Healing Anxiety – An Integrative Approach

By: Dr. Joanna Rosenfeld ND


1 in 4 Canadians will suffer from some form of anxiety disorder in their lifetime. Feeling anxiety, or fear, is a normal part of our physiology but it becomes a problem when anxiety interferes with relationships, the ability to go to work or school, and other aspects of daily life.


Symptoms of Anxiety

The symptoms of anxiety are diverse, and can sometimes be difficult to recognize. Mental symptoms include excessive worry, insomnia, recurrent thoughts, nervousness and a sense of doom. There are also a myriad of physical symptoms – changes in body temperature, changes in digestion, frequent urination, muscle tension, rapid heart rate, chest pain, excessive sweating and more.


Conventional Approach

First line pharmaceutical treatment for anxiety can involve medications to increase levels of “feel-good” neurotransmitters in the body, such as serotonin, or medications that increase the inhibitory neurotransmitter, GABA, to help “chill out”. These can work for some individuals, but medications alone don’t provide a holistic treatment plan. The side effects of weight gain, insomnia or excessive sleepiness and decreased sexual function are often limiting factors in their use.

Naturopathic Approach

Naturopathic Doctors don’t look at mental health as a condition occurring solely in the brain, that doesn’t affect, or have an effect, on the rest of the body. Anyone who has had anxiety before a big test and felt butterflies in their stomach, or felt their heart race, can tell you that anxiety manifests throughout the body.  Below are just some of the ways Naturopathic Doctors can help address your anxiety.


Cause: Stress

Stress is a natural response to a perceived threat. During times of stress our body activates the “fight or flight” division of the nervous system. This increases adrenaline and cortisol in the body: creating many of the symptoms listed above – increased heart rate, increased blood pressure, increased breathing rate, muscle tension and mental worry. It’s easy to see how elevated levels of stress can cause, or contribute, to anxiety.

Solution: Increase the amount of time you spend in the “rest and digest” division of the nervous system. Deep breathing, yoga, meditation and low key exercise all help to decrease high levels of cortisol in the body.


Cause: Hypoglycemia

You haven’t eaten anything for a long time, and you have been surviving on coffee for most of the day to reach a deadline. Panic sets in, along with irritability and maybe you even start feeling lightheaded. Irregular eating habits, combined with coffee, and surviving on office baked goods can set the stage for erratic blood sugar levels and major aggravations of anxiety.

Solution: You may not have a huge appetite if you aren’t feeling great, but try to consume some nutrient dense foods throughout the day, even if it’s just a few bites every hour. Having proteins and healthy fats, and avoiding processed carbohydrates will help keep your mood and energy levels stable.  Good examples include a protein smoothie, hearty soups or stews, homemade trail mix, veggies with hummus and boiled egg with veggies.


Cause: Lack of Sleep

Not getting enough quality sleep can be a trigger for any number of mental health conditions. Feelings of anxiety can also keep you wide awake at night, creating a vicious anxiety/insomnia cycle.

Solution: Create a calming bedtime ritual – journaling, meditation, yoga poses and baths, are just a few examples of ways we can turn on our parasympathetic “rest and digest” nervous system. Dim the lights in your house around 9pm to help signal melatonin production and avoid screens for 1 hour before bed to keep melatonin levels elevated


Cause: Nutrient Deficiencies

Many vitamins and mineral are important in the formation and function of neurotransmitters and are depleted by medications, stress and poor diet. These include all of the B vitamins, magnesium, zinc, iron and probiotics. The neurotransmitters are made of amino acids, derived from proteins, so adequate protein levels in the body are important for formation of serotonin, dopamine, GABA and all of the other neurotransmitters. Up to 90% of our serotonin is made in the digestive tract, so you can see how diet is so important in mental well-being.

Solution: Testing nutrient levels is important and often times correcting nutrient deficiencies can have a huge effect on mood. Your ND will sit down with you and make sure your nutrition provides all the correct nutrients, and that your digestion is working optimally to absorb nutrients from food.


Cause: Hormonal Imbalance

Hormones are the body’s messengers and will communicate to all cells of the body. The thyroid hormone, which is responsible for our metabolism can also have a huge effect on our mood – levels that are too low can contribute to depression and lethargy, while elevated levels of thyroid hormones can increase anxiety.

For women, it is important to have a balance of estrogen to progesterone. Due to medications, environmental toxins and food choices it is common to see a relative excess of estrogen and deficiency of progesterone. Progesterone is our calming hormone, so it makes sense that low levels would lead to more anxiety and irritability.

Solution: Based on your symptoms and lab tests recommended by your ND to assess your hormone levels, you can address these imbalances to achieve optimal mental and physical wellbeing.


Cause: Cognitive Distortions

The way we view a situation can greatly increase anxiety. These mental patterns and habits are established early in life, and create ways of thinking that are not always helpful. These patterns can be a result of trauma, or conditioning early in life.

Solution: Learning to identify behavioural and thought patterns through techniques such as cognitive behavioural therapy (CBT) can be a way to help change well-established mental schemas. A counsellor or therapist can help establish more positive ways of handling situations and relationships to decrease anxiety.

Knee Pain Vancouver

What is PFPS – Patellofemoral Pain Syndrome

By Brooke MacGillivery, Physiotherapist

Patellofemoral Pain Syndrome, commonly referred to as PFPS, is a syndrome characterized by diffuse pain/discomfort surrounding the knee cap. The pain can vary in intensity, location, and duration, and will commonly present after repetitive activities such as running, squatting, or cycling.

Why does PFPS occur?

In order for the lower extremity to function optimally, the ankle,

knee and hip joints must have functional ranges of motion. The muscles surrounding each joint must be strong and balanced as well. Due to the nature of most jobs, the majority of us sit for a better portion of the day. Sitting for prolonged periods can inhibit the posterior chain (glutes, hamstrings, calves), which can lead to weakened muscles. Anytime a muscle group is weakened, the body develops compensatory patterns to achieve a given movement pattern. If the glute muscles are inhibited while climbing stairs, the body will recruit surrounding muscles to get the job done (cue tight hip flexors and quads). The body can tolerate repetitive movements, but only when all the muscles involved are doing their fair share. Tight quads and hip flexors can pull on the knee cap, forcing it to track improperly which can contribute to PFPS and other conditions such as IT Band Syndrome.

There are a number of different factors that can contribute to PFPS, not just the mechanisms listed above. The good news is that by determining any muscular imbalance or mechanical impairments, a treatment plan can be devised to correct imbalances and decrease the stress on your knees.

If you find you have diffuse knee pain that affects your daily activities, seek out a physiotherapist to assess your mechanics. Simple things like foam-rolling your quads, and doing glute-activation exercises prior to a run can decrease the stress on your knees.

Tennis Elbow – Vancouver

By Lindsay Farr, Physiotherapist

Lateral epicondylalgia (LE), more commonly referred to as tennis elbow, refers to pain on the outer side of your elbow.

This pain is usually worsened with gripping and repetitive activities such as typing, mousing, lifting objects with an outstretched arm, and opening doors. It is typically considered a tendinopathy of the extensor carpi radialis brevis muscle, however evidence shows a relationship between the neck, the radial nerve, and LE. Historically this condition was treated with non-steroidal anti-inflammatories (NSAIDs), ice, and rest.

Current evidence suggests there may not actually be an inflammatory component to this condition and studies have shown that physiotherapy combined with a home exercise program is more effective than ice or NSAIDs.

Studies have started to investigate the role of posture and the nervous system in the development of LE and have shown positive correlations. There is a greater prevalence of neck pain in patients with LE versus age matched controls (Berglund, Persson & Denison, 2013) and individuals suffering lateral elbow pain are more likely to test positive for radial nerve sensitivity (Coombes et al., 2013). Sitting at a desk for prolonged periods of time can lead to a chronic “head forward posture,” as pictured below.

Tennis Elbow 1

This position compresses the joints in our neck and narrows the space through which our nerves pass. Chronic poor postures can lead to compression of nerves, such as the radial nerve, which supplies muscles in our lateral elbow. When our nerves are compressed information moving through those nerves is restricted and slowed and this puts structures innervated by those nerves at risk for injury. Where our muscles would normally be able to withstand the repetitive daily tasks such as gripping and opening doors, nerve compression and irritation has limited their tolerance and so they breakdown sooner and start emitting pain signals. This is when we feel “tennis elbow.”

Here are some helpful tips for those of you who are “9-5 desk sitters,” or anybody struggling with lateral elbow pain:
Adjust your desk station: try to attain posture as shown in this image. If you are unable to adjust your station yourself, speak with your manager and ask to have an ergonomic assessment of your desk station

Tennis Elbow 2

Move: set a timer for 45 minutes. Whenever that timer goes off adjust your position. Lean back over your chair to stretch your chest muscles, stand up and walk to the printer/cooler, twist left and right in your chair.

Tennis Elbow 3

Stretch: use these basic neck and arm stretches daily to avoid tight muscles and relieve pressure on the nerves

Tennis Elbow 4

Posture: try to maintain a posture where your head rests over your body. Shoulders should be slightly back, lengthen the back of your neck and gently nod your chin “yes”. Your ears should nearly align with your shoulders when viewed from the side.

Tennis Elbow 5
See a Physiotherapist: if your symptoms persist and are becoming limiting to simple daily activities you should seek medical advice from a physiotherapist who can instruct you on more specific treatment methods and exercises.

Cold Laser Therapy in Vancouver

What can it do for you?

Cold laser therapy speeds up the body’s natural healing process. It is a safe and effective treatment for many injuries and conditions. How can a laser help heal damaged tissue? How does it work?

Well you have to go back to grade nine science class and remember that light makes particles called photons. Photons from the laser light penetrate injured cells and result in a cascade of physiological responses that ultimately repair damaged tissue. Cold laser therapy can:

– Increase cellular energy production to support improved cell metabolism
– Enhance the function of the circulatory system
– Regenerate nerves
– Heal tissues, especially collagen, cartilage and bone
– Reduce swelling and bruising
– Release endorphins to reduce pain

Over 3000 research papers have been published on the positive benefits of cold laser therapy. Are you interested in finding out how it can help you? Chat with Dr. Foot or Dr. Berry, who have special training with the Bioflex Laser system.

Why do my knees hurt when I run?


  By Brooke MacGillavery, MPT, BSc, CAFCI, CSCS

Ever wonder why your knees hurt when you run? Or why you can’t quite achieve a perfect lotus position in yoga?

As a physiotherapist, I will assess your posture and overall mechanics to determine what can be done to eliminate pain and improve your daily life.  Pain and loss of function can develop from a trauma, or something as simple as repetitive postures like sitting at a desk all day.
My goal as a physiotherapist is to help people realize their full physical potential – whether it be training for a marathon, perfecting squat technique, or simply having pain-free neck range of motion.
As a physiotherapist at Qi, I feel my tools are all the more useful when paired with other services such as Pilates for core strengthening, or massage to decrease muscle tension and increase flexibility or range of motion. To start the new-year off right, ask yourself if you have any goals you’re having difficulty achieving due to physical limitations or pain; physiotherapy can help!

The bridge is an excellent exercise to start with:

  • With a neutral pelvis, bend knees

  • Feel the feet, arms and shoulders firm on the floor

  • lift hips and hold

  • Focus your breath into your low abdomen

  • Keep thighs engaged

  • Knees in line with your ankle and large to

  • Hold for 30 seconds

Perform 3 sets ensuring no back or knee pain.

To book in with Brooke call us at Qihealth # 604-742-8383

Healing Injuries with Adhesion Breakers

Adhesion BreakersI am introducing Adhesion Breakers to my practice this week. Adhesion breakers are stainless steel tools used for Instrument Assisted Soft Tissue Mobilization (You may have heard of similar tools, such as Graston Technique, gua sha and FAKTR tools). This system of healing has been used for centuries in Chinese medicine to reduce pain, remove scar tissue and improve healing in muscles, ligaments, tendons and fascia. The practitioner uses Adhesion Breakers to create localized pressure and friction where adhesions and scar tissue have formed. This is one of many myofascial release techniques that guides the inflammatory process of healing so that damaged tissue can be replaced with organized healthy tissue.

Tissue scarring occurs for many reasons. A single traumatic event such as a whiplash injury or sports injury creates tissue tearing and subsequent scar tissue formation during recovery. A repetitive stress injury results in scar tissue caused by improper tissue tension over many repetitions, for example running, typing or golf. Desk workers often experience chronic tension injuries and scar tissue formation in the back and neck, which occur when tissues are put under long-term low-grade stress. Regardless of how scar tissue is formed, it cannot be resorbed by the body without treatment. Scar tissue results in diminished blood flow, stress and pain within the tissue.

If you have any nagging aches and pains, Adhesion Breakers may be helpful to allow your body to break down scar tissue, restart the healing process, and redirect your tissues to form in proper alignment. All soft tissues have the ability regain their full elasticity, strength and endurance, which means you can get back to feeling your best. Book an appointment today and see what Adhesion Breakers can do for you.

Common conditions successfully treated with adhesion breakers include: ankle sprains, shin splints, plantar fasciitis, knee pain, IT band syndrome, tendonitis, medial/lateral epicondylitis (tennis/golfer’s elbow), carpal tunnel syndrome, and back and neck pain.

Article prepared by Dr. Nina Foot, BSc, DC

What Are 3 Injuries That Can Be Treated Using Acupuncture?

I posted a blog earlier this month called 3 Injuries You Never Thought Acupuncture Could Treat. If you’ve recently injured yourself and you’re wondering what to do next, check out this article. Maybe you can add acupuncture to your list of treatment options.

Using Acupuncture to Treat Residual Pain After an Injury

I get this question time and time again –

How does an acupuncture needle help get rid of my pain from an old injury?

When patients ask this question they are not looking for the Traditional Chinese Medicine explanation, they are looking for some scientific proof.  A recent article written by Helene M. Langevin provides research-based evidence on how connective tissue is related to post-injury pain and how acupuncture can be used to treat the pain.

Connective Tissue and Scar Tissue


Connective tissue and scar tissueConnective tissue supports and connects all the bones, muscles, organs, blood vessels and nerves in the human body. It’s what holds all the parts of our body in place.  Connective tissue creates a link between our head, arm and foot.

Scar tissue forms in the body after there has been trauma to a tissue. Various cells are recruited to deposit collagen and contract the tissue back together, but in doing so they form a dense matrix known as scar tissue.

Why is there pain after the injury has healed and scar tissue has formed?

If the previous injury becomes irritated and inflamed, the cells are signalled to deposit excess collagen.  This will subsequently increase the tension and contraction in the tissue,which limits range of motion leading to pain. One of the reasons that pain can be difficult to manage is that many people do not have a detectable malformation.

So how do we deal with the Scar Tissue?

Static stretchingAcupuncture can help relax the tension in the connective tissue. How does it do this? When an acupuncture needle is inserted into the skin and rotated, the connective tissue actually becomes attached to the needle causing it to stretch and change shape1. The tissue continues to remain stretched as long as the needle is in the skin and the changes occurring in the tissue are related to relaxation of the tissue.  The restructuring of these tissues is a slow process therefore it is important to be patient as it may take a few treatments to feel the results.

Learn how acupuncture can be used to treat your lingering pain.

Jessica Zerr is a Registered Acupuncturist at Qi Integrated Health

To learn more about Jessica visit Jessica Zerr Acupuncture


  1. H.M. Langevin et al., “Mechanical signaling through connective tissue: A mechanism for the therapeutic effect of acupuncture,” FASEB J, 15:2275-82, 200


I Have Pain In My Shoulder – What’s Wrong?

Often I see patients in my clinic at Qi Integrated Health who have suffered from debilitating shoulder pain that has been ignored or inappropriately treated. Desperate for results, some of these people have progressed to the point where something as simple as getting a mug out of an overhead cupboard, or putting on a jacket, becomes impossible. While a seemingly minor complaint at first, shoulder pain can progress secondary to altered kinematics, leading to muscle imbalances, instability, additional pain, and ultimately, loss of function.

As one of the most intricate joints in the body, obtaining the correct diagnosis and beginning an appropriate treatment regime requires a thorough clinical examination. Given the complexity of the shoulder, it’s easy to appreciate the number of causes for shoulder pain, so today we will focus on the rotator cuff.

The Rotator Cuff – What is it?

Supraspinatus Muscle

The rotator cuff is made up of 4 key muscles that are responsible for – as you guessed it – providing rotation and movement of the shoulder joint, but more importantly, dynamic joint stabilization. One of these four muscles is called the Supraspinatus. It is also the muscle most prone to injury.

Where is the Pain?

The supraspinatus muscle sits in the supraspinous fossa, or above the boney ridge on the shoulder blade. It attaches to the head of the humerus and is responsible for ABDucting the arm, or moving your arm straight out to the side. An injury to the supraspinatus may cause pain directly at the shoulder, or the pain may be referred down the front or back of the arm, sometimes even as far as the wrist.

Common Causes

There can be several different causes, but some of the most common include:

  • A fall on an outstretched arm
  • Sports that involve repetitive, strenuous movements of the shoulder such as baseball, softball, tennis, volleyball, and swimming.
  • Household chores such as washing windows or painting.
  • Degeneration associated with advancing age.


My Treatment Approach


One of the reasons the supraspinatus muscle is difficult to treat is that it sits below the trapezius muscle.  Acupuncture is a great way to treat this injury because it can target specific points deep to the trapezius muscle that things like massage cannot reach as well. For all you acupuncture buffs, SI12 is one of the key points.

Activity Modification

Activity will likely only aggravate the muscle and slow the healing process. Trying to limit the activity that causes pain, as difficult as that may be for some, it is very important.

 Rotator Cuff Exercises

Rehabilitative exercises for the rotator cuff muscles that are gentle and controlled will help with the recovery and prevent the formation of scar tissue.


Stop guessing what’s causing your pain, and hoping it will disappear. Speak to an acupuncturist trained in musculoskeletal health, and see what acupuncture can do for you.

Jessica Zerr Acupuncture

Knee Pain – What Could Be Wrong and How To Fix It

Dr Ayla Wilson, Naturopathic Doctor

Sports Medicine + Prolotherapy

If you suffer from chronic knee pain or knee joint instability, this practical guide can help you understand what structures may be injured, and how your condition can be treated.

Your first visit will involve a discussion of your current and past medical history, as well as an orthopedic exam of the injured area and any surrounding areas that may be contributing.  For example, knee pain may be related to a problem within the ankle or the arch of the foot, so both areas are always looked at.

When the knee is assessed, I will examine the location of the pain, when the pain occurs, and what symptoms are experienced.  Here is a basic guide:

Location of the Pain

  • Back of the knee – Baker’s cyst
  • Front of the knee – Chondromalacia patella, Osgood Schlatter Disease, Patellar tendinitis
  • Medial knee – MCL (Medial Collateral Ligament) Sprain or Tear, Medial meniscus injury, Osteoarthritis
  • Lateral knee – LCL (Lateral Collateral Ligament) Sprain or Tear,  Lateral meniscus injury, IT band syndrome (Iliotibial), Osteoarthritis

Common Symptoms and What They Mean

  • Instability or ‘Giving out’ – Sprain or tear of the knee ligaments (ACL, PCL, MCL, LCL)
  • Popping sound – When a pop is heard during an injury, it can indicated a tear of a knee ligament (ACL, PCL, MCL, LCL)
  • Grinding or crepitus – Indicates advanced osteoarthritis where the bone has ground away the cartilage within the joint.  This can be due to extensive ‘wear and tear’ or may develop secondary to an injury that did not heal properly
  • ‘Bone on bone’ sensation – Also indicates advances osteoarthritis
  • ‘Catching’ or locking – May indicate a medial meniscus tear, also known as a Bucket Handle Tear. Osteochondritis dessicans, also known as ‘joint mice’ can cause these symptoms as well.  Joint mice are fragments of loose bone that are floating around within the joint fluid.  Joint mice are usually due to poor healing after knee trauma.
  • Swelling – If swelling occurs, it may indicate either an acute injury such as a recent ligament tear or fracture.  Chronic fluid effusion from the joint may indicate weakness or a defect in the joint capsule, for example in the case of a Baker’s Cyst, where fluid is allowed to leak out of the back of the knee joint.  Chronic fluid effusion may also indicate an injury within the joint or surrounding ligaments leading to friction, low-grade inflammation and swelling.  *Swelling with heat, redness, pain and fever indicates infection which is a medical emergency.

Timing of the Pain

  • First thing in the morning – Pain first thing in the morning that resolves with movement generally indicates osteoarthritis
  • After prolonged sitting – Osteoarthritis
  • After prolonged standing – Knee ligament laxity
  • Going up stairs – ACL or PCL injury
  • Going down stairs – Chondromalacia patella, ACL or PCL injury
  • Going up or down spiral staircases – MCL, LCL, medial or lateral meniscus injury

Treatments for Knee Pain

Conventional treatment for knee injury usually includes the RICE protocol which involves Rest, Ice, Compression and Elevation.  Often ASA (Aspirin), Ibuprofen and other NSAIDs are taken as well.  While these treatments may be effective in reducing swelling and inflammation for an acute injury,  they interrupt the body’s natural healing process and are not useful for sub-acute and chronic joint injury.

Mobility + Strenghtening

For chronic knee pain, mobilizing and strengthening exercises are essential for healing.  A joint that is immobilized with rest or bracing will not lubricate itself with joint fluid, and the cartilage and other connective tissues within the joint will dry out and become stiff.

Strengthening exercises are targeted at muscles groups surrounding the knee to stabilize the joint and prevent re-injury if imbalance in the musculature of the leg exists.

After your first visit, you will be given exercises to do at home that promote joint movement, muscle strengthening, and proper joint tracking.  Other types of exercise such as swimming, pool running, qi gong, or cycling may be recommended.


Prolotherapy is a nonsurgical treatment for damaged cartilage and stretched or torn ligaments. This treatment has an 85% response rate and is highly effective for repairing knee damage and alleviating chronic knee pain and instability.

Prolotherapy injections usually contain a combination of dextrose (a sugar), lidocaine (anaesthetic) and saline.  Injections are targeted where ligament and tendon insert onto the bone, and intra-articular injections into the joint space can also be done on the knee to access the anterior and posterior cruciate ligaments and the articular cartilage.

Injection of dextrose creates a controlled and localized area of inflammation where connective tissue injury has occurred.  As a result, the body’s own healing cells are brought to the site of the injury and lead to rebuilding of ligament, tendon and cartilage tissue.  Imaging studies show that injuries treated with prolotherapy promotes normal repair of dense, organized connective tissue fibers, in contrast to the disorganized fibers and scar tissue seen after chronic injury.

Prolotherapy can be used to treat a variety of knee conditions including:

  • ACL, PCL, MCL, LCL tear or sprain
  • Meniscus damage, Bucket handle tear
  • Osteoarthritis
  • Osgood Schlatter disease
  • Patellar tendinitis

Find out more about prolotherapy here./p>

In order to identify the cause of your knee pain, you must be assessed by a qualified healthcare practitioner. Book your comprehensive assessment today at Qi Integrated Health!   604-742-8383