The holiday’s come and our fitness takes a hit. It happens every year: studies have shown that most adults gain weight over the holiday season and you’re likely amongst those counted. With a little mindfulness and three easy-to-follow hacks, this season will be different. 

EAT BEFORE THE PARTY

For most, the holidays are a time to indulge. Glutinous food is abound and it’s hard to show restraint.  Did you know that the average holiday meal ranges from 3500 to 4500 calories! That’s almost three to four times the calories needed for one day! In fact, 3500 calories is equal to one pound of fat! One of the most effective ways to balance your fitness goals and ensure you stay on track when it comes to eating is snacking healthily before you head to one of likely many events scheduled over the season. The method is simple but highly effective, and one that can be used throughout the year. Focus on healthy fats and lean sources of protein, as these will help to slow digestion and the absorption of alcohol.

HYDRATION IS EVERYTHING

With holiday celebrations also come larger than normal amounts of alcohol. It’s important to remain balanced, so rather than depriving yourself altogether, be smart with your alcohol intake.  This is a question I get all the time: Which alcohol is the healthiest??  The best way to go is to mix with water (sparkling or flat). Not only does it dilute the alcohol content to keep you going at a steadier pace, but it helps to level out the dehydration caused by your drink. Club soda is definitely better than carbonated fake juices—even better, try coconut water a wonderful hydrating mixer to keep you going through the night.  Loaded with health benefits, this hydrating drink is additive-free, and will replenish your electrolyte levels to help you wake up happier the next morning.

STAY ACTIVE ANYWHERE

Staying active will give you energy, reduce stress, tension and, of course, help subsidize some of the extra calories you may be eating. Travel allows for plenty of cardio options!  When you’re not in your regular routine you can add high-intensity interval training, which burns the maximum calories in the minimum amount of time, can be a blessing over the holidays. Set an exercise bike, treadmill or step machine for the interval program option, where periods of working out at high speed are interspersed with slower recovery intervals. If you don't have access to such machines, try sprints,  skipping, and burpees to name a few, alternating bursts of quick activity with a slower pace.  Lastly remember balance and moderation are key building blocks of a healthy lifestyle during the holidays and throughout the year.  

Devon Collins

Strength & Conditioning Specialist

devon@catalyst-health.ca

Headaches are a very common issue that likely everyone has experienced at one point or another. What was typically considered standard procedure – popping a painkiller , we now know is not necessarily the best approach to deal with headaches due to issues surrounding dependence, as well as negative repercussions on the stomach and liver with overuse.

So how can we manage our pain without turning to pills?

The trick is identifying the type of headache you are experiencing and addressing the root cause.

The 3 main categories of headaches are

1.     Vascular

2.     Inflammatory

3.     Musculoskeletal

Vascular

The most common vascular headache that is experienced is a migraine. Note that this term is often used to describe a particularly severe headache, however that is incorrect. Migraines are a particular type of headache believed to be caused by rapid constriction and dilation of blood vessels in the head. The mechanism is not fully understood, however it is thought to have a neurological component as well. Migraines range in severity, and can be proceeded by an aura (visual disturbances), as well as accompanied by nausea and sensitivity to light and sound.

Migraines typically have triggers that are associated with them.

Some common triggers include:

·      Tannic foods (tea, dark chocolate, red wine,cheese etc)

·      Citrus fruit

·      MSG

·      Stress

·      Sleep deprivation

·      Specific scents

Common treatment: Avoidance of triggers, as well as prescription medication taken as a preventative or abortive measure.

Alternative treatment:

·      Stress management through alternative therapies such as massage, meditation, and acupuncture has been shown to be effective to reduce migraine frequency and may  cut down on the amount of medication necessary for management

·      Peppermint oil has also been shown to be effective in stress reduction and as a distractant/ pain modulator.

Inflammatory

The most common inflammatory type of headache is a sinus headache.

The paranasal sinuses are hollow cavities within the skull, lined by tissue called mucosa. This tissue can become inflamed or irritated if the sinuses become full of mucus. This inflammation and/or pressure from the filled sinuses can cause a headache. Pain usually presents in the forehead, ocular, upper teeth region(s). In order to relieve this headache, you need to address the sinus issue.

Common treatment for sinus inflammation and lack of drainage is to take an over the counter decongestant. Antibiotics might be necessary if a bacterial infection is present.

Alternative treatment options:

·      eucalyptus oil in hot water,creating an antimicrobial steam

·      Using a neti pot or other irrigation system

·      Alternating hot and cold towels over the face

·      Acupressure over the sinus regions (the colored areas indicated above) can help facilitate drainage and offer temporary relief from the pressure

Musculoskeletal

This category encompasses the most common types of headaches that result from either joint dysfunction in the neck (cervicogenic headache), or muscular issues (tension headache).

These headaches will often present in the temple region or at the base of the skull and will be accompanied by neck and/or shoulder pain, stiffness and restricted movement.

The good news about this type of headache is that there is a lot that we as practitioners can do about it.

Pain causing tissue impairments

·      Trigger points aka “knots”

·      Increased muscle tension

·      Fascial restrictions

·      Compression of nerves/blood vessels

·      Compression of the joints in the neck

Causes

·      Poor posture (seated, slouched, head forward)

·      Carrying a heavy bag

·      Poor shoulder mobility

·      Poor breathing patterns

·      Trauma (whiplash, motor vehicle accident)

·      Poor eyesight

·      Grinding or clenching the teeth

·      Physical or emotional stress

Treatment

The treatment approach will be dictated by the underlying cause of the musculoskeletal headache. The combination of soft tissue massage, joint mobilization and an exercise/stretch program is typically indicated.

Chiropractic, Physiotherapy, Massage and Acupuncture are all effective and complementary therapies that can treat musculoskeletal headaches.

Self care

·      Heat can help reduce muscle and fascial tightness

·      Meditation, progressive relaxation and diaphragmatic breathing can help to manage stress

·      Peppermint oil can help reduce stress and act as a pain modulator

·      Practicing postural awareness, limiting screen time and time spent seated

**This is by no means an exhaustive list of headache types, only a select few of the most common.

Kisner, Carolyn., and Lynn Allen Colby. Therapeutic Exercise: Foundations and Techniques. 5th ed. Philadelphia: F.A. Davis, 2007.

It is no secret that sugar is bad for us. It causes cavities, makes our kids hyper, weakens our immune system and increases our daily caloric intake.  But what if it was doing more than that? What if sugar was responsible for the rapid rise in cases of obesity, type 2 diabetes and heart disease? What if there were recent studies linking sugar consumption to Alzheimer’s and the spread of cancer? And what if sugar was actually so addictive that we couldn’t stop eating it, even if we tried?

Pretty scary.

Sugar is found in almost everything – not just candy and ice cream. Start reading labels: sugar is the main ingredient in over 80% of food items sold in the grocery store. Pasta sauce, cereal, crackers, salad dressing, peanut butter, etc.. Even the labels themselves can be deceiving. The word “sugar” may not appear at all. Other common names include corn syrup, dextrose, evaporated cane juice, fructose sweetener, fruit juice concentrates, glucose-fructose, high-fructose corn syrup, honey, liquid fructose, malt syrup, mannitol and molasses (to name just a few). All sugars (including natural ones like honey and pure maple syrup) are processed by the body in the same way. Physiologically-speaking: sugar is sugar.

When sugar is consumed in large quantities (or even worse – large quantities in liquid form i.e. pop or fruit juice) it is sent directly to the liver where it is immediately metabolized into fat. This leads to insulin resistance and metabolic syndrome – both of which, in time, are the primary causes of type 2 diabetes, heart disease and obesity.

Sugar is completely void of any nutrients. It contains no fibre, no protein, no vitamins and no minerals. In fact: you’re the process of digesting sugar actually depletes the body of essential nutrients. Vitamin D, Vitamin C, B-vitamins, calcium, magnesium and chromium levels are all disrupted by sugar consumption. In small doses no big deal but imagine the long-term health effects that could arise if you are chronically deficient in all of these essential nutrients?

According to the most recent analysis from Statistics Canada the average Canadian consumes 110 grams of sugar daily. That’s 26 teaspoons a day – approximately 47 litres of sugar per year. Those statistics are from 2004 – odds are today’s numbers come in even higher.

All of the above should be reason enough to ditch the sweets, but it’s not that easy. Sugar is addictive. Research has shown it to stimulate the same parts of the brain as drugs or alcohol. A famous study published by the Public Library of Science (PLOS) found refined sugar to be more addictive than cocaine. When rats were given the choice over 94% of them chose sugar water over the drug (even the rats who were already dependent on cocaine quickly shifted to the sugar once it became available).

Research regarding the long-term effects of sugar consumption is still not definitive. Refined sugar was not a staple in the standard North American diet until recently. There are many factors that contribute to disease and illness – some that are within our control and others that are not. But it certainly does make you think twice about what you are putting into your body on a daily basis. What we are dealing with here may be more than just empty calories…

 

Danielle Bossin-Hardy

Holistic Nutritionist

Strength & Conditioning Specialist 

Enough talk. Get it done. 

Goals. We all have them. Unfortunately, not everyone can say that they have the best success rate when it comes to sticking to their goals all the way through. With the end of August approaching, and September on its way, many new fitness goals will be gearing up for a second coming. #newyearsresolutionpart2

Here are 5 tips that will help you keep on the right path towards your fitness goals.

1.Get it over with

Rise and grind! Get the crust out the eye and get your goals out of the way first thing in the morning. Putting the gym first on your to-do list has many benefits. It gets the blood flowing, metabolism moving, and finally, you get it out of the way. If you start with exercise first thing in the day you can put the “I'm too tired” excuse to rest.

2. Invest in your fitness

Make it cost you. Investing in yourself by purchasing a personal training or group fitness classes will greatly help with keeping yourself accountable. We don’t want money to go to waste by registering for a gym membership just to not attend. Investing in a trainer or a class will help to push you into the right direction. A good trainer will push you to take the right steps towards conquering your goals. Many trainers will also have cancellation fees which will add to you taking an initiative to get up and out of bed to get towards your goals. Of course, it isn’t the cheapest route but there surely are habits within your life that you should be cutting to reach your goals. Establish your values and see it through.

3. Tell the world

Telling people what your fitness goals are will help with accountability. The more that people know, the more likely you are not going to bail on your own goals. Speaking about your goals repeatedly also serves as a positive reminder to yourself for what it is that you are working towards. Telling those that are close to you also gives you supporters which can help catapult you towards your goals.. especially when times get tough. You are a supporter yourself and you don't even know it. All those likes you give to people you follow on social medias like Instagram and Snapchat help push them towards their goals. Have your own following and make something of it.

4. Train with a partner

After telling the world you should stumble upon individuals that share the same goals as you. Hold on to these people and create your own 'gym wolf pack'. There are many perks to training with a partner. From keeping each other accountable, providing each other motivation, and pushing one another in and out of the gym. Find your wolf pack and conquer your goals together one step at a time.

5. Set a time

Grab your calendar. Be realistic and set a day. This is the date you are going to check in to see the results of your hard work. When you set a time to accomplish a goal you are more likely to stay motivated and driven towards that goal. It works when your boss assigns you a task. In this situation you are your own boss with your own deadline set. So get to it.

When it is all said and done it is entirely up to you to achieve your goals. If you want something, you must put the effort to get it. It all comes down to the effort that your put forward. Establish a goal, think it, do it.

Steven Bolé

Strength and Conditioning Coach

Catalyst Health

steven@catalyst-health.ca  

Minty fresh breath. The flavour appeal to consumers for that ‘minty clean feel’ has always been a huge selling point for marketing products.   The benefits of peppermint—actually a hybrid of watermint and spearmint—goes much further than the tastebuds.
In capsules, added to food (it makes a surprisingly delightful addition to both salads and noodle bowls) or brewed in tea—regardless how you take your peppermint, here’s a few reasons why to do it.

1. Exercise longer and stronger. A study published in 2013 tested the effects of peppermint on 12 male athletes, and the results? Shocking. The participants used 0.05ml of peppermint for a consecutive period of 10 days, concluding that the oil not only improved performance levels and increased blood flow, but offered a high boost in the time until exhaustion—about 25 per cent.

2. Stomachache relief. Suffering with tummy pain? Peppermint has your back—or in this case, your stomach. Taking peppermint oil extract daily can decrease the severity of irritable bowel symptoms, according to the book Nature’s Medicines, “Peppermint oil extract relaxes the smooth muscles that line the intestines and other internal organ”. This sounds a bit gnarly, but the deal is that a good cup of peppermint tea will help your gallbladder secrete bile, which is used for the digestion of fats, and thereby calm your aches.

3. Stress calmer. Take a few moments out of your day to unwind, deep breathe, and be present in the moment. By placing a few drops of peppermint essential oil on the sides of your temple, you can reduce your stress level and achieve some instant relaxation. There’s a reason the mint scent is sometimes featured in our gym cold-compressed towel fridge! ;)

4. Natural nasal decongestant. Reach for peppermint before over-the-counter pharmacy methods to decongest your sinuses. Its natural scent opens your respiratory track, acting as a natural anti-inflammatory. Peppermint also holds antibacterial properties that put up a strong fight against any bacteria attack you may encounter -- although it's still summer, this is the kind of intel that could come in handy as soon as the cold winter hits us once again. And, as if you needed more reasons, it loosens bronchial constriction and allows you to breathe deeply.

5. Bad breath breaker. It isn’t by accident that 90 per cent of chewing gum is peppermint flavoured. Studies have shown that peppermint essential oil is more effective at beating bad breath than traditional mouthwash. So ditch the chemical-infused mouthwash and pick up the plant!

6. DIY peppermint clay mask – No better way to unwind than to pamper yourself with an face mask. Oily or acne prone skin? No more – mix together French Green Clay, crushed almonds, baking soda and 2 capfuls of peppermint oil. The clay deep cleans, the crushed almonds and baking soda exfoliates, and the peppermint helps you achieve that tingly-clean sensation.  

What do you use peppermint for?

Sam Turchan
Client Relations Manager
Catalyst Health
sam@catalyst-health.ca 

 In 2012, I graduated from the University of Windsor and began my studies at the Canadian Memorial Chiropractic College. As I now prepare to walk across the stage this summer, my family and friends still ask me “how is physio school going?” “Can you massage my feet for me?” “It took you eight years to become a chiro?!” At first, it broke my heart to hear that so many people (especially my friends and family) we ignorant to chiropractic. On top of that, it has been astonishing to hear such questions as “are chiropractic adjustments dangerous?” or, “is it true that chiropractic adjustments of the neck can cause stroke?” Before I go any further, lets clear this up.

The risk of suffering a stroke after a neck adjustment is reported to be less than 1 in 3 million. To put this into perspective, the odds of being struck by lightning in Canada are 1 in about 960,000. You’re greater than three times more likely to be struck by lightening than suffer a stroke after a visit to your chiropractor! The theory is that an adjustment of the neck may cause a dissection of the vertebral artery. Dissection (or tearing) of this artery may compromise blood flow to the brain, causing stroke. Research has show that more stress is placed on the vertebral artery when you check you’re blind spot while driving. Would you refrain from checking you’re blind spot while driving in fear of suffering a stroke? I guess that’s up to you.

Right Vertebral Artery

The stroke statistic is only based on a temporal relationship; patients who suffered a stroke reported receiving spinal manipulation as far as 2 weeks before the stroke was detected. This is a typical case of being at the wrong place at the wrong time. To date, there have been no studies showing that spinal manipulations (ie. adjustments) CAUSE a stroke. Statistics show that you are more likely to suffer a stroke after visiting your medical doctor! Once again, this is a temporal relationship.  During the initial stages of a stroke, symptoms may mimic musculoskeletal problems, such as neck pain, headaches, dizziness, blurry vision and so on. When these patients visit their health care professionals, or in this case their chiropractors, a stroke may already be in progress, but they are not aware of it.  If a proper and through examination of the patient is not completed, a stroke may go undetected until the condition has progressed significantly, after a visit with their health practitioner. Similar statistics are seen with low back adjustments and disc herniation.

Let’s get back on track now. What is Chiropractic? As described by the Ontario Chiropractic Association (OCA):

“Chiropractic is one of the largest primary health care professions in Ontario. It is a non-invasive, hands-on health care discipline that focuses on the musculoskeletal system. Chiropractors practice with a manual approach, providing diagnosis, treatment and preventive care for disorders related to the spine, pelvis, nervous system and joints. Chiropractors use a combination of treatments, all of which are predicated on the specific needs of the patients. After taking a complete history and diagnosing a patient, a chiropractor can help develop and carry out a comprehensive treatment/management plan, recommend therapeutic exercise and other non-invasive therapies, and provide nutritional, dietary and lifestyle counselling.”

Chiropractors manage physical conditions involving the nervous system and musculoskeletal system. A common question I hear is “what is the difference between a chiropractor and a physiotherapist?” There are many similarities in the scopes of practice of these two health professions. The main thing that I believe sets us apart from other manual therapists is our expertise in administering spinal manipulative therapy (SMT), aka “the adjustment”. SMT can be described as taking a joint to its passive end-range, then applying a high-velocity low-amplitude thrust to take that joint to its paraphysiological space. This space is found just past the passive end-range of a joint, without causing tissue damage. When this space is reached with SMT, an audible “pop” or “crack” can be heard, which is termed a “cavitation”. There is some controversy with the cause of the cavitation.  Previous theories suggested the cavitation to be the popping of gaseous bubbles. Most recent research has used MRI for real-time visualization of joint cavitation in knuckles. This study has shown joint cavitation to be due to tribonucleation: the rapid separation of surfaces (in this instance the articulating surfaces of two bones) with subsequent cavity (space) formation (Kawchuk, et al. 2015). If you are interested in seeing what cracking you’re knuckles looks like with MRI, check out the YouTube link below:

https://www.youtube.com/watch?v=aJLU-4M-hdE

SMT can be applied to any synovial joint in the body. A synovial joint is when two bones meet and are connected by a fibrous joint capsule. Within this capsule, the joint cavity is filled with synovial fluid, which acts to reduce friction between the articulating bone surfaces. For numerous reasons, a joint can become restricted. Inadequate movement and reduced joint space can lead to degeneration of the cartilage and pain of the joint. This is commonly referred to as “arthritis” (joint inflammation) or “arthralgia” (joint pain). SMT can be used in both acute and chronic joint issues to improve joint function and joint health. Aside from its local effects on the joint, SMT has also been shown to act as an analgesic, improve neurological function, improve muscle function and influence hormonal levels. When a joint is moved within its passive-end range, it is referred to as a joint “mobilization”.

As chiropractors, SMT is our bread and butter. It is what sets us apart from other manual therapy disciplines. Students at CMCC participate in over 4,200 hours of academic and clinical education, which is comparable to, if not more than, most medical doctor programs. In the first three years, 336 hours are devoted to the hand-on practice of assessments and treatments, including the SMT. The 4^th year involves a 12-month internship of providing chiropractic care under the license and supervision of an experience chiropractor. This internship includes 1000 hours of working in a clinic with a minimum of 250 SMT’s provided during a minimum of 380 patient treatments. No other health profession receives this much training and practice in the application of SMT.

Although joint manipulation can be applied to many joints in the body, there are 3 particular cases that I wanted to highlight: low back pain, neck pain and headaches.

Low back pain (LBP) is very common. Up to 84% of adults have low back pain at some point in their lives, and greater than 25% report low back pain in the last 3 months. In the US, health care expenditure for low back pain in 1998 was estimated at $90 billion. Since then, costs of low back care have risen. Low back pain is one of the most common reasons for missed work or reduced productivity while at work, resulting in high indirect costs.  LBP can be classified as acute (lasting <6 weeks), subacute (lasting 6-12 weeks) and chronic (lasting >12 weeks). Some key studies on low back pain and spinal manipulation (AHRQ, 2016) are highlighted below.

·       Acute LBP

o   2 trials found SMT to be associated with better effects on function versus sham SMT. Effects on pain favoured manipulation, but this finding was not statistically significant.

o   1 trial found patients with acute or subacute LBP found SMT associated with moderate effects vs. usual care on pain and small effect on function at short-term follow-up.

o   4 trials found SMT plus either exercise or advice associated with greater improvement in function at 1 week versus exercise or advice alone (no difference at 1 month or 3 months).

·       Chronic LBP

o   1 high quality trial found SMT associated with greater improvement in the “main complaint” vs. an inert treatment.

o   A systematic review found SMT associated with better short-term relief vs. other active interventions at 1 month and 6 months. SMT was also associated with greater improvement in function versus other active interventions at 1 month.

o   A systematic review found spinal manipulation plus another active treatment associated with greater pain relief at 1 month, 3 months and 12 months versus other treatment alone. This combination therapy was also associated with better function at 1 month, 3 months and 12 months.

·       Radicular low back pain (example, sciatica)

o   1 good-quality trial found SMT plus home exercise and advice associated with greater improvement in leg and back pain in 12 weeks versus home exercise and advice alone.

·       No serious adverse events were reported and most adverse events were related to muscle soreness or transient increase in pain.

Neck Pain, as described by the Ontario chiropractic association (OCA), can be broken down into non-specific (not due to whiplash) and whiplash-associated.

·       Non-specific à The annual prevalence of non-specific neck pain (aka “mechanical neck pain”) is estimated to range between 30-50%. Persistent or recurrent neck pain is reported by 50-85% of patients 1-5 years after initial onset. Its course is usually episodic and complete recovery is uncommon for most patients. 27% of patients seeking chiropractic treatment report neck problems.

o   Acute

§  SMT is recommended for the treatment of acute neck pain for both short- and long-term benefit (days to recovery, pain) when used in combination with other treatment modalities (advice, exercise, and mobilization).

§  Mobilization is recommended for the treatment of acute neck pain for short-term (up to 12 weeks) and long-term benefit (days to recovery, pain) in combination with advice and exercise.

§  Home exercise with advice or training is recommended in the treatment of acute neck pain for both short and long-term benefits (neck pain)

o   Chronic

§  SMT is recommended in the treatment of chronic neck pain for short and long-term benefit (pain, disability)

§  SMT is recommended in the treatment of chronic neck pain as part of a multimodal approach for both short- and long-term benefit (pain, disability, neck range of motion).

§  Mobilization is recommended for the treatment of chronic neck pain for short-term (immediate) benefit (pain, neck range of motion)

§  Manual therapy is recommended in the treatment of chronic neck pain for the short and long-term benefit (pain, disability, neck range of motion, strength) in combination with advice, stretching and exercise.

·       Whiplash-associated disorders (WAD) à WAD of the neck is further divided into 4 categories (WAD 1 to 4). 90% of WAD cases are diagnosed as type 2 – a whiplash injury with neck symptoms (pain and stiffness), musculoskeletal signs and substantial interference with activities of daily living (ex. Point tenderness, decreased neck range of motion). Recommendations for SMT vary, depending on the time frame since injury.

o   Very low-frequency of SMT is recommended in the initial 7 days post-injury

o   High frequency of SMT is recommended from 1 to 12 weeks post-injury

o   Low to medium frequency of SMT is recommended greater than 12 weeks post-injury.

Headaches, based on patient history and physical examination, can be further classified into 3 types: migraine, tension-type and cervicogenic.

·       Migraine

o   SMT is recommended for the management of episodic or chronic migraine (with or without aura)

o   Multimodal multidisciplinary care (exercise, relaxation, stress and nutritional counseling, massage therapy) is recommended for the management of episodic or chronic migraine

·       Tension type

o   Low-load craniocervical mobilization is recommended for longer term (ex. 6 months) management of patients with episodic or chronic tension-type headaches

o   SMT cannot be recommended for episodic tension-type headaches, and a recommendation cannot be made for or against the use of SMT for chronic tension-type headaches.

·       Cervicogenic

o   SMT is recommended for the management of cervicogenic headache.

o   Joint mobilization is recommended for cervicogenic headache.

o   Deep neck flexor exercises are recommended for cervicogenic headache.

Low back pain, neck pain and headaches are the most common conditions treated by chiropractors. However, there is much more chiropractors can help with, including, but not limited to:

·       Strains and Sprains

·       Repetitive strain injuries

·       Work and sports injuries

·       Arthritis

·       Limited range of motion in joints

·       General health and well-being

For more information on what a chiropractor can do for you, you can visit the Ontario Chiropractic Association website, ask your Catalyst chiropractor or ask myself. Stay active and stay healthy!

Mitch Broser

Strength & Conditioning Specialist

Resources:

1.     Cassidy JD, et al. risk of vertebrobasilar stroke and chiropractic care. Spine. 2008. 33:4S; S176-S183.

2.     Kawchuk GN, Fryer J, Jaremko JL, Zeng H, Rowe L, Thompson R (2015) Real-Time Visualization of Joint Cavitation. PLoS ONE 10(4): e0119470. doi:10.1371/journal.pone.0119470

3.     Effective health care program. Noninvasive treatments for low back pain. Comparative effectiveness review, number 169. Agency for healthcare research and quality, 2016.

4.     Clinical practice guideline for the chiropractic treatment of adults with neck pain. 2014. (available at: www.chiropracticcanada.ca)

5.     Practice guide for the management of whiplash-associated disorders in adults. 2010. (available at www.ccachiro.org).