NOTE: Please be advised that the clinic is temporary closed as Dr. Bouharevich is on Maternity Leave. Please contact via email or telephone.

I went to an indoor cycling class yesterday and after the class I overheard a class member ask the instructor why and what she should do about her quads fatiguing so quickly on a bike climb or sprint. This can be due to many reasons. It can be due to having over-fatigued legs from an activity the day before or day of the class. It can be due to one’s diet; having eaten something inflammatory (dairy, beer, or anything one might be sensitive to) or not eating enough (protein after the last workout or working-out without having eaten that day). It can also be due to lack of sleep. However, what is often overlooked is that when she rides, she is overemphasizing her quad work (the push down) more than her hamstring work (the pull up).

In fact, many cyclists have overdeveloped quadriceps muscles and weak hamstrings, a classic problem that is a result of pedaling. Even off the bike, those powerful quads pull the hips forward and down, and the weaker hamstrings can't pull back enough. This leads to overly fatigued quads, restricting the workout, but more importantly it leads to poor posture and weak lower-back and abdominal muscles. On the bike, it translates into a loss of power due to fatigue, and a greater chance of back pain, even injury.

The hamstring link is key. The tendency is to muscle through a ride with your quads. A few easy tips are to first, bike with cycling shoes, and second, when cycling, make sure to dig your heals in and pull up with the pedals, providing a more well rounded revolution. This will help to engage the hamstrings and recruit core power to ride faster. So make sure your hamstrings are strong and/or flexible enough to really get their full use so that you can ride faster and reduce your quad pain!

#TotalSpineTuesdays @DrBouharevich Millions of people suffer from Low Back Pain. The Medical approach focuses on addressing the anatomical problems of the low back. For best results, try a well rounded approach. Check out my website blog at www.JointCare.ca for some overlooked remedies for lower back pain relief.

Release your endorphins

Endorphins, hormones made naturally in the body. When endorphins are released in the body, they help block pain signals from registering with the brain. They also help alleviate anxiety, stress, and depression, which are all conditions that are often associated with chronic back pain.

Try the following activities to release these feel-good messengers:

◦ Aerobic exercise

◦ Chiropractic adjustments

◦ Massage therapy

◦ Deep breathing

◦ Meditation

◦ Acupuncture

◦ Laughing and smiling

◦ Eating dark chocolate

◦ Listening to music you love

◦ Being social

Get restorative sleep

Approximately 2/3 of patients with chronic back pain suffer from sleep disorders. Paradoxically, inadequate sleep can make back pain worse. This vicious cycle makes it ineffective to treat just one of the problems. Both the sleep problems and the chronic pain need to be treated.

There are many options for treating sleep problems that accompany chronic lower back pain:

◦ The California Poppy Seed (Consult your doctor before taking)

◦ Melatonin (Consult your doctor before taking)

◦ Relaxation techniques

◦ Psychological techniques

◦ Cutting back on caffeine

◦ Eating the correct foods

◦ Getting the right amount of exercise

◦ Writing your worries down

Often, a combination of approaches will work best.

Exercise your core

The muscles in your abs and back play a critical role in supporting the lower lumbar spine. These muscles don't get a good workout in most people's normal day. When exercising, many people ignore their back and focus on the front of their bodies. This leads to overdoing their abdominal exercises which can lead to back pain and strain. Download an application or two for some simple and short abdominal and back exercises.

Soothe the pain with temperature

Don't underestimate the impact of regularly applying cold packs and/or hot packs to help reduce lower back pain and help the healing process.

Cold therapy

Cold application has two primary benefits:

- It reduces inflammation, which usually occurs with back pain.

- It acts as a local anesthetic by slowing down nerve impulses, which keeps the nerves from spasming and causing pain.

Heat therapy

Heat application has two primary benefits:

- It stimulates blood flow, which brings healing nutrients to the affected area of the low back.

- It inhibits the pain messages being sent to the brain.

Heat can come in many forms, and it's best to try several to find what works best for you. Taking a hot bath or shower, soaking in a hot tub, or using a heating pad, hot water bottle, or wrap that provides continuous, low level heat are all ways to bring healing warmth to your lower back.

Ask your doctor for what method might be best for your particular issue.

Stretch your hamstrings twice daily

One of the easiest things you can do to help alleviate lower back pain is to gently stretch your hamstrings. Tight hamstrings place additional stress across the lower back and sacroiliac joint, leading to more pain. Hamstring stretching should be done at least twice per day.
There are many gentle stretching exercises that should not hurt (ask your Doctor or download an application).

Engage your brain

Pain specialists have long understood that pain is more complicated than just a sensation. The way the brain interprets and processes the pain signals plays an important role in how people perceive their pain.

The good news is that you can develop skills for your brain to reduce or ignore the pain signals. Developing expertise in these skills can go a long way to help you have more influence over the pain.

Chronic pain can be devastating to your life, affecting your relationships, finances, and/or productivity at work and at home. It can also interrupt your sleep and destabilize your mood. Because many other problems commonly occur along with chronic lower back pain, anything you can do for yourself that is a natural anti-depressant will help.


#MomentumMondays @DrBouharevich The hardest thing to do is shift from relaxed weekend mode back into focused, get-stuff-done work mode. It feels like jumping into cold water.

Start on the weekend. Many of us go to bed and wake up later on Friday and Saturday because we are not going to work. Because of this different pattern during the weekend, we find it difficult to wake-up on Monday morning. Maintain your wake-up time on Saturday and Sunday mornings, and your Monday morning will be easier.

Prepare Sunday night. Prepare your clothes and food for work on Sunday night that way you won’t have to hurry or possibly forget stuff on Monday morning. Review your to-do list for Monday morning.

Early to bed, earlier to go. Go to bed early on Sunday night and wake-up earlier on Monday morning. That way you will be able to relax as you wake-up, get prepared and have your breakfast. Then leave home earlier, beat the traffic and listen to good music during your drive to work. By getting to work early, you can concentrate and get high-priority work done with fewer interruptions before your co-workers arrive.

Enjoy your Monday. Beginning your week with positive momentum will lay the foundation for a great week to look forward to. If you prepare your to-do list on Sunday evening, you can start working first thing Monday morning. Choose something small and important to complete at the beginning of the day. Then choose something you enjoy doing. For example, checking Facebook or catch up on current events and research.

Also, avoid negative interactions with argumentative and difficult people at the beginning of the day. Choose more positive interactions that will be energizing and help you feel good about yourself, your work, and your Monday.

Schedule important stuff for later in the week. If possible, schedule important meetings for the later part of the week. You will feel more relaxed and have the early part of the week to prepare.

Plan some fun for Monday. Schedule lunch with a friend, meeting your partner at the gym after work, or taking it easy reading or listening to music Monday evening. That way you will have something to look forward to on Sunday night when you go to sleep and throughout the day on Monday.

Finally, we are getting some nice weather here in Ontario! This means more people are getting out and becoming active. Whether you are active year-round and started to gear up the activity or have just started exercising again, you will want to take a moment and read the following Newsletter so that you can avoid injury this summer! 

The beginning of summer, when many people become more active, is a time of the year when injuries are very prevalent.  Often injuries are from over-use/repetitive stress or from increased intensity. I wanted to go over four injuries from the knee down that are very common this time of year because of this increase in activity. Hopefully,this can serve as a guide as to what to do if you experience these pains and/or to avoid any pains below the knees this summer!

First, we often find patients complaining of pain in the front of their knee (behind their kneecap). I’m speaking of Patello-Femoral PainSyndrome (PFPS). This occurs when either abnormal forces (e.g. increased pull of the lateral quadriceps with acute or chronic lateral patello-femoral dislocation) or prolonged repetitive compressive or shearing forces (running or jumping) on the knee joint. Basically, the patella (kneecap) grinds on the underlying femur bone. So, as we bend the knee, if the kneecap/patella is not tracking/moving properly in the groove or if there is too much pressure on it (i.e. from overly tight and/or imbalanced muscles) then inflammation starts to occur underneath the knee.

The pathognomonic feature to this is that the patient will describe the issue as painful when going up the stairs but markedly worse when he/she is going down the stairs.   As well,note that it is often from an overexertion. So, if you were cycling or runningyou might have to scale back from the intensity, dial down the tension, and/or stretch yourself/see a professional for deeper stretching techniques.

The second common injury we see below the knee is Shin Splints. In fact, just about every runner has experienced this pain in the front of their shins at some point in their lives. So, the infamous muscle here is the Tibialis Anterior (TA) muscle which runs on the outside of the rather pointed bone (i.e. Tibia) that forms the shin from your knee to the inside of your ankle approximately.  With Shin Splints, the muscle is experiencing micro-fibrous tears from again overuse of the TA muscle and/or increased intensity of activity.  This could have occurred from possibly the wrong shoes or having to run up hills for example, causing one to lift his/her feet higher and faster than previously. Generally, a patient will explain that it is painful to touch the outside of the shin and even find it difficult andtiring to walk or run after a certain amount of time.  So, in this case, if you find yourself suffering from this pain, I recommend seeing your Chiropractic Doctor or equivalently a Sports Medicine Doctor to diagnose the issue and help with recovery.  It will be very important, however, to let the body heal because there are actual tears in the muscles and they need to repair themselves. Unfortunately, this is one issue that won’t simply “go away”or repair itself while you are continuing to train intensively.

The third injury I would like to address is Plantar Fasciitis. This is very painful and affects the heel and underside of the foot. The plantar fascia is a fibrous tissue that runs from the base of your heel down to your toes. It helps to support the foot and helps to keep the arch in our feet, which dissipates the ground force load on our body (i.e. joints, spine, etc.). Again, this occurs from overuse, increased intensity of exercise,but this time other factors such as weight and age can affect the fascia similarly. So, when you don’t have sufficient arch support (i.e. flat shoes, lack of strength in the muscles of the foot which help to hold the foot’s arch) or you are bearing too much weight, you will get micro-fibrous tears as with Shin Splints.

In this case, the pathognomonic feature is that the pain gets worse when you go from rest to increased movement (i.e.worse when you wake up and start walking). After a few minutes of walking/running the pain will often reduce/stop but as soon as you stop and rest for 20 minutes, it’s those first few steps you take that will bring back that pain to which you will find yourself hobbling on that ankle. So, finding the proper shoe for the activity is key. See a professional to help you get that activity dependant, supportive shoe. As well, to get rid of the pain and possible scar tissue build up, your Chiropractic Doctor and/or a Sports Medicine Doctor can help definitively diagnose your issue and treat the fascia to help speed up recovery of the tears/scar tissue build up in your heel/base of foot.

The fourth and final common injury below the knee that I see in increased frequency at this time of the year is Achilles Tendinopathy. The Achilles tendon is a tendon made from the confluence of muscles that run along the posterior/back portion of the leg (i.e. the calf).So, when we are exerting ourselves at a greater intensity and placing strain on the calf muscles this tendon ends up creating, yet again, micro-fibrous tears.This can cause inflammation and pain. It makes one more susceptible to an Achilles Tendon Rupture (i.e. full tear) which can take months to years to recover from. In fact, at that point, depending on how badly the tendon is torn, one might have to have the leg booted/casted for a while or worse undergo surgery. 

SO, WHAT DO WE DO?

1)    SLOWLY RAMP UP! Prepare your muscles for this increase in intensity.

2)    For Patello- Femoral PainSyndrome:

Strengthen the Vastus Medialis Muscle. The quads are made up of four muscles and so with Patella Femoral Pain Syndrome we end up having an imbalance in the pulley system of the quads pulling on the patella/kneecap which is why we get bad tracking, pain, and inflammation.

3)    For Shin Splints:

Strengthen the Tibialis Anterior Muscle. Begin with Toe tapping. Keep heels on the floor and lift the front of the foot off the floor.The key is endurance, so, if you are able to do about 80 of those in a row then you are probably able to start running/activity again without injury.

4)    For Plantar Fasciitis:

Proper support and Stretch the Plantar Fascia. If you can get your hands on a golf ball use it! Place the ball under your foot and roll it from your heel to your toes. Make sure you are on a surface that is not slippery or the ball will slide too much.

5)    For Achilles Tendonopathy:

Stretch the Achilles Tendon. Before you exercise do a dynamic stretch by standing with the balls of your feet on a stair. Then drop both ankles off the stair with a count of two and then lift both ankles up until youare on your toes with a count of two. Repeat that movement ten times. After the exercise, cool down with a static stretch for the calf muscles. While standing, hold onto a high enough table or have hands on a wall and step back with your right foot keeping your ankle on the floor. Hold that there for 15 seconds. Note, that if you do not have a stair for the first dynamic stretch then you can do the static stretch but lift the ankle up until you are on your toes and back down holding each position for a count of only two seconds.  Also note that the theory of dynamic stretching (i.e. jumping, lunging, etc. to increase blood flow and moving the muscles) before exercising and static (i.e.holding the stretch to elongate the muscles) stretching after exercising is true for all activities to help all muscles warm up, cool down and to prevent injury.

These stretches and exercises are not the be-all-and-end-all because they are only one of several that are needed for each injury. See your Chiropractic Doctor if you have previously or currently experience the pains that I discussed above. Chiropractors have the education and training to help you avoid injury and diagnose your injury in order for you to recover from any pains.

If you have any questions about the above blog and/or wish to learn more about injuries of the rest of the body send your comments to [email protected]. Or, if you would like to make an appointment please call 905-853-1490.

Dr. Alexandra Bouharevich, DC, MHK, BHK

Chiropractor, Rehabilitation Specialist, and Graston Technique Provider

JointCare wants you to care for your body (i.e. joints, muscles, bones, ligaments, organs, etc.) just as much as we care for our teeth by going to the Dentist and our eyes by going to the Optometrist. It is understandable that with the current health paradigm being centrally medical, it makes it difficult and confusing to think of any natural options for health and wellness of our bodies. Let's be open to the science and facts we are overlooking. There are other, safer and less invasive solutions to a healthier, stronger body than drugs and/or surgery!

Join Sport Science Coach expert and Chiropractic Doctor Alexandra Bouharevich for JointCare's Daily Health and Wellness Tips. This blog will aim to address daily issues, myths and actions that may be limiting the average person from achieving their potential for health and wellness. By simply being open to the science behind how to move, eat, and think you can be proactive in boosting your body's ability to slow down degeneration, avoid or eliminate pain and optimize daily/sport specific movements.