Category Archives: exercise

Osteoporosis and Exercise

By Lauren Harding, Registered Kinesiologist

What is osteopenia and osteoporosis?

unnamedOsteopenia and osteoporosis are conditions characterized by a loss of bone mineral density (BMD). BMD is a measure of the quantity of minerals (calcium and phosphorus) in a precise volume of bone. The difference comes in their severity.

Osteopenia indicates a lower BMD causing bones to be generally weaker. This bone weakness becomes more pronounced with osteoporosis as the bones become more brittle and porous (filled with air pockets), ultimately increasing the risk of fracture. Though less severe, osteopenia is a serious risk factor for developing osteoporosis.

Osteoporosis is often labeled as the ‘silent thief’ since bone loss occurs gradually, typically without symptoms. However, these four factors can signal underlying osteoporosis:

  • Loss of height over time and/or development of a stooped posture
  • Sudden back pain without any obvious cause
  • Fracturing after a seemingly minor incident

 

How are these three conditions treated?

An excellent approach is early intervention physiotherapy treatment, accompanied by a well-designed exercise program. It is important to consult your doctor before starting a new exercise plan. As with any exercise, there is always risk associated.

Osteoporosis Canada recognizes exercise not only for increasing cardiovascular endurance, but also as a fundamental component to protecting your bones. Exercise maintains bone mass and builds muscle strength, as well as increases flexibility and range of motion, balance and coordination. Benefits also include reduced pain and inflammation, while promoting loss of excessive weight. Additionally, the risk of falling is reduced.

 

What types of exercise should I be doing?

There are 5 types of exercises recommended for individuals with osteopenia and osteoporosis:

Types of Exercise How Often Should I Do These?
Aerobic 3 to 5 days per week, a minimum of 150 minutes per week
Strength Training 2 to 3 times per week
Balance Every day
Stretching Every day
Posture Training Always

 

Aerobic Exerciseunnamed

Aerobic exercise is considered any continuous, rhythmic activity that strengthens and stimulates the heart and lungs, thereby improving the body’s use of oxygen. It is recommended that ALL adults get 150 minutes of moderate to vigorous physical activity a week, or about 20 to 30 minutes per day, for at least 10 minutes at a time. During moderate-intensity activity, your heart beats faster and you breathe harder. The rule of thumb is that you are able to talk during these activities, but you are working too hard to be able to sing. During vigorous-intensity activity, your heart beats faster still and you continue to breathe harder. You are unable to say more than a few words at a time during vigorous activity. It is important with osteopenia and osteoporosis to do weight bearing aerobic exercises. Examples of weight bearing aerobic exercises include:

  • Brisk walking, dancing, stair climbing, running, step aerobics, hiking, jogging, jump rope, and treadmill walking/running

 


Strength Training

Elderly_exercise

In order to increase your muscular strength, you must work against resistance until your muscles feel tired.

This helps to reverse muscle atrophy, a condition that occurs when your muscles start to waste away due to lack of use. Furthermore, resistance training strengthens the muscles surrounding your joints, ultimately reducing further joint damage and decreasing risk of injury. ALL adults should do 2-3 days of strength training a week. Exercises using free weights (dumbbells), exercise bands or weight machines are strongly recommended. Examples include:

  • bicep curls, sit-to-stand, lunges, rows, calf raises, bridges, triceps kickbacks, countertop push ups

 

Balance Exercises

Balance exercises help maintain your footing when an unexpected movement occurs in your daily life. Improving balance and coordination can reduce your likelihood of falling, therefore decreasing your fracture risk. Ironically, in challenging your balance, you run the risk of falling. For this reason, you must always take precautions such as having a chair nearby to hold onto. When you are training your balance, there are two main types of balance exercises:

  • Static Exercises – Stand still in one spot holding a certain posture in order to practice balance. For example, standing on one foot on the floor.
  • Dynamic Exercises – Balance is challenged more with adding movement. For example, walking ina straight line while touching the heel of one foot to the toe of the other with each step.

 

Stretching

unnamed (1)As you age, you lose flexibility which can increase your stiffness and discomfort, often preventing you from staying active. Stretching exercises help you to counteract this by increasing the range of motion of your joints and improving your flexibility. It is important to note that stretching should always be done after the muscles and the body are warmed up since stretching cold, stiff muscles increases your risk of injury. Just like in balance training, there are two main ways to stretch:

  • Static Stretching – Take the muscles to their end range of motion and maintain that position for at least 30 seconds in order to enhance soft tissue and muscular flexibility.
  • Dynamic Stretching – Functional, multi-joint movements that typically increase in range of motion and speed as the body begins to warm up.

While both are effective, dynamic stretching has been shown to be more beneficial than static stretching as a way to warm up prior to activity since it has been found to improve balance, strength, reaction time and agility. Static stretching, however, is still important and is most beneficial when performed at the end of exercise as a cool down. Static stretching can also be done separately when the body is warm as part of an everyday attempt to improve body mechanics, posture and flexibility.

 

Posture Training

unnamed (1)We all have a natural curve in our spine, however, weak back muscles and/or spinal fractures can cause an excessive forward curvature of the spine. Rounding of the upper back is known as exaggerated kyphosis. This puts pressure on the front of your vertebrae, placing them at even great risk of fracture. Posture training exercises help to improve the alignment of your spine by correcting shoulder, back and neck positioning. Focus should be placed on exercises that strengthen the back muscles and reduce forward head posture. Abdominal exercises that strengthen the core muscles, help to maintain good posture as well.

 

To Sum Up

An exercise program is a vital component in the management of osteoporosis.

Regular participation in aerobic and strength training is fundamental, as well as balance, posture management and stretching.  All in all, physical activity for individuals with osteopenia or osteoporosis can promote bone health and overall quality of life.

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Exercises and Strategies for Stair Climb Events

Stair climbing is both a functional activity that most people complete daily and an activity that can be used for exercise. There are two different strategies that can be used to climb a flight of stairs: the knee first strategy (Figure 1) and the hip first strategy (Figure 2). In the knee first strategy, the movement is broken up into two distinct vectors with a horizontal vector (1) initiating the movement and the vertical component (2) following. This movement pattern relies on the quadriceps muscles as the primary mover and places increased stress on the knee which increases the likelihood of knee pain developing during stair climbing. The hip first strategy combines the vertical and horizontal components and results in a diagonal vector of movement. It relies primarily on the gluteal muscles to initiate the movement. This strategy decreases loading through the knee and reduces the risk of knee pain with repetitive stair climbing. Using a hip first strategy becomes especially important when using stair climbing as an exercise or when training for/completing an event like the CN Tower Climb.

Stair climb Fig 1 and 2

Excellent strength and endurance of the gluteals (buttocks), quadriceps (front thigh muscles), and core are required to successfully complete the CN Tower Climb without injury. A good preparation program will involve both strengthening exercises and stretches for the major muscle groups of the lower extremity and core.

Strengthening Exercises

As the CN Tower climb requires good muscle endurance, each exercise should be performed for a minimum of 20 repetitions.

Squats

Stair Climb - Squat

Stand with feet hip width apart, toes facing forward. Keeping the chest open and shins vertical, reach the hips back as if sitting on a chair, allowing the knees to bend. The knees should never go in front of the toes.

 

 

 

 

Single Leg Squats

Stair Climb- single leg squatStand on one leg, keeping the pelvis level. Keeping the knee in line with toes and maintaining a level pelvis, reach the hips back and allow the knee to bend as if sitting on a chair. The knee should never go in front of the toe.

 

 

 

 

Step Ups

Stair Climb- step upsPut one leg up onto a step. Keep the knee in line with the toe and drive through the glute to straighten the knee and hip. Weight should not shift forward prior to initiating the movement.

 

 

 

Monster Walks

Stair climb- monster walkStand on a band and cross it in front or tie the band around mid thigh as shown in the picture. Do a mini squat, ensuring that the hips are back and knees are behind toes. Keep the pelvis square and level and take a step to one side, slowly bring the other leg in. Perform to both sides.

 

 

 

 

Plank

Stair climb- plankWith forearms shoulder width apart, gently squeeze shoulder blades together and pull down from ears. Balance on knees (easier) or balls of feet (harder), keeping the spine long, hips in line with shoulders, and chin tucked. Hold 30-60 seconds.

 

Single Leg Jump

Stand on one leg, keeping the pelvis level. Do a mini squat, power through glutes and calf to jump off ground. When landing, ensure heel is on the ground, knee is bent, hip is back and knee is in line with toe.

Box Jump

Stand with feet hip width apart a comfortable distance from the box. Do a mini squat before powering through glutes and swinging arms up to jump onto the box. Land keeping knees behind toes and core engaged. Stand up straight. Jump off the box and land in a controlled squat.

Sprint

With good running form, sprint for 60 seconds. Walk or lightly jog to recover for 2-3 minutes. Repeat 5-8 cycles.

Stretches

All stretches should be held for 30-60 seconds and repeated twice. Stretches should be performed daily when trying to lengthen a muscle or after a work-out when the goal is to maintain muscle length.

Hip Flexors

Hip flexor and quad lungeIn a lunge stance with the back knee on the floor, tuck the pelvis under keeping the back straight.

 

 

Glutes

Piriformis supine #2 (1)Lying on your back, keeping shoulders and back on the floor, cross the leg to be stretched over the other in a figure 4 position and bring both hips to a 90 degree angle.

 

 

Hamstrings

Hamstring seatedSit with the leg to be stretched straight and the other foot tucked in. Keep the back straight and lean forward towards the straight leg by hinging at the hips.

 

 

Quadriceps

Quad standingStand and bring the heel of the leg to be stretched towards the buttock. Ensure that the bent knee does not drift forward in front of the other knee.

 

 

 

Calves (Soleus and Gastrocnemius)

image6Soleus

Stand in a lunge stance. Keeping the torso

upright, bend both knees and sit back over the back leg.

 

 

image7

Gastrocnemius

Stand in a lunge stance. Keep the back leg straight and bend the front leg keeping the back heel on the ground.

 

 

 

Child’s Pose

Stair climb- prayer stretchStart on hands and knees with hands and knees shoulder and hip width apart, keep hands on the ground and sit hips back towards the heels until a stretch is felt through the back.

Injury Prevention and Physiotherapy

By Cassandra Kroner, PT

best-chicago-group-step-class.jpgIt is a common misconception that you only need to see a physiotherapist if you have an injury or pain. Physiotherapists have a wide range of skills, and recognizing the risk for future injury is one of them. Injury prevention is applicable to all individuals, regardless of their activity level, from the office worker to the athlete, and especially for those with previous injuries that could reoccur.

Repetitive Strain Factors

  • Occupation
  • Training errors
  • Age
  • Excessive or repetitive loads
  • Inappropriate footwear
  • Structural abnormalities
  • Muscle control
  • Core stability
  • Joint alignment
  • Muscle strength and flexibility imbalances
  • Previous injury
  • Posture

In general there are two types of injuries – traumatic and repetitive strain. Traumatic injuries are easier to understand, as they are the result of a singular event that causes damage. On the other hand, repetitive strain injuries occur when stressors that normally do not cause harm are repeated to the point of causing micro trauma that builds over time until the tissue becomes inflamed and injured. These injuries tend to begin subtly, and gradually increase in severity. Combined with the multi-factorial list of possible contributing factors, repetitive strain injuries can be challenging to diagnose and treat. However, in most cases repetitive strain injuries can be avoided with a good injury prevention and maintenance program.

A Common Factor: Muscle Imbalance

When an individual is involved in one specific sport or has a repetitive aspect to their job, the muscles are put under a great deal of strain to repeatedly perform the same movements. Sedentary jobs involving prolonged postures can have similar effects with certain muscles constantly working for long periods. Over time, muscle imbalances develop as the muscles that are being used the most continue to get strong while the reciprocating muscles become lengthened and weak. These muscle imbalances can cause movement restrictions that affect performance and increase stress on the body. Increased stress on muscles, joints and ligaments eventually leads to a repetitive strain injury.

15250-a-young-woman-stretching-outdoors-before-exercising-pv-630x390.jpgThe First Steps Toward Injury Prevention

Getting started on the road to injury prevention is as simple as booking an appointment with a physiotherapist. If you are unsure how injury prevention could apply to you or if you could be at risk for injury, speaking with a physiotherapist can help clarify your needs and goals. The same expert assessment skills physiotherapists use to diagnose injury will be used to proactively assess for risk factors that could lead to future injury. Your lifestyle, the demands of your job, and the specific sports or activities you participate in will be considered, along with the assessment findings, to develop an individualized treatment plan. This plan could involve manual therapy to correct joint restrictions or muscle length imbalance, strength and flexibility exercises, correction of movement patterns, and education.

By addressing several predisposing factors to injury, the body is optimally prepared to handle the demands of the workplace or sport. This can translate to decreased frequency and severity of future injuries, with the added benefit of a shortened recovery time in the event an injury does occur. Don’t wait for an injury to strike to take charge of your health!

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Why dancers need the perfect balance of strength and flexibility

By Kelsey Jack, PT

My ballet teacher once told me that given a choice between having strength and flexibility, she would choose strength. This has always stuck with me as there is such an emphasis on flexibility within the dance world that often there is a lack of focus on building the strength required to make use of that flexibility. This enhanced focus on flexibility instead of a balance between strength and flexibility creates muscle imbalances. If dancers work to improve their flexibility and ignore balancing the strength around the joints, it leaves the dancer vulnerable to injury.

Why is balancing strength and flexibility important?

Stability is provided to joints from a combination of passive and active structures. Passive structures include the bones that make up the joint and the ligaments that surround it and support it. Active structures are the muscles and tendons that act to both maintain stability and move the joint. Focusing on passive, static stretching, as is often the case in dance, can lead to instability of joints as the ligaments that are meant to stabilize the joint become stretched out and no longer provide joint support.

Flexibility, or range of motion can be divided into two categories: passive and active. Passive range of motion is demonstrated by how high a dancer is able to lift their leg using their hands whereas active range of motion is how high a dancer is able to lift their leg using their hip muscles and is demonstrated by doing a step like a developpé.  Practically speaking, flexibility without strength limits active range of motion and will hinder the height of legs when performing steps that involve controlled movements and sustained positions.

Back bends are a good example of a movement that is common in dance where strength is required to balance the flexibility of the spine. Dancers without good core strength and control will hinge through their spine, relying on one or two segments to gain all of their movement through. This leaves the spine vulnerable to injury as the ligaments and discs are relied on for support. Ideally when doing a back bend the spine should form a “C” curve. Many teachers instruct dancers to breathe up and extend through the top of their head into their back bend to encourage control into this movement pattern. Engagement of the abdominals and stabilizer muscles of the spine are required to move through each segment of the spine in a way that supports the passive structures of the back to create the desired curve.  It is subtle differences such as these in how a dancer moves, using strength to control their flexibility, that improves the quality of movement and decrease the future risk of injury.

Evidence to support strengthening to increase flexibility

As dancers are often concerned about their hip flexibility, a study was done looking into the best way to increase hip active range of motion. The researchers compared three stretching programs over a six week period. The first group of dancers completed a strengthening program where they worked at strengthening their hip flexors at the end of their available range of motion. The second group completed a “light” stretching program for their gluteals, hamstrings, calves, and quadriceps muscles, holding each stretch for 1 minute. This group was asked to perform stretches at an intensity of 3/10 on a scale where 0 is no stretch and 10 is an intense stretch that elicits a burning sensation. The third group performed the same stretches but at a “moderate-high” intensity which was rated as 8/10 on the same scale. The study found that all three groups had an increase in their passive range of motion but only the strength training and the low intensity stretching groups improved their active range of motion. The strengthening group saw the greatest improvements in both passive and active range of motion which is explained by the hamstrings relaxing as the hip flexor is contracted. This allows the hamstring to lengthen while the hip flexor is strengthened. Intense stretching without strengthening (as in the high intensity group) leads to lengthened, weakened muscles which functionally hinder a dancer’s ability to make use of their range of motion. This study demonstrates that exercises that specifically train the hip flexors progress flexibility in a way that translates into dance.

Strengthening allows dancers to maximize their flexibility without compromising the integrity of their passive support structures and increasing their risk of injury. A physiotherapist can assess a dancer’s strength and flexibility and develop a program that will safely allow a dancer to increase their flexibility while strengthening the muscles needed to support their joints, improve performance, and decrease risk of future injury.

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References:

Wyon MA, Smith A, Koutedakis Y. A Comparison of Strength and Stretch Interventions on Active and Passive Ranges of Movement in Dancers: A Randomized Controlled Trial. Journal of Strength and Conditioning Research. 2013. 27(11)3053.

The Importance of Hydration

Hydration

With increases in temperatures during the summer months, ensuring adequate hydration is extremely important, especially during activities requiring physical exertion.  Every cell and system in the human body relies on water to survive and to work correctly and efficiently, but water is lost every day through sweating, urination and breathing. Sweating is the body’s cooling mechanism, so naturally we sweat more when outdoor temperatures are higher or during exercise. A combination of hot, humid temperatures and physical activity can easily put the body into a state of dehydration. Dehydration decreases the ability of the body to regulate core temperature and decreases blood flow, both of which can have a detrimental impact on exercise performance.

Certain people will be more susceptible to dehydration than others, i.e. children lose water more quickly due to smaller body size, while older adults have difficulty conserving water and have a decreased sensation of thirst. Anyone who works or exercises in hot and humid conditions is also more likely to become dehydrated due to an increased level of sweating. Humidity makes it difficult for sweat to evaporate from your skin, which means it is harder for your body to regulate its temperature and keep cool. Although heavy and prolonged exercise makes people most at risk for dehydration, there is a cumulative effect.  This means with inadequate fluid intake over a few days, even mild or moderate exercise can create a state of dehydration. For athletes, mild dehydration of 1-2% of body weight can decrease the ability of muscles to use glucose, which diminishes aerobic performance and causes fatigue more quickly. Therefore, it is very important to ensure proper hydration in the days leading up to races or games.

How to tell if you are dehydrated:

  • Little urine output and/or urine that is darker than usual
  • Dry mouth, thirst
  • Fatigue
  • Headache
  • Dizziness, lightheadedness
  • Muscle cramps
  • Nausea

Drinking fluids and replacing electrolytes is the easiest and quickest way to treat dehydration. If you have any of the above symptoms and think you may be dehydrated, drink small amounts of water frequently in order to prevent an upset stomach. Sports drinks can also be helpful in treating or preventing dehydration, but take caution as the sugar in sports drinks can cause diarrhea. Eating foods high in water content, such as fruits and vegetables, will help in the rehydration process; and be sure to avoid anything that will continue to dehydrate you further, such as caffeine and alcohol. Severe dehydration will require a trip to the hospital for rapid hydration through an intravenous line. Symptoms of severe dehydration include loss of consciousness, rapid or weak pulse, low blood pressure, and confusion. Untreated severe dehydration can lead to complications, such as heat stroke, and can damage kidneys and muscles. Heat stroke occurs when the body overheats and is no longer able to sweat and cool itself down, usually due to prolonged physical exertion in hot conditions. This is extremely dangerous and requires immediate medical attention, before brain or other organ damage occurs. A milder form and precursor to heat stroke is heat exhaustion, which has symptoms such as heavy sweating, lightheadedness, and muscle cramps. It is very important to treat heat exhaustion before it becomes heat stroke, by moving the person into a cool, shaded area, cooling off with wet towels, and giving liquids if possible. If symptoms continue to worsen, call for emergency medical attention.

How much do you really need to drink?

Although there are many recommendations for how much water to consume, a general rule of thumb is to consistently drink throughout the day, before you feel thirsty. Exercisers will need to consume more than non-exercisers due to water loss through sweating. In the hour or so prior to a workout, try to consume 1-3 cups of water. During exercise, if possible, drink about ½ cup or a few mouthfuls every 15-20 minutes. This will help to prevent dehydration and is especially important if the weather is hot, or the activity is particularly long and strenuous. A handy trick to know how much to drink after finishing a workout, is to weigh yourself before and after. For every pound that you have lost during the activity drink about 3 cups of water. If you weigh the same amount before and after, it likely means you hydrated adequately throughout the activity, and can just continue drinking normally for the rest of the day.

Keeping cool and staying hydrated should be a priority in the hot summer months. Dehydration negatively impacts the body and can lead to a decrease in athletic performance, heat exhaustion or even heat stroke. Drinking water consistently throughout the day, and increasing this amount before and after exercise will help to keep you hydrated and safe during the summer.


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