Move Better, Perform Better

Low Back Pain, How a Chiropractor can help?

Low back pain has been ranked as the leading cause of disability among 291 conditions examined by the Global Burden of Disease study in 2010. Low back pain can be caused by many sources from the body such as muscles, discs, ligaments, nerves and bones, and it’s important that all these potential sources are examined when obtaining the best pain relief techniques.

A Chiropractor is a type of doctor that specializes in the diagnosis and management of musculoskeletal injuries of the body. A lower back injury falls into this category, and classically, Chiropractors have been the go to doctors to help with these conditions. The first visit to a Chiropractor will include a focused clinical history where questions will be asked about past injuries, family and personal health history, current health problems, current and past health care measure taken, lifestyle and diet choices, and sleeping habits. Then a physical examination will be conducted that includes a comprehensive look at what is causing your back pain. This may include taking your blood pressure and/or X-rays, or requesting co-management with your family doctor to discuss other medical options.


After examination, the Chiropractor will offer a diagnosis and treatment plan that may last only a few visits to multiple visits over several weeks, it all depends on the nature of the injury. It is not uncommon for manual therapists to ask patients to seek manual care to treat their injuries over several weeks, as the body takes time to respond to the manual therapy, exercises and rest in between.

There are a variety of treatments Chiropractors use to help find pain relief for their patients. Chiropractors often use manipulation and mobilizations of the spine (moving the joints of the spine) to help improve the ranges of motion and activity of the spine and muscles, while offering pain relief to the localized area, thus improving function overall. In addition, the use of manual muscle therapy techniques and acupuncture can also be used to help with pain relief. It is important that your Chiropractor also works in finding a way to increase the active component of your treatment plan by prescribing home based exercises. Studies do show that when home based exercises are paired with visits to the chiropractor, low back pain intensity is quickly reduced and there are higher chances of long term success in reducing onset of the pain and preventing re-injury.

It is true that you are more likely to re-injure your back after you have already injured it before! That is why it is also important to get your low back checked out a few times a year even if you are not experiencing any pain. Remember, pain is your body’s way of saying I need rest to recover in the immediate, similar to how your lips get dry when you’re very thirsty. Now you don’t drink water when your lips only get dry do you? So why seek manual therapy for low back pain after experiencing it before, only when you have pain? So be active and proactive when seeking care for your low back pain!

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Dr. Nourus Yacoub, DC
Medical Acupuncture Provider

Dr. Yacoub is the owner and Chiropractor at the Royal Chiropractic and Sports Injury Clinic. He currently works with The Sports Clinic at the University of Toronto Mississauga , and is the medical trainer for the University of Toronto Mississauga Varsity Eagles., Team Chiropractor for the Evolution Martial Arts Fight Team and the MAFA Fight Team.

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3 Shovelling Tips to keep your back healthy during the Storm!

If your thinking you don’t have to read this because “I have a snow blower”, you’re not in the clear just yet! So there’s a storm, and you have to shovel, let these three tips help you prevent any aches and pains that you may encounter during or after the task.

1) Warm-Up Before Going Out

Take about 10 minutes and lightly stretch out the upper and lower body: Hamstring, low back, abs, hips, shoulders and neck should all be stretched. After a set of light static stretching, try a dynamic set of stretches like jumping jacks, running in one spot, forward and rear shoulder shrugs, and body squats.

2) Keep it Close and Breathe

When shovelling, keep the shovel close to your body. Have a tight grip and bend and lift with your knees and hips, not your back! If you start feeling that your back is getting sore, or tired, stop, take a breath and think what part of the body your are using when tossing that snow! Try to feel your knees and hips doing most of the work. Mind the way you’re breathing…tighten that abdominal core by breathing deep, creating a braced-like feeling. This brace helps keep those muscles tight and will allow you to rotate with less pressure on the low back.

3) Have a Plan and Take your Time

Don’t just go in without a strategy. Shovel with some intention, understand the dimensions of the driveway you’re about to shovel. If its near a sidewalk, you may want to start from there. Or if there is layers of snow, try shovelling off a layer first, then the second layer a bit later. That brings me to my next point, take breaks, take shifts, and don’t do it all in one shot! You’re more than likely to get injured when you are tired and your muscles are fatigued.

Remember to listen to your body, if it wants to stop, just stop…you will thank yourself you did!

Good luck and Shovel Safe!

Got a Question? Ask Below

Dr. Nourus Yacoub

Bite Sized Artichokes, Spinach, and Brie Hors d’oeuvre

With the Year coming to an end, many people are taking to condo/house parties for their New Years Eve bashes. Here is one of my favorite bite sized snack recipes that packs on some great health benefits and would make a great addition to any party! it is easy to make and great for all the guests.

1 9-ounce box frozen artichoke hearts
2/3 cup cooked chopped spinach
1 teaspoon lemon pepper
1/4 teaspoon salt
18 thin slices brie

Preheat broiler to a medium heat, then prep the artichoke hearts according to package directions. Combine the spinach, lemon pepper and salt in a small bowl. Place each artichoke on a baking sheet, then top with the spinach mixture and place brie on top. Broil until cheese melts for about 2 minutes, then serve!

Health Kick: Artichokes are low in saturated fat and cholesterol. They are rich with a source of fiber, and pack a lot of vitamin A and C. And, they are full of minerals such as calcium, iron, zinc, sodium, potassium, manganese and phosphorus. Artichokes are rich with antioxidants, fight cancers, lower LDL (bad cholesterol) and blood pressure, cleans your liver, great for maintaining bone health and they are a vasodilator which helps bring more oxygen to the brain!  And in case you haven’t picked it up yet, for those of you who have one too many drinks at the NYE party, this veggie will help cure your hangover so you can start your New Years with a visit to the gym, like you planned…no excuses this year!

Enjoy this recipe and have a safe new year!

*Thanks to for this one!

Dr. Nourus Yacoub

Pumpkin Soup!….I Love Pumpkin Soup!

In those cold winter months, sometimes having a nice bowl of soup can really help warm you right up! Why not make it a pumpkin soup and add some nutrients to the diet! Pumpkins are full of Vitamin A, C and E which are powerful antioxidants. Vitamin A is very good for maintaining the integrity of your skin and helps protect vision. Also, studies show it can help protect against some cancers too! Pumpkin also has a rich source of Vitamin B which is good for maintaining the health of your digestive system, immune system, heart, nerves and muscles! Wait! Don’t throw the pumpkin seeds away…did you know that half a cup (100grams) of pumpkin seeds has 110% of the recommended daily intake of iron and just about ZERO cholesterol, not to mention its a great source of dietary fibre! Try topping of the soup with some of those or keep them as a pick me up snack throughout the day.

Say no to those canned soups and get your hands dirty in the kitchen with this warm pumpkin soup recipe:

Pumpkin Soup
1 cup organic chicken or vegetable broth
¼ cup unsweetened coconut milk
1½ cups organic canned pumpkin
½ Spanish onion sautéed.
1 cloves garlic, roasted
1½ tablespoons brown sugar
½ teaspoon paprika (optional)
¼ teaspoon cayenne pepper (optional
½ teaspoon freshly ground nutmeg
Salt and freshly ground black pepper, to taste

1. In a large non-stick wok pan, on medium heat, slice a clove of garlic and toss it in with a teaspoon of you favorite cooking oil (coconut oil is mine).

2. Add some small finely chopped onions for a bit of flavour.Sauttee them for a bit, until they get a bit brown.

3. Dump all the ingredients into the wok, and simmer on low to medium heat for about 7 minutes.

4. Garnish with toasted pumpkin seeds. Enjoy!

Dr. Nourus Yacoub, DC

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The Road to ACL Knee Rehabilitation

Ouch! You just had your ACL surgery and probably feel like you will never play your sport again….I get a lot of questions from many different level athletes regarding “How I should rehabilitate my ACL injury” and “why does my knee still feel unstable after a year of rehabilitation”. First off, I never tell my athletes they will never play again. I tell them you will play again, just takes time to recover from this injury, and that time you use to recover needs to be well spent!
Less than a half of athletes return to their sport after their first year following an ACL repair, and about 1 in 5 athletes will require a second surgery. As a health care provider, one of the biggest things to consider in your athlete is their neuromuscular control during dynamic movements. Any deficits in this system will result in increasing the chances of re-injury if no attention is paid to during rehabilitation.

After an ACL repair it is common to have muscle weakness, impaired movement, abnormal neuromuscular control and difficulty returning to your sport. These can lead to asymmetrical imbalances between both knees and hips and abnormal pelvic control. Some things to watch out for that affect neuromuscular control are: muscle weakness (or inhibition as I rather call it), joint effusion, abnormal ROM and impaired function, which can last up to several months following ACL repair. It is important to communicate that this process is going to take a little longer than normal to heal the ACL and get it back to functional working capacity for their sport.

When assessing neuromuscular control with your ACL repair patients, health care providers should be sensitive at picking up any: increases in external knee abduction, excessive out-of-plane knee loads, any frontal displacement of the trunk, decreased core proprioception, lower extremity biomechanical differences and flexor activation, between sides. Some test I like to use with my ACL patients to help assess for any asymmetries would be the Non-Weighted Front Squat, Prone Isolated Gluteal extension, Single Limb Hop Test, Tuck Jump, Drop Vertical Jump test and assessment of Deep Breathing Techniques. It is important to look for asymmetrical movement patterns during these tests, and even be sure to look at the opposite side (knee and hip)! In fact, I would argue that many health care providers don’t spend time assessing the opposite side (probably because we are driving toward a pain focused program of care and because we only spend about 15-20 minutes with a patient). Research has suggested that compensatory strategies of the uninvolved hip (transverse plane) are a primary predictor of risk factor for developing a secondary ACL injury. Other researchers argue to look at frontal knee plane and sagittal knee plan motions and postural stability as other risk factors to secondary injury. So, lets be smart health care providers when taking on a patient with ACL injury and preparing them to return to sport. I forgot to mention, we should also be looking for strength ratio symmetry between the quads and hamstrings (tests like the single hop test will help with this).

Ultimately it is the discretion of the health care provider to progress the athletes into the proper stages of rehabilitation while assessing neuromuscular deficits. There should always be good communication with the athlete and proper clinical judgment used when creating a proper progressive plan of management. I mean you shouldn’t get your ACL repair patient to do single leg hop after 1 week of surgery, duh! The main thing is to focus on restoration of symmetrical function and use those aforementioned tests to help determine the progress of any neuromuscular deficits as this is a big factor (I argue for it) in re-injury.

Now go out there and rehab properly, soccer season is approaching, wait isn’t it always soccer season?


Dr. Nourus Yacoub, DC

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Work, Work, Work but don’t let your posture down

With back to school and the new fall work schedule quickly approaching, we are going to be finding ourselves siting at the desk a lot, and as a result we may find ourselves suffering from poor upper posture, shoulder pain and maybe even headaches. Let me introduce you to what is known as Upper Cross Syndrome (UCS): Basically, it is a poor balance between the upper back muscles, neck muscles and shoulders. The person would usually complain of tightness in the front of the shoulder and chest area, have a head that protrudes forward, and upper back muscles that feel like steel! If you find that you have some of these, listen up, I got these 3 tips for you:

Preventing Poor Posture While Working

  1. Get up and Get Something!
    Often when we are seated, we tend to sit for a long time, finish our project and start another. Take about a 1-2 minutes break every 15 minutes from sitting. Get up from your seat, stretch around, make your way to the copy room, have a snack or a glass of water, do whatever you need to do just don’t sit. When we are seated, even when we think we are sitting with a neutral posture and crunching our abs to maintain proper stability, over time, our body likes to relax and your posture goes into a slouch. Our lower and upper back rounds out, our heads tend to inch forward, and our shoulders begin to round inwards. So by getting up, it gives your body a break from that poor posture technique and give you an opportunity to reset your posture. What I like to do is have a 15 minutes timer on my watch to remind me to get up, try it!
  2. Exercise!
    Some of the exercises that I find help my patients deal with UCS is scapular retraction exercises. All I recommend is about 1 or 2 sets of 10 reps per day, and the good thing is you don’t need a monthly gym pass, just a Tensor Band. The scapular is essentially that bulky boney part that makes up the back of the shoulder. First you would grab the tensor band in both hands and place it in front of you with your arms out, then begin by stretching the band about 25% of the way out and drawing your shoulder blades (scapula) in, squeezing them ever so slightly, and then relaxing back to the starting position. This helps wakeup the rhomboid muscles and mid and lower trapezius muscles, the ones that our body likes to forget to use, especially with UCS. I carry a tensor band in my bag, or keep one in my office desk, you should too.
  3. Stretch!
    With this UCS type of posture, one of the main problems is rounding of the shoulder. We can get a lot of other problems such as shoulder impingement with this as well. Often the pectoralis minor is the main culprit here, and we should know how to effectively stretch this one out. All you would need to do is hold your arms out against a wall and turn your body away from the wall, feeling the stretch in the upper shoulder chest area. Perform this with a few seconds hold about 10 times on each side.

Now, this should give you some temporary relief from poor posture, help condition against having it and help you get through your day without having the woes of feeling stiff after work! Remember to stay fit, health and keeping moving throughout the day!

Dr. Nourus Yacoub

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