Monday, 23 June 2014

Use cold or heat - but be careful.

I'm always asked the question "should I use ice or heat?".  Sometimes the answer is easier than others.  Generally speaking, ice should be used immediately and for up to 72 hours of an acute injury.  This helps to reduce pain and inflammation.  Typically, an injury has acute sharp pain, redness or swelling.  Ice can be applied for 10-20 minutes and can be repeated 2 or 3 times with a rest period of the same.  Never apply ice directly to the skin but rather use a towel or cloth in between.  It is even better to dampen a towel with warm water first and apply the ice over top.  This makes it more comfortable to apply the ice and the dampness allow for a deeper penetration of the cold.

On the flip side, heat is more often used for chronic, dull, achy pain and for muscle tension.  This allows the body to increase circulation and improve healing.  Plus it usually feels very good.  Heat can be applied for about 20-30 minutes at a time.  Sometimes, a contrast of ice and heat is recommended.

One issue to be very careful about is to check your skin every so often for problems due to the application of ice or heat.  One thing that is very important is to not keep a heating pad on too high and don't fall asleep on one.  This can cause swelling and even worse, burning.  This is seen on the example below where one of my  patients could not feel the pain from the burn (there is a scar from previous surgery).  It happens more than you think.




Just be aware of what's happening and have someone check the area if you are unable.  If you are unsure what to use, just give us a call (416) 512-2225 or email me at welcomeback@welcome-back.ca. - Spinal Decompression Toronto

Thursday, 19 June 2014

What are my options for neck and low back pain?

Eighty percent of North American's will experience back pain (or neck pain) at one time or another.  That's a lot of back pain.  But where is the best place to start for treatment?

The choices are divided into two major categories, invasive and non-invasive.  Non-invasive therapies encompass the conservative therapies which include, but are not limited to, chiropractic care, physiotherapy and massage whereas invasive therapies include injection, surgery and even acupuncture.  Acupuncture is a conservative therapy but, as the needles break the skin barrier, is considered invasive.  Although injection and acupuncture are deemed minimally invasive, injections will introduce chemicals into the body that one may not want and have potential side effects.  Of course, medication is also an alternative but typically medication will not address the cause of the problem and may also have unwanted side effects.

When I discuss the order to which I believe patients should have therapy, the conservative ones are at the top of the list.  I think a trial of conservative therapies are beneficial but if you are finding little to no results after a while, you should consider your next step.

When it comes to neck and back pain, if not already done, consideration should be made for imaging, whether that is x-rays, CT or MRI.  Consideration should also be made for a more advanced therapy such as spinal decompression therapy

If all else fails, injection therapy or surgery should be discussed.

Monday, 16 June 2014

Epidural Corticosteroids for Sciatica: More Trouble Than They're Worth

The original article, with title as above, was published in Dynamic Chiropractic Canada in their June 2014 issue.  Dr. Deborah Pate writes that although this procedure fails to demonstrate evidence that it is helpful, it's use has dramatically increased over recent years.



23 randomized trials of over 2000 patients were analyzed in which epidurals for sciatica were compared to placebo.  Epidural steroid injections produced only small, insignificant, short term improvements.  Plus there are many risks involved including infection, bleeding, nerve damage and dural puncture (lining of the spinal cord).  Many side effects have also been related to the use of steroid medication.

Read the full article here: Epidural corticosteroids for sciatica

Invasive intervention should only be entertained once other, safer, generally non-invasive techniques have been exhausted.  These may include chiropractic care, massage therapy, physiotherapy, acupuncture and spinal decompression.  Visit our website for more information - Spinal Decompression Toronto