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By: Natasha Mansell, NT, CNE

Spring is springing, the birds are singing… and it’s time to make room in our lives for warmer weather, outdoor exercise routines and a rainbow of delicious summer foods! With this in mind, April is the perfect month to take stock of our health and make any necessary adjustments to our wellness routine.

Creating good diet and exercise habits is certainly a commitment, but it doesn’t always have to be a massive, instantaneous life overhaul that requires weeks of planning. Instead, try to take small steps towards better choices on a daily basis, and it will become much easier to build a lasting lifestyle of vibrant health. To help you get started, here are 4 simple tweaks you can start incorporating right away:

1.Drink a glass of warm lemon water every morning

 This is my favourite go-to tip for clients – as soon as you wake up, squeeze half of a fresh lemon into a glass of warm water. Give it a stir and drink it through a straw at least 15 mins before eating or drinking anything else. Adding this to your morning routine will kickstart your digestion, help to stave off mid-morning food cravings, balance your blood sugar, detox your liver, alkalize your system, lower blood sugar and reduce inflammation. Keep drinking water throughout the day to stay hydrated, promote weight loss and improve energy.

2. Replace one meal a day with a large salad

 Leafy greens are a staple of any healthy diet, and a colourful, filling salad is the best way to get them into your life. For lunch, grab a couple of large handfuls of organic baby spinach or kale, add your favourite raw veggies or even fruit (berries and apples are delicious!), and throw in some protein – hardboiled eggs, beans, chicken or salmon. Remember to get a good amount of healthy fat in there, such as nuts, sunflower seeds, pumpkin seeds, and avocado. These will keep you full, and help your body to absorb all the nutrients you’re taking in. For dressings, avoid the sugary store-bought ones and make your own! Olive oil mixes perfectly with a bit of vinegar or lemon juice, and just a hint of maple syrup or honey.

3. Take a probiotic once per day

Our gut bacteria play a major role in everything from immune system regulation, allergy prevention and digestive happiness to reduction in inflammation, bone weakness and risk of cancer. With modern day dietary, environmental and medical (ahem… antibiotics) toxins offsetting the balance of these bacteria, they need as much support as they can get to keep doing their jobs well.

Many brands of the probiotics available are packed with a variety of Lactobacillus and Bifidobacterium strains that can do wonders for your health. Talk to Green Base’s Naturopath, Dr. Alex, or Nutritional Therapist, Natasha, to find a brand that’s right for you!

4. Revamp your snacks

 There is nothing wrong with snacking, as long as you are snacking smart! When a craving strikes or energy starts to lag, it is way too easy these days to grab a processed ‘protein’ bar, muffin, soda or double-shot-skinny-vanilla-no-foam-extra-rainbows-and-unicorns latte. None of these options contain the magical protein + fibre + (good) fat combo that will fuel your metabolism, while balancing your blood sugar between meals. Instead, plan ahead by stocking your kitchen with whole fruit, veggie sticks, rice crackers, almond butter, hummus, hardboiled eggs, and homemade trail mixes and energy bars. If you have an organised, readily available stash of these health-promoting snacks, you won’t need to resort to processed quick fixes that break down your wellness routine.

Wishing you all a happy and healthy Spring!

An Athletes Curse: Delayed Onset Muscle Soreness

An Athletes Curse: Delayed Onset Muscle Soreness

By: Robyn Ellis, RMT

As the snow clears and the warm weather beckons us outside it’s easy for us to get a little excited and over-ambitious about getting out and getting in shape. Runners start running, outdoor boot-campers start flipping tires and yogis start taking over the park and EVERYONE overdoes it. A day or two days later you feel it, the pain of Delayed Onset Muscle Soreness.


Delayed Onset Muscle Soreness, or DOMS, is the muscle pain that occurs 24-48 hours after physical activity and tends to last for 2-3 days. It is believed that DOMS is caused by micro tearing of the muscle fibres, primarily during eccentric muscle contraction, and the inflammatory process that is a result of this tearing.


During activity, especially if it’s a new activity, excessive loads are placed on muscle fibers and this is what causes the micro tearing, more specifically, an ECCENTRIC muscle contraction. An eccentric muscle contraction is when a force is applied during the lengthening phase of movement. For example; the lowering phase of a bicep curl, the downward phase of a squat or lunge  but also the load on the quadriceps muscles when the knee bends with the force of your own body’s momentum when walking or running downhill. But these aren’t the only causes of DOMS, any form of excessing load that you are unaccustomed to can cause micro tearing and therefore DOMS.


Good question… some say you can and some say you can’t. Here’s what I recommend:

  • Always warm up, especially the muscle groups you plan to use during your activity
  • If starting a new activity regime be sure to progress slowly, too much too fast is a sure-fire way to get injured.
  • Allow rest days after intense work outs. This doesn’t mean do nothing, it means go easy on your body when suffering from DOMS


My number one recommendation when you are experiencing DOMS is to go easy on your body but to KEEP MOVING. Being sedentary after an intense work out is a bad idea, you want to stay activity to ensure that your range of motion and muscle length won’t be compromised causing more problems later. Although there has been no objective research done saying that STRETCHING will help with your DOMS symptoms but then again, there’s no research that says it doesn’t. From a muscular standpoint, when you use muscles they shorten and if you don’t lengthen them they will likely remain short and this could cause more damage than good.

Something you can try as a post-workout soreness prevention tool is a HOT/COLD FLUSH in the shower or bath. Switching from hot to cold a few times causes a vasodilation/vasoconstriction action that acts as a pump to flush away metabolic waste caused by exercise and bring new, oxygen rich blood to the area. *Always finish with COLD, it’s not the best feeling but it can help avoid excessive inflammation.

Here’s some shameless self-promotion… MASSAGE THERAPY is a fantastic way to ease the pain of DOMS. It helps to flush away residual inflammation but also relaxes the muscles and relieves pain and muscle adhesions.


Typically DOMS is not a serious condition but there are exceptions to every rule. The pain of DOMS will eventually go away in about 2-3 days, if your pain lasts longer it may mean that you’ve cause more damage than just micro tearing and you may have a more serious muscle strain. Signs like bruising, swelling and redness may indicate a sprain or strain and you should use your best judgement about whether to see a doctor.

More seriously though is the potential of kidney damage. Excessive muscle damage causes a release of a protein called MYOGLOBIN into the circulatory system. Normally, myoglobin is filtered through the kidneys and excreted in the urine. Excessive and recurrent muscle damage can cause too much myoglobin in the blood and this can be too much for the kidneys to handle and can cause a condition called MYOGLOBINURIA, that means an excess of myoglobin in the urine and this can cause Kidney insufficiency or failure. A sign of myoglobinuria is very dark, even brown, urine. If you think you may be experiencing myoglobinuria it is important to see your doctor.


Happy Spring Time Everyone!

Patellofemoral Pain Syndrome: The Bane of the Novice Runner

Patellofemoral Pain Syndrome: The Bane of the Novice Runner

By: Dr. Joel Dixon, DC

This winter has appeared to come and go with little more than a whimper and if you’re like me you’re probably itching to get outside and enjoy the fantastic weather that is around the corner. For some individuals this will entail running, biking and recreational sports. The one unifying factor for all of these people is that a significant percentage will experience knee pain that will either affect their performance or prevent them from participating all together. Although there are a number of different possible causes for knee pain in active individuals, patellofemoral pain syndrome (PFPS) is one of the most prevalent and accounts for 25-40% of all knee pain complaints seen in sports injury clinics. The purpose of this article will be to shed light on the cause, prevention strategies and therapies of PFPS.

What is PFPS?

PFPS is defined as diffuse pain over the front of the knee that is aggravated by movements that increase the compressive force of the knee (patellofemoral) joint. These activities include squatting, going up and down stairs, prolonged sitting and running. PFPS has been described as an orthopaedic enigma, in that an alarmingly high number of individuals with PFPS have recurrent or chronic pain.

Pain generating Structures

There is limited evidence to suggest that a number of local structures contribute to pain in individuals with PFPS. These structures include the infrapatellar fat pad, increased water content in subchondral patellar and bone marrow lesions. There is no new evidence that the lateral retinaculum contributes to pain in individuals with PFP. There are some theories that suggest the distal attachment sites of the IT band are pain generating structures. These include the attachment site to gerdy’s tubercle on the (anterior-lateral) tibia and the fibular head. There is no new evidence to support these claims.


Grays Knee 1 - PFPS


Is PFPS a self limiting condition or should I be worried about future complications? (PFP & PFOA)

A subject of major interest and debate is the possibility of a continuum from PFPS to arthritis (osteoarthritis) of the patellofemoral joint (PFOA). Although it is possible that there is a subgroup of PFPS that goes on to develop PFOA, there is no evidence as of yet support this view.

Quadriceps Activation and PFPS

One of the proposed mechanisms of PFPS is that there is an imbalance between the muscular pull of the lateral part of the quadriceps (vastus lateralis) muscle compared to the medial (VMO). Proponents of this theory believe this causes a tracking issue with the patella leading to PFPS. However, functional MRI, used to display activation of the quadriceps has raised doubts that altered quadriceps activation patterns are seen in individuals with PFPS.

Grays 2 - PFPS


Foot Mechanism and PFPS

The relationship between the biomechanics of the foot and PFPS remains unclear. Studies have shown that individuals with PFPS demonstrate increased rear-foot eversion, which may be linked with increased hip adduction. Rear-foot eversion is when your heel (calcaneus) bends towards the outside of your leg. This causes the arches (medial) of your feet to flatten, your shins (tibia) to rotate inwards (internal) and your knees to approximate (valgus loading). Nevertheless, no studies have yet to identify altered foot biomechanics as a predictor of PFPS.



Knee structure and biomechanics

New evidence suggests that abnormal structure or alignment of the knee cap and femur (PFJ) may lead to cartilage damage and focal areas of loading and stress that manifests as bone marrow lesions (BMLs).  The relationship between structure and biomechanics is not known. It is possible that structural abnormalities coupled with poor biomechanics will increase the likelihood of PFPS. On the other hand if there is normal structure then the biomechanics may not matter.

Taping and PFP

A review of 21 studies found that tailored patellar taping (customized to control for lateral tilt, glide and spin) provides immediate pain relief and promoted an earlier activation of vastus medialis oblique (VMO) contraction. Untailored patellar taping also demonstrated immediate pain relief; however, the results were not as prominent as the tailored group. Therefore, there might be promise for therapies such as kin taping.

PFPS and gluteus medius activation

The gluteus medius is an important abductor and stabilizer of the hip during a single leg stance. Evidence has shown that gluteus medius activation is delayed and of shorter duration in patients with PFPS. Studies have also shown excessive hip adduction and/or internal rotation in women with PFPS. It should be noted that the glut med is not strong enough to support the hip and that the opposite (contralateral) psoas major is important for stabilizing the low back and preventing hip drop.

Treatment options for PFPS

  • Facilitation (Neurological activation) and improved muscular endurance of the gluteus medius.
    • Previous Studies have demonstrated a 75% improvement in symptoms individuals with PFPS who perform rehabilitation exercises for the gluteus medius.
    • Facilitation of the glut med includes electrical stimulation with exercise, acupuncture with electricity and rehabilitative exercises, such as: side lying leg abduction with a resistance band, hip hikes and clam exercises.
  • Tailored Kin Taping of the knee joint to control undesired movement of the patella.
  • Minimize rear-foot eversion by working on short foot exercises or using orthotics.

*All of the information provided is based on the current evidence from the 3rdInternational patellofemoral pain symposium*

Tension Headaches and the Myodural Bridge

Tension Headaches and the Myodural Bridge

-by Dr. Joel Dixon, DC.

Headaches are among the most prevalent healthcare disorders affecting North Americans. The most common type of headache is a tension headache. Tension-type headaches affect 30 – 80 % of the general population (women are 2x’s more likely to be afflicted) with the average individual experiencing tension headaches twice a month. Three percent of the population suffer from chronic daily tension headaches. Tension-type headaches are usually classified as either episodic or chronic based on the frequency. According to the International Headache Society (IHS), episodic tension headaches occur less than 15 days per month; whereas, chronic tension-type headaches occur more than 15 times a month, for at least six months.

Signs and Symptoms of Tension Headaches

Tension Headaches are characterized as a squeezing or vice sensation that presents bilaterally on the front, sides or top of your head. Patients with tension headaches tend to notice that their symptoms present later in the day, are associated with stressful events and affect a persons ability to concentration. Research has shown that the intensity of tension headaches increases with the frequency in which they present.

Tension headaches differ from migraines in that they do not present with neurological impairments, such as: vision, balance or strength deficits. Patients usually do not present with severe sensitivity to light/sound, nausea and vomiting.

Causes of Tension Headaches

There is no definitive cause or family predisposition for having tension-type headaches. Tension headaches are usually associated with inadequate rest, poor posture, emotional or mental stress, depression, fatigue and overexertion.

Suboccipitals and the Myodural Bridge

RMAJ (Blue), Inferior Oblique (Red), Superior Oblique (Green)
RMAJ (Blue), Inferior Oblique (Red), Superior Oblique (Green). RMIN not shown.

One proposed mechanism for the cause of tension-type headaches that has gained a lot of traction in recent years in the relationship between the suboccitipal muscles and a myodural bridge. Before we continue, let’s cover some basic anatomy.

The suboccipitals are four small muscles that are located on either side of the base of your skull. The four muscles are rectus capitis posterior minor (RMAJ), rectus capitis posterior major (RMIN), inferior oblique and superior oblique. The subocciptal muscles are responsible for fine motor control; as well as stabilizing, extending and rotating the head and neck. Smaller muscles like the subocciptials tend to have a lot of sensors, such as muscle spindlesthat detect the rate in which a muscle changes its length or position. This positional awareness is called proprioception and is often described as your sixth sense.  The suboccipitals are so important for propriocetive information that one study found that the inferior oblique and RMAJ had 242 and 98 spindles per gram of muscle tissue, compared to the traps and lats which had 2.2 and 1.4 muscle spindles per gram.

The other proposed mechanism of the suboccipitals is that they have been shown to modulate the tension of the myodural bridge. The myo (muscle – suboccipital) dura (outer most pain sensitive lining covering the brain and spinal cord) bridge is a ligament like structure that attaches the suboccipital muscles to the dura. The bridge provides passive and active anchoring of the spinal cord. It also prevents the dura from buckling inwards when you extend your head. Conversely, it prevents compression of the spinal cord when you bend your head forward. Of the four suboccipital muscles, the RMAJ, RMIN and inferior oblique have all been shown to have their own myodural bridges. It is the job of those muscles to adjust the tension of the bridge (via the stretch reflex), anchoring the spinal dura during changes in head and positioning.

When there is significant trauma to the neck, studies have shown that the cross-sectional area (CSA) of the suboccipitals decreases (atrophy). Reserach has also shown that there is a correlation between the decreased CSA of RMAJ and RMIN in individuals with chronic tension-type headache. The reason for this is following an injury to the neck, the subocciptals alter their function, and lose some of their sensory information and endurance strength capabilities. This affects their ability to anchor the spinal dura during head and neck movements, causing the dura to buckle with neck extension. A reduction of sensory information also alters the gate control of pain.

Myodural Bridge and Post-Concussive Symptoms

A recent article published in the American Journal Neuroradiology looked at the CSA of the RMIN in individuals with post concussive symptoms. The researchers found that a smaller CSA was associated with increased symptom severity, longer recovery time, poor verbal memory performance and increased prevalence of headaches. The authors concluded that

‘Given the unique connection of this muscle to the dura, this finding may suggest that pathology of the myodural bridge contributes to symptoms and prognosis in concussed individuals’.

Treatment of Tension Headaches

The initial pharmaceutical Intervention for tension headaches is over the counter pain medication. Pain medication, muscle relaxants, anti-depressants, blood pressure medication and anti-seizure medication may also be prescribed in a preventative, daily nature. Patients should be informed that taking daily medication for headaches can lead to medication overuse headaches.

Therapeutic Interventions for Tension Headaches

For chronic tension-type headaches the Canadian chiropractic association’s clinical practise guidelines (CPG) recommend low force mobilization of the head and neck. The CPG also mentions a high quality study that found spinal manipulative therapy (adjustments) to be effective for chronic tension type-headaches. Kahkeshani and Ward found similar results in their study. They postulated that the myodural bridge provides a mechanical explanation for the efficacy of massage and manipulative treatments with tension and cervicogenic headaches. Other therapeutic interventions include deep neck flexor endurance exercises, as well as subocciptial rehab exercises.