Breathe with your Belly

Do you know how to breathe (properly)? Although this may sound like the setup for a bad joke, it is a question that I actually ask my patients.


What I mean when I ask this, is are you only using your chest to breathe, or are you engaging your diaphragm (belly breathing)? In normal breathing, the primary respiratory muscles are used, the intercostals (between the ribs) and the diaphragm. In heavier breathing (like during exercise), accessory muscles including the scalenes, SCM, levator scapulae and pec minor are used. If you are a “chest breather”, these muscles are typically being engaged even during normal, quiet breathing, which can lead to pain and postural dysfunction.

There is a very easy way to assess how you are currently breathing. Lay comfortably on your back, with one hand on your chest and the other on your stomach. Now the challenging part – try to breathe as normally as possible. Close your eyes, and give it some time to get into your normal rhythm. Now, think about what your hands are doing. Is one moving more than the other? When is each one moving?

Ideally, you want there to be very little movement of the hand on your chest. Rather, you want to feel the hand over your stomach do the majority of the movement. Keep your hands in this position, and experiment a little. Can you focus on sending the breath deeper, causing more movement of the belly hand?

This can be challenging at first, particularly if you are used to mostly using your chest. Practice pushing the belly out (hand moves up) while you inhale, and feel it fall while you exhale while laying down with hands in place. Once this is comfortable, practice the same but while seated. As you practice this action more, it will become more natural and you can begin to integrate this type of breathing into your day to day. You should get more comfortable doing this without the hands in place to cue the movement, but can always try placing them to check in with how you are doing.

Now that I’ve explained how to do this diaphragmatic breathing, why should you add this practice? Proper muscle recruitment and posture are just one aspect of why this type of breathing is important. Another is that this type of breathing, especially when done purposefully, is actually a great way to increase core muscle strength and stability. If you have core stability in mind, practice your breath laying down, inhaling through the nose and exhaling through the mouth while thinking about recruiting the abdominal muscles throughout movement. Keep in mind that during the exhale, it is less about sucking the bellybutton down to the floor, and more about tensing across the muscles (bringing the sides towards the middle). Similarly, this is in important breathing technique to utilize postpartum, as it also activates the pelvic floor. If you are interested in this as postpartum rehab, be sure to discuss with your healthcare practitioner before starting.

Diaphragmatic breathing (particularly when breathing in through the nose, and out through the mouth) is a great technique if you are experiencing stress and anxiety. Using this slow breathing pattern causes stimulation of the vagus nerve. This nerve is unique in that activating it actually lowers the “fight or flight” response in your body and promotes relaxation by activating the parasympathetic nervous system. You can increase this effect by lengthening your exhale compared to your inhale. Practice spending 1-2 minutes of breathing while focusing on expanding the belly with each inhale through the nose, and taking an extra long exhale through the mouth. You should notice that this helps to slow your heart rate, and may make you feel more relaxed.

*Educational content only, not meant as medical advice. Please speak to your healthcare practitioner to discuss any concerns and before starting any new rehabilitation or treatment.

Are you getting a good sleep?

Sleep is something that is so important, yet many people are not getting enough. Though you may not be able to help the things that impact sleep during the night, you can prepare yourself for sleep as best as possible. This is often called sleep hygiene – and really involves setting practices and routines to optimize your setting and body to prepare for sleep.

Most adults need about 7.5-8 hours of sleep to function well, while kids, teens, and those who are pregnant need even more. This is also an average- some need more or less than these guidelines.

When it comes down to it, there are three main purposes for sleep. These are rest, restoration, and reorganization. It is required to process emotional reactions, manage mood, and even transfer memories. So, not only does a good sleep help you feel more ready for your day, it is actually an active process where specific regions of the brain have increased activity.

If you are having trouble falling asleep, give these tips a try.

1. Try a relaxing pre-bed routine – take a warm bath or shower, dim the lights and try a calm, quiet activity.

2. Stick to a regular sleep schedule – trying to both go to bed and get up at the same time daily helps to set a schedule, trying to avoid naps can also help this.

3. Limit stimulation before bed – this includes afternoon caffeine, alcohol after dinner, large/spicy meals late at night and even exercise 4-6 hours before bed.

4. Try relaxation techniques (both physical and mental) to de-stress before getting into bed.

5. Only use your bed for sleeping – not as a place for watching TV, doing work, reading or studying.

6. Keep up a regular physical activity routine – although exercise is not ideal right before bed, keeping active helps to reduce stress levels, and has been reported to improve sleep quality.

7. Do not go to bed either very full or very hungry, try a light snack in the evening if needed.

8. Go to bed when you are drowsy, and if you don’t fall asleep within about 15 minutes, get up and do a relaxing activity.

Give a few of these tips a try, and see if you notice a difference with your sleep.

My elbow hurts- is it Tennis or Golfers elbow?

Not all elbow pain falls under one of these two categories – but they are quite common. The terms are thrown around a lot, but what do they really mean? If you don’t play either of these sports, how do you know what you have?

Tennis elbow is the more common name for the condition lateral epicondylitis. In the forearm, there are two main groups of muscles; those that extend the wrist, and those that flex it. A major group of those extensor muscles all come together into one tendon that inserts on the lateral (outside) of the elbow, on a bony prominence called the epicondyle. When these muscles are overused, you can end up with small tears or other microtrauma. This ends up with you having pain on the outside of your elbow and forearm that typically comes on slowly, and may even end up with weak grip strength on that arm. Common causes of this include tennis, golf, gardening, typing, videogames and musical instruments. It is common in plumbers, carpenters and electricians due to the nature of their work.

If tennis elbow refers to the extensor group of muscles, then it makes sense that golfers elbow involves the group of flexors on the inside of the elbow (medial epicondylitis). The mechanism of this type of injury is nearly the same, with pain worse during wrist flexion activities. Because of the proximity to the ulnar nerve, you may even get some tingling in the fourth and fifth fingers. Golfers elbow is common in overhead athletes (golf, baseball, racquet sports), factory workers, and those who work with vibrating tools. Because most activities require some involvement of both the flexor and extensor groups, there is a certain amount of overlap in the individuals who get these conditions.

What is important to note is that these injuries both come on slowly over time due to repetitive activities or overuse, they are not caused by trauma. If you are having pain anywhere on your elbow, it is important to make sure you have a full assessment to rule out other potential causes. Your chiropractor or other practitioner will perform a thorough history and physical exam, involving a number of special tests to identify if this is the injury that you have.

So if you have been diagnosed with either of these conditions, what happens next?

There are a number of treatment options, and what you end up doing will depend on both your practitioner and your own preferences. Common treatments include lifestyle modifications, soft tissue therapy (manual or instrument assisted), mobilizations of the elbow, modalities such as laser or ultrasound, acupuncture, and home stretches and exercises, and bracing. Not all of these components need to be involved for successful treatment, each individual case has different requirements.

The vast majority of patients respond very well to conservative care, and do not require further intervention. If you are having pain that sounds like this, get an evaluation to get you on the road to recovery.

Chiropractic care during pregnancy?

Moms to be – whether first time or not – are under a lot of pressure to make all the right decisions for both them and their babies. There is a lot of information out there, and it can be very hard to sort through. My goal for today is to give you the most up to date information about the safety of chiropractic care during pregnancy, so that you are empowered to make the right decision for you.

To start – what are some reasons that a pregnant woman may seek chiropractic care? Both low back pain and pelvic girdle pain are common during pregnancy due to the wide range of changes to the body, even if a woman has never experienced this type of pain before. Carpal tunnel and mid back pain also become more common throughout pregnancy, and may be debilitating.

The prevalence of low back pain during pregnancy is up to 90%, with 75% of women reporting that their pain continued at least 6 months postpartum. A smaller percentage even report still experiencing this pain 2-3 years later. It may be severe enough to interrupt activities of daily living, including sleep and caring for children. Although this pain may be common, that does not mean that it is normal and must just be accepted as a part of pregnancy. Although the exact cause of pregnancy related low back and pelvic girdle pain are not known, it is thought to be a combination of hormonal changes, biomechanical changes due to increased weight and changes in weight distribution, and changes in abdominal musculature to accommodate the fetus.

Although more research is needed, chiropractic care including adjustments and exercise may be beneficial for relief of low back and pelvic girdle pain related to pregnancy. Chiropractic care has also been found effective in treating other conditions that pregnant women may present with, such as neck pain or headaches.

Regarding safety of chiropractic care for these conditions, a new systematic review and update of the literature was published this year (2021). The group looked at 21 quality studies (including systematic reviews, randomized controlled trials, cohort studies and a case study) of pregnant or postpartum patients receiving chiropractic care, and any reported adverse events (from significant to minor). These studies were all published 2011 and later, as studies before that were included in the previous systematic review published in 2015. All of this literature except for the one case study presented only mild and transient events. The case study that was included did demonstrate a serious event after neck manipulation. The previous systematic review demonstrated 4 adverse events after neck manipulation, and 2 adverse events after low back manipulation.

Based on this evidence, the authors determined that adverse events following manipulation in the pregnant and post-partum population are rare. More research still needs to be done, which is common with this population.

When it comes down to it, you as the patient always makes a decision on the type of treatment that you want to receive. Although chiropractic care is generally safe for the pregnant and post-partum population, you should always discuss any questions and concerns with your chiropractor. They will be able to let you know of any contraindications you may have, or suggest alternate treatment options at that time.

Even if you are not interested in chiropractic adjustments, I encourage you to reach out to a chiropractor or other health care professional if you are experiencing pain related to your pregnancy. Although it may be common, it is not something that you should have to live with.

Resources:

Weis, C. A., Stuber, K., Murnaghan, K., & Wynd, S. (2021). Adverse events from spinal manipulations in the pregnant and postpartum periods: a systematic review and update. The journal of the Canadian Chiropractic Association, 65(1), 32–49.

Stuber, K. J., Wynd, S., & Weis, C. A. (2012). Adverse events from spinal manipulation in the pregnant and postpartum periods: a critical review of the literature. Chiropractic & manual therapies20(1), 1-7.

Should I be exercising during my pregnancy?

Pregnancy is a very exciting, but often scary time. Guidelines are continuously being updated for what you should (and shouldn’t) eat, and what you should be doing throughout your day. Exercise is a major point that people are unsure about, especially with their first pregnancy. Between advice from doctors, parents and friends, as well as what you read online – it can be very confusing to figure out what you should be doing.

Regarding exercise, new guidelines were released in 2019 from CSEP (Canadian Society of Exercise Physiology) and SOGC (Society of Obstetricians and Gynaecologists of Canada). It is the Canadian Guideline for Physical Activity throughout Pregnancy and can be found in it’s entirety at the link. The groups found that less than 20% of pregnant women were getting the recommended amount of exercise. They also discuss that activity throughout pregnancy is not simply a recommendation, but rather “a specific prescription to reduce the complications of pregnancy, and to optimize the health of the mother and her baby.”

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Instrument Assisted Soft Tissue- What is the benefit?

You may have noticed these shiny metal tools in some of my photos, or seen “instrument assisted soft tissue mobilization” (IASTM) discussed as a treatment option in some of my posts. You may have even heard of different types of this treatment called “Graston Technique” or “Gua Sha”. But what is the benefit of having these (sometimes scary looking) tools used on you?

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Headaches Part 4: Cluster Headaches

The last of our series on common headaches is an odd one – cluster headaches. These are certainly the least common occurring of the four types, and are very distinct in their symptoms.

This type of headache is 3 times more common in males than females, and typically occur between the ages of 20 and 50. Common risk factors or triggers include stress, bright lights, allergies, alcohol and tobacco. These may also be defined as episodic or chronic. Episodic cluster headaches last from 7 days to 1 year, separated by pain free intervals of approximately 2 weeks, typically lasting 2 weeks to 3 months. Chronic however occur or more than 1 year with no remission (or that of less than 2 weeks) and are more resistant to care.

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Headaches Part 3: Cervicogenic Headaches

If you are someone that suffers from headaches that seem to be related to your neck muscles, you may be a little confused after the post on tension headaches. You are pretty sure it is related to tight muscles, but your headaches do not feel like a tight band. If this is the case, you may be suffering from cervicogenic headaches.

Cervicogenic headaches are defined as head pain that originates from the neck and occipital area (the base of the skull). These types of headaches are relatively common, and tend to occur in those with previous neck trauma or cervical joint dysfunction.

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