The Modern Art of Acupuncture

Acupuncture is used to treat illness by bringing a person’s body back into balance and optimum health, utilizing ancient scientific principles. Modern science is now being performed to help describe how this ancient technique actually functions within the body, and why it is so effective.

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How does traditional chinese acupuncture work?

In traditional Chinese medicine, it is believed that illness is caused by imbalances in the basic energetic flow of life, known as qi or chi (chee). Qi flows through meridians in the body. These meridians and energy flow can be accessed through over 400 labelled acupuncture points. By inserting extremely fine needles into these points, acupuncture practitioners believe that your energy flow will rebalance. This rebalance of qi allows your body to heal naturally.

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HOW IS CONTEMPORARY MEDICAL ACUPUNCTURE DIFFERENT from traditional chinese acupuncture?

Contemporary Medical Acupuncture is a certification program taught at the McMaster University to already licensed health care professionals such as chiropractors, physiotherapists and medical doctors. These medical professionals use acupuncture as a tool to complement their regular treatment protocols, dealing mainly with pain related disorders. 

 

Contemporary Medical Acupuncture uses very thin needles inserted into specific points of the body to relieve pain and stimulate healing. These points can be a combination of traditional Chinese acupuncture points along with anatomical locations that target specific muscles or nerve pathways. These inserted needles may be stimulated by hand or with a low frequency electricity (which feels like a heart pulsing). The therapeutic purpose may be to stop pain, improve function that may be lost due to injury, or even reset learned pain pathways in the brain, such as with chronic pain conditions like fibromyalgia. 

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Sometimes Contemporary Medical Acupuncture treatments result in disappearance of the symptoms, and other times results in permanent resolution of the dysfunction, especially when there has been an underlying dysfunction of the nervous system. 

I often use acupuncture to help relieve painful symptoms and trigger points, but also to reset neurological pathways and proper firing of muscles by “resetting the system”. Often when there has been an injury and it has gone on long enough different muscles get “turned off” or do not function properly. Often 4-6 treatments in conjunction with rehabilitative exercises can get the body back into proper functioning allowing to build up optimal strength and stability.

HOW DOES ACUPUNCTURE WORK? 

According to the National Institutes of Health, researchers are studying at least three possible explanations for how acupuncture works:

  • Opioid release.
    During acupuncture, endorphins that are part of your body’s natural pain-control system may be released into your central nervous system, your brain and spinal cord. This reduces pain much like taking a pain medication.
  • Spinal cord stimulation.
    Acupuncture may stimulate the nerves in your spinal cord to deliver to the brain, pain-suppressing chemicals and messages. 
  • Blood flow changes.
    Acupuncture needles may increase the amount of blood flow in the area around the needle. The increased blood flow may supply additional nutrients or remove toxic substances, or both, promoting healing.

WHAT HAPPENS DURING AN ACUPUNCTURE TREATMENT?

Acupuncture therapy typically involves a series of weekly or biweekly visits. Each visit includes an examination and assessment of your current condition, the insertion of needles, followed up with a discussion about possible homework such as, exercises or other helpful tips to ensure optimal recovery. An acupuncture visit generally lasts about 20- 30 minutes.

During an acupuncture treatment, sterilized individually wrapped stainless steel needles are used only once and then discarded. When the needle is inserted, sometimes you may feel a brief pinching sensation, but generally the treatment is painless. It can be common to feel a deep aching sensation when the needle is inserted in the correct spot.

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CONDITIONS acupuncture CAN HELP

  • Low back pain (disc, stenosis, arthritis, muscular)
  • Neck pain (disc, stenosis, arthritis, muscular)
  • Headaches & migraines
  • Osteoarthritis
  • Hip, knee and ankle pain (ITB syndrome, runner’s knee)
  • Shoulder (rotator cuff)
  • Elbow and wrist pain (golfer’s and tennis elbow)

It can also help with several internal disorders.

If you would like further information on how Dr. Tammy Bowler may be able to help you through the use of Contemporary Medical Acupuncture please visit her website at www.backinbalancemuskoka.ca or call her office (705) 571-2250.

Solving the Mystery of Low Back Pain

Mechanical Low Back pain is extremely prevalent in our society today. It also makes up the largest part of musculoskeletal problems treated by chiropractors and many other therapists. In fact, many medical doctor offices are overloaded with patients experiencing mechanical low back pain. Although chiropractic and other passive therapies can help temporarily remove pain and movement dysfunctions, a patient must take an active role in managing their long-term pain and rehabilitation.

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What is meant by Mechanical Low Back Pain?

The main causes of mechanical back pain include muscular, bone, disc or nerve related structures. All of these tissues in the back can cause pain. This is by far the most typical back pain seen in my chiropractic practice.

So how do we approach treating a patient with low back pain? Let’s use an example of a typical patient with low back pain who comes in to see me.

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Meet Jane: Jane experiences some pain in her low back periodically, but most of her pain is in the buttock muscles and back of her thigh. She was previously diagnosed with “piriformis syndrome”.

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Jane says her pain goes from the side into front of her hip joint, and also on the buttock and down the back of her thigh. The pain can also occasionally go all the way into her toes. Although Piriformis Syndrome is real, it’s rare. The pain is likely coming from the nerves in the low back. Upon assessing Jane we find she has lack of movement in her lumbar spine and hip/pelvis. She has weakness in her buttock and abdominal muscles and tightness in the muscles of her low back, back of the thigh “hamstrings” and also front of her hip “hip flexors”. However, stretching these tight muscles have not helped her much in the past.

So What Do We Do For Jane?

Our first priority as chiropractors is to get these joints, and muscles attached to them, moving. Then we educate Jane. We discuss postures to reduce load on her spine at work, at home and at the gym. When she is sitting, she should sit upright and avoid bending forward in any way. As illustrated in the picture below, the third image represents the ideal posture.

 We discuss ergonomic set up at work, as illustrated above.

We discuss ergonomic set up at work, as illustrated above.

 We suggest the use a lumbar support temporarily to train her to remove the pressure to the nerves and disc. We ask her take numerous breaks throughout the day. During those breaks, we promote movement based exercises, such as the Cat-Camel illustrated below.

We suggest the use a lumbar support temporarily to train her to remove the pressure to the nerves and disc. We ask her take numerous breaks throughout the day. During those breaks, we promote movement based exercises, such as the Cat-Camel illustrated below.

 Cat Camel Movements

Cat Camel Movements

We also have her go for short walks and work on her running technique with a neutral spine. We also start to incorporate some very specific strengthening exercises for her core and hip muscles to support the spine (abdominals, back and hip muscles), such as the Bird Dog and Curl-Up illustrated below.

 The Bird Dog

The Bird Dog

 The Curl Up

The Curl Up

After one treatment, Jane starts to feel some improvement. Therefore, we knew we were on the right path. After a couple of weeks; including a couple of treatments consisting of tissue massage, mobilizing and spinal adjustments, along with Jane being mindful of postures while faithfully performing her exercises, she improves significantly. When we follow up in the next couple of weeks, Jane’s pain is almost completely resolved.

Jane is the typical low back patient we see in practice. Sometimes patients present with only low back pain. Sometimes the pain travels into the buttock, front or back of the thighs or even the feet, such as with the involvement of a spinal disc. With all of these conditions the cause is usually mechanical, meaning it involves the back joints, muscles and nerves. In fact, it is estimated these cases account for 90% of all low back pain. It is also likely that these low back problems will resolve on their own over the course of 4 to 12 weeks. However, it is our job as chiropractors to rule out other unlikely causes of the back pain that could prove more sinister, and to speed up recovery time.

Chiropractors have training to identify these possible causes, and refer to medical doctors for further investigation and possible imaging, such as an x-ray or MRI, when necessary.

Research shows that chiropractic treatments (soft tissue therapy, mobilization, manipulation or adjusting), paired with patient education and proper exercise, help to rehabilitate and improve a patient’s recovery time and prevent future recurrence.

Chiropractors have evolved to provide “active care” by coaching patients through pain avoidance strategies and educating them on appropriate exercise programs. Patients and medical doctors should feel confident utilizing the services of a chiropractor, or other therapists, who treat mechanical low back pain by encouraging proper movement and work to build stronger core and pelvic stabilization as strategies to long-term patient rehabilitation.

Most employee benefit plans include chiropractic care.

If you have any questions, please feel free to contact me for further information.

Running Injury Prevention….Now that Spring has Sprung, are you experiencing the “Running Bug”?

Whether you are running your very first race or a seasoned runner gear up for a big race, spring is in the air, and it’s time we hit the roads or trails to prepare to meet our running and fitness goals.

Many local events, like Huntsville’s Band on the Run, have various options for the beginner to the seasoned runner. This can make 5km run/walk a realistic goal for many new runners.

However, it is estimated that as high as 80% of runners will end up with a running related injury at some point in their running career. Of that 80% majority of them are overuse or muscular imbalances. As a chiropractor who treats a large variety of sport related injuries, it is my job to educate patients on running injury prevention. So, wherever you are with your training or running career, there are some hard and fast rules to follow in an effort to prevent running injuries.

1.   STRENGTH

Strength seems like a simple concept. The bottom line, if you develop a strong muscles, ligaments and tendons they can guard against many running injuries and improve running form. More often than not, we as therapists, see runners coming in with muscular imbalances. It may initially show up as back or hip pain, perhaps even knee, ankle or foot pain. Yes, other more serious structural injuries need to be ruled out, but typically it is due to a muscular imbalance. Typically what happens is repetitive use of the same muscles time and time again start to create tightness, weakness and imbalance. If the big stabilizers of the hip, pelvis (gluts) and core are weak and not functioning properly, other smaller muscles are called upon to do work they normally would not. Eventually these small muscles start complaining. How your knee turns in, your hip drops and your foot pronates with each step. This can remain consistent if things are strong, but if there is weakness, more stress is put on the muscles and the joints they attach to. Strength provides greater control and stability. This is particularly true because much of our running stride is carried out while standing on one leg or the other, not both.

Here are a few exercises to consider 2-3 times per week to build stabilizing muscles:

  Wall Press     Why : activates gluteus medius   How : Stand with right side near a wall. Bend the right knee at 90 degrees and make contact with the wall. Push your knee into the wall and hold for 20-30sec. Do 2 sets of 3 on each side   

Wall Press

Why: activates gluteus medius

How: Stand with right side near a wall. Bend the right knee at 90 degrees and make contact with the wall. Push your knee into the wall and hold for 20-30sec. Do 2 sets of 3 on each side

 

  Eccentric Heel Drop    Why : Strengthens the calves, ankle muscles and achilles to create stability when landing.   How : Stand with one leg on a step with your heel off of the edge. Lift up onto your toes, then slowly lower down until your heel is below the step. Start with 1 set of 10, build up to 3 sets of 15.   

Eccentric Heel Drop

Why: Strengthens the calves, ankle muscles and achilles to create stability when landing.

How: Stand with one leg on a step with your heel off of the edge. Lift up onto your toes, then slowly lower down until your heel is below the step. Start with 1 set of 10, build up to 3 sets of 15.

 

  Stability Ball Bridge    hy : Strengthens the gluteus maximus and multifidus (small muscles in the back for spinal stability)   How:  Lie on the ground with your feet on a stability ball, arms extended out or by your side. Lift your hips up off the floor so your body is in a straight line from knees to shoulders and hold. Try to hold for 60sec without the hips dropping. As you get stronger you can move the ball out toward the calves, then the heels for more of a challenge. Also, progress your arms from outstretched 90 degrees to your body to parallel beside your body, then lift them up 90 degrees straight into the air. There are many more exercises to consider, but these are 3 to start with.

Stability Ball Bridge

hy: Strengthens the gluteus maximus and multifidus (small muscles in the back for spinal stability)

How: Lie on the ground with your feet on a stability ball, arms extended out or by your side. Lift your hips up off the floor so your body is in a straight line from knees to shoulders and hold. Try to hold for 60sec without the hips dropping. As you get stronger you can move the ball out toward the calves, then the heels for more of a challenge. Also, progress your arms from outstretched 90 degrees to your body to parallel beside your body, then lift them up 90 degrees straight into the air.
There are many more exercises to consider, but these are 3 to start with.

2.   MOBILITY

Along with strength comes mobility. If muscles are overworked and they experience trauma, they will repair themselves, but are usually knotted together and limit our range of motion. Breaking down these adhesions allows the muscle to move more freely through its full range. It is best to do these after a run.

  Hip Flexor Stretch    Why : tight hip flexors attach at the inside and front of the hip and into the low back. If they are tight, they can limit our back swing of our leg. Putting more stress on the leg joints.   How : in a lunge position, you can drop the back knee to the ground and keep the back upright tucking the tailbone under the pelvis and forward. That stretch should be felt in the front of the hip. Hold for (20-40 seconds).

Hip Flexor Stretch

Why: tight hip flexors attach at the inside and front of the hip and into the low back. If they are tight, they can limit our back swing of our leg. Putting more stress on the leg joints.

How: in a lunge position, you can drop the back knee to the ground and keep the back upright tucking the tailbone under the pelvis and forward. That stretch should be felt in the front of the hip. Hold for (20-40 seconds).

  Calf Foam Roll    Why : Knotted calf muscles are less effective shock absorbers   How : Sit on the floor and place a foam roller under the calf of an outstretched leg. Roll your calf over the roller, and if you find a painful spot, hang out there and press into the roller allowing it to ease (30-90sec).

Calf Foam Roll

Why: Knotted calf muscles are less effective shock absorbers

How: Sit on the floor and place a foam roller under the calf of an outstretched leg. Roll your calf over the roller, and if you find a painful spot, hang out there and press into the roller allowing it to ease (30-90sec).

3.  Running Form

I will not get into running barefoot or minimalist etc. That is a discussion for another article. There are many differing opinions and variability in quality research. However, there is one common theme. Running with good posture and a proper stride can help reduce injuries.

  Posture:    ·          
  
  
   
   
   
   
   
   
   
   
   
   
   
   
  
  
  
  
  
  
  upper torso upright, low back not arched (don’t allow your butt to stick out), head should be over shoulders  ·        swing the arms forward and back to maintain trunk stability, not across the body  ·        land lightly, it tends to shorten our stride and tends to allow us to land mid-foot, which lessens forces through our joints  ·        keep the body weight central and drive your hips forward, it keeps posture upright  ·        a faster cadence (number of steps per minute) can minimize forces on the joints by not over-striding  ·        when you land on your lead leg, your knee should be directly over your ankle  ·        engage your glutes, it can be as simple as tapping on your butt for a couple of seconds to keep the glutes active for stability

Posture:

·        upper torso upright, low back not arched (don’t allow your butt to stick out), head should be over shoulders

·        swing the arms forward and back to maintain trunk stability, not across the body

·        land lightly, it tends to shorten our stride and tends to allow us to land mid-foot, which lessens forces through our joints

·        keep the body weight central and drive your hips forward, it keeps posture upright

·        a faster cadence (number of steps per minute) can minimize forces on the joints by not over-striding

·        when you land on your lead leg, your knee should be directly over your ankle

·        engage your glutes, it can be as simple as tapping on your butt for a couple of seconds to keep the glutes active for stability

4.  The 10% Rule:

Have you heard of the training rule of 10’s? The 10-percent rule is one of the most important and time-proven principles in running. It states that you should never increase your weekly mileage by more than 10 percent over the previous week.

The 10% Rule gains its importance from the fact that the vast majority of running injuries are overuse injuries. They occur when you run too much or increase your weekly training program too quickly. Say you’ve been running 15 km per week. For some reason—perhaps you want to prepare for an upcoming race or you just feel that you’re ready—you decide to pick up your training. Instead of running 5 km three times a week, you manage to fit in five 5-km’s. Your training increases from 15 km a week to 25 km a week—a 67 percent increase. Too much too soon.

This 10% rule also applies to speed work and intensity, including hills etc. as well as distance or time.

5.  Shoes:

Again, another huge topic on its own. Basically go to a store that has options and someone who has some knowledge of shoe types and basic gait analysis. They should look at your old shoes, look at your type of foot and be able to offer you a few suggestions. Try on several pairs. The bottom line is you want a pair that offers you neutral pronation. What does that mean? Here’s how to figure it out: Rock side to side on your bare feet and feel the middle position. Then rock forward and backward to find the middle point. That is how your feet should feel when you are in your shoe. Neutral and comfortable. The foot should pronate, but not overly. If you feel you may have overly pronated feet or “flat feet”, you may require some support. However, there is no evidence custom orthotics are better than over-the-counter supports. If you have any questions, or are in pain, you will want to consult a therapist or health care professional who can properly assess your biomechanics and offer you some suggestions.

Also, changing footwear is extremely important. It is estimated that you should change your shoes every 400-600km. Even have a rotating pair of shoes. Or different types of shoes if you are varying your training. One for distance, one for speed work, one for trail runs. When you are starting out, one solid pair is enough. Be sure to keep track of the mileage you are putting on, it does add up quickly. One of the first signs footwear needs to be changed can be shin, or foot pain.

Running is a very enjoyable sport. It is generally quite affordable, compared to many other sports, and it is easy to take with you wherever you go. However, it can be quite demanding on your body. Walking and running is controlled falling. With each step we require the proper muscular control, stability and balance to keep us upright, and stop us from potentially injuring ourselves.

There are many learn to run programs offered through various gyms, and other groups across Muskoka. There is even a detailed running guide available, if you are to register for Band on the Run or join the MARS Running Club (Muskoka Algonquin Runners), compiled by our very own local Dr. Pierre Mikhail. Utilize these resources and join a like-minded group to help you reach your running goals…injury free.

If you have any questions regarding running injuries or proper training techniques you can feel free to contact me at Back in Balance Muskoka. I am a Chiropractor and Acupuncturist with a background in treating many sport related injuries. 

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Our Feet are our Foundation – What can you do about foot/heel pain?

Most people can identify with taking the first few steps out of bed in the morning and feeling a searing pain in the bottom of your foot. It appears to get better when further steps are taken. It can come back often if you are on your feet for long periods of time, or at the end of the day. You can also experience it during or after exercise; such as running, or with weight changes; such as with pregnancy.

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If you have had this foot pain, you are not alone. We have all had this issue at one time or another. It is part of the charm of being human and upright, bearing our full bodyweight on our feet.

The clinical name is Plantar Fasciitis pronounced (PLAN-ter fash-ee-EYE-tis) or Plantar Fasciosis, if it has been around for a while.

 

What is plantar fasciitis and why does it happen?

The plantar fascia is a band of tissue (ligament) in the bottom of our foot that connects the heel bone to the toes. Its job is to support our foot when we stand, walk or run. When we bear the full weight of our body on our feet it exerts an immense amount of force through this ligament. Excessive force can cause the plantar fascia to overstretch from the toes into the heel, much like a thick elastic band. If the strain continues enough, it then pulls on the heel causing small micro tears. These tears lead to pain and swelling. However, your body is an amazing machine, and it will try to repair itself. The constant tugging at the heel bone can cause a boney growth to form on the bottom of the heel bone. This is called a bone spur, and can be detected by an x-ray. Most people forget that bone is a living, growing tissue in our body. It continually changes based on the forces you apply to it. So if the plantar fascia is constantly pulling on the heel bone, more bone will form to support that extra force. It will attempt to strongly attach the fascia to the heel bone to prevent it from pulling the tendon right off of the bone. Our bodies are truly amazing!

 

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How do health care providers diagnose plantar fasciitis?

We examine your feet and speak with you about the history of your problem. There are several conditions that can cause heel pain, and plantar fasciitis must be distinguished from these conditions. That is done with a thorough examination of your feet testing the muscles, joints and function of the foot while you are standing and walking.

One thing we often over-look are the basics we learned in school, which comes in the form of a song. The foot bone’s connected to the..ankle bone, the ankle bone’s connected to the…knee bone…to the hip bone…etc. Not only are we upright creatures, but walking is a very complicated process for all of these joints and muscles to work together in concert to move us around. Often as a chiropractor I see a foot problem show up as pain in the hip, knee or even the low back. Again, this shouldn’t come as a big surprise. If a problem goes on long enough, our body responds by trying to correct itself. Unfortunately, it doesn’t always do so in a positive way.

Thus, it is important to further assess your muscles and joints of the entire leg and hip, to determine if there might be a bigger issue at play here. Why did you get the foot pain? What can be done in the future to help prevent it from happening again?

Once your examination is complete, and we have confirmed that it is plantar fasciitis, we have treatment options that will help speed your recovery. Treatment will often help you return to your active lifestyle more quickly. Most often, in fact 90% of the time plantar fasciitis will resolve with non-invasive and non-surgical treatments.

How is it treated?

It is important to note, there is no single treatment that works best for everyone with plantar fasciitis.

Here are a few things to try first on your own:

-Give it some rest. If you are a runner, change to a softer surface. Or change to biking, swimming or an elliptical machine.

-Roll it out with a tennis ball a couple of times a day, for a minute each time.

-Stretch out the foot, toes and also the calf with basic heel stretches off of a step or toes against a wall.

-Roll it out on a frozen water bottle at the end of the day, to help relieve pain and bring down inflammation.

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If it is persistent and you have given it some time to “work itself out”, then it is likely time to see a therapist. Don’t wait too long. 6-8 weeks is enough time.

A doctor may recommend splints worn at night, non-steroidal anti-inflammatory medications or possibly an injection of medication into the heel. An x-ray may be ordered to rule in or out other possibilities.

A therapist (chiropractor, physiotherapist, massage therapist, osteopath) may recommend more advanced non-invasive techniques.

Often the first treatment we use is to control pain and swelling with use of ice packs and soft tissue massage. We also give you exercises to improve flexibility in the calf muscles and plantar fascia. (these are similar to the suggestions listed above).

Although a customized orthotic can be useful, it is used conservatively if the problem is persistent. An orthotic is often not a long-term solution, unless there are structural issues that will not change with therapy. To provide temporary relief, we may recommend the use of a heel cup or a silicone heel pad which can reduce the pressure on the area of pain.

One of the most effective non-invasive techniques I have encountered so far has been Extracorporeal Shockwave Therapy, simply known as “Shockwave”. There has been scientific research to support its effectiveness (75-95%), along with our success clinically. It is a non-surgical treatment, with no side effects, available at a reasonable cost. The treatments are non-invasive and promote a rapid recovery of injured soft tissue, bone and heel pain.

What is Shockwave?

It is an intense, but very short energy wave traveling faster than the speed of sound. This technology has been used for decades for millions of people for issues such as breaking up kidney stones.

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Therapy sessions are short, usually 20-30 minutes, and provide successful relief of chronic pain and restore mobility. Permanent relief typically begins about 72 hours following treatment. Typical treatment plans consist of 3 treatments, spaced a week apart. Most insurance companies will cover this therapy.

In addition, there are often joints and muscles in your foot &/or leg &/ hip that are not working properly. These mechanical issues often cause or contribute to the foot pain. We often perform soft-tissue massage, mobilize joints and teach strengthening exercises to further provide pain relief and prevent future problems.

Often the best results take a combination of different approaches and can take some time. You may have less pain within a few weeks, but it may take a month or so for the pain to go away completely. It really depends on a number of variables.  In some situations, it can take up to a full year or more for the problem to be completely resolved. So don’t get discouraged. Continue to be diligent with your exercises and therapy recommended by your health care professional.

Please book a consultation at our office if you would like us to provide you with more information regarding Plantar Fasciitis or other muscular and skeletal complaints you may be experiencing.  We are here to help you bring your optimal health back into balance.

Other conditions that can also be treated with Shockwave include:

-Achilles Tendinopathy                                    -Jumper’s Knee

-Scar Tissue Treatment                      -Rotator Cuff Tendonitis

-Tennis Elbow                                     -Stress Fractures

-Golfers Elbow                                    -Non Healing Ulcers

3 Knee Exercises to Keep You Running Pain Free

You may be training for your first 5km, or be a more seasoned runner striving toward a half marathon or marathon. Whatever your end goal, the key to completing your race is to remain injury free as your running starts to build-up.

Knees are often the most problematic of injuries sustained through running. Knee injuries such as Patellofemoral Pain (Runner’s Knee) and IT Band Syndrome are two of the most common injuries experienced by distance runners.

Thankfully there are some simple, but often forgotten steps, you can take to help prevent such injuries, and keep you running without knee pain. These preventive exercises are likely the same as exercises your health care professional may give you to treat such running knee injuries.

Simple Runner’s Knee Exercise Routine

It’s always best to perform the following exercises after a gentle warm-up, rather than stretching from cold.

  • Side Lying Quads Stretch: 3 x 30 seconds on each leg
  • Resistance Band Glute Bridge: 10 x 5 second hold
  • Romanian Single Leg Deadlift: 3 x 10 reps on each leg

Aim to complete this routine 3-4 times weekly alongside your running.

Shoulder Rehabilitation

Shoulder injuries are very common in athletes who play overhead sports ie swimming and baseball, as well as individuals who do a lot of work overhead ie. Electricians and carpenters.
The shoulder consists of two anatomical joints: the Gleno-humeral joint and the Acromio-clavicular joint. The Gleno-humeral joint is the connection of the arm with the scapula (“shoulder blade”) The Acromio-clavicular joint is the connection of the clavicle (“collar bone”) and the scapula.

A large number of muscles and ligaments are important to the shoulder. The most important are the rotator cuff muscles (supraspinatus, subscapularis, infraspinatus and teres minor) and the Acromio-clavicular ligaments along with the Gleno-humeral joint capsule. The rotator cuff is a group of muscles and tendons, which hold the Glenohumeral joint together and help lift the arm overhead, such as throwing a ball or swimming.

A typical shoulder rehabilitation protocol consists of two major components; flexibility and strength. 

Flexibility is the first component of shoulder rehabilitation and consists of range of motion (ROM), static stretching, and dynamic stretching. ROM is desired degrees of range of motion of movement pattern that is pain free and maybe assisted with a stick/ towel or unassisted.
Static stretching are stretches that are pain free and held for 20-30 seconds and repeated 3-6 reps. Dynamic stretching are stretches that are pain free and held for 1-5 seconds and repeated 10-15 reps. 

Strength is the second component of shoulder rehabilitation and consists of dumbbell, tubing, and functional exercises.

 

Lower Body Injury Prevention

Lower body injuries are common in athletics and often result from poor body mechanics, particularly poor control over the motion of your knee. When you are running, forces from the ground run up into your feet and travel along a kinetic chain throughout your leg.  Injury may result if those forces add up to be too much, or in the wrong place, along that kinetic chain (e.g., ACL tear).  

Knee pain

Knee pain is a common overuse injury often caused by patellofemoral pain syndrome – when the cartilage behind the kneecap gets roughened and irritated. Pain occurs when there is increased pressure between the femur (thigh bone) and patella (kneecap). Although some may be prone to such knee pain due to genetic factors, other causes include overuse, weak thigh muscles, obesity, flat feet, knock-knees, and worn out shoes.

In order to prevent knee problems, be sure to warm up, cool down, and stretch in the time surrounding workouts (especially after work-outs). It’s particularly important to keep your front and back thigh muscles flexible. Wear shoes appropriate to the sport you’re playing, and make sure they’re not worn out and that they have good arch supports.

If you suffer from a painful kneecap, avoid kneeling or sitting with your legs crossed. Don’t sleep on your stomach because this puts direct, constant pressure on the kneecaps. Instead, sleep on your back with a pillow under your knees or on your side with a pillow between the knees. If you like to use stairclimber machines, try taking smaller steps. Once you no longer suffer knee pain, try doing exercises such as straight-leg raises. Either sitting in a chair or lying down, hold your leg out straight and raise it off the ground to strengthen the quadricep muscle without irritating the patella. (Lunges and squats are good exercises, too, but could be damaging to the knees if done improperly).

Shin Splints

Shin splints are a common overuse injury that develops over time in athletes who pound their legs – runners, sprinters, figure skaters, gymnasts, etc. Pain occurs on the inside of the lower leg, where the soleus muscle of the calf attaches to the shinbone, or tibia. Running and other weight-bearing exercises exacerbate pain. In order to prevent shin splints, train on softer surfaces, such as grass or a treadmill, or engage in lower-impact workouts, such as swimming or cycling. Proper footwear is essential for runners to reduce the stress of impact. Ice is the best treatment for shin splints, and massage can help as well. Taping the shins can relieve pain, but should not be used to enable exercise on injured legs.

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Stress Fractures

Stress fractures are tiny cracks in the bone, which occur when muscles are overexerted and lose the ability to absorb shock, which is then transferred to the bone. People who develop stress fractures are usually those engaged in repetitive weight-bearing activities, such as running, tennis, basketball, and gymnastics. Having flat feet, rigid arches, or osteoporosis will increase your risk of a stress fracture, which typically occurs in the lower leg or foot. To prevent such injury, build up the intensity and duration of your exercise routine gradually so your muscles have time to strengthen. Symptoms include pain that increases with time and is still painful after a few days. The pain increases with activity, and there may or may not be swelling. You should go to a doctor if the pain doesn’t go away after 2 days of rest.

Sprains

A sprain occurs when a ligament (the fibrous tissue that connects bones) is overstretched or torn, but there is no dislocation or fracture. The sprained joint will cause immediate pain, swelling, bruising, and warmth at the injured site. As the sprain heals, the damaged ligaments and connective tissue will be replaced by new fibrous tissue that is stronger, but not as flexible. This is why it’s important to move and stretch the injured site during the healing process, as long as it doesn’t cause pain. The joint may not fully recover for many weeks.

To treat sprains, follow R.I.C.E. (described below), and make sure ankle sprains are elevated above heart level even during sleep. Standing or dangling the leg can lead to more swelling, throbbing, and pain. Do not treat acute sprains with heat, only ice.

The best pain reliever to take right after injury is Ibuprofen because it is also anti-inflammatory (decreases swelling). Acetaminophen (Tylenol) is not an anti-inflammatory and Aspirin will increase internal bleeding if taken within 24 hours of the injury. Always consult a physician for information on use of medications. Crutches are useful if the leg cannot bear weight fully, but early walking is important to prevent tightening of the tendons that connect muscles to bones.

Strains

Strains are often the result of overuse or injury, when muscles or tendons are overstretched or overexerted. While sprains concern ligaments, strains affect tendons, the tissue that connects muscles to bones. Strains cause pain, tenderness, swelling, and bruising at the injured site. Because sprains and strains affect different types of tissue, you can have both types of injury at the same time. For example, an ankle sprain and a strain of the Achilles tendon.

Tendonitis (also spelled “tendinitis”)

Tendonitis is any inflammation or irritation of a tendon, which connects muscles to bone. The condition causes pain, tenderness, and stiffness near a joint, usually around the shoulders, elbows, and knees, and is commonly the result of injury or overuse. The pain of tendonitis is aggravated by movement, so rest, ice, and pain medication is usually the best treatment. In order to avoid tendonitis, don’t participate in activities that place abnormal amounts of stress on your tendons, such as running uphill. Also, try cross-training to limit and spread out high-impact workouts, such as running.

Treating Sprains, Strains and other Sports Injuries

If the injury does not appear serious, stop what you’re doing and use R.I.C.E.:

  • Rest the injured area as much as possible for 24 to 48 hours.
  • Ice the injured area as soon as possible for 20 minutes on and 20 minutes off. After a couple hours you can reduce icing to 20 minutes 4 times a day.
  • Compression. Apply an elastic bandage to the area to control movement, but loosen it if you feel numbness, tingling, or increased pain.
  • Elevation. Raise the injured area above heart level.

Full return to activity should be avoided until full range of motion no longer causes pain.

 

Patello-Femoral Pain Syndrome

Patello-femoral pain syndrome is an inflammation to the front of the knee joint caused by the patella (knee cap) not tracking properly over the distal femur (thigh bone at the knee). The patella normally rides in a groove on the femur. The patella is like a fulcrum, it gives leverage to the big muscles on the front of the thigh. These thigh muscles are called the quadriceps because they consist of four muscles

With patello-femoral syndrome (PFS), you get an imbalance in these muscles—usually the lateral or outside muscle overpowers the inner medial muscle, and this pulls the patella out of its normal groove. When the patella doesn’t track properly, it causes pain under the patella. PFS can have multiple causes, which can include foot problems, such as foot pronation, weak lateral hip muscles, genu valgum (knock-kneed), and a larger Q-angle (the angle from the front hip to middle of the knee cap). These can all affect the biomechanics of the patello-femoral joint. When experiencing these problems with your knee, it’s important to find ways not to keep it irritated.

Occasionally, the injuries start with a clear-cut onset, like stepping in a hole or falling on your knee. Usually, though, it feels like it comes out of nowhere. This means that you’ve been gradually creating the injury over a longer period of time like a few days or weeks. Something that you do during the day sets it off, but it’s commonly very hard to figure out was exactly is the aggravating activity. Nonetheless, you’ve overdone it. Try not to worry if you can’t figure out exactly why your knee got sore. That may not be necessary to determine in order to get better. The more often you make your knee sore, the longer it will take to get better.

The inflammation seldom builds up to a level where it keeps you in bed, so it’s tempting to keep up and about on it. This may keep it stirred up. Try to avoid all the activities that make it sore, i.e., sitting with your knee bent for a long time, walking a lot, going up and down stairs, or exercising. While it doesn’t cause more damage, it does keep the inflammation from going away. You may find it helpful to sit with your knee straight or get up and move around occasionally. Also, try stairs one step at a time using your uninjured leg. These knee injuries can be very stubborn before they get better. The sooner you stop aggravating it, the sooner you can get back to the activities you like.

Low Back Pain & Core Strength

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Low back pain can be the result of many different things. Pain can be triggered by some combination of overuse, muscle strain, and/or injuries to the muscles, ligaments, and discs that support the spine. Over time, a muscle injury that has not been managed correctly may lead to an overall imbalance in the spine. This can lead to constant tension on the muscles, ligaments, bones, making the back more prone to injury or re-injury.

Since low back pain can be caused by injury to various structures in the spine and its supporting structures, it is important to consult your professional health care provider if you have had back pain lasting longer than 1-2 weeks. They can provide a diagnosis and explain what structure is injured so that appropriate treatment and exercises can be prescribed for your specific injury.

Each diagnosis is treated with different protocols, therefore it is important that you consult a health care professional before beginning any strenuous rehabilitation program. Low back exercises and flexibility can be the best treatment option for almost all types of back problems as it is likely to help restore balance in the spine. Low back exercises concentrate on strengthening with the abdominal muscles, to be able to give stabilization of the spine. Rehabilitation programs or preventative rehabilitation programs that focus on strengthening lumbar muscles combined with core stability and proprioception will reduce the risk of low back pain if exercises are done correctly, and on a regular basis.