All Posts tagged Physical exercise

Motion is lotion

Motion is lotion

Understanding the “Why” behind Movement & Exercise

How do our mindset and beliefs around exercise affect the decisions we make? This blog explores the nitty-gritty of the “why” movement and exercise are beneficial to you in order to help you make the change you are seeking.

As Physiotherapists, one part of our job is to provide evidence-based education to our patients about the importance of movement and exercise. Movement can be active (something you do) or passive (something that is done to you such as joint mobilisation or muscle/nerve/fascia release as common examples). Saanich Physiotherapy  and Sports Clinic prides itself in providing an engaging holistic approach to your health & wellbeing. Movement and exercise are but one part of that approach.

We are each of us unique. We come with complexities and intricacies that make us who we are. In order to delve deeper to understand the “why”, it is important to highlight that all injuries are not the same, even if they are the same injury. Equally so, all pain is not the same, despite the pain seeming to originate from a particular region. Confused? It’s ok, it’s a little bit complex, but I promise to break it down for you so it’s easy to digest. No-one likes pain and our brains are wired to take short cut’s. It’s part of being human. We all want a quick fix. We don’t have time for this pain or injury. It’s stressing us out. Sometimes a quick fix can work to provide some temporary relief, and that’s ok. However, there is usually more to the story and so I will tell you about what we’ve learnt from the many 1000’s of patients we have had the pleasure of helping by getting to know their stories around exercise and movement.

If you’ve tried quick fixes and you haven’t solved the issue your internal voice may speak up and tell you to “do exercises to fix the issue”. That seems logical. Then you probably google it.

Movement and exercise to fix an issue

If logic has taken you on a bypass route straight to a Dr Google search or an Instagram video providing a generic or formulaic approach to exercise as a “fix”, the bypass route will not provide all the answers you need and may even steer you in the wrong direction. There is nothing wrong with information however, which information is critical. Which exercises? When to do them? How many to do? How often to do? When to increase? When to decrease? When to change? What if I get worse? Do I persist? Do I modify? How should I modify? These and many more questions will not be answered by trying to skip the longer scenic route with your physiotherapist as your co-driver and guide to improving your skill. Heading straight to the bypass route either solo or with only partial information that applies to you specifically will often lead to an aggravation of your pain and a delay in the healing process.

Please don’t stop reading here as there is so much more to share with you. Your Physiotherapists job is to know people and people are like complex ecosystems. Bodies – brains, hormones, muscles, bones, tendons, ligaments, nerves, fascia, neural networks, chemicals transmitting signals everywhere, emotions, expectations, histories, unconscious and conscious biases and everything that makes you tick, it’s all interacting with your environment, with other people, constantly re-evaluating. How amazing is that? People are awesome. You are awesome and that is why you need a multifaceted and complex problem-solving approach to your treatment. That is what we do. There are no exceptions. None of us can say we are exempt, we don’t get to opt-out, as we are all made up of the same pieces, it’s just that our jigsaw puzzle, once completed, like our neural networks and their interconnectedness, looks different to anyone else’s. And that is the beauty of people and everything each of us brings with us.

Mindset and Beliefs

Before we look at the “why” exercise is important, it is imperative to understand the mindset and beliefs we each carry within us in relation to movement and exercise. Simply hearing the word “exercise” can invoke a range of varying emotions and responses in each of us. These responses are based on our subconscious and conscious biases, our way of thinking, our past and recent experiences.

We all know exercise is supposed to be good for us – but “knowing” is simply often not enough to make the leap to effect a change in our behaviour, specifically around learning and developing new patterns of behaviour. In order to learn and lay down new habits, we must “do”, we need to act and we must “repeat”. Another vital link to laying down new patterns of behaviour is attributing a positive meaning to our new “doing”, in this case, exercise. Here we explore a range of common responses to exercise prescription or even the thought of doing exercises and the likely mindset linked to each.

This could be anything from:
*a closed mindset response – I am not doing that
*a negative mindset response- I don’t want to do that
*a stress response – I don’t have time
*a fear response – I can’t do that
*an avoidance response – that doesn’t apply to me
*an unsure response – I didn’t know that could help
*an angry response – I don’t want exercises. I just want someone to fix me
*a curious mindset response– how will that help me, can you tell me more so I can understand?
*an open mindset response – I will do my best to execute that
*an eager response – what can I do to help myself
*an overeager response – If I just do a lot of these this should fix my issue
*an honest response – I may not have the time, nor energy, but I understand that this can help me so I’ll give it a try
* a mindful response ­ I will tell myself I’ve done a good job when I do my exercises, even if it’s not as often as it could be, I am doing the best I can at this moment.
*a non-judgemental response – I will not tell myself off if I don’t do my exercises as this is not helpful to me learning new patterns of movement and exercises.

Exercise prescription – Finally the nitty-gritty of why exercise and movement are good for us

Exercise prescription can be given for a range of reasons too. The majority of the physiotherapy patient population are prescribed exercises for improving the functionality of a muscle – it may be weak, lacking endurance capacity or overactive and tight. A muscle can also be slow at responding to input from our immediate surroundings which can affect our sense of balance and lead to issues such as falling over.

However, exercise can be given for other reasons too, such as pain modulation, down-regulating an overactive and sensitized nervous system, improvement in bone density, decreasing stress hormones (ie cortisol ) and substance p ( a neurotransmitter & neuromodulating chemical responsible for providing information back to our central nervous system about pain sensations in the body), to minimise and manage the inflammatory chemical response to acute injury or chronic stress on the immune system ( there are many inflammatory mediating chemicals that are produced inside our bodies such as histamines, prostaglandins and bradykinin – this one increases the bodies sensitivity to pain).

Exercise and diet may also assist in the management of overproduction of pro-inflammatory hormones (such as insulin and eicosanoids). An overproduction of these hormones can lead to chronic hyperactivity of our immune system and the development of immune system disorders (including but not limited to rheumatoid arthritis, Crohns’s disease, asthma, ulcers, cancer, atherosclerosis {heart disease}, sinusitis and more ).

Exercise decreases the levels of TNF (tumour necrosis factor) and CRP (C-reactive protein), which are both involved in systemic inflammation. In order to maximise the benefits of exercise and avoid chronic inflammation, we need to ensure we allow sufficient time for your body to recover after each strenuous exercise session.

Foods that increase the inflammatory response in our body are sugars, refined carbohydrates, saturated fats, trans fats, omega 6 fatty acids, MSG, gluten and casein (arthritis.org ).

Exercise can help us to get to sleep (when we get into a regular morning exercise routine our brain produces a sleep chemical called melatonin and exercise also stimulate the brain to produce a chemical called adenosine which makes us feel sleepy). Your circadian rhythm (your natural sleep/wake cycle) is maintained with regular exercise and therefore your sleep patterns are maintained consistently. This is very important in the management of pain and mental health stability.
Exercise regulates our mental health by reducing the body’s arousal, anxiety and depressive symptoms (after exercise our brain produces endorphins, dopamine, norepinephrine, and serotonin and these chemicals make us feel happy and improves our sense of wellbeing ).

Exercise helps our brains remain engaged. As we age, our brain needs to keep learning new things to keep it active and exercise can play a major role in keeping neural circuits in our brain open or creating new neural circuits. By engaging in exercise, we effectively slow down the process of ageing. Working on proprioception, which is your brains understanding of where you are in the world, you can improve your balance reactions, allowing you to do more for yourself and prevent falls.

So that is my condensed version of the nitty-gritty of why exercise is good for us. For me, I enjoyed sharing with you my passion for moving and I hope you learned a few new things too; and now both you, who has most likely sat for a length of time to read this article and me, as I have sat for a lengthier time to write this article, need to get up and move.

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Calf strength in Running and Walking

Calf strength in Running and Walking

Calf Strength in Running and Walking

Running and Walking are both movements that propel us forward, but did you realise that we use a different amount of energy from our lower limb muscles to perform both of these activities?

These differences in the amount we engage our different muscle groups in our lower limb, depending on whether we go for a run or a walk, are important to understand so that you can target your training effectively.

Why is Calf Strength Important?

What you may find most surprising is that both in walking and running our calves do most of the work in our lower limbs, so calf strength is super important to consider in our training. If you want more power in your strides for either running or, walking then spending some time each week on specifically improving your calf strength will definitely help your movement efficiency.

According to research (Novacheck, 1997) when we go for a walk our calves do 53% of the work, whereas when we go for a run our calves do 41% of the work. This is also why our calves are often sore after a walk or run. This can be especially so if we are new to the exercise or have had a break from walking or running for a while. Post walk or running calf stretches and or foam rolling will also help you keep your flexibility in calves.

At Saanich Physiotherapy and Sports Clinic we recommend that if you are going to start doing strength training, it is best to stretch and foam roll your targeted muscles first . Remember each stretch should be held for at least 30 seconds and foam rolling can done for approximately 1 minute on each leg. Now you are ready to tackle your strength training exercises. If you think about it, trying to contract a muscle that is already super tight it won’t be as effective as you will not have as much available muscle length to work with.

Here are some stats on other important muscles groups:

Lower limb muscle use during walking
Hip Extensors – 7%
Hip Flexors – 30%
Hip Abductors – 6%
Knee – 4%

 

Lower limb muscle use during running
Hip Extensors – 14%
Hip Flexors 20%
Hip Abductors 3%
Knee – Quads 22%

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Swimmer’s shoulder

Swimmer’s shoulder

With ninety percent of the driving forces coming from the upper body, it is little surprise that swimmer’s shoulder is a common condition in swimming. The shoulder is a complex joint, and as swimming placed it under load, an appreciation of its function and limitations can help keep the body injury free. This is especially true for those who swim very regularly or have poor stroke technique, as they are most at risk.

Shoulder mobility as a strength and a weakness

Compared to other joints in the body, the shoulders and hips have an unparalleled range of motion. This is due both of them having ball and socket joints capable of a 360 degree conical movement. However, stability for each of these joints differs. The hip joint fits snugly like a ball in a glove, as the rounded head of the thigh bone, fits into the deep, cup shaped socket of the pelvis. Unlike the hip, the shoulder has a small flat socket about half the size of the ball, along with several other bones, plus a collection of muscles and tendons that support this wide range of motion. Although one of the largest and most complex joints in the body, its unique structure is also a weakness, as the shoulder accounts for up to 20% of all athletic injuries and is the most commonly dislocated joint in the body.

This balance between shoulder mobility and stability is put to the test during sports that require overhead motion. Racket sports such as tennis, or throwing sports like volleyball require two or three patterns of overhead movement. Swimming however, requires multiple overhead movement patterns and a steady conical 360 degree motion of the humerus, the bone of the upper arm. This bone fits into a socket of the scapula, more commonly known as the shoulder blade, which has a cuff of cartilage called the labrum. This ring of rubbery tissue helps keep the ball like head of the humerus in place.
As the humerus fits loosely into the shoulder joint compared to the hip, a collection of muscles and tendons known as the rotator cuff, provide support for raising and rotating the arm. To further aid fluid motion there is a small sac of fluid called a bursa that protects and cushions the rotator cuff tendons. It lies between the rotator cuff and the roof of the shoulder blade, which has two bony projections, the coracoid process and the acromion, which is above the bursa and attaches to the clavicle. Otherwise known as the collar bone, the clavicle, makes up one of three bones of the shoulder, the other two being the previously mentioned humerus and scapula. These three bones are connected to the shoulder by four joints, one being the ball and socket joint of the humerus and scapula, one for where the scapula meets the ribs at the back, and two for the clavicle which joins the scapula at one end and the chest bone at the other.

All of these structures have the potential to be injured, and as such swimmer’s shoulder can derive from a variety of sources. An appreciation of the forces at work upon the body during swimming, can provide a greater understanding of the root cause of swimmer’s shoulder.

The sources of swimmer’s shoulder

Good swimming technique requires a greater range of motion and flexibility of the shoulder compared to other sports and plays a major role in the upper body’s ability to provide locomotion. This placing of the shoulder under load, is further increased since swimming is performed in a fluid medium. As opposed to air, water creates greater resistance and forces upon the structures of the shoulder.

In one study, two thirds of the elite swimmers reported shoulder pain. In some cases swimmer’s shoulder can involve irritation to the tendons of the rotator cuff muscles, but it can also be due a range of painful shoulder overuse injuries such as impingement. This is where the shoulder blade’s bony point that joins with the collar bone, rubs on the rotor cuff and bursa. This can then lead to inflammation of the bursa, known as bursitis, or tendonitis.

The four tendons that make up the rotator cuff and one of the bicep tendons are most commonly affected by tendonitis, once again as a result of wear. Like with any other joint in the body, the ligaments, tendons, and muscles around the shoulder can tear or become loose. This can lead to instability in the shoulder and the chance of greater injury, such as a tear to the the ring of cartilage that holds the humerus in place, or dislocation. Also these areas can be affected by chronic conditions such as osteoarthritis.

The repeated overhead motion of the arm in swimming and pressures placed upon the shoulder joints in water, mean that immediate care of a newly acquired injury and preventative measures are essential. Seeking physiotherapy treatment can identify the exact area of injury, alleviate pain and then planning can be put into place to regain stability, strength and flexibility. For example a gym program with some simple strength and flexibility exercises can be easily prescribed. Through future self management of the swimmer’s shoulder condition there lies the opportunity to proactively train the body so as to minimise the risk of injury.

Managing shoulder health

First of all as with any inflammation injury, the PRICE principle should be applied to the shoulder. This is achieved by protecting the injured area, resting the shoulder, applying ice for 15-20 minutes every two to three hours, compression with a bandage and elevation of the arm above the level of the heart.
Once the area has recovered due to rest or treatment by a physiotherapist, and a strengthening plan has been devised for the injured area and surrounding structures, then it is time to venture back into the water. At this point advice from your physiotherapist, doctor should be taken and the help of a qualified swimming professional or experienced swimmer could ease the transition back to the pool.
After all investigating and understanding proper swimming stroke technique, could prevent a relapse of injury and aid in the rehabilitation of an recovered shoulder. It is also important to know the limits that a recovering shoulder can take, being sure to train conservatively so as to avoid tired muscles. This is also true for those who are injury free, as training at a limit within the body’s fitness level will maintain stability of the shoulder and aid correct function.

Prevention through correct technique

Swimmer’s shoulder can develop with all styles of swimming, with freestyle, backstroke and butterfly seen to be the most responsible for injury, as the arms circle overhead. Although the most gentle looking, breast stroke still places pressure on other parts of the body, and like the other styles, requires good technique to avoid injury. So an option could be to vary the types of swim stroke performed, as this can provide rest and recovery to muscles, joints and tendons that would otherwise be overworked. Refining the technique and building the strength of each swimming stroke style can also avoid other swimming conditions that effect the knees, neck and lower back.

In general terms there are four areas of swimming technique that can aid protection against shoulder injury. As with land based activities, good posture is essential, so keeping the shoulders back and the chest forward will help. Next is developing symmetrical body rotation, that is encouraged by a balanced left and right breathing pattern. This allows for better support to the rotator cuff and generates more power by engaging the muscles of the back and core.

Regarding the best practice for stroke technique, hand placement as the arm enters the water and the shape of the arm when pulling through the water, are also essential in injury avoidance. It is best to have a flat hand as it enters the water at the start of a stroke. This is fingertips first, rather than thumb whereby the arm is rotated outwards. Lastly as the hand then catches the water and pulls through, the elbow should be high so that the water is pushed back, rather than down when the elbow is dropped or the arm is very straight.

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Running and Osteoarthritis

Running and Osteoarthritis

Does running accelerate the development of osteoarthritis?

There are so many misconceptions about running and how bad it can be for your joints. You may have heard many friends and family members comment on this and they may have even tried to convince you to stop running and go swimming instead. Here is what the scientific research tells us so far:

Osteoarthritis (OA) is a musculoskeletal condition that involves degeneration of the joints and impact during weightbearing exercise such as running and may contribute to joint loads. There is very little evidence however, that running causes OA in the knees or hips. One study reported in 1985 by Sohn and Micheli compared incidence of hip and knee pain and surgery over 25 years in 504 former cross-country runners. Only 0.8% of the runners needed surgery for OA in this time and the researchers concluded that moderate running (25.4 miles/week on average) was not associated with increased incidence of OA.

In another smaller study of 35 older runners and 38 controls with a mean age of 63 years, researchers looked at progression of OA over 5 years in the hands, lumbar spine and knees (Lane et al. 1993) . They used questionnaires and x-rays as measurement tools. In a span of 5 years, both groups had some participants who developed OA- but found that running did not increase the rate of OA in the knees. They reported that the 12% risk of developing knee OA in their group could be attributed to aging and not to running. In 2008, a group of researchers reported results from a longitudinal study in which 45 long distance runners and 53 non-runners were followed for 21 years. Assessment of their knee X-Rays, revealed that runners did not have a higher risk of developing OA than the non-running control group. They did note however, that the subjects with worse OA on x-ray also had higher BMI (Body Mass Index) and some early arthritic change in their knees at the outset of the study.

Is it better to walk than to run?

It is a common belief that it must be better to walk than to run to protect your joints. In a recent study comparing the effects of running and walking on the development of OA and hip replacement risk, the incidence of hip OA was 2.6% in the running group, compared with 4.7% in the walking group (Williams et al 2013). The percentage of walkers who eventually required a hip replacement was 0.7%, while in the running group, it was lower at 0.3%. Although the incidence is small, the authors suggest the chance of runners developing OA of the hip is less than walkers.
In the same study, Williams and colleagues reinforced that running actually helped keep middle-age weight gain down. As excess weight may correlate with increased risk of developing OA, running may reduce the risks of OA. The relationship between bodyweight and knee OA has been well-established in scientific studies, so running for fitness and keeping your weight under control is much less likely to wear out your knees than being inactive and carrying excess weight.

Is there a limit?

Recent studies have shown that we should be doing 30 minutes of moderate exercise daily to prevent cardiovascular disease and diabetes. But with running, researchers still have not established the exact dosage of runners that has optimal health effects. Hansen and colleagues’ review of the evidence to date reported that the current literature is inconclusive about the possible relationship about running volume and development of OA but suggested that physiotherapists can help runners by correcting gait abnormalities, treating injuries appropriately and encouraging them to keep the BMI down.

We still do not know how much is “too much” for our joints. However, we do know that with age, we expect degenerative changes to occur in the joints whether we run or not. Osteoarthritis is just as common as getting grey hair. The important thing is that we keep the joints as happy and healthy as possible.

How do you start running?

If you are not a runner and would like to start running, walking would be a good way to start and then work your way up to short running intervals and then longer intervals as you improve your fitness and allow time for your body to adapt. Therefore, running in general is not bad for the joints. It does not seem to increase our risk of developing OA in the hips and knees. But the way you run, the way you train and how fast you change your running frequency and distance may play a role in future injuries of the joints.

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