10 Thoughts About Things

September 21, 2012 by

Just a few quick thoughts that passed through my mind between clients yesterday evening. In fact, these may have been ALL my thoughts for the day:

  1. There is something special about watching heavy dead lifts done by a client who has just rehabbed from lumbar disc bulges and a surgery.
  2. Bio-Freeze gel is like a magical potion condensed in a tube; how do they get all that coldness squished up in there?
  3. Every single day I become more aware of just how important your glutes are. And by “your” glutes, I mean glutes in general, not your glutes specifically. Although, you should take care of your glutes.
  4. There are a lot of people out there with some form of back pain. And a large proportion of them have sadly resigned themselves to living with it instead of trying to fix it.
  5. Most of them have some form of glute involvement, dysfunction or amnesia.
  6. Chin ups, pull ups and all their variations are very satisfying to do. It reminds me of when I was a siamang in a past life. What’s more satisfying, though, is seeing an adult client do one for the 1st time ever in his life.
  7. Why does it seem so hard to break bad habits and so hard to form new ones? Damn you and your ilk, Haagen Dazs! Why can’t I just put the tub down before it’s empty?
  8. When done correctly, glute bridges will really make the backside burn. And make you walk all funny after. I’ve  just come to realize that I may be a little glute obsessed.
  9. Computers really make me slouch. A lot. For long periods of time. And I know better. Must work on awareness.
  10. I love my job. I get to help some pretty amazing people get back to doing the things they want to do. My clients are simply awesome.

Dev Chengkalath

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The Power of Posture

September 20, 2012 by

Are you always trying to find a comfortable position for your head?

Do your shoulders feel tight and stiff?

Do your neck and back ache on a regular basis?

The culprit to all that ails you may be your posture…

I could tell you all the things that could be wrong with your posture. But I’m not going to do that because I’m pretty sure you already have a few good ideas.

If you sit for work, make sure your chair or workstation is adjusted for your body.

Chairs, desks and computer monitors are NOT all built for one body type. And I am going to to make a guess that Bob from accounting doesn’t have the same body structure as you. In fact, you will likely need to adjust the height of your fancy or not so fancy chair, you may have to rearrange the items on your desk and you will almost certainly have to position your monitor for your own personalized optimal viewing angle.

Don’t buy in to the one size fits all mentality.

While that may work for all those fancy items you see on late night infomercials, it doesn’t work for most items that have to be purchased during regular business hours.

One size very seldom fits all.

Get neutral. Spine that is.

Physiotherapy in Woodbridge Spinal AlignmentNeutral spine postures start at your hips and pelvis. From there, your chest should be up up (don’t let it cave it – be proud!), your head should be held long and tall with your chin slightly tucked in. Think of a string attached to the crown of your head pulling you up to the ceiling. This position should place your nose as the farthest point forward.

If you’re reading this at work, stop for a minute and have a look around you. You’ll see that many of your colleagues lead with their chins.

This will help you avoid slouching, which in itself isn’t bad.

It only becomes a problem when you do it ALL THE TIME.

Which is a perfect lead in to the most important lesson from today’s blog post:

The best posture is the one that keeps changing.

So make sure you change your position often and avoid holding any postures for prolonged periods of time.

Yes, this means when you’re driving, sitting on the couch watching TV, or working at your desk.

So, tell me, how does YOUR posture stack up?

Dev Chengkalath, Physiotherapist

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Running sucks.

September 18, 2012 by

OK, so that’s not entirely true but it caught your attention didn’t it?

While traditional long-duration, steady-state cardiovascular exercise such as running confers numerous health benefits, for most people it’s also a very inefficient (and potentially risky) way of losing excess body fat and getting in shape.

There’s nothing inherently wrong with running. In fact, there’s nothing inherently wrong with any form of exercise that makes people get up and move.

We encourage this! We applaud this! Movement is good.

We want people to move more and sit less.

We even called this out on a previous post about the most dangerous thing you do all day.

However, on the wrong feet and by the wrong person, running can put certain individuals at increased risk of repetitive strain and overuse injuries such as shin splints, plantar fasciitis or the oft-lamented IT-band syndrome. In our experience, many novice runners unfortunately haven’t prepared their bodies for the rigors of this type of exercise, and we regularly see the painful fallout at our clinic.

For this reason, we strongly believe in getting fit to run, not running to get fit.

Now if you LOVE running for hours on end, and you’ve trained your body to an appropriate base-level of fitness that can tolerate the constant pounding, then by all means, go out and run to your heart’s content.

You’ve earned it.

But if you HATE running, it bores you, and the only reason you’re doing it is because you heard that it’s was the best way of dropping extra pounds and improving your fitness, please keep reading.

What we’re about to tell you may just save you a few extra hours a week and help you drop a few extra pounds in the process (assuming that you’ve taken care of your nutrition!).

Results in less time, isn’t that what we all want?

Enter High Intensity Interval Training (HIIT)

Q. What is HIIT?

A. As the name suggests, HIIT is the term given to a form of cardiovascular system training where bouts (intervals) of very high intensity exercise are interspersed with periods of recovery. In true HIIT, the work segments should be completed near or at maximal intensity whereas the recovery bouts involve complete rest or are done at a much lower intensity.

Q. How does HIIT work?

A.  Without getting too deep into the still controversial physiology behind HIIT, suffice to say that after the interval session is complete, this leads to an increase in a physiological event called Excess Post-Exercise Oxygen Consumption (EPOC) when compared to stead-state cardio. In EPOC, our bodies undergo numerous physiological processes designed to return us to the pre-exercise resting state. This process of returning to baseline requires energy, which is furnished by the body from its energy stores.

Q. How do I do a HIIT session?

A. There are many methods of completing a HIIT session, using various modalities (bike, swim, run, rower etc). The only limitation is your imagination! HIIT can be performed with a work to rest ratio of anywhere from 2:1 (e.g. Tabatas: 20 seconds ultra-intense activity:10 seconds rest) to 1:4 or greater and can be repeated for any number of cycles (typically 4-10) lasting for a total session timeline typically between 10-20 minutes.

The following is an example of a HIIT session that we’ve used with clients in the past, repeated 2-3 times a week:

  1. Warm up (5 minutes)
  2. 30 second all-out bike sprint
  3. 120 seconds slow recovery pedaling
  4. Repeat the cycle of 30 s: 120 s a total of four times (10 minutes)
  5. Warm down (5 minutes)

Q. Why would I want to do HIIT instead of steady-state cardio exercise such as running?

A. If you love running and have the time for it, keep running. However, as noted earlier, if you don’t enjoy it and could get similar or better results in less time, why would you do it?

  • Minimum time investment: HIIT requires only a fraction of the time investment when compared to steady-state cardio but can often confer similar or better results for fat loss and conditioning (important note: HIIT is only one component of a well-rounded training and nutrition program).
  • Decreased repetitive strain/overuse injury risk: The duration of HIIT sessions is only between 10-20 minutes, the repetitive stresses faced by the body when compared to an hour or more of running are far less. Think about it this way, in an hour long run, you are taking thousands of steps, each having it’s own impact through your body. In 10 minutes, the odds are that you’re not even coming close to the number of impacts.
  • Avoid boredom: Many people get bored with hour long steady-state cardio sessions. The fast-paced, short duration set up of HIIT is often fun and engaging. And we all know if we enjoy something, we’re more likely to stick with it.

Q. This seems too good to be true. What’s the catch?

A. Yup, there’s always a catch. You don’t ever get something for nothing and the same holds true for HIIT.

  • To get the true benefit of HIIT, the high intensity bouts have to be very high intensity. Real high intensity intervals hurt. They’re incredibly hard. They might make you feel like you are going to vomit. Your muscles will be extremely sore. And that’s why most people don’t do true intervals. They are uncomfortable. Incredibly so.
  • HIIT may also put you at risk for injury. This of course depends on your starting fitness level and the type of training you’re doing (e.g. sprinting is higher risk than stationary bike) but is still a consideration when deciding whether HIIT is for you.
  • Due to the intense nature, correctly performed HIIT should not be performed daily but 2-3 days per week at most.

In summary:

The two most important pieces of advice regarding  any form of exercise, including steady-state cardio and HIIT are:

  1. Build up your fitness level gradually and progressively (e.g. if you’ve been a regular on your couch, don’t go all out into HIIT or even jogging, start gently and let your body adapt).
  2. Pick an activity that you enjoy and will actually do on a regular and consistent basis. If you love to run, go and run. If you love dancing, go out dancing. If you prefer something more intense and are crunched for time, consider interval training. Each has its benefits and risks. Find something that suits your lifestyle and do it.

Yours in movement,

Team Primal

 

 

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Wake and Break

September 14, 2012 by

As the shrill scream of your morning alarm slices through your dreams of flying over tall buildings, and otherwise saving the world from destruction, you realize that your peaceful respite from wakefulness has unceremoniously come to an end.

Morning has broken and it’s time to start your day.

You slowly rub the sleep from your eyes, fling the warm, enveloping covers off your body and allow the frigid air of your bedroom to jolt you further from your reverie.

“Why does my back feel so stiff?” is your first, fleeting thought as you hunch forward on the edge of your bed, pawing for your fuzzy slippers with your feet. Your sleep-drunk legs have trouble locating their targets so you bend farther forward through your back to get a better look. From this forward bent position, you’re finally able to find the foot-hugging sanctuary of your slippers and your daily routine carries on.

You pull yourself to a somewhat upright position, stumble to the bathroom on your unsteady legs, turn on the tap, bend down to the sink and splash the last vestiges of sleep from your being…

So maybe you don’t dream of saving the world, and perhaps you don’t have fuzzy slippers. Heck, you might not even wash your face. But if you’re like most people, you likely go through some of the same movement patterns described above.

What’s the big deal?

The big deal is that your intervertebral discs (yup, the same discs that are often erroneously described as “slipped”) are actually in a hydrated state which unfortunately puts them at higher risk for injury with certain types movements, according to Dr. Stuart McGill’s research.

Why do the discs “inflate” overnight?

After having spent six to ten hours in a horizontal position while sleeping, the effects of gravity are minimized through your spine. So instead of being compressed (as they are when you’re upright), your discs are unloaded to a certain degree and actually suck up fluid like a sponge. This is why you’re actually taller after waking.

What can you do about it?

This is the simple part. Avoid flexion (bending forward) through your spine until the discs have had a chance to lose some of that fluid. See, I told you, simple.

McGill’s research suggests that it will take about an hour after waking for this to occur. After that golden hour, it’s safer to bend that way.

Now the hard part: avoiding flexion means you’ll have to modify how you get out of bed, how you sit on the edge of your bed, how you wash your face, brush your teeth and even sit on the toilet.

And depending on how fast you are at getting pretty in the morning, it would also mean you’ll have to avoid slouching at the breakfast table, if you even eat breakfast.

Yup, these are all automatic habits you’ve been reinforcing for years. It’s not going to be easy to change them, but as many former low back pain sufferers will tell you, they much prefer dribbling toothpaste down their chins than having bolts of lightning shoot down their legs.

Yours in movement.

Team Primal

 

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Officer Down.

September 13, 2012 by

And it’s not from what you might think.

Data suggest law enforcement officers such as police are at greater risk of certain diseases (e.g. diabetes, cardiovascular disease) and premature death, at a rate higher than the general public.

In fact, a Virginia Municipal Group Self Insurance Association (VMGSIA) study found that officers lived, on average, only 2-5 years past their retirement.

manage stress to avoid untimely death

Not an exciting prospect, is it?

All those years of service and only a few years to enjoy the fruits of your labor.

This exceedingly high illness, injury and death rate was attributed to a lack of personal and agency fitness and wellness programs. Many of the injuries and illnesses were considered to have “modifiable risk factors” where the health conditions and related costs could be controlled and minimized.

At this point, you’re probably thinking “what can I do about it?”

The short answer: take a proactive approach and modify your risk factors.

While it would be impossible to remove all the risk factors (e.g. shift work, exposure to various environments, and on-the-job stress like chasing armed bandits) you can definitely put yourself in the best position to manage the ones you do face.

This would make it less likely that your retirement will be cut so tragically short.

Photo Credit: Joshua Sherurcij

What does that mean for you?

That means you’ll need to not only get in, but stay in, the best physical shape possible. You’ll need to improve your endurance, strength, power and athleticism. You’ll need to learn how to bend, twist, and move efficiently. You’ll need to manage your daily stresses so that your body can recover. You’ll need to prevent injuries before they happen and resolve the ones you currently have so they don’t get worse or put you at risk.

You will need to become the one in charge of your body, so it does what you need it to do, when you need it to do it.

If you’re not sure where to begin, we can help you!

As a high performance sports medicine and physiotherapy clinic in Woodbridge, we have significant experience working with emergency service personnel such as members of the Toronto Police Service and the Toronto Fire Service. We understand the specific physical job requirements that ensures you make it home safely at the end of your shift.

If you’re interested in finding out how our specialized programs for emergency service personnel can help you, contact us today!

Yours in movement,

Team Primal

 

 

 

 

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No Gym? No problem…with 8 minute fitness!

September 12, 2012 by

The following is a eight-minute routine using only body weight that can get you started back on your fitness journey. While this type of program won’t get you contest ready or into the upper echelons of sport, it’s a great way to safely introduce a basic level of physical fitness back into your daily routine.

And that’s what we’re all about: the habit of exercise and the behaviour of movement.

The Pros:

  • You don’t need a specialized gym or fancy equipment – this can be done anywhere, anytime
  • You can vary the intensity as required – you control of how hard you push yourself, or how easy you go)
  • It’s a gateway into introducing more activity without being overwhelmed – you only have to invest eight minutes!

The Cons:

  • Unless you’re quite sedentary, 8 minutes of activity may not be enough to change your physique or fitness levels
  • If you’ve been very sedentary or you’re really out of shape, this eight minutes is going to feel very tough

Prior to going through the exercise circuit, take a few minutes to warm your body up with movement. A dynamic warm-up is more effective for preparing you for activity than the “old” version of just stretching prior to exercise. This should only take about three minutes (yes, this is part of the eight minutes) and you should break a light sweat.

You can do any activity that you enjoy as long as it keeps your body moving continuously (upper and lower body). Some examples include:

  • Jogging on the spot
  • Jumping jacks
  • Skips, hops, jumps
  • Crab walks
  • Bear crawls
  • Variations of lunges, leg swings, kicks

Now for the actual exercises. Do each exercise one after the other without any breaks between each exercise in a circuit format. Aim for 3 cycles of the circuit. Use only a short 20-second rest break between each cycle. Done in this manner, this will give you a total of five minutes of exercise.

  • Burpees (no push ups): 20 seconds
  • Side Plank: 2 per side x 10 seconds
  • Air Squats: 20 seconds
  • Push Ups: 20 seconds

Give the above 8 minute workout a try and let us know how if felt.

Yours in movement,

Team Primal

 

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23 and a half: a visual lecture that will make you think.

July 26, 2012 by

Thoughts?

At Primal this is our type of medicine.

 

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What should I do when I get injured?

June 11, 2012 by

While the answer to the above question depends on the type and severity of the injury, for most simple, uncomplicated musculoskeletal traumas such as slight sprains and strains, R.I.C.E will come to the rescue. For all others, seek the assessment and advice of a qualified expert.

Rest: To reduce risk of further injury, trauma, pain, or compensation patterns. This can include stopping the painful activity or using supports such as slings/crutches to offload the injured area for a short period of time, and as appropriate. Rest should NOT usually entail complete sedentary behaviour but rather should be directed towards avoidance of pain-provoking activity. For example, if you’ve hurt your shoulder playing golf and it hurts every time you swing a club, might be a good idea to take a break from golfing.  It doesn’t mean you should stop walking and set up shop on your couch, feeding your feelings of woe with chips and ice cream.

Ice: To control swelling and pain. Commercial gel ice packs work really well, with frozen peas coming in a close second. Ideally you want a cold pack that will conform to the injured area. When using any form of icing, be wary of putting the cold pack directly against the skin as this can potentially lead to frostbite. A safer option is to cover your ice pack in a moistened towel and place the covered pack over the injury site. Typically aim for 20 minutes on followed by an hour off. Repeat once or twice.

Too much compression?

Compression: To help with swelling, to brace/support the injured area, and to remind yourself that the area is injured. Tensor bandages, various commercial sleeves (e.g. elbow, knee, ankle), athletic tape can all help with creating compression in the injured area. Compression should be strong but should not be so intense as to cut off circulation. Also, to make sure that you aren’t overly compressed, remove your support/brace/tape every so often to let circulation flow unimpeded. You should never develop numbness, tingling or loss of sensation from using a compressive device.

Elevation: To help control swelling, which in turn will often decrease pain. Gravity is not just a good idea, but a law. Use this to your advantage to help drain extra fluids from injured areas. Try to get your injured site above heart level. The longer you can keep the area higher up, the less likely that fluid will pool at the injured area. Elevation works really well when coupled with R.I.C from above. For example, if you’ve sprained your ankle, you could lie on your back with your foot supported above you (pillows, stool etc), ankle wrapped in a tensor and covered in a cold gel pack for 20 minutes.

These four action steps, held in high regard by physiotherapists, chiropractors and personal trainers globally, have helped numerous individuals manage and mitigate the negative fallout from a sudden minor traumas for years.

They are, and will continue to be, one of the best first responses for these types of acute injuries.

Yours in movement.

Team Primal

 

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My Top 3 Core Exercises for People with Low Back Pain

May 3, 2012 by

In the previous post, I wrote about the 3 worst abdominal exercises for people with low back pain.

In reality, I could have written a list of ten, fifteen or even more ab exercises that should be avoided.

The three exercises that ended up on my no-no list, ended up there for a variety of reasons. Since this blog can’t account for every individual difference and most people wouldn’t stick around to read my tome if I tried, I picked those exercises that I felt were most commonly used or encountered in the real world.

This means I chose the exercises that a LOT of people with low back pain are doing.

They’re doing them at home (sit ups/crunches) or they’re doing them at the gym (twist and extension machines). And they’re potentially aggravating their back pain situation while under the notion that they’re doing something that should be helping them.

That was my rationale for part 1.

Now onward to part 2:

For starters, gold star if you noticed that this post used the word “core” instead of “abdominal” in the title.

Most incomplete low back pain programs will tout the advantages of abdominal training to relieve pain and resolve dysfunction.

Unfortunately, it doesn’t work that way.

Our core is much more than just the abdominal muscles. It’s more than the pretty six pack (rectus abdominis) that’s visible along the front of lean bodies. It’s also more than just the other muscles that make up the abdominal box (internal obliques, external obliques, transverse abdominis, diaphragm and pelvic floor).

Since there are so many different definitions of the core, I’m not going to list them all out. Suffice to say that I believe the better functional definitions of the core should include muscles of the hip, back and torso. All of which should work cohesively to stabilize the spine and allow for appropriate mobility at the hips and shoulders.

How’s that for a vague description? But I digress…

Moving on to what you’ve all been waiting for, here are my top 3 picks for core exercises for people with low back pain:

  1. The Birddog:This exercise has been a staple in my clients’ low back rehab programs for years and has proven its worth and then some. In fact, it’s a staple in my own programs whenever I’m getting back into any heavy lifting involving compound movements such squats, overhead presses, and dead lifts. The kicker, I don’t have any low back problems. Why the birddog? Because it’s simple to execute but forces the exerciser to pay attention to what he or she is doing. I’ve never seen anyone build rippling washboard abs using this exercise alone, but that’s not its purpose. It’s designed as a scalable, entry-to-mid-level core activation exercise that minimizes the compressive loading on the spine while still activating the appropriate protective muscle patterns. Which really just means that it helps stabilize the spine without having to creating excess force. Huge benefit with less risk. As with most injury rehab or performance-based training programs, I’m always looking to tip the scales in favour of benefit over risk, as often as possible.

  2. The Hip Hinge:This is another stalwart of my spinal rehab programs for much the same reasons as the birddog above. It’s simple, requires no equipment, and teaches a fundamental movement pattern that has the ability to protect our spines from current injury or potential trauma. When executed correctly, the hip hinge teaches us to move through our hips while keeping our spines stable. In my injury rehab and physical therapy treatment book, that’s a great combination! Benefits 2 – Risk 0.

    Woodbridge Physiotherapy Vaughan Hip Hinge Exercise

    Hip Hinge Start and End Positions

  3. The Plank Variations:The ubiquitous plank…I actually like to break this exercise down into two distinct versions, the front plank and the side plank (each version can be either regressed or progressed according to ability and technical mastery of the person doing them). Again, this body weight based exercise requires no fancy equipment and very little space. It’s portable, straight-forward, and can teach numerous beneficial postural habits if we’re willing to learn from it. For most back pain sufferers, I prefer to start with the side plank variations as these minimize the loading on the spine while still engaging the core musculature. As technique and ability improve, these can be progressed to more challenging version then in to the front plank variations.

    Front Plank and Side Plank

The most important component of choosing the appropriate core exercise for low back pain is to make sure that the exercise doesn’t cause you any pain. If it hurts, that’s usually your body’s signal that something’s wrong. In the end, it comes down to making sure you’re doing all your exercises right because you get what you train.

And there you have it, my top 3 choices of core exercises for people with low back pain.

Agree? Disagree? Have your own exercises?

Feel free to share your thoughts!

And if you’re struggling with back pain, contact us today to get booked in for your assessment!

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The Three Worst Abdominal Exercises for People with Low Back Pain

April 30, 2012 by

The internet has reshaped our world.

It has the ability to transfer information and knowledge across the globe in real time.

You have a problem, Google your signs or symptoms, and more than likely you’ll find thousands and thousands of pages of solutions with Dr. Google coming to the rescue!

So what’s wrong with that?

As a physiotherapist in Vaughan, these are the questions I ask myself: How good is the information? What’s the source? Can it be trusted? Will it help? Or will it harm? What are the risks? The benefits?

This becomes even more important when dealing with various injuries or illness where the potential for making things worse may be higher, where the risk of aggravating already irritated tissues may compound or where delaying appropriate treatment may lengthen the course of recovery.

It’s no different with relieving low back pain. Plug in those search terms and instantly you’ll have at your disposal more information than you could possibly even use.

Often, a good portion of the information that shows up discusses strengthening your abs to fix your back problems. This may sound quite similar to the advice many people are given by their medical or fitness professionals:

“Strengthen your core to protect your back”.

Unfortunately, over the years, abdominal training has become popularized as the foundation of core training. In reality, abdominal training accounts for only a small part of the bigger core training picture.

To make matters worse, poorly designed or applied abdominal training can make you worse and keep you in pain.

So in keeping with the spirit of this post, here’s my list of the three worst abdominal exercises for people with low back pain:

  1. The traditional crunch or sit-up: These staples of most back rehab programs should be eliminated due of the incredible compressive loading forces created through the spinal discs. Dr. Stuart McGill, one of the foremost spine researchers in the world, has measured compressive forces of approximately 3300N (730 lbs) in the spine with these types of exercises. The scary part: this is equal to the amount of force listed by certain government health agencies as the amount of force needed to cause injury!
  2. Abdominal twist machines: So if crunches or sit-ups can cause as much damage to your spine, imagine what happens when you take a similar exercise, restrict movement at certain joints, isolate movement at others, twist and then add a load? By taking a flexion movement and adding a loaded rotation component on these machines, you’re well on your way to sending yourself off to the disabled list. In fact, we’ve  dubbed these types of exercises “disc herniators” and inform our clients that they should only continue to do these if they wish to help us finance our latest facility expansion.
  3. Back Extension Machines: As described by Dr. McGill, the repeated spine flexion/extension movements (forward/backward bending) used by these devices create the same conditions that were necessary in his lab to produce disc herniations in his spine models. Enough said. Why would you want to do the same to your back at the gym when you’re trying to help it heal?

So there you have it…The 3 worst core exercises for people with low back pain. If you love your back, you should probably stop doing them.

In our next post, we’ll discuss 3 spine sparing core exercises that are appropriate for people with low back pain.

Yours in movement.

Dev Chengkalath

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