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Month: May 2017




Born and raised in Italy, Francesca’s passion for the functions of the human body began at the age of 16, when after an ankle strain, she needed physiotherapy treatments. She started her career as a physiotherapist, but daily experience taught her that Western Medicine protocols, when equally applied to every single patient, did not properly suit or help them all. Therefore, she studied osteopathy. She believes it is important to combine Western medicine, such as her background in physiotherapy, with holistic and alternative medicine, as is her osteopathic practitioner approach, to be able to consider patients’ concerns from a double point of view, and provide a comprehensive treatment accordingly.

Educational Background

She graduated as a Doctor of Physiotherapy with honors from the University of Modena and Reggio Emilia in 1998, then started working as a hydrokinesis therapist, massage therapist and kinesiotherapist with post-op patients and local athletes. During this time, she decided to broaden her educational background by taking on a 6 year long course of Osteopathy, at Collegio Italiano di Osteopatia, were she graduated in 2010 as D.O.M.P. (Diploma of Osteopathic Manual Practice).
Francesca is a member of the Osteopathic Association of British Columbia, which guarantees the highest quality levels in osteopathic treatment and continuous updating.

Areas of Practice

Francesca has helped her patients heal from several diseases related to the muscoloskeletal system as well as visceral issues, post-op cases and scar tissue concerns, TMJ troubles, pregnancy pains and childhood problems.

Personal History

Francesca loves travelling, reading, spending time with friends at the cinema or at the beach and her two cats are her passion.
Eating homemade Italian food, pizza and drinking a glass of wine are a way to invite people at her place and sharing with them happiness and good conversation.
Since moving to Vancouver, she also began hiking and snowshoeing.

Chiropractic vs. Medicine for Acute LBP: No Contest

Chiropractic vs. Medicine for Acute LBP: No Contest

Acute low back pain patients demonstrate significantly greater improvement with chiropractic than “usual care.”

By Editorial Staff

With the publication of the Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) Study1 in The Spine Journal, one of the most frequently cited spine research journals in the world,2 the health care community at large may finally appreciate what the chiropractic profession has known for more than a century: Patients with acute mechanical low back pain enjoy significant improvement with chiropractic care, but little to no improvement with the usual care they receive from a family physician.

Published in the December 2010 edition of The Spine Journal, the study found that after 16 weeks of care, patients referred to medical doctors saw almost no improvement in their disability scores, were likely to still be taking pain drugs and saw no benefit with added physical therapy – and yet were unlikely to be referred to a doctor of chiropractic.

The study is “the first reported randomized controlled trial comparing full CPG [clinical practice guidelines]-based treatment, including spinal manipulative therapy administered by chiropractors, to family physician-directed UC [usual care] in the treatment of patients with AM-LBP (acute mechanical low back pain).” (Evidence-based clinical practice guidelines have been established for acute mechanical low back pain in many countries around the world, but sadly, most primary care medical doctors don’t follow these guidelines.) Researchers found that “treatment including CSMT [chiropractic spinal manipulative therapy] is associated with significantly greater improvement in condition-specific functioning” than usual care provided by a family physician.

Study Parameters

cheese king down The Chiropractic Hospital-based Interventions Research Outcome (CHIRO) initiative was “designed to evaluate the outcomes of spinal pain patient management strategies that involve a component of chiropractic assessment and/or spinal manipulative therapy, administered in a hospital-based spine program outpatient clinic.” The study utilized the CHIRO framework “to examine the effectiveness of current evidence-based CPG-recommended treatments for patients with AM-LBP pain.”

CPG “study care” (SC) was compared with the usual care (UC) provided by family physicians. Patients were first seen by a spine physician and then randomly assigned to either the SC group or the UC group.

Patients in the SC group received acetaminophen, a “progressive walking program” and up to four weeks of lumbar chiropractic spinal manipulative therapy. The manipulative therapy was provided “using conventional side-posture, high-velocity, low-amplitude techniques” to the lumbar region only, and only by a chiropractor.

Patients assigned to the UC group were referred back to their family physician, who was “simply advised to treat at their own discretion.” Patients in this group received treatment from “a variety of professionals including family physicians, massage therapists, kinesiologists, and/or physiotherapists.”

All care was provided at a hospital-based spine program outpatient clinic. The primary outcome measure was the Roland-Morris Disability Questionnaire (RDQ), administered at the beginning of care and at 16 weeks, when acute low back pain is considered to become chronic. The RDQ was also administered at eight and 24 weeks.

Other Important Findings

After 16 weeks, “78% of patients in the UC group were still taking narcotic analgesic medications on either a daily or as needed basis.” (Only 6 percent of this group received chiropractic care.)

Condition-specific improvement after 16 weeks “clearly favored the SC group, with mean RDQ improvement scores of 2.7 in the SC group compared with only 0.1 in the UC group (p=.003).”

While the difference in improvement “was not quite significant at 8 weeks,” it was found to be “clearly significant at 24 weeks of follow-up (0.004).”

Both groups showed improvement in bodily pain and physical functioning, but “patients in the UC group uniquely showed no improvement whatsoever in back-specific functioning (RDQ scores) throughout the entire study period.”

The inclusion of NSAIDs and manipulation/mobilization performed by physical therapists were no more effective in treating patients than family doctors who offered patients advice and acetaminophen. The study found: “[T]he addition of NSAIDs and a form of spinal manipulative therapy or mobilization administered by a physiotherapist to the lumbar spine, thoracic spine, sacroiliac joint, pelvis, and hip (compared with a detuned ultrasound as placebo manipulative therapy), to family physician ‘advice’ and acetaminophen were shown to have no clinically worthwhile benefit when compared with advice and acetaminophen alone.” [Italics ours]

The study criticizes a 2007 report that had derided the efficacy of spinal manipulation by pointing out that the older report based its conclusions on the outcomes of therapies performed by non-chiropractors. The 2007 study concluded that patients “do not recover more quickly with the addition of diclofenac or spinal manipulative therapy.”3 By contrast, the CHIRO study noted: “Although spinal-manipulative therapy is currently administered by many different healthcare professionals, including: chiropractors, osteopaths, orthopedic surgeons, family physicians, kinesiologists, naturopaths, and physiotherapists, the levels of training and clinical acumen vary widely. The study design used by Hancock, et al., therefore, differs from our study because [their study] did not use chiropracticspinal manipulation, and current guideline based care does not endorse any forms of spinal manipulation administered by any other practitioners.” [Italics ours]


  1. Bishop PB, Quon JA, Fisher CG, Dvorak MFS. The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) Study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain. Spine Journal, 2010;10:1055-1064.
  2. Brunarski D. “Impact of the Chiropractic Literature.” Dynamic Chiropractic, Dec. 2, 2010;28(25).
  3. Hancock MJ, Maher CG, Latimer J, McLachlan AJ, Cooper CW, Day RO, Spindler MF, McAuley JH. Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomised controlled trial. Lancet, 2007 Nov 10;370(9599):1638-43.

Article reposted from Dynamic Chiropractic

What is “trigger point therapy”?

What is “trigger point therapy”?

The term “trigger point” was coined in 1942 by American Physician Dr Janet Travell to describe a clinical finding with the following characteristics:

  • Pain related to a discrete, irritable point in skeletal muscle or fascia, not caused by acute local trauma, inflammation, degeneration, neoplasm, or infection.
  • The painful point can be felt as a nodule or band in the muscle and a twitch response can be elicited on stimulation of the trigger point.
  • Palpation of the trigger point reproduces the patient’s complaint of pain, and the pain radiates in a distribution typical of the specific muscle harboring the trigger point.
  • The pain cannot be explained by findings on neurological examination.

Travell’s work treating US President John F. Kennedy’s back pain was so successful that she was asked to be the first female Personal Physician to the President.

Studies estimate that in 75–95 percent of cases, myofascial pain is a primary cause of regional pain. Myofascial pain is associated with muscle tenderness that arises from trigger points – focal points of tenderness, a few millimeters in diameter, found at multiple sites in a muscle and the fascia of muscle tissue. Biopsy tests found that trigger points are hyper irritable and electrically active muscle spindles in general muscle tissue

Trigger points may be caused by a number of factors, including acute or chronic muscle overload, activation by other trigger points, disease, psychological distress (via systemic inflammation), homeostatic imbalances, direct trauma to the region, accident trauma (such as a car accident which stresses many muscles and causes instant trigger points) radiculopathy, infections and health issues such as smoking.

Trigger points form only in muscles. They form as a local contraction in a small number of muscle fibers in a larger muscle or muscle bundle. These in turn can pull on tendons and ligaments associated with the muscle and can cause pain deep within a joint where there are no muscles.

Injection Therapy

Injections, including saline, local anesthetics such as procaine (Novocain), and anti inflammatory medications such as Traumeel, can provide almost immediate relief and can be effective when other methods fail. A low concentration, short acting local anesthetic such as procaine 0.5% without steroids or adrenaline is recommended. Dry needling methods such as acupuncture and intramuscular stimulation (IMS) can also be effective but causes more post-injection soreness.


ART … Is it right for me?

ART … Is it right for me?

You might have heard of this acronym from a chiropractor, massage therapist, athletic therapist, or physiotherapist, and not really known what they were talking about.  Dr. Michael Leahy, the founder and developer of ART, is a doctor of chiropractic in Colorado Springs, Colorado. He utilized his background in aeronautical engineering and anatomy to develop a system of treating soft tissue injuries not responding to other forms of therapy.


Here is some essential background information on ART to give you some insight into a very effective treatment protocol.

What is ART (Active Release Technique)?

ART is a soft tissue system that is centered on movement based massage techniques. It can treat problems with muscles, tendons, ligaments, fascia and nerves. Some of the conditions it can help resolve include headaches, back pain, carpal tunnel syndrome, shin splints, sciatica, plantar fasciitis, knee pain and tennis elbow. There are over 500 specific protocols within the ART system to diagnose and treat a multitude of soft tissue based problems. Each ART session combines both the physical examination and treatment as the provider evaluates the texture, tightness and movement of the soft tissues using his or her hands. Most of the conditions that can be resolved using ART occur as a result of overused muscles.

You are probably wondering what causes an overuse condition. Aren’t muscles meant to be ‘used’? An ‘over-used’ muscle (ligament, tendon, etc.) can change in three important ways. First there are acute conditions. These include strains/sprains, pulls, collisions and tears. These present more as an acute injury. Secondly, there is the accumulation of small tears, otherwise known as micro-trauma. This is generally seen with tasks involving repetitive motion like throwing, running, using a mouse or a keyboard or improper sitting and standing posture. The third is when the muscle is not receiving enough oxygen, in which case the muscle enters into a state of hypoxia.

Each of these factors can contribute to the production of tough, dense scar tissue in the affected area. This scar tissue binds up and ties down tissues that need to have the ability to slide freely past each other. As scar tissue builds up, muscles become shorter and weaker, tension on tendons results in tendinitis, and nerves can become trapped. All of this combined can contribute to reduced range of motion in a joint, loss of strength, and pain. If there is a trapped nerve present, you may also feel tingling, numbness, and weakness.

The purpose of ART is to find these areas of scar tissue where the various soft tissues have formed an adhesion to each other. Once that area is found, tension is applied and the muscle is moved in an anatomically specific direction to maximize friction under the contact area. This breaks up the adhesion (scar tissue) and allows the structures to slide freely past each other, restoring motion to the area.

Any other questions about ART? Ask Dr. Terry Dickson or Dr. Anita Hildebrandt today!

For more information please see: