involves removal of bony elements within the spine to increase the cross sectional area of the spinal canals. Indirect decom-pression involves the placement of a device within the spine to change the alignment in an attempt to increase the cross sec-tional area of the spinal canals. Patients who have leg dominant rather than back dominant symptoms tend to do better after surgery; however, the benefits tend to diminish over time. The vast majority of individuals with DLSS receive non-sur-gical care. However, what constitutes effective non-surgical care is unknown. Most common non-surgical therapies include physical therapy, chiropractic, acupuncture, massage therapy, medication and epidural injections. Anti-inflammatory medi-cation and epidural cortisone injections tend to be ineffective since the symptoms are generally due to neuro-ischemia and not inflammation. This is demonstrated by the immediate re-duction in symptoms when flexing forward (which restores spinal blood flow). This would not likely be the case if the condition was due to an inflammatory process. The ability to reduce symptoms of DLSS, by changing spinal posture/structural alignment and/or increasing blood flow to the spinal nerve, provides potential mechanisms for interventions to improve symptoms and walking ability. The Rebecca MacDonald Centre for Arthritis and Auto-im-mune Diseases at Toronto’s Mount Sinai Hospital has designed and implemented a six-week self-management training program – The Boot Camp Program – for DLSS. The goal of the training program is to provide patients with the knowledge, skills, self-confidence and physical capacity to manage their symptoms and maximize their function on their own. The program is multimodal, tailored and directed to the structural, functional, physiological and psychosocial consequences of DLSS. It includes structured aerobic exercise (walking, cycling or swimming) to build stamina, self-confidence, lower extrem-ity strength, balance and overall fitness. There is instruction on specific exercises that help build core strength aimed at ena-bling individuals to reduce the lordosis (body realignment using pelvic tilt) during standing and walking. Education is provided using a cognitive behavioural approach, and is aimed at problem solving, goal setting and building self-confidence to self-manage and maximize mobility. Manual therapy is provided with the aim of improving intersegmental lumbar spine flexion and overall flexibility, with the goal of facilitating the ability to self-align the lumbar spine to a more functional position using the pelvic tilt while standing and walking. The program is delivered one-on-one over six weeks. During this period, a step-by-step home exercise program is designed and tailored to the individual with the goal of being maintained for life. There are currently two clinical trials evaluating the effectiveness of this approach – one at the University of Toronto and the other at the University of Pittsburgh. Kosim ideal for health Chiropractic, Physiotherapy, Massage Therapy & much more! Toll Free: 1-877-50KOSIM or WWW.KOSIM.CA KOSIM MEDICAL SUPPLIES val! Arri w e N ComboCare 2-Channel Ultrasound & E-Stim Combo • 1 MHz & 3 MHz for Ultrasound, • 2-channel of electrical stim output • IFC, Russian, EMS, and TENS ULTRA Drug FREE Pain Relief Super Pulsed Laser World’s most advanced pain relieving modality Starting from $6,620. 00 Full range of portable TENS, EMS, IFC units As lowest as $38. 00 Special $1,250. 00 -every major ideos V 190 muscle Micro-Sphere Cervical Pillow BUY 5 GET 1 FREE * Sectional Divided Design The best app for patient education. Foam Roller Techniques puts a video library at their finger tips. Tap a muscle and watch the proper rolling technique demonstrated. Includes progression and regression variations as well as search by sport or injury. Based on the Roll Release® system by Dr. Ryan Emmons. 135 SPARKS AVE (Victoria Park & Steeles East) Toronto, Ontario M2H 2S5 T:416-502-3700 F:416-502-2808 email: [email protected] 32 Canadian Chiropractor April 2015 FoamRollerApp.com www.canadianchiropractor.ca
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