The Core Principles of Evidence Based Medicine


The core principles of evidence-based medicine dictate that relevant research, the practitioner’s clinical experience, and the patient’s values all need to be considered when determining the best course of action in any given clinical scenario. Because clinical experience and a patient’s values are considered subjective variables, clear communication and understanding between the practitioner and patient is crucial. Appraising and interpreting relevant research, however, offers a key objective component to consider in the clinical decision-making process.

When it comes to joint pain, we often think of injections or surgery as our only options, however, it is important to understand that the bio mechanics of a joint, or the way a joint functions, is heavily dependent on structures that are adjacent to it. Think of the nerves in the muscles, tendons, and ligaments that relay messages to and from the brain about that joint. Knowing this, it is not surprising that the relevant research around managing many musculoskeletal conditions is to employ what is known as a ‘multi-modal’ approach to treatment. This means that the best outcomes are achieved by utilizing a variety of treatment options, including addressing changes to fascia, muscles, and tendons surrounding a joint, in addition to working through an individualized strengthening program to re calibrate or rehabilitate the function of that joint, and perhaps even protecting it from further damage with a brace.

In applying these concepts, the key to successful outcomes at Elite Sport Performance and the Knee Clinic is our three-pronged approach to treatment: treat the problem, strengthen the area, and avoid or modify offending activities.

Dr. Arif Karmali

BSc(Kin), DC



What does it mean to be a Chiropractic Sport Specialist?

By definition “chiropractic is an evidence-based, non-invasive, hands-on health care discipline that focuses on the musculoskeletal system.” – Ontario Chiropractic Association

Chiropractors treat a large range of maladies related to the spine, pelvis, nervous system and joints. After a thorough patient history and physical exam, a chiropractor may use a combination of treatments, manipulations, hands on therapies, exercise prescriptions and lifestyle counselling. A chiropractor is indisputably an integral part of our primary healthcare team.

So what makes a Sport Specialist Chiropractor stand out?

Sport specialist chiropractors are highly educated and uniquely trained to provide expert assessment, diagnosis, and management of musculoskeletal conditions. In addition to a health science or kinesiology undergraduate degree and 4-year Doctor of Chiropractic degree, the intensive post-graduate sports sciences fellowship can take an additional 4 years to complete. With over 1500 hours of field work, academic focus on exercise physiology, sport nutrition, sport psychology, radiology, advanced imaging, rehabilitation, sport specific research, acute and chronic injury management, and sport administration training, the sports sciences fellowship provides the most extensive sports specialty training in the chiropractic profession.


Dr. Arif Karmali

Strength Training and Knee Pain

With Strength comes stability and with stability always comes less knee pain.

If you have spent any amount of time in our clinic, this is something you have more than likely heard. Dr Karmali shares a little on what makes stability so important to the health of our joints.

“When it comes to maintaining the long-term health of any joint in our body, stability plays a critical role. Take for example, the knee.
The knee joint is the largest and most superficial joint, primarily operating as a ‘hinge’, allowing for bending and straightening of the leg. These hinge movements are combined with gliding, rolling, and rotation, which add to the functional complexity of the knee. Despite being well constructed, the knee joint is relatively vulnerable mechanically because of the in-congruence of its articular surfaces, which can be likened to two balls laying on a warped tabletop.

With that thought in mind, imagine if we didn’t have any ligamentous or muscular control to hold things together… We wouldn’t have a very good knee and understandably, be more prone to injury or accelerated joint degeneration. It is with this notion that ensuring the integrity of joint-specific ligaments as well as adequate and timely neuromuscular control that we can provide our joints with optimal loading and force dissipation to maintain and even improve their longevity.”