5 Stretches to reverse the effect of prolonged sitting

Gout Revisited

April 5, 2022

Originally discussed in December 2018, we rewrote about this topic with a few changes in particular, with more information on how high fructose corn syrup can have a large impact and the biological processes involved.  


Gout is an inflammatory arthritic disease in which the metabolic condition of hyperuricemia leads to the deposition of monosodium urate monohydrate crystals in the joints, tendons, bursa but also in the kidneys.  Most commonly, gout will affect the big toe first, but can also be present in the ankles, other toes, knees, wrists and hands.  An acute flare up typically lasts 5-7 days and eventually settles down.  But a second flare up often comes on soon after.  To provide more information on this joint disease, we will look more closely at the symptoms, diagnosis, treatment and prevention methods.  


Symptoms

Most commonly, the very first symptoms of Gout include sharp, stabbing pain in the big toe, often with redness and inflammation.  The reason the big toe is the first to be affected, as some have suggested, is because the big toe is often the coldest area in the body (as it is furthest from the heart) allowing the uric acid, which is sensitive to temperature, to form crystals.  The peak pain intensity occurs within the first 24 hours and often will take 5 days to 3 weeks to completely resolve, even without treatment.  However, a second episode will soon follow.  Blood work typically shows elevated uric acid levels.  Without treatment, the attacks may continue to occur in single joints or multiple joints and involve the formation of “tophi”, which are larger subcutaneous deposits of uric acid crystals.  Tophaceous gout is characterized by chronic pain, joint stiffness, joint damage and erosive arthropathies occurring most often in the toes, ankles, knees, fingers, wrists, elbows, and less commonly in the ears as shown in the picture below.  


Diagnosis

The definitive diagnosis of Gout comes from the microscopic analysis of the synovial fluid (fluid from the affected joint) for the presence of uric acid crystals.  But this is not usually done as a first method of diagnosis as it is a bit more invasive.  The diagnosis of gout may come strictly from the history of presentation and the symptoms of acute arthritis of the big toe.  Initially, the patient may not have elevated uric acid in blood tests and xrays of initial presentation often show little to no changes in the joint.  And elevated blood uric acid doesn’t always mean the presence of Gout.  Independent laboratory references should always be considered, however, in general, blood levels of uric acid over 420µmol/L in men and 360µmol/L in women would be considered as hyperuricemic.  


Gout can be diagnosed on x-ray, but typically only after there is extensive bone damage.  


Treatment and Prevention

The first line of treatment for acute Gout are non-steriodal anti-inflammatory drugs (NSAIDs) to help with the pain and reduce the inflammation. However, the ultimate goal is to treat the hyperuricemia.  Uric acid is produced from the breakdown of purines.  Purines are nitrogen containing nucleotide bases that are highly used by our cells, particularly in the production of DNA and RNA.  Purines are found in high levels in meat and seafood as well as in some dairy products, vegetables and grains.  There is a genetic component to Gout that may cause an inclination towards producing more uric acid than normal.  If your parents had Gout, there is a good chance that you may carry a gene that increases your risk of also developing Gout.  Hyperuricemia is treated very well with medications like Allopurinol and Colchicine, which can help prevent the onset of acute Gout flares.  Typically, uric acid lowering drugs are not administered until at least 2 episodes of acute Gout have occured.  There are other options to the above mentioned medications if they are not tolerated well.  


In addition to the breakdown of purines, uric acid can be produced from the breakdown of fructose (the biochemistry pathway is quite extensive, but here is a very interesting podcast which discusses this in extensive detail CLICK HERE).  Treatment then is to avoid foods that increase the production of uric acid including the high purine containing foods as mentioned above and foods with high levels of fructose, or even worse, foods with high fructose corn syrup.  Let’s discuss fructose a little more in depth. 


Fructose is a sugar that is found naturally in fruit.  Sucrose, or table sugar, contains one molecule of glucose combined with one molecule of fructose.  Glucose is metabolized in the body to produce energy.  Fructose is also metabolized in the body but requires a lot of energy to do so.  Eventually, if we eat a high amount of fructose, our energy will drop dramatically, so much so that it stimulates a starvation mode causing further hunger, thirst and the need to store energy as fat.  Animals that hibernate are stimulated to go into a fat storage mode as temperatures drop and eat a high amount of berries and other fruits to increase fat storage which will be used for energy while they hibernate over the winter.   When we eat sucrose, or even fructose in fruit, it needs to be broken down first in the intestines before it will be absorbed and delivered to the liver for further metabolism.  This will take a bit of time and is not at a high concentration.  However, high fructose corn syrup, which in liquid form is highly concentrated fructose, will be absorbed very quickly and delivered to the liver in high concentration.  This will lead to a higher amount of fat storage in the body and/or the liver, a condition known as nonalcoholic fatty liver disease (NAFLD), which is becoming increasingly prevalent around the world.  


Even while on medication, avoiding high purine foods and fructose can make a big difference in uric acid levels.  So one should avoid foods and drinks like liver, beef kidney, brain, sardines, anchovies, herring, mackerel, scallops, beer, yeast extract, nutritional yeast.  Other foods with moderate amounts of purines include asparagus, lentils, cauliflower, any drink with sucrose or high fructose corn syrup, any baked goods with high sugar or use of high fructose corn syrup.  


Chiropractic Recommendations

Diagnosing Gout in a chiropractic office is fairly common.  Treatment on the other hand, is less so.  Often, due to the extreme pain of the patient, they will hardly let you near the area, let alone try to adjust the joint.  Due to the erosive nature of Gout, adjusting or manipulating the joint would be contraindicated.  However, once the pain settles down, and there is no evidence of erosive joint destruction, some gentle joint mobilization or manipulation may be beneficial to the joint health.  Likely, the most effective treatment a chiropractor can provide would be nutrition and dietary recommendations.  


If you have any further questions on Gout or your health in general, please contact us directly at

drmarnie@mmdchiropractic.ca, Book Online, or call 905-529-2911.  

 

Lumbar Spinal Stenosis

February 6, 2022

Lumbar spinal stenosis is a condition of the spine within the group of disorders classified as degenerative in nature.  As this condition is prevalent in 30% of the older population, lumbar spinal stenosis (LSS) accounts for the largest growth in lumbar surgeries.  The most common symptoms include a substantial limitation in walking, disability and an increased risk of falls.  There was little high quality research in the non-operative management of this condition up until the past 6-8 years....


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Home Office Ergonomics

January 10, 2022


The past 22 months has brought on some interesting and new injuries for many of you since your work stations have changed.  More of you are using computers and sitting far more than you have ever before.  Improper work stations can put strain on many parts of the body, including your neck, low back, wrists and even strain your eyes.  Now that many of you may be working from home again, I thought it would be a good ideato review some basic office ergonomic components that you can include in yo...

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Self care for acute spine pain

December 6, 2021



This is a topic we have discussed to some extent in previous articles, however, the need to review some of this information is due and it is always a good time of the year to discuss again due to the upcoming holiday time.  When you travel, or more importantly, when many businesses are closed for the holidays, you may find that you may be stuck to look after your acute back pain until things open up again.  And with the ever changing pandemic conditions, staying close to home may be the only ...

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Massage Therapist Needed

November 22, 2021

We have an exciting opportunity for someone to take over an existing RMT's active clients. MMD Chiropractic Health Centre has been in operation for over 10 years, with owner and chiropractor, Dr. Marnie Mabee D’Andrea treating patients for 20 years. Located next door to the Runner’s Den, athletes make up a large part of the practice. However, our clinic would be classified as a family practice as we see anything and everything dealing with the neuromusculoskeletal systems.

Dr. Marnie works...


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Is it a joint injury or disc injury?

November 8, 2021

When someone presents with low back pain, the diagnosis can be one of many things. Most commonly, the problem can be due to a lumbar spine joint injury, disc injury or a muscle strain. Less commonly, you can get low back pain from an infection like a urinary tract or kidney infection, bowel issues, uterine fibroids, ovarian cysts, tumors of the spine or spinal cord, or muscle tears, to name a few.

Let’s take a look at the symptoms of two of the most common low back pain sources, a joint in...


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Posterior Knee Pain

October 6, 2021

We have previously discussed knee pain, including in the last issue when we discussed the injuries to the medial side of the knee. Today we discuss the final area of the knee, the posterior knee. 

Let us first look at the anatomy of the posterior knee.

If we consider all the anatomical structures on the posterior side of the knee, we will find there are 7 muscles, 4 ligaments, 3 bones, 4 bursas, 2 mensicus, and multiple arteries, veins and nerves. There are also three surfaces of bone  li...


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Medial Knee Pain

April 12, 2021

In the last issue, we discussed the difference between Patellar tendinopathy vs Patellarfemoral pain.  This issue, we will continue to discuss knee injuries, but will focus on the medial side of the knee.  

Let us first look at the anatomy of the medial knee.  

If we consider all the anatomical structures on the medial side, or inside, of the knee, there are 9 muscles, 3 ligaments, 3 bones, 2 bursas, 1 mensicus, multiple arteries, veins and nerves and four surfaces lined with cartilage. All of ...


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Anterior knee pain: Patellofemoral Pain vs Patellar Tendinopathy

March 8, 2021

Anterior knee pain is a very common symptom in many musculoskeletal rehab or family practices.  In this article, we are going to look at the two most common conditions associated with anterior knee pain, Patellofemoral Pain (PFP) and Patellar Tendinopathy (PT) and address the differences in their respective symptoms and treatment options. 

The following chart shows a comparison of the clinical features of PFP vs PT.


Signs

Patellofemoral Pain

Patellar Tendinopat...


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We are Hiring!

February 7, 2021
We are currently looking for a Registered Massage Therapist and a Physiotherapist to join our team.  This is a difficult time in the world with the current pandemic.  Our clinic follows very stringent protocols for screening, cleaning and maintaining a high level of disinfection inorder to keep ourselves healthy, as well as our patients that are coming into our space. 

The successful candidate for massage therapy will be registered with CMTO and have atleast 2 years experience working in a cl...
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Staying Healthy at home: Part 3: Maintaining our Mental Health

February 3, 2021



In the past two issues of our Staying Healthy at Home series, we first discussed exercising from home with the equipment that is available to you.  In our last issue we discussed cutting the sugar from our diets to avoid insulin resistance and to cut down on the typical North American diet of high carbohydrate meals.  In this article, we will address our mental wellbeing. 

With the current pandemic situation we are limited in the activities we can do, people and family we can see and travel...


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Staying Healthy at home: Part 2: Cut the Sugar

January 12, 2021




In the last article, we talked about exercising at home and I provided ideas on how to do this with minimal equipment or items you likely already have at your disposal.  In this article, I want to address nutritional changes that you can make that only require small changes to your shopping lists and cooking habits.  In particular, I want to discuss reducing the sugar or carbohydrates in your diet as a starting point. 

A personal trainer that worked with us previously, had these little challen...
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Staying Health at home: Part 1 Exercise

December 8, 2020




We are not quite sure how much longer this pandemic is going to keep us out of the gyms, but it doesn’t mean we have to stop exercising.  There are several ways to exercise at home, we just have to be creative with what we have access to.  Here are some ideas of making the most of what you can do at home:

  • Safe space:  Ensure you have a space large enough for the length of your body with your arms out stretched in all directions.  Within this space, you can do many things to keep up your ca...

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Corrective Exercise: Part 3 in our Exercise and Movement series

April 15, 2020


unlock your potential and start moving vetter

In our last two newsletters we discussed both prehabilitation and then rehabilitation to help you make it through an injury.  Now let’s take a look at your overall motion and make sure you are moving well.  

There are many different screening methods that have been utilized during various medical evaluations, team tryouts, combines or sports training camps.  The evaluators of these screens take different information from them that may lead to a score of overall functioning, readiness t...


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Rehabilitation: Part 2 of our Exercise and Movement series

March 9, 2020

Rehabilitation - restoring back to normal after an injury


In our last article we discussed prehab and noted the difference with rehab.  To recap, by definition, Rehabilitation (according to Oxford dictionary) is "the action of restoring someone to health or normal life through training and therapy after imprisonment, addiction, or illness".  Prehabilitation can be defined as "the process of care, initiated before surgery, whereby patients’ physical, nutritional, medical and mental conditions are strengthened while waiting for surgery in order ...


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Prehabilitation:  Part 1 of our Exercise and Movement series

February 12, 2020


Prehabilitation is a newer buzz word that is used often in the healthcare industry, in particular, more amoungst physical therapy providers like chiropractors, physiotherapists, occupational therapists, athletic therapists, massage therapists and some orthopedic surgeons.  By definition, Rehabilitation (according to Oxford dictionary) is "the action of restoring someone to health or normal life through training and therapy after imprisonment, addiction, or illness".  Prehabilitation can be de...

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Common Fractures

December 29, 2019

The image above illustrates the various types of fractures that can occur.  The terms "Compound Fracture" is used to describe a fracture that breaks through the skin resulting in an open wound or also called an "Open fracture".  Many displaced fractures, meaning the two ends of the bone do not align, are Compound fractures.  The term "Simple fracture" refers to fractures that are "closed" or do not penetrate through the skin.  The terms in the image above are used to describe the fracture lin...

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How do I know if my low back pain is serious?

November 12, 2019



Believe it or not, this is not a common question.  Often, I find myself letting patients know the serious symptoms that may arise with a back injury so they are aware of what to look for.  I wonder sometimes if this scares people, but I know that in discussing this with patients they will be better prepared to recognize these symptoms and may not ignore the symptoms if and when they arise. 

One of the first signs or symptoms to look for is the presence of “saddle parathesia”.  This is n...


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What causes low back pain?

November 12, 2019

There are several sources of low back pain. 

To understand the symptoms of low back pain, we must be aware of all the anatomical structures and how they contribute to the movement of the spine.  These sources can be grouped into our “mechanical” sources of low back pain (LBP). 
There are other sources of LBP that tend to be secondary to another condition that we will also briefly discuss.  We will refer to this second group as “non-mechanical” sources. 

Mechanical Sources of Low Bac...


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Delayed Onset Muscle Soreness (DOMS)

November 7, 2019


When we use the term DOMS or Delayed Onset Muscle Soreness, we are referring to the post workout pain that tends to peak around the 24 to 48 hour mark.  We want to discuss the potential treatment for DOMS and recommendations for the prevention of this pain.  After reading a great, lengthy article on this subject by Paul Ingraham (painscience.com) , I will summarize some his points. 

How delayed is this muscle pain?  The muscle soreness can come on almost immediately post exercise, but tends ...

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Cold cream review

October 7, 2019
What is your cold cream of choice  for use on sore and ache muscles?  We had a fun little experiment on one of our Monday afternoon meetings where we each tried out the cold creams that either we sell in the clinic, or various other products that companies have sent samples to us to try out.  Here are the contenders:
Biofreeze


Fisocream


Motion Medicine

Medistik solid 46%


Medistick spray 22%

 
After testing all five on each of our forearms, we rated each on smell, coldness, absorption rate, and leng...

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Proper Backpack fitting

August 13, 2019

As we prepare for the back to school season, let us remind you of how a backpack should be worn.  Remember the weight should be 15% of your body weight if you are older than 12.  Younger than 12, the backpack should only be 10% of your body weight.  If you have a scale at home, it is really easy to see how much your bag weighs.  Simply pack your backpack up for school with all the items you normally take with you and place it on the scale.  These rules also apply for all the other types of ba...


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Camping in Pain: Choosing Your Sleep System

July 9, 2019

Camping is a wonderful, age old summer tradition for outdoorsy Canadians. Something about natural landscapes and outdoor activities being good for your health. A road block for a lot of people can be pain. We know from the science that restriction of activities due to pain can lead to co-occuring mental health disorders like depression.

But it doesn't have to be that way.

It can be possible to adapt to pain while still doing what you love or even trying something new. When it comes to camping, ...


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Is your bike ready for summer? Summer Bike Tune Up.

June 6, 2019




The weather has been... well ok we won't talk too much about the weather as it has been raining a fair bit in the last while but I swear it can't rain all the time and when you catch those sunny days you will want your bike to be in ready-to-ride condition. A lot of people bring their trusty steeds up out of the basement between April and June to drop off at the local bike shop for tune ups but the truth is, a lot of the bikes only need a few small and simple adjustments that can be done at h...

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Range of Motion Training

May 9, 2019

 There is always a lot of talk about specific exercises for certain injuries or rehab protocols for different muscle groups.  One theory that has emerged in the last few years looks at the reason why many injuries happen, and that theory revolves around having an inaccurate range of motion. 

 The dancer above would not be able to move the way she does if she did not have full ankle planter flexion and toe flexion, knee flexion, hip flexion and extension, spinal extension, shoulder flexion, abd...

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Acute care for your Temporal Mandibular Joint Pain and Dysfunction

April 9, 2019
We have previously discussed Temporal Mandibular Joint (TMJ) Pain and Dysfunction in more detail (click here for previous article).  In this article, we want to review some acute care procedures you can do at home to help care for this problem.  

Finding Your TMJ

First, lets remind ourselves how to accurately feel where your TMJ is on our skull.  If you place your hands on the side of your face, just in front of your ear, your hand should be right over your TMJ (see diagram below).  To test if ...
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Tabata Workouts

March 2, 2019


Most people have one of two relationships with cardiovascular exercise... tolerate or hate. It's hard to refute the benefits of cardiovascular exercise for heart health. If you are in the hate category, Tabatas might be the right fit for you. Tabata exercises were created by Dr. Izumi Tabata, who researched new approaches to training the Japanese Olympic speed skating team. He created a 4 minute cardio workout that involves 20 seconds of work and 10 seconds of rest for 8 cycles. His research ...

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Spotlight on Women's Cardiac Health

February 26, 2019

March 8 is International Women’s Day and we decided to focus our newsletter on women’s heart health, an understudied, under-diagnosed and under-treated health concern for women. Though there have been incredible improvements in cardiovascular mortality rates in women, heart disease is still the leading cause of mortality in women. Regardless of age, women tend to die more frequently within 1 year of their first heart attack (at 26% vs men at 19%), and within 5 years, at 47% vs men at 36%,...


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Welcome to the gun show!

February 11, 2019

You guessed it!  The guns we are referring to are the biceps.  In this article, we will discuss proper motion, common injuries, exercises and things not to do at the gym! 

The biceps brachii have two muscle bellies and attach the shoulder to the elbow.  For those that would like to know more specific anatomy, the short head, attaches to the coracoid process of the scapula and the long head attaches to the supra glenoid tubercle of the scapula.  Together, both muscle bellies come together to ...


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Gout: Recognizing, Risk Factors and Treatment

December 5, 2018

Gout is an inflammatory arthritis caused by excess uric acid in the bloodstream.  The symptoms of gout arise due to uric acid crystals that are deposited in the joints and the body’s response to them.  The pain is often so intense, anything touching the joint involved, including clothing or socks, causes extreme pain.  The most common joint affected is the big toe, with patients often commenting that even their bedsheet hurts the toe.  As this is a potentially destructive joint disease, it ...


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