Thursday, September 14, 2006

One stop for all your health related questions!

Please visit our new website for more articles and useful information related to your health and sporting performance!

Saturday, April 01, 2006

ART Success Story

Dear Dr. Pho:

I want to let you know how much relief I have had since receiving A.R.T. treatments with you. Having had chronic back pain for over 18 years, I have seen a variety of medical providers in several cities in North America for this pain, including several orthopedic back specialists and physiotherapists specializing in back rehabilitation, a sports medicine specialist, a neurologist and a physiatrist. I have had several complimentary medical providers treat me for the pain (massage therapists, acupuncturists, and exercise therapists). I have also tried various exercise and stretching regimens to alleviate the pain. None of the therapies had any effect on reducing my pain level. In fact, some made it worse.

A.R.T. is the first therapy I have had that has reduced my pain on a consistent basis enabling me to do daily activities with little or no pain. My sincere thanks to you for working wonders on my back!

Janice F.
Calgary, AB

Friday, January 20, 2006

What is Active Release Techniques (ART)?

What is it?

ART is a patented, state-of-the-art soft tissue system that treats problems with muscles, tendons, ligaments, fascia and nerves. Headaches, back pain, carpal tunnel syndrome, shin splints, shoulder pain, sciatica, plantar fasciitis, knee problems, and tennis elbow are just a few of the many conditions that can be resolved quickly and permanently with ART. These conditions all have one important thing in common: they are often a result of overused muscles.
(Taken directly from the ART website,

How does it work?

At the most basic level, ART works by breaking up scar tissue, muscle adhesions and restrictions, muscular spasm and tightness. The mechanism by which it does this is for the examiner to put a muscle in it's most shortened position (through movement of the nearby joints), then apply a tension with his/her thumb or fingers, and while maintaining that tension he/she will lengthen the muscle throughout it's range of motion. In this way, any adhesions or scar tissue is broken up along the entire length of the muscle.

How it is different from other treatments?

The most significant difference between ART and other treatments is the shortening and lengthening of the muscle. Other treatments involve a muscle being at it's resting length, and then pressure is applied in the area of pain or irritation, such as trigger-point technique or massage. While these treatments can be very effective, some times a muscular adhesion or scar tissue is at an insertion that is concealed or covered by other bony or muscular structures. In order to reach these areas, a muscle needs to be moved through it's range of motion in order for these more difficult points to be reached.

Who can it help?

ART is effective for any condition of the musculoskeletal system. With over 500 muscular protocols, there is a move for almost every muscle and ligament in the body.

For more information, visit

Wednesday, December 21, 2005

A New Spin on Sudden Onset Low Back Pain

Low back pain is the most common form of personal injury, and it can come from many sources. The most debilitating form of low back pain is the sort that comes on suddenly, and often leaves the patient in a lot of pain with very limited mobility (Sudden onset low back pain). Now do not be deceived, this kind of pain can be related to something as simple as muscular spasm, or it can be caused by many more serious conditions related to multiple internal organs, such as the abdominal aorta, or can also be a result of metastatic disease. The musculoskeletal cause of back pain, (muscles, ligaments, nerves, and joints) is by far the most common, but the best way to distinguish between causes is to visit a health professional.

For the purpose of this article, I will be focusing on the musculoskeletal causes of low back pain. As a chiropractor, I get to see many different injuries, among them sudden onset low back pain. A common statement I hear from patients is “I don’t know what I did, I was just bending down to pick something up, and it locked up on me”. The onset can be related to something as simple as picking up a pencil. The patient then experiences debilitating low back pain and muscular spasm. The most common diagnosis that I have seen among other health professionals is “disc bulge” or “disc injury”. It is an easy diagnosis, because disc injuries can occur suddenly with minimal trauma. However, 30% of the population are walking around with "disc bulges" and they don't even know it because it is not putting any pressure on the spinal cord. The spinal canal is actually 1/3rd spinal fluid, so you need a fairly severe discal protrusion for it to cause any pain. Discal protrusions or herniations that are severe enough to impinge on the spinal cord will cause severe shooting electric pain down into the legs, sometimes all the way down to the heel and toes. So for the person presenting with acute low back pain, who is not experiencing symptoms into the leg, there is another explanation. The notion of “acute spinal buckling” has been investigated only recently, and there is much research coming out now on the topic. It is a fairly complicated sequence of events, but I will do my best to describe it simply.

There are muscles in the body that have “feed-forward” properties. What this means is, before your body initiates movement, there are certain muscles that become activated and contract before the movement is actually made. These muscles have stabilizing properties that prevent injury. One such muscle is called the multifidus, the most important of your spinal stabilizing muscles. The multifidus is a very tiny muscle that runs up 2-3 spinal levels from vertebrae to vertebrae. It is known as a "local mover", which means that it has the capacity to create movement only in a local small area. "Global movers" are muscles that can create movements on a larger scale. Local movers will create movement between individual vertebrae, whereas global movers create movement between groups or 'blocks' of vertebrae. To illustrate an example of the sequence of movement, think of the action of bending forward to pick something up (even something as small as a pencil). Before you initiate the action, your multifidus should contract in order to stabilize the spine so that you can complete the movement without damaging any spinal structures. When the multifidus does not contract, the global movers of your spine will contract first, which will cause 'block movement' of your vertebrae, which results in micro-trauma and increased stretch of the muscles, joint capsule, and ligaments adjacent to that level. This phenomenon is known as “spinal buckling” which will create resultant muscular spasm of the multifidus. Whenever an injury occurs, nearby muscles respond by going into a strong contraction to prevent further injury. While this is a protective function, it is the muscular spasm that causes the pain and limited range of movement that is characteristic of sudden onset low back pain. This "buckling" is what creates the sensation of the back "locking up".

Now you might be wondering “why wouldn’t the multifidus contract in the first place?” The answer is multi-factorial. It can be related to fatigue of the muscles or a lack of physical fitness, which will cause a de-conditioning of the muscles that stabilize the spine. It can also be related to chronic episodes of low back pain, which will cause an inhibition of these same muscles over time. Another cause is the concept of “visco-elastic creep”. While this term may seem complicated, it is relatively easy to understand. In effect, if a muscle is placed in a lengthened position for a long period of time, it loses its visco-elastic properties, meaning that its ability to “spring back” into its normal tension and contractility are compromised. So if you are the type of person that spends a lot of time bending forward to lift objects, or even if you spend a lot of time bent over a computer desk, the muscles in your back are being held in a lengthened position, which will eventually compromise their ability to return to their normal state, making you more susceptible to minor traumas as a result of normal movement. Studies have shown that if you spend 15 minutes in a forward flexed posture, it takes 3 times as long (45 minutes!) for your muscles to return to their original state. During this period of transition, subtle movements that would otherwise not cause injury could do just that. This is why many people will experience extreme pain after picking up a very light object. The firing of the stabilizing muscles of the spine is compromised, and small trauma to the spine will result, which will initiate the pain-spasm cycle described above.

While this might all seem very complicated, the treatment and prevention of this kind of low back pain is not. The first step of treatment is to release the muscular spasm. While this can be accomplished in a variety of ways, the most successful treatment I have encountered is that of Active Release Techniques. By breaking up the pain-spasm cycle, the patient then becomes mobile enough to function, and to start the next phase of treatment. This second step is that of rehabilitating the stabilizing muscles of the spine. In most cases, these muscles need to be stimulated and strengthened so that the next time a movement is initiated, these muscles will contract first, preventing further injury. These muscles have subtle movements, and just because the multifidus attaches to the spine, does not mean that it is strengthened by doing hundreds of back extensions. In fact, this could actually cause more harm than good. The multifidus when contracted causes a very subtle movement and stabilization of the spine, that can be taught by the appropriate health care practitioner. By teaching how to contract these muscles, and by increasing their muscular endurance, the patient will eventually be able to contract these muscles without having to think about it. Then the feed-forward mechanism discussed above is restored and the patient is protected for further episodes of low back pain so long as they continue to perform their exercises.

Many patients feel victim to recurring low back pain, but with this simple approach, patients can now gain control of their symptoms and prevent more episodes in the future.

Wednesday, October 26, 2005

The Truth About Lateral Knee Pain

Many athletes complain of the condition known as “Iliotibial Band Syndrome” or ITBS. The condition often presents as lateral knee pain (pain outside the knee), or also as lateral hip pain. This condition is particularly prevalent among athletes involved in running or cutting activities, such as football and hockey athletes, long distance runners, and sprinters.

To date there have been many different approaches to the treatment of ITBS. Some include stretching, massage, ultrasound, and soft-tissue techniques, all with a varying degree of effectiveness. While the treatment will often clear up the patient’s symptoms, there is a large degree of recurrence weeks, months, or years down the road with continued activity.

The most commonly overlooked aspect of the treatment of ITBS is the active strengthening and rehabilitation of the involved structures. Until recently, it was not entirely understood what the precipitating factors were in the development of ITBS. A recent study in the Clinical Journal of Sports Medicine (Fredericson M, Cookingham CL, Chaudhari AM, Dowdell BC, Oestreicher N, and Sahrmann S. Hip abductor weakness in distance runners with iliotibial band syndrome. CJSM 2000; Jul 10(3): 169-175.) revealed that runners with iliotibial band syndrome had decreased strength in the muscles that abduct the hip (raise the leg out sideways) when compared to runners without ITBS. These muscles, otherwise known as the gluteus medius and minimus, also play a large role in the stability of the pelvis. Standing on both feet, if you raise your left leg in the air, the right gluteus medius/minimus is responsible for keeping the hip steady so that it doesn't buckle underneath you. You can imagine the implications of a weak or tight gluteus medius when it comes to sporting performance. If these muscles are not working at peak function, then you will see a lot of lateral deviation of the pelvis during activity and power and speed are lost. If the gluteus medius/minimus muscles are weak, nearby muscles attempt to take up the slack. The tensor fascia latae muscle, which acts as a hip flexor and a weak hip abductor, will attempt to accomplish the action of the weakened glutes. Now here is where it gets interesting. The tensor fascia latae (TFL) is directly continous with the iliotibial band (ITB), and any contraction of the TFL transmits itself down the ITB. Because the ITB attaches at the lateral knee at it's most distal end, this is why you get lateral knee pain as a result! In essence, knee pain is a result of weakness at the hip! If you understand the mechanism, then you will also understand why treatments aimed solely at the ITB and lateral knee and only temporarily or not at all effective.

This same study that discovered the relative weakness of the hip abductors in persons with ITBS also revealed that after a 6-week rehabilitation program aimed at strengthening the hip abductors, 22 of 24 runners were pain-free, and were able to return to running and did not suffer any recurrence of their symptoms after 6 months. As you can see, active rehabilitation was the key to resolving the issue.

Soft-tissue techniques such as Active Release Techniques ® and Graston Technique ® are very effective in treating the symptoms of ITBS. Combine these techniques with a hip rehabilitation program, and not only will your pain resolve, but it will be less likely to return. Be careful when discussing a rehabilitation program with your trainer or health care practitioner. The strengthening of the hip abductors demands a very particular pelvic position in order for the glutes to contract in the absence of the TFL. If the TFL is still trying to compensate for a relative weakness, all you are doing is exacerbating the problem instead of fixing it. Make sure to consult a health care practitioner with a strong knowledge of rehabilitation. Don't let a simple problem side-line you from doing what you love.