Snow Shovelling - Preventing Back Pain

Winter is here and snow shovelling will not be far behind. This can be a busy time for Chiropractors and Physiotherapists. Keeping our sidewalks and driveways clear of snow in the winter can be as ongoing as the back pain that can follow the shovelling. For some, this may mean getting the local teenager to do the heavy work, not a bad idea in hindsight when you are nursing a sore back. For most of us we will be outside meeting all our neighbours come the first good snowfall. The most common snow shovelling related injury is to the lower back, so it is important to know how to avoid back pain while clearing snow.

Why is snow shovelling so hard on the low back? It involves bending the spine forward to pick up the snow and twisting to move the snow. According to Dr. Stuart McGill, Professor of Spine Biomechanics and the University of Waterloo, these are the two movements that cause injury to the spine. When shovelling, try to bend at the hips and knees not your spine. Dr. McGill recommends sparing your back by resting your forearm on your thigh when lifting a load of snow with a shovel (see picture). It is better to avoid lifting a shovelful of snow altogether and instead use the shovel to push the snow forward.

Before you start shovelling snow make sure you choose the right shovel. The journal Geriatrics published some recommendations on choosing the right shovel. Choose a shovel that is an appropriate length so you don’t have to bend your back excessively. Choose a shovel with a plastic blade as this can be lighter than a metal shovel. Look for a shovel with a bent shaft as it requires less bending at the spine. Apply silicon spray to the shovel so that the snow doesn’t stick to it.

The Ontario Chiropractic Association has come up with a list of tips to help keep your back from being injured this snow season. Remember to dress for the weather. Wind-proof and water-proofed clothing in layering helps keep you warm. Don’t forget proper footwear with good treads to avoid slipping (spreading salt or sand can also help).

1. Don’t let the snow pile up: frequent shovelling makes for smaller amounts of snow being shovelled. Don’t overload your shovel.

2. Push don’t throw: where possible push the snow rather than trying to lift a heavy shovel and trying to toss the snow to the side.

3. Bend and your hips and knees: Bending at the hips and knees keeps your spine from having to bend. This keeps your back from positions that can injure and cause pain. Move your feet instead of twisting your spine.

4. Warm up: warming up involves activities such as walking and moving around. If you have been sitting, spend time standing before shovelling. Avoid stretches such as twisting and bending of the spine as these stretches can destabilize your back leading to injury.

5. Take a break: frequent breaks allow the muscles of the spine to rest and recover. Don’t keep shovelling if you are starting to feel discomfort in your back. If your pain persists you may be a good candidate to make use of our Chiropractic or Physical Therapy services here at Wellington Ortho & Rehab.

Wellington Ortho & Rehab has an Integrated Spine Program which incorporates Chiropractic, Physiotherapy and Massage Therapy. The Clinic also has Orthopaedic Surgeons and a Physical Medicine Specialist. We use evidence informed treatments to help settle your back pain and keep it better.

Paul S. Nolet, DC, MSc, MPH

Chiropractor

OtisMed Custom-Fit Knee Replacement

There is a buzz in the orthopaedic community regarding how we size and position knee replacement implants, in essence challenging how we perform knee replacement surgery. Although touted by some as a paradigm shift in technique, I believe it represents an evolution of technologies, such as computer assisted navigation, presently used in our clinical practice.

Late last fall, Surgeons at Brantford General Hospital “made Canadian medical history” (-link with video), by becoming the one of the first centres outside the United States to perform a custom-fit knee replacement surgical procedure using the OtisMed Shape Matched Technology (this phrase is a trademark of OtisMed, a company purchased by Stryker Corporation) (-link).

Simplified, this technique as I see it involves the following steps:

1. A detailed MR scan of the arthritic knee is performed, using a specific protocol.

2. The MR scan information is sent to Otis Med in California and analyzed by proprietary software that allows computers to reconstruct a 3-dimensional model of what the knee looked like in a pre-arthritic state.

3. The software then matches implants from the Styker Triathlon system to the surface contours of the pre-arthritic model (the concept of shape matching).

4. Next, the software calculates where the diseased knee would need to be cut, the size of the implant required, and precisely where the implant should be placed to match the computer generated model of the knee in its pre-arthritic state.

5. Customized cutting guides (jigs) are then fabricated and shipped to the location where the actual surgery will be performed.

6. The surgeon then uses the customized guides to perform the knee replacement procedure, replicating the bone cuts and implant placement calculated by the software.

Prior to the availability of Shape-Match™ technology, surgeons have traditionally used cutting guides and techniques to make every replaced knee straight mechanically, aligned and centred on a plumb line running from the centre of the hip joint to the center of the ankle joint (the mechanical axis). To do so often requires balancing of the surrounding soft tissues by releasing contracted ligaments and tightening stretched knee ligaments. This balancing, the exact sizing and the final placement of the implants (especially with respect to rotation), relies largely on the experience and intra-operative judgment of the surgeon.

Next month a group of local surgeons and I will get our first “hands-on” exposure to this system. As we further analyze this radically new way to position knee implants I must say I am intrigued by the OtisMed philosophy. Their concept places critical importance on the balance and range of motion of the knee, with axial alignment secondary and almost an after thought. Traditional techniques stress axial alignment and soft tissue balance above all else.

Some important points to remember:

• This technique is more expensive to perform AND requires a MRI scan pre-op

• Shape-Match™ technology relies heavily on the software’s ability to predict what the knee looked like in it’s pre-arthritic state.

• The actual implants are the same as we currently using here at Guelph General Hospital (Stryker Triathlon -link)

• The surgical exposure is the same as we currently use, minus the releases (see above) that are sometimes required for complex knee deformities.

• There are very few peer review published articles supporting the Otis Med concept and little in the way of long-term follow-up studies.

• “Traditional” alignment techniques have an excellent track record with success rates of 90%, 10 to 20 years after implantation. It will be a long time before we know whether this new technique is able to match or exceed these results.

The debate, which is just heating up within the orthopaedic community, promises to be spirited. I will post after I’ve had further exposure to this system.

K McKenzie MD, FRCS(C)
Orthopaedic Surgeon

MASSAGE THERAPY: MORE THAN JUST A BACK RUB

By Patrick Stiles, RMT SMT (cc)

There is often a misconception among the public and health professionals alike, that massage therapy is only intended for relaxation. Utilizing massage therapy as a health care option to assess and treat conditions and injuries is often overlooked.

My name is Patrick, and I am the Director of Massage Therapy at Wellington Ortho & Rehab. Welcome to our blog site - and the first of many entries on massage therapy and it’s possible uses and benefits.

Although there is absolutely nothing wrong with a good relaxation massage; or a good back rub, massage therapists in Ontario are trained to do much much more. We have all graduated from a rather intense 2200 hour program, covering anatomy, physiology, pathophysiology, neurology, assessment, orthopaedic testing, treatments and hydrotherapy. Additional courses that I have personally taken are: equine massage, sports/advanced sports techniques, esalen deep tissue techniques, and most recently a course on “Building the Ultimate Back: from Rehab to Performance”, by Dr Stuart McGill.

In the past three years, since graduating from Sutherland-Chan School and Teaching Clinic (in Toronto, ON), I have had the privilege of working with many athletes and dancers from all levels, recreational to professional. I spent two seasons with the Guelph Storm (OHL) at home and away largely providing pre-game massage. I also help out on an ongoing basis with the University of Guelph Athletics department - Athletic Therapy Services, treating a variety of varsity athletes, largely from football.

I now devote most of my time to my community based sports massage practice treating a variety of athletic and non-athletic issues.

www.guelphsportsmassage.com

Search for guelph sports massage on facebook!

New Sign, New Year...

Well it has been an interesting first year for us. With the challenges of opening up and six months of major road construction behind us, we can now focus attention on some of the interesting and innovative ideas we have for our care centre. The clinic blog site is a piece that will ultimately compliment our website (presently under development). This blog will focus on interesting news, educational content and patient success stories.

My plan is to post content on a regular basis. I will also include postings from our care-providers, focused on their specific areas of expertise. Become a subscriber to follow us and for alerts on new content.

We welcome your comments and/or ideas for future articles.

Happy New Year to all !!!

K McKenzie MD