Welcome to Apple Creek Sports Medicine


Crossfit and Massage Therapy

Many people will book massage therapy treatment because it is a great way to help them relax and reduce their stress.  However, there are many other reasons CrossFit athletes should seek out massage therapy.  For CrossFit athletes, massage therapy can be a very effective way of helping treat tight muscles, increasing the flexibility of your muscles, increasing your range of motion and decreasing soreness from training.  If you find that you are constantly using the foam roller or lacrosse ball to try to work out stubborn muscles, this is a good indication that you may need manual hands on therapy.  Here are a few great ways that a massage therapy session can help with your recovery and keep you training efficiently and injury free:

  1. Reducing and eliminating trigger points in your muscles. A trigger point is a tender spot in your muscle (kind of like a knot) that can cause pain in other areas of your body. For example, you can have a trigger point in one of your glute muscles that refers pain down the back of your leg or the outside of your leg. Not only do these trigger points cause pain, but they can also reduce the strength in your muscle and reduce the flexibility of this muscle.  This can affect how low you can go in a squat, limit your overhead range and not allow you to lift as heavy.
  2. Increasing range of motion and mobility. Many movements in Crossfit require adequate range of motion to be able to safely and effectively complete the exercise. For example, you need good range of motion in your shoulders and your upper back in order to be able to perform any movement overhead (thruster, overhead squat, overhead press etc). If you find that you have restrictions in your range of motion that can’t be increased with mobility exercises or foam rolling, you will probably need some hands on work to help release the muscles that cross the joint, as well as mobilizations to the joint itself.
  3. Decreasing tightness in your muscles. How many times have you felt tightness in your low back after doing deadlifts; or that you couldn’t go lower in your squats because of tightness in your hip flexors; or restricted in the front rack position because of tightness in your forearms?  Massage is a great way to reduce tightness felt throughout muscles so that you can perform these movements with greater ease.  Tightness does not always present itself in pain or limit you in what you can do, but it definitely does not allow you to move as efficiently.

Crossfit and Massage

Crossfit is a great way to get fit and build strength, however it is so important to take care of your muscles and joints that you use during these workouts!  Just like your car needs regular maintenance, so does your body; especially given the intensity of Crossfit workouts.

-Shannon Weekes RMT

To heat or to ice, that is the question!

One of the most common confusions to face patients is whether they should be icing or heating after an injury.  Ice and heat therapy is a common at home self-care strategies that patients use, however, in order to receive the best benefit from your self-treatment it is good to know which treatment choice to use and when.

In order to decide which option is best for you it is important to understand that injuries fall into two general categories, acute injuries and chronic injuries.  Acute injuries are often a result of a trauma or impact, they are sudden and typically symptoms are short lived.  The most common symptoms involved in an acute injury are pain, swelling, redness, and skin that is warm to the touch.  A common example of an acute injury is a sprained ankle.  Chronic injuries, however, develop slowly and symptoms persist for a longer period of time, they are often a result of overuse and common symptoms include tightness, dull pain or soreness.  Also, acute injuries that aren’t properly treated may become chronic in nature.

The Quick and Dirty…..

  • New, re-aggravated, sharp pain, warm or swollen = ICE
  • Old, stiff, dull or achy pain = HEAT

The Nitty Gritty……

Ice is the best protocol for acute injuries because it reduces swelling and pain.  Ice should be used from the time of injury and for the next several days or as pain and/or swelling persists.  Icing is also a good at home treatment method for a chronic injury after each flare up.  For example if you have long standing knee pain that is aggravated each time you run, icing post run will help decrease pain and any swelling associated with the activity.  Some tips to keep in mind when icing include:

  • Ice should only be placed directly on the skin when the bag of ice has had all air removed, leaving a vacuum sealed appearance by sucking out the air. If this is difficult to create, place a very thin tea towel or paper towel that has been moistened against the skin and then the ice can be applied over that protective barrier.  Thick towels or dry material will not allow the transfer of cold into the tissue adequately.
  • Ice until the area just becomes numb – timing will differ depending on the area of the body, the size of the person etc. So listen to your body and apply until the area begins to feel numb.  Allow the area to warm to normal body temperature (compared to other side of the body for example) until you consider applying ice again.  You want all the benefits of the procedure, so allow your body to send all that nice fresh warm blood, full of nutrients to your injured tissue.  Any time after that, ice can be applied again.
  • Ice can and should be used several times per day

Ice for treatment

Heat is the best protocol for chronic injuries where no inflammation is present.  It is also a great at home treatment option for sore stiff muscles after a long day at work, say sitting at a desk in front of a computer.  Heat will bring blood flow to the area to help reduce muscle spasm and aid in the healing process.  Some tips to keep in mind when heating include:

  • Using a moist heat source such as a hot damp towel is always better than using a dry heat source. The moisture penetrates the tissue much better, providing a deeper, more significant effect.
  • Never apply heat directly to the skin, ensure that enough layers are present between the heat source and the skin to avoid burns
  • The greatest benefit of heat is delivered in the first 15-20 minutes. Prolonged heat applications can be detrimental to the tissue so be careful and never fall asleep with a heating apparatus applied.

Finally, alternating between ice and heat is a great at home treatment method for injuries that are in the sub acute phase, meaning they are more than a couple days old but less than a few weeks.  This protocol will help reduce swelling and increase the body’s healing mechanisms.  When using this protocol, use the application of heat and ice as described above, always allowing the tissue to return to normal temperature before applying the ice or heat.  Begin with heat and always end with an icing cycle.

Heating Pack

Although icing and heating are great at home strategies it is best to remember they are always more beneficial when used in conjunction with other treatment methods such as Athletic/Physio or Chiropractic therapy, soft tissue massage, stretching or mechanical corrections through exercise.


Stef Moser CAT(C)

Certified Athletic Therapist


Staying Fit on the Road

Business meetings, client dinners, flight delays… travelling for business can leave you with little time for staying fit.  For most people fitness involves sticking to an established routine, however, if you are someone who travels for business it doesn’t mean you have to throw your diet and exercise routine out the window.  Here are some strategies to help you stay active while travelling.

  1. Plan your accommodations. Before you leave find out if your hotel has a fitness center, or if it has a partnership with any gyms in the area.  If not ask the concierge to recommend some local gyms that offer daily or weekly passes.
  2. Pack your workout. Some workout equipment such as resistance bands, running shoes, or a jump rope can easily be packed into your suitcase and take up minimal room.  Just seeing the packed equipment in your suitcase may be motivation enough to get you active while on the road.
  3. Schedule early. Your schedule may not be yours while you travel so planning workouts early in the day before things get hectic guarantees that you get it in.
  4. Use your room. Exercises such as jumping jacks, push ups, mountain climbers, squats, lunges, yoga and Pilates can all be done with no equipment in the privacy and comfort of your own hotel room.  Not having to leave your room to work out means you can squeeze in 15-20 minutes after waking up or before going to bed without having to take the extra time to get to the gym.
  5. Use your feet. If getting in a resistance workout is too challenging on your busy travel schedule try simple things like taking the stairs or walking rather than taking a taxi to get in some cardio while on the road.

Staying fit on the road

Committing to eating healthy, getting adequate sleep and drinking plenty of water will also help achieve your fitness goals on the road.  While no one expects you to stick to your fitness routine 100% while away on business getting in even 20-30 minutes of exercise per day should bring you home in the same condition in which you left.  Just remember, even a little exercise is better than nothing!

Dr. Livia Chiarelli


Headaches are one of the most common health complaints of people presenting to my office.  The World Health Organization (www.who.int) estimate that 47% of the world’s population has had a headache at least once in the last year.  However, although this number is quite high most people don’t know what kind of headache they are actually suffering from.  It is important to know what types of headache you suffer from in order too not only prevent them, but to ensure that you are receiving the appropriate treatment.

Headaches ChiropractorAlthough there are several different types of headaches, 150 diagnostic headache categories approximately, the most common types of headaches are:

Tension headaches:

  • The most common type
  • Feels like constant pressure, like a band around the head
  • Over the counter medications often help alleviate symptoms
  • Some say these headaches are a result of the contraction of neck and scalp muscles, which may be a result of stress

Cluster headaches:

  • More common among men than women
  • Recurring headaches that occur in groups or cycles
  • Occur suddenly and are characterized by severe, often debilitating pain on one side of the head
  • Often accompanied by a watery eye, a runny nose, or nasal congestion on the same side as the pain
  • During this type of headache suffers often feel restless and unable to get comfortable

Migraine headaches:

  • Diagnosed based on a set of criteria
  • Last between 4 and 72 hours
  • At least two of the following four symptoms are present
    • Throbbing pain
    • One sided pain
    • Pain that is worsened by or interferes with routine activity
    • Nausea and or vomiting
    • Sensitivity to light
    • Sensitivity to sound
  • Can occasionally be foreshadowed by an aura such as hand numbness or visual disturbances

Sinus headaches:

  • Deep constant pain in the cheek bones, forehead or bridge of the noise
  • Pain usually intensifies with sudden head movements
  • Usually accompanied with other sinus symptoms such as nasal discharge, fever, feeling of fullness in the ears and facial swelling
  • Can be treated with antibiotics, antihistamines or decongestants

Cervicogenic headaches:

  • Originates from structures in the neck
  • One sided pain only, that starts at the back of the neck and moves forward to the forehead or temples
  • Often accompanied with restricted neck range of motion, and same sided neck, shoulder or arm pain
  • Discomfort can be alleviated by the use of certain over the counter medications such as anti-inflammatories

Once you have determined which headaches you are suffering from it is now time to seek relief.  Acupuncture, chiropractic care, naturopathic medicine and massage therapy are all great options to treat many of the most common types of headaches.  Next time you’re at Core Focus Health Group make sure you tell your practitioner about your headaches to see if they can help.

Low Back Pain and Chiropractic Treatment

Low back pain is a major health issue.  It affects over 80% of the working population at some point in their life, second only to the common cold as a cause of lost work time.  However, as a patient at Apple Creek Sports Medicine Centre back pain doesn’t have to hijack your sick days.

Image result for low back pain

What causes low back pain?

The back is a complicated structure of bones, joints, ligaments and muscles.  You can sprain ligaments, strain muscles, rupture disks, and irritate joints, all of which can lead to low back pain.  While sports injuries or accidents can cause back pain, sometimes the simplest of movements, for example picking up a pencil from the floor, can have painful results.  In addition, arthritis, poor posture, obesity, and psychological stress can cause or complicate low back pain.

What will a chiropractor do?

A chiropractor will first take a medical history, perform a physical examination, and may use laboratory tests or diagnostic imagining to determine if treatment is appropriate for your low back pain.

The treatment plan may involve one or more manual adjustments in which the doctor manipulates the joints, using a controlled, sudden force to improve range and quality of motion.  Many chiropractors incorporate soft tissue therapy to the surrounding muscles, exercise and rehabilitation, or acupuncture treatment into the treatment plan.  The goals of chiropractic care include restoration of function and prevention of injury in addition to back pain relief.

If low back pain hits you this year don’t suffer through the pain, we are here to help you feel better. Contact us at Apple Creek Sports Medicine Centre to schedule an appointment and we will get you back on track to feeling your best.


Dr. Livia Chiarelli, B.Sc(Hons), DC

Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by pain and stiffness of the shoulder joint.  Frozen shoulder occurs in about 2% of the population, targeting people between 40-60 years of age and affecting women more than men.

The shoulder joint is known as a ball-in-socket joint, allowing for approximately 180 degrees of motion.  This joint is surrounded by a strong connective tissue known as the shoulder capsule.  To allow your shoulder to move more easily the shoulder joint and capsule are lubricated with a natural fluid known as synovial fluid.

In frozen shoulder, the capsule surrounding the shoulder joint thickens and tightens, developing what is called adhesions.  These adhesions limit the normal range of the shoulder making it very difficult to move the shoulder.

Frozen shoulder typically develops in three stages:

  1. Freezing: in this first stage the pain slowly increases; as the pain increases you develop a decrease in range of motion.  This stage can last anywhere from 6 weeks to 9 months
  2. Frozen: in the second stage pain symptoms generally improve, however the stiffness and decrease in movement continue.  This stage can last anywhere from 4 to 6 months.
  3. Thawing: in the final stage motion slowly improves, return to normal or close to normal motion of the shoulder can take anywhere from 6 months to 2 years from initial onset.

Unfortunately, the cause of frozen shoulder is not yet fully understood.   There are however, a few factors that put you more at risk for developing frozen shoulder.

  1. Diabetes: frozen shoulder occurs more often in people with diabetes, affecting 10-20%of these people.
  2. Diseases: some additional medical problems that are associated with frozen shoulder include hyperthyroidism, hypothyroidism, cardiac disease, and Parkinson’s
  3. Immobilization: frozen shoulder can occur after the shoulder has been immobilized for a period of time from fracture, surgery, or other injury.

While frozen shoulder has a lengthy course of natural recovery, symptoms can be ameliorated by visiting your chiropractor or physiotherapist, who can work to break down the adhesions and improve the shoulder’s strength and range of motion.


Dr. Livia Chiarelli

Doctor of Chiropractic

Medical Acupuncture Provider

Certified Active Release Technique® Provider

Contemporary Medical Acupuncture vs. Traditional Chinese Acupuncture

Contemporary Medical Acupuncture:

This form of acupuncture takes the Traditional Chinese Medicine (TCM) approach and modifies it slightly using modern day scientific understanding.  At first glance this form of acupuncture will look very similar to TCM acupuncture, as they both require the placement of small, thing needles in specific points along determined meridians for an extended period of time in the body.

In contemporary medical acupuncture treatment is rendered after a medical/neuro-functional diagnosis has been made and the practitioner will often use acupuncture in conjunction with other treatment modalities such as soft tissue therapy, electrical stimulation, joint mobilization or manipulation, and rehabilitation protocols.

The points used are often chosen in relation to the joints, muscles, nerves and ligaments, which correspond to the diagnosis, based on the presenting symptoms, medical history questions and physical examination findings.

At our clinic this form of acupuncture is provided by Dr. Livia Chiarelli and can be billed separately under acupuncture with most extended health plans.

Traditional Chinese Acupuncture:

Practitioners of Traditional Chinese Acupuncture treatment in rendered after a TCM diagnosis has been made through complex theories based on disturbances in the body’s energy balance.  These imbalances are determined through diagnosis based on the tongue and pulse and are quantified by excess or deficiencies in the five elements; fire, water, earth, metal and wood.

The points used are often chosen in relation to flow of the body’s qi (chi) and manipulation of needles is often conducted to reset the imbalances previously determined.

Traditional Chinese Acupuncture unlike medical acupuncture can be used to treat infertility, overdue pregnancies, smoking cessation, etc…


Dr. Livia Chiarelli

Doctor of Chiropractic

Medical Acupuncture Provider

Certified Active Release Technique® Provider

Back Pain: Strength vs. Endurance

Are you someone plagued by low back pain?

Have you been told that stretching and strengthening the low back muscles will help ease your pain?  These are two common misconceptions, it is thought that stretching the back muscles and increasing the range of motion will reduce back problems.  However, scientific evidence shows that an increase in low back range of motion often leads to a greater risk of injury.  Also, strength has little association with reducing low back pain.  Most often times people actually injure their low backs while performing exercises to increase strength.  So if both stretching and strengthening can lead to injury and therefore not decrease low back pain what should someone do?  The answer is to increase endurance!

Stuart McGill, a professor of spinal biomechanics at the University of Waterloo, is one of the world’s leading experts on spinal research.  McGill has identified three exercises, which increase low back muscle endurance, increase core stability and have a low probability of causing injury.  The three exercises that McGill suggests are referred to as “The Big 3” and are comprised of: The Curl Up, The Side Bridge and The Bird Dog.

The Curl Up

The curl up is different from the standard abdominal crunch in that there should be virtually no movement through the low back.  While lying on your back place your hands in the small of your back to act as a guide of low back movement if flattening of the low back is felt then too much movement is occurring.  Bend only one leg and place your foot on the floor, alternate which leg is bent half way through the repetitions.  Lift only the head and shoulders off the ground hold for a moment and then lower back down.  Perform 12 repetitions.
back 1



The Side Bridge

Begin by lying on your right side supported by your right elbow, hip and knee.  Using your left hand press up through the hips until you are supported by your right elbow and knee.  The top hand can rest on the hip, or the down shoulder for extra support.  Progression includes moving to being supported by your elbow and feet rather than the knees.  Holding the position for as long as possible is the best, however once your form starts to break or you become shaky lower back to the ground.  Perform this exercise on both sides.
back 2

The Bird Dog

Begin on both hands and both knees.  Lift one leg no higher than parallel with the torso and return the leg to the starting position.  Follow this by lifting the opposite arm no higher than parallel with the torso and return the arm back to the starting position.  To progress both the leg and the opposite arm are lifted at the same time to parallel with the level of the torso.  When the leg, arm or both the leg and opposite arm are lifted hold for no more than 6-7 seconds.  This exercise is performed by alternating sides.  Further progression involves drawing a square with the leg and opposite arm when they are lifted.  It is very important to ensure not to lift the limbs higher than the torso and to ensure no rotation is occurring through the torso when the limbs are lifted.  A water bottle can be placed on the low back to help indicate if movement is occurring.  Perform 8-10 repetitions on each side.

back 3

Before performing these exercises it is important to brace the core.  In order to do this rather than drawing the navel toward the spine tighten the entire core as if you were bracing for a punch to the stomach.  Placing your fingers one inch below your hipbones and one inch toward the midline is a good way to perform a self-check.   Once there you should be able to feel the muscles under your fingertips contract.

It should also be noted that these exercises have the most beneficial effect when performed daily and performed in conjunction with a cardiovascular component such as walking.  Be patient and stick to the program, pain reduction and increases in endurance may not be seen right away.


Dr. Livia Chiarelli

Doctor of Chiropractic

Medical Acupuncture Provider

Certified Active Release Technique® Provider



Active Release Technique

What is Active Release Techniques (ART)?

ART is a patented, state of the art soft tissue system/movement based massage technique that treats problems with muscles, tendons, ligaments, fascia and nerves. Headaches, back pain, carpal tunnel syndrome, shin splints, shoulder pain, sciatica, plantar fasciitis, knee problems, and tennis elbow are just a few of the many conditions that can be resolved quickly and permanently with ART. These conditions all have one important thing in common: they are often a result of overused muscles.

How do overuse conditions occur?

Over-used muscles (and other soft tissues) change in three important ways:

  • acute conditions (pulls, tears, collisions, etc),
  • accumulation of small tears (micro-trauma)
  • not getting enough oxygen (hypoxia).


Each of these factors can cause your body to produce tough, dense scar tissue in the affected area. This scar tissue binds up and ties down tissues that need to move freely. As scar tissue builds up, muscles become shorter and weaker, tension on tendons causes tendonitis, and nerves can become trapped. This can cause reduced range of motion, loss of strength, and pain. If a nerve is trapped you may also feel tingling, numbness, and weakness.

What is an ART treatment like?

Every ART session is actually a combination of examination and treatment. The ART provider uses his or her hands to evaluate the texture, tightness and movement of muscles, fascia, tendons, ligaments and nerves. Abnormal tissues are treated by combining precisely directed tension with very specific patient movements.


These treatment protocols – over 500 specific moves – are unique to ART. They allow providers to identify and correct the specific problems that are affecting each individual patient. ART is not a cookie-cutter approach.


Dr. Livia Chiarelli

Doctor of Chiropractic

Medical Acupuncture Provider

Certified Active Release Technique® Provider


Osteopathy – it’s not just for bones and joints!

Lots of people ask me what osteopathy is and how it helps.  They assume osteopathy means bones, but Osteopathy is bigger than that.  Originally, the word was coined by Andrew Still in 1974, using the Greek words to describe “Bone” and “Sensitive to” as a description of his starting point for assessing and treating pathological conditions.  Over the years the profession has evolved to encapsulate the whole body, using the body’s ability to heal itself through self-regulation.  Osteopathy helps to restore function and promote vitality within the body.

For those of you who have received treatment, trying to describe it can be difficult.   Patients sense the touch as being gentle – they say – “it doesn’t really feel like anything”, but after treatment they feel better?

For those of you who might be considering treatment, it is tough to describe because the prescription for everyone is different.  Based on a thorough history, assessment of the body, consideration of life factors and presentation of current state of physicality, the osteopathic manual practitioner will treat accordingly.

The standard definition of Osteopathy is

“A natural medicine which aims to restore function in the body by treating the causes of pain and imbalance. To achieve this goal, the Osteopathic Manual Practitioner relies on the quality and finesse of his/her palpation and works with the position, mobility and quality of the tissues.”

What does this mean?

The body has an amazing ability to heal itself – if you get a cut, the body patches it with a scar and over time the scar disappears along with the pain and function is restored.  Problems occur when the body is under too much pressure (trauma, stress, poor posture, gravity etc.) and it cannot easily repair itself.  This creates dysfunction in tissue, which sometimes results in pain, pressure, poor function or disease.   Osteopathic practitioners try to locate the original dysfunction, the epicenter of the problems, remove the dysfunction through appropriate treatment, which then allows the body to start the healing process and run efficiently again.

Another question I get often is, “sure you helped my mom with back pain, but can you help me with …”

The optimistic answer is yes!  As an osteopathic manual practitioner, we try to get the subjects body to run efficiently by removing the barriers to health.  This can be done in various ways which may include gentle techniques like cranio-sacral therapy, visceral mobilization, muscle energy techniques or a more specific structural osteoarticluar correction.  These techniques in combination of the body’s amazing ability to heal itself can help kick-start health, positive healing and better environment for your body’s functions to function.

My story is one that is pretty common for both patients and practitioners.  As a student I had the pleasure of being taught by an osteopathic practitioner in a sport injury course.  It was easy to see at the beginning of the course that this person was looking at things differently, but from a logical perspective.  They presented the anatomy, physiology and functionality all together which made so much sense.  I then sought treatment from an osteopathic practitioner for a cranky low back that had been plaguing me for years.  After seeing multiple therapists and practitioners, it was osteopathy that was able to marry my description of pain, history of falls and car accidents, examine other complaints and quickly remedy my physical barriers and correct my low back pain.  It was at that point that osteopathy would be my next educational goal; to gain a better understanding of healing and assist my patients in attaining their goals.  I enrolled at the Canadian College of Osteopathy in Toronto, a private school which includes a 5 year academic calendar and topped off with a defence of a thesis of independent, original research.  There are some other educational institutions that are teaching osteopathic principles, but in my experience, it is just scratching the surface.  There are so many levels of osteopathy, the body’s anatomy and physiology, as well as the healing process, that future patients need to choose their practitioners wisely.

-John Sage