Spinal Osteoarthritis

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Doc, I was told that I have arthritis in my neck and lower back. Is it genetic or is it just aging?

This is a very common question I hear nearly daily. Some people may have a genetic disposition to Osteoarthirits (OA). Nevertheless, since we can’t change our genes or age, let’s focus on what we can change.

OA is most common in weight bearing joints, such as knees, hips and the spine. OA is also seen frequently in the shoulders and hands, with overuse and repetitive movements. It is common in the first toe (bunion) as well.

With OA in the knees, we may see swelling in the knees. With OA in the hands, we may see nodules in the fingers. OA in the spine may show with poor posture, such as forward head posture and poor sitting posture habits. Some people with OA in the spine may have…

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Changes in Diet affect the Brain

Dietary changes that reduce the incidence of, and prevent, mental health disorders are a cost-effective and efficacious means of improving mental health, urges a position statement that sets out a series of recommendations that will advance nutritional medicine in psychiatry.

burger and fries

photo by Brandon Morgan

The statement, released by the International Society for Nutritional Psychiatry Research (ISNPR), emphasizes that there is tested, basic scientific, and clinical evidence to show that diet both influences risk for, and outcomes of mental health disorders. Moreover, a number of nutrients are linked to brain health.

Felice N. Jacka, PhD, associate professor, Division of Nutritional Psychiatry Research, IMPACT Strategic Research Centre, Deakin University, Geelong, Australia, and president of the ISNPR, played a central role in the development of the consensus statement.

But it’s everywhere…  “The situation we find ourselves in around the world is one wherein unhealthy food products are ubiquitous. They’re heavily marketed, they’re socially acceptable and normalized, and we believe that they’re highly addictive,” she told Medscape Medical News.

“The changes to our diet globally have resulted in a tsunami of ill health, and an unhealthy diet is…understood to be the greatest cause of early mortality.

Mental Health Treatment “Suboptimal” In developing the statement, published in the 2015 October issue of World Psychiatry, the ISNPR says that although the outcomes achieved by current treatments of mental disorders are “suboptimal,” little attention is paid to prevention. As such, diet and nutrition are modifiable targets for the prevention of mental disorders and play a key role in the promotion of mental health.

A number of nutrients, it says, have a “clear link” to brain health, including omega-3 fatty acids, B vitamins, choline, iron, zinc, magnesium, S-adenosyl methionine, vitamin D, and amino acids, and that dietary consumption could be supplemented by the prescription of nutraceuticals.

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Get BACK into Fitness this Fall

Be Active Be Healthy

Let’s face it, you have had back pain in your life as an active person, or you know someone who has. And fall is that time of year that we get back into our fitness routines but have life tugging at us as well. Back pain is one of the most common injuries and major complaints. There are many reasons why you can have back pain, let’s focus on lower back pain.

First, think about your lifestyle that surrounds your workouts. Do you drive to your workouts right after getting out of bed or after a long day of sitting at work? Do you then drive home without doing a proper cool down? These are common realities of many people who work out in fitness clubs, local running groups, or yoga studios. Remember, your body needs time to warm up, maybe 5-10 minutes of cardiovascular work and then some light…

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Whiplash and Sport Injury

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Fall means Football!

Be Active Be Healthy

With every new season there is a popular sport that fans wait for in anticipation. Spring and summer bring tennis, soccer, golf and Blue Jays baseball. Winter is for hockey. But in the fall…..fall brings football!

I have to admit I am not a huge football fan-but have a healthy respect for the strategic game and the players that seem to have ball magnets for hands. Football players are giants of men and are passionate about the game.  As a sports fan, I enjoy a well played game, the skill of the players, and when the under-dog wins.

As a sport doc I am also very aware of the news coming from Boston about NFL players and the changes in their brains. Football players who died at a young age, with a history of personality and mood changes following multiple concussions have brains that show signs of Chronic Traumatic Encephalopathy…

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Omega-3 Prevents Long-term Psychosis

A new study shows that adolescents and young adults considered to be at high risk for developing psychosis, show significant reductions in their progression to psychotic disorder 7 years after a 12-week treatment of omega-3 PolyUnsaturated Fatty Acids (PUFAs). This study was led by G. Paul Amminger, MD, of the University of Melbourne, Australia and was published online August 11 in Nature Communications.

This is the first study to show that omega-3 prevented transition to full-threshold psychotic disorder and led to sustained symptomatic and functional improvements in young people with an at-risk mental state for 7 years.

adolescentAbout the research: For this double-blind study of 81 patients, the average age was 16.5. The daily supplementation consists of either 700 mg of EPA and 480 mg of DHA (treatment group) or placebo capsules. Relatively similar results were obtained over various time periods from additional analyses of continuing studies.

Interest in the role of omega-3 in preventing psychosis has been driven by its known role in reducing systemic inflammation, which has been linked to mental illness. Furthermore, deficiencies in omega-3 PUFAs have been observed in schizophrenia.

Since there is still no “gold standard” of care for patients with attenuated symptoms of psychosis, Omega-3 is a fantastic option without the side effects and without stigmatizing patients who are taking prescribed antipsychotics medication.

High lights

  • Nutrition is of critical importance when serious mental illness is addressed.
  • The rate of cannabis abuse in the long-term follow-up was 0 in the Omega-3 group vs (11.4%) in the placebo group.
  • the timing of the treatment may be critical ― during adolescence and before conversion to psychosis, when the neurodevelopment in brain regions relevant to schizophrenia occurs.
  • 70% of those in the Omega-3 group were employed full time.
  • There were almost 50% fewer patients being prescribed antipsychotic medication in the Omega-3 group than in the placebo group.

If we want to start helping people holistically, we must recognize that nutrition, including supplementation, is a vital factor in maintaining mental health, including depression and autism. The benefit is beyond relieving the symptoms. It will change the focus of research and change not only the way we treat patients, but also the way we think about health and disease.  Nat Commun. Published online August 11, 2015. Full text

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Acetaminophen Ineffective for Arthritis

medications background by naypongOver the years, many back pain sufferers have been prescribed one of the most commonly known pain medications – Acetaminophen (i.e. Tylenol ®).

According to a systematic review and meta-analysis published by Australian researchers in the British Medical Journal on March 31, 2015, the value of Acetaminophen has long been exaggerated. Their research reveals that Acetaminophen has been shown to be ineffective for lower back pain and clinically insignificant as a relief from hip or knee osteoarthritis (OA).  Furthermore, again according to that analysis, Acetaminophen has been shown to quadruple the risk of liver function abnormalities.

It is no surprise that on the basis of their analysis, the Australian researchers have suggested that Acetaminophen as the first choice for clinical treatment of both osteoarthritis and back pain should be questioned. Dr Bannuru of Tufts University recently reached similar conclusions in a meta-analysis of pharmacologic interventions for knee osteoarthritis.

Edward Michna, MD, Director of the Pain Trials Center at Brigham and Women’s Hospital, Boston, Massachusetts, and member of the American Pain Society Board of Directors, stated “… The problem is that patients, out of frustration and anxiety, will continue taking medications even if they don’t help, just so they feel they are doing something to treat their pain”.

Dr. Michna added, “If medications are not helping, they need to be stopped. Patients have to have this point reinforced. There is no point taking medications that are not helping and that could produce harmful effects”.

My own clinical experience and working with other manual therapists (including osteopath and physical therapists), have indicated that many sufferers are seeking alternative pain-relief choices.

Osteoarthritis is the most common type of arthritis. Most osteoarthritis is due to overuse of the non-weight-bearing joints (shoulders, elbows and wrists) and misalignment of the weight-bearing joints (spine, hips and knees, etc).

Nobody wakes up one day with osteoarthritis. It develops over time. Patients need to be advised and their attitude reinforced by their primary care providers/physician that early postural training/exercises and proper footwear can avoid continuing development of arthritis.

Unless proper joint and postural alignment are taken care of, arthritic damaging to the joints will continue.

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The lasting effects of Concussion: Verbal and memory impairments last longer than other symptoms

More sport teams are doing base-line measurements than before – targeting young players who are susceptible to concussions. Base-line measurements compare a person’s body or bodily function both before and after a ‘concussive event’. Some base-line measurements seem to limit such measuring to the player’s sense of balance but that does not reflect the full effects of a concussive event.

Anthony Kontos, PhD, from the University of Pittsburgh, said “More and more people are starting to realize that you need to take a comprehensive approach so that you don’t send a kid back who might be recovered on one measure but not another,”

Brain injury by Samarttiw

Brain injury by Samarttiw

Dr Kontos and his team followed 24 female and 42 male high-school and college athletes after a diagnosis of concussion in accordance with established medical guidelines. The average age of the athletes was 16.5 years.

Key Findings:

  • The biggest improvements in self-reported symptoms occurred in the first 2 weeks, but they continued to improve up to 4 weeks.
  • Verbal and memory impairments last longer than vestibular (balance and eye movement) and oculomotor (vision) symptoms.
  • Female athletes took longer to recover than male athletes.
  • Clinicians are advised to follow a more comprehensive approach, not just one, to assess whether an athlete has recovered from a concussion. This approach may measure changes in such areas as: 1) verbal memory, 2) visual memory, 3) visual motor processing speed, 4) reaction time 5) dizziness, 6) vestibular and 7) oculomotor symptoms.

As a practitioner, I also found that among those patients who have had concussions – whether from sport injuries, whiplash injuries or car accidents – self-report memory impairment seems to last longer than the patient’s balance impairment.

Some clinicians suggest that concussion recovery requires only a 7- to 14- day recovery period. However, this consensus is based upon studies of male American football players that looked ONLY at neurocognitive tests and symptoms.

The study conducted by Dr. Kontos was only limited to 4 weeks due to funding limitation. Some imaging studies (PET scan) have suggested abnormalities beyond that time period.

Dr Kontos presented his findings at the American College of Sports Medicine 62nd Annual Meeting 2015.

References: Br J Sports Med2013;47:250-258

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Sugar, Salt and Hypertension

Toronto has an enviable supply of ‘ethnic’ restaurants. I visited a Tibetan one about a few years ago. When I met the owner, he offered me a traditional Tibetan tea. After the first mouthful, I exclaimed, “Wow! Now that’s salty!” A long conversation about salt, tea and hypertension followed.sugar and salt

“How can this be good for the heart and hypertension?” I knew that many, if not all, Western physicians are as confused about that as I am. But I finished the whole cup, knowing that Tibetans have been drinking it that way – salt included – for centuries.

blood pressureFrom the Western point of view, too much salt in the diet leads to hypertension. In fact, Western physicians very strongly urge their hypertensive patients to reduce salt. This urging has resulted in some patients obediently going to great lengths to maintain a salt-free diet. Cutting out that extra spoonful of salt is probably a good idea, but it should be noted that a recently published review article suggests that sugar, not salt, is the culprit. It appears that sugar is likely the major contributor to most of the hypertension risk that translate into one or more of the cardiometabolic ‘diseases’ (diabetes, heart attack, stroke).

Richard Krasuski, MD, from the Cleveland Clinic in Ohio states that “It is a little bit frightening that we have been focusing on salt for so long”. Dr Krasuski said  “The conclusion that sugar represents a greater danger to the heart than salt was an “eye opener”.  He also acknowledged that he should have anticipated it. He and other cardiologists have noticed that the recommendations to increasingly lower salt intake have not resulted in the expected positive cardiovascular outcomes.

James J. DiNicolantanio, PharmD, from Saint Luke’s Mid America Heart Institute in Kansas City, Missouri, and Sean C. Lucan, MD, MPH, from Albert Einstein College of Medicine in Bronx, New York, detailed those findings in a review of epidemiological and experimental studies in Open Heart:

  • Consuming 25% or more calories from added sugar, increases three-fold the risk of death due to cardiovascular disease.
  • Drinking sugar-sweetened beverages has been DIRECTLY associated with heightened blood pressure.
  • Estimated individual annual sugar intake rates in the U.S. range from 77 to 152 lbs.
  • Replacing processed foods by natural whole foods is desirable.
  • High-sugar diets may make a significant contribution to cardiometabolic risk.
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The secret to looking good in skinny jeans

You wake up one morning feeling great and you just want to look as amazing as you feel.  Going through your wardrobe, you spot a beautiful pair of pants (skinny jeans perhaps!) that you haven’t worn in 6 months, you put them on and… you can’t button them up.  Somehow, 2 inches of fat have sneaked up between you and these gorgeous pants that once flattered your body.

This scenario has happened to almost all of us, unfortunately probably more than once.  Losing weight is always at the top of the list for New Year’s resolutions and maybe you were amongst those that swore that this year, they would improve their body composition. Now, a few months later, how is that resolution going?  Possibly… not as well as planned.  We know that to lose fat we need to exercise, eat healthy and get proper amounts of sleep.  However, we rarely talk about the mental aspect.  From my personal experience and while working with clients as a personal trainer, I have come to learn that the psychological aspect is the principal reason in determining your success or failure when it comes to your fitness goals.

Why does why matter?

You say “I want to lose 10 pounds”, but really you don’t.  Dig deeper, why 10 pounds? Is it so you can fit comfortably in your clothes, have more energy, be able to play with your grandkids?  Truth is, it is not 10 pounds that you want to lose, it is what that 10 pounds represents to you.  Once you have determined your real reason(s), focus on why you want to achieve that goal.  The more whys, the more meaningful they are, the easier it will be to stay strong in moments of weakness.  Really commit to your whys by writing them down.

You are smarter than you think!

Anthony Robbins says “ask dumb questions and you will get dumb answers”.  If you ask, why am I so fat?  Your brain will give you an answer.  Instead, focus your energy on smarter questions.  How can I make exercising fun in order to look forward to my workouts?  What strategies can I implement that will allow me to make healthier food choices?  Think of smart questions and I guarantee that your brain will find an answer.

2015-02-06 09.56.24The power of Internal talk

I’ve tried everything.  I just can’t lose weight. You’ve probably heard those statements before, maybe even used them or at least thought them yourself.  And if you’ve said them, what did your brain tell you?  “YOUR RIGHT!”, you’ve tried everything.” “You can’t lose weight, it’s too hard”.  We all can imagine what happens next.  We go back to our old ways.  Back to that comfort zone.  Success leaves cues.  Look at the area of your life that you have succeeded in.  What did you tell yourself?  What did you say when times were tough? If you can’t think of a past experience, make a mantra.  A mantra is a statement that you repeat frequently.  Think of a sentence that will help you keep moving forward.  Have fun with it.

When it comes to fitness, we often overestimate what we can do in 1 or 2 months and underestimate what can be accomplished in 12-18 months.  Determine why you want to make the change and what it means to you.  Ask smart questions that will lead you towards your goal and formulate a mantra that you will repeat everyday.  Armed with these tools, you can now improve your diet, exercise and give your body appropriate rest in order to achieve the physique that you desire.  After all, health and fitness is a journey.  You might as well enjoy the process.

Guy DufourGuy Dufour. Coach Guy Dufour is the founder of Corefit Training.  Has a master athlete in functional movement competitions, Coach Guy understands the adaptations required to remain active as we age.  He focuses on helping men and women to find their inner athlete and become stronger to enjoy a higher quality of life as we get older.  Coach Guy can be reach through his website www.corefittraining.ca



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