Laser therapy has been used in clinical practice for the treatment of musculoskeletal injuries for over 26 years. As with other healthcare applications utilizing laser technology, knowledge of this modality has grown considerably since its inception.  A recent study published in the American Journal of Sports Medicine examined the usefulness of low intensity laser therapy for the treatment of achilles tendon injury. A significant difference was found between the treatment group and the placebo group, with the laser patients healing much faster.  Specifically, the laser group achieved the same level of healing in 4 weeks that the placebo group achieved in 12 weeks. (Eccentric strengthening of the tendon was given to both study groups since this has been established in the literature as beneficial for overuse tendon injuries). For those readers seeking a viable treatment approach for their Achilles tendon injury, this recent research supports an approach combining low intensity laser therapy and eccentric exercise.

From a practitioner standpoint, this paper provides some other useful information. The success of laser therapy for various injuries largely depends on the settings chosen by the practitioner.  A longer, more intense setting is not necessarily better.  Through clinical trials like this one, it has been discovered that the use of certain lower settings for tendon injuries will benefit the patient more.  Perhaps another example of how scientific evidence can guide practitioners and patients in choosing the best treatments available.  If you have an achilles injury (achilles tendinopathy, achilles tendinosis, achilles tendonitis, achilles rupture, achilles tendon pain) call or email our clinic right away…we can help!

References

Stergioulas A, Stergioula M, Aarskog R et al. Effects of low-level laser therapy and eccentric exercise in the treatment of recreational athletes with chronic achilles tendinopathy. The American Journal of Sports Medicine 2008: 36(5); 881-887.

World Association for Laser Therapy (WALT). Laser dosage recommendations. Available at http://www.walt.nu/dosage-recommendations.html

Disclaimer
The purpose of this blog is to educate patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Our chiropractic clinics in Burlington, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site. Should you have any further questions about these topics please contact our chiropractics clinic in Burlington.

The Q-Angle (quadricep angle) is a measurement used by many health care practitioners to assess patello-femoral alignment. It is often mentioned in running magazines and on different websites because of its apparent ability to identify those persons at risk of certain knee injuries. But is it a valid measurement tool?

The basic premise of the Q-Angle is that a higher angle (such as what might be expected in women with a wider pelvis) would affect the way that the patella (knee-cap) lines up with the lower limb. Some practitioners use it to identify those patients at risk of patella-femoral injury. According to the scientific literature though, the Q-Angle is a measurement which over-simplifies knee biomechanics. It only examines a person in one plane of reference (like a two-dimensional object) and does not take into account the complex forces that occur during running, walking and jumping. Numerous publications in very reputable journals have scrutinized its ability to accurately identify those people at risk of injury. Despite this, many practitioners continue to use it and many magazine articles and websites continue to present it as reliable. Perhaps again, an example of something that’s popular but not validated by science.

As always, we do our best to bring you the most current and accurate information both in our clinic and on our website. References are provided below. We encourage your questions or comments!! Want more? Sign up for our complimentary email feed (on the right of the page) which gets sent out every two weeks.

References

Duffey MJ, Martin DF, Cannon DW et al. Etiologic factors associated with anterior knee pain in distance runners. Med Sci Sports Exerc. 2000; 32: 1825-1832.

Nguyen AD, Boling MC, Levine B, Shultz SJ. Relationships between lower extremity alignment and the quadriceps angle. Clinical Journal of Sports Medicine. 2009; 19(3): 201-206.

Thomee R, Renstrom P, Karlsson J et al. Patellofemoral pain syndrome in young women. A clinical analysis of alignment, pain parameters, common symptoms and functional activity level. Scand J Med Sci Sports. 1995; 5: 237-244.

Witvrouw E, Lysens R, Bellemans J et al. Intrinsic risk factors for the development of anterior knee pain in an athletic population. A two-year prospective study. American Journal of Sports Medicine 2000; 28: 480-489.

Disclaimer
The purpose of this blog is to educate our patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Burlington Sports Therapy, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site.

Our bones are constantly remodeling, a balance between the cells that breakdown and the cells that rebuild bone.  When we place excessive demands on an area (from something like excessive running or walking) there can be a net balance of bone breakdown, which can result in a stress fracture.  A stress fracture is a painful bone injury that can affect anyone.  Common with runners and military personnel, stress fractures are most frequent in the lower extremity.  Specifically, the metatarsals (small bones in the foot) and the tibia (the bone in our leg below the knee) are common sites.  X-ray is often the first step in diagnosing a stress fracture.  Unfortunately, it is not the most sensitive tool for detection.  The literature suggests that on average, pain is usually present between two weeks and three months before an x-ray will detect a stress fracture.  In addition, 85% of stress fractures are missed on the first x-ray and follow-up x-rays only detect them 50% of the time. Therefore, bone scans or magnetic resonance imaging (MRI) are more useful for detecting stress fractures, but x-rays can serve as a good starting point.

The primary treatment for a confirmed stress fracture is rest.  In doing this, the bone is allowed to remodel with the net balance in favour of bone building (instead of breakdown).  At present, there are no proven methods for preventing stress fractures in the lower extremities, but there is some research that suggests shock absorbing insoles being potentially helpful.  Common sense would perhaps indicate that a gradual progression of mileage and distance for runners and walkers would help the bone in adapting to increased demands.

As always, we do our best to bring the most current and accurate information to our clinic and our website. References are provided below if you are interested in further reading.  We encourage your questions or comments!  Want more?  Sign up for our complimentary email feed (on the right of the page) which gets sent out every two weeks.

References

Arendt E, Agel J, Heikes C et al. Stress injuries to bone in college athletes: a retrospective review of experience at a single institution. American Journal of Sports Medicine 2003; 31(6):959-968.

Moran DS, Evans R, Hadad E. Imaging of lower extremity stress fracture injuries. Sports Medicine 2008; 38(4): 345-356.

Rome K, Handoll HH et al. Interventions for preventing and treating stress fractures and stress reactions of bone of the lower limbs in young adults. Cochrane Database Syst Rev. 2005; 2:CD000450.

Shaffer SW, Uhl TL. Preventing and treating lower extremity stress reactions and fractures in adults. Journal of Athletic Training 2006; 41(4): 466-469.

Yeung EW, Yeung SS. Interventions for preventing lower limb soft-tissue injuries in runners. Cochrane Database Syst Rev. 2001; 3: CD001256.

Yochum TR, Rowe LJ. Essentials of Skeletal Radiology 1996, Williams and Wilkins.

Disclaimer
The purpose of this blog is to educate our patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Burlington Sports Therapy, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site.

Quite often our patients ask us what the best sitting posture is. Based on our own review of the pertinent literature, we recommend the following…

Maintain Lumbar Lordosis - Several studies have found that a flat or flexed spine (pictured on the right) causes the lower back muscles to relax. Although this may sound beneficial, it places a greater strain on passive structures like intervertebral discs, ligaments and joint capsules. Lumbar lordosis (pictured on the left) loads the various structures of the lower back more evenly so that one area is not exposed to excessive forces.

Allow Postural Variation - Many people are under the impression that once ideal sitting posture is attained you will be safe from pain or injury. Not true. According to several studies published in very credible journals, mixing up your posture keeps the joints lubricated and helps to prevent sustained loading of a single structure.

Allow the Muscles to Help - As mentioned previously, it is not ideal to have the muscles completely relaxed. A recent study published in the journal Clinical Biomechanics looked at female office workers and their sitting posture throughout the workday. Interestingly, they found that the muscles in the lower back were very inactive while seated. The authors of the study found that this was a response to their spines being in subtle flexion (slightly rounded forward, or “flat” in the lower back). As a result of this lowered muscular activity, the subjects of the study endured a sustained stretch of passive structures in the lower back, ultimately causing pain and dysfunction. A gentle contraction of the different abdominal and lower back muscles is recommended to help support the spine and dissipate the load on passive structures.

If you found this information particularly interesting, you may want to review a previous blog of ours entitled “Good Posture for the Lower Back”. Enjoy!

Questions? Comments? Please post them right on the site! Want more? Sign up for our complimentary email feed on the right of this page!

References

Corlett EN. Background to sitting at work: research based requirements for the design of work seats. Ergonomics 2006; 49: 1538-15546.

Mork PJ, Westgaard RH. Back posture and low back muscle activity in female computer workers: a field study. Clinical Biomechanics 2009; 24: 169-175.

Pynt J, Higgs J, Mackey M. Milestones in the evolution of lumbar spinal postural health in seating. Spine 2002; 27: 2180-2189.

Williams MM, Hawley JA et al. A comparison of the effects of two sitting postures on back and referred pain. Spine 1991; 16: 1185-1191.

Disclaimer
The purpose of this blog is to educate our patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Burlington Sports Therapy, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site.

In this weeks blog we’re going to address the age old question that enters the mind of every low back pain sufferer at one point in time…what kind of mattress should I buy?

A 2003 study published in The Lancet investigated the effect of mattress firmness on the clinical course of patients with chronic non-specific low back pain. Patients were either given a medium-firm or a firm mattress to sleep on for a 90 day period. Throughout this period patients were asked to rate the level of pain while in bed, rising from bed and pain throughout the day, as well as the level of perceived disability throughout the day. At the end of the 90 day period the results suggested that a mattress of medium firmness improves pain and disability among patients with chronic non-specific low back pain.

A 2008 study published in the journal Spine compared the effect of 3 structurally different mattresses. It investigated the waterbed, a foam mattress and a hard futon mattress. After a one month trial the waterbed and foam mattress influenced back symptoms, function and sleep more positively than the hard mattress, albeit the differences were small.

So what do these two studies tell us? Although a hard mattress is commonly believed to have a positive effect on low back pain, the research fails to support this theory. Unfortunately, the published research has been unable to provide clear evidence based recommendations for mattress selection. Mattress selection is personal and subjective…our best advice is to shop around and find a mattress that suits your individual needs!

Questions?  Comments?  Please post them right on the site!  Want more?  Sign up for our complimentary email feed on the right of this page!

References

Bergholdt K, Fabricius RN, and Bendix T. Better Backs by Better Beds? Spine 2008; 23: 703-708.

Kovacs FM, Abraira V, Pena A, et. al. Effect of firmness of mattress on chronic non-specific low-bacl pain: randomized, double-blind, controlled, multicentre trial. The Lancet 2003; 362: 1599-1604.

Disclaimer
The purpose of this blog is to educate our patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Burlington Sports Therapy, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site.