OFFICE UPDATE: March 29, 2020

We hope that you and your family are staying safe in these very challenging days.

We are in the process of moving from 255 East Island Highway to the new location at 673 Temple St. There have been some delays in completion of the new office building but it is very close to completion.

Our reopening date is dependent upon the directions and guidelines of the public health authorities. We are continually monitoring advisories by the public health authorities closely and will update you as soon as possible.
For more information on COVID-19 please see:

Please stay safe and keep moving!
Dr. Larry

Dear Patients:

Dear Patients:

Your health and safety is of great importance to us. In following public health authority recommendations on social distancing, we have made the difficult decision to temporarily close our clinic in an effort to help slow the spread of COVID-19.

Please be advised that Dr. Larry Smith will be closed effective immediately.

All scheduled appointments for this time period will be cancelled, and patients will be contacted as soon as possible to reschedule.

The office will reopen at our new location at 673 Temple St. (near Pym) on Monday April 6, 2020. Please note that we will be monitoring advisories by the public health authorities closely and will update you if we need to extend this projected re-opening date.

Please call the office at 250-248-6333 for further updates.

We apologize for any inconvenience this may cause. Trust that we recognize the importance of your health care appointments and appreciate your understanding as we navigate this unprecedented and challenging situation together.

Best regards,

Dr. Larry Smith

Tennis Elbow Anyone?


Have you ever seen a person wearing a tensor bandage or support around their elbow? It is very likely that they are suffering from “tennis elbow.” The medical terms for tennis elbow are “lateral epicondylitis, lateral epicondylosis or lateral epicondylopathy.” It is a condition that causes pain, tenderness and inflammation on the outer part of the elbow.

Tennis elbow is caused by repetitive activities such as tennis, hammering or using garden shears. Repetitive overuse causes inflammation of the muscles & tendons attached to the outer part of the elbow.

Health professionals can make a diagnosis of “tennis elbow” after taking a detailed history and from performing a thorough physical examination. Tennis elbow cannot be diagnosed from blood tests or X-rays.

A common medical treatment for tennis elbow is to modify the activity that is causing the pain. For example tennis players can change the grip size of their racquet and carpenters can use different size screwdrivers or hammers.

Other standard medical treatment for tennis elbow includes ice, stretching, elbow braces, OTC medications such as ASA or ibuprofen, cortisone shots and in rare cases surgery.

There is an exciting new treatment for tennis elbow called the Graston Technique® (G.T.)

G.T. is instrument-assisted soft tissue mobilization that utilizes stainless steel instruments to detect “scar tissue” When skillfully utilized by a trained practitioner; these instruments help breaks down “scar tissue” and fascial restrictions.

G.T is a new and innovative way to decrease pain and improve function. It is highly effective in treating tennis elbow and several other conditions.

The Graston Technique® was conceived by an athlete who suffered a debilitating knee injury while water skiing. After conventional therapy failed, he applied his professional background in machining to create the initial Graston Technique® instruments.

The concept of cross fiber massage is not new. Graston Technique® is grounded in the works of Dr. James Cyriax, a British orthopedic surgeon. The use of specially designed instruments and protocol has been a recognized part of the manual therapy industry for more than 20 years.

Graston Technique® has become standard protocol in many universities and hospital-based outpatient facilities as well as industrial on-site treatment settings.

Graston Technique® was 1st researched at Ball Memorial Hospital and Ball State University in Indiana. It is engaged in research projects at Indiana University, Texas Back Institute, New York Chiropractic College and St. Vincent Hospital in Indianapolis. Graston Technique® has become part of the curriculum at 21 respected universities and colleges. It is included in doctoral physical therapy programs, athletic training programs and doctor of chiropractic programs. Today, there are nearly 5000 clinicians who use the Graston Technique® protocol. The technique is also being used within the professional sports industry by the NBA, NHL, NFL, and Major League Baseball trainers.

Do you know anybody who might benefit from the Graston technique?
Let us know!

There are no stupid questions…

Do you recall being at school when your teacher said, “Remember there is no such thing as a stupid question.”
Yet, I admit that I was more than a little afraid of being laughed at by my classmates if I asked a stupid question.

In the very 1st year of my chiropractic career, I remember a patient who was responding very well to treatment for headaches. However on one particular visit, he said he wasn’t doing well and felt very weak. He felt aching in his low back and his abdomen and also down both of his legs.

Then, he looked at me in a somewhat embarrassed fashion and said, “I hate to ask a stupid question doc, but do you think this might be sciatica?”

“Where did it hurt first?”
“Actually the pain started in my gut and then spread down to my low back. Now I even feel it down the front of my legs.”

Loud warning bells went off in my head as I feared a very serious and perhaps life threatening problem. I could feel a pulsating mass as I gently pressed on his abdomen. The pressure also caused pain down the front of his legs.

To make a long story short, I called the patient’s family physician and explained my findings to him. He rapidly arranged for emergency surgery.

My patient had a severe abdominal aortic aneurysm that was about to burst. In fact according to the surgeon, it had already started leaking. Without this life saving intervention, he would have been dead.
Apparently, my patient had experienced the pain in his abdomen for quite some time, but did not report it to anybody. He later said he still felt stupid asking me that question.

So, the moral of the story screams out loudly. Remember, there is no such thing as a stupid question!

How Running Gait Increases Injury Risk

I hope you enjoy this great special report to The Globe and Mail authored by Alex Hutchinson published on June 10, 2018

Maybe it’s not the pounding after all.
Since the 1970s, biomechanics researchers have been searching for the telltale traits that predict which runners will get injured and which won’t. Most of their attention, understandably, has focused on the vertical forces that radiate up through the legs each time your foot hits the ground.

But a new study from researchers at the University of British Columbia explores the question from a new angle, linking horizontal braking forces to injury risk. The findings, which were presented at the American College of Sports Medicine conference in Minneapolis last month and now appear in the Scandinavian Journal of Medicine & Science in Sports, bolster the controversial claim that running form is linked to injury risk, and offer some tentative hints on how to run better.

In the study, 65 female runners visited the Fortius Institute in Burnaby for a detailed three-dimensional gait analysis, which involved running on a treadmill with 42 reflective markers pasted to their head, trunk, and limbs while being filmed from six angles. This allowed the researchers to calculate the various forces experienced by the body at each stage of the running cycle.
The runners then completed a 15-week half-marathon training program, with injuries monitored by a sport physiotherapist.
The researchers suspected that the best predictor of injury would be the “average vertical loading rate,” which is a measure of how jarringly your foot hits the ground. This is a widely studied hypothesis, although studies have produced mixed results on whether high vertical loading rates really predict injuries. As a secondary hypothesis, they looked at a less heralded variable called “peak braking force,” which is the amount your front foot pushes backward horizontally as you land, slowing you down briefly.

During the training program, 22 of the runners suffered injuries – and surprisingly, braking force turned out to be by far the best predictor. When the runners were split into three equal groups based on their braking force, those in the group with the highest force were eight times more likely to sustain an injury compared with the lowest group, and five times more likely than the middle group. None of the other biomechanical measurements, including vertical loading rate, had any significant links to injury risk.

These results are seemingly unexpected, since the vertical forces during running are about ten times greater than the horizontal forces, says Chris Napier, a physical therapist and UBC doctoral candidate who is the study’s lead author. But our bones and other tissues are designed to withstand vertical forces, leaving them more vulnerable to forces acting in other directions.
The findings raise two key questions: First, how do you know if you have excessive braking force? And second, how do you change it?

Coaches often assume that runners who “overstride” – that is, whose feet land far in front of their bodies – will have the highest braking force, especially if they land on their heels. But that’s not necessarily the case, Napier says. In follow-up studies that haven’t yet been published, he and his colleagues have found that the two best predictors of high braking force are running speed and stride length, regardless of where or how your feet land.

That means slowing down is a simple option to reduce braking force – although not one that most runners are interested in trying, Napier acknowledges. Luckily, taking shorter, more frequent steps – for example, increasing your cadence from 165 to 170 steps a minute, without reducing speed – will also likely reduce braking force. In addition, they found that runners who tried to run “softly” successfully reduced their braking force.
There are already wearable gadgets, such as the Lumo Run, that measure a version of braking force, and tell runners whether it’s higher or lower than normal. Such insights won’t be a magic bullet that prevents all running injuries – “but it’s another piece of the puzzle,” Napier says, alongside other risk factors like how quickly you increase your training from week to week.

The new findings are a reminder that the long-debated links between running form and injuries are more complex than expected – but they do exist. “In running, just like in any task,” Napier says, “how you do it matters.”
Alex Hutchinson is the author of Endure: Mind, Body, and the Curiously Elastic Limits of Human Performance. Follow him on Twitter @sweatscience.

What is Pain?

One of the most difficult questions that I have ever been asked during my 30 plus years of practice is, “What is pain?”
“Why is the pain there?”
“Why does it hurt so much?”
“Why is my body doing this?”

According to the medical dictionary, “Pain is an unpleasant feeling that is conveyed to the brain by sensory neurons. The discomfort signals actual or potential injury to the body. However, pain is more than a sensation, or the physical awareness of pain; it also includes perception, the subjective interpretation of the discomfort. (

The International Association for the Study of Pain describes pain as, “An unpleasant sensory and emotional experience associated with actual or potential tissue damage.”

It has been further simplified by numerous sources as, “acute mental or emotional distress or suffering.”

Today’s health professionals describe pain as a complex and highly sophisticated protective mechanism. In other words, one’s body perceives damage and prevents it from experiencing further pain and suffering.

In my opinion, one of the best descriptions of pain comes from chiropractor Dr. Barry Weinberg.
According to, Dr. Weinberg, pain is nothing more than the experience of separation. If you cut your finger with a knife, the separation of the skin causes pain. If you break a bone, the separation of the bone tissue causes pain. If you break up a relationship or a loved one dies, the separation from that person causes emotional pain.

I totally recall the moment I got the phone call from the hospital that said my father had died. My sister, Linda and I were prepared for the news, but it did not stop the devastating feeling of separation. The voice on the phone stated, that “unfortunately Mr. Smith has passed away.”
I immediately felt my chest being crushed and I found it very difficult to breathe. My logical brain knew that we all die and that Dad had lived a wonderful life. However, at that moment it felt as if Dad had been ripped away. All I felt was crushing pain. I looked over at Linda and her response appeared to be identical. This emotional pain was no different than any type of physical pain I had suffered. Whether pain comes from a severe physical injury or from a broken relationship or the death of a loved one it really hurts and we will all experience it.

All pain is separation.

If the separation continues and becomes great enough, the pain begins to diminish until it is no longer felt. In these circumstances we may feel as if the injury or trauma is “healing” because the pain is going away. In fact, the pain is diminishing because the separation is becoming so great that it grows beyond our level of awareness. Rather than healing (becoming whole) we are merely becoming numb.

We may think, “I’m better! The pain is gone!” Only to find a few weeks, months, or years later, that we re-experience the same pain…only stronger. We take a few ibuprofen or go for a cortisone injection…enhancing our separation. Once again, the pain is gone…for a while. If we lose a loved one or have a break up in relationship, we can choose to self-medicate with alcohol and drugs. The pain may go away for a short period of time, but it is still there.

It is like the gas light in the car. Have you ever been driving when suddenly the gas light comes on? You keep driving and the gas light goes off. A few minutes later it comes on a little longer…and again it turns off. Even quicker, the light comes on again — and stays on. If you don’t get gas now, you’ll probably come to a sudden halt. Our bodies, and our pain, function in a similar way. Eventually, if we don’t listen to the signal, all will come to a stop.

When we understand that pain is not the problem, but the signal of a problem, we are more equipped and more responsible to take action and find a solution to the problem rather than just attacking the signal through a pain reliever, alcohol, muscle relaxant, anti-depressant or anti-inflammatory drug. If the fire alarm went off in your house, would you not be annoyed if the fire department came and merely removed the alarm? What about the fire?

So why do things begin to hurt more when you begin to heal?
As you heal, or become more whole, you become more aware of your body and yourself. With this increased awareness, the pain signals are experienced more. It is not that the pain is getting “worse”… you are feeling more. Healing is not about feeling better; it is about being better able to feel.

The more aware we are of the subtle signals of our bodies, minds and spirits, the more able we are to adapt to the changes in our environment. Would you rather hear the lion’s roar miles away…or feel its breath on your neck? When we are more aware of the subtle, we have more room to make decisions. Our bodies give us such signals, but often they are ignored. Over time, the body must get our attention or more severe circumstances will ensue.

We begin to experience pain…if we don’t listen to this more advanced signal, the pain will increase to a point, but then suddenly stop. We have become numb. This part of us will surely die, unless immediate and critical action is taken. As the part, which has become so separate that it is unfelt, begins to become more whole with the body, the pain will return. Often it will be very intense, but as the healing continues it reduces and we begin to enjoy a finer quality of life. In order to heal, that part must be felt. We must be aware of it.

When Dr. Barry first began Chiropractic College, he met a woman who was paralyzed from the waist down, with no feeling or movement in the legs. She told him that a heavy box fell on her when she was five years old, and she had been crippled ever since. Four years later, he ran into her again…literally. She was walking. He was astounded and asked what had happened. She explained that she was under intensive treatment and that over the course of four years; she got her legs back. He asked her what that was like. She said that it was the most painful experience of her life. First her legs began to tingle for about three months…then they began to throb for about six months…for almost ten months after that, she felt constant excruciating pain. Finally, the pain began to subside and she was able to feel her legs pleasantly and walk. He asked her if it was worth all that to get her legs back. She said she would have experienced it twice over to get her legs back.

What are you willing to feel in order to heal?

In closing, I would like to share a technique I learned from Dr. Barry that I use with my clients when they are feeling pain. Rather than trying to make the pain go away (through drugs, therapies or any other means), I recommend feeling it completely. Not just the pain, but the part that is hurting. Sit in a chair or lie down, take nice deep breaths, and just allow yourself to feel the hurt part. Just be aware of it…no judgment…no complaints…no worries…just be aware. As you stay aware of it, realize that the pain is not you. The pain is a signal from you to you alerting you that something is separate. As you stay aware, the pain will become more separate from your experience, but the part of you that is separate will begin to re-unite with yourself and heal.

From Runners World – “Sitting is the New Smoking- Even for Runners”


Hope you enjoy the following article from Runners World!

You’ve no doubt heard the news by now: A car-commuting, desk-bound, TV-watching lifestyle can be harmful to your health. All the time we spend parked behind a steering wheel, slumped over a keyboard, or kicked back in front of the tube is linked to increased risks of heart disease, diabetes, cancer, and even depression—to the point where experts have labeled this modern-day health epidemic the “sitting disease.”
But wait, you’re a runner. You needn’t worry about the harms of sedentary living because you’re active, right? Well, not so fast. A growing body of research shows that people who spend many hours of the day glued to a seat die at an earlier age than those who sit less—even if those sitters exercise.

Up until very recently, if you exercised for 60 minutes or more a day, you were considered physically active, case closed,” says Travis Saunders, a Ph.D. student and certified exercise physiologist at the Healthy Active Living and Obesity Research Group at Children’s Hospital of Eastern Ontario. “Now a consistent body of emerging research suggests it is entirely possible to meet current physical activity guidelines while still being incredibly sedentary, and that sitting increases your risk of death and disease, even if you are getting plenty of physical activity. It’s a bit like smoking. Smoking is bad for you even if you get lots of exercise. So is sitting too much.”
Unfortunately, outside of regularly scheduled exercise sessions, active people sit just as much as their couch-potato peers. In a 2012 study published in the International Journal of Behavioral Nutrition and Physical Activity, researchers reported that people spent an average of 64 hours a week sitting, 28 hours standing, and 11 hours milling about (non-exercise walking), whether or not they exercised the recommended 150 minutes a week. That’s more than nine hours a day of sitting, no matter how active they otherwise were. “We were very surprised that even the highest level of exercise did not matter squat for reducing the time spent sitting,” says study author Marc Hamilton, Ph.D., professor and director of the inactivity physiology department at Pennington Biomedical Research Center. In fact, regular exercisers may make less of an effort to move outside their designated workout time. Research presented at the 2013 annual meeting of the American College of Sports Medicine from Illinois State University reports that people are about 30 percent less active overall on days when they exercise versus days they don’t hit the road or the gym. Maybe they think they’ve worked out enough for one day. But experts say most people simply aren’t running or walking or even just standing enough to counteract all the harm that can result from sitting eight or nine or 10 hours a day.
Spuds on the Run.

Unless you have a job that keeps you moving, most of your non-running time is likely spent sitting. And that would make you an “active couch potato”—a term coined by Australian researcher Genevieve Healy, Ph.D., of the University of Queensland to describe exercisers who sit most of their day. If they aren’t careful, she says, active couch potatoes face the same health risks as their completely inactive counterparts.

“Your body is designed to move,” Hamilton says. “Sitting for an extended period of time causes your body to shut down at the metabolic level.” When your muscles, especially certain leg muscles, are immobile, your circulation slows. So you use less of your blood sugar and you burn less fat, which increases your risk of heart disease and diabetes. Indeed, a study of 3,757 women found that for every two hours they sat in a given work day, their risk for developing diabetes went up seven percent, which means their risk is 56 percent higher on days they sit for eight hours. And a study published in the American Journal of Epidemiology reports that a man who sits more than six hours a day has an 18 percent increased risk of dying from heart disease and a 7.8 percent increased chance of dying from diabetes compared with someone who sits for three hours or less a day. Although running does much good for you, Healy says, if you spend the rest of your waking hours sitting, those health benefits depreciate. In a 12-year study of more than 17,000 Canadians, researchers found that the more time people spent sitting, the earlier they died—regardless of age, body weight, or how much they exercised.
Adding to the mounting evidence, Hamilton recently discovered that a key gene (called lipid phosphate phosphatase-1 or LPP1) that helps prevent blood clotting and inflammation to keep your cardiovascular system healthy is significantly suppressed when you sit for a few hours. “The shocker was that LPP1 was not impacted by exercise if the muscles were inactive most of the day,” Hamilton says. “Pretty scary to say that LPP1 is sensitive to sitting but resistant to exercise.”

Heart disease and diabetes aren’t the only health hazards active couch potatoes face. The American Institute for Cancer Research now links prolonged sitting with increased risk of both breast and colon cancers. “Sitting time is emerging as a strong candidate for being a cancer risk factor in its own right,” says Neville Owen, Ph.D., head of the Behavioral Epidemiology Laboratory at Australia’s Baker IDI Heart and Diabetes Institute. “Emerging evidence suggests that the longer you sit, the higher your risk. It also seems that exercising won’t compensate for too much sitting.” According to Alberta Health Services-Cancer Care in Canada, inactivity is linked to 49,000 cases of breast cancer, 43,000 cases of colon cancer, 37,200 cases of lung cancer, and 30,600 cases of prostate cancer a year.

As if that weren’t enough to put you in a sad state, a 2013 survey of nearly 30,000 women found that those who sat nine or more hours a day were more likely to be depressed than those who sat fewer than six hours a day because prolonged sitting reduces circulation, causing fewer feel-good hormones to reach your brain.
Scared straight out of your chair? Good. Because the remedy is as simple as standing up and taking activity breaks. Stuart McGill, Ph.D., director of the Spine Biomechanics Laboratory at the University of Waterloo says that interrupting your sedentary time as often as possible and making frequent posture changes is important. “Even breaks as short as one minute can improve your health,” he says. Developing healthier habits will also improve your running performance, says Nikki Reiter, biomechanist with The Run S.M.A.R.T. Project. The combination of going for a run and then parking your butt for the rest of the day (or vice versa) could be a recipe for injury. “The static sitting position can cause certain muscles to become tight or overstretched, neither of which is good for your running,” she says. Even if you went for a really intense or long run, regular activity throughout the day will help your recovery. So stand up now: It’s good for your body and mind.