Heat or Ice??

The question of whether to heat or ice is one we get frequently. And the answer for the most part is actually quite simple.

Despite much discussion about the theory of both heat and ice either increasing or decreasing inflammation, bloodflow etc., there is not much scientific evidence that either will help your healing in the long run. Therefore, my most common answer is "Whatever alleviates your pain."


There are, however, a few situations where I do have specific recommendations:

1. Many continue to recommend ice for the first 24-48 hours after injury to reduce inflammation (see my previous blog on this topic). This also up for discussion, but it is a situation that I continue to recommend ice rather than heat as there is no downside to icing in this situation.
2. I also never recommend heat to an already hot or swollen joint. This might be a result of osteoarthritis, or a recent surgery. If a joint is already hot, there is no need or benefit and it may even be deleterious to add heat to it (although many arthritis sufferers prefer heat - and if after years of suffering this is what makes you feel better - you know your body best!).
3. You have been icing a tendon for ages to no avail. Try heat! There is evidence that with chronic tendinopathy, there is actually no inflammation present (hence the name change from tendinitis to tendinopathy). That combined with the fact that tendons have very poor blood supply lends to the idea that chronic tendon injuries may respond better to heat (which increases blood flow to the area).

As always, thanks for reading!
Rebecca

Images courtesy of google images.

Most Common Golf Injuries and Tips to Minimize Them

The sun is shining (finally!) and it feels like Golf Season!

At this time of year (and after golf trips, lets be honest) there are always a couple of people who come in, having played too much golf without any preparation, with various injuries. Golf injuries can run the gambit but the following are a couple of the most common injuries:

1. Low Back Injuries: Golf exposes the back to tremendous forces. Combine this with the fact that the repetitive torsion is always in one direction and you are doing most of it in the bent over position, golf is the perfect storm to produce a back injury. See my previous blog for easy tips to reduce the strain on your back. A pre-season core strengthening and hip mobility program will also help reduce low back issues.

2. Elbow Tendinopathy: 'Golfers Elbow" is the obvious issue; but 'Tennis Elbow" (the same insertional tendinopathy only on the opposite side of the elbow) is equally prevalent amongst golfers. These issues are usually a result of either training errors (too much too soon, weakness in the forearm etc) as well as impact issues. Try not to overdo the golfing on the first day out - especially hitting from a rubber mat at the driving range! Pre-season grip and forearm stretching and strengthening will also help minimize these injuries.

3. Rotator Cuff Injuries: Rotator cuff injuries result from much the same reasons as listed above for elbow injuries; too much too soon, weakness and/or impact with the ground. A pre-season rotator cuff strengthening program and easy stretches can help minimize these issues.

Here is a link for some stretches that will not only be important at the first tee; but for the two weeks prior to the season starting. don't forget the strengthening too!

As always, thanks for reading. If you have any furthur questions (or end up with a golf injury) please contact us. I am a 'Fit Fore Golf" Level 3 qualified Physiotherapist!

Rebecca

Image courtesy of Google Images

Why Lie About Doing Your Home Exercise Program??!?

Ya, SUUURE You Did Your Home Exercises!

Here are a few reasons why NOT to lie to your physiotherapist about not doing your home exercise program:

1. Your physiotherapist is not your school teacher. There is no grade. We won't judge. OK maybe just a little, but honestly we have seen PLENTY of people who haven't done their home exercises before, you aren't that different.
2. We might start taking up more time looking for other causes: Maybe you have some neural tension... When really you just haven't bothered to drop that leg over the edge of the couch to stretch your hamstring!
3. Your physiotherapist usually has an arsenal of exercises: we can change and tailor your routine if you are finding it hard to fit into your daily life. Make it shorter, or change the positions so it is easy to do at your desk, etc.
4. The only person you are hurting is yourself! We are not giving a physiotherapy exercise program for OUR health!
5. Last but not least: Your physiotherapist usually knows anyway.

OK, so here it is from my perspective. Your physio exercises are important. They may seem either far too easy or at the other end of the spectrum seem too overwhelming to do. But humour us... you might just see a faster improvement!

As always, thanks for reading, Rebecca

Photo courtesy of google image.

5 Tips for Maintaining Good Posture

Good posture doesn't just look good; it is crucial in maintaining physical health and is very often than a key part of physiotherapy treatment. Think about it: when you are spending ALL of your time in a poor position, sooner or later something will breakdown! It is part of why we as physiotherapists spend time just looking at your positioning and why we have coined phrases like "forward head posture" "anterior pelvic tilt" or "anterior humeral shift" to be used when diagnosing and treating orthopaedic conditions. Without doing a specific postural assessment, here are some easy tips for maintaining good posture:

1. Desk Stretches. One way to get frequent breaks and to stop poor posture is to do desk stretches on a regular basis. Squeezing your shoulder blades together and moving your ear to your shoulder and holding for 30 seconds are two examples of good neck stretches.
2. Frequent Breaks. Prolonged sitting is often a cause of poor posture. We are just not meant to sit for 8 hours a day so frequent breaks are a must!
3. Core and Upper Back Strengthening. These muscles help hold you in proper posture, so keeping them strong is a must.
4. Stretches. Over time some muscles can become tightened and hold you in a poor posture. Two common muscles that become tightened are the pectoral muscles and hip flexors, so give them a daily stretch.
5. Fitness Maintenance. Overall fitness will help your sense of well being, work your rib cage and improve overall posture
6. Relaxation Techniques. Posture can be worsened during stress - shoulders start to rise and bodies start to slump! Throw a yoga class or some simple breathing exercises into your routine and you will help alleviate some of that stress.

Physiotherapists are trained to assess and work towards correcting poor posture. If you have a painful condition that you think might be related to poor posture contact us!

As always thanks for reading. Rebecca 

Photos courtesy of google images.

A Running Program:

Part 3: The Stretching Program

This is no longer a "pre-season" program, so I will rename it simply a running stretching program. I always recommend a stretching program for any runner. This allows you to at least partially counteract the muscle imbalances and tightness that come from being a runner. These imbalances can be even more pronounced if you are a runner who sits at a desk all day (see my previous blog on this topic). The following stretches are pretty basic and aim to stretch the main muscle groups of the lower body: calf, quads, hamstrings, gluts and hip flexors. They include stretches that are given at our clinic on almost a daily basis.



1. Calf Stretches: the important thing about doing calf stretches is that you do them both with the knee bent as well as straight to be sure you get the two main muscle groups of the calf. If you are doing both these positions, it really doesn't matter whether you do them with your foot against the wall (targeting plantar fascia a bit more), over a step or in a lunge against the wall (as shown).

2. Hamstring Stretches: We prefer these hamstring stretches since they allow you to target different portions of the hamstring (medial and lateral) and give your knee a bit of protection since it is supported, but again whatever stretches work the best for you are fine. Sitting on a supportive structure (bench, couch or bed will do) first lean forward with a straight back (left image). Second, turn your shoulders away from the leg you are stretching and lean the same shoulder toward your knee still keeping your back as straight as possible (right image).




3: Quadriceps Stretches: We give this quad stretch out very regularly since the traditional quad stretch doesn't target the rectus femorus (also a hip flexor).When the rectus femorus is tight it can effect your hips and back as well as your knee. 
Standing with one knee on a chair behind you, and holding onto someting stand up as straight as you can until you feel the stretch in the front of the quad. Back of a couch or arm of a chair can also be used to prop the foot up.

4. Hip flexor Stretch: A favourite of Richard, this stretch targets
the hip flexor without putting too much strain on the back. Putting one foot on a higher structure like a table or railing, lunge forward until you feel the stretch at the hip of the standing leg.

5: Gluteus Maximus Stretch: Holding on to your leg in the crossed over position hig the knee in to your opposite shoulder and hold.








6: Gluteus Minimus (and other small, deep hip external rotators) Stretch. this is my favorite stretch! Since starting Fascial Stretch Therapy, I have given this stretch out a lot as it is the closest I can get to mimicking the deep hip stretch that I give. Sitting in this position and keeping both hip bones on the floor let your knees fall to both sides to target specific muscles.


To actually increase muscle length, stretches are best done when the core temperature is slightly raised (after activity) and should be held for a minimum of 30 seconds (as opposed to dynamic stretches which are done as pre-activity preparation), but any time is better than none. I find myself cutting them out after a run to save time, but will do them before bed as a relaxation technique... Do whatever works for you!

Remember, stretches alone might help reduce injury but will rarely help you recover on their own. See my previous blogs on running injuries, running strengthening, and eccentrics to give you more clues!
As always, thanks for reading!

Rebecca Chambers, MSc in Exercise Science and BSc(PT)

Photos courtesy of google images

A Pre Running Season Program: Part 2

Part 2: Strengthening Program

This running strengthening program is a compilation of the top 5 of our favourite exercises to prepare you for your running season. They are simple, quick and require no equipment. They also assume that at the moment you are injury free! Below our Top 5 are a few more of our favourite exercises that require some simple equipment.

Top 5 Running Preparation Exercises.

Lunges. Targets: gluts, squads and a bit of hamstring. Has the added benefit of a functional hip flexor stretch. I like reverse lunges, regular and walking lunges for different reasons. Reverse lunges will work both glut max as well as glut min in a stabilizing capacity, but will give you less hip flexor stretch. Reverse lunges are less common so I will give you their description and pictures, but feel free to replace or rotate with regular or walking lunges. Description: Standing with feet shoulder widths, take a step backwards about 2-3 feet (.75m-1m) depending on your ability and bend both legs keeping the majority of your weight on your front leg. From the bent position step back onto the front leg and drive the back leg forward. Without putting that foot back down, repeat by placing it back behind you again.

Side Lunges. Targets: quads, hip adductors and abductors (small gluteus muscles). Description: starting with your feet shoulder width apart, step out to the side 3 or more feet bending that leg and keeping the standing leg straight and step back in a fluid motion. Repeat on the opposite side

 

Chair Bridge Marching. Targets: hamstrings, glut max and low back. Description: laying on the floor with your heels on a chair and knees bent, lift your bottom off the floor. Maintaining your position and trying to keep your hips even lift one leg and then the other.

Plank with Knee to Elbow. Targets: abdominals and hip flexors. Description: Holding a straight arm plank with back flat, bring your right knee to your right elbow. Repeat with left knee to left elbow. For the next repetition, attempt to bring your right knee to your left elbow. Alternating elbows works all hip flexors.

Dead Bug Marching. Targets: abdominal muscles and hip flexors as well as core control. Description. Start lying on your back with your hands under your bottom with your hips and knees bent at 90 degrees (and your shins parallel to the floor). Without letting your back lift off the floor and keeping your knee bent at 90 degrees attempt to bring your heel to the ground. Only go as far as you can keeping your back flat. If this becomes easy try without your hands under your bottom.

Start by repeating 10 of each of these exercises. As they become easier, add a second then a third set of 10. Try to do some sort of strengthening 3x/week for maximal gains, 2x/week for maintenance. This list is by no means exclusive, and will be augmented by mixing it with some of your favourite exercises or some of our "Also Ran" exercises to break up the boredom!

"Also Ran" Exercises: These exercises require some equipment but are worth adding in!

Squats. Targets: body weight squats increase muscular endurance of quads and glut max. Start with 20-40!
Side Walks. Targets: small gluteus group. With a theraband wrapped around your ankles - in a half squat take 10 steps to the side in one direction then repeat in the other direction.
Single Leg Anything. Targets: small gluteus muscles as well as core stabilizers. Do arm curls, arm raises, overhead presses all standing on one leg. To make them work your stabilizers even harder, do one arm at a time on one leg!
Dead Lifts. Targets gluteus maximus, hamstring and low back strength and no program would be complete without adding these in! Description: standing with legs shoulder width apart and slightly bent, lower light weights (5-10lb to start) down the front of your legs keeping your back straight. Allow your knees to bend as needed to keep your back straight!

Stay tuned for part 3: Pre Season Stretching Program

Please proceed with caution for all of these exercises. If you are experiencing any injuries or have any medical conditions, consult your physiotherapist or physician before starting this program. For more information on our team and services, please consult our website.

As always, thanks for reading, Rebecca

A Pre Running Season Program: A Three Part Series

 

Part 1: Why do a Preseason Strengthening and Stretching Program??



If, like me, you are a fair weather runner, it's time to get ready for your next outdoor running season! It's time to strap on the runners and just go right? Not so fast. If you want to avoid injuries, as well as following my previous tips, you might want to add a pre-season primer to prepare your body for the upcoming season. The following are a few reasons why you might want to incorporate this program into your season's plan:

1. You need to address the muscular imbalances that have built up after a winter of couch lying (or working too many hours at a desk) and might contribute to your next running injury.
2. Strengthen stabilizers to withstand the repetitive impact they are about to incur throughout the upcoming season
3. Improve muscular endurance to improve running performance

In the upcoming blogs MacLean Sport Physiotherapy will give you an overview of a few of our basic, favourite strengthening and stretching exercises to prepare your body for the upcoming running season! Stay tuned!

Image courtesy of google images.

What is Fascial Stretch Therapy?

Fascia is a network of layered connective tissue that is present throughout the body and helps keep tissues supported and in place. The diagram pictured at the side will give you a good visual. The white areas represent fascia where it is thickened, but in reality, there is fascia surrounding all the muscles. In the realm of physiotherapy this tissue is important because it helps keep muscles and tendons in place. It hosts the nerves and blood vessels that supply muscle, ligament and tendon. It also weaves into structures such as ligaments and joint capsules which help support joints. This becomes critical in rehabilitation when the fascia becomes adhesed to its surrounding tissue due to acute or overuse injury and limits its function.

Fascial Stretch Therapy or FST (TM) uses multi-planar and multi joint stretches to target the fascia. They are bed and anchor based stretches. For more a more detailed idea of what this is about check out the Stretch to Win website. This treatment aims to do the following by "unsticking" that fascia:

• Relieve chronic muscles tightness and tension
• Improve joint mobility and overall flexibility; often reducing stress on other structures
• Improve posture
• Improve circulation, relaxation and sleep - thus maximize rehabilitation and sports recovery

 

It is a great compliment to other forms of rehabilitation and soft tissue therapies, including ART, massage, acupuncture, and of course exercise therapy.

Think this therapy would be beneficial to you? We proudly provide FST (TM) to the Burlington, Ontario area. Please check out our website for more information.

Pictures courtesy of Google Images.

Top 4 ways to Avoid an Injury from a Fall this Winter

 

With this year's thaws and freezes, as well as my own slip on the ice, I thought a blog on falls would be topical this winter. According to Stats Canada falls are the leading cause of injury and the most common cause of injury hospitalization in Canada. The most susceptible demographic are seniors with 85% of all injuries in seniors being a result of a fall. One statistic that surprised me, was that the majority of falls among seniors occur in their own homes. So here are 4 ways to avoid falls or their negative ramifications this winter:

1. Clear the Path: This not only includes shoveling your driveway and walkways which is obvious at this time of the year, but also clear the path indoors. Reduce clutter, make sure edges of rugs are flush with the ground (or get rid of them) and wipe up water spills immediately.
2. Stay Active: Engage in physical activity every day. It's your best defence against falls. Increase or maintain muscle and bone density with resisted activities. Consult your doctor before engaging in a new activity.
3. Live a Healthy Lifestyle: Smoking, poor diet and inactivity can all lead to weak, brittle bones and turn an otherwise innocuous fall into a debilitating injury. Get your bone density checked if you suspect an issue; you may need medical intervention on top of healthy changes.
4. Be aware of Your Surroundings: Get your eyes and ears checked, ensure adequate lighting as much as possible and practice mindfulness.

If you have any questions about our services in dealing with these issues, please visit our website or call us at 905.333.1267.
As always, thanks for reading, Rebecca

Pictures courtesy of Google Images.

7 Most Common Work Station Mistakes

As well as sport related injuries, I see lots of work station related issues; mostly neck and headaches, but also low back, shoulder and elbow. The following are a list of work station mistakes that may be contributing to your injuries:

1. key board and mouse position. If either of these are too far away, too high or too low, you will run into problems.  The biggest issue I encounter is if the mouse or keyboard are too far away. This most often can contribute to shoulder issues as the shoulder is forced to engage on a continuous basis (remember, it might not seem like much, but you are doing it for up to 8 hours!) Your elbows should be at your side and at 90 degrees when using both.
2. screen position. If your screen is too low (or you are using a laptop) the tendency is to be looking down - again for 8 hours a day. The screen should be positioned so that when you close your eyes, move both your head and eyes around then find a natural position, you should be looking at the middle of the screen. Another marker is that the top of the screen should be approximately at eye level.
3. using two screens. Using two screens for 8 hours a day probably means you are turning your head to one side for prolonged periods. This can lead to serious neck pain and headaches. Try using a split screen or moving your body each time you use the second screen.
4. cradling a phone with your shoulder. Another no-no for the neck! A headset is a great neck saver for that reason.
5. no work station. Do you work from home and use your laptop anywhere? On the couch? I am constantly saying that laptops keep me in business because people have terrible neck and back positions when they use them!! Set up a work station.. invest in a separate key board so you can fix the arm and head positions for at least part of your day.
   
6. poor lumbar position. Lumbar support in a chair can help, but just becoming aware of your sitting posture will do more. A standing work station can also help
7. sitting too long. Regardless of how perfect your workstation is, we are just not meant to stay in one position for prolonged periods. Set a timer to go off once an hour to get up and get a glass of water or do some stretches.

Also visit my previous post on how your work station could contribute to your sports injury!

If you have any enquiries regarding our services please visit our website for more information.

As always, thanks for reading! Rebecca

Pictures courtesy of Google Images

6 Training Tips for Avoiding Running Injuries

Injuries are the bane of every runners existence and sometimes are a fact of the runner's life, but here are a few training tips that might help you avoid injuries before they start.

1. Slow and steady wins the race. Give yourself lots of time to train for your event. You may need an extra week of recovery.  Do not increase any element of your training too quickly. 10% per week is a good amount of distance to increase per week. I always stick to 1 km to keep it safe.

2. Do more runs, not less. You are better off to do 4 runs of 20 min runs in a week instead of  a 40 minute run twice.

3. Only change one element per week. Do not add hills AND intervals in the same week.

4. If you feel an injury coming on, take a step back (see my previous blog on managing your own running injury)

5. Stretch and strengthen. There is plenty of information out there to keep you strong and healthy for your running season (see my favourite running website strength running) . A good base before your running season of glut, hamstring, hip flexor and core strength will go a long way and maintaining that strength throughout  the season will really help keep you injury free (and running better!). Anyone who runs needs to incorporate some stretching into your program too - especially if you sit at a desk all day (one of my previous blogs details the "dangers" of sitting at a desk all day). I have some insomnia issues so do my stretching before bed every night. I find it doubles as both injury prevention and relaxation technique!

6. Keep a healthy weight. Of all the factors associated with running injuries overtraining and a higher body mass seem to have the highest correlation. On the flip side, a low BMI has also been associated with an increase in stress fractures and spinal injuries in women. Stress the HEALTHY in healthy weight!!

If you find you are injured and would like more information on our services visit our website.

As always, thanks for reading, Rebecca

Photos courtesy of Google Images

Top 6 Signs You Need Physiotherapy

My husband has been complaining about an Achilles issue for a couple of years now. With two little ones to be constantly trading off, there is no time for in clinic, hands on treatment from me. But as you may have guessed, I am a big exercise pusher... So a couple of weeks ago he lamented (again) "am I never going to be able to run again?" And, my response (again) was "Have you been doing your eccentric exercises?" This time, though, he has actually followed my advice and has been doing them regularly. Last night he said to me "I think those exercises are actually working."
Really? Was my advice your last resort?
So, when do you know that you need an expert (physiotherapist or otherwise) opinion in regards to your injury?

1. You have an acute injury. Heard a snap? Have bruising? Swelling? Are you limping? Time to see a doctor or physiotherapist. Your physiotherapist can assess your injury and will help maximize your recovery as well as give you a program to help you get back to your sport/activity of choice while minimizing the chance of re-injury.

2. You have had surgery or been immobilized. Surgery and immobilization can lead to limits in strength, range of motion, proprioception (balance and motor control) and gait. your physiotherapist is trained to maximize your recovery of all these elements.

3 Pain is holding you back from your normal activity levels. I am a firm believer in living an active lifestyle. Activity helps you heal faster, sleep better, live longer and improves mental and emotional well-being. And in my opinion REST RARELY fully RESOLVES the issue (see my instructions on dealing with running injuries!) So do what ever you need to get back to it!


4. You have numbness. Any numbness indicates there is a pinched nerve. Your sports/orthopaedic specialist (doctor, physiotherapist, chiropractor) will help diagnose where the numbness is coming from and how best to deal with it.

5. Dr. Google hasn't helped. It is hard to diagnose yourself. I have a hard time doing it and I am a trained professional! Yes, sometimes you can help yourself with one quick fix, but in most cases someone needs to physically see your weaknesses, tightness, posture and more to really give you an appropriate diagnosis and program.

6. All else fails. Hopefully you will not be like my husband and wait until this happens, but if you are at this stage maybe its time...

To see what a physiotherapist at our clinic can do for you, see a list of our services on our website.

As always, thanks for reading, Rebecca

Guidelines for Dealing with your Running Injury

As I was out enjoying a beautiful fall run this weekend, it occurred to me that some easy guidelines for dealing with running injuries would be helpful to a lot of people. The following are a few simple steps that I tend to follow when I suspect a running injury of my own:

1. Go back to the volume and intensity you were doing before the pain started. The human body has an amazing ability to adapt to stresses placed on it, but if training increases are greater than the body's ability to adapt, you will get overall regression in tissue strength instead of progression. In a study looking at types of running shoe correlating with injury, it was actually body mass index and training intensity that were correlated to injury; shoe type had no correlation! And try to do this AS SOON AS you realize there is a problem. I always tell people the longer you have an overuse injury, the longer it will take to heal from it. The tissues have be degrading the whole time you have been in pain, often even longer!


2. If the pain persists after a week of reduced running volume and intensity, do modified activity for a week. This could include running in the water, biking, hiking or a yoga class. Anything that will decrease the impact on your body, while maintaining some fitness.


3. Do some specific rehabilitation exercises. While you are doing your modified activity, it is a perfect time to try to do some exercises to promote your healing and address imbalances. I would recommend eccentric strengthening (see my previous blog on eccentric strengthening) if you think it is a tendon issue, ITB roller or some specific massage ball work, gluteus and core strengthening and lots of stretching. Every runner I have ever treated could do more hamstring, calf and hip flexor stretching. Do them every day you remember.

4. If after a week of modified activity and rehab exercises your pain has reduced significantly (80%better) go back to #1. If not, I would suggest consulting a sports medicine specialist or physiotherapist. You probably need specific exercise prescription as well as some hands-on treatment or modality intervention.



If you are lost trying to figure out which rehabilitation exercises are right for you or if you are on a rigid training timeline, you may need to see your physiotherapist even sooner!


Happy running!!
For more information on our practitioners and services, please see our website www.macleansportphysio.ca.

Pictures courtesy of Google Images.

Doping in Canada: Views on steroid use from a sheltered athlete

With the scandal surrounding the Russian track and field team for the upcoming Rio Olympics, I am reminded of my own experience as a short term member of Canada's Track and Field team. I entered track quite late in life - 1994 to be exact. This was 6 years after the Ben Johnson affair, after the Dubin enquiry and all the shame that it brought to Athletics Canada and the country in general, so my experience was shaped significantly by these events. I personally never saw any evidence that any drugs were in use. I never saw anyone giving each other needles in the change room, a practice that I heard from a close friend had once been commonplace at the Metropolitan track and field center where I trained. I was never approached by anyone offering me any illegal substances. We were schooled extensively by medical staff before any international competition on substances that were illegal that we might not even know about (anything with Sudafed for example - so I have always had a hard time believing someone was taking anything "by mistake"). I was drug tested 3 times; once randomly during the training season and given 3 days to show up and pee in a bottle; and twice with my placing at the Canadian track and field championships where I was escorted for a test immediately after the competition was over. Any undesired activity that was happening was kept on the down low; the Canadian centre for ethics in sport and the Canadian anti-doping program were doing their best to minimize the chance of another scandal. Canada had incurred enough humiliation.

So, am I surprised by the information coming out about the Russian athletics team, or the government instituted cover-ups? Not really. There were always rumors alluding to this kind of activity (both the use and the cover-ups) I had a friend who was approached by Charlie Francis who was still coaching despite his life-long ban - suggesting something new. There was a local doctors that gave "vitamin B12" injections to help performance (ironically, the same Dr who did my random drug test... hmmm). And those were just local rumours. At the time the Americans never seemed to get caught - why was that? Did they just have deeper pockets? (this was before the Marion Jones scandal). How did some athletes get so big or so strong so quickly? or recover from injury so fast? Athletes are always on the edge of injury and overtraining, especially when it comes down to centimeters or 100ths of seconds, and anything that will allow you to train harder or have faster recovery would be very tempting, especially if it was something new and there was minimal chance of discovery. And when there are even larger egos on the line (coaches, government officials and a whole country), I am even less surprised that this has occurred.
Saddened, but not surprised.

This blog is written by Rebecca Chambers, physiotherapist at MacLean Sport Physiotherapy. For more information on our staff, treatment and services please visit our website.

 

Photos courtesy of Google Images

 



Top 6 things that bother me (as a physiotherapist) about Televised Sport

I love to watch sports and enjoy it the same way most people do - for the competition and pure spectacle of it. But every once and a while something just irks the physiotherapist in me. So here are the top 6 things that bother me about televised sports:

6. Not showing what the therapists are doing out there on the field. I want to see what tests they are doing and from that extrapolate what they think the injury is (although I do recognize that this may not be interesting to everyone...)
5. Not showing enough replays of injuries. Unless there are bones sticking out, I kinda want to watch it again (and again and again.)  I want to figure out what the injury is!!
4. The "magic" sponge. C'mon people, after that spectacular fall, a wipe down with a sponge and you are all better? What drama school did you go to?
3. Labeling an injury "upper body" or "lower body" injury. Really? This is top secret information?? Just give me the details already.
2. Announcers shortening or not labeling the injury. One example that really gets me is when it is announced that so-and-so "has a hamstring." Well, yes they do. So do you, and I and almost everyone else on the planet. There is more than one thing that could be wrong with said hamstring.

And the number one thing that irks me about televised sport is..

1. The inference that it is because an athlete had "all the best treatment" they have recovered so well. While this may be partly true, it negates the fact that the athlete is a)in amazing physical shape to begin with and will thus recover more easily and b)that the athlete probably WORKED THIER BUTT OFF to get there! I would like that to be the take home message to the public... not that there is some magic physiotherapy treatment that they are missing out on!

By Rebecca Chambers, Registered Physiotherapist, Acupuncture and Fascial Stretch Therapist.
Picture courtesy of Google Images.

Top 5 Ways to Get the Most Out of Your Physiotherapy Program

These are all very self explanatory, so here goes...

5. Be Realistic. In general the longer you have had a condition, the longer it takes to reverse it. Also if you continue to do the things that have caused the condition whether by necessity (work) or unwillingness to cut back on exercise, it will take much longer to recover.

 

4. Be Optimistic. You almost always have the capability to improve your function if not reverse the condition but it may take work (see number 1!)

 

3. Be Honest. We cannot accurately adjust your treatment and program if you do not tell us what has made you better, what has made you worse or whether you do your exercises (but see number 1!)

 

 

 

2. Follow Instructions: If your physiotherapist has suggestions for work station or training changes, position or movement changes, they have given you these suggestions to help mediate your recovery (also see number 1.) Remember, we see you for at most 2 hours out of the week - what you do the rest of the time is more important than what we do in the clinic!

and the most important way to get the most out of your physiotherapy program...

1. DO YOUR HOME EXERCISES!! Whether the goal of the exercise is to optimize healing (see my blog on eccentric exercises), correct muscle imbalances or to maximize function, each exercise has been given for a reason. And when I say do them, don't just go through the motions; be aware of the purpose and the proper mechanics while you are doing them. However, if you are finding it hard to get all of your exercises in (I will openly admit I get a bit carried away at times) please let us know (see number 3!). There are often one or two exercises that are the most important for recovery and doing them will be better than doing nothing at all. It is after all 'Physical Therapy!'

written by Rebecca chambers, BSc(PT), MSc
pictures courtesy of Google Images

Fascial Stretch Therapy

I have just returned from a week long course certifying me as a level 1 Fascial Stretch Therapist. Fascial Stretch Therapy (TM) is a system of therapist led, bed based stretches. It differs from traditional stretches which target specific muscles. Fascial Stretch Therapy (TM) targets any tissue that might be limiting range of motion as well as function of movement.

As a physiotherapist with a science background preparing for this course, the first thing that struck me was the name. Really? How much is the fascia limiting range of motion and am I really 'stretching' it? Within the first two days of the course they showed a fascinating video showing the importance and dynamic nature of the fascia. The fascia is highly adaptable and contractile in nature, so yes, it can limit range of motion as well as effect the nerve and blood flow in the body. Having now taken the course, I also feel that the name Fascial Stretch Therapy is a bit of a misnomer. Perhaps Neuro-Fascial Stretch Therapy would be a better description as the program zones in on relaxing the nervous system as much as stretching the fascia. This relaxation is achieved through several avenues; synchronized breathing, joint traction as well as the use of the stretch reflex (PNF stretching). This system of addressing the body as a whole to increase range of motion and flexibility really clicked with me.

The second thing I wondered was how I was going to integrate this therapy into my rehabilitation based practice. In the week since I took the course, I have found it to be quite useful. It is great for relaxing whole joint complexes, even multi-joint chains and saving my hands for the specific work as I need to do it. Postural tightness or years of overuse exercise, which have probably lead to the injury at hand, are relaxed and loosened up much more easily than with previous hands on treatments. On the whole, I have found the Fascial Stretch Therapy (TM) to be a great treatment technique that I have been able to incorporate immediately into my practice with great results.

For more information on FST please see the excellent explanation of what it entails and its benefits on their blog.


**Permission has been granted by the Stretch To Win Institute to use the trademark Fascial Stretch Therapy (TM) or FST(TM) as long as certification is maintained in good standing. For more information about FST(TM) please visit www.stretchtowin.com.**

What does "Use Pain as your Guide" really mean??

Patients are often told by their physiotherapist, surgeon, or sports medicine doctor to "use pain as your guide" in recovering from an injury, but what does that really mean? Will you get better results if you push through more pain or should you stick to no pain at all? The answer to this is usually somewhere in the middle. When rehabilitating from an acute injury such as a fracture or surgery, you need to push through a bit of pain to get the gains in range of motion and strength you need, however if you push too hard you can create inflammation, which may lead to more scar tissue formation, or worse reinjure yourself.

Here are the guidelines I often use (and these may be different for your health care professional, so make sure to ask!):

1. Distinguish between the stretch or muscle fatigue sensations and a pain sensation. Stretch and muscular work are OK
2. Don't let the exercise increase your pain by more than a 2/10. In some cases you may want NO increase in pain with the activity (for example nerve pain should be non-existent with an activity since nerves are so sensitive)
3. Does the increase in pain last for more than 30 minutes after your rehabilitation exercises or activity? Or do you get a rebound effect where it feels the same or better initially, but your pain increases two hours or longer after an activity? If so, it was probably too much!
4. Most importantly when you look at the big picture is your injury improving, static or worsening? If it is one of the latter two, it is time to revisit your exercises and activity program!

In conclusion "use pain as your guide" does not mean you should have total rest, but modify activity within limits. Stretching and strengthening even if the exercises feel "lame" will help you heal and get back to your normal activities faster!!!

Image courtesy of Google Images.

Top 5 Worst Gym Exercises

I recently polled all the physios, chiros and trainers who were friends of mine to see what they found as the worst offenders for causing or contributing to injury (needless to say this article is based on absolutely no scientific evidence). I got some great answers, including dropping a weight on your foot! In general, however, it seemed to be the consensus that it was usually overtraining, poor preparation or poor posture that were the causes of most injuries as opposed to specific exercises.

With that caveat in mind, here were the top 5 worst gym exercises:

5. kettle bells - if weak, will strain your back or intercostals
4. anything behind the head (pull downs or presses) - who does that anymore??
3. bench press - requires great rotator cuff stabilization - trouble if they are weak
2. upright rows - hello shoulder impingement

And with near perfect agreement, the worst offender for causing (most likely worsening) injury, the number one worst gym exercise is...

1. knee extension machine - lets add patellar compression to a knee that has patellar femoral pain!


picture courtesy of google images

Could Sitting be the Cause of my Sports Injury?

I have long maintained in my practice that no matter how well you set up your work station, humans are just not meant to sit for prolonged periods. There is a wonderful TED talk on the dangers of sitting. It highlights all sorts of negative effects of sitting.
One aspect the talk did not touch on was how, for all you weekend warriors out there, it can contribute to sports injuries too!!! I see many patients who, despite their active lifestyles, end up with injuries that are partially related to spending the majority of their day sitting at a desk or in a car.

One structure prolonged sitting puts strain on is the intervertebral disc. Over time sitting can lead to a weakening of the outer fibrous layers or annular fibers of the disc. Then if you participate in an activity where there is lots of forward bending, such as volleyball or hockey goaltending, putting further strain on the disc, you may end up with a herniated disc. In addition, because these annular fibers are angled, sports with forceful unidirectional twisting such as golf or softball may also lead to herniation when the disc is in this weakened state.

Prolonged sitting also leads to muscle imbalances which can in turn contribute to injury. Hip flexor tightness can lead to ITB friction syndrome, tight pecs and weak scapular muscles can lead to rotator cuff impingement, tight hamstrings can lead to hamstring tendon issues... you get the idea.


So what can you do about it? Its not like you are going to quit your job. Here are a few hints to try to minimize the negative effects of sitting:

• get up and walk as often as you can during your work day
• try not to adopt poor posture while you are sitting (see the picture above!!)
• try to pick activities that are not in the sitting position after sitting all day- or modify so that you aren't sitting as much - for example walk the course instead of sitting in a cart, pick an upright bicycle instead of leaning forward
• keep yourself fit outside of your sport participation - stretching and strengthening will help keep you in the game!

I hope these tips help you keep your active lifestyle for as long as possible.

Pictures courtesy of Google Images