Tag Archives: injury prevention

Snow Shoveling Safety

Snow.jpegIf you are like us, you have probably spent a good chunk of time clearing off your car, driveway, and sidewalks these past few weeks. If you are not used to this kind of strenuous activity, you also might have felt tired and sore once you were finished. At BodyTech Physiotherapy we have already seen an influx of people with low back pain due to shoveling snow. As a result of this, we have compiled a list of safety tips to keep you moving injury-free until spring rolls around.

  1. Consider hiring snow removal services if you have lower back issues or heart problems, including a previous heart attack, a known cardiac disease, high blood pressure, and/or high cholesterol.
    • Snow shoveling can be as strenuous on your body as lifting weights – a sudden increase in physical activity levels, especially without proper form, can predispose you to injury.
    • Studies have shown that exercise using your arms (like shoveling) significantly increases blood pressure levels compared to leg exercise (like walking), putting you at a higher risk of a heart attack.
  2. OLYMPUS DIGITAL CAMERAUse the proper tools
    • Sturdy, non-slip winter boots and salting are essential to prevent slips and falls.
    • An ergonomic shovel can help reduce excessive amounts of forward bending, which could otherwise put a lot of strain on your lower back.
  3. Use proper form
    • Stand with your legs hip width apart
    • Hold the shovel close to your body
    • Space your hands apart to increase leverage
    • Bend from your knees, not your back
    • Engage your core/tighten your stomach while lifting
    • Avoid twisting while lifting
    • Walk to dump your snow instead of throwing it
    • Pushing is easier than lifting
  4. Warm up
    • Cold, stiff muscles are more prone to injury. Get your body warmed up and ready to go by marching on the spot, doing some small squats, and rotating your upper body from side to side.
  5. Shovel early and often
    • Freshly fallen snow is lighter and fluffier than snow that has been sitting for a few hours, which makes moving it much less stressful on your body.
  6. Slow and steady wins the race
    • Though it may be tempting to power through and get your shoveling done as fast as possible, work at a slow and steady rate while focusing on proper form to decrease your risk of injury.
    • If there is a large amount of snow, work in layers of 2-3 inches instead of trying to lift it all at once.
  7. Take breaks and hydrate!
    • We recommend shoveling for 15 minutes followed by a 15 minute break
    • Remember to drink water or other non-alcoholic beverages during your break – shoveling is hard work!

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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.


BodyTech Physiotherapy

BodyTech Physiotherapy
519.954.6000 | BodyTechPhysio.ca

 

The Truth behind Core Activation

Development of a strong core can be a common goal for numerous reasons, such as:  improving physical physique, preventing/relieving back pain, improving performance in recreational or competitive activities and building a stable base for our arms and legs to perform normal activities of daily living. This article will correct any myths about proper core activation. It will explain how development of a strong core will improve overall function for not only the lower back, but our bodies in general.

The first key to a strong core is developing a stable inner core. The inner core works as a unit to create dynamic stability around the spine and pelvis.

The inner core is made of up of four muscle groups:

  • transversus abdominis
  • pelvic floor muscles
  • multifidus
  • diaphragm

 

Transversus Abdominis (TA):

pic 1Transversus abdominis is a muscle that lies deep within the abdomen, attaching to fascia at the spine and wrapping forward towards the belly button, creating an internal corset. The function of the TA muscle is to stabilize your low back and pelvis prior to moving your arms or your legs. This muscle should be engaging subconsciously with any arm/leg/back movement throughout the day; however for many of us this is not the case. Reasons for inhibition of this muscle include: low back pain, surgery to the low back or abdomen, or pregnancy. To re-educate this muscle you must learn to tighten your lower abdomen without tilting your pelvis or puffing out your chest. Engagement is achieved by gently drawing your belly button inpic 2 towards your spine feeling tension develop on the sides of your pelvic bones. Make sure you remember to breathe naturally from your abdomen as you hold this contraction. Once the muscle is activated, movements of the arms and legs can be added to increase the difficulty and by integrating TA contractions into activities of
daily living.

 

Pelvic floor:

The second wall of the inner core is composed of the pelvic floor musculature. This creates the floor or base of the inner core unit. Contraction of these muscles can be achieved by envisioning that you are stopping your urine flow midstream. This exercise is very similar to the traditional Kegel exercise, and adds a second component of stability to our inner core. Please note that if you are experiencing any incontinence or retention issues you should visit a pelvic health physiotherapist before starting pelvic floor exercises.

 

Multifidus:

pic 3The third component of our inner core is the multifidus muscle. Multifidus is located on either side of the spine. This muscle is a segmental spinal stabilizer, and atrophy can be seen at one or multiple levels.  To retrain this muscle you will likely need the help of a physiotherapist. Your physiotherapist will palpate (touch) the sides of your spine and you will be asked to swell the muscle under their fingers. This is difficult for many of us to do without the help of additional muscles. Common ways we cheat to mimic this muscle function is by tipping the pelvis forward, flexing the hips or tightening the muscles of the buttock. A good way to feel multifidus activate would be to take a step forward while palpating the gutters beside the spine; you will feel a small bulge of muscle under your fingers as multifidus contracts.

 

Diaphragm:

The fourth component or roof of the inner core is the diaphragm muscle. To ensure correct stability/function through this muscle, make sure you breathe from your stomach (abdominal breathing) rather than from your chest during the inner core contraction. Breathing from the chest is less than ideal for proper core function and limits the use of the diaphragm muscle.

 

Why Core Engagement Helps Prevent Muscle Injury:

Dysfunction of the inner core results in increased pressure placed on passive structures (ligaments, bone/joints, discs, capsules) of the lumbar spine due to lack of support and stabilization when moving. If the passive structures are not supported with the core, repeatedly or over a prolonged period of time, injury or dysfunctions such as stiffness or poor movement patterns may occur, creating pain.

 

Lack of Proper Inner Core Strength Can Lead to Injury:

Often exercises that are meant to strengthen the core can lead to injury. A common mistake individuals make is performing exercises that challenge outer core muscles without proper endurance of the inner core. Performing exercises such as sit-ups and planks without a stable foundation can lead to injury of the lower back/pelvis due to the lack of dynamic stabilization around these joints. Without a strong core, maintaining the correct exercise position is also difficult and can lead to injury. Similarly, if an individual performs a lift without anticipatory engagement of the inner core, increased load is placed on the passive system of the back and pelvis, possibly leading to an injury.

 

Functional Retraining of Proper Core Engagement:

The core acts as a foundation or stable base on which all body movements are generated to maintain back and pelvic stability. Strength of core musculature enables effective load transfer throughout the body with functional movement and activity.

The exercise strategies listed above can be utilized to re-educate use of the inner core muscles. Once inner core activation is successfully achieved, activation should be performed in differing functional positions and levels of difficulty. Following successful re-training of the inner core, your physiotherapist will begin to introduce outer core exercises (to challenge your rectus abdominus, external obliques, internal obliques). Isometric outer core engagement will be integrated while performing arm and leg movements, ensuring that the spine remains stabilized in neutral throughout.

The outer core can be categorized into four sling systems, which exist in the body to help with stability around the trunk and pelvis. Your physiotherapist can create a graduated outer core retraining program using these slings once correct inner core engagement is achieved.

 

Outer Core Sling Systems:

Four sling systems (specific groupings of muscle) exist in the outer core. These sling systems are designed to help with Force Closure to the joints of the low back and pelvis (SI joint). Force closure describes use of the muscular and fascial system to assist with stability around joints.

 

Posterior Oblique Sling:

The posterior oblique system assists with force closure by use of the following muscles/fascia:

  • Gluteus maximus
  • Opposite latissimus dorsi (lats)
  • Thoracodorsal fascia (band connecting trunk to lower extremity)

pic 4An example of an exercise that incorporates use of the posterior oblique sling is bird dog.

Functionally the posterior oblique system is used during walking and rotational activities (ie. swinging a golf club).

 

Anterior Oblique Sling:

The anterior oblique system assists with force closure by use of the following muscles/fascia:

  • External obliques
  • Opposite internal obliques
  • Transversus abdominis

pic 5An example of an exercise that encourages use of the anterior oblique sling is dead bug.

Functional use of the anterior oblique system is used during the acceleration phase of throwing.

 

 

Longitudinal Sling:

The longitudinal sling system assists with pelvic stability. The muscles/fascia making up the longitudinal sling include:

  • Erector spinae (low back extensors)
  • Multifidus
  • Thoracodorsal fascia
  • Sacrotuberous ligament (ligament at the SI joint)
  • Biceps femoris (outer hamstring muscle)

pic 6An example of an exercise that would engage the longitudinal sling is the reverse boat pose in yoga or a superman exercise.

The longitudinal sling is functionally utilized during walking and running activities.

 

Lateral Sling:

The lateral sling is important for force closure across the pelvis, and also ensures positional control of the pelvis during single leg stance and walking. Muscles/fascia included in the lateral sling system are:pic 7

  • Gluteus medius and minimus
  • Opposite hip adductors (inner thigh muscles)

Exercises designed to promote activation of the lateral sling are often performed in a single leg stance position, ensuring correct core and pelvic control. Specific exercises for the lateral system include: step ups, step downs and side step ups.

The lateral sling is used functionally during walking and any single leg activity.

pic 8The final step to successful core retraining is to obtain full function. Performing functional movements while maintaining controlled trunk and limb movements in changing environments is the first step in functional retraining. Once you are comfortable with this activity, speed of activation and increased load can be added to challenge the core further. Further information and a staged exercise program can be discussed with your physiotherapist.

Diane Lee & Associates: training for the deep muscles of the core (Internet). South Surrey: D G Lee Physical Therapist Corp;  (cited 2016 Jan 12). Available from: http://www.dianelee.ca/article-training-deep-core-muscles.php

Running Injury Prevention Part 2: Stretches for Runners

The differences between a dynamic warmup and static stretching were outlined in our previous blog post, explaining that both are key to help prevent injury for runners. Part 2 of our running injury prevention series will cover the static stretches you should be doing after your run. Dynamic stretching as part of a warmup before activity helps to prepare the body for the demands of physical activity, and involves moving muscles through their range of motion. Static stretches done after activity are important to decrease stiffness by improving flexibility and joint range of motion. These stretches are called static because they involve elongating a muscle and holding it in the same position for a short period of time.

 

Why Static Stretching Should be Done After Activity

For many years the widely accepted belief was that static stretches before activity were important to reduce injury. Research in recent years has shown that not only do static stretches before activity provide no benefit, but can actually reduce strength, power and performance when running or jumping. The correct timing to receive optimal benefits from static stretching is following activity, once the muscles are warmed up and more elastic.

 

Benefits of Static Stretching After Activity

Static stretches after activity can improve flexibility, decrease muscle tension, increase muscle length, and improve joint range of motion. Shortened muscles can result in muscle imbalances, which impact performance and can lead to pain and injuries over time. An example common among runners is short hamstrings, which can lead to knee pain and injuries from the resulting stress placed on the knee joint. Short hamstrings are also susceptible to strains, and can cause low back pain as the pelvis is pulled down into an unstable position. In addition to causing muscle imbalances, short muscles also limit joint range of motion. This can decrease performance, affect running stride and therefore contribute to injury. Static stretches after activity also provide an additional recovery benefit of increasing blood flow to help remove waste products accumulated during activity.

 

Short vs Tight Muscles

Muscle tension is different than shortened muscles, and differentiation between the two can determine which treatment type will be most effective. Shortened muscles will feel tight and stiff with a limited range of motion, resulting from the muscle itself having a reduced length. Short muscles will put a strain on tendons and joints, which can contribute to discomfort and injury. Tight or tense muscles may have focused areas of discomfort caused by fibers that are unable to release their contraction. These are commonly known as muscle knots, and are nodules that can be felt in the muscle. Deep massage or foam rolling is required to release these spots of contraction, and stretching alone may not be enough.

If a stretching program is not relieving the feeling of tight muscles, there may be another underlying cause resulting in the sensation of a consistently tight muscle. Muscles can feel tight when they lack the strength or endurance to support the demands of activity. Additionally, a muscle can be too stretched out and also weak but still feel tight because it has to work too hard in a lengthened position. These muscles should be strengthened to decrease the feeling of tightness rather than stretched. A detailed physiotherapy assessment can help identify which muscles need to be stretched and strengthened and will address any underlying joint restrictions. A deep massage from a massage therapist can also be beneficial for all individuals with tight muscles.

 

Stretching Guide

A good stretching routine should include the major muscles used during the activity, and at BodyTech Physiotherapy we have created a stretching routing specifically for runners to do after their runs. Each stretch should be held for 25-30 seconds, gradually deepening the stretch upon exhalation. The stretches are easy to perform anywhere after a run, and we have also included number 8 and 9 with a foam roller as part of a routine at home or the gym.

 

BodyTech Static Stretches for Runners

1. Hip flexor – tuck buttocks under to tilt pelvis posteriorly, keeping back straight.

image1

 

2. Quadriceps – tuck buttocks under to tilt pelvis posteriorly. Make sure the flexed knee does not drift forward in front of the other knee.

image2

3. Hamstring – tilt pelvis forward while keeping back and buttocks in line to avoid arching the back.

image3

4. Hip Adductor – keep back straight and bend forward at the hips.

image4

 

5. Glute and External Rotator – keep back straight and rotate entire trunk at the hips instead of twisting upper body.

image5

 

6. Soleus – bend both knees and sit back over back leg, keeping torso upright.

image6

7. Gastrocnemius – from the soleus stretch straighten back leg while keeping heel on the floor.

image7

 

8. Iliotibial band – support with the top leg while maintaining a tight core to keep hips from dropping, rolling the side of the thigh from the hip to knee.

image8

 

9. Gastrocnemius – cross legs on roller and roll from the knee towards the foot.

image9

 

A warm up before activity in combination with static stretches afterwards provide multiple benefits for every athlete, including increased performance and decreased chance of injury. Running is a repetitive and symmetrical activity that requires a balance of muscle length and joint range of motion on both sides of the body for optimal performance, and both can be maintained through proper warmups and cool downs. The repetitive nature of running can also lead to overuse injuries, which is why the warm up and stretches afterwards are especially important as part of every smart runner’s routine.

Running Injury Prevention Part 1: Dynamic Warm-Up for Runners

Why should you never skip the warm-up before exercise? Cold muscles do not function efficiently, which results in a decreased ability to absorb shock and impact and makes the body more susceptible to injury. A suitable warm up safely prepares the body for the increased stress of exercise by gradually raising your heart rate and getting your muscles ready for activity by increasing circulation, which improves mobility and performance. An activity or sport specific warm-up should be done before strength training, aerobic exercise and stretching. It is the key to exercising safely and effectively.

The Difference Between Warm-Up Exercises and Stretching

One point of clarification that should be noted is that stretching is not the same as warming-up. The confusion usually arises from the difference between the types of stretching; dynamic and static. Dynamic stretching should be included in the warm-up before activity, whereas static stretching should be after the activity. Dynamic stretching is essentially a warm-up that takes your body through motions that mimic the sport or activity without holding at the end position (we will call this a dynamic warm-up to avoid confusion). The warm-up and post activity stretches are both important for an optimal workout and to maintain good mobility and function, therefore helping to prevent injury. During warm-up exercises you are increasing your body temperature and slowly preparing your body, the working muscles, and joints for the increased demands that are to follow. When performing static stretching after activity you are focusing specifically on improving flexibility.

Benefits of Warming-Up

A warm-up reduces your risk of injury and helps to improve movement, function, efficiency and performance. Pre-existing conditions or injuries to certain areas of the body may be identified during a warm-up, and your activity should be modified based on these injuries in order to prevent further injury. A visit to a Registered Physiotherapist would be recommended to address these concerns, as activity modification alone is usually not enough for effective recovery.

Additional benefits of a warm-up

  • Preparation of your muscles for more intense or quick movements
  • Gradual increase of your heart rate and blood pressure
  • Lubrication of your joints and decreased stiffness
  • Reduction of the chance of soft tissue (ligament, tendon and muscle) injuries by allowing your muscles and joints to move through a greater range of motion easier
  • Increased movement of blood through your tissues, making the muscles more mobile and efficient
  • Increased delivery of oxygen and nutrients to your muscles
  • Improved coordination and reaction times
  • Promotion of hormonal changes in the body responsible for regulating energy production
  • Preparation mentally and physically for exercise

BodyTech Dynamic Warm-Up for Runners

  1. Hip swings – While holding onto something stable for support, swing one leg forward and backwards and then repeat. Keep your core strong and your back straight. Perform the move 10 times each side.
  2. Hip circles – Standing with your feet hip width apart and your hands on your hips, rotate one hip by lifting your foot and bending your knee and moving your hip in a clockwise circle, and then counter clockwise ten times with each leg.
  3. Walking lunges – Step forward with your right leg into a lunge position, dropping your back knee towards the ground. Make sure your front knee does not come in front or your ankle. Push yourself straight up by using your right leg to lift you. Then step forward with the left leg to repeat the same action. Perform the lunges in a slow and flowing motion, taking 10 steps forward.
  4. Lateral Lunge – Start with good posture and your feet wider than your shoulders. From there, squat your hips down and over to the right while keeping your left leg straight. Keeping your feet flat on the ground, use your right glute to push you up to your starting position. Repeat on the left side and do 10 total.
  5. Butt Kicks – Walk forward slowly while kicking your heels in towards your glutes for a total of 20 kicks (10 per leg).
  6. High Kicks – With your body tall, walk forward while lifting your legs straight in front of you. Do not bend your knees. Do it 10 times on each side.
  7. Marching on the spot – 15-30 seconds.
  8. Jogging on the spot – 15-30 seconds.

Warm-Up Guide:

  • A proper warm-up should be done before any exercise session or participation in physical activity regardless of how long that activity will be. A warm-up should be done before cardio, weight lifting, or stretching (yoga).
  • A warm-up should aim to gradually increase your heart rate over a 5-10 minute period. Start at a slow pace and gradually increase to match the activity. Be sure to include all the large muscle groups of the body.
  • Your warm-up should last at least 5-10 minutes. The higher the intensity of the activity, the longer the warm-up should be (or slightly longer in cold weather).
  • The warm-up can be a low intensity, low impact version of the workout you are about to do. Or it can be a set of exercises that mimic the motions of the sport or activity. For more serious participants or athletes, the latter option is recommended. The warm-up should always increase your heart rate and warm up the muscles that will be used during the activity.

An activity specific warm up should always be included as a part of your workout and only takes a few minutes to ensure your body performs optimally. This essential part of injury prevention is something every runner and athlete should make part of their routine. Stay tuned for the second part of our running injury prevention series as we cover the stretches you should do after your run.

BodyTech Physiotherapy

BodyTech Physiotherapy
519-954-6000