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

The 5 W's of Stretching

I am asked about stretching in the clinic at least once a week, so I thought a blog about stretching would be pertinent. Here are the Who, What, When, Where, Why, and even How of stretching:


WHO?
Everyone! Whether prescribed by your physiotherapist for rehabilitation, as an injury prevention strategy or simply to delay the loss of range of motion associated with aging, everyone should stretch!!

WHY?
Stretching can have two main goals. The first is to prepare for the upcoming activity (and to reduce injury in that activity). The second is to try to increase tissue length to maintain or restore the health of the muscle or joint in question.

WHAT?
The goal of the stretch will determine the type of stretching you do.
Pre-activity or preparative stretching will be dynamic in nature.
Static stretching (stretches which are held for 30s-1minute) are done with the goal of increasing tissue length.

WHEN?
Dynamic stretching should be done before activity. Static stretches pre-exercise not only have no affect on injury prevention but may actually diminish performance.
Static stretches can be done any time (other than pre-activity) but will be more effective when you body temperature is elevated - after exercise, light activity or even a hot-tub.

WHERE?
Anywhere!!

HOW?
Dynamic stretches could include leg swings, dynamic trunk twists etc. Dynamic stretching should be progressive in intensity and be related to or mimic the upcoming activity.
Static stretches should be held for at least 30 seconds (or over a minute according to some studies) to effectively achieve gains in range of motion.



Pictures courtesy of google images