years or older
• Clinical risk factors for fracture (menopausal women, men age 50 to 64 years):
  • Fragility fracture (breaking a bone as a result of a minor accident)
  • Long term use of glucocorticoids such as prednisone
  • Having a parent who had a hip fracture
  • Having a spine fracture or low bone mass identified on x-ray
  • Being a smoker
  • High alcohol intake (greater than or equal to 3 units per day on a consistent basis)
  • Low body weight (less than 60 kg or 132 lbs) or major weight loss (present weight is more than 10% below your weight at age 25)
  • Having other disorders strongly associated with rapid bone loss and/or fracture as mentioned above.  

Consequences of Osteoporosis

Fracture is the biggest risk for people with osteoporosis.  An astounding 80% of fractures in people over 50 years of age are contributed to osteoporosis.  The most common areas to fracture are the spine, shoulder, wrist and hip. 
Hip fractures are common, with roughly 70% to 90% of the 30,000 of them a year in Canada, contributed to osteoporosis. 28% of women and 37% of men who suffer a hip fracture will die within one year and also have a 50% chance of another hip fracture within 5 years.  
Spinal fractures also contribute to a lot of disability.  The pain and loss of mobility has a direct impact on quality of life.  Spinal fractures have a 20% re-occurrence rate in the first year, causing progressive spinal deformity and lack of mobility.  

Treatment for Osteoporosis

No single cause for osteoporosis has been identified but there are a number of preventative things you can do. Peak bone mass is achieved for women at the age of 16-20 and for men at the age of 20-25.  This means building strong healthy bones during childhood and adolescence is essential to help avoid osteoporosis as an adult. Osteoporosis has been called a "pediatric disease with geriatric consequences". 

1. Diet
Diet is an essential start in the prevention of osteoporosis. Calcium rich foods are essential for your body to create bone mass. How much calcium do we need? Dietary guidelines state that age 19 to 50 you require 1000 mg, age 50 plus you require 1500 mg, and pregnant or lactating women require 1000 mg. 
Calcium rich foods include dairy products and green leafy vegetables. If you can't consume dairy products, try calcium fortified almond or soy milk.  Canned salmon or tuna is also a great source of calcium. According to the National Osteoporosis Foundation "Recent research has found that olive oil, soy beans, blueberries and foods rich in omega-3s, like fish oil and flaxseed oil may also have bone boosting benefits. While additional research is needed before the link between these foods and bone health can definitively be made, the many overall health benefits of these foods make them excellent choices to add to your diet".
Foods that should be avoided in excess include caffeine, alcohol, wheat bran, soft drinks, and high protein diets. 
A nutritional guideline resource can be found at https://www.nof.org/healthy-bones-guide/

2. Exercise
In childhood and adolescence, exercise will stimulate the body to create more bone mass. In adulthood, exercises help in the prevention of further bone loss but unfortunately has minimal effect of producing more bone mass.  However, it is never too late to start exercising.  It is important to consult with your healthcare provider to determine your limitations with an exercise program.  This is very important if you have cardiovascular conditions. Research shows that weight bearing exercises are the best for osteoporosis. There is low impact and high impact type weight bearing exercise. Low impact include: Tai Chi, Palates, yoga,  walking, stair stepper, and glider workouts. High impact include: aerobics, running, dancing, racquet sports, weight lifting and climbing stairs.  
There are many other benefits to exercise as it also helps with muscle strength and balance which directly helps to prevent falls.  

3. Medication
Osteoporosis medications slow down the breaking down of bone.  Bones naturally break down and re-build, but as we get older the rebuilding of bone can't keep up with the break down.
Bisphosphonates are the most common medications prescribed for osteoporosis treatment. These include:

• Alendronate (Fosamax)
• Risedronate (Actonel)
• Ibandronate (Boniva)
• Zoledronic acid (Reclast)

Your doctor might also prescribe different medications depending on your kidney function, hormonal levels, and  if you are using steroid medications. 

Osteoporosis is "The Silent Thief".  Children and adolescents need calcium rich balanced diets to help grow strong bones.  As adults we need to keep active with weight bearing exercises and work outs that promote the preservation of strength and balance to help reduce fall risks. Avoid smoking, excess alcohol along with a healthy diet.  If you have risk factors for osteoporosis, contact your medical doctor for possible bone density screening and treatment.

Activity fact:  Fractures from osteoporosis are more common than heart attack, stroke and breast cancer combined!  Get active and keep strong.