AuthorFabio Levi

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Nerve pain down your leg? You may be suffering from ‘Piriformis Syndrome’

Do you experience tingling, numbness, burning or sharp pain travelling down the back of the leg? This may be related to a common condition known as ‘Piriformis Syndrome’.

Nerve pain may or may not originate form the spinal cord and nerve roots. In certain cases, however, the cause of the problem is isolated to a different area rather than the spine.

There is a muscle located deep to the large gluteal muscles and it is called the Piriformis muscle.

6eb1ff846176165ae7ee4819a0ceda9fThe largest nerve in the human body is the Sciatic nerve, which provides sensation and motor control to several muscles of the leg. Depending on your body, the sciatic nerve may pass above, through or below the piriformis muscle.

If the piriformis muscle tightens or has increased tone from overuse, injury, poor posture or trauma, it can compress the sciatic nerve and result in tingling, numbness, burning or sharp pain travelling down the back of the leg.

How do you know if you have piriformis syndrome or not? You need a thorough assessment by a healthcare provider, such as a chiropractor, who is trained to examine and treat these conditions. Don’t wait for the condition to worsen!

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Text Neck

The term “Text Neck” is now recognized by many, but the implications are not always appreciated. This picture illustrates the increasing strain placed on your neck with every degree of forward head position. Do your part to prevent this from happening – keep your head up!


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Headaches slowing you down: Which type do you suffer from?

If you suffer from headaches, it is important to identify which type of headache you experience as this will dictate the plan of management. Each type of headache has unique features and treatment will vary accordingly. Below are the types of headaches and some common features of each.
Tension Headache
Tension headaches are the most common type of headache. They tend appear intermittently and feel like a constant ache, “squeezing” or “pressure” sensation around both sides of the head, particularly over the temples, front or back of the head, similar to the feeling of wearing a tight band. The pain is typically even, not throbbing and will not cause nausea, visual changes (aura), sensitivity to light or sensitivity to sound. Potential causes include general stress, lack of sleep or rest, muscular stress, postural imbalance, and jaw dysfunction. Tension headaches are not typically aggravated by physical activity. Management includes massage therapy, physical therapy, chiropractic, stress management, nutrition, acupuncture, medication, and self-care lifestyle modifications.
Cervicogenic Headache

Cervicogenic headaches originate from dysfunction of the joints and muscles of the neck. Pain is typically one-sided but may be found on both sides. The pain is localized to the neck or back of the head and may radiate to the forehead, temples, or eye region. Symptoms tend to appear gradually and are often described as a dull ache and stiffness. Decreased or limited neck range of motion is not uncommon and particular movements will aggravate the pain. Management includes chiropractic, massage therapy, physical therapy, stress management, nutrition, acupuncture, medication, and self-care lifestyle modifications.


Cluster Headache
Cluster headaches are recurring headaches that occur in groups or cycles. They appear suddenly and are characterized by severe, “debilitating”, “excruciating” or “piercing” pain on one side of the head, and are often accompanied by a watery eye, nasal congestion or a runny nose on the same side of the face. During an attack, people often feel restless and are unable to get comfortable; they are unlikely to lie down, as someone with a migraine might. The exact mechanism of cluster headaches are unknown  however, potential causes include genetic predisposition, hormonal influences due to hypothalamus dysfunction, disorders of serotonin metabolism, histamine irregularity, and disrupted regulation of arteries of the brain. Potential triggers may include stress, glare or bright lights, allergies alcohol and tobacco and extreme temperatures. Management includes massage therapy, physical therapy, chiropractic, stress management, nutrition, acupuncture, medication and self-care lifestyle modifications.

Sinus Headache
Sinuses are air-filled spaces located in your forehead, cheekbones, and behind the bridge of your nose. The sinuses drain through channels in the nose. When a sinus becomes inflamed, often due to an infection, tumour or allergic reaction, the inflammation causes swelling and increased mucus production, which results in an increased pressure leading to pain. Symptoms of a sinus headache feel like a deep and constant pain in the cheekbones, forehead or bridge of the nose. The pain is usually accompanied by other symptoms such as nasal discharge, feeling of fullness in the ears, fever and facial swelling. Headaches due to sinus infection can be treated with antibiotics, as well as antihistamines or decongestants.

Rebound Headache

Ironically, rebound headaches are caused by regular, long-term use or abuse of medication used to treat headaches. These medications include Aspirin, Acetaminophen (Tylenol), or Ibuprofen (Motrin, Advil), as well as prescription drugs. The mechanism of this is explained by two theories: 1) Excessive medication use can cause the brain to shift into an excited state that triggers more headaches, and 2) Rebound headaches are a result of withdrawal as the level of medication drops after dependency has been established. Symptoms of rebound headache vary from person to person  and typically range between a tension headache and a migraine headache, sometimes with severe exacerbations. They are often relieved by retaking the involved medication and worsen rapidly as the medication wears off. Management includes gradual decrease of medication use, though the headache will typically worsen before it improves as the body adjusts to this change.


Migraine Headache
Migraine headaches result in intense throbbing or pulsating sensation typically over one side of the head, localized to the temple and frontal regions, though the location may vary. Symptoms are often accompanied with nausea, vomiting, and sensitivity to light or sound. Some migraines are preceded by sensory “warning” signs (“aura”) such as flashes of light, blind spots, or tingling and numbness in the arm or leg. The pain and associated symptoms may last hours to days and are frequently described as debilitating. Migraines are still poorly understood though links have been made to familial predisposition, stress, imbalances in the brain (particularly serotonin), hormonal changes in women (fluctuations in estrogen), pregnancy, menopause, oral contraceptives, foods (aged cheeses, salty or processed foods), skipping meals, food additives (aspartame and monosodium glutamate), drinks (wine, caffeine), bright lights, changes in wake-sleep cycle, changes in barometric pressure and certain medications. Management of migraine headaches include stress management, chiropractic, relaxation techniques, massage therapy, hydrotherapy, sleep, nutrition (feverfew, omega-3 oils, calcium, vitamin D, riboflavinoids, magnesium, vitamin B2 and B6), acupuncture and prescription medication.

Warning Signs for Pathological Headaches:
  • abrupt onset or very severe (especially if no previous history)
  • new headache in an older individual
  • headache due to trauma
  • tingling or numbness
  • disturbed vision or pressure behind the eye
  • cognitive changes / altered consciousness
  • seizures, vomiting
  • persistent, progressive headache
  • marked neck stiffness
  • persistent or severe headache in a child
  • known cancer 
If you or a loved one experiences any one of these types of headaches, schedule a chiropractic and medical check-up as soon as possible to have an assessment and to determine the appropriate plan of management. Should you or a loved one experience any warning signs for pathological headaches, visit a medical doctor or emergency physician as soon as possible. Don’t let headaches slow you down!
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“Tingling and Numbness” in the Extremities…. Are you getting your nutrients?

Tingling, numbness, burning, weakness and pain in the upper or lower extremities (“peripheral neuropathy”) may have a number of culprits. Though these sensations are frequently caused by a pinched, irritated or damaged nerve, this condition may also be attributed to an underlying nutritional deficiency. It is important to note that certain medications and chronic health conditions may interfere with nutritional absorption, and leave you vulnerable to developing a nutritional deficiency. The following is a list of the most common nutritional factors known to cause these nasty symptoms in the extremities.
Thiamine (Vitamin B1)
Food Sources: Broccoli, fish, beans, lentils, eggs, yeast, yeast extract, pork, cereal grains, oatmeal, flax, sunflower seeds, brown rice, onions, green beans, summer squash, carrots, kale, tomatoes, green peas, beet greens, Brussel sprouts, spinach, cabbage, eggplant, romaine lettuce and crimini mushrooms.
Deficiency: “Dry Beriberi”
Deficiency Symptoms: Severe burning and abnormal tactile sensation in the feet and hands, weakness, muscle wasting, shiny skin, hair loss, sensory loss. Other symptoms may include fatigue, loss of sensation, pain and heaviness in the legs, glove/stocking sensory abnormalities and difficulty with climbing stairs and standing on one leg.
Niacin (Vitamin B3)
Food Sources: Red meat, fish, poultry, liver, beef, fortified breads and cereals, enriched pasta and peanuts.

Deficiency: “Pellagra”

Deficiency Symptoms: Dermatitis on hands, feet, face and neck, Diarrhea, and Dementia. Other symptoms may include depression, excitation, seizures, insomnia, dizziness, muscle rigidity, tremor, loss of hearing, tingling fingers, muscle tenderness, glove/stocking numbness, and a compulsion to immerse ones hands and feet in cold water. Sensory changes progress from the extremities to the knees, thighs and hips, after which weakness in the legs develops.

Pyridoxine (Vitamin B6)

Food Sources: Beans, poultry, fish, liver, pork, veal, fortified cereals, nuts, leafy greens, papayas, oranges and cantaloupe.

Deficiency Symptoms: Numbness and tingling in all of the toes which moves up the feet and legs, occasionally appearing in the fingers and hands, at which point pain and/or burning develops in these areas. Other symptoms may include loss of power in the legs, tonic-clonic seizures, mucosal symptoms, fatigue, decreased level of consciousness, anorexia, vomiting, and anemia.

Cyanocobalamin (Vitamin B12)

Food Sources: Fish, shellfish, liver, poultry, eggs, milk and milk products.

Deficiency: Pernicious Anemia, Achlorhydria

Deficiency Symptoms: Symmetrical glove/stocking sensory abnormalities, tingling of the toes, numbness, coldness, pins and needles sensation, feelings of swelling or constriction, weakness and spasticity. Other symptoms may include muscle wasting, wasting of the visual (optic) nerve, sphincter dysfunction, mental disturbances, mild dementia, disorientation, depression, psychosis and persecutory delusions, weakness, light-headedness, vertigo, tinnitus, palpitations, angina, heart failure, cardiomegaly, paleness, rapid heart beat, as well as liver and spleen enlargement. If left untreated, symptoms may include a beefy, red and sore tongue, anorexia, dysfunctional walk, spasticity, contractures

Alpha-Tocopherol (Vitamin E)

Food Sources: Nuts (peanuts, hazelnuts), seeds (sunflower), avocado, vegetable oils (sunflower, wheat, germ, safflower, corn and soybean), wheat germ, spinach, and broccoli.

Deficiency Symptoms: Decreased reflexes, decreased positional awareness (proprioception), decreased vibration, pain and temperature senses, muscle weakness, difficulty swallowing, heart dysfunction, night blindness and dementia.


Food Sources: Dark green leafy vegetables, avocado, spinach, liver, years, asparagus, Brussel sprouts, fruits and fruit juices, nuts, beans, peas, dairy products, poultry, eggs, seafood, and grains.

Deficiency Symptoms: Nearly identical symptoms as that of Vitamin B12 deficiency, however, dementia tends to be more prominent.


Food Sources: Meat, poultry, fish, milk, eggs, nuts, beans and seeds.

Deficiency Symptoms: Tingling in the tongue, fingers and toes, and may progress to severe weakness, decreased reflexed, sensory loss, and dysfunctional nerves of the head. Other symptoms may include dementia, muscle dysfunction and incoordination.


Food Sources: Turnip greens, spinach, Swiss chard, kale, mustard greens, asparagus, summer squash, legumes, whole grains, nuts and seeds.

Deficiency: Common after bariatric (weight-loss) surgery.

Deficiency Symptoms: Disease of the spinal cord, weak and stiff legs when walking, sensory loss in the extremities and dysfunctional optic (visual) nerve.


Food Sources: Legumes, nuts, seeds, whole grains and green leafy vegetables such as spinach.

Deficiency Symptoms: Fatigue, weakness, loss of appetite, nausea, vomiting, numbness, tingling, muscle cramps, seizures, or abnormal rhythms of the heart.


Food Sources: Bananas, potatoes, plums, orange juice, and other vegetables..

Deficiency Symptoms: Muscle cramping and weakness, constipation, bloating, abdominal pain, muscle paralysis and  irregular heart rhythms.


Excess Symptoms: Decreased pain and temperature sensation in a stocking/glove distribution, pain and weakness, in the feet and possibly the hands. Possible difficulty with climbing stairs and walking. Other symptoms may include urinary or fecal incontinence (loss of control), gastrointestinal dysfunction and abnormal sweating.

If you or a loved one experiences these symptoms, schedule a chiropractic and medical check-up as soon as possible to have an assessment for appropriate management of the particular condition.

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Question of the day: “What makes the popping or cracking sound during a chiropractic adjustment?”

A chiropractic adjustment is a highly controlled, specific and gentle thrust applied by one’s hands to a joint of the body with the intent to restore proper movement, maintain joint health, decrease muscle spasm, remove nerve interference and optimize body function.

An adjustment will often, but not always, result in an audible “popping” or “cracking” sound similar to when a cork is taken out of a champagne bottle or when a soda can is opened. This sound is not your spine or your bones cracking – that would be bad! The sound heard is a release of gas, namely nitrogen, oxygen and carbon dioxide, from within a joint.

Many joints in the human body are known as synovial joints consisting or two intersecting bones with smooth cartilage in between them. A fibrous joint capsule encloses the joint and contains synovial fluid, which helps nourish and lubricate the joint. When an adjustment is applied to a joint, nitrogen gas that was dissolved in the synovial fluid is drawn out of the solution, forming a bubble. When the bubble escapes and pops, this creates the audible sound and this process is called a “cavitation”.

It is important to remember that therapeutic benefits from an adjustment are not dependent on the presence of this audible sound. That is to say that restoration of movement, decreased muscle spasm, reduced nerve interference, and improved body function may be achieved even if no sound was heard.


For more information or to schedule an appointment, contact Dr. Levi and learn more about the benefits of chiropractic.

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Top 10 ways to beat the winter blues

For many of us living north of the border, it has been a long and gruelling winter season. Despite the frigid cold and frustrating weather, there are many things that you can do to lift your spirits and stay healthy. Here are Dr. Levi’s top 10 ways to beat the winter blues:

1) Exercise
Exercise has many benefits, including stress relief, elevated metabolism, increased energy throughout the day and the release of “feel good hormones”. Exercise also helps improve lymphatic and cardiovascular circulation, detoxification of waste products, facilitate weight loss and enhance positive body image. These are just some of the benefits of regular exercise.

2) Eat a Healthy Diet
Avoid refined and processed foods (white breads, rice, and sugar). These foods not only lack vital nutrients but they deplete your energy levels and can affect your mood, thereby contributing to depressive episodes, lack of concentration, and mood swings. Instead, incorporate more complex carbohydrates (whole wheat breads, brown rice, veggies, fruit). Consume the recommended daily intake of 8 cups of water. These healthy foods provide your body (and mind) with nutrients, stabilize your blood sugar and increase your energy levels.

3) Act on your resolutions
Research has shown a strong link between healthy behaviours and depression. Individuals who exhibit healthy behaviours such as exercising, not smoking and organizing had less depressed days than those whose behaviours were less than healthy and disorganized.

4) Make time for yourself
Each week, dedicate some time for yourself – as little as 30 minutes per day will go a long way. Plan activities that are relaxing and take time to participate in your favourite hobbies. Plan something that’s exciting to you — a weekend trip, a day at the spa, comedy show or dinner with friends.

5) Avoid binge drinking
Staying inside with a cold beer or a nice glass of wine may seem like an easy alternative to do in the winter months, and many people who feel down also tend to turn to alcohol when they’re feeling this way. But alcohol is actually a physiological depressant and actually does not improve your mood. Avoiding alcohol when you are already depressed is a good idea. Moderate drinking is fine for most people, but binge drinking (defined as having 5 or more drinks in one sitting) is not a healthy choice.

6) Relax
You’re busy! Work, class, family, friends, appointments, meetings. Everyone needs some time off. An important skill to have is the ability to say “No” to extra events so that you can slow down from your busy week. Try to spend a few minutes each day doing nothing! Read a book or magazine, sleep in on the weekend, take a bath, go to bed early, try some meditations, or take a yoga class. Relaxation, mental exercises and positive thinking can alleviate stress and leave you with a calm energy.

7) Embrace the season
Instead of always avoiding the cold and the snow, look for the best that it has to offer! Take up a winter sport like hiking, ice skating, snowboarding, skiing, curling, hockey, or even sledding! Staying active will boost your energy. Seeing winter in a positive light, with all the fun activities that it has to offer, will keep your spirits high.

8) Social Support
The impact of a strong social support network cannot be overemphasized. Friends, family, mentors, co-workers, and neighbours can be a great source of support and companionship throughout the year. Don’t be afraid to ask for help or encouragement when you need it.

9) Sufficient Sleep in a dark room
With our busy lives, sometimes sleep is the first thing to go. With time management a little self-discipline, you can meet the recommended 7-8 hours of sleep each night. Make it a priority to keep your bedtime and waking time consistent. Try not to oversleep as this will make you feel more tired.

10) Go outside and get some sun
Most people know that sunlight provides us with Vitamin D and improves your mood. Winter days are shorter and darker than other months, and because of the cold weather, a lot of people spend less time outdoors. This lack of sunlight can lead to depressed mood. When at home, keep your shades up during the day to let more light in. Try to spend more time outdoors.


Dr. L

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15 Bad Habits You Need to Break to Maintain Spinal Health

We all have poor habits, but here are Dr. Levi’s top 15 bad habits that you need to break to maintain spinal health, particularly when it comes to headaches, neck and back pain:

1) Poor posture (forward head, rolled shoulders)
2) Carrying a bag on one shoulder

3) Sleeping on the couch
4) Sitting all day
5) Keeping a wallet in your back pocket
6) Sleeping on your stomach

7) Running on the same side of the street
8) Slouching in your seat
9) Sitting on your leg
10) Wearing high heels
11) Sleeping on a very soft or old mattress
12) Lifting with your back rather than your hips and knees.
13) Physical Inactivity
14) Wearing old shoes
15) Carrying a heavy bag (more than 10-15% of your body weight)


For more information to maintain spinal function and avoid injury, contact Dr. Levi. If you do experience an injury, schedule an appointment to receive the appropriate care and return to optimal health.

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Flat Feet & Overpronation: The Impact on Your Health and Functioning

Flat feet (“pes planus” or fallen arches) is a postural deformity in which the arch of the foot collapses, causing the entire sole of the foot to come into complete or near-complete contact with the ground. Pronation is a term used to describe the natural way that our feet absorb shock. Pronation is the rolling in of the foot and the collapse of the arch.  When you take a step, your foot strikes the ground on the outer portion of the heel, then the arches flex down and in to disperse and absorb the shock. Every person pronates to some extent and this is a necessary moment in the normal walking cycle as it allows the forefoot to make complete contact with the ground.
Overpronation is the most common abnormality found in the foot, and for this reason, is the most studied. In overpronation, the arches flex excessively causing the feet   and ankles to rotate too far inward. Overpronation is when a person pronates too much and for too long.  This places  excess stress on the tendons and ligaments in the foot and lower extremity.

A foot that overpronates acts like a loose bag of bones during the walking cycle.  This makes this type of foot very flexible but inefficient.  The foot has to work much harder to propel the body, fatiguing easily and placing mechanical stresses on the lower body. Some of us have always overpronated, for others overpronation develops with age, weight gain, regular standing work or intensive exercise.

Why should I care about overpronation?skeletoneffects

Overpronation can negatively affect overall body alignment. The lowering of the arch pulls the heel bone in, causing the leg, thigh bone and hip to rotate inwards, and an anterior (forward) tilt of the pelvis. Unnecessary strain to the ankles, knees, hips and back can result, causing pain and dysfunction. Overpronation can also contribute to osteoarthritis, sprains and strains, plantar fasciitis, inflammation, metatarsal pain, problems with the Achilles tendon, pain on the inside of the knee, and bursitis in the hip.

How can you know if you overpronate?

Overpronation can be observed by posture, walking patterns and the wear on the bottom of your shoes. Overpronation is suspected with excessive wear on the instep side of shoe heels and with foot arches that “collapse” excessively when you walk. However, the best method to determine if you have overpronation is to have a thorough physical assessment by a trained health professional (i.e. chiropractor, podiatrist, etc).

What can I do about overpronation?

Studies have shown custom foot orthotics to be a great help for overpronation. Orthotics are inserts for your shoes that are designed to align the foot and ankle into the most anatomically efficient position. Custom orthotics look like shoe insoles, but are specific plastic medical devices that are custom made to correct imbalances and biomechanical misalignment. Custom orthotics improve skeletal alignment, reduce stress and strain on your body, and improve function of your feet and lower limbs. Consequently, orthotics improve one’s biomechanics and reduce discomfort throughout the lower kinetic chain, including the feet, ankles, knees, hips, pelvis and low back.
Custom orthotics are made from precise imprints of your feet and they can be used to treat a variety of conditions including:

  • Plantar fasciitis
  • Osteoarthritis
  • Flat Feet (Per Planus)
  • High Arches (Pes Cavus)
  • Over-pronation
  • High Arches
  • Bunions, Calluses and Corns
  • Metatarsalgia
  • Morton’s Neuroma
  • Achilles Tendonitis
  • Ankle Sprains
  • Shin Splints
  • Knee Pain
  • Iliotibial Band Syndrome
  • Hip Pain
  • Low Back Pain
  • Diabetic Feet
  • Sports Performance

In addition, there are specific exercises that should be prescribed by an experienced health professional to strengthen the muscles of the foot and its arches.
The important message here is to identify the presence of overpronation and manage this early on to prevent health implications down the road.

Contact Dr. Levi for more information regarding foot assessments, orthotics and exercises for optimal foot health. Don’t hesitate to ask!

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15 Bad Habits You Need to Break

We all have poor habits, but here are Dr. Levi’s top 15 bad habits that you need to break, particularly when it comes to headaches, neck and back pain:

1) Poor posture (forward head, rolled shoulders)
2) Carrying a bag on one shoulder

3) Sleeping on the couch
4) Sitting all day
5) Keeping a wallet in your back pocket
6) Sleeping on your stomach
7) Running on the same side of the street
8) Slouching in your seat
9) Sitting on your leg
10) Wearing high heels
11) Sleeping on a very soft or old mattress
12) Lifting with your back rather than your hips and knees.
13) Physical Inactivity
14) Wearing old shoes
15) Carrying a heavy bag (more than 10-15% of your body weight)


For more information to maintain spinal function and avoid injury, contact Dr. Levi. If you do experience an injury, schedule an appointment to receive the appropriate care and return to optimal health.

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