Think Twice Before You Ice!

Think Twice Before You Ice!

For over 40 years we have all been routinely treating injuries with ice. Yet, surprisingly, there is no scientific evidence to support the use of ice for tissue healing and recovery.  In fact, recent scientific research and clinical studies show that, not only is the application of ice ineffective in some cases, but it can also delay the healing of an injury.

A 2013 Journal of Strength and Conditioning Research article concludes that “these data suggest that topical cooling (icing), a commonly used clinical intervention, appears to not improve but rather delay recovery from eccentric exercise-induced muscle damage”.

Gabe Mirkin, the doctor who came up with the popular treatment acronym RICE in the late 1970s (rest, ice, compression, elevation) is backtracking and admits RICE was widely accepted without scientific validity.

According to Gary Reinl, the author of “Iced! The Illusionary Treatment Option”, icing does not reduce swelling or inflammation.  The lymphatic system is responsible for eliminating the “waste” in the tissues caused by inflammation.  It does this predominantly by muscle movement putting pressure on the one-way valves.  Ice inhibits this muscle pump and therefore does not reduce swelling.

When tissues are damaged, more blood arrives at the injury site and with it, inflammatory cells such as leukocytes and macrophages.  These cells rush to the damaged tissue to release proteins which clean up and heal the injured site.  This build up of fluid, or swelling at the site should be considered a positive reaction.  It allows the inflammatory process to progress, and prevents further injury (by increasing sensitivity to pain and restricting movement).  Healing is delayed by anything that temporarily blocks blood flow to the injury site – like certain medications and ICE.

We should not stand in the way of our body’s natural inflammatory response, which consists of a universally recognized 3 phase healing process.  Inflammation is the first phase followed by the tissue repair and tissue remodeling phases.  So if we stop inflammation, we are stopping the healing process.  Essentially there cannot be healing without inflammation.

Ice can still be used for temporary pain reduction and local numbness –  just be aware of its role in inflammation and swelling. Do your due diligence and then get on board with the huge industry-wide movement!

Our physiotherapists believe in keeping up to date with best practices and the most effective treatment strategies.  

Sleep Hygiene

Sleep Hygiene

The Importance of Sleep

Natural sleep is one of the most powerful immune system boosters, aiding in our ability to ward off illness and infection. Quality sleep is necessary for injury recovery, forming new memories, maintaining a healthy body weight and managing stress and anxiety.

Your Personal Habits

• Fix a regular and consistent bedtime and wake time, even if you are retired or not working.

• Avoid napping during the day as this will affect your sleep drive – your ability to fall asleep and stay asleep.

• Avoid alcohol 4-6 hours before bedtime. While alcohol has an immediate sleep-inducing effect, a few hours later, as the alcohol levels in your blood start to fall, there is a stimulant or wake-up effect.

• Avoid caffeine 4-6 hours before bedtime. This includes coffee, tea, energy drinks, pop, as well as chocolate, ice cream and many pain relievers.

• Open the blinds first thing in the morning or get outside in natural light.  This helps to set your internal clock and promotes melatonin production (the sleepy hormone) at bedtime.

• Exercise every day to help build your drive to sleep.

Your Sleeping Environment

• Reserve the bed for sleep and sex. Don’t use the bed as an office, workroom or recreation room. Let your body “know” that the bed is associated with sleeping.

• Room should be dark, cool (19-21 °C) and well ventilated. 

• Ensure your room is calm and quiet (use a noise machine to block out all distracting noise).

Consistent Bedtime Routine

• Eat a light snack with a protein and a complex carbohydrate. Low blood sugar can lead to night waking.  Warm milk and foods high in the amino acid tryptophan, such as bananas, can help promote sleepiness.

• Establish a pre-sleep ritual, such as a warm bath (your body needs to drop in temperature to help sleep process), a cup of chamomile tea or a few minutes of reading.

• Practice relaxation techniques before bed, such as yoga, light stretching, deep breathing or meditation (check out guided meditation apps – Calm, Insight Timer, Yoga Nidra, 10 % Happier)

• Don’t take your worries to bed. Try journaling or doing a ‘brain dump’ to see the worries on paper. Some people find it useful to assign a “worry period” during the evening or late afternoon to process these issues.

• Get into your favorite sleeping position. If you don’t fall asleep within 20-30 minutes, get up, go into another room, and read until sleepy.

• If you find wake in the middle of night and cannot get back to sleep within 20-30 minutes, then leave the bed. Read, do a calming and quiet activity, or take a bath. *Avoid screens as light disrupts melatonin production. 

Weekly Sleep Diary

Use this to track your progress, putting a checkmark beside the strategy you used and rating your sleep quality for that night.

Running as a minimalist

Running as a minimalist

Humans have been running for over 2 million years and when they first started running, they ran barefoot of course!

In Christopher McDougall’s book “Born to Run” he discusses various scientific studies about barefoot running and how we evolved into humans made for running. McDougall describes why running injuries familiar to us are unheard of in the Copper Canyon of Mexico where barefoot tribal folks run for hours on end.

It is clear from recent research that the modern running shoe has a significant impact on our bodies and our running mechanics.

When we run with modern cushioned shoes, we tend to land heavily on our heels, which increases the force at impact.  Conversely, when we run in bare feet we land more on the forefoot or mid foot and with more bend in the knees, both of which absorb the force of impact more efficiently.

The modern shoe also significantly reduces stride frequency and changes the contraction sequence of the leg and back muscles. Running with an increased stride frequency, or higher turnover rate of the feet, decreases the amount of force and time of each foot strike, which is believed to decrease the chance of repetitive type running injuries.

Many running experts are now recommending weekly training drills in bare feet to strengthen the intrinsic muscles of the foot and ankle, improve our proprioception (body’s awareness in space), thereby reducing the chances of running injuries.

Keep in mind that any changes in your training program must be gradual.  Extreme changes can cause an overload on your tissues and possibly an injury. Why not try taking off your shoes and baring your sole!

Should Kids Be Wearing Supportive Running Shoes?

Should Kids Be Wearing Supportive Running Shoes?

Runners, coaches, medical professionals, and now parents, are all realizing the benefits of allowing children to have proper natural foot motion.  According to the experts, parents should think twice before putting their kids in a pair of “good sturdy shoes.”  It seems that the smartest design that will ever be developed for injury free activity is the human foot itself.  Our feet are sensory organs that allow us to interact with our environment and to develop natural movement patterns. Studies suggest that shoes can interfere with that development. “Balance, stride length and stride width are all influenced by our ability to sense the surface we are landing on. The more “stuff ” between the foot and the ground the less ability we have to sense the landing surface.” says Paul Langer, D.P.M., chair of the American Academy of Podiatric Sports Medicine’s Shoe Committee.

Rob Conenello, D.P.M., international lecturer on podiatric sports medicine, advises putting children in the “most minimal shoe possible, and adding support if necessary.”The level of minimal that is possible will vary with the child and may vary as the child ages.”

RECOMMENDATIONS FOR PARENTS: (Jonathan Beverly, Running Times Magazine, April 2010)

1) Encourage kids to go barefoot whenever possible: in the house, yard, parks, on the beach.

2) Buy the most minimal shoes appropriate for your child. Look for shoes that are flat, with low heels, little cushioning, flexible in all directions, light weight with lots of toe room. In early development, a child’s foot is widest across the toes.

3) Ensure all of your kids’ shoes are running-friendly. Kids don’t change into running shoes to run, they do it naturally throughout the day.

4) Add support only if necessary. Get an evaluation from a physiotherapist or podiatrist if your child shows signs of needing structural support.

5) Allow and encourage kids to run more like they do when they are very little: short bursts that end when fatigued, with a relaxed stride, at a variety of paces.

6) Encourage kids to participate in a wide variety of physical activities that build strength and flexibility.

7) Help kids stay at an appropriate weight through diet and activity.

Given what we’re learning about how minimal shoes can be beneficial to an adult’s running technique, efficiency and injury prevention, it makes sense that we should be starting our kids off on the right foot.

Sue Underhill is a registered physiotherapist and owner of Maximum Physiotherapy. She offers running assessments using video analysis and treadmill running and gives technique and footwear advice.   To book a running assessment at Maximum call 705-444-3600.

Lengthen to Strengthen… (Eccentric Strength Training)

Lengthen to Strengthen… (Eccentric Strength Training)

When we have a sore muscle from physical activity, we assume the muscle must be tight and that we need to stretch it.  Often though, especially if we’ve been participating in a repetitive activity/sport for many years, a sore muscle may indicate a relative weakness in the muscle.

To recover from a muscle strain or to prevent one altogether, it’s important to strengthen your muscles “eccentrically”.

An eccentric muscle contraction occurs as the muscle fibres lengthen.  This happens when we do things such as lowering a weight by controlling it through a muscle’s full range of motion.  Eccentric training, often referred to as “negatives”, focuses on slowing down the elongation of the muscle.  This type of training allows for the greatest muscle forces at relatively low energy costs.

Many muscles cross two joints: hamstrings and hip flexors cross the hip and knee, the gastrocs cross the knee and ankle, and the long head of biceps crosses the shoulder and elbow.  So to strengthen these particular muscles, we need to look at the position of both joints to make sure the muscle is being contracted throughout its full length.   For example, to strengthen the bicep muscle eccentrically, lie on your back on a bench with your arm over the edge, and slowly lower a weight by extending the elbow and also extending the shoulder.

To get the biggest return on your investment, make sure to include eccentric strength training throughout a muscle’s full length.

Sue Underhill, Owner/Physiotherapist

Maximum Physiotherapy

Collingwood, On