We are moving

1A Anderson Avenue


After 5 wonderful years in Churchill Square it is time to move the St. John’s Back Pain Clinic to it’s new home at 1A Anderson Avenue. We will be sharing space with the Podiatry Associates. You will be able to access our clinic through the entrance at the right side of the building near the main parking lot entrance. The new clinic space is clean, bright and easy to access. There will be plenty of parking available and thankfully there are no meters.

The grand opening is October 25th, 2016. If you have an appointment scheduled on that day or after you can find us at 1A Anderson Avenue. If you have an appointment before October 25th please find us at our current location on the second floor of the terrace on the square. You will be able to contact us as always at 722-2300 or our usual email address @backpainclinic.ca.

So where is 1A Anderson Avenue? It’s 1.9 kilometers from Churchill Square. Head west on Elizabeth Avenue past Memorial and towards Freshwater Road. Take a left onto Anderson Avenue as you approach Summerhill Plaza. You’ll see us on your right as you reach Freshwater Road. You can view the map below to view the surrounding area. We’re looking forward to the move and are excited to show you our new space.

Clinic Map

You Have Arthritis

With a look of resignation my patient explains that their family doc told them their knee pain was arthritis and they could only manage it with anti-inflammatory meds and eventually surgery. I asked them, as I ask many patients, “what do you think arthritis actually is?”. Most patients look at me, somewhat perplexed, and give a variety of answers hovering around the idea of joint damage. In the most simplistic terms osteoarthritis is excess wear and tear on a joint, it’s not congenital, auto-immune, infectious or most importantly it is not an uncontrollable condition. For the average person (average meaning without major trauma, surgery etc) it’s the result of their sports, work and day to day activities compounded over their lifetime. Excess wear and tear.

Early signs of arthritis in the knee

Patients actual xrays with subtle loss of space between her femur and tibia. Thicker white lines on the joints surface of the femur and tibia.

Luckily this patients had been referred for knee xrays, so we took a look at her films together. I showed the patient the space between the bones in her knees and where I’d look to see bony indicators of degenerative change. We could both appreciate that the changes were subtle. We read the report together, “signs of early arthritic change” was the key line in the two sentence report on otherwise normal knees. So I asked another question “do you think arthritis is still the only reason you might have knee pain”. With a little more optimism she started to question the original diagnosis. For the sake of comparison the image on the right shows moderate to severe osteoarthritis.

This is more significant arthritic change. There is an obvious difference when comparing to our "arthritic" patient.

This is more significant arthritic change. There is an obvious difference when comparing to our “arthritic” patient.




Let’s look back at that simple definition, osteoarthritis is the result of excess wear and tear. Excess wear and tear is often the result of poor joint movement. Maybe the balance of leg/hip strength, flexibility and coordination has forced or allowed her knee to move poorly and now painfully. Maybe she wasn’t feeling the pain of worn cartilage but the pain of stressful movement.


What’s the point?

Worn cartilage and arthritis feels very much out of our control. Strength, flexibility and movement is something we can control, work on and ultimately improve. Arthritis is an effect of poor joint movement.  If you feel like throwing in the towel because you’ve been told or think you have arthritis it might be time to reconsider your understanding of this process. Take charge by truly understanding the source of your pain, not just the symptoms. Invest time moving your body and getting stronger.

Hip Mobility and Strength for Ultimate

Outdoor ultimate season is upon us.  Hip mobility as well as hip strength are important parts of both performance and injury prevention. I had the pleasure of running this part of the injury prevention clinic for new and intermediate players with Ultimate NL this week.

Great hip function is a necessity during sprinting, direction changes, jumping and lunging. This comes from a combination of the passive flexibility to achieve the positions needed but more important the strength and coordination to control those positions. Trying to achieve or control positions you don’t already own is a recipe for poor performance and eventually injury.

The mobility and strength drills in the video above are not for everyone and you may not feel comfortable performing each and every one. There should be no pain during or after the movements. You should feel better when they are done compared to when you started them. Loose, relaxed and comfortable. Take the simplest variation or make modifications so they can be completed comfortably and successfully.

Welcome Aleasha Kettle, RMT

Aleasha Kettle

We’re happy to announce that Ms. Aleasha Kettle, RMT has joined the St. John’s Back Pain Clinic team. As a recent graduate Ms. Kettle has a fresh view on injuries, treatment techniques and the recovery process. After her first week she is already building a name for herself and her appointment times are filling quickly. Within your first few minutes of meeting Aleasha you will quickly appreciate her passion for helping people recover from their injuries and also teaching them how to prevent those injuries from returning in the future.

Aleasha is accepting new massage therapy clients. Her current hours are Monday through Thursday mornings from 8:30am to 12:30pm and Fridays from 8:30am to 4pm. You can set up your first appointment online using our appointment requests tool, via email at [email protected] or call 722-2300.

Basics of gym strength training

This is a conversation I have regularly with people who are experienced with strength training at a typical gym (Goodlife, the Works, MAX, reps etc). They’re picking exercises they feel they can execute safely and correctly but aren’t sure how to organize their workout, sets, reps, etc. Here are some key points that I try to convey in that conversation.

1. Intensity

This refers to how many repetitions you can perform of an exercise based on the movement, resistance, speed/tempo and rest time. To keep things simple I consistently give this rule of thumb for appropriate intensity:

With appropriate intensity it should be challenging to complete an exercise 10 times

This means you’ve picked a movement, weight and rest time that allows you to complete it 10 times in a row where the last few repetitions were far more challenging than the first few. More intensity will allow fewer repetitions, once you pass 10 repetitions the intensity may be too low to stimulate muscle growth. High intensity requires more rest time and has a higher risk of muscle strain. Lower intensity allows less rest time and lower risk of muscle strain.

2. How many sets and exercises

Your muscles respond well to the stress that comes from at least 15 sets of exercises for a body region. This doesn’t mean 15 sets of one exercise. I’d suggest spreading that out over 2-3 sets of 4-6 exercises per body region.

3. Recovery time between exercises

This is an important part of training with a lot of numbers thrown around by trainers, bloggers etc. It relates back to intensity and your own aerobic fitness. As a simple rule of thumb I’d expect at least 30 seconds between the sets of any exercise. If you are still catching your breath from an exercise give yourself longer. If the next 10 repetitions at the same intensity become very difficult that may dictate your recovery time as well. Don’t assume every exercise needs 2-3 minutes rest between every set. You may be cheating yourself out of a great cardiovascular challenge with too much recovery time between sets.

4. Recovery time between workouts

An incredibly important factor that is often missed. This refers to the between workouts for a particular body part. Your muscles need 48-72 hours to appropriate repair and improve before they’re stressed again.

5. How do I gauge progress?

Gauge success by knowing you completed the desired volume of training 2-3 set of 4-6 exercises and with an intensity that challenged you to complete 10 repetitions. Over the coming weeks maintain the volume and see the intensity start to creep up and hopefully your required recovery time between exercises lower down closer to 30 seconds. Don’t base your success on how sore you’ve made yourself.


In summary a good organization for weight training would involve 2-3 sets of 4-6 different exercises for a body region. For each exercise aim for an intensity that makes 10 repetitions challenging. Give yourself 30 seconds or more to recover between sets and 48-72 between complete workouts for a body region.

Shovel Right, Shovel Light

Most people warn that shoveling to hard will give you a heart attack. While that risk is present the most common result of snow shoveling is a sprain or strain injury and it affects more people than you’d expect. Here are some tips to better prepare you for that next day in the driveway.

Shoveling is exercise

Accept this fact and you’ll fair much better. Getting out for a good shoveling session starts with the right gear. Warm, comfortable clothes and shoes with good traction is an important start. Like any other exercise it’s best to begin with a warm up. Take a brisk walk up and down your street and follow that with some light stretching. This could be as simple as giving yourself a nice big hug to jump start those shoulders, some light bending from side to side to loosen up that torso and take a few long strides steps to get those legs prepared.

Know your limits and rest when you need it. Each lift of the shovel should not feel like you’ve just set a personal best in weight lifting. Stay within your limits. Once you’ve done a dozen or so snow pushes or shovel lifts take a short break and strike that classic ‘elbow on shovel’ pose. This will let you recharge for the next round.

Finally, end that workout with an appropriate cool down. Take another stroll down the street and let those muscles relax with a light stretching session.


Out-smart snow

Your trusty shovel may be your greatest ally or leave you feeling better off with a spoon. Selecting a good shovel is key. Consider these points when selecting your shovel.

  • push style shovels are your best bet
  • a modest size blade helps you lift light
  • an ergonomic handle does make a difference
  • pick a handle length that lets you stay upright as your work
  • a slippery blade coating will keep snow from weighing you down

Plan ahead for the next snowfall and be proactive by heading out for a light shoveling session every 5cm or less. This will let you shovel lightly more often and take good size breaks in between. This will help you avoid trying to take 20cm or more of snow at once. Most often it’s large snowfalls that lead to shoveling related injuries.

Finally, there is always bad techniques in shoveling that can lead to injury even with the best of shovels. These technique tips can help you become more efficient and reduce your risk of injury.

  • Keep your nose between your toes to avoid twisting your back
  • Push the snow instead of throwing when possible
  • Bend your knees to let your legs do the work
  • Keep your head up to help you maintain good back posture

If done right shoveling can be a rewarding and healthy activity. Remember to treat shoveling like exercise by using the right gear, warming up and cooling down. Outsmart the snow by planning ahead, shoveling small amounts often and using the right shovel to it’s full potential. Like all activities you can expect some mild soreness that day and the next, if it goes beyond a couple days, seek professional care.

Vacation time

We have two excellent Registered Massage Therapists at the St. John’s Back Pain Clinic. One of our therapists, Crystal North will be on an extended holiday until September 22nd, 2014. Judy Batten will be continuing her usual hours during that time and is happy to see any of Crystal’s existing clients. Feel free to call or use our appointment request feature to book your appointment today.

My strength training is cardio

People at the gymI’ve had this conversation with numerous patients. We talk about the need for strength development and their response is “I go to the gym already”. I ask them to describe their work out and its something along these lines “20 minutes on the treadmill, 20 minutes on the elliptical and 10 minutes on the stepper”. I’ve come to learn that its a common assumption that anything that happens within gym walls will make you stronger. Here are some key concepts I pass along to patients:

1. Time under Tension

Tension is a major stimulator for strength changes. Enough tension in a focused period of time produced through a muscle contraction and you’ll get a cascade of events that lead to larger muscle fibers. The right amount of tension varies for every muscle and every movement but here is a simple rule of thumb.

With appropriate tension it should be challenging to complete an exercise 10 times

It can be that simple. From the opening example 20 minutes on the treadmill gives about 2000-4000 footsteps (people range from 100-200 steps per minute). To accomplish 2000 steps your body is generating far less muscle tension than is required to stimulate growth and your body uses many passive spring like tissues to supplement the muscle work.

2. Muscles become fuel

A very relevant point about cardio focused training is that if you calorie intake is less than your workout demands you will start breaking muscles fibers down to fuel the run. In a pinch proteins from muscle will give you about the same energy as the same volume of carbs. Once you burn up those energy reserves you’ll switch to a catabolic state when muscles are broken down for fuel rather than built up for strength.

3. Range of motion

The last point about strength is range of motion. Even if we ignored the effects of tension and muscle catabolism, cardio moves you through a very specific motion. If strength gains could be made they’d only apply to that movement meaning it won’t make you stronger to lift that box on to a shelf or smoke someone in a pushup contest.

That’s the usual discussion. If we have time I’d certainly expand on why strength is essential to good musculoskeletal health and the basics of a gym training program.

Heat or ice for back pain

heating padThis may be the most common question that comes up during a new patient visit. So doc, should I use ice or heat on my back when it hurts? My answer, with consideration of the literature that has been published over the last few decades, my clinical experience and the understanding of patient preferences is to use heat for diffuse muscular stiffness and ice for sharp localized pain.


How does heat help 

Heat is a natural by-product of muscle activity and the support systems for that muscle (blood/oxygen supply, nerves, lubricants, hormones) act differently to help as the heat rises. Heat opens blood vessels which means more blood carrying oxygen and nutrients to fuel and rebuild injured muscle as well as take away toxins and damaged tissue. A warmed muscle is more able to slide along muscles/bones/tissues in the area giving you decreased resistance or stiffness. Much like a warm up for sport heat can help bring muscles to a point where the muscle contraction and release is more efficient, bringing relief to that sense of stiffness.



How does ice help

Ice is very effective as a numbing agent to reduce localized pain, especially near the skins surface. Rather than popping pain killers and waiting, ice can often provide immediate pain relief to superficial regions like your tail bone. Opposite to heat, ice encourages blood vessels to constrict and reduce blood flow which can be valuable if swelling or bruising is an issue.


effective delivery

Your body is excellent at regulating its temperature. So that hot water bottle may bring your skin temperature up but an inch below the surface that extra heat is dissipating quick. The same idea applies for ice. If your target is superficial an ice or heat pack will work well with continuous heat for up to 30 minutes or ice applied in intervals of 10 minutes on, 10 minutes off. If the target is deeper or thicker tissue you may want to drive up your whole body temperature with a hot shower.


Quick summary

Heat works well for diffuse muscle stiffness when used for up to 30 minutes continuously.
Use heat packs for smaller superficial areas and a hot shower for deeper/thicker muscles.

Ice works well for superficial sharp localized pain.
Use ice packs in intervals of 10 mins on, 10 mins off for pain relief and to reduce swelling/bruising.

Always be cautious applying extreme temperatures directly on your skin.


Updated: Snowfall Warning for January 29, 2014


3:00 PM: We will be closing the clinic at 5pm. Those will appointments after 5pm will be contacted personally to reschedule. The storm should clue up overnight and we will be operating as usual tomorrow, January 30th. The roads are slick and a heavier snowfall is expected after 4pm. Drive safe.

11:00 AM: Skies are clear and winds are under control. Most weather centers are predicting heavy snow by 4 or 5pm. We will provide another update at 3pm.

After weeks of rain mother nature has dropped her temperatures to bring back winter. We’re expecting a heavy snowfall later in the afternoon on Wednesday January 29th, 2014. We’re planning to open in the morning before the potential storm. An update will be made at 11am and if necessary again at 3pm regarding afternoon and evening appointments. Those with affected appointments will also be contacted personally.