Blog

Running Errors

2011-09-22T11:28:00.001-04:00

Written by: Dr. Adam Martynuik DC, HKIN, CSCS. TAG Fitness | Health Services chiropractor & sports conditioning specialist.

Running injuries are great in the fact that most come on gradually overtime due to repetitive stress. This means that they are preventable with proper sports conditioning & self-care techniques.

This article is aimed towards novice and beginner runners and not intended to address advance running biomechanics. Most readers will find themselves in the former category.

Running has to be the most common & primitive form of cardiovascular exercise and is also a basic movement pattern common to many sports. Whether you run the treadmill, road, hills, or trails you will find this information very useful.

The first running error often begins long before you tie into your shoes. It is the motivation behind why you run. Most beginners are going to fall victim to an early injury which ultimately ends their running career prematurely, falling far short of their goals. The reason is that their intentions are good, but they are taking the wrong approach towards reaching their motivational goal. The problem is that beginners lack the basic conditioning to just up and start logging miles on their shoes far beyond what their bodies can handle in terms of physical repetitive stress.

So what motivates most to start running? Here is what I see. #1. Fat-loss. #2 Wanting to accomplish a physical-mental feat such as a 10km run, try-a-try, marathon, etc. Here are the problems with those as motivating factors:

1. Fat-loss: This is a nutritional problem with a nutritional solution. Trust me when I advise that cutting 200 calories of refined sugars & carbohydrates from your diet is insanely easier than burning that same 200 calories on a run. Do not use running as your first attempt at fat-loss, especially if you are not making the required nutritional modifications first.

Exercise is not an excuse for eating poorly and the toll on your long-term health of one without the other is devastating. If you are overweight then likely your joint stabilizing muscles are also de-conditioned or tight which along with the extra weight and joint-pounding repetition is sure to results in a running injury (foot pain, shin splints, knee pain, hip pain, low back pain).

2. The unrealistic competition goal: I am all for people setting physical fitness goals, but they have to be realistic and not damaging to their body or health, otherwise what is it proving? All too often people set a goal to compete in a race with little running experience and not enough time to do the proper training to get them there safely.

Running is one of the only competitive sports where everyone thinks that they can just pick it up and compete in a marathon meant for advanced running athletes because of how basic the movement seems, but no one thinks that they can strap on some skates, grad a stick, and then play in the Stanley Cup finals by the end of the season. Yes, the movement is basic, but it is also very repetitive which is where the risk lies. If your biomechanics are not spot on or your training schedule is not properly laid out over the appropriate time then again injury ensures.

If those are the wrong reasons, then what is the right reason to start a running routine? The proper reason to begin running is to improve the function of how well your lungs collect oxygen & then for your heart to pump that oxygen in your blood to specific muscles & body tissues, and improve how your muscles take up & use that oxygen. This is your caridorespiratory function. Improved cardiorespiratory function through running training is useful for disease prevention (heart disease, stroke, cancer, diabetes, depression, etc) or for improved functional performance (sports or activities of daily living like mowing the lawn & climbing stairs without getting winded).

Running biomechanics can consist of actual running technique, but also a lot of runners ignore non-running sports conditioning required for good running mechanics. Adequate hip & thigh strength, core stability with respiration, along with the ability to control hip, knee, & foot stability within an adequate reaction time are all necessary for the injury-free runner.

Muscle & joint mobility also play a key role with injury prevention for runners. If something is stiff or weak, then it constitutes a ‘weak link’ where energy is lost. The energy must go somewhere, typically in the form of physical overstress to a nearby tissue. This is why where the pain is, is not always where the problem is.

Common weak links in the runner are:

1. Lack of ability to full extend the hip backwards. If caused by tight hip/groin muscles the leg has to be pulled forward by the hip muscles, instead of swung through by momentum, causing low back pain and groin pain. If you cannot extend because the glutes (butt) are weak then the hamstring and/or low back muscles compensate resulting in pain or muscle strain.

2. Weak side glutes (butt & hip) unable to maintain the pelvis in a level position causing strain on the outside of the hip as these muscles are repetitively stretched, low back pain, knee pain, and even causing some sciatica-type symptoms!

3. Tight piriformis (butt) muscle causing you turn your whole leg outwards with each step leading to outside hip, knee, & foot pain.

4. Tight hip muscles creating tension that pulls all the way down the thigh (IT Band) creating knee pain behind the knee cap and/or burning along the thigh.

5. Poor foot function, low arches or high arches, or simply lack of control due to weak hip and shin muscles causing foot pain, ankle injuries, shin splints, knee & hip pain, low back pain.

6. Lack of core stability when running and at high levels of respiration leading to low back pain and cramping.

At TAG Health Services we can screen injury-free runners for their weak links & give preventative exercises. We also perform orthopaedic & functional assessments on injured runners to identify the cause of their overstressed tissues resulting in pain then give appropriate exercises, rehab, & sports conditioning. If necessary we prescribe orthotics designed specifically for runners.

Dr. Adam Martynuik is a doctor of chiropractic, kinesiologist, & sports conditioning specialist at TAG Fitness | Health Services. He has a special interest in fitness, activity, & sports-related injuries, prevention, & conditioning.

Osteoporosis in Youth and Old Age

2011-04-16T15:27:00.002-04:00

Osteoporosis and chiropractic, I know what you are thinking. A disease known for brittle bones and a profession most well known for “cracking” them. Not a good combination, right? Well, let me explain why a chiropractor can be at the front line of helping you or someone you know to prevent and treat this disease.

The best general advice for someone looking to reduce the risk of, or manage, osteoporosis is to start early in life with regular, resistance and weight-baring physical activity, balanced nutrition based on whole food sources high in Vitamin D and Calcium, maintenance of an adequate body weight, quit or never start smoking, and limit alcohol consumption. Fall risk prevention, balance training, and gait training all play a vital role in the osteoporotic individual.

How does a chiropractor help this individual? By the addressing the lifestyle factors with exercise therapy and prescription, nutritional counselling and management of supplementation, and by keeping an individual healthy and injury free through manual soft-tissue therapy so they may follow an active lifestyle.

Read more to see why, and how, a Chiropractic Doctor is an ideal choice for a natural approach to this disease process.

A little background information

Osteoporosis is a disease typically associated with old age, however, the initiating events that lead to this disease start when you are young. Our bodies are always replacing and remodelling cells and minerals based on all types of environmental, cellular, and physical stresses in order to adapt, stronger. This includes our bones. When we are young these processes which breakdown our bones for remodelling are well balanced with the processes which lay down new bone in a stronger arrangement, or at least they should be.

Normal bone versus Osteoporotic bone. These arches of connective tissue and minerals organized organized and strengthened by the physical stresses imposed on them support our bones from the inside out, but become porous and weakened by Osteoporosis where new bone is no longer built as quickly as it is broken down for remodeling due to lack of materials and cellular signalling.

Chiropractic doctors on the other hand are specialist in neuro-musculo-skeletal disorders (aka disorders of the nerves, muscles, bones, and joints). They utilize manual therapy techniques, exercise prescription, and the management of lifestyle factors, such as nutrition, to treat these various disorders.

The audible pop associated with a manual chiropractic adjustment is, in fact, coming from the joint, not the bone itself. Chiropractic adjustments are simply one manual technique, albeit the most commonly used by the majority of chiropractors. However, it need not be the only treatment skill used, if at all, in the care of a patient with or at risk of Osteoporosis.

So how can chiropractic care be beneficial in the prevention and treatment of Osteoporosis?

Let’s look at two scenarios, a young, slender 30 year old woman working mainly at a desk job and an older 58 year old woman post-menopause.

So you’re 30, currently healthy and have always been lean, not out of shape. Why would you even consider worrying about developing osteoporosis when it is still so far away? Because it is not. Osteoporosis by definition of diagnosis is a statistical value on a bone mineral density scan were you either have it, are close to having it (Osteopenia), or do not have it. Very black & white.

Well, real life is not nearly as clear cut, as with most chronic and lifestyle diseases, your body demonstrates cellular process changes long before things get so bad that we can stick a label on it like ‘Osteoporosis’. Starting around age 25 there is generally a shift in our bodies whereby the processes which breakdown old bone remain highly active, but the bone building processes start to slow. Are you going to feel any different? No, and it will be years before a diagnostic test such as a bone mineral density scan can determine any significant change. So this is where you have a choice, do something about it now and prevent the disease (primary prevention), or wait till you already have it (see scenario 2) and do your best to slow it down (secondary prevention).

If you are young I recommend you take preventative steps now, particularly if you have any of the risk factors such as Osteoporosis in your family health history (genetic predisposition), are thin or underweight, have a sedentary work or home lifestyle, or an overly active lifestyle without adequate nutrition, poor nutritional habits low in a variety of fruits or vegetables, a smoking habit, or regular moderate to severe alcoholic consumption (above a couple drinks a day on a regular basis).

Scenario 2, you are a post-menopausal, 58 year old woman who has just had a DEXA scan indicating that you have, in fact, developed Osteoporosis. What do you do now? First of all you are applauded for taking the time and effort to determine your bone density, and your medical physician should be very helpful with your medical management options and overall co-management of the condition. First thing is first, there is still plenty that can be done to reduce the main repercussions of Osteoporosis, namely the risk of relatively easy fractures to the spine, hip, and other bones from unexpected falls.

Prescriptions and vitamin supplements are not the only, nor necessarily the best, answer, yet many people in this situation do not attempt to do anything more about their condition. All too often I see the development of a ‘fragile attitude’, but that is nothing more than a slippery slope leading to a downward spiral of this disease and a future of dependence on others to complete even the most basic tasks of daily living. Essentially, some individuals once diagnosed begin to ‘paint themselves into a corner’ by eliminating physical activity they find too strenuous, causing generally benign aches or pains, or to be too great a risk for someone with their condition or of their age. They give into the disease without attempting any strategies to combat it naturally.

Nutrition is vital at this stage as much as it was in the preventative stage. If you have spent a lifetime eating a certain way, such as a diet high in refined foods and caffeinated beverages while a consuming minimal variety and amount of fruits and vegetables, it is likely the most difficult lifestyle factor to change. Other actions as simple as increasing responsible exposure daily to natural sources of sunlight over a large exposed area of the skin can have profound effect on natural Vitamin D production combating a host of disease processes including Osteoporosis.

Balance, reaction time, and strength of muscles, ligaments and bones can all improve through training and a little bit of time and effort. There is no age limit to this, it is never too late, and there is an abundance of scientific studies on the subject demonstrating safety of these activities as well as significant improvements in short time frames, particularly with older individuals with little previous exercise experience.

It should also be noted that yes, men get Osteoporosis as well, although the age of onset tends to be significantly later in life then women. Osteoporosis can also be secondary to another condition such as: Hyperthyroidism (or a medically over-corrected hypothyroid), Hypo- & Hyperparathyroidism, Vitamin D deficiency, decreased dietary sources or absorption of magnesium or phosphorus, Diabetes, Cushing syndrome (adrenal hormone imbalance), Chronic Kidney Disease, and some medications including Glucocorticoids. Many of these lead to Osteoporosis by altering the processes of bone mineralization in some way. Visiting your Naturopathic or Medical doctor for screening and correction of these is recommended.

If the ‘threat’ of Osteoporosis does not motivate you into a lifestyle change, you should note that many of the same prevention strategies suggested will also have a profound effect on the risk for other chronic diseases such as cardiovascular disease, diabetes, and cancer to name a few. Hardly worth sweeping these suggestions under the rug until ‘risk’ becomes ‘disease’ as evidenced by a diagnostic test. If you fell from a ledge the ambulance and hospital will do their best to treat your injuries, but why not walk away from the edge in the first place saving yourself the pain and suffering.

Men are at risk for Osteoporosis too, but I am guessing not this guy! There is no age limit, and it is never too late to start physical activity.

A note to parents: Attaining peak bone mass by the time they are 25 is likely the best strategy for helping your children avoid this disease. It begins in utero with a healthy birth weight as even during pregnancy your child’s bone development relies on the mother’s current bone health processes and habits such as Vitamin D levels, lack of exercise, and of course no smoking.

This responsibility carries through into childhood where maintaining calcium and Vitamin D intakes through adequate nutrition and responsible sun exposure, as well as physical activity play a major role. You want your child’s bones to have plenty of reserve minerals for a lifetime to come, not to mention setting proper habits in place to preserve those stores when it becomes their own responsibility to maintain them.

References:

Grossman, Jennifer et al. Osteoporosis Prevention. Current Opinions in Rheumatology. 2011; 23: 203-210.

Russell, Linda. Osteoporosis and Osteomalacia. Rheum Dis Clin N Am. 2010; 36: 665-680.

Dr. Adam Martynuik DC | Director of TAG Health Services

Doctor of Chiropractic &
Kinesiologist

Active Release® & Contemporary Acupuncture Provider

Sports Conditioning Specialist

TAG Fitness | 90 High Street | Collingwood, ON

www.TAGhealth.ca | 705.607.9849 | info@TAGhealth.ca

Why Stretching Does NOT work

2011-02-25T12:07:00.002-05:00

Okay, so the title of this blog is a bit of a troll, but I do it to make a valid point. Those who suffer from chronic neck and back pain or discomfort often resort to remedial, self-direct attempts to 'stretch' the area of pain or discomfort, which is often described by the patient as being "tight".

How often does this technique usually work for you? 30 seconds? a couple minutes? Often it is not very long, and there is a good reason for that. The reason is that the 'tightness' you feel is typically not due to a muscle being literally shortened, but more likely that muscle is over-lengthened giving the perception of being tight.

We have receptors in our muscles sensitive to stretch which are capable of over-riding a pain signal, but soon after you stop that stretch the pain and discomfort creep back.

So what is the solution? You need to determine what muscles are actually tight and winning the tug-of-war against the lengthened and painful muscles. This is difficult for the lay-person to determine because the 'real' tight muscles are almost always painless. This is the difference between having a professional evaluate you to determine what is really going on since everyone is different.

Only once the tight muscles are released (whether it be through PNF stretching, Active Release, etc.) allowing the overworked & lengthened muscles to be strengthened with specific exercises will you truly realize long-term relief.

Dr. Adam Martynuik DC | Director of TAG Health Services

Doctor of Chiropractic &
Kinesiologist

Active Release® & Contemporary Acupuncture Provider

Sports Conditioning Specialist

TAG Fitness | 90 High Street | Collingwood, ON

www.TAGhealth.ca | 705.607.9849 | info@TAGhealth.ca

Stress, Poor Posture & Pain

2011-02-15T18:44:00.002-05:00

I cannot count the number of times someone has presented to the clinic calling on stress as the inciting factor for muscle tension, but how exactly is stress linked to symptoms such as back & neck pain, headaches, shoulder problems and a laundry list of other issues which many suffer from?

The answer may reside in our evolution and primary reflexes which still dominate our subconscious. There are several primal subconscious reflexes which can override our actions when we feel we are in danger. An example of this is the Blink Reflex where our eye-lids close when an object gets within a certain distance.

The reflex we are concerned with when talking about stress and poor posture is the Startle Reflex. Think of a scared cat, they hunch their back, round their shoulders forward, and lower their head but stick out their chin to maintain eye contact. All these actions would work to protect the vital organs in an animal on all-fours. However, in a human, walking upright, and rarely in immediate danger these strategies have less of a purpose and all typically define what we would call poor posture.

It seems our nervous systems may be predisposed to certain postures in the presence of disease, even if the disease is stress. Professor Valdimir Janda, a world renowned physical therapist, noted several decades ago that there are certain muscles which show patterns toward spasticity (tightness) in children with cerebral palsy, and those that tended toward paralysis (weakness) in stroke victims.

These same patterns of weakness and over-activity can be seen, although to a lesser extent, in sedentary or injured individuals. These imbalances create the same poor posture pattern associated with a prolonged Startle Reflex.

How does this relate to stress and emotions? Well, internal psychological stress is simply the prolonged, over-activation of the sympathetic (fight or flight) response meant to keep us safe from a predator in a moment of danger. However, thanks to modern society we have progressed to a point where almost anything we perceive as negative or threatening to us (e.g. relationship, work, or money problems) can lead us into an extended stress response which is terrible for the body in many, many ways. In terms of posture just think of the image you get when imagining someone depressed or suffering psychological anguish, likely they are hunched over or slumped into their own turmoil. “Keep your chin up” is even a common expression for someone feeling down in the dumps.

So, it may be that psychological stress is in fact at least contributing or perpetuating muscle imbalances which lead to a whole plethora of conditions. I’ve seen this present itself most commonly as headaches and neck pain, but also in low back pain, shoulder problems, and even tingling in the fingers from a restricted and tight pectoral muscle running overtop the nerves and vessels headed to the arm.

A manual therapy practitioner skilled in muscle release can help dramatically with the physical symptoms or stress, but long term resolution may be in part up to each individual to correct postural habits, modify lifestyle factors, and find appropriate & healthy coping strategies.

Dr. Adam Martynuik DC | Director of TAG Health Services

Doctor of Chiropractic &
Kinesiologist

Active Release® & Contemporary Acupuncture Provider

Sports Conditioning Specialist

TAG Fitness | 90 High Street | Collingwood, ON

www.TAGhealth.ca | 705.607.9849 | info@TAGhealth.ca

References

Myers, Thomas. Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. Churchill Livingstone. 2001.

Ski Conditioning & Injury Prevention in Alpine Skiers

2010-11-24T11:58:00.003-05:00

This is a must read for any skier. This blog is an adaptation from a presentation I give to ski instructors and patrollers and contains important information for the elite ski racer to those working with individuals just learning. It is meant to provide a stepping stone to more information and raise awareness about preventing serious knee injuries and low back pain in the alpine skier. It is my hope that it will also open a door for some to the strength and conditioning methods for the sport beyond just stretching and resistance training.

To be complete and as close to my presentation as possible this will be a long one, but I will try to break it up into sections with lots of visuals. All the information that I have developed in this plan is based on evidence from medical and conditioning journals on the subject and the references are listed at the end of the blog.

PART 1: A Little Background Information

ACL tears in skiers: epidemiology and demographics

Over the late 70s and early 80s the rate of tibial fractures and severe ankle sprain-fractures decreased due to equipment improvements (improved ski boots and release systems).

However, the rate of severe knee sprain (usually ACL) over this same time period tripled, and by 1994 these represented 20% of ski injuries versus only 3% in 1972. Knee injuries in 2008 represent 50% of all ski injuries!

The degree (severity) of sprain also increased with complete or severe tears going from 17% to 70% over the same time period (the only negative ski injury trend in a 22-year study).

“The risk of ACL sprain in skiing is comparable to that in College football” ref 5

ACL deficient knees are at an increased risk for secondary injuries such as meniscal tears and the early development of osteoarthritis.

ACL (anterior cruciate ligament): Basic functional anatomy

The ACL sits inside of the knee capsule bridging the thigh bone to the shin bone.

Although the primary job of the ligament is to check how far forward the shin bone (tibia) can move under the thigh bone (femur) the ligament experiences most tension when these two bones twist in opposite directions as shown above. Weight bearing exponentially increases the force on this ligament during twisting.

Here you are look at the knee from the front with the knee cap and capsule removed. It can be seen how closely the ligament is linked to other structures in the the knee such as the meniscus and explains why injury to several of these structures is often seen together in one injury.

PART 2: Prevention through awareness: [Ettlinger et al.]

In 1995 Carl Ettlinger and associates completed a 22 year long study with the on-slope staff of 42 ski areas in Vermont (4000 subjects).

The first 20 years they identified the 2 most common mechanisms of ACL injury during skiing through review of videotaped injuries.

The last 2 years they developed a psychomotor learning program where individual could develop a kinaesthetic appreciation for the situation that precedes an ACL tear. This is different from simply having a cognitive understanding of the injury mechanisms.

i.e. Actually seeing the injuries happen, or almost happen allows skiers to recognize potentially dangerous situations and develop strategies to avoid these situations.

Serious knee sprains declined in the intervention group (video group) by 62% versus the control group (no training/intervention) where there was no improvement [based on the reported injury rates by the staff over the previous two decades].

ACL injury mechanisms while skiing:

There are many mechanisms for injury while skiing, including contact/collision mechanisms which may be out of the skier’s control. The 2 most common non-contact mechanisms of ACL injuries in skiers as depicted in video analysis are shown below. Other mechanisms include hyperextension as well as valgus with external rotation.
The Phantom Foot Mechanism

Six common elements, often in order, may become present when the skier is off balance:

1.The upper arm is back behind the body.

2.Weight of the body is off-balance to the back/rear.

3.Hips fall below the knees (knees are bent)

4.The uphill ski is un-weighted.

5.All of their weight is on the inside edge of the downhill ski tail.

6.The body faces downhill ski (i.e. twisting the whole body in a direction opposite to the direction the lower leg is twisting)

Figure: Phantom foot mechanism (ref 5). The most common mechanism of injury. The tail of the downhill ski acts as a lever in a direction opposite to the foot. This lever (ski) torques the lower leg twisting it inward (right side of figure).

It is important to note that actually visually seeing these injuries happen or almost happen through recovery strategies via video is an instrumental step in reducing these injuries in real life situations.

Recognizing potentially dangerous situations while there is still time to respond.

Dangerous strategies:

1. Attempting to get up while still moving in the fall.

2. Attempting to recover from an off balance position.

3. Attempting to sit down after losing control.

Figure: Likely not enough time to respond

Responding to Immediate Risks Quickly and Effectively

Recovery strategies:

Both arms forward
Bring the feet together
Place hands over skis

These strategies should effectively:

Reposition the downhill thigh with the downhill ski, thus reduce twisting at the knee.

Reposition the uphill ski so that weight can be shifted away from the twisting downhill knee.

Position skier for recovery or controlled fall-out.

More importantly, develop your own response strategy and practice it!

The Boot-Induced Mechanism

Jump with a hard landing and straight legs while off balance.

After beginning a jump off balance to the rear the skier rotates one arm upward and behind while fully straightening the opposite side knee.

The tail of the ski hits the ground first forcing the back of the ski boot against the calf (arrows). This drives the lower shin bone forward out from under the thigh bone. One of the primary functions of the ACL is to resist this motion/translation, but if the force is too high or the supporting muscles too weak or slow to respond a tear or rupture may occur.

Keeping the knees bent (along with hips) will take the resting tension off the ligament on landing.

Figure: Boot induced mechanism (ref 5).

AVOIDING High Risk Behaviour:

RISK: Straightening legs when you fall (often the initial response to a full blown ACL injury).

RESPONSE: keep knee bent during a controlled fall until you stop sliding; OR correct the other elements (arms/hands forward, skis together, re-establish balance) before attempting to resume a normal skiing stance in a recovery attempt.

RISK: Attempting to get up before you’ve stopped sliding.

RESPONSE: When you’re down, stay down. Relax your body and let the fall happen.

RISK: Landing on a backward outstretched hand to break a fall.

RESPONSE: Arms up and forward in any kind of fall.

RISK: Attempting a jump with a straight leg, single leg, or off balance landing.

RESPONSE: Land on both feet flat with knees bent.

Further information resources for awareness training

The preceding information is based on the 1995 study and ongoing thirty-five year research project conducted by: Dr. Robert Johnson - University of Vermont, Department of Orthopaedics; Dr. Jasper Shealy - Rochester Institute of Technology, and Carl Ettlinger - Vermont Safety Research. Most of the information can be found at their website http://www.vermontskisafety.com/ and the videos are excerpts from their home ACL awareness DVD program. Individual copies can be purchased at their website. I have no affiliation with the authors or VSR.

WARNING: No claim is made that adherence to the principles set forth will absolutely prevent injury. The most common ski mechanisms of ACL injury have been covered, however there are other ways to injure the knee. The awareness part of the presentation is only meant to decrease the risk and modifiable risk factors.

PART 3: Prevention of Injury via the Manipulation of modifiable risk factors

Prevention through modification of risk factors: Equipment. Burtscher, M. et al. 2008

The percentage of knee injuries in alpine skiing is twice as high for women in the 14-60 year age range (pre-pubescent and post-menopausal are less susceptible).

Studies show that female skiers without newly adjusted bindings are at a greater risk (1.8-fold).

The key word in this sentence is newly adjusted. Release values are known to increase with the age of the binding so the bindings must be adjusted more frequently to ensure proper release, especially in women.

The literature suggests that setting bindings 15% below the recommended binding release values can reduce knee injuries in women.

Women are commonly at greater risk for ACL injuries in other sports. It is suggested this is due to several non-modifiable risk factors (e.g. hormonal susceptibility) and modifiable risk factors which will be addressed in the prevention through training section. A discussion on the all the risk factors is out of the scope of this article.

Prevention of modifiable risk factors: biomechanical and neuromuscular

An off-season conditioning program, in-season maintenance program, and regular prevention warm-up will not only decrease the risk of ACL and other injuries it will improve ski performance through improved agility, balance and dynamic muscular endurance.

The common biomechanical risk factors are:

Kinetic chain deficiencies: Trunk, knee and hip weaknesses and imbalances, range of motion restrictions, and lack of flexibility relate to compensation by other tissues, in this case the ACL

Neuromuscular control in relation to fatigue: Neuromuscular control is the proper firing and relaxation of muscles by the nervous system in a particular pattern and force that ensures adequate joint alignment and prevention of joint injury.

When certain muscles become fatigued or they cannot fire fast enough, strong enough and there is compensation, typically by the passive support structures such as ligaments (ACL), cartilage, etc.

Muscles can also become recruited to perform a function they are not designed for (typically a global mover compensating for a smaller stabilizer) leading to muscle pulls and tears (e.g. Hamstrings).

This is why injuries tend to happen at the end of a game or session when the athlete is tired.

Training can improve dynamic stability, even when the passive structures are no longer there or lax (previous ACL tear).

Particular strategies of an ACL injury prevention program should focus on:

Enhancing body control: balance and proprioception.

Improving kinetic chain mechanics and equalizing muscle imbalances.

Emphasizing soft, controlled eccentric landing mechanisms.

Improving reaction response times, dynamic muscle stiffening, and muscular endurance.

PART 4: Sport-Specific Strength and Conditioning: prevention and performance training in alpine skiers

Specific studies on a prevention training program designed for alpine skiers is not currently available in the medical literature. The following principles and exercise objectives are based on the successful programs studied in other sports which also have a high ACL injury rate such as soccer.

Actual mechanisms of injury from other sports differ from those in skiing, but the biomechanical stresses imposed on the ACL remain the same.

The good news is that these types of training also have a profound effect on athletic performance and likely hold the potential to prevent many injuries in addition to those to the ACL.

Programs are typically 6 weeks and best done pre-season. An in-season maintenance program would then be necessary to prevent de-conditioning.

Types of training which have been shown to be effective:

Plyometrics (most effective).
Balance and proprioceptive.
Sport specific agility.
Strengthening.
Core conditioning.
Muscular endurance.
Practice of on-hill exit strategies for high risk situations.

Training Overview:

This program is simply a sample and not meant to be a how to guide on performing these exercises, it merely an introduction to the training methods you could have at your disposal. Training should be conducted with a professional strength and conditioning specialist (someone skilled at working with athletes) until you are skilled at these advanced exercises yourself. If done incorrectly these training methods hold the potential for injury in their own right. Each section will contain exercise samples, but it is not expected at are done in one session and in most cases present a natural progression.

Warm-up (2 min)
Plyometrics (5 min)
Balance (3-5 min)
Strengthening (5 min)
Core (3 min)
Stretching (2.5 min)
Additional Training

Open ended agility drills
Practice of on-hill exit strategies for high risk situations
Aerobic lower body conditioning

Warm-up:

Increase muscle temperature making them more pliable and elastic for plyometric exercises while also increasing firing rate.

Non-specific, but should include forward, backward, and sideways movements to challenge muscles that work in all directions.

Attempt to make the whole program more specific by performing it right before activity and even with ski equipment on. It doesn’t have to be running, could be flat skiing forwards and backwards then shuffle side to side.

Straight forward jog (50 yards).
Backward running at 75% (50 yards).

Keep upright, reach back with the leg at the hip
Strive for long strides with full hip extension

Shuttle run at 50-75%

Plyometric Training:

Shown in the literature to be the most effective component of an ACL prevention program for reducing risk factors and injury rates.

The training focuses on the quality of proper form, especially soft, sound landings. As we saw before skiers need to focus on soft landings with deep hip and knee bending and this is where you do it.

The outcome should be an increased dynamic strengthening of the knee (and hips) allowing for controlled deceleration of movements, with proper biomechanical alignment, and adequate reaction times.

1-2 sets of 6-8 repetitions (30 seconds). Allow adequate recovery to ensure proper form on the next set. To the right is a natural progression of exercise difficulty. All 5 exercises have necessary sport specific cross-over training effects for skiers.

A WARNING: plyometrics are an advanced form of exercise, near perfect form is important as well as having an adequate athletic base and lower body strength prior to performing these tasks. Proper instruction at the beginning of training with feedback is therefore often essential to a positive outcome and reducing risk, as opposed to increasing it.

Jump squat:

Two-foot Side-hop:

Cycled split squat jumps:

One-foot jump:

One-foot side hop:

Balance and Proprioception:

Begin any balance program just by attempting a singe leg stance without postural compensation.

When you can do this, challenge it with something like single leg toe raises.

Next, move onto to something a little more challenging like the star excursion exercise.

Adding an unstable surface (pillow, ski on snow, dyna disc, wobble board, BOSU) and also removing visual feedback (eyes closed) will further challenge this system.

Finally, adding perturbations (unexpected external forces challenging your equilibrium) such as catching a medicine ball or another object, or having a partners push you from different directions.

Your goal should be focused on technique (as little sway or postural compensation as possible) for an extended period of time or during perturbations. Aim for at least 1-2 min/per limb.

Star excursion exercise:

BOSU squat with medicine ball catch:

Strengthening:

A balanced, sport specific resistance strength conditioning program is essential for athletes to equalize muscle forces through joints improving performance and preventing injury.

Co-ordinated functional movements with a focus on muscular endurance should be your goal.

Skiing is mainly a lower body sport. Most of the efforts should be set on the muscles responsible for hip and subsequent knee positioning and stiffening.

Co-activation of gluteus maximus and gluteus medius/minimus for hip joint positioning are essential for safe biomechanical movements of the lower limb.
Also, improving hamstring strength, particularly eccentric strength in comparison to strength of the quadriceps is also a primary goal of strengthening since the hamstrings exert the same forces keeping the shin in-check under the thigh as the ACL does.

The following are suggestions of exercises which would achieve these objectives. Attempt 1-2 sets of at least 15 up to 30 repetitions with as little rest periods between exercises as possible while still maintaining proper form. Typically the majority of strength training is completed in the off/pre-season with maintenance during the season.

One-Leg Bridge (hip lift):

1 or 2 leg hamstring curl on ball/ski from bridge position:

Single leg dead-lift:

One-leg squat:

Walking lunges:

Basic Core-Conditioning:

This is your absolute basic core conditioning in an effort to make this program more time efficient.

It is not meant to undercut the importance of the core muscular endurance in stabilization of lower extremity mechanics as well as whole body balance and power.

If you have specific core deficiencies, low back problems, etc., you’ll want to make your core conditioning section more comprehensive.

This could include adding bridges, quadrupeds, chops, lifts, etc.
Back pain in ski instructors and patrollers has prevalence equal to that of the general population, whereas most athletes have a much lower prevalence. Prevention training through core conditioning is suggested to be beneficial.

To compensate for the lack of specific core training in this program core bracing really should be emphasized throughout the preceding parts of the program (plyos, balance, strengthening). Training core in this way is likely even more functional.

Endurance, or static holds of 8 seconds for several repetitions to start is a good measure.

Bird-dog:

Front and side planks:

Stretching:

Tight and overactive hip flexors and adductors (along the front and inside of the hip) cause increased hip flexion and anterior pelvic tilt which severely limits the ability of the gluteal muscles to stabilize the hip and maintain a neutral alignment of the hip and knee.

‘Reciprocal inhibition’ is a natural body mechanism whereby a shortened-tight muscle causes weakness and relaxation of the opposing muscles. This is typically a protective mechanism to avoid muscle tearing as it is being lengthen, but in chronically tight muscles causes improper movement mechanics.

Releasing the tight muscles allows strength and function to return to the opposing muscles, particularly when combined with conditioning.

Studies show that stretch duration is more or less unimportant whether held for 15, 30, or 60 seconds, but the shorter the hold the more repetitions you should perform. Generally, 1 rep of 30 sec daily should suffice.

Perform the stretching component last, when the muscles are warm and more pliable. Ensuring proper form and full range of motion throughout all exercises will supply the body with dynamic stretches throughout the workout.

Low back stretch:

Hip flexor stretch:

Hip adductor stretch:

External rotator stretch:

Additional Training:

Open ended agility drills:

Provides training of dynamic balance
Cutting movements without adequate motor planning risk knee ligament injury.
Thus, training drills involving unanticipated changes of direction using visual cues allow an athlete to train to increase the time available to pre-plan a movement.
E.g. Skiing downhill, friend below randomly indicates direction change with arm movements (R or L) and skier must carve immediately on visual cue attempting to minimize the response time.

Practice of on-hill exit strategies for high risk situations:

As outlined previously:

Recovery Strategies:

Skis together,
Arms forward,
Hands over skis.

Correct responses to high risk situations:

Knees bent during fall until you stop sliding.
Re-establish non-phantom foot form before straightening up.
When you’re down, stay down and relax body.
Arms up and forward in any kind of fall.
Land with both feet flat and knees bent.

Aerobic lower body conditioning :

Muscular endurance is important as muscular fatigue is a modifiable risk factor for ACL injury.

Cross training, particularly during the off season, for lower body aerobic and muscular endurance can help prevent injuries occurring late in a session when a skier is fatigued, especially at the beginning of the season when they have returned from a long period of inactivity.

In Conclusion:

In injury prevention there are never any guarantees. What we just learnt attempts to address the most common risks, however there are other many and varied risks and mechanisms of injury in skiing including those outside of your control.

Research on prevention programs is still in its infancy, but interest in the last decade is on the rise, and with it will come more specific and effective programs.

Being aware of the common injury mechanisms and their exit strategies, modifying equipment risk factors, and training to be in adequate athletic shape for your sport is currently the best strategy for injury prevention, in any sport as well as on the slopes.

Check out the website for further information on sports injury prevention and care!

Dr. Adam Martynuik DC | Director of TAG Health Services

Doctor of Chiropractic &
Kinesiologist

Active Release® & Contemporary Acupuncture Provider

Sports Conditioning Specialist

TAG Fitness | 90 High Street | Collingwood, ON

www.TAGhealth.ca | 705.607.9849 | info@TAGhealth.ca

References:

1.Alentorn-Geli, E. et al. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 2: a review of prevention programs aimed to modify risk factors and reduce injury rates. Knee Surgery, Sports Traumatology, and Arthroscopy. 2009; 17: 859-879.

2.Boutin, R., and Fritz, R. MRI of snow skiing and snowboarding injuries. Seminars in Musculoskeletal Radiology. 2005; 9(4): 360-378.

3.Burtscher, M. et al. Effects of modern ski equipment on the overall injury rate and the pattern of injury location in alpine skiing. Clinical Journal of Sports Medicine. 2008; 18(4): 355-357.

4.Chimera, N. et al. Effects of plyometric training on muscle-activation strategies and performance in female athletes. Journal of Athletic Training. 2004; 39(1): 24-31.

5.Ettlinger, C., Johnson, R., and Shealy, J. A method to help reduce the risk of serious knee sprains incurred in alpine skiing. The American Journal of Sports Medicine. 1995; 23(5): 531-537.

6.Gilchrist, J. et al. A randomized controlled trial to prevent noncontact anterior cruciate ligament injury in female collegiate soccer players. The American Journal of Sports Medicine. 2008; 36(8): 1476- 1483.

7.Griffin, L. et al. Understanding and preventing noncontact anterior cruciate ligament injuries: A review of the Hunt Valley II Meeting, January 2005. The American Journal of Sports Medicine. 2006; 34(9): 1512-1532.

8.Hewett, T. et al. The effect of neuromuscular training on the incidence of knee injury in female athletes. The American Journal of Sports Medicine. 1999; 27(6): 699-706.

9.Mandelbaum, B. et al. Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2-year follow-up. The American Journal of Sports Medicine. 2005; 33(7): 1003-1010.

10.Myer, G. et al – Neuromuscular training improves performance and lower-extremity biomechanics in female athletes. Journal of Strength and Conditioning Research. 2005; 19(1): 51-60.

11.Paterno, M. et al. Neuromuscular training improves single leg stability in young female athletes. Journal of Orthopaedic and Sports Physiological Therapeutics. 2004; 34(6): 305-316.

Single-leg Leg Exercises

2010-11-09T10:56:00.006-05:00

Besides not training them at all, which unfortunately is all too common in many training regimes, the number one mistake in training legs is designing an entire workout revolved around a wide, double-legged stance which will only work muscles in the sagittal (front-to-back) plane.

The best leg workouts for all-around function and health need to include multi-planar (multi-directional) exercises making use of single-leg and split stances in functional positions in addition to the traditional double wide stance movements.

The occasional, but not dominant, use of unstable surfaces also carries many benefits for proprioception, balance, and core conditioning vital to lead an active and independent lifestyle as we age. These systems can be trained, and if you do not use them you will lose them.

Figure: A typical double-leg stance squat

Why are multi-planar single-leg and split stance leg exercises so important?

It very simply comes down to how we use our bodies and legs in real life situations including many sporting activities. When you are standing with both feet on the ground side-by-side your joints do most of the work and your pelvis (along with the rest of your body attached above it) is held level because it is supported on both ends like a table where a pair of legs on each end keep either side from dropping to the floor. This creates a very stable environment and why it is typically called the readiness position in most sports. There are two problems with training your legs only in this type of stance however:

(1) It is very impractical in real life dynamic situations or sport to only be strong in this position. From sprinting, cutting, running, back-pedaling, skating to even just walking our body needs to function well when we have only one foot on the ground as very few activities require simply double-leg standing or jumping. If you train only in a double leg stance you will not be as good or strong as you could be in any of the above activities or as stable in the positions they put your body in. This leaves you more susceptible to injury in the lower extremity or anywhere in the body should a fall happen.

Figure: During a run you will spend 100% of your time in one-leg stance. The law of specificity in training implies that at least some of your exercises should mimic this closely.

(2) If you have to two feet on the ground in a wide stance your joints can basically only move in one plane of motion, sagittal, which would mean flexion or extension forward or backward. This will generally only work muscles on the front and back of the legs and hips.The problem is that we are 3-dimensional and our bodies and muscles were built that way, so only working them in one plane sets you up to develop weakness in the other directions, which leads to muscle imbalances and, again, injury.

Figure: Thigh and hip muscles attaching to the pelvis from all directions. To adequately condition them you need to stress them from all directions.

You cannot forget about the important muscles along the inside and outside your thighs and hips which are essential for single leg activities such as walking or running. Typically you might think of these muscles as the ones which bring your legs towards and away from your body in the sideways direction (frontal plane) and back in the day this is how they were trained (remember the Thigh Master?). These muscles will do these motions, but only if you are on your butt, or say kicking a ball. Functionally what these muscles really do is hold the pelvis level side-to-side when we walk or run because these activities require us to be in single leg stance most or all of the time. Think about the table again, if you took a pair of the legs away from one end of the table you would expect that side of the table to drop towards the ground, and this is what gravity makes the pelvis want to do on the side of the body which has had the leg removed/lifted.

Figure: The hip abductors (gluteus medius, gluteus minimus, tensor fasciae latae) are weak in the person on the right on their right side due to deconditioning and allow the left side of the pelvis to drop. Table on the right supported bilaterally at each end.

It is therefore the muscles on the inside and outside of the hip and thigh of the leg remaining on the ground to tension, balance, and hold the pelvis level. Without enough muscular strength or balance between those on the inside and outside of the hip a dropped pelvis will occur and throw off the proper mechanics in lower limb movements.

When this happens you will have less control of your legs leaving you more susceptible to a traumatic injury or to a more subtle cumulative trauma injury overtime in the knees, hips, or low-back areas to name a few. These injuries will occur while doing your favourite, and therefore most repetitive, activities and you will not understand why because nothing specific happened, the pain was just “there” one day. These muscles also importantly control twisting movements about the hips and pelvis in addition to levelling, which can be just as influential to lower limb function.

How can you improve your leg workouts starting today?

Easy, introduce common exercises you already know, such as a squat, hamstring deadlift, bench step-up, and perform them while standing in a one-leg position. By taking the other side’s support away all the muscles on all sides of the hip and thigh cannot help but activate and get a workout because you are demanding that they function in the way they were designed.

Figure: One-legged squat performed with a kettle-bell.

Also good is a split stance such as that used in split squats and lunges since one leg is doing most of the work or at least a different job than the other there are elements of single leg stance are involved and the stance also tends to be narrow which decreases stability.

Figure: Split-squat performed with the back leg up on a bleacher while holding a kettle bell.

When you get good at these, incorporate even more functional exercises such as walking lunges, sumo lunges, backwards lunges, side step-ups not to mention making use of various unstable surfaces to challenge core, balance and proprioceptive systems using these new stances and exercises. Athletes will want to merge these concepts into their current plyometric routines if they have yet to do so.

Figure: Side step-up being done as a plyometric exercise.

Do not underestimate how hard these exercises will be in the beginning, start without weights and a nearby support (such as a chair) until you can build yourself up to performing them with your own body weight. Remember your hip and legs are not use to being challenged from all sides at once and they no longer have the other side for support and the strength that goes along with having that support. Like any workout regime progressing gradually doing only what you can with perfect form is the best way to ensure safety. Remember, it’s having a healthy pain-free body which you are ultimately striving for so do not let haste blur your vision of this true goal.

Lastly, exercises should never be painful, if they are you need to seek professional help to find out why and fix it. Pain is simply a signal, if you ignore it, it will likely get worse, and if you avoid it, it is only a matter of time before the underlying problem presents itself in some other way.

At TAG Health Services we can screen injury-free individuals for their weak links & give preventative exercises. We also perform orthopaedic & functional assessments on injured individuals to identify the cause of their overstressed tissues resulting in pain then give appropriate exercises, rehab, & sports conditioning.

Sleep Hygiene

2010-10-07T21:54:00.002-04:00

Sleep Hygiene has nothing to do with Bed Bugs, it refers to the modifiable personal, cognitive, and environmental factors which affect our sleep and restfulness. It is not all about quantity but also quality of sleep and rising feeling well rested.

There are 3 major things which affect our general health and immune function: nutrition, sleep, and physical activity & function. All must be well balanced, and if you neglect one you are neglecting optimal health and leave an open window of opportunity for disease.

The following are some of the major factors I have come across in the medical literature that you may want to consider if your sleep is less than optimal. In no particular order:

· Keep the room temperature cool and use covers as needed

o It is harder to fall asleep when the ambient temperature is hot. Think about a restless night you may have had when trying to sleep without air conditioning on a very hot summer day. Our body temperature rises as we fall into a sleep and a cool room provides a more comfortable and quality sleep.

· No eating or strenuous exercise right before bed

o Cease these activities at least 2 hours prior preferably.

· No electronic stimuli in the bedroom or anything that may wake you up

o Cell-phones, phones, computers, televisions, digital clocks with a light,
etc. all carry the potential to interrupt your sleep prematurely and have no place in the bedroom.

· Designate the bedroom to the function of sleep only

o You should not be doing work on your laptop in bed, reading, or watching television. Make your bedroom a shrine for sleep and your body will adjust to recognize it as such and sleep will come easier since that room is not associated with other cognitively stimulating activity.

· Do not stare at a computer or television screen at least one hour before bed

o The types of lights used for these devices affect the sleep center of the brain essentially delaying the natural series of events that lead the brain to ‘shut down’ for the day.

· Develop a routine and stick to it

o Make going to bed a ritual. Whether it brushing your teeth, preparing a nutritious lunch for work the next day, reading something for leisure, etc. in the hour before bed stick to it every night and your body will learn that these are the actions leading up to sleep and begin to shut down gradually like it should,

o None of these activities should contain activities that will stress or excite you.

· Keep a regular pattern of sleep and wake

o The more you adhere to it the easier sleep gets. Think about the earliest time you may need to get up during your week on any of the days. That should be your regular wake time. While first attempting this you may not be able to get to sleep early enough to get your full sleep time while waking up at your designated wake time. You WILL be tempted to sleep in at this point, but resist it! This minor sleep deficit will make it easier to fall asleep later that night and soon all the pieces will fall together.

· No napping

o This will make you want to stay up later at night and disrupt your continuous sleep cycle at night.

· Do not oversleep on weekends

o Unless in a serious sleep deficit, which you shouldn’t be in with proper sleep hygiene, do not sleep in more than half-an-hour to one-hour past your regular wake time on weekends.

· Do not lay awake in bed for more than 10 minutes if you cannot fall asleep

o Get up do something non-stimulating such as reading the newspaper and then try again 10-20 minutes later. You only want to associate the bedroom with sleep, not restlessness.

· Be asleep by 11pm

o Studies have shown that there are important health effects in being asleep between the hours of 11pm and 1am that you cannot get at other times of the night no matter you personal 'schedule'.

o Shift-work is harmful to your health as it disrupts regular bodily maintenance that occurs due to the timed release of specific hormones that restore body resources.

· Get at least 7 hours of sleep and no more than 8

o In general, there are health repercussions for getting less than 7 or more than 8 hours of sleep, although these numbers can vary slightly on an individual basis.

· Sleep with the blinds open and not in an artificially darkened room

o The natural rise of the sun touching our skin signals our sleep cycle that lets us awaken more gradually and refreshed. This includes switching into different phases of sleep and lowering body temperature.

o If you are immediately awoken from a dream then you were quickly pulled out of REM sleep, which means it was not gradual and it will be less likely you feel refreshed when having to get up at that point.

o If you awaken and your body temperature feels relatively very warm or the ambient temperature feels extra cold (but it is not actually) than again you have likely woken up too quickly, which is more common when you get less than your 7 hours.

· Wear ear plugs if you sleep in a noisy house or next to a snorer

o Better yet, get them help as snoring may be related to several underlying causes which can potentially be dangerous.

· When trying to fall asleep, meditate

o Typically the best time to meditate is during the day when you are not tempted to fall asleep, but at night you can use aspects of meditation to provoke sleep. The main method is to push all unwanted thoughts away and not think about one particular thing. This is not the time to plan your next day, stress about work, finances, or a confrontation you had earlier that day. You have done all you can do in a day and there is no benefit to worrying at this point, push it all out of your mind and attack these things when you awaken refreshed in the morning with more physical and mental resources to deal with life’s adversities.

o A good example of a meditation strategy is the use of a mantra. A mantra is a sound, syllable or word that only you know and you repeat it over and over to break any continuous stream of thought that may keep your brain awake. This technique is actually more difficult than it sounds and takes practice, but when falling asleep slowly repeat your mantra and as you begin to realize your mind is starting to wander to a particular subject push that out and focus again on the mantra (you could also use your own breathing pattern in place of the mantra).

These simple tips should give you a running start to a better sleep and in return improve your energy and mood during the day. Do not forget to balance your nutrition with healthy, whole-food choices and balance your physical health with exercise and regular maintenance care with a manual therapy practitioner.

Dr. Adam Martynuik DC | Director of TAG Health Services

Doctor of Chiropractic &
Kinesiologist

Active Release® & Contemporary Acupuncture Provider

Sports Conditioning Specialist

TAG Fitness | 90 High Street | Collingwood, ON

www.TAGhealth.ca | 705.607.9849 | info@TAGhealth.ca

Big Fitness Myths: Sit-ups Are A Good Core Exercise

2010-09-09T17:02:00.005-04:00

This is a long standing myth in the fitness world. I am still amazed to hear this cited or even prescribed as a core exercise despite the fact that nearly a decade ago research in exercise science demonstrated the havoc this exercise wreaks on an individual’s core fitness and spinal health.

It is not any one source’s particular fault that this myth has perpetuated well beyond its endorsement. It simply stands attest to the longevity with which this exercise was cemented into public mind by trusted role-models in the fitness and health fields as a gold standard of physical fitness. Many of us grew up with the 60-second sit-up test in gym class to determine personal fitness goals and who can forget the boom of the fitness product craze of the 1990’s which for a lot of time revolved around re-inventing a new way to do the same sit-up motion. Sadly, even now this article will likely get lost among the sheer volume of misinformation on the subject polluting the internet and the locker room.

I’m not saying that sit-ups will not work to develop the Rectus Abdominis muscle (“6-pack”), it absolutely will increase the muscle bulk, strength and endurance, but what I am asking is at what cost to your body and health?

The saddest part is that most people are not even using sit-ups for the reasons purposed. The commercial fitness industry has made millions selling the notion that spot-fat-reduction is possible over the abdomen by completing resistance exercises on the muscles underlying the fat. It is not. The only way that it could possibly help in this manner is by increasing your caloric demand through sheer energy consumption derived from your fat deposits to fuel the muscles involved. Even then your body decides where to extract the fat, and it may not be from where you wish. There are far more efficient means to accomplish fat-reduction that will dawn the light on a set of 6-pack abs or a flat tummy while accomplishing this through quicker and healthier means. Why someone should be interested in exercising this area is to improve core muscular function, function from which almost all of our movements are based and transferred through to achieve true healthy movement and physical function.

The Rectus Abdominis is just one part of an entire system of muscles which comprise the core, and most exercise scientists have not even considered it to be the most essential component. Muscles such as the Transverse Abdominis and Multifidus have been suggested in past research to be very important, but likely the most acceptable answer is that all core musculature plays a vital role and none can stand alone without causing stress on the system that eventually leads to a breakdown. In this case that stress will begin at the spine, but if you have talked with anyone who has ever suffered through a significant case of lower back pain the physical pain can cause exponential stress in other areas of your life.

So why am I advising you to pack your favourite “Ab” exercise away in the back of the closet along with your Ab-cruncher and Ab-roller, or anything else that uses ‘Ab’ as the preverb to the product name? It has to do with two main reasons. First, the amount of compressive stress experienced in the spine during a sit-up results in significant cumulative trauma over many repetitions. Second, the sit-up reinforces improper movement patterns which stem to create other imbalances leading to injuries far more removed from the lower back along the kinetic chain.

During a full sit-up, or even most crunches since most are done improperly, the shear and compressive forces imposed on the spine reach a level of tissue failure and breakdown. This may occur on a small level at first and present as short-term increased soreness in the low back when beginning a new exercise routine. Over time however the microscopic damage will be become macroscopic, most significantly affecting, but by no means confined to, the spinal discs which are most vulnerable to damage during repeated bouts of weighted flexion and extension, or as we call it “the sit-up.” This does not even take into consideration those who weight the trunk flexion movement with some sort of pulley or weight-plate which would only speed up the process of degradation and injury.

There are safer exercises available to achieve a flat stomach which do not involve isolating one particular muscle in the core and appropriately do not compress the spine nearly as much. This leads to the second problem the sit-up causes, and that is beginning a cascade of improper function and imbalance of the core muscles. As stated earlier, the core muscles function as a unit, each comprising an important role in the core health, and thus low back stability as well. When functioning correctly each muscle’s pull balances out the pull of the other muscles in the core effectively creating a stabilized system. When one muscle is weakened, or in this case strengthened when trained in isolation relative to the other core muscles the balance is disturbed and the system collapses. The physical structures of the spinal column make a vain attempt at compensating for the lack of muscular support, but this is only a temporary solution which quickly ends in low back disease.

Disease is a better word than pain since pain is only one attribute of many underlying processes occurring in a dysfunctional lower back as a result of cumulative physical stress. The muscle imbalance created in the core is often only a stepping stone for further dysfunction down the kinetic chain. The first step down this dysfunctional chain is often over-activity of the Psoas and other hip flexors which are used as prime movers in the sit-up effectively shutting off opposing muscles, the Gluteals, over time due to reciprocal inhibition running amuck. This destroys any chance of healthy hip movement. Add a beginner or novice running component to your workouts like most do and this opens up a whole Pandora’s Box of potential lower limb overuse injuries by throwing off the proper sequence of biomechanics. This chain of dysfunction will move down the links reaching as far as the feet, hands, and neck.

Increasingly less common in today’s fitness world is focus on muscle isolation to increase size and strength of a particular muscle. These rules only have importance in the competitive world of bodybuilding and during the early stages of rehabilitation. Fitness experts and exercise researchers are now function driven, or at least should be since bench pressing 300 pounds with your back pinned to a bench hardly achieves the required resources you need to lead a healthy life. Training to achieve a safe range of physical reserve necessary to accomplish functional tasks like carrying heavy box from your trunk into work early in the morning or even that required for many sports and favourite activities should be the goal of any individual spending time each week training with the ideal of health in mind.

Illness and disease are caused by stress on your system. Chronic stress is all around us in today’s modern world weather it comes from improper food choices causing systemic illnesses due to the free-radical stress on a cellular level, a stressful environment from exposure to chemicals and modern technologies, or mental and emotional stress from relationships, work, or financial issues. Physical stress can be added to that list, and it comes in two forms: traumatic, as in a football tackle or fall, and the often over-looked cumulative stress. Cumulative physical stress can come through repetitive cumulative trauma tasks (the higher the load the higher the toll on the system) as demonstrated by the repetitive, compressive load imposed by sit-ups. There is also the more subtle sustained cumulative trauma as that experienced when, for example, desk-sitting with a rounded lower back the entire time. In the majority of people mixing the two extremes of the cumulative category spells a recipe for disaster in the core and lumbar spine.

By now you may be asking yourself what are the good core exercises? I could never do justice to them with a quick blurb at the end of an article, but by removing offensive and out-dated exercises such as sit-ups from your routine you will have taken the first step to improving your core health. Activity modification is the component most often over-looked for those with bad backs can be the distinction between the success or failure of any therapy or rehabilitation program.

While there may be a small handful of exceptions in elite athletes who require forceful trunk flexion to compete even they must limit the use of such an exercise as any tissue can only withstand so much repetitive stress before reaching a breakdown point. Improper training technique equals injuries, and if you base your workouts on what you see around the gym, your favourite pro-athlete’s routine, or what an ‘old-school’ trainer says then you may have bet your money on a horse that has yet to reach their own breaking point. It will be pretty had to work on your 6-pack one day when you cannot even bend over to get down on the floor due to chronic low back pain and the pot-belly will likely prevail.

Dr. Adam Martynuik DC | Director of TAG Health Services

Doctor of Chiropractic &
Kinesiologist

Active Release® & Contemporary Acupuncture Provider

Sports Conditioning Specialist

TAG Fitness | 90 High Street | Collingwood, ON

www.TAGhealth.ca | 705.607.9849 | info@TAGhealth.ca

References & Further Information:
McGill, S. PhD. Ultimate Back Fitness and Performance. Wabuno Publishers. 2004
McGill, S. PhD. Low Back Disorders: Evidence-based Prevention and Rehabilitation. Human Kinetics. 2002.

Golf and Low Back Pain: The Golfer's Guide to Low Back Pain Care & Prevention

2010-04-29T15:46:00.005-04:00

Professional golfers have the highest incidence of low back pain compared to all other professional athletes. Although most of the pro's injuries tend to be that of overuse, it is no wonder that the amateur golfer often falls victim to low back pain as a result of faulty and inconsistent swing mechanics, poor core conditioning and in-coordination, and certain range of motion deficits.

The good news is that many of the causes of low back pain in the golfer are not serious and are often amenable to modification of these risk factors through conservative care involving exercise rehabilitation, a proper warm-up, manual therapy, and last but certainly not least swing analysis and correction with a professional.

There is a growing body of evidence in the medical literature supporting the involvement of these risk factors as well as the interventions to combat them. In this article we briefly take a look at the most important contributors to low back pain in the golfer as illustrated in the literature.

Although most amateurs attempt to muscle through a drive, the weakness in their game tends to lie in the inconsistencies and in-coordination of their swing. This is also true of the low back in golfers with pain in that region. The muscles in the low back of these golfers show over-activity on EMG studies during swing analysis. This is an effort on the part of the golfer to further stabilize their spine for protection, but in this vain attempt they only increase the compressive loads on the low back. Real protection comes from an efficient and coordinated muscular core section, which in the low back pain golfer is often late to engage, out of sequence, and thus dysfunctional.

It is for this reason that dynamic core stabilization training with a rehabilitation professional beginning with the spine in a neutral posture and progressing to golf-specific activities tops my list of effective low back pain care and prevention. This technique is also the most often endorsed in the literature on conservative management of low back pain in the golfer.

There are several aspects of a golfer's swing and putt that can contribute to the overall clinical presentation of low back pain. A more neutral position of low back at the address (set-up) by positioning yourself closer to the ball, the use of a shorter driver, and use of a longer putter are all suitable modifications that a golfer can try. But even more importantly are the swing biomechanics during the transition between take-away and downswing, as well as the follow-through which deserve special attention.

The amount of separation between the shoulders and pelvis while the pelvis is kept silent during take-away due to a stationary lead foot increases what is called X-factor. It is this X-factor which is said to contribute to the power and club head velocity of the Modern swing. However, it is also this X-factor which may be most implicated in the development of low back pain in a pre-disposed group golfers who demonstrate a reduced ability to rotate their lumbar spine in a controlled manner. Dynamically during a golf swing these golfers are more likely to go beyond their physiologically safe range of lumbar rotation reaping detrimental effects of the structures in their low back.

The best strategy in this case is for the golfer to incorporate more Classical swing aspects into their swing whereby the lead heel is lifted and rotated with take-away allowing the pelvis to move, at least in part, with the shoulders. A shortened backswing alone or in combination with these classical components is also another option. Considering some recent evidence shows that such modifications do not necessarily have to have a negative impact on power and club head velocity it seems worthy of a try in the low back pain golfer, although a period of transition is to be expected.

Golf has a high percentage of it participants falling into the older age group. As result more players may also present with a pre-existing limitation in their ability to extend their low back backwards due to such things as Osteoarthritis and degeneration. As such the hyperextended reverse-C position of the follow-through in the Modern swing poses risks in this population.

Again, a suitable strategy is to incorporate classical components during the later stage of the swing so that on follow-through the lagging heel lifts and rotates allowing the pelvis to move with a weight shift in the direction of the ball's trajectory. Done correctly the golfer should finish in an upright-I position where the low back remains relatively straight as opposed to a backward bending reverse-C.

Besides lumbar range of motion, hip range of motion also play an important role in low back pain. It has been found in one particular study done on professional golfers that only those with low back pain show a decreased ability to turn their lead hip inwards (toes-in) or outwards (toes-out when the hip is bent). If the golfer can no longer pivot as much around that hip they with look to compensate for the amount of rotation by using the lower back, resulting in pain. The fix remains similar to that stated above for lumbar restrictions.

This brings up an important point however. Studies on the treatment of golfers with low back pain are limited in that in addition to these swing modification the subjects also received care from a manual practitioner that included therapies which addressed these range of motion restrictions in the back and hips and core conditioning deficits allowing for decreased stress on the low back. It appears that it is likely a multi-model approach addressing all these factors with a manual practitioner and golf professional that stands to be the most successful approach to treating the golfer with low back pain.

With Chiromechanics I treat all aspects of sports injuries down to the root issue causing compensation and pain in the first place. The variety of therapies used are safe, effective, and tailored to your specific performance deficits. Contact us today and I'd be more than happy to get you back in the game!

Dr. Adam Martynuik DC | Director of TAG Health Services

Doctor of Chiropractic &
Kinesiologist

Active Release® & Contemporary Acupuncture Provider

Sports Conditioning Specialist

TAG Fitness | 90 High Street | Collingwood, ON

www.TAGhealth.ca | 705.607.9849 | info@TAGhealth.ca

References:

Brandon, B. and Pearce, P. Training to prevent golf injury. Current Sports Medicine Reports. 2009: 8(3); 142-146.

Cole, M. and Grimshaw, P. Electromyography of the trunk and abdominal muscles in golfers with and without low back pain. Journal of Science and Medicine in Sport. 2008: 11; 174-181.

Gluck, G. et al. The lumbar spine and low back pain in golf: a literature review of swing biomechanics and injury prevention. The Spine Journal. 2008: 8; 778-788.

Hume, P. et al. The role of biomechanics in maximising distance and accuracy of golf shots. Sports Medicine. 2005: 35(5); 429-449.

McHardy, A. et al. Golf Injuries: a review of the literature. Sports Medicine. 2006: 36(2); 171-187.

Praziale, J. and Mallon, W. Golf injuries and rehabilitation. Physical Medicine and Rehabilitation Clinics of North America. 2006: 17; 589-607.

Sutcliffe, J. et al. Magnetic resonance imaging findings of golf-related injuries. Current Problems in Diagnostic Radiology. 2008: Sept-Oct; 231-241.

Vad, V. et al. Low back pain in professional golfers: the role of associated hip and low back range-of-motion deficits. The American Journal of Sports Medicine. 2004: 32(2); 494-497.

Wadsworth, T. When golf hurts: musculoskeletal problems common to golfers. Current Sports Medicine Reports. 2007: 6; 362-365.

Safe Shoveling Methods for Collingwood and Georgian Bay

2009-12-09T15:15:00.013-05:00

It's that time of year again, skiing, snowboarding, skating, lots of baked goods, and family get-togethers. But with all these great things comes that heavy white stuff that mother nature likes to drop right on our doorstep... literally, and we in the Collingwood and southern Georgian Bay area expect to get lots of it so lets review some easy tips on staying injury free from our favorite winter chore, shoveling snow.

Step 1: Buy a snow blower (ha ha).

(Real) Step 1: Let’s deal with the most serious first, worse than your back going out is the risk of cardiovascular complications that can occur in a certain group of individuals when physically exerting yourself while shoveling. If you have known heart condition or use shoveling as your only form of physical activity all year this means you. So if you’re not accustomed to regular physical or manual activity don’t expect to be a shoveling machine come the first snow fall.

• Complete your shoveling through several short periods of shoveling and even still pace your rate of shoveling while out there.

• It can be harder to catch your breath in the cold air if you are not used to it, so take your rests inside if you find yourself getting out of breath and have a warm drink waiting to re-hydrate yourself.

• Be aware of your limits and any out of the ordinary symptoms you may be feeling and DO NOT push through them.

• Lastly, if you fall into this group you are the weekend warrior and likely not taking care of yourself year round, so get active in the ‘off-season’ and exercise regularly with both cardiovascular and resistance training so that the tasks you must complete may be accomplished easier and safer.

Step 2: Shoveling technique.

• Ergonomic shovels and wide-mouthed shovels that allow you to do more pushing of small amounts of snow are likely better than a small mouthed shovel that requires more bending and lifting. Also look at shovel length, too short and you are going to be in a constant bent over position which will tire out the back quickly. Choose a shovel that when in front of you touching the ground at an angle doesn’t require you to arch your lower back to get a good push.

• With either pushing or shoveling the snow, keep the load on the end of the shovel small and light, it is better to do more lifts with a light weight than many with a heavy weight as the lighter weight allows you to maintain proper shoveling form easier then a heavy load which will fatigue your back muscles sooner, causing improper form and reliance on the passive structures in your back, all leading to very sore, aching, or spasmed back shortly thereafter. Just because you have a wide-mouthed shovel does not mean you have fill it to capacity each time.

• Also be aware of the snow conditions, wet snow is a lot heavier and as such you will want to shovel smaller amounts. On the days when it’s really coming down with no end in sight, don’t wait, get it done once and then again later as this will reduce the shovel load as it will likely be overwhelming later and too tempting to lift all 3 feet deep worth of snow on the end of your shovel.

• When it comes to dishing the snow off to the side there are a few things you want to do and a few you want to avoid.

o Do NOT allow your lower back to bend or hunch over. When you do this you take your powerful low back extensor muscles out of the equation and put all the stress on you joints, ligaments, and discs which is a recipe for disaster. To avoid this keep a straight and flat lower back which is protective for your spine. Instead of bending in your back use your hips to bend forward while also bending your knees to keep your centre of gravity between your feet so that you are not overreaching yourself (see picture).

o Do NOT lift a load and twist to the side or to dish the snow behind you, this type of rotation in the low back when loaded with weight causes shearing of tissue which is another cause of low back pain. Instead always stand beside the shovel with your body and feet angled toward the direction where you plan to put the snow and shovel forward (see picture).

o Do NOT hold both hands high up on the shovel when lifting as this makes the load at the end of the shovel feel even heavier to your arm, shoulder, and back muscles, thus fatiguing you quicker. Hold your lower hand close to the mouth end of the shovel, but just high enough to allow comfortable bending. You’ll have to get a little lower with each shovel, but as long as you are using the hips and knees with a flat back this is okay, and will actually provide you with a great leg workout.

o Hold the shovel as close to your body as possible, the farther away from your body the heavier that load and the harder that your muscle have to work and the more stress on your back.

o Switch the side of the shovel that you stand on frequently, this will allow balance between the muscles you are using.

o Lean to use an abdominal brace. Abdominal bracing with all activities is vital and one of the most important things I can teach someone with functional low back pain. Abdominal bracing uses a constant contraction of the deep core abdominal and low back musculature to stabilize and protect the low back while it is in movement during a task. To brace, tension your abdomen creating a light contraction of all the surrounding abdominal musculature while simultaneously swelling the muscles of the lower back. Keep your breathing regular, this is something you hold over long period of time, but make sure you engage this brace before each lift at least. It can take a while to get the brace right, but with time it can become automatic protecting your back through many of your favorite activities, not just snow shoveling.

Thanks for reading, keep safe, and if you’ve already hurt your back or have any other questions we have many options to help you get back on the ice, give us a call to book an appointment today.

Dr. Adam Martynuik DC | Director of TAG Health Services

Doctor of Chiropractic &
Kinesiologist

Active Release® & Contemporary Acupuncture Provider

Sports Conditioning Specialist

TAG Fitness | 90 High Street | Collingwood, ON

www.TAGhealth.ca | 705.607.9849 | info@TAGhealth.ca

Collingwood ON - Chiropractic Active Release Therapy for Injuries

2009-09-03T23:31:00.004-04:00

Active Release Therapy, or ART for short, is a regulated form of soft-tissue therapy which is widely becoming famous for its use in the athletic world on Olympic class athletes, but also for its use and versatility when applied to many common conditions experienced by patients seeking chiropractic care. The foundation for ART is based on freeing different tissues from one another bound by adhesions (scar tissue from old injury or inflammation). Adhesions can cause muscle dysfunction and weakness and lack appropriate sliding of between muscle, tendon, ligament, or nerve alongside another such structure. ART allows the doctor is able to extend treatment beyond typical chiropractic care to include all the structures that contribute to faulty joint movement and pain.

PATIENT EXPERIENCE: During ART the doctor is able to adjust their hand tension according to patient comfort and tolerance, so proper communication is important. Patient experience ranges from a comfortable deep focal stretch to slight discomfort typical to that experienced during deep-tissue massage. Immediately after treatment patients report feeling looser with decreased pain and more range. Some soreness comparable to that experienced the day after working out is typical and indicates a therapeutic reaction in the tissues. Patient prognosis is variable, but many uncomplicated cases see significant improvement after the first to third visit.

ACTIVE RELEASE THERAPY: Typically the doctor will first palpate the structure causing problems determined by physical exam. The doctor then uses knowledge of anatomy and function to place a thumb, finger, or hand in contact with the appropriate structure at the proper tissue depth. The structure is then tensioned or held in place with the doctor’s hand while a specific motion of a body part is carried out either by the doctor guiding the movement or by the patient after being instructed on the appropriate movement. With this movement the surrounding soft-tissues (muscles, ligaments, nerves and associated fascia) glide around the target tissue being tensioned in place. The result is a break in the many connective tissue adhesions (scar tissue bridges) that prevent fluid movement and contribute to pain. The newly ‘freed’ structure can now move as it is intended to and carry out its correct function without compromising the surround tissues and nearby joint. In the weak injury-prone scar tissue is replaced by strong healthy connective tissue helping to heal those old injuries once and for all!

Rehabilitation exercise to re-educate the muscle’s, or other structure’s, function for optimal performance is often essential and can be the key factor in preventing a recurrence in the future.

Dr. Adam Martynuik DC | Director of TAG Health Services

Doctor of Chiropractic &
Kinesiologist

Active Release® & Contemporary Acupuncture Provider

Sports Conditioning Specialist

TAG Fitness | 90 High Street | Collingwood, ON