How can my old ankle injury be the root cause of my hip pain now?

A: Do you know what a kinetic chain is? 

The body is a series of kinetic chains starting from the foot to the ankle to the knee and works its way up the chain to the hips, low back and so forth. In a kinetic chain, movement of one joint affects movement of another joint within that kinetic chain. Do you remember the song we learned as kids “the knee bone is connected to the hip bone?” That song is right. Everything is connected in the body so if one part of the body is injured or affected then it affects often distant parts of the body, unbeknown to you!

When someone injures their ankle, for example a basketball player goes up for a layup; when they land, they invert or roll their right ankle and tear or stretch all the ligaments and tendons surrounding that joint…  Or maybe someone was walking and they stepped off a curb wrong and roll their ankle…  When that person goes to put weight on that ankle and take a step, they notice pain. Ouch!  To avoid pain, they start to limp in an effort not to fully weight bear on the injured ankle. Due to compensation, the rest of the body now has to change to adapt to the injured ankle.

A good analogy is car alignment. If the car’s brakes are working and tires aligned, the 4 tires will wear evenly. If the car is out of alignment, some of the tires will wear unevenly and faster to make up for that bad alignment.

When you have pain, the body starts to compensate. In this case, due to the ankle injury, there is less body weight on the right ankle which causes the left side of the body to work harder.

This puts a lot of stress on the left side causing all those muscles to work harder and get tighter, while the right side is getting weaker. When the body starts to compensate to avoid pain, the body will begin to adapt to those changes. This isn’t good for the body over all because the body is now moving in an unbalanced motion pattern which leads to stress on the muscles, tendons, ligaments, joints and overall nervous system.

Your nervous system compensates too and thinks this is your new normal in the first 48 hours!

When you have an ankle injury and that ankle joint is not functioning properly, then the kinetic chain as a whole is not functioning properly. What started as unbalanced motion in the ankle can work its way up the chain to the knee, the hip joint and upward.

In practice, these explanations are super relevant and important! New patients that have never experienced back pain before come in and say “I have this back pain that just started and I don’t know where it’s coming from, I haven’t done anything different.”

Then in the history, I ask about recent events and they explain that they recently turned their ankle.  I explain how the body is connected and how compensation due to pain and the resulting adaptation changes our biomechanics causing a domino effect throughout the body. It’s only in the examination with an eye to detail that we see the kinetic chain and explain that the ankle position is torqued and that they are not walking nor absorbing the shock of heel strike through their foot adequately.  This will result in poor knee extension, hip rotation and pelvic torque, and somewhere, something will start to let you know it’s not happy about it.  For them it just happens to be the lower back that is letting them know that there is a problem!   Treating the whole kinetic chain, not just the point of pain will result in longer term results and a happy, and yes more educated patient. Adding appropriate exercises, fascial rolling and small ball work will assist in giving the patient tools to manage their problem at home.

It’s all in the details.

If you have pain in your body that you cannot pin an issue to, it is probably a kinetic chain issue. If you have had other health care professionals work on your issue, and it is still there, then we would like to help!  Call The Foundation for Integrated Health at 604-988-7080; or go online to www.fih.janeapp.com to book with Dr. Aleem Remtulla or Dr. Linda Drake.  You’ll be glad you did!

Ever wondered whether you should use ice or heat on your body? Simply understand which each one does and how time is the factor!

The difference between cold and hot is what it does to the surrounding tissue.  Applying ice will cause a constriction of blood vessels which reduces blood flow and will help to decrease swelling or inflammation.  The ice also has an analgesic effect which can help reduce pain.  Therefore, when needing to reduce swelling or treat an acute injury (first couple of days) ice is recommended.  For sudden injuries like this, the protocol of “RICE” applies: Rest, Ice, Compression, and Elevation. This protocol is designed to reduce inflammation to the area and prevent further damage from occurring.  

Use ICE when:

– the injury just happened

– to control pain and reduce reactive swelling

– use ice for 10 mins on, 20 mins off for up to 6 hours 

Heat, on the other hand, can be helpful for chronic injuries or nagging aches and pains. Heat will increase blood flow which helps to bring in healing factors and soothe muscle and joint pain.  Conditions that respond well to heat are arthritic joint pain, chronic muscle tension, overuse injuries, and general body discomfort.

Heat will speed up your healing, but it doesn’t work on its own to heal you.  Be an active participant in your health (i.e.  treatment, rehab, home exercise plan, lots of water) you can speed up healing and help prevent a similar injury from happening again. 

Each person is different and may not react the same to self-treatment. If you have any injuries or pains that you have questions about please contact us to see what the next steps towards your healing might be – call 604.988.7080 or book online at www.fih.janeapp.com; Dr. Aleem Remtulla

SIT/STAND DESKS?  HOW TO TRANSITION TO THEIR USE!

One great intervention that we’re seeing more of is the Sit/Stand desk. We all know that sitting for an entire work day can be bad for your health/posture, and this is why the sit/stand desk was invented. More and more patients are telling us that they’ve bought one for themselves since they’re working from home and/or their office has installed these types of desks.

Although it is great news that you may have a standing desk, it is important to know how to use it. Gradually easing yourself into standing more often is the way to go and not go from sitting all the time to standing for too long. A common situation I’ve heard is patients will get to work and stand for 3 hours straight before sitting for most of the day and then standing again for another 1-2 hours at the end of the day. This may cause other issues like low back, leg, or foot pain if your body isn’t ready to make such a drastic change.

The key to using a sit/stand desk is variability.  The body likes movement and not being stuck in one position for too long (sitting too much or standing too much). Therefore, changing positions often will be beneficial for the body. A good way to start (if you’ve never used this type of desk before) is to stand for 15 mins after 45-60mins of sitting. It is important to get up and walk around or change positions every hour. So, starting the first week with 15 min intervals of standing every hour is the most reasonable way to begin. As your body gets used to the change, try increasing the amount of time you’re standing for. Eventually, the ideal scenario would have your sitting for 30 mins then standing for 30 mins. Lastly, you can include some simple range of motion movements or stretching during the periods of time that you’re standing.  Hope this information helps you manage the transition to your new desk!

If you are still having problems with pain and discomfort in your neck, shoulders, arms or your lower back/hips, please don’t hesitate to give us a call.  We can help you with your postural issues and relieve the stress on overworked joints and muscles as well as teach you strategies to manage the day.

Dr. Aleem Remtulla, DC and the FIH Team; www.foundationforintegratedhealth.com; 604 988.70

As Yogi Bera said, “It ain’t over till it’s over.” And apparently Covid is not!

Though you wouldn’t know it walking the around the streets of the North Shore where unmasked citizens are high-fiving and hugging like there is no care in the world.

However in the three most vaccinated countries on the planet, The U.S., the U.K. and Israel, there has been a worrying uptick in new cases created by the Delta variant. 

As a chiropractic and massage therapy clinic in North Vancouver we need to take this information seriously.

As Sharon Kirkey reported in the Vancouver Sun on Saturday, July 17th:

Today, all three of those “three big vaccinators” are seeing an upturn in COVID driven by the Delta variant that first surfaced in India in October 2020. It’s now the globe’s most dominant strain, and an exquisitely contagious one.

The experience in other countries offers Canada a cautionary tale on vaccinations, especially second doses. Without “really, really high immunity,” Russell said, “there’s going to be a tonne of virus in the population.”

Some vaccinated people have also been infected, though breakthrough infections are not surprising and, according to experts, are not occurring at an alarming rate. The vaccines don’t offer 100 per cent protection against SARS-CoV-2 and not everyone inoculated mounts a strong response. But COVID is generally less severe in the doubly vaccinated and is not killing people at the rate it once was. “In this vaccinated group, we’re seeing much milder disease. And this is going to be very much the norm for the new few months, or possibly years,” King’s College London epidemiologist Tim Spector, head of a massive COVID symptom study, said in a video update this week.

Still, confirmed cases per million in Britain, where two-thirds of adults have received two doses of a vaccine, are “pretty high up compared to those around us,” Spector said. With the July 19 so-called “Freedom Day” — and the lifting of virtually all public health restrictions — mere days away, the U.K.’s rolling seven-day average this week was more than four times higher than it was a month ago. Britain reported 48,553 new cases on Thursday, while the number of people in hospital rose 42.8 per cent in a week, Bloomberg reports.

Spain, Portugal, Greece and the Netherlands are all experiencing rebounds for reasons that, Spector said, can be attributed to “the very special properties of the Delta virus” — it has an uncanny ability to glob on to human cells more tightly — “and a slight relaxation of restrictions in most countries.”

Israel has reinstated its indoor mask rule. In the U.S., confirmed COVID cases are up 70 per cent over the previous weeks and deaths 26 per cent, with outbreaks in parts of the country with meager vaccine uptake. The U.S. seven-day average now more than 26,000 daily cases, more than double its June low of around 11,000 cases. According to public health experts, 99 per cent of Americans now hospitalized with COVID haven’t been vaccinated.

In severe cases, COVID from Delta doesn’t look much different from severe illness caused by older iterations of the virus. People can end up on life support, with multiple organs failing. “What is very different about those patients is that, for the most part, they have been young people, and almost all of them, in our experience in Saskatchewan, have been unvaccinated folks,” said Dr. Hassan Masri, a critical care and ICU specialist in Saskatoon. “We have not seen a single patient land in the ICU who is double-dose vaccinated.”

In severe cases, COVID from Delta doesn’t look much different from severe illness caused by older iterations of the virus. People can end up on life support, with multiple organs failing. “What is very different about those patients is that, for the most part, they have been young people, and almost all of them, in our experience in Saskatchewan, have been unvaccinated folks,” said Dr. Hassan Masri, a critical care and ICU specialist in Saskatoon. “We have not seen a single patient land in the ICU who is double-dose vaccinated.”

The young and not inoculated are largely driving Delta’s spread in other parts of the globe and, in Canada, young people seem less eager to be vaccinated. Also concerning: the rate of increase for the first dose has slowed and less than half of Canadians are fully vaccinated. Masri predicts that by the end of September or early October, as people move back inside and schools and campuses reopen, Canada will see a small but consistent increase in spread, as public health measures are, appropriately so, relaxed.

An initially silent, asymptomatic spread will likely continue for four to eight weeks, he said, followed by a not-so-silent spread, “and we will have the nucleus of the fourth wave. I think we do need to understand that’s going to happen, we need to make sure that we continue to be cautious.”

An uptick in cases doesn’t necessarily translate into a proportionate increase in hospitalizations or deaths, he said. But the proportion of Canadians with only one dose — or none — remains high.

“This fall is not a reason to double down on public health measures — certainly, I think most relaxations of public health measures are appropriate,” Masri said. “This is more of a warning to double down on the efforts to vaccinate.” We must go harder, he said.

An uptick in cases doesn’t necessarily translate into a proportionate increase in hospitalizations or deaths, he said. But the proportion of Canadians with only one dose — or none — remains high.

“This fall is not a reason to double down on public health measures — certainly, I think most relaxations of public health measures are appropriate,” Masri said. “This is more of a warning to double down on the efforts to vaccinate.” We must go harder, he said.

Spector, of King’s College, believes it’s also important people recognize that the symptoms of COVID are different in breakthrough infections. COVID after vaccination very much resembles a bad cold — runny nose, headaches, sneezing, and sore throat, perhaps a possible loss of smell. “But don’t wait for coughs and fever,” he said in his video. “They may never happen. Assume you’ve got COVID, get a test.”

Delta is hyper-contagious, and the unvaccinated are clearly more at risk of getting infected and getting sick. “This is becoming a pandemic of the unvaccinated,” U.S. Centers for Disease Control and Prevention Director Dr. Rochelle Walensky said during a press briefing this week. Recent research from France bolsters the case for a second dose: blood samples from people given one dose of Pfizer or AstraZeneca “barely inhibited” Delta. Two doses generated a neutralizing response in 95 per cent of people.

One of the most pragmatic questions now, said Russell of Memorial, is, “What does it mean, on an individual basis, if you’ve been vaccinated and we’ve got Delta around?”

Even if infected, even if the antibody response is low, “you still shouldn’t get as sick as if you had no vaccine, so there’s no doubt it’s better to get vaccinated,” he said.

“You might not have a high viral load in your nose, and you might not spread … but nobody knows their nasal viral load. Which is why I’m telling people, ‘Wear your mask for another few months, until we see what happens here.’”

Ever “Dr. Google’d” Plantar fasciitis?  It’s a commonly heard of condition and many have it, especially runners.  But what exactly is Plantar fasciitis?  How is it treated?

What is Plantar Fasciitis?

This disorder is generally due to inflammation, swelling and weakness occurring along the ligament that runs from the arch of your foot connecting your heel and toes. Because of this, there can be sharp stabbing pain on the bottom of your foot along the arch (or heel) and is aggravated when walking, standing, or moving around after a long period of inactivity (sitting at your desk, getting up from bed in the morning).

How do we at FIH treat it?

Luckily, there is treatment available to correct the issues that are causing the pain. Considering more than just the foot itself is essential as we have found the cause of the irritation always has an alignment component!

Dr. Drake and I most often see an underlying nerve dysfunction at the 5^th lumbar nerve root – the last vertebra at the base of your low back. Almost all of the patients that present with plantar fasciitis have an alignment problem/ nerve conduction problem that leads to an imbalance down one of their legs. If this is not addressed then the full “power” or strength of the nerve going down to the foot causes abnormal muscle firing which does not allow your foot to go through the proper phases of gait which results in too much stress on the plantar fascia and the typical pain. Treatment using the Adjustor to decompress this nerve root along with TRIGENICS neuro-muscular balancing really works to reset and correct the problems along the whole chain (from low back to the hips to the knees and down to the ankle and foot).  The adjustor is then used to mobilize the small bones in your foot and with the help of cold laser therapy we can promote healing and reduction of inflammation to the area to aid in recovery. Generally, advice on proper stretching and rolling techniques along with foot stabilizing exercises are also given to help with the prevention of future episodes.

With treatment there will be a reduction of strain on the plantar fascia itself, which will prevent further trauma occurring to the area and reducing pressure on that spot. Another option may be to create custom made orthotics that are specifically tailored to your foot and arch to continue to help reduce pressure on the heel and keep your arch in its optimal position. This intervention is very beneficial for those who are on their feet for long periods of time, whether it be from exercise or due to work.

If you are experiencing heel and/or foot pain and suspect you have plantar fasciitis, come in for an assessment. The earlier you seek treatment, the sooner your feet can stop hurting.