Wednesday, January 1, 2014

Tuesday, July 12, 2011

Importance of chiropractic research

Hello all,

I recently became a contributing member to the Canadian Chiropractic Research Foundation. This organization is led by Dr. Allan Gotlib, a passionate chiropractic researcher that understands the future of chiropractic relies on good quality research to help us treat our patients better. Recently, the CCRF with the help of the British Columbia Chiropractic Association (BCCA) and the University of British Columbia
put together the following videos promoting the importance of this type of research that some of the professions best and brightest are involved with.

Here they are for your review:

Research is the Foundation - Dr. Greg Kawchuk
Spinal Disc Degeneration Research - Dr. Mark Erwin
Spine Research at UBC - Dr. Jean-Sébastien Blouin

Amazing stuff! Keep up the good work!

Here's to your Saúde!


Saturday, June 25, 2011

Update on consussion in sport

Hello again!

Long time I know. I've been hoping to be more consistent with posting and updating my blog but unfortunately have been unable to keep up my half of the bargain. I'm currently working on revamping the purpose of this blog and am learning of ways to spread the good word about it. Anyways, work in progress...

I wanted to share a link to a very interesting and informative lecture that was recently put on by UofT's Sport Medicine group and given by Dr. Doug Richards. Dr. Richards is a very well respected sports medicine physician in Toronto and has worked with many professional sports teams in the Toronto area. I was first introduced to Dr. Richards back in my PHE days while at UofT and since then, he has been one of my favorite lecturers to listen to.

Click here for the link to the presentation.

This lecture was given at University of Toronto on Tuesday June 21, 2011 and is approximately 45 minutes in length. Unfortunately, the first 15 minutes of the lecture was on mute (and removed by the administrators), and the last little bit on the UofT management model of concussion was cut short. However, prior to being cut off, (SPOILER ALERT!! STOP READING NOW IF YOU INTEND TO WATCH THE ENTIRETY OF THE WEBCAST!!) I was very interested to learn that from a rehab perspective, their first order of conduct (after the patient has been medically screened and formally diagnosed with a concussion) is to provide an exercise program that emphasizes neck stabilization. Interesting since all physical activity is out right banned in the acute setting. Unfortunately the presentation ended here... a question that I would've had for Dr. Richards is why the contradiction? I suppose one could argue that it is very symptom dependent and that the athlete is closely monitored but the argument can be made that this may be a contradictory recommendation based on his previous statement of "thou shalt not participate in any physical activity... including sex... with self or otherwise!" Nonetheless, based on his earlier arguments surrounding the potential involvement of the upper cervical ligamentous structures in long standing symptomatic concussions, that stabilization would appear appropriate.

With the increasing focus on concussion in sport, I'm hopeful that these and other pathophysiological questions will become clearer in time.

Please let me know what your thoughts are. Better yet, if you can help answer my questions above (or if you were at the presentation) please enlighten me!

Thanks and here's to your Saúde!


Tuesday, October 12, 2010

Chiropractic integration: Where we are today

Hello all,

I trust that this post finds you all well. It has been quite the hiatus since my last post. Time has not been on my side. Things have been busy but I'm hoping to dedicate more time to posting thoughts and clinical experiences here. In that spirit, a good friend and colleague of mine, Dr. Ryan Shum, sent me this interesting article. Take a look when you have a chance.

Here's to your Saúde!

Sunday, May 9, 2010

Joint health and supplementation

Hello all,

It has again been a while since my previous post but I thought that I would add something that I came across recently.

I have patients who come to me to help treat their joint related aches and pains, and have never really been a big proponent of supplementation but recently was invited to try out a product on myself... I'm getting older and my body doesn't bounce back as quickly as it used to after physical activity.

After doing some "consumer research", I came across this site that ranks a number of different products on the market. It likely wasn't done based on rigorous scientific method, but by the sounds of it, they did their best with the information available to them. Check it out and feel free to contact me should you have any questions.

Here's to your Saúde!

Tuesday, February 16, 2010

Back Pain and Pregnancy: How Can We Address the Problem

It has been a while since my previous post and I am hopeful that with practice settling a little, I'll be able to contribute regularly. On with the show...

I have been inspired to share this with you because of the increasing number of friends who have decided to start a family. 'Tis the season I suppose! :) For those of you who are pregnant, know someone who is pregnant, know someone who is planning on having a baby sometime in the near future, or is just interested in how to decrease the chance of back pain during or after pregnancy, this will be of interest to you!

Back Pain and Pregnancy: How Can We Address the Problem

Pregnancy is one of the most gratifying experiences in life. However, back pain is often a common symptom of many pregnant and post-partum women, and in severe cases, can be debilitating. A recent study by Mens and colleagues looked at the prevalence of low back pain during and after pregnancy and found that 67% of women experienced low back pain leading up to and at the time of delivery, while 37% reported that they experienced low back pain within 18 months after delivery. A possible explanation for this may be a combination of factors including hormonal changes, increased weight due to the presence of a fetus, and a forward shift in the centre of gravity. However, women have also reported low back pain very early in their pregnancy when the weight of the fetus is insignificant. As a result, researchers now believe that the major contributing factor is the increase in the hormone relaxin which promotes loosening of ligaments of the pelvis to allow for ease of passage through the birth canal. The everyday wear and tear that your joints experience is therefore amplified during pregnancy as a result of a decreased supportive and dampening role that is usually provided by ligaments in your pelvis and low back. As a result of this, your ligaments have an increased range of motion which may place extra stress on the associated ligaments causing pain.

What to Avoid

What can we do, or NOT DO, to prevent the severity of the back pain during pregnancy? Some of the things that have been shown to be associated with low back pain during pregnancy include the following:

• Standing for more than 30 minutes (90%)
• Carrying a full shopping bag (86%)
• Favoring weight on one leg/leaning on one leg (81%)
• Walking for more than 30 minutes (81%)

The percentages represent the number of pregnant women that experience low back pain as a result of the stated activity. As you can see from the above activities, these are things that are done on a daily basis and should therefore be avoided to prevent low back pain. This is not to say that one should lie in bed and do nothing, but it does serve as some leverage next time your partner requests that you do help carry the groceries in the house!

How Can We Prevent It?

In terms of intervention and rehabilitation, van Wingerde and colleagues propose that an emphasis must be placed on muscles of the low back region. They investigated whether or not muscles of this area contributed to stabilization of the joints of the pelvis and low back. They found that the hamstrings, gluts, lats and your deep low back muscles all contribute to stabilizing the joints that are often the culprits in low back pain during pregnancy. But it is important to realize that strengthening these muscles using machines or free weights will often times, NOT do the trick. What needs to be implemented is a specific exercise program to improve the endurance and strength of these muscles and those of the pelvic floor.

A knowledgeable health professional such as a chiropractor, physiotherapist, athletic therapist, or massage therapist will be able to demonstrate exercises such as the bird-dog, planking, side-planking, kegel and pelvic bridge. All these exercises involve nothing but your own body weight and a floor mat, and should be included in any pregnancy exercise program as long as it is tolerated by the patient. It is difficult to describe these exercises in writing and they are only really appreciated when they are demonstrated and performed under supervision. As such, if you currently have a chiropractor or physical therapist, please follow up with them regarding these exercises.

So, if you are planning on having a child, are currently pregnant, have had a child in the past, or have recently given birth to a baby, first of all, congratulations, and secondly, ensure that these exercises are included in any exercise program in which you may be participating. If you have any further questions, feel free to contact me at or visit for more information on where you can find a qualified health professional to help with back pain in pregnancy or any other musculoskeletal issue that you may have.

Henry Candelaria, BPHE, Dip. Acu., DC © 2010


McGill, S. (2004). Ultimate Back Fitness and Performance. Waterloo: Wabuno Publishers.

Mens, J. M. A., Vleeming, A., Stoeckart, R, Stam, H. J., and Snijders, C. J. (1996). Understanding Peripartum Pelvic Pain: Implications of a Patient Survey. Spine, 21(11): 1363-1369.

van Wingerden, J. P., Vleeming, A., Buyruk, H. M., and Raissadat, K. (2004). Stabilization of the sacroiliac joint in vivo: verification of muscular contribution to force closure of the pelvis. Eur Spine J, 13:199–205.

Tuesday, October 20, 2009

Stretching Part 3: Take-Home Points and Conclusion

The controversy over what stretching technique to use, how long one should use the technique, and how frequent should the technique be used is very evident given the information that I have provided in this three part series. The lack of clear cut answers can generally be attributed to lack of quality research available to answer some of the above questions. However, the following major points can be made as a review of the material alluded to in this three part series:

1. the increase in ROM experienced with any stretching protocol is likely due to an increase in tolerance to the discomfort associated with the stretch rather than an actual increase in extensibility of the muscle tissue itself;

2. regular stretching will result in an increase in performance markers such as isometric force production and velocity of contraction but will have no effect on the efficiency/ease of movement

3. acute/pre-exercise stretching does not have a positive effect on performance markers but is associated with an improved running economy/efficiency. Therefore, acute stretching prior to leisure running may be of benefit but is not recommended in advance of performance dependent sporting activities;

4. it appears that a single 30-second stretching bout once a day may be the most effective practice and that periods greater than 30 seconds are no more effective; this however is dependent on the individual who is performing the stretching and serves as a general recommendation. Therefore, adjust the duration of stretching accordingly.

5. in terms of modalities such as ice or heat applied prior to stretch, it does not matter as both appear to improve the outcome of a stretch not by affecting tissue temperature but by adding to the analgesic effect of the stretch;

6. if the main objective of stretching is to prevent injury, then the recommendation would be to eliminate the stretching and increase the warm-up; therefore, it would be a better idea to spend time performing a thorough warm-up, and not so much time stretching prior to activity. However, as mentioned above, it is dependent on the activity that is being performed and the goals of that activity.

7. Finally, due to poor quality research, a recommendation on the optimal stretching technique that would allow for the most efficient increase in ROM is difficult to develop. The focus should be on duration, frequency, and individuality of the stretching protocol rather than a blanket recommendation.

In closing, it is hoped that this three part series has provided some enlightenment on a topic that many trainers/therapists recommend often based on traditional strength and conditioning practices rather than evidenced-based practice. With an increase in research dedicated to the seemingly simple topic of stretching, we will soon have clear cut answers to some of the remaining questions that I have outlined above. For now, if someone asks you about stretching in terms of incorporating it into a general exercise regiment, the one thing you can say with certain is that “it depends.”

If you have any questions or comments on this topic or any other topic related to neuromusculoskeletal health, please feel free to contact me at or visit my website at

Here's to your saude!

Dr. Henry