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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Tuesday, 25 December 2018

Top Blog Posts From 2018

It's been a big year at our clinic, and I thank all of those who have been with us during the way and following our progress. Between growing Cain Exercise Rehab, adding on additional practitioners to our team, and finally making the move to our new office, it's been a full 2018! We look forward to another great year.



With that in mind, let's look back at our top five most-popular blog posts from 2018. You chose them! If you haven't given them a read, please take a look and share the information with those who may need it.

5: The Nocebo Effect - Why Belief In Treatment Is Vital

We spoke about the nocebo effect, which is the opposite of the placebo. It's very possible and common for the belief of harm being done (or simply just the belief in a treatment being ineffective) to turn into reality. This is important in highlighting the need to find a therapist who can productively educate you, as the client, so that trust in the treatment and therapist is there.

4: Get Out Of Pain - 3 Steps For Maintaining Motivation

Everyone tells us that something should be easy to do as long as we want it enough. This disregards the complex, messy, and irrational way our brains work, however. That being said, there are other steps that we can take to make sure that we stay on the right track when it comes to exercise or other lifestyle changes.

3: Cannabis Research - Things To Consider

With the legalization of recreational cannabis in Canada this year, a increase questions and speculation have started cropping up when it comes to the use of marijuana for pain treatment.

Not to rain on the parade, but I just need to remind everyone that our understanding and study into cannabis is still very fresh. While I won't discredit the use of cannabis for medicinal purposes, it's important to take anecdotes and news updates with a grain of salt until we know more.

2: The Stressful Effect Of Stress On Pain

One of our first posts from 2018; stress is EVERYWHERE in our lives, and it absolutely can have an effect on the way our bodies physically feel. When pain is present, stress can exacerbate and prolong it, contributing to the development of countless chronic pain conditions.

This shouldn't be an article to worry you, however; rather, it's a reminder that we can help ourselves by treating our emotional and mental health when we're in pain, as well as the physical.

1: Making Rehab Fun

Our most-read post from 2018, and I'm happy this is the one that took! Rehab, or any exercise for that matter, can often be grueling and unenjoyable. For that reason, it's important to incorporate fun movements and the client's preferred activities into the recovery plan. Having fun during recovery is going to both benefit your mental health as well as ensure that adherence to that physical activity will be maintained.


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Wednesday, 19 December 2018

Don't Be A Hero - Use Crutches

I sprained my foot pretty good, this past weekend. There was a crunch. It hurt. Ruled out a fracture and went on with my next few days. Thankfully, it started feeling better quite quickly, but I definitely needed crutches to walk without a limp.


Bringing me to my point; I have athletes, very commonly, be too stubborn to use crutches when they sustain minor lower limb injuries.

True enough, the pain isn't so severe that walking isn't impossible, albeit with a limp (as was the case for me.) But, despite the fact that you might feel "soft" for using the assistance, the fact of the matter is that you're prolonging your recovery time by limping around.

When an acute injury occurs, we know that consistent movement and range of motion are crucial in those early stages in order to promote proper tissue healing. In the event of soft tissue damage, scarring will start to form. Taking the joint through its regular range of motion means that that scar tissue, as it forms, will align itself in those directions of pull, developing as closely-resembling the healthy tissue as possible.

When limping and protecting that joint, you're preventing proper movement and avoiding stressing that healing tissue, resulting in irregularities in the scar formation. This is likely to prolong the pain and potentially result in mechanical dysfunction later on in time. Conversely, using that walking assistance allows you to deload the limb while maintaining regular (or as close to) movement of that joint and increases the speed and effectiveness of healing.



So, I know that you may not expressly feel the need to use a cane or a crutch when in minor pain from an ankle sprain, hamstring tear, or other lower limb injury. However, buck up and use the assistance until you can walk without a limp; you'll recover faster and stronger for it.

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Tuesday, 11 December 2018

4 Explanations For Common Pain Conditions

Nearing the end of 2018, I've compiled a short list of go-to explanations and busted myths about some of the most common pain conditions that walk in my door. These can hopefully summarize many of the questions that individuals have about their afflictions.


Back Pain

May as well start with the most common! Back pain clients will often have no specific diagnosis and generalized symptoms. It can be a hard thing to wrap one's head around, so here are three major points that I educate my clients with.


Osteoarthritis

A LOT of misconceptions revolve around the reasons for the development of osteoarthritis and the most effective ways to treat it. Does too much activity really deserve the blame? Does movement help or hurt more after diagnosis? Is surgery always necessary?


Shin Splints

"Shin splints" tends to be used as a catch-all term for any shin pain, from muscular tears to stress fractures. However, in true cases of medial tibial stress syndrome, there is a mechanism occurring right down to the level of the bone structure itself. And yes, muscular conditioning will still help or hinder the situation.


Tendinitis

Another heavily-misunderstood condition. What is physically occurring within the tissue during a tendinopathy? And hat are the best ways to treat it?

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Tuesday, 4 December 2018

The Reverse Domino Effect Of Health

"I sprained my ankle. Limping caused my hip to go out. Then I started getting back pain and it's traveled all the way up to my neck."

This is the domino effect occurring. We know for a fact that a dysfunction or injury left unattended long enough can lead to another. It's often small occurrences that begin individuals down a path toward long-term, wider-spread pain.



It's an unfortunate trend, but as we know, it's not necessarily a permanent one. Therapy and rehab, especially those involving movement and exercise, are proven to be able to address these dysfunctions and alleviate the symptoms.

However, it's also a trend for individuals who have experienced this sort of domino-collapse of their joints and muscular system that have a difficult time motivating themselves to begin making those changes for the better again. It can be easy to feel like the time and energy to address such a large number of different (albeit related) problems could be fruitless.

I like to remind clients, though, that it's not necessarily a matter of address every single ache and pain separately, though.

As a biological organism, the human body is good at organizing. In this I mean that this domino effect that we're considering can occur back in the OTHER direction!



I always start with broader corrective exercise when I first treat my clients, only narrowing the specificity down as needed. More often than not, broader changes with how the body moves are enough to begin making the mechanics that we want to see start clicking together. Addressing one area of dysfunction (not even necessarily in reverse of what order it occurred in) can lead to the body further correcting and managing other areas along the chain.

Not acknowledging this reverse domino effect is to not acknowledge the body's own ability to run operations on the most efficient manner that it can. We're a sophisticated system that is excellent at making do with what it has. Small changes CAN make a big difference, and only when those small changes hit a plateau in effect do we need to begin nitpicking for further progress.

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