Hello, my name is Sarah and I work as an osteopathic manual practitioner at the One to One Wellness Centre in Halifax. You or someone you know may be living with pain. Maybe you have tried other therapies and/or medication to help manage your symptoms. My goal is to help you understand what osteopathy is and how it can help you.
Osteopathy is a patient-centred healthcare discipline that uses therapeutic manual techniques to enhance each person’s ability to function and adapt to changes in their environment and circumstances. We use a science-based holistic approach to patient care. Contrary to what the name implies, osteopathic manual practitioners work with more than just bones!
What and Who Do We Treat?
We address the whole body from head to toe, focusing on the musculoskeletal, nervous, vascular, and lymphatic systems. The most common complaints are: muscle pain and tightness (e.g. low back and neck), joint pain (e.g. hip and shoulder), persistent pain, sciatica, arthritis, sports injuries, and headaches.
We work with people of all ages, from infants to the elderly, and from a number of backgrounds. For example, we regularly treat office workers, athletes, teachers, pregnant women, healthcare professionals, cancer patients, etc.
What Makes Osteopathy Unique?
Osteopathy’s philosophy and range of techniques are two major factors that help distinguish osteopathy from other manual therapies (e.g. physiotherapy, massage therapy, chiropractics, etc.).
Our practice is rooted in four fundamental principles that give rise to our holistic perspective of the body. These principles can be summed up as follows:
1) The human being is a dynamic unit of function.
2) The body possesses intrinsic self-healing mechanisms.
3) The body’s structure and function are interrelated.
4) Treatment is based on these principles.
Most osteopathic manual practitioners use a wide variety of techniques, including soft tissue, joint articulation and mobilisation, craniosacral, and visceral work.
The goal of osteopathic treatment is to restore the body’s natural ability to self-heal by enhancing its local and global health by removing obstructions to proper blood flow, fluid flow, and/or nerve function. This ultimately allows for the restoration of function.
How is an Initial Osteopathic Assessment Run?
The primary focus of an initial assessment is to take a case history and perform an examination. The case history allows us to learn more about your lifestyle, health, and details of your presentation. During the examination, we observe your natural morphology, apply our palpatory skills, and will often ask you to perform basic movements. The collection of information obtained from both of these processes allows us to understand:
We will discuss a treatment plan and, if necessary, the need for referral to another healthcare professional.
The 60 minutes we spend with you are also essential to help us understand how your symptoms impact your life and what goals you wish to achieve.
Using all of this information, we can provide you with the appropriate treatment, education, support, and advice to address your symptoms and meet your goals.
Interested in Learning More About Osteopathy?
If you are interested in getting to the root cause of your pain and want help improving your overall wellbeing, please book an initial assessment today. Call the One to One Wellness Centre at 902-425-3775 or send us an email at [email protected] to talk to one of our osteopathic manual practitioners.
What can we do about pain?
– sometimes tissues repair but associated protective patterns may not, and that may be creating the persisting pain. Have you developed protective, but harmful, movement patterns? Are there areas of tension, tightness, weakness, compensation, that are not allowing your body to function normally as it once did?
– some tissues don’t repair as well as we would want, so have you learned how to stabilize, support, mobilize, or strengthen the area to make it as healthy as possible?
November. A month where men become a little warmer and (typically) a little uglier due to a bit more fuzz on that upper lip. One of the main objectives of November is to bring awareness to prostate cancer, the leading cancer diagnosis in men (1). Due to campaigns such as Movember, we are seeing more and more support for the use of exercise in cancer care.
According to the Ontario Cancer Care Guidelines for Exercise and the Clinical Oncology Society of Australia, exercise should be an integral part of every cancer patients treatment plan from diagnosis to post-treatment (2,3). With respect to prostate cancer and the effects of the treatments associated with it, exercise has been shown to improve and/or manage(4):
Exercise goes beyond side effect management and into improving survival rates for prostate cancer survivors. When looking at recurring prostate cancer resulting in death, men who participated in vigorous exercise > 3 hrs/week lowered their risk by 61% compared to those who participated in < 1hr/week However, if you are not at the capacity to exercise at a vigorous level, please do not be alarmed, as those who participated in a moderate exercise for <1hr/week lowered their all cause mortality risk by 46% (5).
Through all that scientific medical jargon, the main takeaway is ANY amount of exercise is beneficial for you and should be started as soon as possible.
One of the more concerning stats I have seen is that 82% of survivors of prostate cancer report their supportive care needs are not met (6), but they are also less likely to bring these concerns up to healthcare professionals, especially if it involves sexual dysfunction (6). Therefore, I encourage you to share with your healthcare team if you are experiencing any symptoms listed below (or any others) (4,8):
Sexual dysfunction; Including but not limited to: Erectile dysfunction, orgasm changes, penile shortening (95% of men)
Bowel/Bladder dysfunction (50% of men)
Loss of libido
It is indisputable that a supervised exercise program is one of the best medicines you can provide yourself. It improves physical, social, emotional, and mental wellbeing, all of which can be impacted by a cancer diagnosis and the side effects of treatments. It can be challenging and difficult to initiate this process, so if you don’t know where to start or if you are experiencing any symptoms above, please reach out and ask for help.
According to a European study, cancer patients felt their pain was viewed as secondary to the cancer treatment itself, and they wish more time was spent consulting on the pain they were experiencing .1 These results are important because it demonstrates the need for Pain Neuroscience Education (PNE) in treating these patients from the beginning stages of treatment and beyond. When treating cancer, it can be lost that this biological process is connected to a human being. The resulting pain can slowly strip away the interdependent, complex components that make us human.
PNE is a foundational pain management tool that helps form a greater understanding of how the biological, psychological, and sociological components of our being are important and play a role in managing and changing the pain experience.2 PNE helps accomplish this by eliminating some fear, worry, and stress through increasing knowledge, and awareness. This can lead to greater empowerment and sense of control for the patient.
PNE can be thought of as a knowledge translation process that helps patients better understand their pain experience in hopes of changing their interpretation of it. One of the main metaphors that we use for mechanical persistent pain conditions (Pain lasting more than 3 months) is this idea of hurt vs harm. This teaches that instead of pain representing damage to the tissues, that there is something wrong with the area, and that you are broken or debilitated, it can be thought of as an area that has heightened awareness or sensitivity due to multiple biopsychosocial factors.2 A common emerging theme viewing pain as a protector (Tame the Beast Video). Our brain does not want us to do a certain task because it perceived it as dangerous before and does not want us to experience that again.
PNE has been proven to be effective in reducing pain for many chronic musculoskeletal disorders,3 but what role does it have in helping active cancer patients and survivors where these biological processes are life-threatening, or in other words where hurt can equal harm?
A possible role of PNE during active cancer treatments is to help the individual learn to distinguish between active cancer pain and pain as a result of active cancer treatments.4 Helping them understand that pain is a primitive protective mechanism that can be exacerbated by context and fear can provide relief.3 The context here is cancer in our society, and the fear can be loss of life, the unknown, and the billion other worries and stress that can coincide with it. So, when going through active cancer treatments it is beneficial to know that tissue injuries are going to result, and this is going to take the natural healing process that involves pain. The difference here can be knowing that this pain is a result of a life saving treatments, not the cancer itself. A mindset that changes the perspective of the experience and can change the interpretation from life-threatening to life-saving.
Survivorship can come with its own challenges as there are often side-effects that result from these life-saving procedures. This can include increased risk of future cancers, joint and muscle pain, peripheral neuropathies,5 and central sensitization. 6 This is where the hurt vs harm analogy becomes very relevant as pain remains despite the elimination of the biological threat, and beyond the normal tissue healing time. This brings up past experiences, fears, and emotions, which all without proper knowledge and interpretation behind it, can lead to behaviours such as remaining sedentary (See Flow Model7).
Some education points through this stage:
In my opinion, PNE’s role in cancer rehabilitation should be immediate and ongoing as the European study demonstrated its importance to patients. Pain, a biopsychosocial phenomenon can take less priority to cancer, a biological entity. Although pain is a symptom of this baffling physiological process, it is the aspect that can lead us to seek help, it takes away our ability to move, it can increase fear/worry/stress and can hurt our relationships. We need to let individuals with cancer know that we are listening, that we can help them understand the what and why surrounding their pain, and that we can help them gain some control over something that is trying to take that control from them.
As an individual journey’s through their cancer diagnosis, the value of exercise cannot be overstated. It has benefits throughout all stages of treatment from pre-diagnosis for prevention, to all stages post diagnosis. It helps prepare your body and mind for treatments, recovery, pain management, coping skills and recurrence depending on what stage you are in (See Picture Below). 1,2
Another important health outcome post-cancer diagnosis is sedentary behaviour. This is concerning for the cancer population because 75% of their time is spent sedentary.1 Furthermore it has been shown that breast cancer survivors spend more time engaged in moderate to vigorous exercise, but spend more time sedentary than their healthy counterparts.,3 Additionally, engaging in this type of behaviour is being associated with cardiovascular risks, diabetes, and increased cancer risk. 4,5 So how do we reduce time spent not moving in a population that can struggle with pain, fatigue, and nausea just to name a few?7
First thing may be to start looking at activity as a continuum,1. When this is done, activity levels progress from doing nothing (.e.g., Watching TV) to activities such as sprinting. Both extremes are recommended occasionally, but not how we want to spend most of our day. In fact, the far right would be impossible to achieve. Now, depending on where an individual is at in their cancer recovery determines their starting point along the continuum. Some people may only be able to perform postural shifts to maintain comfort, and some may be able to do bouts of moderate exercise. Ideally, we want to spend most of our day in the middle of this continuum, with the goal of increasing the amount of time doing activities of daily living and light to moderate exercise.
From a rehabilitation standpoint, it would not be expected for someone to jump from sedentary to moderate exercise if they are physically and mentally unable to tolerate it. Understanding that discomfort and fatigue are two barriers to reducing sedentary behaviour in cancer populations6 is essential to this process. This makes us aware that we need to take more of a stepwise approach of building up tolerance by slowly pushing the limits of where your current level is to try and achieve the next activity goal (See Below). This is where professionals can help you gain a new perspective of why you are experiencing pain and fatigue, and give you strategies to better approach your activity transitions such as edgework and pacing. This may start with gentle postural shifts or mobility exercises to prep the musculature and nervous system to allow you to spend more time toward the middle of the continuum. It can also include multiple light walks or strengthening exercises, it all depends on your tolerance level.
Ultimately, the goal is to be as active as you possibly can throughout the day, and to understand that consistent movement within your limits has the potential to reduce various health risks. Although there is not a specific formula, what we know is that pain and cancer education, movement, exercise, and nutrition will put you in the best position to manage or overcome this cancer diagnosis, meanwhile reducing your future risk of side effects, recurrences, and other health issues.
“It is important to move and to move often, no matter how simple or limited the movement may be.1 ”1. Lucas AR, Klepin HD, Porges SW, Rejeski JW. Mindfulness-based movement: a polyvagal perspective. Int Can Ther. 2016. https://doi.org/10.1177/15347354166820872. Segal R, Zwaal C, Green E, Tomasone J, Loblaw A, Ptrella T, et al. Exercise for people with cancer. Toronto (ON): Cancer Care Ontario; 2015 Jun 30. Program in Evidence-based Care Guideline No.: 19-53. Phillips SM, Dodd KW, Steeves J, McClain J, Alfano CM, McAuley E. Physical activity and sedentary beavhiour in breast cancer survivors: new insight in to activity patterns and potential intervention targets. Gynecol Oncol.2015;138:398-4044. Wilmot EG, Edwardson CL, Achana FA, Davies MJ, Gorely T, Gray LJ, Khunti K, Yates T, Biddle SJH. Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabet. 2012;55(11);2895-29055. Lynch BM. Sedentary behaviour and cancer: a systematic review of the literature and proposed biological mechanisms. Can Epid Bio Prev.2010. doi: 10.1158/1055-9965.EPI-10-08156. Courneya KS, McKenzie DC, Reid RD, Mackey JR, Gelmon K, Friedenreich CM, et al. Barriers to supervised exercise training in randomized controlled trial of breast cancer patients receiving chemotherapy. Ann Behav Med. 2008: 35;116-122.
In industrialized countries, many people sit for most of the time that they are awake. They sit while having breakfast, while going to work in cars or buses, in school classrooms, in meetings, in offices, during dinner, and at home while watching television. Many people also sit at work operating machines which new technology has developed to replace manual work.
Although sitting requires less physical effort than standing or walking, it puts a lot of stress on lumbar area. Combined effects of a sedentary lifestyle, and a job that requires sitting can lead to many health problems. The selection of a suitable chair is a critical step in preventing health problems in people who work in a sitting position. However, you do not have to spend a lot of money to find a proper ergonomic chair.
A good ergonomic chair will have basic adjustability features. The features that should be considered include:
Seat height adjustability: Adjustability is a must – feet should rest comfortably on the floor without pressure on the back of the thighs. When seated, your hips should be slightly higher than your knees. To achieve proper height with respect to your desk or keyboard tray height, you may need a foot rest.
Seat depth adjustability: The depth of the seat is important in order to reduce pressure on the back of your thighs or calves. If the seat puts pressure on the back of the knee, or mid posterior thigh, this will reduce circulation and cause a pooling of blood in the extremities. This can lead to varicose veins, painful conditions, and also blood pressure issues over time. Proper seat depth will allow for a 2-3 finger width distance from the back of the knee to the edge of the chair.
Armrests (height adjustable): To reduce strain on your neck and upper extremities, your armrest height should be as follows: with the arm relaxed and bent while seated, the arm rest should be a 2 finger width higher than the bottom of the bent elbow. Armrests set too high will cause compression of your thoracic outlet. Armrests set too low will cause traction on your neck. The length of the armrests may need to be considered as well so they do not prevent you from pulling in close to your desk or keyboard tray. Armrests set approximately 15cm back from the edge of the chair should be adequate.
Back rest height: A mid back or high back chair offers more support and will reduce lumbar strain. A low back chair is not recommended if you spend a fair amount of time sitting. Regarding shape of the back rest, do not get hung up on molded forms and fancy adjustable parts. The most important factor in reducing back discomfort while sitting is the ability to move around frequently. A chair should not lock you into a position and restrict your movement.
Many of the features described here allow a chair to adjust to a given posture or body size, but it is important to remember the importance of posture change. Adjustability features should allow, rather than inhibit, free posture change. Sitting increases the mechanical force applied on your body.
Stationary postures cause tonic muscle contraction which means they are constantly contracted. This does not allow for the muscles to rest, or allow blood flow. Therefore, by not altering postures or taking short frequent movement breaks, you are at risk of experiencing mechanical pain conditions and excessive muscle tension. Therefore, move around or fidget in your chair frequently, and get up and move around at least every half hour. Your movement breaks do not have to last long, but they do have to be frequent in order to minimize your chances of experiencing discomfort.
Every hour you sit after the age of 25 takes 21.8 minutes off your life.
That’s a pretty eye opening statistic considering the majority of us are sedentary workers and/or enjoy sitting back and watching our TV shows. Suddenly binge watching a Netflix series doesn’t sound so fun (4 seasons of Ray Donovan just took a toll on me). I feel a lot of this comes down to habit and routine.
Most people go to work (sitting), drive home (sitting), eat supper (sitting), then relax (sitting). Sitting is a habit that is now blueprinted into our routine and according to this study is slowly taking time off our life. Breaking habits and routines is central to what physiotherapists do, and it is arguably the hardest part of the job. We need to educate on why it is important to break these habits and form new, healthier ones to not only combat and prevent pain, but to prolong life. So how do we get people to break them?
I recently watched an interesting TEDtalk about how curiosity might be the key to breaking these bad habits.
Although the main focus of this was on smoking and eating, their concept of curiosity, I felt could be translated quite well into time sitting. The gist of it is quite simple; you need to become curious to make you more aware of the impact of your habit. Could I feel better if did more in standing? Would I feel better if I went for a walk instead of watching TV? Do I hurt more after watching TV? Is this worth the 21.8 minutes?
Their success rate was high for smoking, and I am curious to see if it would be similar across the board with most habits. I hope that the statistic alone intrigues your inner Curious George about what it would feel like to go for a walk, get back into the gym or do more work while standing. Life is too short to be subtracting minutes.
Is there a connection between what you eat and your pain?
Well here is a potential answer. An in depth look at gut bacteria and its anatomical/physiological connection to the nervous system and the brain.
By Nick Matheson
Once again, the world is reeling from tragic circumstances. Once again, we are faced with the fear brought on by random and senseless attacks. Once again, the world is on high alert. The goal of terrorism is to terrorize and make us change the way we live.
It just so happens that Lori and I are traveling to Paris this week. I cannot say that I have not had second thoughts, though I am inspired by Parisians insisting that they will not be afraid and continuing to celebrate liberty. After all, #parisisaboutlife. Though there will be mourning, I am inspired to bring whatever love I can to and from this great city.
Reading countless news articles and travel advisories over the last couple of days, I was reminded of the counsel I’ve often offered to those struggling to overcome pain: benign vigilance. In other words, pay attention and notice what the body is communicating; however, do not be overwhelmed and immobilized by fear. Ignoring a problem does not make it go away. Facing challenges with awareness, compassion, and intelligence is, in my experience, the best response. This week I will travel with a new vigilance, but I refuse to be afraid.
The world is full of pain. At its best, pain is a means of elevating awareness. My heart goes out to those personally touched by hateful acts, including those that perpetrate them. Once again, the world needs all that la ville de l’amour represents.
Love and Peace.
By Nick Matheson, Owner
It was eleven years ago; a birthday truly worth celebrating. My oldest daughter, Maryn, had reached a milestone. Three years old and she was cancer free. Born with a rare tumour in her liver, the disease had progressed to her lungs, reaching stage 4, before we had the good fortune of an accidental discovery. A fall on her belly a few months previous ruptured the tumour, threw her into shock, and propelled our family into a 4-month sprint to conquer this disease.
On this particular day, she raced all over the playground, climbing, swinging, and jumping. Not a big deal for most three year olds, but quite a feat for a kid who was only three weeks post liver transplant! Having donated a significant chunk of my liver to the effort, I was quite the contrast as I winced with pain and hobbled lethargically around the park trying in vain to keep up. At only 31 I was already envious of the energy and recovery potential of youth! My family’s brush with cancer taught me that there are many things in life that I cannot control. It was in that moment, full of joy in Maryn’s victory and facing struggle in my recovery, that I vowed to control those things I could. Until that point, health was something I took for granted. It’s easy to do that until you start to lose it. So many people spend so much time and energy focused on things that do not matter at all when their own health or the health of those they love is at risk. Illness can be an important wake up call.
I’m sure my family has claimed more than our share of Nova Scotia’s health care dollars. We are very grateful that the stress of coping with a kid facing a serious illness was not compounded by wondering how we would pay for her care. We are incredibly thankful for the exceptional care that was provided and, of course, for a miraculous outcome. I realize that it is not without problems; however, the system was there for us when we needed it. For the most part, health care in Nova Scotia works when you are sick. The challenge is that it does very little to keep us well. And, frankly, I don’t think there is much it can do. The population of Nova Scotia is aging rapidly, chronic disease continues to increase, and unhealthy lifestyle habits are among the highest in the country. Illness places a growing burden on health care budgets and personnel. I understand fully that there are many things we cannot control. I invite every Nova Scotian to accept responsibility for controlling those they can.
Wellness is too often sacrificed to denial or lack of awareness. Every choice takes one closer to or farther from a state of good health. The scientific literature is full of results demonstrating the positive impact that diet and exercise have on chronic disease. And yet many continue to rely instead on taking a few pills or being caught by the health care system once they’ve fallen. As I’ve said, I’m as appreciative as anyone for that safety net. I’m also determined to strengthen my health and give those around me every opportunity to thrive.
Thriving comes from attention to 3 main areas:
Mind: The first step toward change is awareness. The second is acceptance. In words from those far wiser, all suffering comes from wanting things to be other than they are. Learning to be aware of my ability to respond rather than react has brought great freedom. Practices like meditation and yoga can bring focus, clarity, and relaxation. Becoming more awake means recognizing that I always have choice.
Muscle: As the engine that makes us go, muscle must be maintained in order to do the things we want to do. Loss of muscle begins as soon as we stop naturally growing unless something is done to stimulate strength. Being stronger makes everything you want to do easier. Body composition, which provides an indication of muscle mass, is actually one of the most important measures of overall health and one of the most significant determinants of an active lifestyle.
Movement: Our bodies are meant to move. From a young age, we learn that we are our thoughts and we become somewhat disconnected from our bodies. Sedentary lifestyles contribute to tightness, stiffness, and weakness. Pain can cause further restriction and avoidance. Crappy weather can make us cocoon in front of the TV instead of embracing the great outdoors. There are lots of excuses and all must be overcome. Quite simply, movement is the best medicine for creating change in a person’s physical, emotional, and mental state.
Ultimately, we must all be the change we wish to see in the world. I can see a healthier Nova Scotia. I work every day to become more aware of my choices and to help others align mind, body, and spirit toward their own vision. Please accept this as a Nova Scotia Wellness Challenge and commit today to whatever changes you feel are most important to move you – and all of us – to a greater state of health. That would be worth celebrating!