Tuesday, 14 May 2019

Concussions (Are Not Just A Sports Injury)

Concussions are a hot topic in sports, and the world watches all news and developments closely. They’re a real danger, and sport organizations are, thankfully, catching on quick to the need to treat them seriously.

However, there’s an odd disconnect between how concussions are considered in sport versus any other aspect of life. While it’s widely known that standard protocol dictates no sport participation until a concussion is fully healed, schools and workplaces are still lagging behind. Even insurance companies (*coughICBCcough*) do not treat concussions with the seriousness they require.


The fact of the matter is that concussions do not require a sport or even a car accident to occur. Workplace head injuries are incredibly common, but even simple household accidents such as a tumble down the stairs can be enough. And the struggle with concussion injuries outside of sport is a lesser awareness of the issue resulting in many cases going under-reported and undiagnosed.

Furthermore, anyone who’s been involved in sport understands the hardship of the time-off requirement when these head injuries occur, with almost forceful intervention often being needed to keep recovering athletes out of play. What happens, though, when an employee or student doesn’t have that same watchful eye to prevent them from returning to work or study too early? Unfortunately, pushing through these situations can result in the same complications as an athlete playing through concussions.

Fortunately, concussion reporting at work is seeing an increased rate, and almost assuredly due to increased awareness and not an increased true rate of injury. That being said, there is still room for growth as we work toward seeing brain health in everyday life being treated with the same urgent protocol as it would in sport.

Remember, just because you don't play football doesn't mean a knock to the head shouldn't be taken seriously. Physical AND mental rest and slow return to activity is vital for the brain to recover and best done under supervised, gradual exposure.

Athletic Therapists are one type of healthcare professional specifically trained for recognition and assessment of concussions as well as in return to activity protocol. Consider a consultation with one if you or someone you know is coping with this type of injury.


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Tuesday, 30 April 2019

Am I Feeling Better?

It's funny how often that my clients, when asked how they're feeling, answer that they feel roughly the same as the last treatment.

I then proceed to interrogate question them on their symptoms, and they suddenly realize what improvements that they've made!

Sometimes, the changes are simply just gradual, so the improvement isn't as apparent. Other times, a person's symptoms had become so day-in-the-life that the client noticed neither the symptom anymore nor the progress.

Here are a few questions to ask yourself when you're unsure if your rehab is working.


Is my pain less severe, less frequent, or both?

Many people, habitually, focus on only severity or frequency of their pain, but not always both. It sometimes is worth taking a moment to simply question both of those factors next to each other to remind you that things are getting better.


Is my pain the same but while I'm doing increased work/activities?

This one is humerous. A client will tell me that their pain is still a 7/10....however, they did an hour hike instead of a half hour walk. I think we can put the math together on this one.


Is the pain the same but require more activity to trigger it?

Similar to the last point, but a bit different. Sometimes, people have pain that isn't a gradual buildup, but rather a quick trigger for a flare up. But often, it's easy to miss that the trigger is getting harder to pull, with more work or activity being required before that flare up occurs.

Is my life being affected less by pain?

And finally, pain is sometimes directly affecting very specific aspects of our lives, such as sleep, energy, and even diet. It's good to evaluate all of these sorts of areas to see if there's any improvement and indication that pain is dictating your life even a little bit less.

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Tuesday, 23 April 2019

Shattering The Glass On Exercise Promotion

"It's easy to fit exercise into every single day."

"Just take 20 minutes to get up and move!"

"Time is only an excuse to not exercise."

How often do we see statements like this plastering our media? According to fitness and health professionals out there, exercise is the easiest, simplest thing to insert into your day or week, and no one has an excuse to skip it.

In theory, this makes sense. We all definitely spend 20 minutes or more doing unimportant work during our days. Replacing it with a 20 minute walk should be no problem.


The problem that I have with promotional messages such as this is that they ALL come from professionals who work and spend their entire days in health-promoting environments. Personal trainers who work at gyms, therapists who do exercise with clients all day, doctors who maintain health initiatives for their entire staff; the list goes on.

Let me make this clear. We professionals say that exercise is easy to work into a day because, for us, it IS easy! We work in settings that contain exercise equipment. We spend all day positively enforcing the idea of movement. Our job is to focus on health!

But for the individual who works an office job on the 20th floor of a building in the downtown core with little surrounding greenspace; the member of a staff that is, overall, not active or interested in health promotion; the person who works a second or third job on the side to support their kids, this message has little hold.


If you're not part of that environment, yourself, can you just imagine so for a second? Access to exercise is one thing - and one that many people still do not have to a great extent. Motivation is another. When you spend your days surrounded by people and work that do everything but promote exercise, what is the inclination to partake. (Aside from gorgeous Instagram trainers who make you feel guilty for skipping something soooo easy in your day.)

Now, I'm not saying that the public is a lost cause to convince to exercise, and I'm not guilt-free of trying to make broad, general statements on ways to incorporate exercise into the day. However, as a mindful practitioner, I realize that access and motivation for exercise is a highly-individualized thing, and generalized tips will not go far. It boils down working with each client, one-on-one, to develop methods and ways to increase a client's participation.

And don't feel bad because that guy on Facebook says it should be easy.

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Tuesday, 16 April 2019

Trust Your Body - The Bridge Between Recovery And Comfort

I had a client who I helped to rehab a dislocated shoulder. We got their shoulder strong again and returned its range of motion, and thereafter we went several months without seeing each other again.

Fast forward, and the client returned for a visit after reaggravating the old injury. Upon an update on the past few months, I found out that this client was still having a lot of hesitation, before that point, when it came to supporting weight through the shoulder with a hand on the floor.

To me, this highlighted the importance of making sure that rehab was carried forward beyond simply removing the pain and getting strength in each range of motion back.

Rehab is essentially relationship counselling between the brain and body.

This comes back to what I've talked about before regarding helping clients through avoidance habits. When the hesitation and lack of trust regarding certain movements is too great, it's easy to avoid anything resembling that movement to the point that we see a weakening in that joint's function again.

And with that lack of specific activity, the more likely it becomes to re-injure that joint as soon as you do anything resembling that activity again.

For this reason, as a client, we always recommend perseverance in the rehab program beyond the point where there's simply no more pain. As we return the strength and range of a joint, we then turn the exercise plan into something practical and reflecting the demands of your life and any physical activities that you do.


What's more, the sooner we can start the rehab process, the fewer avoidance habits you'll develop and the more easily we can transition to your life-specific reconditioning.

Rehab is essentially relationship counselling between the brain and body. Being strong is great, but if you can't build trust that your body can perform again, the chances are that it will struggle to ever do so.

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Tuesday, 9 April 2019

3 Ways To Incorporate Your Rehab Into Your Day

We all live busy lives, which can sometimes make following a recovery plan difficult. With that said, it can be very frustrating to be handed a list of exercises by a therapist with orders to do them every day, unconditionally.

As we know, it's just not realistic for many people to simply create a block of time during the day. As well, motivation and energy, fairly enough, may not be in great supply first thing in the morning or at the end of the night.

Some kind of commitment and regularity is needed when it comes to exercise rehab, however, and simply planning to exercise in front of the TV just never seems to work.

So what are some ways that we can work our exercise routines into our daily life without having to feel like we're punishing ourselves or sacrificing other aspects of our day?

1) Pick A Consistently-Free Time

Maybe you find yourself with 15 minutes to relax between finishing breakfast and leaving for work. Maybe it's directly after getting home, before cooking dinner. Perhaps you have a second wind after dinner, and can set aside a moment before hitting the couch and catching up on Big Bang Theory.


It's a common fact that regularity with a time of day to exercise is the best method of making it a long-term habit. IF you have the time during your day or evening that you know you'll always (or nearly-enough) have available, then it becomes easier to make it a rule to yourself to do your exercises then.

2) Warm Up Before Activity

This is an easy one if you're someone who has a workout routine or sport that you stick to on a regular basis. However, it can apply to you if you have a dog that you take to the park, like to go for bike rides, or enjoy any other physical work and activity, such as gardening.

Using your rehab plan as a warm up before any other physical activity that you do, whether it's a traditional workout or simply a walk in the park, is not only a great way to make your exercise a habit. It's also excellent for getting your body accustomed to new ways of moving that the rehab plan is meant to achieve.

Now it's a treat for both of you!

3) Breaks

We all (hopefully) have breaks during our work days that allow us to decompress and take a moment to ourselves. If so, this provides one more opportunity to create an exercise habit.

It stands to reason that work tasks are a common cause of individuals' pain, and so taking routine breaks from those duties to relax and move around is both efficient and a great way to relieve some pain or discomfort while on shift. While not realistic for every single type of workplace, if there's a chance for you to take a corner, or even just stand up at your desk, to perform even part of your rehab plan, then take it.


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Tuesday, 2 April 2019

Don't Chase Your Pain

Wrist pain that has nothing to do with your wrist? Elbow pain that's doesn't stem from a structure of the elbow? Hand pain...well, you get the picture.

Many of our clients see our therapists for pain that just can't be traced to the area where the pain is perceived. Classic examples of this are symptoms in the elbow, wrist, and hand that we find rooted from the neck and shoulder.

It's not at all uncommon for nerves, as they travel from their origin to the spine, to cause pain at the furthest extremities. In the shoulder, for instance, the bundle of nerves leaves the neck and travels through a pathway in the shoulder before innervating the rest of the arm. 

At both of those locations do we often see a restriction of the nerves, whether it's from muscular tension, poor mobility between joints, or anatomical bone structure. That restriction can then result in pain, numbness, tingling, or other neurological symptoms.



However, nerve pain is interesting in that it follows trends, but not rules. Individuals often expect that they need all of the symptom criteria in order to identify the cause as a nerve. Radiating and electrical pain is a classic sign, as is the numbness or other sensory changes throughout the arm.

Neuropathies do not follow strict guidelines, though, and can easily present as localized sensations, resembling muscular soreness, tendinitis, or arthritic pain.

For this reason, we cannot simply point to the pain and assume that that's the spot that we need to rub and exercise. Our therapists will ensure to rule out the joints above and below the site of pain to narrow down, exactly, where those symptoms are originating from. (Fun fact, it could be MORE than one place. Fun.) With that being said, to the carpal tunnel or tennis elbow clients out there that seem to have found no relief, it may be time to seek an additional opinion to make certain that the right area is being addressed.

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Tuesday, 26 March 2019

Don't Ignore Your Finger Health

They may not be the most common joints to injure, but when it happens, it becomes quickly apparent how nagging and debilitating finger pain can be.


Finger injuries occur both acutely and gradually from sudden incident or overuse. From sport to occupation, from rock climbing to typing, from judo to construction.

While the injury itself isn't as common as others, what is common is the tendency for individuals to ignore the pain and wait it out until the pain subsides on its own.

I suppose the thinking is, since the joints are so small and seemingly-less complex than the larger shoulder or hip joints, that there is less to be done except to let time take its course when pain onsets.

However, we know that resting and waiting out any injury can be a detriment, whether it's due to the loss of strength and range in the meantime or simply due to the development of irregular movement habits to work around the pain.

Furthermore, neglecting rehab and failing to effectively restrengthen the joint can result in a predisposition to further conditions down the road, such as osteoarthritis.

Like any other joint, a finger injury shouldn't come with the guarantee of long-term complications, but we need to treat it like those other joints and properly address and rehab it. Reattaining range of motion in the early stages will be vital to curb restrictions later down the road, and further strengthening to both the flexors and extensors of the wrist and fingers will keep the joints conditioned to be durable against the constant activity stress that work and life demand.




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Tuesday, 19 March 2019

Why Your Hip Flexors Are So Tight

That tight feeling at the front of your hip. That pinch in your joint. Maybe even lower back pain to top it all off.

We have a high volume of clients who come to see us for conditions related to their hip flexors. Whether they've identified that muscle group specifically or they simply complain with generalized discomfort at the front of their hip, this is a very common affliction in both high- and low-activity individuals. From hockey players to desk workers, many of you readers may very well have been there.


Which brings us to the common solution for tight muscles: stretching! And believe me, every hip flexor client of ours has clocked several hours trying to stretch their discomfort away. 

But has that worked for anyone out there, yet?

As we know, muscles get tight for a reason other than simply being overused. More often, a muscle is tight because it's weak, creating an interesting case against static stretching as a fix.

With that being said, we see terrific results for hip flexor discomfort as soon as we begin strengthening those hip flexor muscles (combined with some modest manual treatment). Exercises as simple as high-knee raises have shown great effect.



It sometimes takes some work to identify the hip flexors as a culprit, and oftentimes more work to target the muscle group over other helpers, but once we find the right route, it creates a sure pathway to relieving that nagging discomfort.


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Tuesday, 12 March 2019

What Causes Back Pain?

4 out of 5 Canadians experience back pain at some point in their lives, most commonly to individuals between the age of 30 and 50.

While there are many physical culprits that we can identify in cases of back pain - sprains, strains, discs, etc. - the biggest culprit that causes pain to flare up are our habits. In sport, at work, during life, certain ways that we move (or don't move) can be the determining factor pain-onset, whether x-rays show structural defects or not.

Idle Posture

Allow me to be clear in that "bad posture" does not cause back pain. New studies now find that poor posture, in fact, correlates quite poorly to future pain.

I read an excellent quote, however, stating this:

"The only bad posture is the one that we spend too much time in."



In reality, the fact that we sit or stand a certain way does not result in us experiencing pain. Rather, it's the fact that we hold those idle positions for too long. The body craves movements, and so delivering on this can have great results. Regular breaks from sitting at work, for instance, has excellent benefits on preventing pain.

Solution: Move more.

Repetitive Activities

As another clarification, repetition, inherently, is not bad for you. Our hips move in a forward-and-backward motion to allow us to walk all day, every day, and you don't see the majority of the walking population collapsing due to overuse hip injuries.

The problems arise when the body is not properly conditioned for the particular movement being repeated.

Many runners perform fine without injury occurrence, but the one's that are not properly trained to drive strength from their hips will encounter problems.


As a non-sport example, many housekeepers won't be bothered by the amount of windows they clean. Just the ones that overuse their wrists and elbows instead of utilizing the large muscles from their shoulders.

In short, the body is able to handle just about any repetitive activity. However, depending on the volume and frequency of those movements, a certain level of strength and endurance may be needed.

Solution: Move differently.

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Tuesday, 5 March 2019

How Non-Athletes Can Still Benefit From Athletic Therapy

The “I’m not an athlete” explanation is still a barrier when it comes to members of the public seeing an Athletic Therapist for the first time.

The assumption is that Athletic Therapy will either be too intense or simply non-applicable to individuals who aren’t involved in sports or fitness. Allow us to help you understand why this isn’t true.

You May Not Lift Weights, But You Do Lift Boxes

I think that we can all agree that lifting is universal. Whether it’s boxes at work, furniture at home, or your newborn baby, lifting can be strenuous and be complicated by pain.


So while your Athletic Therapist isn’t going to try to convince you to start going to the gym to desdlift, if that’s not your jam, they will help to keep your back and hip muscles relaxed and pain-free and teach you proper technique to start picking up those heavier loads. (After all, your baby won’t wait for you before growing heavier.)

You Might Not Run Down A Track, But You Do Run After Your Kids

Like lifting, running tends to be a basic necessity of life. Running after your kids as they become more active, chasing after your dog, or simply sprinting for a bus; it’s good to know your body is up for the task for when the situations arise.


An Athletic Therapist can help you if you experience difficulties with your hips or knees that make running more of a challenge. Osteoarthritis, tendinosis, or other afflictions shouldn’t hold you back from these aspects of life.

You’re Not Reaching Up With A Racquet, But You Are Reaching For That Top Shelf

Athletes aren’t the only ones who work overhead. While you might not be hitting a badminton birdie or throwing a baseball, your shoulders still need to be healthy enough to reach for high objects, wash a window, or anything else at home or work involving working up high.


Your Athletic Therapist will help condition your shoulders to be strong with overhead and repetitive tasks. Learning proper use with your shoulders will also spare the smaller elbow and wrist joints from repetitive strain, allowing you to continue with your daily routine.


As you can see, all athletic movements are just higher-intensity versions of simpler activities involved in our daily lives. We don't expect to teach someone how to pitch a baseball or sprint down a track if they have no need. However, the same principles that we DO use with athletes for those purposes easily apply to each unique need of the non-athletic individual.

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Tuesday, 26 February 2019

Tools, Trades, and Upper Limb Pain

We receive a humble stream of trades workers into our clinic, which isn't surprising since the labour-working population is highly prone to aches and pains. The most common afflictions that we see in our trades clients seem to involve the upper limb, that being the wrists, elbows, and shoulders.


It's understandable why these conditions are so prevalent, given the repetitive nature of the tasks involved in this line of work. Construction tools, while designed to be as efficient and easy on the body as possible, certainly don't make you immune to overuse pain.

After a while, and under the right conditions with the way your body moves, consistent hammering, screwdriver use, overhead reaching, and the like can gradually start to overload the tissue and joints, resulting in these overuse injuries.

Luckily, home exercise programs are shown to be hugely beneficial to this population of workers, which is entirely possible to do without the perceived-necessity of taking time of work.

So when it comes to wrist pain, elbow tendinitis, or shoulder injuries from work, here are two major mechanical errors I tend to pick up with assessing these clients.

Forearm Strength

Workers and athletes of all types tend to be incredibly grip-oriented with their physical demands. This results in high development of the wrist and forearm flexors, overtime, which is often associated with the extensors becoming unable to keep up with the strength demands.


Opposing muscle groups need to be in a relative balance with each other. At the gym, individuals don't train biceps while ignoring their triceps. They don't train quads without hitting their hamstrings. However, it's easy to allow the forearm flexors to become inadvertently trained to be much stronger than the forearm extensors. The resulting difficulties with mechanical control between the two sides often leads to the wrist and elbow pain that we're discussing, and so it's usually one of the first areas we look at in rehab.

Shoulder Use

Can your shoulder cause your wrist pain? Why yes, yes it can.

The other prevalent cause of upper limb pain, in my experience, is a lack of use at the shoulder when it comes to repetitive tasks.

Especially with small-range, low-force movement, it's easy to allow the wrists and elbows to become prominent with initiating the tasks. However, when these movements are done at high volume, those smaller joints become easily fatigued. When it comes to these small tasks, a complete lack of involvement from the shoulder can quickly overload those joints with forces.


Teaching clients to use their entire shoulder girdle, and not just the smaller joints down the chain, has proven vital to keeping their pain from relapsing. After all, the shoulder is the largest joint of the upper limb. Why wouldn't we keep it strong enough to do the majority of the work?



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Tuesday, 19 February 2019

The Best Time Of Day To Rehab

At the end of appointments, my clients always ask me when the best time of day to do their exercises would be.
The start of the day? In the evening? Before working out? Afterward?

Firstly, let me make it clear that any time of the day is better than never. So if you find yourself unable to set time for your rehab exercises when it might be the most ideal, you're still reaping the benefits by doing them whenever else you can.

As for when the most ideal time is, my opinion is that performing them as closely before the most physically-active time (or times) of your day is the best. Whether you're doing it as part of your warm up before working out or before leaving for work at a labour-intensive (or even a low-intensity) job, rehabbing prior to other activity will likely see the most benefit.

After all, the point of rehab is to create a change in the way that you're moving to eliminate and prevent pain. Practicing those new ways of movement before other activity or tasks is going to provide an opportunity to let those exercises carry forward in the day. Essentially, you get to practice using those new mechanics throughout your daily/workout routine.

In contrast, simply going through your entire day or workout first and saving your exercises until the end might mean you've just spent all that time reaffirming your old ways of movement.

As I said, if early doesn't work for you, I understand. It's not realistic for every client who works at 6:00AM to set aside an additional 20 minutes in the morning to exercise before leaving for the job site. (Although I always do expect my athletic or gym-going clients to incorporate it into their warm ups for best effect.) But all in all, as long as you do them at all, I'm happy.


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Tuesday, 12 February 2019

Pain, Health, And Rehab: Our Favourite Unit Of Measure

During the rehab process, therapists, their clients, and their doctors and lawyers often like to see objective measures of the injury's extent and its progress of improvement.

But how do we measure the impact of pain and the rate of recovery? We know that pain tolerance is too individual and subjective to rely on pain scales and descriptions. Muscular strength and flexibility don't correlate well to dysfunction. And you can't exactly hold a measuring tape to pain.


Although, while scientists are trying to find new ways to measure pain, there's one method that I prefer over any other to determine a client's state. It's also the unit that will nearly always be the most meaningful to the client: the activities that they can do.

My most successful clients are usually those that come into the clinic concerned about a loss of ability, not simply those who are in pain. A lot of individuals feel pain, but it is the motivation to regain a certain lifestyle that drives them into a rehab program.


That being said, using lifestyle and activities as our unit of measure helps both the client and the clinician. The therapist is able to accurately gauge the client's physical improvement (or their readiness to improve) while the client is able to truly feel and see that improvement while using those lifestyle activities as goal-setting and motivation. A client going from being able to barely walk to walking 30 minutes per day and then finally back to hiking is a much more important observation than her MRI findings or the angles I find her pelvis to be sitting in.

At the end of the day, it's not simply how strong you are. It's not whether or not you can touch your toes. It's not what shows on an x-ray. It's how you feel, physically and mentally, and what you're able to do leave the clinic and do.

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Tuesday, 5 February 2019

3 Reasons To See An Athletic Therapist In The Most Acute Phase Of Injury

I see a lot of very long-term, persistent types of pain cases in my practice. Often, individuals come to see me to recover from complications of an injury that occurred weeks, months, or even years ago.

Oftentimes, these cases are complicated even further due to the time lapse between the initial injury and the point of first contact with a medical professional. As time passes, secondary conditions often develop, and the time for recovery will increase proportionately.

In contrast, individuals who see Athletic Therapists during the most acute phase of injury - and we're talking as early as within 24 hours of the incident - will benefit the most quickly and efficiently from treatment. Here's why.

1) Optimizing Inflammation

Contrary to popular belief, inflammation does not need to be completely eliminated. Being the active mechanism for initiating healing, an inflammation response should be allowed to occur during an injury, to an extent. What does need to be prevented is excessive swelling around the injury site, but outside of controlling that, there are always mild-level techniques and movements that can be done to maximize the bloodflow and metabolic activity that accompanies inflammation itself.


2) Maintaining Range of Motion

As many people try to "rest away" an injury and wait for it to "settle down" before initiating treatment, the joint is often kept immobilized in order to protect it from further injury and pain. We need to remember the body's strict use-it-or-lose-it policy, however.

By immobilizing an injured joint, the joint becomes conditioned to that state of low-movement. As a result, it creates an extra step in the rehab process where range needs to be reattained. By seeing a therapist in the acute phase, however, we can eliminate this step by making sure the range is maintained in as tolerable a volume as possible.


3) Activity-Specific Treatment from Day One

Every individual has their own unique life demands. As such, why would we treat every injury - even if it's a similar or identical type of injury - the same? 

Athletic Therapists gain a lot of experience working on-site with competitive athletes in order to fast-track them back to play as quickly as it is humanely possible by making the rehab as applicable and practical to their exact sport from the first day of treatment. This concept jumps immediately from sport to any other type of activity, occupation, and lifestyle. If a 30 year old construction worker and a middle-aged client who enjoys gardening have the same shoulder injury, the rehab processes still aren't going to look alike.


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Tuesday, 29 January 2019

Muscle Soreness, DOMS, and Recovery

A researcher that I closely follow on social media posted about a great study on muscle soreness.

To date, we have been unable to determine exactly why we experience post-exercise delayed onset muscle soreness (DOMS). The problems that we've had regarding DOMS are as follows:

1) If the soreness is from tissue damage, then why do DOMS even occur in individuals who are simply new to exercise and not exercising at an intense enough volume to have truly initiated significant muscle breakdown?

2) On that same note, individuals adapt quite quickly to the point of experiencing little to no DOMS after regular, intense activity, even when tissue breakdown must be present.


This new research suggests that DOMS might have less to do with an accurate indication of the extent of muscle damage, but rather a (adaptable) pain response intended to remind the body to rest. This is similar to one of our theories on the need to sleep; while not initiating much in terms of physical changes to the body itself, it might be our bodies' way of forcing us to rest and achieve recovery.

This mechanism would explain why we can adapt so quickly and stop feeling as sore following exercise. As the body learns that we're recovering without much difficulty, it will feel less of a need to initiate that exaggerated rest-signal.

As the researcher pointed out, however, complete absence of that soreness does not equate to an absence of muscle damage, and it's still important to take those earlier DOMS experiences to learn on how to properly moderate your work and rest together. At the same time, this is reassuring to active individuals who worry about requiring soreness as an indication of a workout being beneficial.

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Wednesday, 23 January 2019

Hang Up The Orthotics

In over two years of practice as an Athletic Therapist, I have not recommended foot orthotics to any of my clients.

The fact isn't that I consider orthotics to necessarily be a detriment and that they don't have their place; rather, I see other alternatives to attempt first, for a client's recovery, before going with the orthopaedic support route.

Orthotics went through a phase of being heavily over-prescribed for a couple decades, with any sign of a flat or stiff arch condoning their recommendation.


It is true that structural changes in the foot, such as a flat arch, might contribute to a higher rate of overuse injury in the lower body. However, it's important to remember that your arch is maintained by both ligaments and muscles, and so it stands to reason that exercise and strengthening can help to improve that arch support on its own. In fact, some studies find that exercise has a greater benefit than artificial insoles.

As well, it's important to point out that, like with any crutch or support, having the support of an insole can actually decrease the strength and stability of your foot muscles due to lack of need.

What's more, if formal exercise doesn't work for you, minimalist shoes are also shown to have identical positive effects on the strength of those small foot muscles.

Again, this isn't to say that orthotics don't have their place. I will always attempt and monitor the effects of exercise on its own first, and so far all of my clients have had no need for anything further. But if an individual's foot structure, whole-body condition, and specific injury require the extra support, then it should absolutely be encouraged.

BUT (this is the last 'but') it's also important to highlight that expensive, custom orthotics are found probably be no more effective than off-the-shelf insoles, so for those looking into the arch support route, consider giving this a try before making the larger expense.

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Wednesday, 16 January 2019

Treadmill Running and Overuse Injury

Myself, I was never a huge fan of treadmill running. Mostly because I like nature and am a sucker for a nice waterfront view. But I digress...

Treadmill running isn't going anywhere. It's a staple in our gyms and a handy tool for being able to measure and control for our physical activity.


However, there have been some claims that treadmill running may pose an increased risk for overuse injuries.

The idea is based on the fact that overuse injuries stem from repetitive stress to a particular tissue, and this stress is greater when the variance in the movement is decreased. By this, we're referring to the fact that treadmill running strides will typically always be the same length, at the same speed, and with the same impact force. In contrast, running outside will have a much greater variability in the types of strides being taken, with the body needing to learn to adjust and adapt to the subtlest change in terrain.


While this claim is cited by several sources, few of them use hard, researched evidence. We do, however, have evidence supporting the general principle of low variance resulting in increased tissue stress. As well, while treadmill running has been shown to lower the rate of stress fractures, specifically, the same study found it to be less beneficial to bone strengthening than outdoor running. This might translate to decreased overall beneficial training adaptations from treadmill running and, thus, and overall increased injury risk.

I feel I must apologize for the inconclusiveness here, but hopefully it's good food for thought. Don't let this change your training regiment if treadmill running is currently working for you, but if you suffer from running injuries, it may be worth trying a modification in surfaces. And of course, if you're training specifically for running a race, the best training for you will be found outside.

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