• 5 Tips for Managing Intense Anxiety using Dialectical Behavioural Therapy Skills

    We have all experienced anxiety before, whether it be that nagging feeling that something bad is going to happen or that general sense of dread and apprehension. Anxiety can also manifest itself on a physical level, such as an upset stomach, dizziness or a racing heart beat. In some cases, these symptoms subside on their own and other times they require some form of intervention.

    There are some skills that one can use when trying to manage low to moderate levels of anxiety but what happens when anxiety is extreme and leads to a crisis situation? Over the years, many of my clients have reported that when their anxiety is extremely high, what they have learned in previous therapy sessions has not really work for them.  This is when I often turn to a type of therapy called Dialectical Behavioural Therapy (DBT) which takes the core concepts of Cognitive Behavioural Therapy and builds on them. DBT teaches an entire skill set dedicated to surviving a crisis, for those situations where the problem cannot be solved in the moment but finding a way to get through it is essential.

    Imagine you are at work and overcome with extreme anxiety but cannot leave as you have an important meeting to get to. Leaving in this situation would make things worse and likely exacerbate your anxiety. Say you are extremely anxious and want to engage in a problematic behaviour such as skipping your final exam. This would alleviate your anxiety but also has negative consequences like failing the course. These are examples of where you would employ your crisis survival skills and get through the situations (attending the meeting and writing the exam) without making things worse for yourself.

     When you are experiencing high anxiety, your fight or flight system has been activated by your sympathetic nervous system. This is because your body believes it is under threat and goes into survival mode. The sympathetic nervous system is responsible for the adrenaline coursing through your blood, your elevated heart rate and feelings of anxiousness. By activating your parasympathetic nervous system, (the body system that calms the physical symptoms after they have been activated by your fight or flight response) you can reduce your intense feelings of anxiety.

    The following 5 tips are skills that you can try the next time you notice your anxiety is extremely high:

    1. Paced Breathing:

    Deep breathing can trigger the effects of the parasympathetic nervous system.  In order to do this, you want to focus on your breathing by taking a deep breath in through your nose as you feel your stomach expand with air, and breathe out through your mouth, feeling your stomach deflate. You want to stay focused on your breathing and if it helps, visualize yourself breathing in one colour and breathing out another. If you feel your thoughts starting to wander, simply bring them back to your breathing no matter how many times it takes. Picturing the different colours can help focus your attention.

    2. Progressive Muscle Relaxation:

    Sitting in a comfortable position, gently tense a small group of muscles at a time, working your way up from your feet, all the way to your head, while making sure you’re breathing. Gently tense your muscles and hold for 5-7 seconds and then release. As you release the muscles, note the difference between tension and relaxation while you release. There are many guided relaxations online that can lead you through this process.

    3. TIP your body temperature:

    This can be done by submerging your face in cold water or placing an ice pack between your eyes for 20 seconds. This simulates the dive reflex, a body system in mammals that functions to slow our breathing and heart rate to preserve energy. This system would kick in if we were to be submerged in cold water. The temperature skill helps us to use this biological function to our advantage. It tends to work quickly but provides a short window. It is usually best paired with another skill such as the ones mentioned below.   (This should not be attempted by those with a heart condition or if they are taking any heart medication)

    4. Distraction:

    When you are feeling anxious, it is common to get fixated on something and have a hard time thinking about anything else. Distracting yourself by engaging in some type of activity can be very helpful in getting you through the situation and not act in a way which would have negative consequences. Choose something that you can get into that will act as a distraction such as: reading, watching TV, colouring, doing crosswords puzzles or calling a friend. Contribute by doing something nice for someone else that will take your mind off of what you are feeling. Change your emotions by watching a funny movie or listening to very upbeat music. Push away your anxious thoughts by counting backwards from 1000, listing your favourite TV shows and movies, or all the cities that start with the letter A. By focusing on listing things, it is hard to maintain and focus on your anxious thoughts.

    5. Self-Soothe:

    Do something that brings you comfort in the moment by pleasing your 5 senses. Take a bath, smell some scented candles, look at pictures of your pet or loved ones, listen to soothing or calming music, or eat something you really enjoy savouring every bite.

    Often it is the combination of these skills that are most effective. It is also important to note that these skills do not solve the reason why you are anxious, they are simply tools for reducing your anxious feelings in the moment. The best way to figure out which work for you would be to try with them and see which give you the best result.

    Source: DBT Skills Manual for Adolescents (Rathus & Miller).

    Please contact the clinic for a complimentary consultation with Sharon to find out more about how psychotherapy can be helpful for you.

  • Muscle Diary: Article 1. April 2017

    Types of muscle: SKELETAL MUSCLES make up 1 of 11 entire body systems, composed of 600+ muscles, which together account for ½ our body weight. CARDIAC MUSCLE refers directly to the heart. SMOOTH MUSCLE consists of the gut, arteries, veins and muscles of the eyes. Cardiac and Smooth muscles are influenced by the Autonomic Nervous System, which simply means we do not consciously utilize them.

    This Muscle Diary is concerned primarily with Skeletal Muscle, which is governed by the Somatic Nervous System, of which is consciously and reflexively controlled. We will address aspects of mechanical and physiological function as it pertains to everyday living/exercise as well as importance/relevance to remedial care, i.e.: Manual Medicine Practitioners/Trainers/Coaches/You – knowing yourself and what you’re made of and how you work.

    Some of the more common and relevant skeletal muscles discussed readily in Manual Therapy:

     

     

    What is Skeletal Muscle?

    • Actin and Myosin, contractile proteins, form sarcomeres. 
    • Sarcomeres are the smallest functional unit of a Skeletal Muscle. Many sarcomeres form a myofibril. 
    • Many myofibrils form a muscle cell/fibre.
    • Many muscle fibres form fascicles. Fascicles are arranged in neat: circular, convergent, parallel, and pennate forms. 
    • Many fascicles make a muscle belly. Some Skeletal Muscles have multiple bellies, like the bicep which has 2, tricep-3, quadricep-4. Each muscle belly is manually/palpably distinguishable.

    How does Skeletal Muscle Function?

    Skeletal Muscle Contraction: Once an action potential travels down a nerve to the end-bulb at the synaptic cleft, where the nerve meets the muscle, calcium ion channels open allowing calcium to flow into the end-bulb of the nerve, creating a more positive environment on the inside of the nerve fiber forcing its’ vesicles to release acetylcholine (neurotransmitter) into the synaptic cleft. Acetylcholine binds to the ligand-gated ion channels of the muscle where sodium is then able to rush in to the muscle fiber causing a muscle contraction! (Recall the actin and myosin mentioned above – the contraction happens here, in the sarcomere – the functional units of a muscle fibre). After this happens, acetylcholine detaches from the ligand-gate, where an enzyme comes to recycle it and sodium rushes out of the muscle fiber and remains in the synaptic cleft until another action potential calls upon it. Therefore, there are little pools of metabolic constituents (acetylcholine, sodium, calcium, etc) always hanging around waiting to do work.

    Why is this Important?

    Action potentials are voltage-gated, where as ligand-gates are chemically initiated. There are also mechanical-gates which Massage/Manual Therapy/exercise exploit in order to achieve specific goals. This understanding leaves us with 3 areas for issues to arise, altering function and perhaps requiring you to seek therapy. 1. Mechanics is structural injury to the muscle itself (mechanical-gates). 2. Nerve conduction may be structural or metabolic affecting voltage gates. 3. Metabolic issues of consumption/blood origin (ligand-gates). Manual Therapy can provide as passive aid, influencing any and perhaps all of these gates in the function of movement..

    Furthermore, uniformity in contraction is important, spreading load evenly throughout a field of biomechanical play. If this is not possible the body will adapt to provide the next best way. Sometimes our muscle fibres will grasp one another tightly in attempt to retain function. When this happens we feel it as a knot or hypertonic point. If when pressed that knot refers discomfort or pain to an area other than its own, this is a Trigger Point. Manual Medicine, like exercise, helps prevent knots, maintain load dispersal increasing the adaptive potential of body tissues. Through therapy/exercise there is micro tearing of the tissue. As a result angiogenesis ensues – building of new blood vessels in a process of meta-routing blood to heal the area. This is an adaptive process. This process may cause discomfort, as we often feel after physical exertion and sometimes after a Manual Therapy session. Hence the phrase, “No Pain, No Gain”. Conversation with your therapist, experience with proper exercise, will aid you in distinguishing between therapeutic pain/discomfort opposed to unwanted pain/discomfort.

    Awareness in biomechanics (form) allows us to micro tear (destroy) and promote (help build) appropriate lines of tension, both actively through activity and passively through therapy. This makes form during exercise and awareness/knowledge from your therapist necessary. In addition, this also makes stretching, strengthening, and cardiovascular maintenance equally important. Stretching ensures mutual communication between muscle fibres preventing knots, strengthening feeds the muscle fibre amplifying its capacity for power generation, and cardiovascular exercise ensures adequate food is available for muscle fibre function as well as maintains a healthy heart rate for all moments lived.

    Stay tuned for more Muscle Diary - Bianca Anzovino – RMT, Acupuncture & Dry Cupping Provider @ Lemon Water Wellness. bnarmt@gmail.com 
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    FUN FACT: There are tiny muscles that allow our hairs to stand up in the effect of giving us “goosebumps” – Erector Pili are their names.
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    At 9 Mill St. we want you to understand, in the best way we know how, what you are made of and how to take the best care of you and your friends and family. We learn from your questions, so drop by/book in!

  • When life give you Lemon Water

    Through its holistic outlook on healing, Lemon Water Wellness provide its patients with a newfound zest for life.  

    Check out the featured article in the latest version of The Hub

  • Exploring the Art, Science, and philosophy of Osteopathy

    Osteopathy has gained more attention in recent years due to the shift in focus to a holistic approach to health.  Lemon Water Wellness Clinic now offers Osteopathy Manual therapy treatments as part of its integrative approach to wellness.  Although, osteopathy has been around for over a century (founded by Dr. Andrew Taylor Still) and well known in Europe, its practice is relatively new in Canada.

    For this reason, the general population is for the most part unclear about what it involves. The purpose of this blog entry is to help provide some insight into what osteopathy is, the philosophy, and other frequently asked questions regarding treatment.

    What is it?

    Osteopathy (http://osteopathyontario.org) involves gentle hands-on treatment that focuses on removing restrictions and the restoration of movement and function to the entire body in order to restore the body’s natural balance, optimal function, and healing ability. It is unique, in that the practitioners have a deep understanding of the anatomical and physiological interrelationships of the body.

    It considers the whole person:  body, mind, and spirit with treatment individualized to determine the underlying cause of health concern, not just focusing on symptoms.

    Osteopathy Manual Practice utilizes fine-tuning precise palpation to assess and treat in order to restore or maintain health. It involves a silent dialogue between the patient’s tissues (fascia, fluidic, energetic rhythms) and hands of the practitioner. Sensory palpation and a very specific and deliberate motion is applied to the intended tissue.

    Key components of Philosophy of Osteopathy:

    1) The body has an inherent ability to self-regulate and self repair constantly adapting to maintain its balance. The body needs to be mobile to be able to carry out this function. Osteopathy is based on supporting the natural mechanisms of the body by identifying and helping to remove barriers that would interfere with the body’s expression of health and self-healing ability.

     2) The functional unity of the body.  This means that one part of the body or one system (circulatory, nervous, visceral (organs), musculoskeletal, emotional) does not act in isolation. The body acts as a unit and there is constant communication between systems to maintain health. If one system or area is in dysfunction this will impact the other areas of the body.  The body has an important connector called fascia that essentially unites the body.  If you pull on the bottom of your t-shirt you will feel tension at the top and vice versa. The t-shirt can be used as a metaphor for fascia and gives an idea of what can happen within your body. 

    3) The structure of the body affects its function. When an area of the body is not moving well it will disrupt the function of not only that local area but also may disrupt global health and function of the individual.

    4) The movement of fluids is essential to health- this refers to the importance of maintaining a free pathway for all fluids of the body-lymph, arterial, venous return. If one area of the body is not mobile it can compromise the movement of this fluid flow that ultimately disrupts the health of the person. Supporting a clear pathway for neurovascular flow is a key part of osteopathic practice.

    Some of the osteopathic treatment techniques that may utilized when appropriate include:

    • Cranial sacral therapy
    •  Muscle energy
    • Gentle spinal and joint mobilizations
    • Myofascial/soft tissue techniques
    • Counterstrain technique

    Examples of conditions (not limited to) that osteopathy assists in treating:

    • Sports injuries
    • Chronic pain
    • Asthma
    • Sinusitis
    • Back pain
    • Neck pain
    • Sciatica/SI joint pain
    • Urinary Incontinence
    • Headaches
    • Migraines
    • Insomnia/sleep difficulties
    • TMJ/jaw pain
    • Digestive problems-Irritable bowel/constipation/bloating
    • Anxiety/Stress
    • Post Concussion Syndrome

    Frequently Asked Questions:

    What should I wear to my osteopathy appointments?

    Loose, lightweight clothing is recommended during treatments. To evaluate your skin/spine a sports bra/bra/tank top is helpful for women.

    What can I expect during my osteopathy initial appointment?

    • Health history: We will discuss your current health symptoms as well as your lifestyle and past medical history. To identify the underlying cause of your health symptoms and rule out serious pathology, it is important to have a thorough understanding of your health history. The body has to adapt to physical stresses, injuries, traumas, and emotional stresses that we experience throughout our lifetime. Your current pain/discomfort may be a sign of the body’s difficult adapting further.
    • Observation of Posture and Gait
    • Hands-on assessment: A physical assessment will be conducted to help determine primary problem areas. A hands on assessment through palpation and gentle mobility testing of various body structures to evaluate joint biomechanics, tissue restrictions, tone and mobility. Functional strength and range of motion testing may be used as well.
    • Upon completion of the assessment, I will discuss the treatment plan with you with recommendations
    • Referral to medical doctor (eg. blood work, x-rays) if there is any indication from your symptoms/assessment that further testing is needed prior to osteopathic treatment.
    • Initial treatment-hands on evaluation and prioritize what areas to treatment first. Areas that get treated first may not be where you are experiencing symptoms. This is because, osteopathy works on underlying strain patterns to ultimately help your body balance itself. There is a trickle down effect as the body balances itself.

     What to expect on follow up treatments?

    Each treatment session, the practitioner re-assesses areas and evaluates how the body has adapted to previous treatment.  As an Athletic Therapist, Lindsay also has expertise in therapeutic exercise and functional movement. This may be incorporated into treatment when appropriate.

    • Review of changes in medical history/symptoms
    • Quick re-assessment active testing and hands on assessment
    • Treatment including local, regional, global integration

    Is the treatment passive?

    No from the patient’s perspective or from an observer it may appear passive but it is quite the opposite.  The Osteopathic Manual Practitioner acts as a facilitator for your body to balance itself. This is why it is important to not sleep during the sessions. You may be asked during treatment to focus on breathing, do active movements, or bring your awareness and presence on tissue tension changes. There is a “silent dialogue” between the osteopathic manual practitioners hands and patients tissues during treatment. Because of this there are times when it is best to not speak during treatment.

    What to expect immediately after treatment?

    24-72 hours post-treatment is the body’s integration period. During this time, it is common to feel more soreness, fatigue, muscle tension, headaches. Sometimes people experience a temporary exacerbation of symptoms. The body is integrating the treatment and changes during this time. It is important during this time to keep activity light and hydrated to help with integration.

    It is also recommended you refrain from other treatment modalities during this integration period (eg. massage, physiotherapy, chiropractic treatment)

    Follow up appointments are not scheduled before 1 week following treatment to allow the body to integrate.

    How many treatments do I need?

    The goal of osteopathy is to help facilitate the innate healing ability of the body. Osteopathy is not symptom or condition focused rather it involves treatment of the whole person to help restore natural balance. Because of this, individuals often do not experience significant changes until after 4-5 sessions while longer standing problems often require more treatment. However, some people do notice changes in 2-3 sessions. The longer you have been experiencing a problem, the longer it may take to resolve. Ultimately, it is individual and so the osteopathic manual practitioner will provide an idea of number of treatments, timing and re-assess along the way.

    Why are you treating my neck when I have back pain? Why are you treating an area where my pain isn’t located?

    Osteopathy is based on the interconnections of the body. Often due to these interconnections where you have pain isn’t the primary area that needs to be treated.

    Should I book appointments with osteopathic manual practitioner when I don’t have any current injuries, health concerns or my symptoms resolve?

    Yes. The focus of osteopathic treatment is to help facilitate the natural self-healing mechanisms of the body. Booking preventative check-in treatments can help to keep body in balance and maintain wellness similar to booking regular cleaning visits with your dentist.

    Insurance Coverage  

    Osteopathic treatment fees are eligible for coverage under most extended health benefit plans. My professional designation is D.O.M.P. (Diploma in Osteopathic Manual Practice) from the Canadian College of Osteopathy and I am a member in good standing of the OAO (Ontario Association of Osteopathic Manual Practitioners). 

 These are the credentials required for coverage by most plans in Ontario.

    Stay tuned for future blog entries on osteopathy perspective on health concerns.

    Practitioner

    Lindsay Dixon

    • Rehab and/or Clinical Pilates

      Pilates is an exercise regime that has been consistently thriving. Its ever-growing popularity has made it a favourite among celebrities, athletes, and the general population alike. So how does Pilates fit in to the rehab industry and aiding in your recovery?  

      Rehab (or Clinical) Pilates utilizes the classical principles developed by Joseph Pilates with traditional physiotherapy to help individuals establish control and regain balance in order to return to their pre-injury level. It consists of a set of exercises most often completed on special apparatuses, designed to improve strength, flexibility, and posture, and enhance mental awareness. The mind-body approach to these exercises help develop a strong and stable core by integrating the trunk, pelvis, and shoulder girdle. We hear the word core a lot, but what exactly is the core? The core or inner unit is a group of four muscles: the diaphragm, mulitifidi (tiny muscles found along the spine), transverse abdominis (the deepest layer to our abdominal muscles), and pelvic floor. When the core is inhibited, the body’s inherent response is to compensate by looking for stability elsewhere in the body. As a result we tend to overuse muscles in the upper or lower extremity, leading to restriction and overuse injuries.  

      Pilates is a great addition to traditional physiotherapy exercises and treatment because the exercises work two-fold, to elongate and strengthen muscles. This improves muscle elasticity and joint mobility, creating a more balanced foundation for the body. And a body with balance between strength and flexibility has been proven to decrease the likelihood of injury.

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