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What is Myofascial Pain Syndrome? | Health Care Victoria

What is myofascial pain syndrome?Myofascial pain syndrome is a chronic musculoskeletal pain disorder that can involve either a single muscle or a muscle group. It refers to pain and inflammation in the body’s soft tissues. Myofascial pain is a chronic condition that affects the fascia (connective tissue that covers the muscles).

The pain associated with this condition can range from burning, stabbing, aching sensations to include a combination of these symptoms.   With myofascial pain syndrome, excessive strain on a particular muscle, muscle group, ligament or tendon can prompt the development of a “trigger point” that, in turn, causes pain.

Where a person experiences the pain may not be where the myofascial pain generator is located. This is known as referred pain.  Myofascial pain symptoms usually involve muscle pain with specific “trigger” points which can be made worse with activity.

What causes myofascial pain & what are the symptoms?

Myofascial pain typically occurs after a muscle has been contracted repetitively. This can be caused by repetitive motions, injury to an intervertebral disc, or lack of activity (such as a broken leg).

The main symptom of myofascial pain is ongoing muscle pain, in areas such as the low back, neck, shoulders, and chest.  These symptoms may include a muscle that is sensitive or tender when touched, or a pain that feels aching, burning, stinging, or stabbing and does not lessen in intensity.  Another symptom is reduced range of motion in the affected area and a feeling of weakness in the affected muscle.

How is myofascial pain diagnosed?

Trigger points can be identified by pain produced upon digital palpation (applying pressure with one to three fingers and the thumb). In the diagnosis of myofascial pain syndrome, four types of trigger points can be distinguished:

  •  An active trigger point is an area of extreme tenderness that usually lies within the skeletal muscle and which is associated with a local or regional pain.
  • A latent trigger point is a dormant (inactive) area that has the potential to act like a trigger point.
  • A secondary trigger point is a highly irritable spot in a muscle that can become active due to a trigger point and muscular overload in another muscle.
  • A satellite myofascial point is a highly irritable spot in a muscle that becomes inactive because the muscle is in the region of another trigger pain.

How is myofascial pain treated?

Treatments may include any of the following:

  •     Massage Therapy
  •     Physiotherapy
  •     Lifestyle changes -adjusting your workstation, improving posture, avoiding muscle tension
  •     IMS | Trigger point dry needling
  •     Transcutaneous electrical nerve stimulation | TENS
  •     Laser
  •     Ultrasound

Often a combination of physical therapy, trigger point dry needling and massage are needed in chronic cases.  Please talk with one of our health care practitioners to discuss myofascial pain syndrome.

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Mastectomy or lumpectomy? Choice for breast cancer varies across country.

Mastectomy or lumpectomy? Choice for breast cancer varies across country.When Tracy Tarnowski was diagnosed with breast cancer, she opted to have a double-mastectomy, even though her malignancy was confined to only one breast. But the tumour was widespread and aggressive – and she wasn’t about to take any chances.

“I did it because I was only 40,” said Tarnowski, referring to her 2007 surgery. “The decision I made was so I couldn’t have any what-ifs or look back and have any regrets. I did everything I could possibly do to make sure it was gone and wouldn’t come back.

“I had a lot of living to do as far as I was concerned,” the mother of two said from her home in Embrun, Ont., outside Ottawa. “I might have made a different decision had I been 75.”

Age of diagnosis appears to be one factor behind the decision to undergo a mastectomy instead of a less invasive lumpectomy, says a report on rates of breast cancer surgeries across Canada released Thursday.

The joint report by the Canadian Institute for Health Information (CIHI) and the Canadian Partnership Against Cancer show the annual rates for the two treatments vary widely from one province to another.

The rates for women having a cancerous breast removed instead of a lumpectomy, known as breast conserving surgery, was lowest in Quebec, at 26 per cent, and highest in Newfoundland and Labrador, at 69 per cent.

Because figures are in an inverse ratio, the rate for lumpectomies in Quebec was 74 per cent and 31 per cent in Newfoundland and Labrador.

In Saskatchewan, the mastectomy-lumpectomy split was 65 per cent versus 35 per cent, while in Ontario the ratio was 37 per cent for mastectomies and 63 per cent for lumpectomies.

Several factors could explain variations in treatment rates from one jurisdiction to another, including physician practice patterns and patient preferences, said Anne McFarlane, CIHI vice-president for Western Canada.

“It’s important to note that there are two surgeries for people with breast cancer – mastectomy and lumpectomy,” McFarlane said in a telephone interview from Victoria. “Lumpectomy followed by radiation has been shown since the mid-1980s to have equivalent outcomes as mastectomy.”

But, of course, mastectomy is a much more invasive procedure, she said.

“You lose your breast. So from a cosmetic and from a recovery point of view, it would be a more difficult procedure to come away from feeling like you were the same person after the mastectomy as you were before.”

This year, about 22,000 women will have a mastectomy or a lumpectomy followed by radiation.

The report found that a woman’s age seems to play into the choice to go with mastectomy over a lumpectomy.

Rates were relatively high – 44 per cent – for women age 18 to 49. Rates dropped to 35 per cent for those age 50 to 69, then rose again to 45 per cent for women age 70 and older.

“And we think for younger women, that’s because in that age group they’re outside the formal screening (mammogram) programs, so women tend to be diagnosed with more advanced disease and younger women tend to have more aggressive disease,” said McFarlane.

For older women, opting for mastectomy over a lumpectomy could relate to difficulties getting to centres offering followup radiation, as well as less concern about body image.

“We really don’t know the answers for that, but it’s an interesting phenomenon,” she said.

The distance one needs to travel to and from a radiation centre does appear to be a factor.

The 2007-2010 report shows increased numbers of mastectomies corresponding to travel time, with rates exceeding 50 per cent for women who had to drive three hours or more for treatment.

“Radiation following lumpectomy is typically five days a week for between three and six weeks,” said McFarlane. “So although each session of radiation isn’t very long, you have to go to the radiation centre four or five days a week for three to six weeks.

“And if you have a job, if you have little kids, if you have a spouse who’s not well that you have to be there to provide care for – all of those could be barriers to spending that kind of time away from home.”

Dr. Heather Bryant, vice-president of cancer programs at the Canadian Partnership Against Cancer, said the report should help doctors and health-system planners in various jurisdictions “optimize breast cancer care and the experience of women who receive surgery as part of their treatment.”

McFarlane said the report allows physicians to see the bigger picture and how rates differ from province to province.

“It’s only when you can see these analyses done at the national level, where you can see the variations by jurisdiction, that it comes out in such stark relief,” she said.

“I think surgeons and women in Newfoundland, for example, have the expectation that there’s a high mastectomy rate. It’s only when they see that mastectomy rate in comparison with, say, Quebec that they can ask the question: ‘Is this the way that we want it to be? Are we doing the best that we can here?’ “And similarly in Quebec they can also ask that question.”

SHERYL UBELACKER – The Canadian Press

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The Biological Internet That Could One Day Program Artificial Organs

Scientists have just found a way to use DNA to send massive amounts of data between cells, which means we soon may be able to give our cells incredibly complicated instructions.

Much like humans use the Internet to communicate, cells have mechanisms to pass on data to each other. It’s a system that is being hacked by scientists who realize the value of being able to send custom genetic data from cell to cell. Because when large groups of cells can be commanded by humans to work on complex tasks, the possibilities are endless.

Typically, scientists have spurred on communication by sending sugar molecules from cell to cell–the concentration of sugar either activates something in a receiver cell or doesn’t, depending on the command. But this is limiting, says Monica Ortiz, a doctoral candidate in bioengineering at Stanford. “You can’t send very much information with these sugar molecules.” So Ortiz and Drew Endy, an assistant professor of bioengineering, set out to create a more complex system.

We know that we can encode anything we want to in DNA.

Their solution, published in a recent issue of the Journal of Biological Engineering: a bacteriophage, or virus that infect bacteria. “We recognized that phage are essentially nucleic acids packaged by protein, and we know that genes and other elements in the genome are always encoded into DNA. So we know that we can encode anything we want to in DNA,” explains Ortiz. “We can encode genes, activation of transcription in various ways and we don’t need to rely on this middleman sugar molecule.”

Ortiz and Endy selected M13 as their cell-communicating virus. It’s the ideal specimen: It doesn’t kill the host cell, scientists can vary the length of DNA that they’re packaging (M13 packages genetic messages), and it has been engineered to get its DNA into mammalian cells.

The M13 communication system is, as Stanford Engineering explains, like a wireless information network for cells to send and receive messages. M13 wraps up strands of DNA (programmed by scientists) and sends them out in proteins that infect cells and release the DNA messages once they have gained entry. Scientists can send whatever they want in the DNA–everything from a sentence in a book to a sequence that encodes fluorescent protein.

What we’ve shown is that we can send and receive a message.

The M13 system dramatically increases the amount of data that can be transmitted at one time compared to previous cell-to-cell communication systems–roughly 80,000 bits compared to one bit with the sugar molecule system. M13 can also transmit data over long ranges.

“Practically I think sending DNA between cells has a lot of applications,” says Ortiz. “What we’ve shown is that we can send and receive a message and do something in the receiver cell with that message.” In the future–we’re talking decades down the line–the technology could be used in tissue engineering as well as in creating artificial organs and biomaterials that have no direct analog in nature.

Ortiz emphasizes that the research is just beginning. “People are calling it the biological Internet, and that’s a fairly good analogy. I want to make the point that this is a very early stage proof-of-principle paper.”

Ariel Schwartz is a Senior Editor at Co.Exist. She has contributed to SF Weekly, Popular Science, Inhabitat, Greenbiz, NBC Bay Area, GOOD Magazine.

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Who’s fighting for private health insurance in Canada?

Who's fighting for private health insurance in Canada?It’s been seven years since the Supreme Court of Canada struck down Quebec’s ban on using private insurance for “medically necessary” services covered by medicare.

Little has changed since then, but it looks like the seven-year itch is taking hold, because similar cases in Ontario, Alberta and B.C. are all expected before the courts in the coming months.

Readers may recall the case of doctor Jacques Chaoulli, who argued that prohibiting private health insurance jeopardized the well-being of people who desperately needed treatment, like patient George Zeliotis, who felt the wait for a hip transplant was unreasonably long.

Many predicted the Chaoulli ruling would throw open the floodgates for private insurance in Canada. (Six provinces outlaw the sale of private insurance for medically necessary care, meaning physician and hospital services.)

It did not, for a couple of reasons: 1) the case was fought using the Quebec Charter of Human Rights and Freedoms, so it applied only to Quebec and; 2) the court said the prohibition on private insurance could be justified if wait times were not unreasonable.

The Chaoulli case prompted the provinces to set wait-time benchmarks that have helped alleviate some waits. But, more than anything, the ruling gave ammunition to those who want more “choice” – meaning the ability to buy private care.

You’re going to be hearing a lot more about these cases:

McCreith-Holmes in Ontario: Lindsey McCreith travelled to Buffalo to get an MRI rather than wait four months in Ontario; when the test confirmed cancer, he returned to the United States for surgery, arguing the wait was too long at home. Shona Holmes was losing her vision and an MRI showed a brain tumour. Facing waits of up to six months, she travelled to Arizona for surgery. (Ms. Holmes is the star of a Republican Party ad campaign vilifying Canadian medicare.)

Allen-Cross in Alberta: Darcy Allen suffered debilitating back pain from a hockey injury; after two years, he travelled to Montana for surgery, paying $77,503. Richard Cross paid $24,236 for back surgery in Arizona. Both are asking to be reimbursed by the Alberta public health insurance plan and for the prohibition on the sale of private health insurance to be struck down.

Cambie Surgery in B.C.: Brian Day and four clinic patients are challenging provincial legislation that restricts residents from privately accessing health care services that are also funded under the B.C. Medical Services Plan. The patients include two who had long waits for orthopedic surgery and two with cancer. Dr. Day has been at loggerheads with the province for years and has been threatened with fines for extra-billing patients.

The lawsuits all claim that thousands of Canadians suffer irreversible harm as a direct result of the prohibition on the sale of private insurance. They argue that long waits for care, and the inability to circumvent those waits, violate the right to life, liberty and security of the person guaranteed under Section 7 of the Charter of Rights and Freedoms.

An estimated 40,000 Canadians seek health care in the United States each year, some of it covered by provincial insurance plans. Many more are treated in private clinics with private insurance paid by workers’ compensation plans, which are exempt from provincial prohibitions. And some doctors – about 1 per cent – have opted out of medicare to sell their services, which is perfectly legal.

All this is to say the debate over the role of private delivery of care and private insurance is complex and emotion-laden.

The fundamental issue, however, is whether individual rights trump those of the collectivity.

A single-payer system like Canada’s ensures “free” care to all, but often the result is some rationing, some waits.

The alternative is to offer much more choice but ration access based on wealth: Those with money or private insurance get care more swiftly.

As a result, the argument is often caricatured as rich versus poor, or capitalism versus socialism. Invariably, someone will point to Europe and say: They have two-tier health care there and it works. True, but they have far more regulation than Canada, and private insurance is often the norm not the exception.

The complicating factor in Canada is that the prohibition on private insurance applies only to hospital and physician services. Why are we allowed – sometimes even obliged – to buy private insurance for prescription drugs, eye care, dental care, home care, nursing-home care, etc. – but not for surgery and doctors’ visits?

The logic has been lost somewhere. Worse yet, we have opted to stick our heads in the sand rather than debate these issues openly.

These legal challenges involve issues the provincial health ministers and premiers (who will meet to talk health care late this week in Halifax) should be discussing.

Regardless of their views, politicians and policy makers should agree on one thing: Health policy should be fashioned by elected officials, not the courts.

Written by: ANDRÉ PICARD/The Globe and Mail

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Autumn & Acupuncture | acupuncture victoria bc

Autumn & Acupuncture | acupuncture victoria bcIn Autumn, we observe nature withdrawing inward.  We see leaves wither on the branch as the trees gather energy inward and down to the deep center and roots to protect and guard vitality, like a precious secret, throughout the winter months.

As winter draws near, we notice a similar process in our own bodies. Our skin become pale and dry. Our energy draws inward to protect vital organs from the dampness and cold. We develop the urge to be quiet, sleep and stay indoors more than in the warmer months.

Our modern, urban lifestyle often prevents most of us from the luxury of indulging our natural instincts to hibernate when winter arrives. Exposing ourselves to the elements and over-spending energy during cold months can compromise the immune system, leaving us vulnerable to viruses that cause influenza and the common cold.

For those of us who are unable to spend the winter in Mexico, here are some tips on how to protect your immune system:

Never leave the house with wet hair

Dampness allows cold to penetrate more deeply. It’s especially important to prevent the neck and head from becoming exposed to harsh elements. This is usually the first area to be effected by colds and flu. Most infectious illness in winter begin with a stiff neck and headache.

Avoid eating too many cold foods

In winter, our bodies are using energy to warm our internal organs. Help your body in this regard by eating healthy cooked cereals, soups and stews. Fresh fruit and vegetables are important too, but are to be consumed in much smaller quantity than in summer months. Root vegetables, brown rice and carefully chosen protein sources can be a staple.

Try not to eat too much spicy foods

Even though spicy food is great for warming our bodies, it’s too ‘hot’ in nature to be useful in winter. Spicy foods are used in hot climates to promote sweating in order to cool the body and are delicious, however, spicy foods are an inappropriate choice for use during cold weather.

Wear a scarf and cover your legs

Even those of us who don’t feel the need to cover our necks and legs in winter need to avoid exposing bare skin. A light scarf, thin gloves and tights can be enough to guard against the elements.

Try acupuncture to boost your immune system

There is scientific and clinical evidence to support claims that acupuncture is an effective treatment for migraines and headaches.; as well as getting rid of lingering symptoms of colds and flus that are prevalent this time of year.  Acupuncture works by regulating circulation to the internal organs which in turn allows the immune system to work as nature intended to heal the body.

Written by: Victoria Spaurel, R.Ac., Registered Acupuncturist

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Should You Race a Half Marathon to train for a Marathon?

Should You Race a Half Marathon to train for a Marathon?The first question you need to ask is;  is a half marathon a good idea for every marathoner?

The answer is; it depends on your fitness level and marathon goals.

If you’re a first-time marathoner and your only goal is to finish the race, the benefits of a half marathon race aren’t as important.  Remember that racing causes muscle damage, and novice runners won’t heal as quickly as more advanced  runners, which means that the novice runner will need to take time off to recover and this can set back your training schedule.

If you are a experienced marathoner and have a specific time goal, there are advantageous to racing a half marathon to prepare your body. Running a half marathon will allow you to estimate your marathon finish time, familiarize yourself with the course and will give you a much more accurate estimate of your fitness level.

If you choose to race a half marathon as your marathon tune-up race, follow these guidelines:

  • Schedule them 5 to 7 weeks before your marathon to allow sufficient recovery
  • Don’t run more than one half during a marathon training cycle  and don’t wear, eat or drink anything new on race day.
  • Prioritize recovery after the race: extra sleep, an ice baths, and light cross-training will get you back to marathon training as soon as possible
  • Reduce the volume and intensity of the next 1 to 3 runs in your training plan

You know your body best and if you get beat up by racing and need more time to recover adequately you should choose a shorter tune-up race, such as a 10K.

What you don’t want to do is increase your training a few weeks before the race. This is the time when many runners have been racing for at least 2 months and have become used to a certain level of training. Draw strength from the hard work you’ve put in and have confidence in what you’ve been doing.

Running a half marathon can be a valuable tool to help estimate your finish time and gauge how well your body & fitness level will hold up to a full marathon….. Good Luck!

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Degenerative Disc Disease | Rehab Victoria BC

Degenerative Disc Disease | Rehab Victoria BCDegenerative disc disease is one of the most common causes of low back pain.

The lumbar disc is a well-designed structure in the spine. It is strong enough to resist terrific forces in multiple different planes of motion, yet it is still very mobile. However, too much physical activity, gravity, and injuries can cause the spinal column to compress, which narrows the channel through which blood freely flows; and this restriction of the needed nutrients can result in damage and deterioration.

The pain associated with degenerative disc disease is normally caused from inflammation and abnormal micro-motion instability.  Inflammation in the disc space can lead to low back pain radiating to the hips; with associated pain traveling down the back of the legs.

Patients with degenerative disc disease will have some underlying chronic low back pain, experiencing periodic severe low back pain. In an attempt to stabilize the spine and decrease the micro-motion, the body reacts to the disc pain with muscle spasms. The reactive spasms are what make patients feel like their back has “gone out”.

This is why Spinal Decompression tables are one of the most effective treatments for Degenerative Disc Disease.  Spinal Decompression uses a distraction force to relieve the nerve compression often associated with low back pain. This treatment specifically addresses the compression or pressure in the spinal column.

It is a non-surgical treatment that makes use of a specially-designed table that decompresses the specific area of the spine where the pressure is evident. The decompression process reduces the pressure in the affected area of the spine and restores it to its normal position. Spinal decompression’s primary goal is to allow much-needed oxygen, nutrients and fluid into injured and degenerated discs allowing the healing to begin.

Common Symptoms of Degenerative Disc Disease Include:

Low back pain made worse with sitting.  (in the seated position the discs are loaded three times more than standing)

Certain types of activity will  worsen the low back pain, especially bending, lifting and twisting.

Walking, and even running, will feel better than prolonged sitting or standing.

Feeling better by changing positions frequently. (lying down is the best position since this relieves stress on the disc space)

Please contact any of our health care practitioners for more information on Degenerative Disc Disease.

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Acupuncture Provides True Pain Relief in Study

acupuncture victoria bcA new study of acupuncture — the most rigorous and detailed analysis of the treatment to date — found that it can ease migraines and arthritis and other forms of chronic pain.

The findings provide strong scientific support for an age-old therapy used by an estimated three million Americans each year. Though acupuncture has been studied for decades, the body of medical research on it has been mixed and mired to some extent by small and poor-quality studies. Financed by the National Institutes of Health and carried out over about half a decade, the new research was a detailed analysis of earlier research that involved data on nearly 18,000 patients.

The researchers, who published their results in Archives of Internal Medicine, found that acupuncture outperformed sham treatments and standard care when used by people suffering from osteoarthritis, migraines and chronic back, neck and shoulder pain.

“This has been a controversial subject for a long time,” said Dr. Andrew J. Vickers, attending research methodologist at Memorial Sloan-Kettering Cancer Center in New York and the lead author of the study. “But when you try to answer the question the right way, as we did, you get very clear answers.

“We think there’s firm evidence supporting acupuncture for the treatment of chronic pain.”

Acupuncture, which involves inserting needles at various places on the body to stimulate so-called acupoints, is among the most widely practiced forms of alternative medicine in the country and is offered by many hospitals. Most commonly the treatment is sought by adults looking for relief from chronic pain, though it is also used with growing frequency in children. According to government estimates, about 150,000 children in the United States underwent acupuncture in 2007.

But for all its popularity, questions about its efficacy have long been commonplace. Are those who swear by it experiencing true relief or the psychological balm of the placebo effect?

Dr. Vickers and a team of scientists from around the world — England, Germany, Sweden and elsewhere — sought an answer by pooling years of data. Rather than averaging the results or conclusions from years of previous studies, a common but less rigorous form of meta-analysis, Dr. Vickers and his colleagues first selected 29 randomized studies of acupuncture that they determined to be of high quality. Then they contacted the authors to obtain their raw data, which they scrutinized and pooled for further analysis. This helped them correct for statistical and methodological problems with the previous studies, allowing them to reach more precise and reliable conclusions about whether acupuncture actually works.

All told, the painstaking process took the team about six years. “Replicating pretty much every single number reported in dozens of papers is no quick or easy task,” Dr. Vickers said.

The meta-analysis included studies that compared acupuncture with usual care, like over-the-counter pain relievers and other standard medicines. It also included studies that used sham acupuncture treatments, in which needles were inserted only superficially, for example, or in which patients in control groups were treated with needles that covertly retracted into handles.

Ultimately, Dr. Vickers and his colleagues found that at the end of treatment, about half of the patients treated with true acupuncture reported improvements, compared with about 30 percent of patients who did not undergo it.

“There were 30 or 40 people from all over the world involved in this research, and as a whole the sense was that this was a clinically important effect size,” Dr. Vickers said. That is especially the case, he added, given that acupuncture “is relatively noninvasive and relatively safe.”

Dr. Vickers said the results of the study suggest that people undergoing the treatment are getting more than just a psychological boost. “They’re not just getting some placebo effect,” he said. “It’s not some sort of strange healing ritual.”

The NewYork Times | Health & Science                                                                                                                                                              By Anahad O’Connor

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Is your desk slowly killing you? (Infographic)

It’s no secret that the nature of work has changed over the past fifty years. Most of us no longer rely on brawn to bring home the bacon, but instead rely on brains to navigate the knowledge economy.

But could this change in work habits slowly be killing us?

Click through the infographic below to find out more.

The team at Diversified Health Clinic has collected a few statistics that demonstrate what many of us have started noticing more and more: not only we getting fatter as a result of work, our our sedentary desk jobs are starting to take a sinister toll on our health. Never to fear – there are some solutions, from simply eating less and exercising more, to changing the way you work.

Have an idea on how to fight off your deathly desk? Let us know!

Many doctors in Victoria BC promote regular exercise and a change in diet as a treatment for metabolic syndrome.

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Do you Overpronate or Underpronate? | Orthotics Victoria

Orthotics are biomechanical appliances, that enable feet to be held in a more stable position, therefore reducing stress and strain on the body.

Over 50% of the population have feet that overpronate or underpronate. This means that the foot turns too much or not enough. Overpronation or underpronation can lead to serious injury and pain.  Orthotics can help this by correcting the problem by adjusting the angles in which your feet touch the ground.

Do you Overpronate or Underpronate? | Orthotics Victoria Orthotics can help with such conditions as plantar fascitis, chronic blisters, shinsplints and back pain. Most problems that occur within your body, are likely caused by too much stress on it. Too much stress causes things to break, rip or tear. In this case, orthotics help prevent these injuries by reducing the amount of stress that has caused the problem in the first place.

Orthotics help restore the normal balance and alignment of your body by gently correcting foot abnormalities. They gently reduce problems associated with pressure points, and muscle strain on knees, hips and backs.

What type of orthotics to use depends on what you are trying to accomplish for the foot. For the over-pronator, generally a more rigid type of orthotic is necessary since you are trying to limit the amount of rolling that occurs. Softer types of orthotics are indicated for under-pronators, to fill the arch and provide increased shock absorption.

The important point to remember when considering orthotics is that they should be customized for your feet and made by someone well-trained in foot biomechanics. While there is a lot of science that goes into deciding upon and making an orthotic, there is some art as well and sometimes adjustments are necessary. The final orthotic product should be something you would not think of going on a run without, not an expensive dust collector in the back of your closet.

Diversified Health’s lead Chiropractor, Dr. Krisjan Gustavson has been making orthotics for over 25 years, and would be happy to meet with you to discuss if you are a candidate for custom orthotics.

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