Replacing Your Running ShoesHere is a simple guide to help you choose your next pair of running shoes.  Running in old worn-out shoes is one of the most common causes of running injuries. Your shoes lose cushioning, stability and shock absorption over time. A “good” rule of thumb is to replace your running shoes every 500km.

Shoe sizes are not standard:

Shoe sizes will vary according to the brand and the style.  A good rule of thumb is to always try the next size up.  You will immediately be aware if the next size up is too large or might be a better fit, and always go by how the shoe feels. Shoe sizes will vary according to the brand and the style. Don’t buy a shoe according to the number associated with the size; go with how the shoe feels.

Your feet are not the same size or shape:

Make sure that the bigger or more wider foot is fitted first, and be sure to wear the same socks that you will normally wear with your runners.

Be fit for running shoes late in the day:

Always shop for runners later in the day — your feet expand and swell after bearing weight during the day. You should also bring any orthotics or inserts that you normally wear in your runners.

Select shoes that match the shape of your foot:

Everybody has a different and unique shape to their feet (e.g., wide forefoot, narrow heel) and needs to be fitted accordingly. Keep in mind that a popular brand might not work for you, and let go of the notion that the runners will “stretch” to fit your feet.  Also make sure that you compare several brands and styles and test them out in the store.

It might seem obvious but your runners should be slightly longer and wider than your feet, so that the balls of your feet should fit comfortably in the runner. The upper part of the runner should not rub on the ankle bones and the heel should not excessively move inside the shoe. A runner that is either too loose or too tight can cause injuries.

Make sure that you choose a runner that is appropriate for the type of activity you will be doing, such as running, walking, or cross training.

Crawford Hill is a mountaineer and rock climber who enjoys outdoor exercise. For the last three years, pain in his lower back has curtailed such pleasures. In fact, when he walks on level ground, he must stop and stretch every quarter-mile, and when he walks uphill, the pain brings him to a halt.

Seeking relief, Hill had back surgery last year and has tried stretching, physical therapy, epidurals, chiropractic, acupuncture, Feldenkrais, and cranial-sacral bodywork.

All to no avail.

Then his wife brought home a flier about a new treatment that uses electricity to reduce pain and awaken dormant muscles and nerves.

The technique is called eToims, which stands for electrical twitch-obtaining intramuscular stimulation (the T is capitalized because the “twitch” is the heart of the method). It is the brainchild of Jennifer Chu, a retired University of Pennsylvania physical medicine and rehabilitation specialist and former director of the electro-diagnostic lab. She is now an emeritus associate professor in physical medicine and rehabilitation at Penn.

During her 31 years at Penn, Chu, 66, a physician as well as a professor, was always seeking ways to improve the diagnosis and care of patients suffering from neuromuscular pain. When she gave electromyography or EMG diagnostic tests, some patients experienced pain relief when she inadvertently hit acupuncture meridian points. So Chu studied and became licensed in acupuncture, but eventually became frustrated by hit-or-miss results that couldn’t be explained scientifically.

In 1990, Chu learned from a Canadian pain specialist that she could obtain superior results by aiming needles at tender muscles rather than acupuncture meridian points. She began using thicker EMG needles to probe those tender spots, and when manipulation of the needles caused her to develop repetitive stress injury, she invented, in 1995, a gun with an oscillating needle that made the method more efficient.

With the gun, which penetrates muscle with a needle three times in two seconds, she noticed that when she hit the right spot, the muscle twitched, and twitching led to pain relief. The problem with this mechanical technique was that it was uncomfortable, and achieving pain relief required plenty of luck as well as extensive knowledge of anatomy.

Chu kept experimenting. “To treat neuromuscular pain with mechanical stimulation is not sufficient,” she realized. “You need electrical stimulation because that’s how the nervous system works.”

Twitch or trigger points are at nerve and muscle meeting points. The “points” are “a zone of neuromuscular junctions called motor endplates,” Chu says, “and one has to find the spot within the zone that will twitch the best.”

Chu realized that surface electrical current could also be used to stimulate nerve-muscle junctions. But the conventional nerve-stimulation probe, whose electrodes are only 1 1/4 inches apart, deliver an electrical current that is too focused and often painful.

More experimentation led to the invention of the eToims stimulator and probe. Its electrodes are six inches apart, and the broad tips, two inches in diameter, are covered with a special fabric that absorbs water for conductivity. The treatment is noninvasive and painless, Chu says, and can provide pain relief for a broad range of ailments, from aching necks and tension headaches to tennis elbows and herniated discs.

The stimulation technology is patented, and Chu has published two papers about it in peer-reviewed journals. It differs from other electrical-stimulation methods such as TENS, which reaches only shallow muscles and blocks signals to the brain, Chu says; eToims can target individual muscles or groups of muscles, deep or shallow, with adjustable electrical current, from one to five seconds, facilitating regeneration of injured nerves and muscles, Chu says, by contracting, elongating, and opening the muscles.

Stanley Schwartz, 67, an emeritus Penn associate professor of medicine, sought eToims treatment after a red-eye flight last year that caused much neck, shoulder, and high back pain. After about 20 treatments, he experienced improvement, both immediately and over time. He suggests the electrical stimulation may “release endorphins in the nerve roots or spinal fluid.” Schwartz, who has a private practice in Ardmore, recommends eToims to his diabetes patients as well as to patients who complain of musculoskeletal pain.

The other day, I watched as Chu treated Hill, 62, a former Episcopal Academy biology teacher and wrestling coach who now runs an adventure travel business. As he lay on a therapy table, she applied the probe to his quadriceps muscles, and later to his gluteal muscles and hamstrings. When she moved the probe over certain spots, his muscles began twitching and contracting like a freshly caught mackerel jumping and flipping on the bottom of a rowboat.

“Nirvana” is how Hill described the feeling, “phenomenally pleasurable.”

Hill’s back problem, Chu said, stems from major muscles in the region that are tight, knotted, spasmodic, and hence ischemic – lacking blood flow. As a result, they are “asleep” and “frozen,” forcing Hill’s lower back to compensate when he walks and moves.

After more than a dozen sessions with Chu at her Ardmore treatment center, he has more flexibility and can walk more comfortably, he says.

“Back pain doesn’t have to be a part of aging,” Hill says. “It’s a work in progress, but in measurable ways that it hasn’t been before.”

For more information on eToims, please call Dr. Krisjan Gustavson at 250-382-0018.

One in eight Canadians currently suffers from some kind of arthritis, and over the next 20 years, this number is expected to rise to one in four (the result of a less active population, obesity and other factors). For young people –almost 20% of all osteoarthritis patients – the condition develops after an injury or trauma to joints.

One of the major concerns arthritis patients have is the fear that there’s nothing they can do to treat their arthritis. Physiotherapists want patients to know that it doesn’t need to be that way – and that those living with arthritis can get moving for life again.

 

 

 

 

 

 

 

images3Written by Dr. Christopher LaRocque

We are all aware of the term concussion and its relationship to head trauma. Whether the trauma occurs from an accident around the home, in the work place, during recreational or competitive sport, or a car accident it is important to be able to recognize signs and symptoms of a concussion.

A concussion is…

“A complex pathophysiological process affecting the brain, induced by biomechanical forces”.  (Zurich 2012)

“A traumatically induced disturbance of brain function and involves a complex pathophysiological process. Concussion is a subset of mild traumatic brain injury which is generally self-limited and at the less-severe end of the brain injury spectrum”.  (American Medical Society for Sports Medicine)

A common misconception about concussions is that you have to experience loss of consciousness: this is of course false, as is relying solely on conventional neuro-imaging techniques such as MRI and CT scans that often don’t show detectable injuries suggesting a more functional than structural disturbance.

If we can’t identify a concussion with the presence or absence of consciousness nor rely on special imaging techniques what are the indicative signs and symptoms we can expect?

Unfortunately, there are numerous signs and symptoms associated with concussions and mild traumatic brain injuries. A suspected concussion may include a combination of the following symptoms:

CognitiveEmotionalSomaticSleep Disturbance
ConfusionDepressionHeadacheInsomnia
Difficulty rememberingAnxietyFatigueHypersomnia
Slurred SpeechNervousnessNausea and vomiting
Loss of ConsciousnessIrritabilityDizziness
Difficulty thinkingBalance difficulties
Difficulty concentratingParesthesia
Light/noise sensitivity
Seizures
Blurred Vision

Concussion Management:

When an individual presents with signs of a concussion they should be evaluated by a physician as soon as possible. A SCAT3, Impact, Axon, or other concussion assessment/outcome measurement tool should be administered and the individual should not be left alone following immediate head trauma as monitoring for deterioration is critical.

Concussion injuries result in the rapid onset of short-lived neurological impairment that usually resolves spontaneously within 7 to 10 days. Individuals with migraine type symptoms during post concussion exhibit a longer recovery time than with individuals with headache only.

Initially the patient will require physical and cognitive rest until the acute symptoms resolve. Next, they should be put through a progressive exertion program until they are able to return to their pre-concussive state of activity without symptoms. Each step requires an asymptomatic period of 24 hours post exertion.

The program takes approximately one week if no symptoms arise. If symptoms become present the patient should regress to the previous level of asymptomatic exertion and start the program again after a 24 hour rest period.

An example of an exertion program for a return to”play” status for a sports related concussion:

1. No Activity
2. Light aerobic activity
3. Sport – specific exercise
4. Non-contact training drills (more complex drills involving increased coordination & cognitive load)
5. Full-contact practice
6. Return to play

** can be related to work/daily activities

Anyone that has experienced a head injury followed by any combination of the signs and symptoms listed above should consult their medical provider and seek interdisciplinary care from any of the following: General practitioner, Psychologist, Optometrist, Neurologist-Headache specialist, Neuropsychologist, Chiropractor, Physiotherapist.

Take Home Message:

– Concussions are complex

– Multiple signs and symptoms will present (be aware of them)

– Direct patient to immediate medical attention.

– Monitor individual for several hours for any signs of deterioration.

– A suspected concussion should not return to work or play on day of injury

– Physical and cognitive rest is recommended until symptoms resolve

References:

McCrory et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med. (2013).

Baker JG et al. “Return to full functioning after graded exercise assessment and progressive exercise treatment of post concussive syndrome.” Rehabilitation Research and Practice (2012); 705309

Signoretti et al. The pathophysiology of concussion. American Academy of Physical Medicine and Rehabilitation. (2011).

J J, Leddy, H. Sandhu, V. Vikram, J. G. Baker, B. Willer. (2012) Rehabilitation of Concussion and Post-concussion Syndrome. Sports Health. 4 (2). 147.

Cantu, R. C. (2001). Classification and clinical management of concussion. Neurological Sports Medicine: A Guide for Physicians and Athletic Trainers. Park Ridge, AANS, 25-33.

running-shoes_13602015One of the biggest athletic events in Victoria; the annual GoodLife Fitness Victoria Marathon happens every October.

The marathon weekend features four different races: the Marathon, the Half Marathon, 8K Road Race, and the Thrifty Foods Kids Run. The race weekend also includes a Victoria Marathon Race Expo. The Expo is free and open to the public to view over 40 exhibitors featuring sponsors, souvenirs, merchandise, running apparel and accessories, nutritional and fitness products, samples, interactive displays.

Anyone who participates in an event like this, knows that the biggest task is the training and preparation that goes into the marathon months before. Marathon training is a big commitment, incorporating training that is mental, physical and emotionally demanding.

Below are a few must tips to achieve the goal of running a marathon:

1. Find a training plan that suits your needs, including the amount of time you are willing to spend

2. Train by how your body responds to the training and not a predetermined pace of training

3. Make sure that you cross-train and include activities such as biking, swimming or strength training.

4. Strength training and foam rolling are an important part of the process. Strength training is a key component of distance running in order to ensure good running form, and avoid injury, while foam rolling will allow you to give yourself a deep tissue massage after each training session which will help in your recovery time.

5. Remember to stretch before every run, but make sure that you use stretches with controlled movement to improve range of motion, increase heart rate and loosen up stiff muscles

6. Sleep is important to help your body and muscles repair and keep you healthy. On longer runs help your legs recover during sleep by wearing a compression sleeve or sock

7. Respect the rest days. REST don’t train

8. Mimic the course by finding locations to run that have the same topography as the marathon

9. Run a dress rehearsal. Four or five days before the marathon, complete a four or eight kilometer marathon-paced run in your marathon gear and runners.

10. Believe in yourself!

Stiff-Neck-j12-300x205Pillows impact the quality of our sleep – and sleeping on the wrong pillow can contribute to headaches, neck, should and lower back pain. Pillows are designed to keep the spine in a natural alignment.  The human neck curves slightly forward and it’s important to maintain this curve when in a resting position.

According to the Canadian Chiropractic Association, 80 per cent of Canadians will suffer from back pain at some point in their lives, and sleeping with the proper pillow is a simple way to prevent problems.

A pillow should mold to one’s individual shape and alleviate any pressure points. If the height of the pillow is too high when sleeping the neck is bent forward or to the side, causing muscle strain on the back of the neck and shoulders.

Based on the body’s measurements, a pillow should maintain a height of 10 to 15 centimeters to properly supporting the head, neck and shoulders.

How do you know if you need a new pillow…the general rule is you need to replace your pillows every 12 to 18 months. Old pillows can contain skin cells, mold, fungus, and dust mites, which make up more than half of the pillow’s weight.  Still not sure if you should be purchasing a new pillow? Fold your pillow in half and see if it unfolds, or pick up your pillow  and place it on your hand, if it stays flat that’s good, however if the sides flop down, it’s time to purchase a new pillow.

Buying a new pillow:  The goal of using a pillow is to keep your head in a ‘neutral alignment, so…

  • If you sleep on your back, use a thinner pillow that’s not too firm or too high so that your head is not thrown too far forward. Back sleepers should use memory foam, because it molds to the head and neck’s curve.
  • If you sleep on your side, use a firmer pillow, which will fill in the distance between the ear and the shoulder. Look for a firm  or extra firm pillow that supports the space under your neck when lying down.
  • If you’re a stomach sleeper, use a very thin, flat pillow.  This sleep style isn’t recommended, because of the stress it places on the lower back.

Pillow options: The most common materials used in pillows are: down, feather, foam, polyester fiberfill, memory foam, latex and organic products such as buckwheat hulls.

  • Goose down or feather pillows are long-lasting and excellent in terms of comfort
  • Memory foam pillows conforms to your movements and distributes weight evenly
  • Buckwheat hull and other organic pillows will remain cool throughout the night

Can’t find exactly what you need, try a pillow with a combination of material.  Some memory-foam pillows are constructed with polyester microfibre to give the “feel” of a down pillow, but with extra shape to provide more support.

There is no perfect pillow for everyone; if the pillow feels comfortable, you’ll get a good night’s sleep, and  sleep is the body’s chance to repair itself from the postural and physical demands of everyday.

sore_0Mild muscle injuries create microscopic damage/tears to the muscle fibers,  and scientists believe this damage, coupled with the inflammation that accompanies these tears, causes the pain.

Sore muscles are usually caused by doing an activity you’re not used to (like running a marathon when you normally jog just a few miles or you have quickly increased your exercise intensity level or length of your workouts.

One question most people have, is when you have sore muscles, which is better…heat or ice.  The best way to treat sore muscles is with cold therapy first and heat therapy later.

Cold Therapy:

Practitioners recommend icing the muscles immediately after activity to reduce blood flow to the area which will reduce the swelling and inflammation.  You should apply a cold compress/pack for at least 20 minutes, every four to six hours for up to 2 days.

Heat Therapy:

After the first day of soreness, heat can be applied to the inflamed area, which will help sore and tightened muscles relax and will promote blood flow and circulation.  Heat should be applied to the area for 20 minutes; up to three times a day.

Stretching The Muscles:

One of the best ways to prevent sore muscles is by easing your way into your activity or exercise routine.  This can be achieved by using those targeted muscles in lighter exercise than you are going to be performing in the following minutes.

The most important step you can do to prevent sore muscles is to have a cool-down phase after any workout or physical activity. Right before finishing, include at least 10 minutes of light aerobic work such as walking followed by stretching.  Stretching will also help to move the lactic acid out of your muscles.

Keep Hydrated:

If your muscles are sore from intense activities, your muscles are rebuilding themselves, and require lots of water.  Remember to drink water while you work out and throughout the day.

Therapies That Can Help With Sore Muscles:

Massage – is used to relieve pain by working on the soft tissues, the muscles, tendons, and ligaments to improve muscle tone.  Massage stimulates blood circulation and assists the lymphatic system and improving the elimination of waste throughout the body. 

Acupuncture – is used to encourage the body to promote natural healing and to improve function. Acupuncture points stimulates the nervous system to release chemicals in the muscles that will either change the experience of pain, or will trigger the release of other chemicals and hormones which influence the body’s own internal regulating system.

eToims – produces painless deep twitch contractions that stretch and relax damaged muscles. This produces an inflow of fresh blood and tissue oxygenation to tired muscles as pain-producing chemicals simultaneously outflow from affected areas.

Dry Needling – The aim of dry needling is to achieve a local twitch response to release muscle tension and pain. dry needling can reduce pain, while increasing flexibility and range of motion by: stretching receptor in the muscle by stimulation, and drawing blood to the area, initiating the natural healing process.

It’s normal to have sore muscles after you work out, or play sports, just make sure you take care of them!

senior cyclistWhether you are interested in road cycling, mountain biking, or just commuting to work, cycling injuries can happen to anyone.  In this article we will discuss three common bike injuries.

Achilles Tendonopathy: Achilles tendonopathy is an overuse injury caused by a breakdown of the tendon.   If you have tight calf muscles, spending several minutes performing heel raises before beginning your ride will reduces the risk of injury.

Achilles tendonopathy can also be caused by poor bike fit. Having the bike seat too high keeps the positions of your foot and toes pointed down, causing constant contraction of the calf muscles.   When the foot and toes point up during the bottom portion of the pedal stroke, the tension on the Achilles is released and this allows the tendon to have needed periods of rest.

Saddle Sores: A saddle sore is a skin disorder caused by long hours on a bike seat;  which is caused by the friction of your sit bones against the seat.  Having your bike seat too high can also causes this condition.  Lowering your bike seat can lessen the side-to-side motion of the pelvis, which can cause excessive friction against the seat. If you are still having problems, perhaps a different style of bike seat might provide relief.  Also, make sure your bike shorts are providing enough cushion/protection between you and the seat.

Lower Back Pain: Biking for long periods of time in a “riding” position is a major cause of lower back pain. Excessive flexion in the lumbar region of the spine can lead to nerve entrapment and sciatica.

Biking often overlooks core muscles, and having weak muscles can lead to low back pain by forcing supporting muscles to compensate for weaker muscles. Back pain can also be caused by a leg length discrepancy or misalignment of the spine. For more information on how to strengthen your core, please contact our physiotherapists.

Riding a bike that is too big for your frame, can also cause lower back pain; so take the time to have your bike fitted to your body: finding the correct body position on a bike will help avoid future biking injuries.

The most recent Mudd, Sweat and Tears event on Vancouver Island was located at Mount Washington on July 19th.  Our fearless clinic manager decided to take on this challenge solo… and proved that she has what it takes! (Here are 10 things Dawn learned from the Mudd, Sweat and Tears event)

NOW… Diversified Health has decided to enter a team into the next Mudd, Sweat and Tears event in Langford on November 1st.  We are sending out the challenge to any of our patients who would like to be part of this fun event.

For those of you who have not heard of Mudd, Sweat and Tears; it is a 10k obstacle course mud run event of extreme proportion. This course combines the best organic and natural features found throughout each site, with a series of constructed obstacles, which will have you – crawling, climbing, swimming, carrying and dragging yourself, possibly fellow competitors, and a series of objects: up, over, under, through and around hill and dale. And just when you think there can’t be another hill to climb or pit to drag yourself through….

Warning:

Mudd, Sweat and Tears is not for the faint of heart or unprepared. You will get dirty, muddy, scraped up, cold, physically and mentally punished, and may end up smiling continuously. If you’re not of average or above average fitness levels, prepared to race hard, race smart and help your fellow competitors, than this may not be the event for you. On the other hand, for those who are up for the challenge the rewards can be contagious!

Mudd, Sweat & Tears donates 5% of net profits of every Canadian event to Breakfast Clubs of Canada. In addition, we encourage all participants to donate when they register. You can receive a donation receipt for any donation of $5 or above during the registration process.

Please contact Dawn at dsteel@diversifiedhealth.ca if you have any questions or would like to be part of Diversified Health’s Team!!

sugar-sweetner-400x400Sugar substitutes can be in either natural or synthetic form.  All sugar can add to the body’s toxic load, so moderation and  product knowledge is key to minimizing your risks.

Here is a list of some of the most common synthetic sugar substitutes:

Acesulfame Potassium is used in soft drinks, gelatins, and chewing gum.  This sugar substitute “might” be linked to cancer and requires further testing.

Aspartame, Equal, & NutraSweet are synthetic sugar substitutes and are used in drinks, gum, yogurt, and baked goods.  Aspartame has been accused of causing everything from weight gain to cancer.

Neotame is used in drinks, dairy products, frozen desserts, and fruit juices. This artificial sweetener is between 7,000 and 13,000 times sweeter than table sugar and is produced by the same company that makes aspartame.

Saccharin is a synthetic sugar substitute used in Sweet’N Low and is found in many drinks, canned goods, and candy.  Studies in the early 1970s found a link between consuming Saccharin and bladder cancer, prompting in 1981 that all foods containing it must contain a warning label.

Rebiana is used in many diet drinks,  and yogurt. Derived from the stevia plant, rebiana is deemed the natural alternative to artificial sweeteners. It has been linked to DNA damage and requires further testing.

High-fructose corn syrup used in thousands of processed foods including soft drinks, baked goods and cereals.  This sweetener contains the sugars fructose and glucose from processed corn syrup.

Sugar substitutes trick your body into gaining weight by turning off your body’s appetite control system and fooling your bodies metabolism.

Sugar and sugar substitutes brake down in your liver like alcohol, and produces many of the side effects of chronic alcohol use.

Two sugar substitutes that are from the plant kingdom are:  Stevia, a highly sweet herb derived from the leaf of the South American stevia plant and cane sugar.  Both of these sugar substitutes are safe in their natural form and can be used to sweeten most foods.

Natural sweeteners such as honey and agave syrup may seem like a healthier choice, but they’re loaded with fructose and many products that use these sweeteners are highly processed.

The ingredients found in artificial sweeteners can cause inflammation, hormonal imbalances, and chronic disease such as diabetes, heart disease and cancer.

Be informed of the different types of sugar substitutes, and use all sugars, natural and synthetic in moderation.  Understanding that sugar is found in most processed foods in several different forms, so try to incorporate more unprocessed foods, fruits, and veggies, and you will be on your way to a healthier diet.