Archive for the ‘Injury and Prevention’ Category

I recently received a lengthy email from someone filling me in on their back problems going back eight years.

He had a disc problem in his lower back that called for surgery. He was looking for a therapist who would take someone on with chronic back issues.

Past therapies he endured included passive modalities such as TENS and ultrasound. He said he has an exercise routine but isn’t consistent with it. When he exercises, his back flares up. Read the rest of this entry »

As a kid I was always very active. Growing up in Ontario afforded me many opportunities for skating and outdoor rinks were everywhere, and lucky for me my neighbour Jack had one. I was skating by age two. When the ice melted, we switched gears to road hockey.

Organized sports started for me around age eight. There was softball in the spring, soccer in the summer, and hockey in the fall/winter months.

With this bundle of activities, not forgetting the wipe-outs off my bike, there were bound to be a few injuries here and there.  As kids though, we tend to be able to just let our injuries heal and get on with life.

What I didn’t realize then, was I was developing tight ropy bands in my muscles that would eventually make it harder and harder to stretch. Read the rest of this entry »

What happens to the tissues in our bodies when we use them? 

How do they get stronger? Why do they get injured? 

How do they recover so we can exercise the next day? 

Why am I sore a day or two after tough exercise? Why do my legs burn when I’m  exercising? 

How can I recover better? 

I know… lots of questions jumbled together all at once, but it’s a pretty typical train-of-thought scenario I’d like to unravel.

TISSUE INJURY

I heard Dr. Paul Watson speak early on in my years as a physiotherapist. Something he said I have never forgotten was,  “Exercise is controlled injury.” 

When we use our bodies, especially when we use them to play at higher intensity, the tissues actually get what are called microtears, or little tears in them. This creates an inflammatory response. When you experience enough of these tears, you will experience  pain for a day or two after exercising (DOMS or Delayed Onset Muscle Soreness). Contrary to what some believe, this is not Lactic Acid build-up in the muscles.

THE BURNING PAIN

Lactic acid builds in the muscles as a product of the anaerobic system (which is the system our body uses to create energy during short burst activities such as sprinting). Our bodies are able, when trained, to use this lactic acid as an energy source. It’s the build up of lactic acid that creates that fretted burning sensation.

WOLFE’S LAW

What doesn’t kill you will make you stronger. Okay, this is not Wolfe’s Law, but it’s close. When we stress our tissues, our bodies respond by making the areas under stress stronger. This is why we exercise.  

BREAKDOWN

If you were to take a piece of plastic and bend/stress it back and forth in the same spot over and over, eventually it would weaken, then crack and finally snap. Unlike the plastic, when you stress your tissues, they have the ability to recover. 

However, this does take time. If you stress the tissue again before it’s fully recovered, it will gradually reach the point on the STRESS STRAIN CURVE that it snaps.

OVER-TRAINING

This is the biggest cause of injury that I tend to see in my practice. 

TOO MUCH, TOO SOON, TOO HARD, TOO FAST. 

We are all guilty of it. We don’t want to give up doing the activity we love. We want to run every day to help keep the weight off (or so we can eat whatever we like when we like). We tend not to listen to our bodies. 

But like a newborn child who’s hungry, if we don’t pay attention, it gets louder.   

RECOVERY

There is a lot of information out there on how to help your tissues recover so you can keep on track without injury. One of the best ways though is to rest the tissues as needed. The old gym routine where you work the upper body one day and the lower another, then perhaps do some core work the third makes sense. 

I love ice hockey. This involves a lot of work for my legs. I also was a runner and cyclist (also leg work). When I went to the gym then, I did not work my legs at all. No squats, lunges, stair running, jumping. Instead I stretched my legs and focused on my upper body and core. 

YOU ARE WHAT YOU EAT

Our cells are made up of proteins, carbohydrates, fat and water. So why would we not replenish these right away to help with healing? 

After a hockey game, I go for the protein right away (I use a whey protein powder in water). And, what I’ve discovered is my legs are better able to play four games in a weekend tournament when I do this. Last year I occasionally played back to back games (three hours of hockey). Having water with electrolytes on the bench and my protein drink afterwards helped in my recovery. Again there is a lot of information out there on what quantities to ingest for your body size and metabolism. It really is trying things out to know what works best for you. 

SLEEP

When we exercise, we’re stressing our system. The more we stress it, the more sleep we need. I read in a triathlon magazine professionals training for an Ironman will sleep upwards of 12 hours a day. How many people training for these big events are really able to get that kind of sleep while holding down a full-time job and having a family? When we sleep, our bodies process cortisol, the stress hormone that wreaks havoc on our bodies.

WORDS OF ADVICE

1. Listen to your body. If you’re experiencing more pain each time you exercise STOP. 

Your ego really doesn’t have your best interest in mind, despite what it may be telling you. 

2. Cross train. Who knows you might have fun trying something else.

3. Eat a well-balanced diet and drink adequate amounts of water.

4. Get a good nights sleep (watch how much stimulation you get before bed). Dr. Bill Code told me the quality of sleep during the hours before midnight is better than what you get afterwards (it has to do with the hormones released then). I’ve been trying to have my lights out by 10:30 p.m. (after reading for 30 minutes) and I find I’m better rested, even if I wake up at 4 a.m.

IF YOU’RE MOTIVATED:

More on the anaerobic system: http://www.youtube.com/watch?v=uCmNQQWlrc0

Dr. Bill Code’s website: http://www.drbillcode.com/ 

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter sites by hitting the link there. To book an appointment at Start Line, call the clinic at 250-746-7463.

ARE YOU OUT?

How many times I’ve heard a client say: “I have one leg shorter than the other,” I can’t count.

Or there’s, “my hips are out and the therapist tugs on my leg to fix it.”

What exactly are us therapists doing when we pull your leg? What we’re up to is actually a form of manipulation that’s supposed to target the sacroiliac joint (SIJ), where the tailbone (sacrum) meets the pelvis, wing-like bones (innominants). 

I will admit this was a technique I used frequently to help correct my client’s pelvis misalignments. 

I’ve even had it done to my own. The trouble with this is when clients tell me they need to keep having it done, because it keeps going out. 

WHY ARE YOU OUT? 

The pelvis (sacrum or tailbone and the pelvic bones or innominants) has two forms of stability. 

1. STATIC STABILITY, which comes from the shape of the bones and how snugly they fit together as well as the tough ligaments like duct tape holding them firmly in place.

2. DYNAMIC STABILITY, which comes from the muscles and how they pull on the pelvic bones. 

WHAT MUSCLES?

Muscles can have an effect on your pelvis including the muscles at the front of the thigh (quadriceps, tensor fascia lata), the inner thigh muscles, the back of the thigh muscles (hamstrings), the buttock or gluteal muscles, the back muscles, and even some of the shoulder muscles (the lattissimus dorsi, which is a huge muscle coming from the front of the shoulder down into the lower back). 

CHECKING THE PELVIS

I check the alignment of the pelvis on most of my clients who come in for an assessment. 

I had one client who came in for a calf strain as she was training for a half-marathon.  After releasing the calf tightness and following the line of muscle tension up the hamstring to the pelvis, I soon discovered she had significant muscle tightness and stiffness in the left upper thoracic spine (mid-back between the shoulder blades). 

The stiffness was one-sided, so I asked if she had ever been in a car accident (one where because of the shoulder strap crossing over one shoulder only, there may have been a twisting trauma). 

In fact, she had…20 years ago. 

IS THE PELVIS STUCK OR IS IT JUST MUSCLE?

One of the things I learnt from physiotherapist Dianne Lee http://dianelee.ca/ (be sure to check her website for more educational information) is how to better determine what muscles might be contributing to the problem at the pelvis.

Why are you out? This is the question I ask myself. So, I feel how the joint itself is sliding and gliding. Sometimes I feel a stiffness like I am pushing against a brick wall (the joint itself is stuck). Other times (which is actually most of the time) I feel a resistance that resembles trying to push against a mattress spring. This to me is indicative of a tense muscle causing the joint to lose its mobility. In any case, the treatment technique is different. 

With the stiff joint, I will manipulate it (which might be tugging on your leg). With restriction from muscles, I use Intramuscular Stimulation (IMS) http://istop.org/.

COMMON TRAINING ERRORS

One of the biggest training mistakes I see is over-working of the quadriceps (front thigh muscles).  People run, bike, play hockey, then go to the gym and blast the quadriceps more with squats, squat jumps and lunges. 

Tension in the quadriceps builds and has the tendency to pull the pelvis bone (wing innominant) forwards. This then puts strain on the back opposite (antagonistic) muscles, the hamstrings, which can then contribute to a hamstring strain or pull. 

You can see what I’m getting at. It’s all about muscle balance.

DO I NEED STABILITY EXERCISES?

In my honest opinion, everyone can benefit from exercises that focus on stability around the pelvis. It connects the lower half to the upper half. 

There are people who have injured the strong ligaments (after childbirth is one example) that support the pelvis and need to work on regaining the muscle stability. 

There are specific tests we can do to determine if you will benefit from these exercises and if you need extra support (core shorts are what I use).  

When retraining the pelvic muscles, PT Dianne Lee distinguishes the inner core from the outer core. 

Hold tight for more on this in my next blog entry.

So for now, if you are someone who continually needs to have his/her leg tugged on to re-align the pelvis, it’s time to look at whether the SIJ is too loose and needing extra stability or whether it’s a matter of muscle imbalances around the hip and pelvis (or up at the shoulder) that need to be released and stretched. 

It’s time to look for the why (see my earlier blog on our “bullies”) rather than treating the symptom (victim).

IF YOU’RE MOTIVATED:

Read more from physiotherapist Dianne Lee: http://dianelee.ca/

Find out more about IMS: www.istop.org/

Read Wendy’s earlier blog on discovering our bullies: http://bit.ly/qjUCY0

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter sites by hitting the link there. To book an appointment at Start Line, call the clinic at 250-746-7463.