Should We Apply Ice For Injuries?

At some point in your life, somebody like a parent, coach, therapist or doctor has recommended that you go home and apply ice to a fresh injury.

Perhaps you sprained your ankle.  Pulled a muscle in your back.  Had a flare up of arthritis in your knee.

And you followed the recommendation and applied a bag of ice cubes or a bag of frozen peas over the affected area.  Did it help you?  Did you feel like your recovered quicker?

The reality is that over 40 years, there has not been any compelling scientific research that shows icing or cold therapy helps injuries heal faster.  In fact, new research now claims that perhaps ice even slows down your recovery!

But why not?  After all, doesn’t a cold pack on an injury help restrict blood flow to the injured area, numb the pain, and control the swelling?  Aren’t these good things?!

As a practising chiropractor for over 13 years, I too have been guilty of making this recommendation to my patients and over the past year have reduced my recommendation for using ice significantly.  It was what we learned in school, it was commonly used in hospitals and clinics around the world, the R.I.C.E. principle has been around since the 1970s and it just seemed to make sense.

But if we look at the available research on the topic of icing, there actually isn’t much solid evidence of its efficacy for injuries.  And in fact, some of the new research seems to suggest that icing may actually DELAY recovery.

Interestingly enough, even the person that coined the R.I.C.E. principle, Dr. Gabe Mirkin who is a sports medicine doctor and professor at the University of Maryland, has changed his tune, admitting that ice is no longer a good idea.  Bed rest has been debunked for some time now and it’s now relative rest instead where one should avoid strenuous aggravating activity but still engage in active, light movement.

Ice may be bad because it blocks the human body’s natural healing mechanism: inflammation.

We are naturally inclined to think that inflammation and swelling is bad.  After all, we’ve been icing injuries and taking ANTI-inflammatory medications for decades!

But inflammation and swelling is an essential part of healing in the body.  In fact, it is the first step in the scientifically recognized 3 Stages of Healing: Inflammation, Tissue Repair, Remodelling.  Any time a muscle or any other tissue injury occurs, your immune system sends inflammatory cells called macrophages which release a substance called IGF-1 (insulin growth factor) to the damaged area to kick start the healing process.  However, when ice is applied, the arrival of macrophages is delayed, which in turn means that the normal first stage of healing mechanism is delayed.

Post-injury, local redness and heat are caused by increased blood flow. Swelling is the result of the increased movement of fluid and white blood cells into the area of inflammation.  So we actually want these things to occur not inhibit them!

This also means that commonly prescribed and over-the-counter medications like corticosteroids and Ibuprofen which suppress the immune system and inflammation, actually BLOCK healing.

Over the past 12 months, I’ve been changing my tune with patients too and encouraging them to follow a Movement, Elevation, Traction, Compression and Heat or M.E.T.C.H. principle.

For example, if you sprain your ankle:

  1. perform regular light range of motion exercises with the foot,
  2. keep it elevated,
  3. have someone gently stretch out (traction) the ankle joint,
  4. compress it with either elastic tubing, a TENSOR bandage or compression socks and
  5. consider applying heat for short intervals instead.

So while ice may still serve a purpose in dealing with pain, it may be doing an overall disservice by increasing your time for recovery.

7 Tips To Make Your Snow Shovelling Safer

The 2016-2017 winter season here in York Region has been a roller coaster ride with the large snowfalls, icy conditions, rain, cold days and warm days.  If you’re lucky, you may have a snowblower to assist with some of the heavy snow we’ve had.  But if not, fear not!  Keeping your back and spine safe is easy by following these 7 steps:

  1. Stand with stability: Stand with your feet at hip-width apart to maintain your balance. It’s also best to wear boots that are non-slip when you shovel. This will help protect you from sliding when shovelling.
  2. Keep the load close to your body: Hold the shovel close to your body to guard against straining or pulling a muscle. When the snow is deep or heavy, shovel smaller amounts (3–5 centimetres/1–2 inches) of snow at a time.
  3. Grip strategically: Space your hands apart on the handle to increase your leverage when lifting the snow.
  4. Lift with your legs: Bend from your knees, not your back, when lifting. Not only does it protect your back, but you can strengthen your legs as well!
  5. Engage your core: Tighten your stomach muscles when lifting snow. This helps to protect your back as you lift.
  6. Don’t twist: Avoid twisting your body when you lift. Move your feet instead to turn your body.
  7. Don’t toss the snow: Make sure to walk to place the snow on the side of the road rather than throwing it. Turn your feet in the direction you’re dumping the snow which will better position you to maintain good form.

Snow shovelling can be a very strenuous activity, and even more so without the correct, protective technique. With the proper preparation, tools, and technique you can make shovelling safer for yourself, and your walkways safer for your family, friends, and neighbours.

Happy shovelling!

Dr. Keith



Sleep Positions That Cause Problems

sleep-positionsOften times the things that you do unknowingly or subconsciously can be the cause or part of the cause of your pain problem.  Injuries are the sum of all stressors placed on the body and even poor sleep positions can be a major contributor to the injury equation.

In fact, the way you are draping your leg across your body and off the bed, or holding your arm under the pillow, can often be the last straw that pushes you over the edge to injury or keeps you from recovering fully.

Here are some sleep considerations:

Putting the arm under the head or above the head holds the shoulder muscles on the extreme end of their range of motion, increasing risk of shoulder impingement, rotator cuff issues and numbness in the arms or hands from reduced blood circulation.

Draping one leg over the other twists the pelvis and lower back and overstretches the hip musculature for extended periods of time. Favoring one side can also contribute to muscle imbalances.

Stomach sleeping, especially on softer beds, can hyperextend the low back, setting the stage for pain and discomfort by irritating the spinal facet joints.

Turning your head to the side to breathe is a necessity if you are a stomach sleeper, but it’s also a major contributor to stiffness and neck pain.

Plantar flexion, or a “pointed toe” position, can worsen your plantar fasciitis or Achilles tendinopathy by putting your foot and ankle into a contracted position all night.

How you sleep is a result of years of habit and you will usually gravitate toward the position that you are most comfortable in.   Although it can be difficult to change, the body can be “re-trained.”  Like trying to break any other bad habits, make small changes like a pillow between the knees to keep the pelvis stacked in a more neutral position, or re-positioning the arm upon waking—over drastic changes, which may detract from overall sleep quality.

As a general rule of thumb, back sleeping with a pillow under the knees is the ‘best position’ of rest.  Side sleeping with a pillow between the knees is ‘second best’ while the worst is sleeping on your stomach.  Keep your head and neck in a neutral position with an appropriately sized pillow – neither too elevated nor too flat.


Backpack Troubles For Kids

backpackNext time you are at the schoolyard waiting to pick  up your children, observe how many students are lugging around inappropriate backpacks for their school stuff.  Here are some criteria to consider:

1. Too big / Too small?  If the backpack is too big it can pull the child backwards straining muscles. A pack too small won’t offer enough space and will cause more pressure on the shoulders. The bottom of the pack should rest in the curve of the lower back not more than four inches below the child’s waist.

2. Proper padding. Select a backpack with well-padded shoulder straps even if it means the backpack doesn’t have your child’s favorite cartoon character on it!  Your shoulder and neck have many blood vessels and nerves. Excessive pressure in the area can cause pain and tingling in the neck, arms and hands.

3. Two shoulders straps not one.  Too often you’ll see kids with backpacks slung just over one shoulder!  This can cause the child to lean to one side.  Chronically leaning to one side (and we know that people tend to carry things on a favorite side) can cause pain, discomfort and postural issues.

4. Use the buckles.  A good quality backpack will have additional buckle straps across the chest and waist.  Using these buckles can help distribute the weight of the backpack evenly to prevent against and strains or pains.

Once your child has the perfect bag, it is just as important to make sure they are loading it correctly

The bag should weigh no more than 10 per cent of your child’s body weight. If the bag is too heavy, discuss with your child about only bringing home what is necessary for the day’s homework. If he/she has to regularly bring home a lot of necessary school stuff, consider a book bag on wheels  or encourage your child to hand carry a book or another item in front of them. When packing the bag make sure your child is putting the heaviest items closest to your child’s back. It is also important to arrange the materials so they don’t slide around inside the bag.

These simple tips will help prevent alot of the neck and back pains that we are seeing kids getting more of these days!  If you need to address an ongoing problem, Drs. Keith & Kelly and Leanna our physio are available to help!

Tips On Choosing The Right Pillow

I frequently get asked by patients: “Doc, what’s the best pillow to buy?”

There are many different pillows on the market today from traditional feather and synthetic fiber ones to shaped pillows, memory foam and buckwheat pillows. It can be difficult to know what to choose.

A good pillow for sleeping should be comfortable to lay your head upon, but most importantly it must support your neck keeping it in alignment with the rest of your spine whether you choose to sleep on your side or your back.  Stomach sleeping is a no-no.

pillowThe reality is that there is no one “best” pillow for everyone. But you can try these tips to pick the pillow that’s right for you.

  • The pillow should support the natural curve of your neck and put you into a neutral postural position.  The way your head and neck appears standing should essentially be the way you look lying on your side or on your back.  This means you don’t want a pillow(s) that are too flat nor too high.  Ask your significant other to check your position for you.
  • Try out the pillow. Most pillows are packaged in a plastic wrapper so you can lay it on a display bed in the store and put your head on it. This is the best way to find out if you are on the right track.
  • A hypoallergenic pillow is a must if you suffer from allergies, but it is also a good choice for anyone.
  • Buckwheat filled pillows have become increasingly popular. Buckwheat is hypoallergenic, it will mold to the contours of your head and neck providing good support, but it will also change shape when you move.  I like these more than the traditional ‘cervical’ pillow.

Notably, a research study done in 2010 showed consistently good performance of latex pillows in reducing the frequency of waking headache and shoulder/arm pain, and thus these pillows should be recommended to reduce waking symptoms. Feather pillows were not recommended as they are associated with greater likelihood of waking symptoms.  Also the foam contour/cervical pillow performed no better than a foam regular pillow.

A good quality, supportive pillow provides many benefits including a better night’s sleep, improved circulation, fewer aches and pains and even reduced snoring. Take your time and choose carefully…it will be a bit of a trial and error process but your neck and back will thank you for it!

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