The rotator cuff of the shoulder is made of four muscles that attach onto the humerous from the scapula, (the shoulder blade).  Their main purpose is to stabilize the shoulder joint and scapula and help you move your arm at the shoulder joint. This group of muscles is often injured at its insertion on the arm where they join together.   Cuff tears are the most common shoulder disease in patients with shoulder problems and is prevalent in 21% of the general population and estimated to affect 50% of people over 50 years old.  These statistics make cuff injuries a very common presentation in my office. 

Rotator Cuff Tendinitis and Tears

Tendinitis:

A Tendinitis injury is due to overuse of the muscle, repetitive micro injuries, or secondary to trauma. The junction of the muscle tendon to the humerous bone gets inflamed and irritated causing stiffness, pain, loss of joint motion, and joint crepitus. 

Tears:
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There are two types of rotator cuff tears: full thickness and a partial thickness tear.  A partial tear occurs when one of the muscle is partially torn and a full thickness tear occurs when a tear occurs through the whole muscle attachment or it gets pulled off of the bone. Acute tears most commonly are caused when a fall occurs with an outstretched arm, and the ball of the humerous forcefully stretches the rotator cuff.  Chronic tears come from repetitive actions like throwing a ball, rotation of the arm, and overhead work that can cause fraying and damage to the muscle overtime.  Often inactivity and age leads to muscle wasting and the odds of injury increases.  

Symptoms of a Cuff Injury

Symptoms of a rotator cuff injury include:

1. Trouble lifting your arm forward or to the side
2. Give away weakness when using the arm
3. Pain around the shoulder joint, mainly on the side 
4. Clicking or popping when moving your arm
5. Trouble sleeping on your shoulder
6. Pain stretching your arm across your chest
7. Acute pain and swelling

Diagnosis 

A thorough physical exam involving muscle testing, range of motion testing, and examination of your neck and mid-back will be performed.  The doctor is looking for weakness, muscle activation pain, decreased range of motion, and muscle tenderness.  Another common symptom is the impingement sign.  This occurs when tissue is pinched between the  ball of the humerus and the roof of the shoulder joint. A pinching feeling occurs when lifting your arm to 90 degrees.  The cuff muscle is responsible for helping the ball of the humerus move through the shoulder socket.  When the cuff is damaged or inflamed, there is an improper movement pattern and an impingement occurs. 
If an exam reveals suspicion of a tear, diagnostic imaging is needed. Ultrasound can be used to compare both shoulders but most often an MRI is the test of choice. 
 

Treatment

​Treatment of a rotator cuff injury always starts with managing the inflammation and irritation at the injury site.  The use of ice and anti-inflammatory medication is your first line of treatment. The second goal is to regain proper range of motion of the joint and thirdly strength work is needed.  

Manual Therapy:
Conservative, manual therapy is appropriate for partial tears or tendonopathies of the rotator cuff.  Conservative care with the use of manual therapies including massage, ultrasound, current, acupuncture, chiropractic care, and strength training. The proper stretches and exercises will be given so that you can  decrease inflammation and gain proper movement back. Rotator cuff injuries can result in compensatory movement patterns where the muscle of the neck and mid back are engaged to help move the shoulder.  This results in neck and back pain that can be treated with chiropractic care. 
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Injections:
Sometimes your medical doctor might suggest a steroid injection to help reduce chronic inflammation.  This is often suggested if the injury is interfering with  sleep and causing a lot of pain.  The research shows that often injections provide temporary relief and should be used conservatively as they can contribute to weakening of the tendon. 

Surgery:
Full thickness tears and some partial tears require surgery. There are three main surgical procedures including: open repair, arthroscopic repair, and mini-open repair.  The choice of surgery largely depends on  degree of the tear and the structural integrity of the joint.  Your surgeon will discuss what option is best for you. 
Surgery is usually a quick procedure and you will be home the same day. 

The rotator cuff is a common muscle group to get injured.   Overuse or trauma can cause damage to the muscles and result in a lot of shoulder pain.  If you are worried about a rotator cuff injury, visit our office for an evaluation and a receive a treatment plan that will help your shoulder.  We will be able to determine if you need a surgical consult or if you are a candidate for conservative care. 

Activity fact:  Factors that increase your chances of having a rotator cuff tear include: being male, having a job that requires repetitive physical work, age and if you have arthritis in your shoulder.  Get active and keep your shoulders strong to avoid injury!!

Stiff back?, Spasms in your spine, Pain going down your leg?   Low back pain is in the top three causes of disability in the world.  An acute low back pain episode will affect about 80% of us sometime in our lives and is one of the top reasons of 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!

Causes of Low 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 and increased risk of low back pain.  Most people are sitting over 7 hours a day and this leads to deconditioning of the muscles of the spine. Sitting is the new smoking according to some health experts.  Our abdominal and hip flexors shorten and weaken with prolonged sitting and our back muscles stretch with the loss of the lumbar curve. With this and the weakening of the legs and core due to not using them, you will end up with a back injury.  
Sedentary lifestyles lead to obesity and this also has a strong correlation with low back pain risk.
Thirdly, heavy or repetitive physical labor increases your risk of back injury. Years of performing repetitive physical tasks cause strengthening of some muscle groups and eventually an imbalance on joints. 
Lumbar instability can also be a common cause of back pain and can occur after injury, repetitive micro-traumas,  pregnancy, or due to arthritic changes in the spine. 

Treatment of Low Back Pain

Acute and Sub Acute Low Back Pain

The most important thing to do when you have back pain is not to ignore it!  Your spine is giving you a signal that something isn't moving properly.  Would you keep driving your car when the "Service Engine Soon" light comes on?  The longer you leave it the more your body compensates and the harder it is for your body to heal itself.  Chiropractors are trained as spinal care practitioners that can perform a thorough examination and diagnose and treat your problem. 

Low back pain treatment guidelines are developed from the best clinical research evidence available and they all show it is important to:
1. Ice and/or heat your back
2. Use pain medications to lessen pain
3. Spinal adjustments or mobilizations 
4. Keep active with your normal daily activities, including work, and use the level of pain as your guide to your limitations. 
5. Other therapies can help including, massage, spinal exercises, stretching, and acupuncture

Chronic Back Pain
Chronic back pain is described as pain lasting more than 3 months. Research shows that multi-modal care including different treatments, and the patient being active, is the most effective treatment. Clinical guidelines are similar to that of acute low back pain but also include the following:
1. Yoga
2. Regular exercise to tolerance
3.Spinal strengthening exercises
4. massage and acupuncture
5. Chiropractic care (2 times a week for 4 weeks)  
6. non-steroidal medications, spinal injections, and muscle relaxants in some cases
 
Prevention of Back Pain

The only well researched treatment to prevent the re-occurrence of back pain is exercises.  It is important to have a professional examine your spine and determine if there is any imbalance or weakness in your spine or extremities that could lead to pain.  Exercises should start with stretching and a warm up and then lead into working the core area of the back. The intensity of your exercises should depend on your strength level. A progression should occur over time with this including the addition of an unstable platform, by using a gym ball or half gym ball.  Then the addition of weights should be the next progression. Six common key low back exercises include:
1. Planking (front and side)

​2. Pelvic Tilts

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. ​

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.