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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