Category Archives: Health Conditions

Headaches – Tips for Management & Prevention

headache tips

Headaches are a complicated subject because there are many different headache types and there are often many factors involved in their development (often, there is not one single identifiable cause). This article serves as an introduction to the topic of headaches with some tips about management and prevention. More information about headache classification can be found on the International Headache Society website.

The most common type of headache, responsible for ~90% of all headaches, is a tension type headache (TTH). Pain quality is described as a tensor band squeezing the head, bilateral across the temples and/or around the base of the skull. TTHs, along with a few other headache types have musculoskeletal components to their etiology. For example, tight muscles in the neck and shoulders and the joints of the neck and jaw can refer pain to the head. Overall posture and especially head carriage can be responsible for the development of joint irritation and muscle tension that results in headache development.

Management and Prevention Tips:

  1. Have a proper evaluation:

    Most headaches are benign in origin but having a proper diagnosis is important because the management may differ. In addition, certain “red flags” may indicate a pathology that must be taken seriously. Make sure to consult with a healthcare professional if the headache is severe, different from your typical headache has an abrupt onset or is associated with trauma, neurological signs, fever, other unusual symptoms or if you have concerns.

  1. Create a headache diary:

    If you have headaches frequently, creating a headache diary may be beneficial. This will help identify your possible triggers such that you can avoid them. Jot down what you were doing, eating, drinking, feeling, the type of environment you were in, the quality of your sleep, and amount of stress you felt during the 24 hours prior to headache onset. When you see a health professional about your headaches, you can also discuss your headache diary.

  1. Avoid headache triggers:

    Once you establish your headache triggers, you can try avoiding them. Some common triggers are food sensitivity / allergy, coffee, alcohol, stress, dehydration, loud sounds, bright lights, hunger and poor sleep. Wear sunglasses if bright light triggers your headache.

  1. Improve your posture:

Headaches are often associated with posture – especially head carriage. Having optimal posture reduces the stress on muscles, joints and ligaments that can otherwise refer pain to the head resulting in a headache. The biggest culprit is the forward head carriage where the chin and head jut forward relative to the shoulders. The muscles of the neck must work harder and tense to counterbalance the weight of the head (which is like a bowling ball sitting on your neck). Forward head carriage is common in students and office workers who slump forward at a computer for hours each day. Loss of the normal curve of the neck may also be associated with headaches due to joint irritation. A chiropractor can provide you with specific exercises for improving posture and advice regarding office ergonomics.

  1. Exercise regularly:

Regular cardiovascular exercise is good for overall health and stress relief.

  1. Stop smoking:

Smoke may be an allergen that triggers headaches. In addition, nicotine has an effect on the vascular system and the vascular system is thought to trigger certain types of headaches – especially migraines.

  1. Reduce stress:

Overall stress reduction may help headache sufferers. Take some time to enjoy hobbies, socialize and exercise so that there is balance between work and play. Some stress relieving activities include yoga, thai chi and meditation.

  1. Regular sleep pattern:

Getting enough sleep is just as important as maintaining a regular sleep-wake cycle. There are natural fluctuations in the body – for hormone levels, sugar levels and enzyme levels – which are influenced by sleep-wake cycle. These are know as circadian rhythms. Disruption of circadian rhythms may be responsible for headaches in some people. As far as quantity of sleep goes, the typical recommendation is 8 hrs of uninterrupted sleep per night. The best sleep positions for the back and neck are on your back or side (never sleep on your stomach).

  1. Find a cool dark place to nap:

Sometimes when a headache hits, the best thing to do is to lay down and let the headache run its course.

  1. Apply cold or heat

Applying a cool, moist cloth across the forehead or base of the skull can be especially good for relieving headache pain.

  1. Visit your chiropractor:

As previously mentioned, headaches are often associated with tight muscles and dysfunction of joints of the neck or jaw. Regular spinal check-ups and adjustments as part of a wellness plan help keep headaches at bay in many people. Chiropractors are also trained to identify red flags associated with headaches and to refer accordingly if necessary.

  1. Other:

Other natural methods for headache relief include acupuncture and massage therapy.

Headaches can be significantly disruptive to everyday life. I hope these tips have been helpful.

Foot Facts – Tips for Healthy Feet

tips for healthy feetYour feet are your foundation. They function to support body weight during stance and to propel the body forward during gait. There are 26 bones in each foot and 206 total bones in the human body. Thus, your feet account for 25% of the bones in your body! An average person takes between 5000 and 7000 steps per day and this increases for people who are more active.

overpronation causing posture changeYou don’t need to have foot pain to have a foot problem. Typically, unaddressed mechanical problems of the feet exist for a period of time before causing symptoms. Sometimes mechanical issues only become apparent after a change or increase in one’s activity level or an increase in body weight (due to added stress and resulting pain). In addition, a mechanical or alignment problem at the feet can alter mechanics and position of joints higher up in the kinetic chain including ankles, knees, hips, the back and even the neck! Thus, foot posture is related to one’s whole body posture and a mechanical foot issue can cause or contribute to pain in other areas of the body. Uncorrected, postural imbalance and uneven joint wear can accelerate joint degeneration (arthritis).

1) Choose appropriate footwear:

The unfortunate trend is people choosing fashion over function, however, footwear with poor support and fit is frequently the cause or contributor of musculoskeletal foot disorders. Womens’ high heeled shoes are the worst culprit forcing excessive weight distribution at the ball of the foot and inward deviation of the toes. When choosing footwear…

a) choose flats or a slight heal over high heeled shoes

b) ensure correct fit

The toe box should not put excessive pressure on the sides, top or front of feet. A good tip when buying shoes is to take the insole out and place your foot on it – your footprint shouldn’t go over the edges of the insole for correct fit. Another tip is to shop for shoes at the end of the day as your footprint will be slightly larger from the day’s stresses.

c) for adequate motion control and support, shoes should pass 4 tests (shown below)

Dish Rag Test: if the shoe twists easily, it fails the test

dish rag test for torsional rigidityPinch Test:if the heel counter is soft, it fails the test

pinch test for heel counter rigidityFold Test: the shoe should bend easily where the toes naturally bend only

fold test for flexion stabilityShelf Test: there shouldn’t be any drifting of the shelf relative to the heel when viewing shoes end on; there shouldn’t be excess ‘give’ when you push the shelf side to side.

shelf test2) Replace shoes every year:

Running shoes should be replaced at a minimum of yearly but even sooner (every 3-6 months) for runners or the overweight as shoe structure breaks down faster.

3) Weight loss if overweight:

Being overweight will result in more load on all joints of the body but especially the feet because they support the whole body. As a result, obese people tend to have flattened arches more often than the general public. Muscles must also work harder to support excessive weight. The added force of weight also exacerbates any mechanical or alignment problems.

4) Do exercises for feet and calves:

Appropriate stretching and strengthening of the lower extremity muscles can be greatly beneficial. Tight, shortened muscles should to stretched and weaker, lengthened muscles should be strengthened. By doing so, muscles become more balanced which adds mechanical balance to related joints. A chiropractor can give you more specifics related to your particular case. For example, stretching the the calves is particularly helpful for those with plantar fasciitis (a painful inflammation and scarring of the plantar fasciia which results in heel and arch pain that is worst with the first morning steps). Rolling your foot forward and back over a tennis ball is also great, massaging and improving circulation. There are also specific exercises for those with flat feet which help to strengthen and support the longitudinal arch of the foot.

5) Have a gait scan:

gaitscan by The Orthotic GroupHaving a gait scan involves walking barefoot across a pressure sensitive mat. A computer records data and generates an image of where you put pressure on your feet when you walk. This is compared to the normal foot. A gait scan (along with a chiropractic analysis) helps to determine need for orthotics. Data from the scan can be used to create custom-made orthotics which will reduce abnormal foot function while walking and realign your feet to a more normal position. As many as 60-70% of people have some sort of abnormal foot function and can benefit from a custom orthotics prescription. The cost of foot orthotics is covered by most extended healthcare and insurance plans.  Some insurance plans require a referral from your medical doctor first.  Check with your policy for the specifics of your coverage.

6) Have a chiropractic analysis:

Chiropractors are skilled at assessing posture, alignment and function of the neuromusculoskeletal system. As mentioned earlier, foot position relates to whole body posture. Thus if you have a foot problem, a full spinal analysis is beneficial as well. Chiropractic adjustments to the spine help normalize overall mechanics and also reinforce response to orthotic prescription. Chiropractic can assess bones in feet and determine if a particular joint is restricted. If a joint is restricted then it means that other joints must compensate – this can lead to pain. Adjustments help correct this.

7) Other:

Other tips for healthy feet include regular cardiovascular exercise and a healthy, balanced diet as these are beneficial for overall health and healing. It is also important to maintain good foot hygiene including keeping toenails neatly trimmed. Inspect feet for any unusual changes in appearance.

Dr. Elisabeth Miron

Looking for custom foot orthotics in Aurora? Visit Dr. Miron’s chiropractic website.

Middle Ear Infection – Causes, Risk Factors & Treatment Options

Acute_Otitis_MediaEar infection is one of the most common reasons for pediatric visits to the doctor. For the purpose of this article, I’m talking about otitis media which is infection of the middle ear. Ear infections can be extremely uncomfortable producing symptoms such as ear pain and muffled hearing. School aged children with otitis media often have a difficult time concentrating in class.

Causes & Risk Factors:

Otitis media is caused by either bacterial, viral or fungal infection. Interestingly, it appears that for the majority of ear infections, both bacteria and viruses are present (1). Why do some children get ear infections and others do not? The main reason is that your child’s immune system is out of balance. If the immune system were functioning optimally, the body would fight off the infection with little difficulty before it truly becomes a problem. Below are a few risk factors or triggers for ear infection.

  • Recent cold: An upper respiratory tract infection often precedes an ear infection. (Cold and flu infections are both viral.)

  • Anatomical considerations: The eustachian tube of a child is oriented more horizontally than in an adult which anatomically can result in poorer drainage of fluid from the inner ear to the back of the throat.

  • Exposure to second-hand smoke & other environmental toxins: Toxins in the environment and foods (like certain preservatives) can hamper immune system function making one more susceptible to ear infection (and other infections).

  • Food allergies and sensitivities: Food allergies and sensitivities can thicken mucus and contribute to inflammation. One of the most common culprits is milk and milk products.

  • Eustachian tube dysfunction: The eustachian tube connects the inner ear to the back of the throat and is responsible for allowing the inner ear’s pressure to equalize with atmospheric pressure and to serve as a passageway for fluid to drain. Eustachian tube dysfunction is commonly implicated in inner ear infection.

  • Imbalance in overall immune system function: There are other physical, chemical and psychological factors that affect immune system function. Overall health and lifestyle choices will affect immunity.

Medical Management of Ear Infection:

The current literature supports that family doctors and pediatricians follow a “watch and wait” approach for acute ear infections. Certainly, if you suspect your child has an ear infection, he/she should be evaluated and appropriately diagnosed. That being said, most ear infections will heal on their own within a couple weeks (hence, the reason for initial watch and wait recommendation). In rare circumstances, symptoms can persist, become chronic or worsen.

The initial medical management for ear infections is antibiotic use. Keep in mind though, that antibiotics kill bacteria but not viruses and that most ear infections harbour both bacteria and viruses. So if there is a viral component, antibiotics are unlikely to work and may actually make things worse. In addition, antibiotics will destroy the healthy bacteria inhabiting the gut thus lowering one’s overall immunity (as the gut plays an important role in immune system function). Overall, the evidence suggests that antibiotics are poorly effective in treating otitis media (2).

Another option is tympanostomy tube or “ear tube” insertion. This is reserved for chronic cases whereby the infection is gone but fluid persists in the ear. The child is put under general anesthesia and small tubes are surgically attached to the ear drum allowing aeration of the middle ear. Similarly, the necessity and effectiveness of ear tubes is questionable.

Chiropractic Management of Patients with Ear Infection:

For the record, chiropractors do not diagnose or claim to cure ear infection. That being said, there are many benefits to chiropractic care for patients with ear infection. Chiropractic offers an alternative approach or an additional type of care for those who opt for co-management.

Chiropractic care, through natural means, seeks to optimize nervous system function and to correct any mechanical causes or contributors to the problem. It’s about putting your body in balance so that it may heal itself to its greatest potential. Healing comes from the inside.

How does chiropractic work? We know that the central nervous system controls and co-ordinates all systems and functions in the body. A nervous system free of interference will allow optimal communication and hence optimal healing. This is achieved by providing specific spinal adjustments to optimize spinal alignment and mobility. Chiropractic care has been shown to balance immune system function by reducing inflammation and stimulating antibody production (3, 4). A healthy spine = a healthy body.

Chiropractic care can often correct eustachian tube dysfunction as well. As mentioned earlier, it is often implicated in ear infection. Sometimes eustachian tube dysfunction persists after the infection is gone leading to persistence of muffled hearing and stuffiness. Correcting this dysfunction will allow the pressure to balance and the fluid to drain. Read my article about eustachian tube dysfunction.

Chiropractic care is very safe and for pediatric patients, gentle techniques are used. Kids enjoy their visits to the chiropractor!

To me, chiropractic care along with other approaches to boost natural immunity is a logical choice. Read my article about tips to boost immunity.

Has your child been diagnosed with acute or chronic otitis media? Are you searching for alternative care that is safe and effective? See a children’s chiropractor! Or, if you’re near North York, come see me.

  1. Infectious Diseases Society of America (2006, November 6). Most Ear Infections Host Both Bacteria And Viruses, Study Shows.

  2. Dowell, S, Marcy, M, Phillips, W, Gerber, M & Schwartz, B. (1998) Otitis media – participles of judicious use of antimicrobial agents. Pediatrics; 101(supplement)165-171.

  3. Tedorzyk-Injeyan JA, et al. Spinal Manipulative Therapy Reduces Inflammatory Cytokines but Not Substance P Production in Normal Subjects. J Manipulative Physiol Ther 2006 (Jan); 29 (1): 14–21.

  4. Teodorczyk-Injeyan JA, et al. Interleukin-2 regulated in vitro antibody production following a single spinal manipulative treatment in normal subjects. Chiropr Osteopat, 2010;18:26.

Dr. Elisabeth Miron

Check out Dr. Mirons Chiropractic Website!

Scoliosis Treatment Options – Chiropractic Care & Medical Model

scoliosis treatmentScoliosis is a condition in which there is an abnormal lateral deviation of the spine. In layman’s translation: if you look at a person from the back side, the spine has a C-shape or S-shape curve instead of the normal, vertically upright orientation.

There are two categories of scoliosis: postural scoliosis and structural scoliosis. The purpose of this article is to differentiate these two types of scoliosis, to describe the chiropractic approach to scoliosis care and lastly, to differentiate this from the medical approach. This is so that you may better understand some of the various available options for scoliosis care.

Functional / Postural Scoliosis:

overpronation causing posture changeA postural scoliosis is essentially an postural adaptation to an imbalance in your base of support. For example, a leg length inequality or a low arch on one side compared to the other. This will cause the pelvis to dip down on one side. Then your spine will curve as an adaptive response because all of the joints are functionally connected. This type of scoliosis is generally flexible and can be diagnosed from physical examination findings (evidence of short leg and a flexible spinal curve that unwinds with side bending of the torso). This type of scoliosis is also usually fairly straightforward to correct. Custom foot orthotics are used to correct the alignment of the feet or a heel rise is used if there is a structurally short leg. Chiropractic care may also be recommended to the postural scoliosis patient to address any muscle or joint findings and any resulting pain from years of abnormal force distribution.

Structural Scoliosis:

A structural scoliosis is a bit more complicated to deal with. There are many types of structural scoliosis. One such type is adolescent idiopathic scoliosis. This is a rigid, inflexible spinal curve and for unknown reasons, the spine just grows that way. While the spine continues to grow, there is a risk that it will continue to get worse. Chiropractic management includes manual adjustments and/or mobilizations to the spine to improve flexibility, function, alignment and mechanical balance. Chiropractic care is also helpful for naturally managing pain. Exercises are also prescribed.

Proprioceptive exercises are particularly beneficial for scoliosis patients (of either type). Proprioceptive exercises are exercises that improve body position awareness. Examples include exercises on an exercise ball, rocker board, wobble board or vibration platform. Yoga and Tai Chi are also great balancing exercises. Chiropractic care combined with proprioceptive exercises help to retrain the central nervous system. Beyond this, specific corrective exercises may be prescribed which are designed to stretch the relatively tighter muscles and strengthen the relatively weaker ones. Preferably, these should be done daily. Deep breathing exercises and sleep posture awareness are also beneficial.

Risks of Scoliosis:

Just because you have scoliosis does not guarantee that you will have problems later in life. Many people carry on with their lives with no idea and a scoliosis is incidentally found later. That being said, there are some risks with scoliosis. Statistically, with greater curves there tends to be more pain and also earlier onset of arthritis due to uneven wear and tear to the joints. There is also a risk that the scoliosis may continue to progress (especially during adolescence, when the spine is still growing). With structural scoliosis, there is concern about compression of the internal organs when curves progress beyond a certain point.

Scoliosis Diagnosis:

Scoliosis is diagnosed through physical examination and/or x-ray imaging. The physical examination entails an assessment of posture, flexibility of spinal ranges of motion and orthopedic testing. Chiropractors have trained eyes for detecting posture abnormalities such as unleveling of the shoulders, pelvis, hips, knees and feet which may indicate an underlying scoliosis. If a scoliosis is detected, the second step is to determine if it is postural or structural. A postural scoliosis will unwind upon side bending of the torso. A structural scoliosis will not unwind fully upon side bending and will have a positive Adam’s test (forward flexing the spine will have evidence of rib protrusion on one side). An x-ray may be ordered to evaluate the severity and objectively measure the curve. Other potential causes for scoliosis also need to be ruled out.

Conventional Medical Management of Structural Scoliosis:

The conventional medical management of structural scoliosis involves monitoring, bracing, medication and/or surgery. Medication is suggested only as a means for symptomatic relief and does nothing to solve the underlying cause (which is unknown). If the patient is still growing, progression is monitored by first a baseline x-ray and then follow-up x-rays every few months. If the curve progresses, a spinal brace is typically recommended. A brace is intended to prevent further progression but patient compliance is a challenge because spinal braces tend to be uncomfortable and awkward (especially for the self-conscious adolescent). If the scoliosis progresses beyond a certain point, the patient may be recommended spinal surgery in which a metal rod is surgically fused to the spine to straighten it out. This procedure is invasive and has many inherent risks.

Why Chiropractic Makes Sense:

In light of the other available options, chiropractic care is a logical approach for scoliosis management. Chiropractic care is hands on, non-invasive and drug-free. It attempts to correct the underlying mechanical problems in scoliosis, relieve pain naturally and empower the patient to continue appropriate home care corrective and postural awareness exercises. While there is no guarantee that chiropractic will correct a structural scoliosis, there is evidence in the literature that it can slow the progression and improve the curve in some cases. For these reasons, chiropractic care makes sense. If unsuccessful, the conventional medical management is still an option. While chiropractic care is a logical approach, it is not a quick fix. Typically a lengthy course of care is recommended, with regular progress examinations to objectively evaluate changes.

  1. Chen, Kao-Chang & Chiu, Elley. (2008). Adolescent Idiopathic Scoliosis Treated by Spinal Manipulation: A Case Study. The Journal of Alternative and Complementary Medicine: 14(6); 749-751.

  2. Sanna, Mark. (2009). A New Look at Adolescent Idiopathic Scoliosis. The American Chiropractor: April 2009; 18-19.

  3. Woggon, Dennis. (2005). Scoliosis Correction – CEAR Solutions; Chiropractic Leadership, Educational Advancement & Research. The American Chiropractor. February 2005; 54-56.

  4. Hyland, John. (2008). Functional Scoliosis. The American Chiropractor. April 2008; 30-31

  5. Payne, Mark. (2008). Scoliosis: A Postural Approach. The American Chiropractor. April 2008; 26-28.

  6. Yochum, Terry & Maola, Chad. (2008). Scoliosis. The American Chiropractor. April 2008; 14-16.

  7. Lamantia, Marc. (2009). Review of the Literature: Non-operative Scoliosis Treatment. The American Chiropractor. April 2009; 20-23.

  8. Woggon, Dennis. (2006). Can Chiropractic Care Help Scoliosis? The American Chiropractor: May 2006; 24-25.

  9. Morningstar, Mark, Woggan, Dennis & Lawrence, Gary. (2004). Scoliosis treatment using a combination of manipulative and rehabilitative therapy: a retrospective case series. BMC Musculoskeletal Disorders.

Dr. Elisabeth Miron

Eustachian Tube Dysfunction & Chiropractic

Eustachian tube dysfunction refers to when the pressure of the middle ear is unable to equalize with atmospheric pressure.  It can cause a muffling of one’s hearing and can also cause ear pain (otalgia), facial pain and headache. 

The eustachian tube connects the middle ear to the nasopharynx (see diagram).  It is composed partly of bone (near the middle ear) and partly of cartilage.  There are 4 muscles that insert into the eustachian tube controlling its ability to open and close.  These are the salpingopharyngeus, tensor tympani, levator veli palatini and tensor veli palatini.  These muscles are related to the pharynx so each time you swallow or yawn, the ears (in normal cases) will make a mild clicking sound which represents the temporary opening of the eustachian tube to equalize the pressure.  It is thought that eustachian tube dysfunction is a result of disruption of the normal tone of these muscles affecting their ability to contract optimally (1).  Malfunction of these muscles may also affect the ear’s ability to drain fluid.  As soon as the tone returns to normal, the opening and closure mechanism of the eustachian tube is restored and pressure equalization and drainage of any fluids can resume. Eustachian tube dysfunction can occur with or without middle ear infection (1).

Middle ear infections can also occur in adults.  The eustachian tube is responsible for draining fluid of the middle ear, so sometimes when you have an upper respiratory infection (or a cold), mucus and bacteria get trapped in the eustachian tube and the blockage results in an inner ear infection.Eustachian Tube Dysfunction & ChiropracticHow can chiropractic help with ear pain?

Ear pain can occur for a variety of reasons.  It can result from eustachian tube dysfunction (as discussed above), from dysfunction of the joints in the neck, dysfunction of the temporomandibular joint (or TMJ) and ear infection, for example.  A chiropractic examination can identify mechanical causes/contributors of your ear pain and adjustments to the affected areas will help to restore normal function.  For example, the ear itself can be adjusted, the neck can be adjusted and the TMJ can be adjusted if dysfunction is found there.  A few treatments may be required before you notice any difference.  Long standing mechanical issues take a longer time to normalize than newer mechanical issues.  Often times, people have more than one mechanical issue that needs to be addressed.  Depending on the cause of the ear pain, there are also different exercises that may help.

There is preliminary evidence that chiropractic adjustments to the upper four vertebrae of the neck improve symptoms of middle ear infection (3).  The tensor veli palatini muscle is innervated by a branch of the trigeminal nerve which has branches to the C1-C4 nerve roots.  The mechanism of benefit is thought to be from freeing neurological compromise to the tensor veli palatini such that its normal tone is restored (3).

Interesting study:

In children with recurrent ear infections, chewing xylitol gum daily appears to reduce the occurrence of middle ear infection by 40% compared to chewing sucrose gum (2). Xylitol also inhibits the growth of Streptococcus pneumoniae.

Dietary Suggestions:

  • stay well hydrated

  • eliminate dairy foods (dairy may thicken and increase mucus making it more difficult for an infected ear to drain)

  • 1) Murphy D & Gay, C (2011). Manual therapy and ear pain: a report of four cases. J Can Chirop Assoc; 55(1):40-46.

  • 2) Uhari, M, Kontiokari, T, Koskela, M & Niemela, M (1996). Xylitol chewing gum in prevention of acute otitis media: double blind randomised trial. BGJ; 313:1180-4.

  • 3) Fallon (1997). Preliminary evidence SMT may benefit some children with otitis media. J Clin Chiro Ped; 2(2).

Dr. Elisabeth Miron

Looking for a chiropractor? Check out

Fertility and Chiropractic Care

enhance fertility naturallySo, you’re trying to conceive. Perhaps you, like many fortunate couples, will conceive within three to five months. Or perhaps you will find yourselves among the millions of fertility challenged couples. The World Health Organization defines infertility as no pregnancy after a full year of contraceptive-free trying. In Canada, this number is an estimated 11.5-15.7% for couples in which the woman is aged 18-44, a significant increase from ten years ago (1). There is a corresponding increase in the use of assisted reproductive technologies over this time period.

What causes infertility? Sometimes there is a medical explanation. Visiting your family doctor can help you rule out potential medical reasons. However, often no explanation is found. In many cases, certain lifestyle recommendations can significantly improve the chances of conception.

How can chiropractic help with fertility? Chiropractic has long been recognized as a holistic health profession. Chiropractic is a non-invasive, drug-free and hands-on approach to care that also focuses on self-empowerment and healthy lifestyle choices. Chiropractic care, in itself, can be considered a healthy lifestyle choice as it helps restore balance in spinal mechanics and nervous system function. Though many people initially seek care on account of pain or injury, one doesn’t need pain to have a problem. If you have pain or a history of physical trauma, definitely see a chiropractor! Even if you don’t, you can still book a physical examination to evaluate your spinal health. A chiropractor can help you optimize or restore spinal health and recommend ways to keep it.

autonomic nervous systemChiropractors are spinal health experts and spinal health can have a profound influence on overall health. Why? Because the spine supports and protects the nervous system which controls and co-ordinates all systems and processes in the body. Nerves originating in the low back provide and receive information to/from the reproductive organs. This network must be communicating freely for optimal function. Thus, if there is a structural or functional problem involving the low back or pelvis and it impairs communication, then it is possible that fertility may be compromised. Only a chiropractor, through a detailed physical examination, can locate and then correct these structural/functional problems (termed subluxations). A chiropractor can also help you tease apart other chemical, physical and emotional factors that may affect fertility. We look at the big picture.

Where is the evidence that chiropractic improves fertility? While there are yet to be any high quality, controlled studies in this area, there is an increasing number of case reports and much anecdotal support. There are a series of case reports published in the Journal of Vertebral Subluxation Research with successful pregnancies following chiropractic care. (Please see the end of this article for links to the abstracts of these studies). More research is required to fully understand how chiropractic improves fertility and its success rate compared to other options (see table below). However, chiropractic care remains a very cost effective and safe option with an average cost per treatment of ~$40. Depending on the health history and physical examination findings, usually a course of care is recommended.


Success Rate

Cost per treatment

Intrauterine insemination (IUI)



In Vitro Fertilization (IVF)



Gamete Intrafallopian Transfer (GIFT)



Zygote Intrafallopian Transfer (ZIFT)



Intracytoplasmic Sperm Injection (ICSI) (combined with IVF)



Fertility drugs (ex: Clomid, Serophene, Milophene, etc)

20-60% (when combined with other methods)


* in Ontario, OHIP covers a portion of the fees for assisted reproductive technologies

* the above numbers were obtained from

Other healthful tips… By visiting a chiropractor, you’ll likely receive other healthful tips such as the importance of managing stress, cleaning up your diet, physical fitness and reaching a healthy weight. Physical, chemical and emotional factors all play a role in your overall health and wellness. Remember: health and healing come from the inside and you have to take responsibility for your health.

Just to be clear, chiropractors do not diagnose of treat infertility. Instead, chiropractors treat the mechanical issues that may affect the nervous system. However, it can renew hope for those who’ve lost hope and provide a healthy alternative for those who wish to avoid costly assisted reproductive technologies and fertility medications (with dangerous side effects). Chiropractic care is safe, cost effective and even covered by most insurance plans. So, why not make chiropractic a part of your preconception plan? Find a chiropractor in your area. Or if you’re in North York, Toronto, come see me.

  1. Bushnik, T, et al. (2011). Estimating the prevalence of infertility in Canada. Human Reproduction; 9(0):1-9.

Fertility and Chiropractic Abstracts:

Dr. Elisabeth Miron

Conservative Treatments for Knee Pain

conservative treatments for knee painWhen it comes to knees, it is probably best to explore conservative options prior to undergoing surgery, according to some of the latest research (1, 2, 3). Certainly, it is important to be informed as to the potential benefits and risks of any treatment prior to making any decision about your health.

There are many different pain generating structures in the knee (including the cruciate ligaments, collateral ligaments, menisci, muscle tendons, bursae, etc). The first step before entering any treatment program is to establish a diagnosis as depending on the type of injury, the recommended treatment may differ. Seek a chiropractor or other musculoskeletal professional in your area.

Conservative Options:

Chiropractic care: Chiropractors are biomechanical experts who can not only establish the diagnosis but can deliver conservative forms of care. The goals are to restore mechanical balance / alignment in your body such that no one area is being overworked, to relieve pain without medication, to improve function and to accelerate your body’s natural ability to heal.

Pain relieving modalities: Electrical stimulation and acupuncture are both great choices for relieving knee pain without the use of drugs. These are especially helpful during the acute phase of recovery when there is usually considerable pain and inflammation. Depending on the condition, ice or heat can also work well.

Targeted rehabilitation: Following the acute phase, rehabilitation becomes important. Optimal knee function requires muscular balance and both flexibility as well as stability. Rehabilitation involves strengthening the muscles that are relatively long/weak and stretching muscles that are relatively tight/strong.

Soft tissue therapy: Soft tissue therapy can help break down scarring and adhesions from injuries that may otherwise compromise normal range of motion and function. It also temporarily increases circulation in the area to enhance healing.

Activity modification: Sometimes too much activity, or not enough, or poor form during an activity can result in aggravation of symptoms. In addition certain types of activities are not as safe for your knees (such as high impact sports or activities on an uneven terrain). That being said, some amount of activity is necessary as it flushes fluids through the joints, carrying nutrients and removing metabolic wastes. One of the best things for osteoarthritis, for example, is low impact range of motion exercise (such as swimming).

Orthotic for pronationCustom orthotics: Orthotics are special insoles for your shoes. Custom made orthotics are specially constructed to correct the alignment of your feet and to improve shock absorption so there is less impact through your joints. Because the knees are functionally connected to the feet, poor alignment of the feet can cause or contribute to knee pain (or pain higher up in the kinetic chain). A common contributing factor to knee injury is overpronation. Overponation causes the longitudinal arch to drop which results in an inward torsion of the knee (creating more tension on the MCL and medial meniscus and compression of the lateral knee joint space). Over time, this suboptimal loading can result in pain or injury.custom orthotics and knee pain

Appropriate footwear: Choose shoes that are appropriate for the activity with good support, stability and shock absorption.

Ideal body weight: Reaching your optimal body weight if you are overweight, will help lessen the compression though your knees as well as other joints in your body and reduce the risk for osteoarthritis (4).

Knee brace or athletic tape: Using a knee brace or athletic tape while performing activities can help provide passive support to the knee and proprioceptive feedback. For injuries involving ligament damage, there is often a loss of joint position sense (proprioception) due to damage to nerve endings. This can set one up for future injury. Athletic tape provides more stimulation to the skin receptors to enhance your joint position awareness.

Glucosamine supplementation: Glucosamine is a natural substance the body makes that supports the health of joint cartilage.

Anti-inflammatory diet: Different foods are metabolized differently, some promoting inflammation and others reducing it. Having an anti-inflammatory diet will help rid your body of excessive inflammation and help to reduce pain naturally.

Have patience: Depending on the nature and severity of the problem, it may take several weeks or even up to a year to reach maximal recovery.

  1. Moseley JB, O’Malley K & Petersen NJ, et al (2002). A controlled trail of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. Jul11;347(2):81-8.

  2. Katz JN, Brophy RH & Chaisson CE, et al (2013). Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Eng J Med; Mar18.

  3. Kettunen JA, Harilainen A & Sandelin J, et al. (2007). Knee arthrooscipy ad exercise versus exercise only for chronic patellofemoral pain syndrome: a randomized controlled trail. BMC Medicine. 5:38

  4. Felson DT, Zhang Y & Anthony JM et al. (1992). Weight loss reduces the risk for symptomatic knee osteoarthritis in women. The Framingham Study. Ann Intern Med. 1;116(7):535-9.

Dr. Elisabeth Miron

Rehab for Over-Pronation

What is Over Pronation?

overpronation and oversupinationOver pronation is one of the most common foot functional disorders. It occurs when there is a mechanical imbalance that causes the foot to collapse inward when walking or standing, giving rise to the appearance of a low arch.

Appropriate mechanics and alignment at the feet is very important because the feet serve as one’s base of support. A functional problem at the base of support can translate up the lower extremity kinetic chain affecting mechanics and alignment at related joints. Over time, this pattern of suboptimal loading of joints in the lower extremity can lead to irritation and pain in the muscles, joints or ligaments at the feet, knees, hips and even low back.

Over pronation can cause or contribute to the following:overpronation causing posture change

  • plantar fasciitis and heel spur formation

  • callusing of the big toe

  • bunion formation (or outward deviation of the big toe)

  • shin splints

  • knee pain (commonly irritation to the medial collateral ligament)

  • IT band syndrome

  • arthritis

How To Correct Over Pronation:

The best ways to correct over pronation are custom orthotics prescription and rehabilitation of the lower extremity. Custom orthotics provide passive support to the arch whereas rehab helps to strengthen muscles that support the arch and improve balance and posture. Best results are achieved by combining both. If in addition to over pronation there is pain, manual therapies such as chiropractic care can help the problem heal faster and more completely.

Rehab for Over Pronation:

1) Short Foot Posture

Please enjoy the short video demonstration of the short foot posture exercise. This exercise helps to raise and strengthen the arch as well as correct the position of the ankle and knee. You need to master this exercise in order to proceed through exercises 2-5.

2) Short Foot Heel Rise

To further challenge and strengthen the arch, perform the short foot exercise, then raise the heels. The heels should be pointing slightly more towards the mid-line than a straight heel rise. Start with 10 reps performing the exercise in slow, controlled movement. This exercise targets the tibialis posterior muscle which supports the arch.

3) Short Foot Squat

While maintaining the short foot, perform a squat. A squat is done correctly when a neutral spine is maintained and the knees don’t travel past the toes. This exercise is designed to groove appropriate motor patterns. Start with 10 reps.

4) Short Foot One Leg Stance

While maintaining a short foot, try to balance on one foot with the knee slightly bent on the standing leg. Try to hold this position for at least a minute. Repeat for the other side. This is an excellent proprioceptive exercise.

5) Short Foot One Leg Star Excursion

Only perform this exercise if you have mastered the previous 4. This one is very challenging. While maintaining a short foot, stand on one leg with the knee slightly bent (as above). Imagine you are standing in the middle of a clock. Slowly point the toe of the non-standing leg from centre to a point on the clock and back to centre and to the next point and so on (as if you are tracing the outline of a star with many points). Focus your attention on keeping the standing leg strong and solid, only moving your non-standing leg. Repeat this pattern 3 times, then repeat on the other leg. This exercise is another excellent proprioceptive exercise which trains appropriate co-contraction of lower extremity muscles to maintain balance.

6) Bridge Exercise

Bridge exercises are great for strengthening the gluteal muscles. Gluteal muscle weakness often contributes to the over-pronated foot position.

Dr. Elisabeth Miron

Are you looking for custom orthotics in Aurora? Visit Dr. Miron’s website!

Lower Blood Pressure Naturally

lower blood pressure naturallyKnowledge is power. That is why I am about to share some natural ways to lower blood pressure, which is a major risk factor for atherosclerosis (or narrowing and hardening of the arteries).

High blood pressure is often described as the “silent killer” because often times, there are no clinical symptoms before a fatal event like a heart attack or stroke. The problem with high blood pressure is that over time, it damages the inner lining of arteries. This damage encourages formation of fatty deposits called plaques which narrows the arteries and strangles the blood supply serving vital organs. Narrowed arteries increases the risk for a complete blockage or clot. When a clot blocks the blood supply completely, the portion of the end organ that it supplies will die.

Scary stuff! So, don’t let this happen to you.

The good news is that for the majority of cases, blood pressure can be lowered naturally through lifestyle modification. If blood pressure can be controlled naturally, it can allow some people to come off their blood pressure medication safely. Though blood pressure medication may be a quick fix solution, it can come with a cost to your health as medications have damaging side effects.

Understand the Risk Factors:

Most of the items on the following list are modifiable risk factors for high blood pressure. A bit of motivation is all you need to get started in the right direction.

physical inactivity

tobacco use

being overweight or obese

insufficient antioxidants


excessive salt intake

inadequate potassium intake

drinking too much alcohol

certain chronic diseases (5-10% of cases)

family history of high blood pressure

older age

How to Reduce High Blood Pressure Naturally:

It is best to first discuss your blood pressure problem with a health professional before making drastic changes to your diet or lifestyle. A health professional will be able to give you more specific advice for your particular case and any precautions you may need to take.

Fix Your Diet

A healthy diet will encourage a healthy weight and a healthy body composition. Plenty of fresh fruits and vegetables are a must. They contain healthy proteins, antioxidants and fibers. Reduce your intake of sugar, sodium, fast foods, beef and pork, highly processed foods and caffeine. Eat potassium rich produce such as sweet potatoes, bananas, peas and honeydew melon.

Get Active!

With physical fitness, the heart becomes healthier and more efficient. Athletes have a lower resting heart rate on account of the increased efficiency. Over time, blood pressure also improves. If you are completely sedentary, start with something easy like 15 minute power walks and then build from there. People should aim for a minimum of 30 minutes of moderate intensity physical activity for most days of the week to enjoy health benefits.

Reduce Sodium Intake

Sodium encourages fluid retention and thus, with greater fluid volume, blood pressure increases. These days, reducing sodium intake means more than just going easy on the salt shaker. Read food labels. You would be surprised by how much sodium is in processed foods! Better yet, avoid processed foods and make you own – seasoned with herbs and spices instead of salt.

Give Yourself a Break from Stress

Work a little less. Relax with music. Take deep breaths with yoga. Do something just for you and find balance between work and play. Stress and anxiety releases hormones into your blood that increase blood pressure. Many people find that manual therapies, such as chiropractic or massage help with stress too.

Stop Smoking

Tobacco use will cause an immediate temporary increase in blood pressure. So, the longer you smoke, the longer your blood pressure will be high. Beyond this, toxic chemicals from smoking also accelerate damage to blood vessels and atherosclerosis. Smoking is one of the biggest factors increasing risk for heart attack and stroke, even in younger people! Second hand smoke is also bad.

Go Easy on Alcohol

Having 2-3 drinks in one sitting can temporarily increase your blood pressure and heart rate. Limit alcohol consumption to no more than 2 drinks for men and 1 drink for women per day.

Shed Some Pounds

Losing as little as 10-20 pounds can improve blood pressure significantly. Accomplish this through a healthy diet and some exercise.

Kick the Coffee and Drink Hibiscus Tea

Caffeine increases heart rate and blood pressure. Limit coffee and other caffeinated beverages. Drinking hibiscus tea has been shown in several studies to reduce blood pressure in hypertensive patients. Hibiscus tea is a beautiful red colour and tastes delicious. It is made from the calyces of Hibiscus sabdariffa (or roselle) plant.

Supplement with Coenzyme Q10

Coenzyme Q10 is involved in energy production. Organs with high energy requirements (such as the heart and liver) require more coenzyme Q10. Coenzyme Q10 is synthesized naturally in the body but it is also available through diet. For example, it is found in meat and fish, vegetable oils (especially soybean oil) and vegetables (especially parsley). Medications such as statins and beta blockers (which are used to treat cholesterol and high blood pressure respectively) inhibit biosynthesis of coenzyme Q10. Studies have shown that coenzyme Q10 can lower high blood pressure.

  1. Myers, J. (2003). Exercise and Cardiovascular Health. Circulation, 107;e2-e5.

  2. Shephard, R. & Balady, G. (1999). Exercise as Cardiovascular Therapy. Circulation, 99;963-972.

  3. Mozaffari-Khosravi, H et al. (2009). The effects of sour tea (Hibiscus Sabdariffa) on hypertension in patients with type II diabetes. Journal of Hypertesion 23, 48-54.

  4. McKay, D et al (2010). Hibiscus sabdariffa l. tea (tisane) lower blood pressure in prehypertensive a mildly hypertensive adults. The American Institute of Nutrition 140(2); 298-303.

  5. Rosenfeldt, FL et al (2007). Coenzyme Q10 in the treatment of hypertension: a meta-analysis of the clinical trials. J Hum Hypertens; 21(4):297-306.

Dr. Elisabeth Miron


Chiropractic Cure for Vertigo

vertigo and chiropracticVertigo is a type of dizziness in which a person has the sensation of spinning movement when stationary. There are many different causes for dizziness including, for example, low blood pressure, low blood sugar, anemia, anxiety, multiple sclerosis and various inner ear problems. Vertigo can be very upsetting and uncomfortable. It is important to determine the cause of dizziness such that an appropriate solution is found.

There are two types of vertigo that chiropractic care can correct. These are benign paroxysmal positional vertigo (BPPV) and cervicogenic vertigo. By far the most common type of vertigo is BPPV. Chiropractors are trained to differentiate between these types of vertigo using orthopaedic tests and to rule out other potential causes of dizziness (and refer if necessary).

Benign Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo is a type of vertigo that comes and goes based on head and neck position. When triggered, the dizziness can last a few seconds to a few minutes. Symptoms are commonly triggered by rising from sleep, tilting the head, rolling over in bed, looking up or sudden head motion. This type of vertigo is related to an inner ear problem and the most common cause is a sudden trauma (like a fall).

The inner ear is responsible for balance and motion sense of the head. Within the labyrinth of the inner ear are calcium crystals called otoliths (or “ear rocks”). In BPPV, the otoliths are dislodged from their normal position and migrate into the semicircular canals. The semicircular canals are oriented at roughly ninety degrees to each others. They are filled with fluid called endolymph and also have sensory receptors that are stimulated during head movement to provide motion sense. In BPPV, crystals in the semicircular canals stimulate sensory receptors adversely giving rise to feelings of motion when there are none (or vertigo).

The hallmark for diagnosis of BPPV is a positive Dix-Hallpike maneuver. This test will reliably provoke the vertigo and cause rotary or horizontal nystagmus (involuntary eye movement). It also determines the side of ear involvement.

BPPV can be corrected using either Semmont’s Maneuver or Epley’s Maneuver in which the chiropractor assists the patient in slowly moving their body, head and neck into appropriate positions to encourage the ear rocks to return to the correct location in the inner ear. Following the procedure, the patient is instructed to avoid sudden movements and to sleep for 2 nights in a recumbent position. This procedure has a 90% success rate and often only one treatment is required. If the dizziness returns, the procedure is repeated.

Cervicogenic Vertigo

Cervicogenic vertigo is dizziness that arises from the neck. For example, irritation or injury to the joints, muscles or ligaments of the neck can overstimulate proprioceptors (nerve endings that detect position sense) in the neck giving rise to vertigo. Uncomplicated cervicogenic vertigo can be treated by a chiropractor using muscle work (such as trigger point release or stretching), adjustment and/or physiotherapy modalities depending on examination findings. The goal is to balance the biomechanics of the neck and to promote a more rapid and complete recovery of the damaged tissues.

When to Seek Medical Care

By itself, vertigo is usually benign. However, if a patient experiences symptoms such as double vision, slurred speech, difficulty swallowing, fainting or collapse, numbness, nausea and/or unsteadiness when walking, (even if temporary), they should seek emergency medical care. Patients with progressive worsening symptoms or dizziness accompanied with fever and/or infection should also see a medical doctor.

Dr. Elisabeth Miron