Attention Overhead Lifters!

Lifting overhead, whether for training, for sport or for work-related activities, is a movement that regularly leads to shoulder injury and dysfunction if not performed correctly.   I was directed to this interesting demonstration of lifting overhead under fluoroscopy through Dr. Jeff Cubos who has a great blog on evidence based training and rehabilitation.

This demonstration of the mechanics of the shoulder joint was posted by David Whitley.  Watch the videos and then consider the effects of repeatedly performing that overhead lift without correctly packing the shoulder.

Check out the videos HERE.

 

Plantar “Fasciitis”: Not always one cause, not always one cure

One of the problems we have when someone comes to the clinic saying that they have, or were told they have Plantar Fasciitis is that they probably don’t.  The “itis” refers to inflammation and in most cases, there is very little inflammation going on.  Instead, the tissues show more signs of collagen degradation resulting from repetitive, chronic irritation without inflammation.  This is much the same as the majority of cases of “Tendonitis” that we see.  They should predominantly be called a tendonosis and this plantar fascia condition should be called a fasciosis.

One of the reasons for the lack of inflammation, chronicity and slow-healing of plantar fasciosis is that it does not have a very good blood supply, like most thick collagenous structures.  This is significant because it limits the amount and speed of transport of the nutrients and building blocks required for healing.

A second problem that occurs frequently when people come in with this complaint is that they are sure of what they need in terms of treatment.  They either have a friend who’s had the problem before or a requisition for orthotics from their GP.  The trouble is that finding the cause and appropriate treatment for any given case of plantar fasciosis is a tricky business and can typically only be achieved on a case by case basis.  There is no “1″ cause.  There are many scenarios that can create an irritation in the area. 

A few of the potential culprits include:  Heel spurs, high arches, low arches, hyper pronation, sudden weight gain, increased activity levels or a combination of any of the above.  None of those is a guaranteed risk factor however.  Take the example of heel spurs.  If some one has had a plantar fasciosis for a while, it might be recommended that x-rays be taken.  On occassion a person will be found to have a heel spur, which is a bony spur at the medial calcaneous caused by a tugging reaction of the tissues that attach there.  When that is seen on an x-ray, it’s tempting to blame the pain on the heel spur.  The flaw is that not everyone with heel spurs gets plantar fasciitis, not everyone with plantar fasciitis has heel spurs.  The spur can be surgically removed and the patient can still have pain and even when the spur is removed, it will often come back over time.

In general there is some excessive stress being placed on the plantar fascia, causing degradation over time. The fascia spans the peaks of the arch of the foot.  (Imagine the fascia as the string on a bow.)

Plantar Fascia

As that arch collapses under load it stretches and strains the plantar fascia.  Too much of that stretch and strain leads to micro-tearing and cumulative degeneration.

The good news is that although it can be a painful condition and not always easy to determine the cause, it does get better with treatment.  Appropriate conservative treatment can include rest, taping, soft tissue treatment for the plantar fascia and calf muscles, ice and in some cases othotics.  Other options include surgery (which can be quite successful, but can have a long recovery period) or cortisone injections (which do show improvement at 1 month follow-ups, but no lasting improvement at 6 months…with the added “bonus” of increasing the chance of rupture in the plantar fascia).

The bottom line with this (and any other condition), is to make sure you have a proper examination to determine the cause so that you are directed towards the most effective and appropriate treatment.

Illiotibial Band Syndrome: The Runner’s Nemesis

Iliotibial Band Syndrome (ITBS) is one of the leading causes of knee pain in runners and cyclists. It is often referred to as a Friction Syndrome because of one theory that it is caused by the repetitive friction of the iliotibial band (ITB) sliding over the lateral femoral condyle. During flexion-extension ranges of motion at the knee, the ITB moves anteriorly as the knee extends and posteriorly as the knee flexes, which impinges the posterior edge of the ITB. This repetitive friction can lead to irritation and inflammation of the ITB and the bursa.  Another theory has compression playing more of a role than friction and through that compression, structures around the knee become irritated.  In many cases, ITBS is associated with tight musculature at the hip, which can increase pressure or tension on the ITB.

The ITB is a thickening of the fascia that is formed by the confluence of fascia of the hip flexors, extensors and abductors. It extends from the muscles of the hip down to the knee and attaches at 3 sites: the lateral border of the patella, the lateral retinaculum and the Gerdy’s tuberlce of the tibia.   The ITB functions with the hip musculature and plays an important role in stabilizing the pelvis and knee during the support phase of the gait cycle.

The initial goal of treatment should be to alleviate inflammation at the site of irritation by using ice massage, ultrasound, or NSAIDS.  An application of a kinesiotape such as Spider Tech can also be useful at this stage.  Patient education and activity modification are crucial to successful treatment. Exacerbating activities must be avoided and the athlete’s training schedule must be modified.  Stretching exercises can be started once the acute inflammation subsides. This is also when we want to address the myofascial restrictions in the tissues.

Active Release Technique can be an effective treatment for Iliotibial Band Syndrome. ART restores optimal texture, motion, and function to the soft tissues by removing adhesions between adjacent structures. Treatment often focuses on restoring normal muscle motion between the ITB, quads and lateral knee structures. Treatment also focuses on the lateral hip musculature; TFL, gluteus muscles and rectus femoris.

Once the myofascial restrictions have been addressed and range of motion is restored, strengthening muscle weaknesses becomes a very important part of the recovery process. Exercises should emphasize eccentric muscle control, multi-planar movements and functional integrated movement patterns. A return to running program needs to be carried out gradually, with small increases in running mileage and frequency and can be initiated once patients can perform strengthening exercises without pain.

Predisposing factors for ITBS can include training errors, such as increased mileage or intensity too quickly, road camber (always running on same side of road) and excessive down hill running.  Other contributing factors include altered biomechanics such as low/high arches, over pronation, genu varum, tibial torsion, pre-existing ITB tightness and muscle imbalances. Research studies have demonstrated that many people with ITBS have significant weakness in the hip abductors of the affected limb and increased adductor adduction moments because the hip abductors are unable to eccentrically control that movement.

The primary initial complaint in patients with ITBS is diffuse pain over the lateral aspect of the knee. With time and continued activity, the achiness can progress into sharp, localized pain above or below the lateral knee joint. It can also cause pain along the length of the ITB, or at the lateral hip. Pain worsens with continued activity and can be especially aggravated by running downhill, climbing stairs, or after sitting for long periods of time.  Typically the pain begins after the completion of a run or after several minutes of exercise. As the ITB becomes more irritated the symptoms begin earlier and can even occur at rest. In some cases, patients will present with swelling at the lateral knee or report a snapping/popping sensation at the lateral knee or hip.

Physical examination will often reveal tenderness on palpation of the lateral knee approximately 2cm above the joint line. Tenderness is often worse when the knee is flexed at 30, which is the angle that the ITB is at maximal stress. Palpation of the hip musculature (TFL, gluteus medius, vastus lateralis) may reveal trigger points that cause referred pain to the lateral aspect of the knee.

Pack it Light. Wear it Right.

With the return to school upon us, it is a good time to remember some important tips for choosing the right backpack for your children.  Kids think it’s “cool” to strap on their backpacks and head out to school, but if they don’t wear them properly, these important back-to-school accessories can become a pain in the back. Literally – not to mention the neck, head and shoulders.   The BC Chiropractic Association has run a campaign for the past few years on appropriate back-pack use and tips for kids back health.

They’re not moving out, they’re going to school for the day! 

Choose the right backpack, that has two wide, adjustable, padded shoulder straps, along with a hip or waist strap. Make sure they only take what they need for the day, and that the weight is distributed evenly. The total weight of the filled pack should be no more than 10-15% of the child’s own body weight. Pack the heaviest objects close to the body and distribute items throughout the different pockets.

Check out this POSTER of 10 tips for a healthy back and the do’s and don’ts of backpack wearing.

Back pain in school age children is not normal, so when there is pain, it is worth having it assessed by a professional.

 

Off to find the Heat Wave

Thus far, the summer has not been warm here in B.C.  Thankfully, we aren’t dealing with things like flooding, forest fires and heat stroke, but a bump of a few degrees would be more than welcome.

The clinic will be closed from JULY 23 until AUGUST 2, as we go to sample and hopefully bring back some of the warmth that folks are experiencing in Ontario.

We will also be sure to practice the necessities of SUNSCREEN, staying HYDRATED and not exerting ourselves too much in the heat.

See you all when we return.  (If you need to contact us for any reason, please send an e-mail or call the clinic and leave a message.  We will check both frequently while we are away.)

MOVEMENT is the Key

MOVEMENT

Good movement is required for proper function of every system in our body, from muscles and joints, to digestion and circulation.

The body is made up of the same parts in everyone. The same bones, the same muscles, the same ligaments, the same organs, nerves and blood vessels. There are some shape and size variations between people, but in general, we are all made the same. Which is how, when we look at someone, we recognize them as a human, and not a dog, a turtle or a tree.

From that basic differntiation, we get to looking at how people move these virtually identical collections of bones, muscles and ligaments etc. …The variations we find are on an amazingly wide spectrum.

How can that be?  The answer is that some people are moving in the most efficient, least taxing and least strenuous way possible (which is ideal). Everyone else is moving in a less functional, more inefficient, higher stress- inducing, type of pattern.

These less-than-ideal patterns arise from compensations that we make for lack of mobility or excessive mobility that occurs in other areas, or from a disconnect between our nervous and muscular systems.

How do these changes in ideal mobility, or this disconnection between systems occur?  Through injury.

Injury needs to be defined in this sense. Any undue stress on the body resulting in damage at the micro or macro level.   There comes a point where the damage done is irreparable outside of surgery.  Even with “successful” surgery, the body will have to make compensations.  When this occurs, the role of treatment is minimizing the impact of those compensations.  When injuries are less severe, manual therapy and muscle strengthening protocols can be applied to get the movements back as close as possible to ideal.

How do you know if you have one of these compensations, or less-than-ideal movement patterns?
Pain is a great indicator, but does not always point directly to the cause of the problem.
Have your movement assessed by a trained professional.  They should be able to identify any dysfunctional patterns and advise you on treatment or self-care options.

If a dysfunctional pattern exists, it is an indication that undue stress is being put into our system, and if not corrected, will inevitably lead to pain.

A movement pattern analysis system such as the SFMA can be a remarkable tool for tracking down the underlying cause of movement dysfunctional.

Selective Functional Movement Assessment

It is a tool that a trained clinician can use, to track down the underlying problems that are causing you to move inefficiently.

Stay tuned for a further description of the SFMA and how getting your movement checked can lead to less pain and improved performance.

Taking Care of Running Injuries between Visits with TP Performance Therapy

Taking Care of Running Injuries between Visits with TP Performance Therapy

Nothing seems to bring to light, the interconnectedness of different areas of the body like the activity of running.  It is a complex, multi-joint, repetitive activity and if there is a breakdown anywhere along the chain, we’ll start the compensation process for as long as we can until we just can’t compensate our way around it any more, and the pain sets in.  The more common of these pains are plantar fasciitis, shin splints, Achilles tendonitis, and Iliotibial band syndromes.  In our practice in Squamish, BC, there is such an active population that we see a tonne of these types of injuries.

Surprising as it can be, the majority of pains felt at one location are caused by dysfunction at a different location.  As a Chiropractors and providers of Active Release Techniques,  a lot of our job is educating patients as to WHY they are hurting, and not just trying to relieve the hurt.  The more tools that a patient has to take care of themselves, the easier it makes our job and the more satisfied and confident patients become, knowing that there are solutions available to them.

The nature of the majority of these injuries is not an overt trauma to the area, but more typically a result of decreased blood flow and oxygen deprivation in tight muscles, this can cause your body to produce tough, dense scar tissue in the affected area. This scar tissue binds up and ties down tissues that need to move freely which can cause reduced range of motion, loss of strength, and pain. In our practice, we will use ART (Active Release Techniques), to locate and eliminate the adhesions, and find it to be a very effective way of dealing with these types of problems.  One issue that we run into however, is that patients can’t always get in for treatment and the stretching or strengthening advice we provide only has limited effectiveness.

We have also recommended the use of a foam roller in the past for helping break up scar tissue and keep muscles loose, but again we find that because a foam roller is so generic in nature, it ends up being a fairly generic treatment.

We have been using the Trigger Point Performance Foot and Lower Leg Kit with patients over the past 6 months and have found it to be a great solution for patients to maintain lower limb function between treatments.

What impresses me about the Trigger Point Performance Therapy products, is that they are well thought out, specifically designed tools and as a result are much more functional and effective than a foam cylinder could ever dream of being.  The biggest complaint about the products that I’ll hear from patients is that the kits are “too expensive”… They definitely do cost more than a foam roller, but once they have used the tools and realize that it will quickly pay for itself in the number of fewer clinic visits that they will require, they are usually convinced.  Every kit comes with written instructions as well as a very well put together DVD which takes the user through exactly how and WHY to use the different tools for different areas of the body.  Please pay heed to the numerous warnings in the DVD that tell you to take it slow, and increase the pressure gradually, because as anyone who has done any type of rolling in the past knows…it’s a special kind of torture.

So far I have only been using the TP Footballer, TP Baller Block, and TP Massage Ball, for the lower leg.  There are other products available, including the TP Quadballer and TP Grid.  I hope to try out and review these other products soon.  They are available through www.tptherapy.com or in the Lower Mainland at any of the Fitness Town locations www.fitnesstown.ca

Warm Up for Winter Activities!!!

 

It’s getting to be that time of year. We’re looking to our beautiful surroundings and getting outside to take advantage of the winter weather and activities that Squamish and Whistler have to offer. But how do we take part in the adventure, without the injury? Whether you hit the slopes every weekend, love to trek through the trails, or spend most of the winter curled up by a roaring fire, here’s a few hints to stay fit, healthy and injury free when you venture outside from some winter fun.

 

Don’t Strain if You Haven’t Trained: Many winter sports injuries happen towards the end of the day, when we are over-exerted and our body is fatigued. A majority of these injuries can be prevented if people prepare for their sports by keeping in good physical condition, staying alert, and stopping activity when they are tired or in pain. Your muscles are more prone to injury after long periods of inactivity, so it is important to do some off-season conditioning, such as lifting weights and stretching.

Do a Long Warm Up: Cold muscles, tendons and ligaments are more vulnerable to injury and therefore, it is very important to get a good warm-up, especially in colder weather. The goal of a warm up is to increase blood flow to the muscles, increasing your mobility and readying your body for activity.

Drink Lots of Fluids: One of the biggest winter mistakes is not staying well hydrated. In order for our body to function efficiently, we need adequate amounts of fluids and electrolytes. In the winter, we often don’t realize we are sweating because perspiration evaporates almost instantly in cold, dry air.  Drink water often, even if you aren’t thirsty and you will perform better and prevent muscle cramps and weakness.

Dress for the Chill: Often during winter activities, your body temperature undergoes extreme shifts. It’s always a good idea to wear layers of light, moisture-resistant (wicking), breathable clothing so you’ll be able to adjust to any condition. Also remember SUN protection. Snow reflects damaging UV rays back to you face, so be sure to wear sunscreen and sunglasses during sunny winter activities.

Vitamin D Goes Far Beyond Bone Health

Scientists have known for decades that Vitamin D plays a vital role in producing healthy bones. Vitamin D promotes the absorption of calcium, which is necessary for bone development, bone remodeling and preventing bone loss, which can lead to osteoporosis later on in life.  For centuries, we primarily obtained vitamin D from exposure to the sun’s ultraviolet rays, which was easily achieved when humans worked predominately outside.  However, we now spend most of our working days indoors, only longing to be outside enjoying the sun.

Recent research has demonstrated just how widespread low vitamin D levels are throughout our society. Studies have shown that vitamin D deficiency in some North American groups is as high as 80%. The elderly and pregnant women seem to be especially susceptible, and it is also a bigger problem for people with dark skin, which is not as efficient in producing vitamin D from sun exposure.

Where you live also impacts your vitamin D levels. If you live in the Northern United States or Canada (!!), you’re more likely to be vitamin D deficient as the longer, darker winters in these areas restrict sunlight hours.  Another complication is that despite the importance of the sun to vitamin D synthesis, it is prudent to limit our skin exposure to the sun and UV radiation (from tanning beds).   UV radiation is a carcinogen responsible for most cases of skin cancer.

Another factor, which complicates getting sufficient levels of vitamin D is that it is difficult to obtain through our diet.  Natural sources of vitamin D are few and most of us cannot get our required levels of vitamin D solely from foods that we eat.  Some of the foods that are high is vitamin D include; cod liver oil, salmon, mackerel and fortified milk and orange juice.

 

Surprising Research:

In the last 5 years there has been a steady stream of news on vitamin D and its wide-ranging effects on preventing diseases and improving chronic health problems. According to a review of vitamin D published in the Archives of Internal Medicine, people who consumed vitamin D supplements had an overall lower risk of death from any cause. Other research has produced compelling evidence of vitamin D’s impact on cancer.  At the University of California, researchers discovered that consuming 1000IU of vitamin D daily slashed the risk of colon, prostate, breast and ovarian cancers up to 50%. Other studies have revealed reductions in all cancer occurrences in men & women taking vitamin D and amazing 45% reduction in deaths caused by digestive cancers.

This versatile vitamin may also provide additional support for weight loss. Some research demonstrated that participants involved in a calorie-restricting diet, saw a greater reduction in abdominal fat as well as losing more weight, when thet increased their levels of vitamin D.

Muscle Pain & Vitamin D

A deficiency in vitamin D may also play a role in muscle pain. Patients who were suffering from non-specific muscular pain were found to have unusually low levels of vitamin D, according to a study published in Mayo Clinic Proceedings. A study in Spine showed that 83% of low back pain sufferers also had insufficient levels of vitamin D. When their vitamin D intake was boosted, nearly all of the patients showed improvement in pain symptoms. This deficiency in vitamin D has also been demonstrated in children, an age group that had previously been considered at low risk.

Other investigations show vitamin D has a positive impact on rheumatoid arthrtitis, multiple sclerosis, and type 1 diabetes.

 

 

 

Understanding Muscle Dysfunction

When we decide we want to become stronger, it seems that we have a general understanding of what it’s going to take to get there.  If for example we choose to employ the assistance of a personal trainer and we go in for a session and after some basic testing, it is determined that we can bench press 100 lbs.  Our goal, however, is to press 150 lbs… that’s why we’re doing the personal training.

Is anyone in that situation is going to be disappointed or surprised that after one session of personal training, that 150 lb goal has not been reached…N0! of course not.  It is understood that making changes in a muscles capacity to produce force takes time.  It’s going to take a while.  It’s going to take consistent effort with adequate rest, to increase the size and strength of the muscles, gradually increasing from the 100 lbs, by increments up to 150 lbs over weeks or months.

Something that is less understood is there are other factors that are going to contribute to that muscles ability to strengthen and contract and grow which are not able to be addressed by repetitive, consistent effort alone.  The muscles blood supply, innervation, presence of adhesions or trigger points, or an overly tight antagonist muscles all affect that muscles performance.

Muscles can become injured or dysfunctional in a few key ways:

1) Overt trauma, such as muscle strain or tear.  This is usually a pretty obvious situation involving a large force, an awkward position, an unwelcome “popping” sound might make an appearance, pain, inflammation, bruising, (all that fun stuff) and a significant recovery time.

2) Repetitive Strain; where a lower force is applied to the same tissue over and over and over again.  This also eventually results in pain, inflammation and decreased functional capacity.  Common examples of this type of injury are “Tennis elbow” and Achilles’ Tendonitis.

3) Constant Pressure or Tension.  This is usually associated with a postural strain, or a prolonged isometric contraction.  The tension/pressure/contraction limits blood flow and thus oxygen delivery.  Our muscles NEED oxygen and when they don’t get it, fibrotic tissue gets deposited, shortening the muscles, decreasing their ability to contract and lowering their threshold for pain.

Our bodies repair the damage, after going through some inflammation, with fibrotic tissue, to start.  This carries with it some difficulties, including: those repair muscles developing adhesions with things they shouldn’t, shortened muscles altering posture and muscle activation patterns leading to bad biomechanical habits.  This is muscle dysfunction.

We can carry these muscle dysfunctions with us for years and not have them be a problem.  We are very adept at making reasonable compensations for muscle dysfunctions.  Only after a faulty motor pattern, or  poor biomechanics leads to another repetitive strain injury does it become a problem, or when we decide to try and take our training to the “next level” and things don’t respond the way we expect.

This is where seeking appropriate treatment for those dysfunctional muscles comes in.  Much like training for muscle hypertrophy, all the changes we’re hoping for are not going to happen in one session!

A.R.T.® or Active Release Techniques® is on treatment that I’ve found to work very well at addressing this dysfunction, but there are lots of effective techniques out there.

With A.R.T., often there will be some improvement after one treatment.  Typically 3 to 5 sessions are required to effectively address an issue.  So when you go in for a treatment and you can lift your arm to shoulder height, but your goal is to lift it all the way over your head…don’t be disappointed when you can only lift it 3/4 of the way there after 1 session.  Stick with your treatments and don’t set your expectations for yourself too low!  Just because you’ve “ALWAYS” had a bad shoulder since that one accident x number of years ago, for example, doesn’t mean you have to give up on ever throwing a football again!…get it checked out and assessed properly.