When Your Low Back and Hip Pain is Really Sacroiliac Joint Pain…

Often times, patients come in complaining of low back pain and/or hip pain but after their consultation and assessment, I discover that the true problem is in the sacroiliac joint or SI joint for short.

SI-JointThe SI joint is where the large ‘tailbone’ (sacrum) and the pelvic bone (ilium) connect.  You have a left SI joint and a right SI joint.

As a simple guideline, here’s how to tell if you have a SI problem.

The first clue is pain directly over the joint, usually only on one side.  You will find the SI joint in the area around the ‘dimple’ on your backside.  If the pain is greater when you bend back­wards, inflammation of the joint is the probable cause of your symptoms.

If the pain is greater when you bend forward, then you’re probably experi­encing strained ligaments around the joint. However, low back pain in general has been associated with SI joint problems in a large number of patients. In one research study, close to 30% of patients x-rayed with lower back complaints showed either degenerative or inflammatory conditions affecting their SI joints.

Local pain is not the only way you can tell you have an SI joint problem. Referred pain from these joints is often felt in the groin, and can also travel into the buttocks and down the back of the leg, mimicking sciatica or a lumbar disc herniation.  Furthermore, if the SI joints are not functioning properly, this can lead to disturbances in your gait, which may cause hip, knee or feet problems.

Although these are crucial weight-bearing joints important for their part in the stability of the pelvis, they also move slightly for proper mechanics when walking or running. The SI joints can be affected by overex­ertion and injury. Often times a simple adjust of the SI joint will alleviate pain.

Too much strain is what leads to SI pain.  As mentioned, the SI joint helps to maintain pelvic stability. The SI joints are surrounded by tough, fibrous ligaments but if one or more of your SI joint ligaments become strained, you’re likely to feel pain directly over the SI joint.  You can cause strain to these ligaments from a fall on the buttocks, trauma from a car accident, lifting something heavy or repetitively, excessive sitting.  Women, and especially pregnant women are more susceptible to SI problems also.

When they get strained repetitively, these ligaments can lose some of their structural integrity, making your SI joints more prone to subluxate or shift out of position. Since the two joints work in unison, if one of the SI joints becomes unstable, the other joint can become restricted. Regular chiropractic adjustments may be needed to maintain a proper balance between mobility and stability.

Alignment of the spine is dependent on the function of the SI joints. When an SI joint is improperly positioned, it is possible that the sacrum is also out of its normal position. When this happens, the lower lumbar vertebrae can subluxate, leading to a greater chance of an abnormal lumbar curve and appearing as conditions like scoliosis and hyper- or hypo-lordosis (ie. overarching lower back curve or a flat back)

Any time the spinal curves are altered, it leaves you vulnerable to painful conditions in the lower back, such as facet irritation, disc herniation or muscle strain.


What should you do about an SI joint problem?  First, you should get a chiropractic assessment. As a joint specialist, a chiropractor is uniquely positioned in the healthcare field to assess and treat any joint in the body.

For the first 2-4 days after the onset of pain, you should attempt to limit your activities that cause soreness and apply ice to the affected area for 5-10 minutes at a time to decrease inflammation.  Alternatively, a great topical ointment instead of the often prescribed Voltaren, is a natural product called Lymphdiarial.  Low intensity laser therapy is also very helpful in quickly resolving pain and inflammation of the SI joint.  At Meridian, we use the Meditech Bioflex laser.

Restoring normal joint mobility is the next goal. If your chiropractor discovers that SI joint restrictions are part of the problem, chiropractic adjustments will be used to restore alignment and function.  Also, if joint instability is suspected, it may be necessary to temporarily wear an SI belt – a supportive device that wraps around the pelvis to stabilize the SI joints.

Finally, it will be necessary to perform specific stretching and strengthening exercises, combined with regular chiropractic adjustments, to balance the alignment of your pelvis in the long term.

Postural Improvement…Now There Is An App For That!


Most of us know that our posture is not quite as good as we’d like or our chiropractor would like 🙂

And we are all aware of the wonderful benefits that good posture can bring:

  • Look and feel even better than you already do,
  • Prevent back aches and muscle pains,
  • Decrease wear and tear on your joints,
  • Use less energy for daily tasks, and
  • Increase your spine’s flexibility and resilience.

But improving your posture requires daily effort to break out of some of the bad habits we’ve built over many years if not decades!  Stand like this, sit like that, strengthen these muscles, stretch these other muscles…there can be a lot of things to remember to do.  Where should you start?

Luckily for you, the Canadian Chiropractic Association has just released a FREE app available on your iPhone or Android device that provides step by step daily instructions on things to do to rebuild your posture.  It only takes 3 minutes per day!

Try it out!  Download the STRAIGHTEN UP CANADA app here and take the first step towards a healthier body and a healthier YOU!

Straighten Up Canada app features:

  • 12 unique posture exercises
  • Adult and youth exercise options
  • Easy to follow Image stills and video content
  • Tracking function
    • Set personal reminders
    • Track your progress
  • Share your posture exercise progress with friends through social media
  • Learn about your back and common back-related problems
  • Find a Chiropractor in your area quickly and easily
  • Read the latest blog posts on MSK health


Mattress Buying Secrets Revealed!

It’s time to replace our mattress!  Although it’s only been about 3 years since we bought our current mattress set from Sleep Country, it’s simply no longer comfortable for me or my wife!  And since we know that a good night’s sleep is invaluable to our physical and mental health, we will be embarking on another treacherous journey into the Mattress Industry!

No doubt many of you have gone through this exercise and often wondered if you bought the right mattress or gotten a good deal.  Here is an article written by an former mattress salesperson that gives some valuable pointers as we navigate the local mattress stores.  Give it a read if you’re in the same boat!

Article source:

Mattresses might be soft to sleep on, but they are notoriously hard to buy. Various stores sell very similar mattresses under different names, thwarting attempts to compare prices. Salespeople often steer shoppers toward ultra-expensive products. And manufacturers highlight features that consumers can’t easily evaluate. As a result, many shoppers pay hundreds of dollars more than necessary—or end up sleeping for years on mattresses that they hate.

Beware of these traps…

TRAP: It’s very difficult to compare mattress prices from store to store. With the exception of certain specialty mattresses, each retailer typically uses product names and numbers that you won’t find anywhere else. This is true even when the mattresses are virtually identical, aside from cosmetic changes involving fabric colors and quilting patterns.

What to do: When you find a mattress that feels comfortable (see the “Mattress-Shopping Checklist“), jot down every available piece of information about what’s inside the mattress. Include the coil count and coil wire gauge…dimensions including the height…firmness (based on your judgment of where it falls on a one-to-10 firmness scale with one the firmest)…materials used…how the sleep surface is described…and what position the list price occupies compared with other mattresses at the store from the same manufacturer. When you visit other mattress retailers, examine mattresses that fall in the same general position in the manufacturer’s price scale until you find one that matches up very closely. Start there and compare coil counts, firmness and other characteristics of various models until you find one that seems to match. Lie on this mattress, if possible, to confirm that it feels about the same as the one you tried earlier.

Tell the salesperson that you found the corresponding mattress at the other store, and ask if he/she can beat the other store’s price. If the second store has the lower price, you could return to the earlier store and try the same tactic. Most mattress stores and many furniture stores will negotiate. Their list prices tend to be double their cost, so it’s perfectly reasonable to try to negotiate a price 20% to 40% off list price (which could mean a savings of $400 off a $1,000 mattress). Department stores often won’t negotiate, but they sometimes will honor their price-match guarantee if the customer shows that a mattress at another store is essentially identical despite different names. And the department store might offer a better deal on shipping and better return options if you’re not satisfied, both important considerations.

Reasonable price: You should be able to find a good queen-size mattress for $700 to $1,000—for guest rooms, $500 to $800.

TRAP: “Pillow top” softness may not last. So-called pillow-top mattresses feel great when you lie on them at the store. They have thick, soft layers of fiber and/or foam above the mattress springs. Trouble is, these thick layers soon will develop deep, annoying body indentations. The heavier you and/or your partner, the faster this will happen.

If you love the soft pillow-top feel, opt for a “plush top” instead. These have perhaps two to three inches of foam and fiber, rather than the four to six inches of a pillow top—and they will be less likely to develop deep body indentations. Plush tops also tend to be $100 to $300 less expensive than pillow tops.

Helpful: If there are two separate “tape edges”—ropelike lines—running around the mattress above and below the foam layers, it is called a pillow top.

TRAP: Warranties and satisfaction guarantees are less impressive than they seem.If you voice concern about whether a mattress is right for you, the salesperson might assure you that there’s no need to worry because the store offers a satisfaction guarantee.

Quiz the salesperson about this guarantee. Can you get cash back or only exchange the mattress for a different one—and how much time do you have to return it? Is there a restocking fee for returns? What about a pick-up charge or additional shipping charge for the replacement mattress? And if you purchase a mattress during a sale, will you be able to exchange it for one of similar list price or only for a lesser one with a list price similar to the sale price you initially paid?

Caution: Manufacturers’ mattress warranties cover only major defects. They won’t permit you to return the mattress because you don’t find it comfortable. Mattresses generally should be replaced every eight to 10 years.

TRAP: New foundations often are unnecessary. If you buy a mattress, expect the salesperson to push you to buy the matching foundation (what used to be called a box spring) as well. You might be told that this foundation will extend the life of your mattress or make it more comfortable or that not buying it will void the mattress warranty. None of this is likely to be true.

Unlike old-fashioned mattresses, many modern mattresses do not require you to flip them over from time to time, and these no-flip mattresses don’t require springs beneath them at all. Today’s “box springs” really are just simple wood-and-wire frames covered in fabric. These foundations cost retailers very little, yet they’re often sold for hundreds of dollars.

If your old foundation has no obvious problems such as sagging or cracking and is the same size as the new mattress, you can continue to use it. If you have an old spring-type box that flexes when you push down on it, you don’t want to use it with a new “no-flip” single-sided mattress.

If you have a platform bed or a bed with slats that are spaced no more than two inches apart, you can skip the box spring entirely—assuming that the resulting mattress height is not too low. If you do need a new foundation, purchase the one that’s matched (brand-wise) to your new mattress. Don’t feel that you need to match the fabrics. A lower-priced foundation of the correct size should be fine if you’re buying a single-sided mattress.

TRAP: A higher coil count doesn’t necessarily mean higher quality. For spring mattresses, mattress salespeople often stress high coil count—more springs per square inch—as they steer shoppers toward high-end models. It’s true that having more coils is better than having fewer coils, all else being equal, but all else is not equal when it comes to coils. Coils might be made from different materials or in different ways.

Example: A mattress with independent coils—coils each made from a separate piece of wire—is likely to do a better job of conforming to the contours of your spine than a mattress with coils made from continuous strands of wire, even if the coil count isn’t as high. Independent coils also do a much better job of isolating movement, a big plus for those who share a bed.

TRAP: Delivery and removal charges. Ask about delivery charges before you agree to buy a mattress. Some retailers provide free delivery, but others see it as a way to slip one last sneaky fee into the deal.

Also ask whether removal of the old mattress is included in delivery—there’s sometimes an additional charge for this. Include any delivery and pick-up fees when you compare prices at different stores.

TRAP: An expensive specialty mattress might have drawbacks. Solid foam and dual-zone, air-filled mattresses look great in ads and can feel great when you lie on them—but there might be issues that the salesperson won’t mention. For instance…

Memory foam mattresses such as those made by Tempur-Pedic do a wonderful job of conforming to the contours of the body and providing support—but they also make some sleepers feel too hot.

If you want foam but are a warm sleeper, consider a natural latex foam mattress, which sleeps cooler. Some synthetic foam mattresses have gel embedded in them to keep sleepers cooler, but these mattresses are extremely heavy and difficult to move.

Dual-zone, air-filled mattresses such as Sleep Number by Select Comfort provide separate firmness controls for each side of the bed. But humidity and perspiration tend to build up around the internal air bladders of even the best-made air-filled mattresses. Mildew and mold can spread if the bladders are not cleaned frequently using liquid detergent.

These mattresses can be opened up for cleaning and for ventilation—but make sure that the mattress is completely dry before closing it up.

Source: Ronald Czarnecki, a former manager of multiple mattress stores in the Pacific Northwest. He is author of Shop for Sleep and Survive the Bite: How to Shop for a Mattress and Save Money in the Cold White Sea of Deception

Why Does My Child Have Back Pain?

Summer vacation is over and your kids are heading back to school this week!  A common parental concern I’ve noticed relates to children and back pain.  It is surprising to many folks that kids would even develop back pain.  After all, they’re just kids right? Shouldn’t they be less susceptible to back problems than adults?

The reality is our kids live pretty active lives these days and there are certainly more, or at least newer risk factors that affect kids in 2014 than what we may have experienced when we were kids.

Digital Age Dilemma – the explosion in usage of iPads, smartphones and other personal media devices has resulted in a generation of youth that is sitting more and being less physically active.  Not only that, they are sitting in poor positions or postures for lengthy periods of time.  I know kids as young as 6-7 who are addicted to games like Minecraft and Clash of Clans and who sit slouched in chairs for 1-2 hours playing the game on their iPads.  Parents need to limit electronic device usage and get their kids engaged in a wide variety of physical activity instead.

Overweight Children – possibly correlated to the Digital Age Dilemma but also poor nutritional habits, a recent Canadian study in 2012 revealed that almost one third of kids aged 5-17 are overweight or obese and particularly in boys.  Just like adults, extra pounds increase the load on your spine, taxing your muscles and dumping pressure on the soft tissue around your vertebrae. This can exaggerate the natural curve of your lower back, throwing off your spine’s alignment and causing chronic lower-back pain.

Carrying Heavy Loads – kids these days get alot of homework…definitely more than I did back in the ’70-80s.  And the weight of the stuff they have to carry to and from school has correspondingly gotten heavier too.  Large backpacks are stuffed with duotangs, binders, textbooks, extra shoes, lunches, etc.  Whenever I drop off my own daughter at school, I am continually surprised to see so many kindergarten kids carrying backpacks that were too large for their little bodies!  Often, backpacks may equal 20% to 40% of the child’s own body weight (equivalent to a 150-pound adult carrying a 30 to 60-pound back pack around 5 days a week). Older kids frequently carry their bags on just one shoulder which creates overuse and muscle imbalances too.  Is it any surprise really that kids are developing back pain?  For tips on how to adjust your child’s backup, follow this Backpack Checkup.

Higher Risk Extracurricular Activities – it’s great that many kids are involved with after school physical activities and sports.  Parents should keep in mind though that all activities carry an inherent risk for injury not only to the back but other areas of the body also.  Fast and impact sports like hockey, soccer, taekwondo/karate can result in back injuries.  Gymnastics and dance which often teach movements that hyperextend the spine can also create back problems and even stress fractures in kids who are competitive or training several times per week.  Also be cautious that we often want our kids to play sports to get fit but that kids are not fit to play.  Team coaches and trainers are often enthusiastic volunteers who may not have the education to provide a well rounded fitness program for the kids that gets the kids ready to play. Warmup and cooldowns may not exist or be adequate and basic strength training to enhance the kids’ preparedness for the sport may not be available.

Things are certainly different with each generation of children and it’s vital for parents and health care providers to understand the changing health needs of our kids. Let’s keep the lines of communication open!

Dr. Keith

Do I Need An X-ray or MRI?

Most people with injuries, very understandably, want to know what is causing their pain and hope that an imaging test of some sort will help them pin down the cause of their problem and provide a diagnosis.


For example, patients who come to see me at my Richmond Hill chiropractic clinic often ask if an x-ray is required.  95% of the time I will say “No”.


This is because x-rays are very good at showing bony problems such as fractures and dislocations.  So unless you’ve had a serious fall, accident or trauma of some sort, taking an x-ray is unlikely to show anything informative for your case.


X-rays could also show moderate to severe arthritic changes in the spine…but this is less likely unless you are older or have a history of putting your body through a lot of wear and tear through work or recreational activities.  Plus, arthritis isn’t always the primary cause of your pain even if it’s visible on x-ray.  At the end of the day, most ‘garden variety’ aches and pains are in fact, due to soft tissue/muscle problems and these can’t be diagnosed on an x-ray.


MRIs are geared more towards assessing soft tissues (discs, ligaments, nerve roots, cartilage, muscle).  However, they are costly and the typical waiting list can range from weeks to months.  And MRIs typically just confirm the doctor’s original diagnosis already made through a complete patient history and physical examination.Only in more severe cases does an x-ray or MRI actually lead you to more special care like surgery.  For the most part, these tests will simply confirm that you do have tendonitis, an injured disc, swelling in the joint, arthritic changes, or sometimes even that everything appears normal.


Either way, the next step is to simply follow through with a regular course of conservative care with your chiropractor, physiotherapist, massage therapist or trainer. If you simple follow through with their treatment recommendations you may find yourself already feeling great again before you even get that MRI appointment!


Natural Remedies To Pack In Your Suitcase For March Break


March Break is upon us and if you are lucky enough to get away from this bitterly cold weather, you’ll want to arm yourself with some natural remedies so that you can enjoy you r getaway without getting sick!

So let’s start with the usual disclaimer…please make sure you are not allergic to any of the ingredients in the remedies I recommend or also use caution if you are pregnant or breastfeeding.  I am always around at the office if so please ask me if you are not sure!

Traumeel  Cream & Tablets (by Heel) – A must-have if you are active (or clumsy like me! J).  I carry these on vacation, but also in my gym bag.  They are great for preventing bruising and swelling from an injury.  The cream can be applied directly to NON-OPEN wounds or bruises, and the tablets are best dissolved under the tongue every 1-2 hours after an injury.

Unda 270 Ointment (by Unda) –  This is an all-purpose ointment that can be used for mild irritations, wound-healing and even diaper rash!

Pascallerg (by Pascoe) – If you suffer from seasonal allergies, this remedy works quickly to reduce the stuffy nose and sneezing.  You dissolve the tablet under your tongue every 15 minutes until the symptoms are gone.  I usually only have to take 2 doses in the morning.

Mucococcinum (by Unda) – Great for preventing and treating colds & flu.  You can dissolve one tablet twice under your tongue 2X the week before you travel, and daily for the first 3 days .  Not for sure in autoimmune disease or pregnancy.

Lymphdiaral Cream & Drops (by Pascoe) – If you get a lot of ear infections, or fluid behind the ear, lymph nodes that get inflamed when you get sick, then 10-15 drops of Lymphdiaral drops just before take-off and landing will help with the pressure that can build up in the ear and cause that terrible ear pain.  The cream can be used over swollen glands, lymph nodes, and ankles to improve lymphatic fluid movement.

Probiotics – It’s easy to get an upset tummy if your body is not used to eating new and different foods and drinks.  You can strengthen  your gut before your trip by taking probiotics (about 25 billion for adults per day), daily for 1-2 weeks before you leave, as well as during your travel.  Always take probiotics with food.

Grapefruit Seed Extract – To help protect against food poisoning, grapefruit seed extract can be taken for a few days before your trip and also during the trip.  It comes in liquid or capsule forms and kills viruses, bacteria and fungus.

Safe travels everyone!  Remember to stay well hydrated and catch up on sleep!  I will be here during the March Break– it is a great time to bring in your kids for a Naturopathic and Food Sensitivity assessment.

Dr. Misa

Save Your Back With Proper Shovelling Technique

I don’t know about you, but I’m already sick of all the ice, cold and snow we’ve had this winter.  And as I write this, even my back is sore in part because of the extra shovelling I had to do this weekend!  So I’m prompted to write a quick article to remind myself and you on how to ease the strain of snow shovelling this winter!

Warm Up:

Although you may not think it, snow shovelling is a workout.  And just like exercising or working out, properly warming up beforehand is a good idea.  Cold, tight muscles are more susceptible to injury than warmed up, flexble muscles.  Five to ten minutes of lighter activity like a brisk walk followed by stretching your low back and hamstrings would be a good start.

Ergonomic Tips:

  • Always face the pile of snow that you intend to lift – have your shoulders and hips both squarely facing it.
  • Bend at the hips, not the low back (ie. don’t hunch over).   Keep your chest up, pointing forward.   Keep your abdominal muscles tight.  Also, bend your knees and lift with your leg muscles, keeping your back straight.
  • You are better off shovelling light amounts of snow more frequently than trying to lift more snow fewer times.  Don’t try to lift snow/ice that is too heavy for you.
  • For leverage, grip the shovel with one hand as close to the blade as comfortably possible and the other hand on the handle (handle and arm length will vary the technique).
  • Push the snow to deposit it where you want rather than reaching or tossing the snow.

Pace Yourself:

  • As much as we want to clear the driveway as quickly as possible, it is important to pace yourself like you would in any sport
  • In fact, shovelling small amounts more frequently is less strenuous than shovelling a large pile at once
  • If you are faced with a deep amount of snow, remove a few inches off the top at a time instead of trying to shovel the whole depth in one go
  • Remember to take a 1-2 minute break after 15 minutes if you are feeling strained or overworked…remember snow shovelling is a workout!

Invest in a Snowblower:

  • Every winter a good number of patients come in with shovelling related back injuries which results in one or more lost days of work
  • Although snowblowers are not inexpensive, they are a great investment and your return on investment comes from saving your back as well as eliminating lost days of work and pay
  • You should still take some precautions with using a snowblower like using the power of your legs to push the machine while keeping your back straight and knees bent

Keeping these simple guidelines in mind during the rest of this 2014 winter season will lessen the chances of developing new  or old back problems from shoveling.  Hopefully it will make your winter a healthier and more enjoyable experience…better yet book yourself a winter getaway down south!

Dr. Keith


Too Much Sitting Is Hazardous To Your Health!

Over the past few centuries, society in general has moved from a largely farm based lifestyle to one where people mostly sit throughout the day.

While you would think that sitting puts you at less risk for injury compared to say the daily grind of working the field of a farm, there is a growing trend of office workplace injuries related to neck, shoulder, back and nerve injuries.  On top of that current research shows that sitting for long periods of times is a risk factor for a variety of chronic diseases such as obesity, heart attack, stroke, Type 2 diabetes and even early death!

According to the Healthy and Active Living Research Group in Ottawa, Canadian adults spend, on average, three-quarters of their waking hours each day sitting or reclining. This static behaviour is rubbing off on your kids, too. On average, Canadian children spend two-thirds of their daytime hours sedentary.

Interestingly, this seems even higher than our U.S. counterparts as shown in the infographic below:

So what can you do to take a ‘stand’ against sitting too much all day?  Here are a few suggestions:

  1. Use a Standing Desk.  You can actually burn 40% more calories while working from an upright position!  As well, sitting for prolonged periods can increase you triglyceride levels, decrease your HDLs and decrease your insulin sensitivity.  The seated position is actually very compressive on your spine and discs too.  There are commercially available standing workstations…talk to your HR department, Health & Safety or manager about if this is feasible.
  2. Take frequent walk breaks.  Many people are already doing this but there are still lots who don’t and simply sit at their desk for their breaks or lunch time.  Even quick regular walks help with circulation, refocuses your brain and helps burn fat.  As well, it prevents muscle and joint stiffness from settling in.
  3. Perform desk exercises.  Schedule your work breaks to include some simple stretches.  I have a patient who sets a computer alarm to remind him to take a break every hour.  He then follows a simple 5 minute routine to stretch his neck, arms, shoulders and lower back.  Office Fitness Break Reminder is a simple and free program you can download to your work computer!
  4. Try an exercise ball chair.  Sitting on one of these large fitness balls instead of a regular office chair helps to engage your core muscles and improve balance.  However, some recent research indicates that sitting all day on the ball isn’t a good thing either.  Try swapping back and forth between the office chair and the ball during the work day.
  5. Have active meetings.  Why not considering shunning the typical sit-around, boardroom meeting and try bouncing ideas around with team members during a walk outside.  The fresh air and activity may bring new perspectives on business and efficiency.  And you will all burn more calories while you are at it!

Don’t let a sedentary lifestyle ruin your health!  Simple changes to your daily routine can yield massive benefits!

Until next time,

Dr. Keith