Thursday, June 4, 2009

Cyclists with Desk Jobs...

...are a pain in the neck (just kidding). What I mean to say is that they can often suffer from neck pains due to their activities. I have recently had a number of clients who cycle regulary (for transportation or sport) and have office jobs. They come to see me regarding their neck and upper back pains.

Each case is individual, and some are complicated, with specific joint restrictions, nerve compression, muscle imbalances and faulty movement patterns. But the general factors leading to their injuries in the first place are quite simple:

Both their occupation and sport involve very similar postures in the cervical and thoracic spone, as well as the shoulder girdle and upper extremities. They use their bodies in the same ways, ie: stretching the same structures, loading the same structures, for hours on end. This can lead to chronic injury directly, or can predispose them to other injuries.

So, the very general rules for prevention of these problems are:

1) find the optimal posture for your body
2) vary positions through-out the day
3) stretch and do activites or sports that utilize the other natural body movements that may be neglected

These are very general and simple guidelines, but if everyone followed them, there would be less need to come see physiotherapy in the first place.


Tuesday, February 24, 2009

Overcoming Disc Injuries

I recently assessed two different clients with discogenic (arising from a disc) back pain. Both had been told by their doctors that they should decrease their physical activity if they were to avoid having this arise in the future. One even had "no more running" written on their referral.

So, is recovering from a disc injury really so difficult? Do you need to decrease physical activity to stay healthy?

The answer for both questions is no.

In the management of disc injuries, the type of treatment, movement retraining and exercise is pretty well researched and laid out. The difficult part for many people is actually committing to and doing the exercises you need to.

And definitely less activity isn't the answer. Less during the acute phase, yes. And less activity while the body isn't moving well or isn't conditioned enough to deal with the sport or activity, yes. But once you have trained up properly and are using your body appropriately, you need to do more.

In recent weeks, the Canadian Alpine ski Team has been doing very well. Two notable performers from the world championships in France were Michael Janyk and John Kucera, receiving Bronze and Gold medals respectively. Both have recently dealt with significant disc injuries, one with motor nerve involvement and the other who could not get closer than 15 inches away when trying to touch his toes. Yet both are now able to perform in a sport that is especially taxing on the low back. How do they heal so well while the average person seems to suffer more? Well, they are young and fit, but the most significant difference is that they are committed to doing whatever it takes to rehab properly.

It's not just elite athletes that can do this. I am in no way an elite athlete. I work full time and have a family, but with the right exercise, my 2 lumbar disc injuries (L4-5, L5-S1) do not bother me, be it running, jumping or twisting. Only by committing to the exercises.


Thursday, December 11, 2008

Med Student Tutorials

Earlier this week, my business partner and myself were lucky enough to take part in a tutorial for 4th year medical students from UBC. This tutorial took place in the same medical building that one of our clinics is in, the Gordon & Leslie Diamond Health Care Centre, as UBC operates out of the second floor and has teaching opportunities throughout the building.

Medical School prepares their doctors to be very effective at screening assessments, looking out for serious spinal pathologies, such as cancer, vascular conditions, fractures, etc... Assessment of the non-specific mechanical back pain, which makes up almost 70% of these cases, is not so well covered. During the tutorial we went over a very straight forward case study, answering questions as we went along. Following the case study we were able to share our treatment approach and techniques with the group. This was fun for me and hopefully beneficial for the students.

Some of the main points we discussed:

- the importance of a full biomechanical assessment
- the importance of appropriate exercise for long term success
- nutritional concerns
- core stabilization
- manual therapy
- intramuscular needling
- psychosocial apsects involved in chronic pain
- the lack of evidence for many of the modalities historically used
- how physiotherapy specialization typically occurs post grad.
- how to look up Physiotherapists in BC via our PABC directory

These interdisciplinary tutorials are something that I will try to be a part of every year.


Sunday, November 9, 2008

The Power of Youth

The Fountain of Youth
Many of us, somewhat jokingly, attribute our injuries to "old age". We can't always use this as an excuse for injuring ourselves, as most injuries can be avoided with proper training, but there are some age-related changes to be aware of.

Clinically, we can see a notable difference in injury extent, rehab and recovery time amongst athletes of varying ages. The 18-year olds may not always commit fully to their rehab, they may stay out too late and ingest the wrong things, but they still seem to bounce back quickly. This approach does not work so well for the athletes over 30.

Now before you groan and say "over 30?!?! ...that's it?", let me explain. Physiologically speaking, we can measure things such as bone density, which typically peaks in your early twenties. Skeletal muscle mass also peaks around this time (in the absence of any training). It follows that many other physiological processes, such as soft tissue healing, also begins to slow past this time. We see this reflected clinically as well. My oldest current patient is 92, and she tells me I'm silly for considering 30 plus as "older".

This doesn't mean hope is lost for the ancient "over 30" crew. But simply, that to stay healthy, there must be greater focus on proper training (both mentally and physically) and diet. Any older athlete who is competitive at the elite level of their sport must be commited to this. This is how we can counter some of the effects of aging. Truly 95% of injuries are preventable with the proper training, and we can't just chalk things up to old age and unavoidable accidents.

Aside: My son, 10 months old, had a hernia repair surgery last week, and was bouncing up and down the following day. Ah, youth.


Tuesday, October 7, 2008

"Sports" Injuries

People often want to classify whether they have a sports injury or not. Our culture has us believe that the sports injury is somehow more heroic or justified. Sometimes, the "sports injury" I see in the clinic is actually more work-related than you might think.

For example, I might see someone in the clinic who strained a hip adductor (groin) while playing hockey one Saturday night. In truth, their adductors and hip flexors were likely tight and weak (especially in the extended position) from hours of sitting behind a desk, Monday thru Friday. Feeling that tearing sensation during a big stride while accelerating on the ice was the result, but the root cause was actually well off the ice. The injury stemmed from weakness, tightness, muscle imbalances, poor trunk dissociation and faulty biomechanics.

So when you pick yourself up after you hurt yourself on the field, don't just look at your immediate surroundings and situation to find the cause of your injury. Look at the typical daily activities and postures you find yourself in for more answers.


Thursday, September 18, 2008

Supporting Our Athletes

I wrote this post down a while back, but never got around to posting it. The incident is old news, but the point (no pun intended) is valid.

There was an unfortunate show of poor sportsmanship, by one of our Canadian fencers at the 2008 Olympics. No need to mention her name again or describe her actions. Her outburst was by no means justified, but I can easily see some of the external factors she had to deal with. The positive side effect of all this was that, through her post-competition interview, the masses were able to learn what an elite athlete has to go through when her country can’t adequately fund her sport. To continue at the elite level, she had to live and train abroad if she wished to continue at the world level.

I feel that Canada has failed her more than she may have diminished our image, as the larger issue was our Country’s support (or lack thereof) of amateur sport. I’m proud that we are improving by leaps and bounds in this department, through projects such as the “Own the Podium”. And I don’t think we have to (or are even able to) dump endless resources into it like some countries do, as there are more important social issues to address. I just hope we continue seeing the value of amateur sport long after the hype (and funding) of 2010 has passed.

It’s very difficult to quantify the effect in monetary terms, but the effects are many. Our athletes can inspire us in many facets of life, promoting health and fitness, which in turn prevents many other health issues, and through competition they can bring the world together where common ground and mutual respect can grow.


Wednesday, September 3, 2008

The (not so secret) Olympic Equation

I remember back when I was watching the opening ceremonies, I bet my wife that China would end up with 49 gold medals. In the end it was 51 with some gymnastics controversy, so I’m going to pretend I was bang-on (kidding). The U.S. won the overall medal count which was also no surprise to most people... but how do they do it? The U.S. is said to be the most overweight , sedentary and unhealthy countries in the world. We (Canadians) like to think we are so active and healthy, but childhood obesity is steadily increasing for many years now.

So what’s the equation for Olympic success?

+ FUNDING + the athletes = Olympic Success

Joking aside, I realize I’m not the first person to come up with this, as almost anyone involved with sports at any level is aware of this. I just felt the urge to write it down. And it’s because of this reality, that I am most inspired by the Olympic athletes that make it with very little support.