Knee Alignment

Knee alignment is important for knee health because it helps to distribute weight evenly across the joint, which can help to prevent pain and injury. When the knees are misaligned, the weight is not distributed evenly, which can put stress on the ligaments, tendons, and cartilage in the knee. This can lead to pain, inflammation, and even injury.

There are a number of factors that can contribute to misalignment of the knees, including:

  • Genetics
  • Age
  • Occupation
  • Sports participation
  • Previous injuries
  • Posture

If you have misaligned knees, there are a number of things you can do to improve your alignment and protect your knee health. These include:

  • Maintaining a healthy weight
  • Strengthening the muscles around your knees
  • Stretching your muscles
  • Wearing supportive shoes
  • Avoiding activities that put stress on your knees
  • Seeing a doctor or physical therapist if you have pain or other symptoms

Here are some additional details about the importance of alignment for knee health:

  • Weight

Carrying excess weight can put extra stress on your knees. If you are overweight or obese, losing even a small amount of weight can help to improve your knee alignment and reduce pain.

  • Muscle strength

Strong muscles around your knees help to support the joint and protect it from injury. Exercises that strengthen the quadriceps, hamstrings, and glutes can help to improve your knee alignment.

  • Stretching

Stretching the muscles around your knees can help to improve flexibility and range of motion. This can help to reduce pain and improve your alignment.

  • Shoes

Wearing supportive shoes can help to improve your alignment and reduce stress on your knees. Shoes with good arch support and cushioning can help to absorb shock and protect your joints.

  • Activities

Some activities are more likely to put stress on your knees than others. If you have misaligned knees, it is important to avoid activities that put too much stress on your joints. This includes activities that involve running, jumping, and twisting.

  • Chiropractor or physical therapist

If you have pain or other symptoms related to misaligned knees, it is important to see a chiropractor or physical therapist. They can help you to identify the cause of your pain and develop a treatment plan to improve your alignment and reduce your risk of injury.

By following these tips, you can improve your knee alignment and protect your knee health.

Sitting Posture

Sitting Posture

Tips to get the best sitting posture at your computer:

  1. The 90-degree Rule – Elbows
  2. The 90-degree rule – Hips and Knees
  3. Feet flat on the floor
  4. Sit back in your chair
  5. Lumbar support
  6. Computer screen level
  7. Get moving

Working from home has many benefits but it also comes with some challenges. Here we’re going to look at modifications that can be made to your sitting posture and ergonomics at your home desk to prevent aches/pains, chronic fatigue and enhance productivity through your work week.

The 90-degree rule – Elbows:

  • The 90-degree rule refers to the positioning of your elbows, hips, and knees. Firstly, your elbows need to be set in the best position to prevent you from over activating your shoulder/neck muscles and reducing strain on your wrists.
  • When rolling your shoulders back into a relaxed and optimal position, you should have your arms by your side and the elbows at 90 degrees. From this position you should be able to reach your keyboard comfortably without needing to extend the arms forward or reach up.
  • Adjust the arm rests on your chair to support your elbows and forearm. The main factor to be aware of is that you’re not shrugging your shoulders up which will activate your upper trap muscles and add tension to your neck. Keeping the elbows at the 90-degree level will also help off load the tension in the wrists and prevent carpal tunnel.
  • Adjusting the height of your desk may be necessary to correct this positioning.

The 90-degree rule – Hips and Knees:

  • Make sure the height of your chair is at an appropriate level for you.  If you’re too high up it will feel like you’re being pulled forward which will add strain to your back. If you’re too low then you’ll be forced to the back of your chair causing a slouched posture and shortening/tightening of your hip flexors.

Feet flat on the floor:

  • When sitting for many hours through the work day we tend to shift our weight from side to side, cross our legs, cross one leg over the other, etc.  These habits can eventually become a problem for your hips and back by adding strain to those areas causing extra wear and tear and activation. If the rest of the desk is set up correctly (90o Rule) then chances are your heels may not be touching the ground perfectly. Try finding the correct size box/stool or platform that will allow you to keep your feet flat and steady to create a comfortable base for your body and prevent you from leaning and shifting out of place.

Sit back in your chair:

  • The length of the chair seat should be ideal for your height. If your tall, then sitting all the way back is probably easier for you but make sure the length of the seat is extending from your butt all the way to just before where your knees are to provide the full-length support and not be cut off midway through your thighs. If you’re shorter, then the seat length should also be a bit shorter so that you can sit comfortable at the back rest and not have the chair seat go past the back of your knees.

Lumbar support:

  • The low back has a natural curve to it that can be difficult to maintain when sitting for a long time. We all tend to slouch and round out our low back which is terrible for the spinal joints. If your chair already has good support to help you maintain the lumbar curve then that’s great. If not, try using a small pillow/roll up a small towel to add support to your low back curve and prevent slouching.

Computer screen level:

  • Out of convenience we see a lot of people working all day on their laptops which unfortunately require you to look down at the screen and reach out to get to the keyboard. This posture can lead to neck pain, headaches, and back pain over time and is not recommended for long term use.
  • Try getting an external keyboard and mouse so that you can set your laptop up on a stand so the screen is at the correct level. Then you can place the keyboard and mouse in its ideal position. Getting an external larger monitor would be helpful too if needed.


  • Even with the perfect desk set up, sitting for long hours causes a lot of strain on the joints and muscles in your body. Getting up and moving around throughout the day is important to prevent the muscle strain buildup. Try setting a timer on your phone to remind you to get up and stretch or go get some water.
  • The convenience of working from home also allows for you to have your own space to get up and properly stretch your back or roll out your muscles through the day which will greatly reduce tension through your body and prevent injuries.

Concussion Myths Part 4

Concussion Myths Part 4

Our last segment on concussion myths is about prevention of concussion and the potential for long term effects.

  1. Concussions cause long term brain damage.
    1. There still isn’t enough evidence yet to support this claim. We still don’t know the exact causative link between concussions, multipole concussion, head trauma, and CTE or long-term neurodegeneration. Just because you’ve had concussions, doesn’t mean you’re going to have brain damage in the future. There are a lot of factors that apply, such as: how far a part were your concussions, were you fully healed from your concussion before the next one occurred, are concussions occurring frequently and with lighter forces, etc.
  2. Concussion recovery is not possible after a couple of years.
    1. It’s true that recovery is more challenging the longer it’s been but it is not impossible. Really depends on how badly you want to get better and finding the right team to work with in identifying where your symptoms are coming from and following through with the correct forms of rehab and re-training.
  3. Helmets and mouth guards prevent you from getting a concussion.
    1. Unfortunately, there hasn’t been an intervention yet that can actually prevent concussions. Protective gear such as helmets and mouth guards can reduce/redistribute some forces but they don’t stop the brain from shaking back and forth, which ultimately causes the concussion. Still important to be wearing a helmet to prevent skull fractures and other dangerous injuries, and mouth guard to prevent dental damage.

The best thing to do is have an assessment and see where you stand in your recovery and explore the treatments that are available to help you get back on track.  Book online at or call 604.988.7080

Concussion Myths Part 3

Concussion Myths Part 3

In part 3 of our debunking myths about concussions we focus on what has been said about treatments and the do’s/don’ts

  1. There is no treatment for concussions
    1. This is definitely wrong. There is a lot that can be done to treat concussions and find where the symptoms are coming from to help alleviate them and get you back on track. A variety of effective, evidence based, treatments are available ranging from neck and back manual therapy, visual/vestibular rehab, exercise, diet/nutrition, counselling/mental health support (CBT – cognitive behavioral therapy), and more.
      1. Studies have shown the amount of force required to cause a concussion and to cause neck trauma. The amount needed to cause a concussion is far greater than that to cause injury to your neck. Therefore, if a diagnosis of concussion is made, we know for sure that there was enough force to also traumatize the neck. Also, about 90% of whiplash symptoms overlap with concussion symptoms, and so it is important to have that area addressed.
  2. You can treat a concussion with medication or other passive modalities.
    1. There is insufficient evidence to suggest any medication will successfully treat a concussion. Most of the time a pain medication is prescribed to help deal with headaches or inflammation from the immediate trauma that was endured. Although this may help short term while you’re recovering in the acute stage, it is not affecting your concussion in any way and may just be masking your symptoms as you move further along into your recovery, especially if there are lingering symptoms. The side effects to the medications also mimic concussion symptoms and could be painting a confusing picture.
  3. Having an increase in your symptoms is bad and should be avoided.
    1. This misconception seems to be one that many people have and keeps them from progressing through the post concussion phase. Patients seem to be concerned about having slight set backs and making their symptoms worse or damaging their brain if they get an increase in symptoms. The truth is that the body adapts to the stress you put on it and that is the way it can grow and heal. As long as there aren’t multiple physical hits to the head, putting yourself through stressors and trying to slowly desensitize yourself to them is part of the process during PCS. Therefore, identifying what is causing your symptoms to increase and gradually exposing/working your way into it is the correct method of response

Call 604.988.7080 or book online to make sure you’re on the right path to recovery.

Concussion Myths Part 2

Concussion Myths Part 2

Continuing from our last blog post here are some more common misconceptions regarding concussion and the treatment of concussions.

  1. Rest is the main/only form of treatment for concussion.
    1. Once again, concussion research has evolved significantly and no longer is “absolute rest” the go to recommendation after a concussion is sustained. Previously, the advice given was to not look at screens, read books, exercise, or expose yourself to other stressors and to sit in a dark room until the symptoms have resolved. It’s since been shown that following this protocol, although it may help alleviate some symptoms in the short term, actually may lead to worse patient outcomes and persistence of concussion symptoms beyond the typical recovery period. The current recommendation from the international consensus guideline is to have “symptom-limited activity” within the first 24-48 hours after a concussion. Meaning, reduce factors that make your symptoms worse.
  2. It is okay to return to sports once you no longer have symptoms.
    1. Brain recovery doesn’t always correlate with symptom recovery.  Generally, concussion symptoms can go away in the first 7-10 days after injury, but it is shown that full brain recovery may take 14-30 days to recover. There is evidence that suggests that the brain is more vulnerable to additional trauma while it is in recovery, so less forceful hits can have the protentional to cause more damage to the brain and create an additive or cumulative effect. Exercise and returning to practice are important during recovery but the patient must be cleared using objective measures to see what the brain can handle before being put at risk.
  3. You must lose consciousness for a concussion to occur.
    1. Once again, dated information on concussions suggested that for a diagnosis of concussion to made there must have been a loss of consciousness following the injury. This we know for certain is incorrect. It has been widely researched that only 10% or less of diagnosed concussions resulted in the person “blacking out” or being knocked unconscious.

As always, feel free to call or book online to get your injury assessed and managed correctly. 604.988.7080 or

Concussion Myths Part 1

Concussion Myths Part 1

When it comes to information around concussions, a lot has been said over the years and a lot of new research is constantly evolving and shaping our understanding of this topic. We get a lot of patients who come in and have either found incorrect information online, or were told by someone to just sit and rest until they feel better which may have caused a delay in their recovery.  In part 1, we’re going to briefly discuss 5 myths and misconceptions surrounding concussions.

  1. Concussions only happen from hits to the head.
    1. Although, one of the easiest ways to get a concussion is getting a hard hit directly to the head, this isn’t the only way for a concussion to occur. The mechanism of a concussion is an acceleration/deceleration of the brain (having the brain shaken up). Therefore, if enough force is sustained to the body (ie: hard body check in a contact sport) causing the head to shake back/forth or even a whiplash injury (ie: car accident) can all result in a concussion.
  2. Concussion is a bruise of the brain.
    1. This was a previous theory that suggested the brain smashes into the skull causing a bruise to either the front or back portion of the brain and a lot of times when you look up concussion, this is still the image that shows up. Technically this would be called a cerebral contusion and not a concussion. As mentioned previously, a concussion occurs when the brain is moved with force back/forth which causes axons to stretch and shear resulting in functional not structural damage.
  3. Concussions can be seen or diagnosed on an MRI or CT scan.
    1. This is also false. As noted in misconception #2, a concussion is a functional injury and so it changes how the brain functions but not how it visually appears. Therefore, if someone were to be referred for an MRI or CT scan, it would be to investigate a more significant injury such as the cerebral contusion, a brain bleed, or for skull fractures. If a concussion is diagnosed, then the images of the brain will appear “normal”.

Stay tuned for part 2!  If you have any questions regarding concussions or require an assessment, book online at or call 604-988-7080

The Kinetic Chain

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 to book with Dr. Aleem Remtulla or Dr. Linda Drake.  You’ll be glad you did!

Heat vs Ice

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.

Use HEAT when:

– The injury didn’t happen in the last couple of days

– To increase blood flow and speed healing

– use heat for 10 min on, 10 min off, and repeat

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; Dr. Aleem Remtulla

Sit Stand Desk


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;; 604 988.70

COVID: The Delta Variant

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.’”