What's New at Physio Sport Med

​The team at Physio Sport Med has grown again.   Two amazing massage therapists have joined Michael on our team.    This means that we are happy to offer massage therapy 6 days a week for your convenience and care.

Liia is an experienced musician that brings a different perspective to her treatments.   She recognizes that musicians share many of the same injury concepts as elite athletes including overuse and repetitive strain injuries. Liia also adds cupping therapy and Gua sha therapy into her treatments.  Dedicated to education, she is adding to her skills but studying Acupuncture and Acupressure.
 
Carmen is a certified athletic therapist and registered massage therapist.   She has treated a variety of athletes, from recreational to professional to industrial. As part of medical teams, Carmen has attended many high performance events including Pan American Games, Deaflympics and Canada Games. She is passionate about working with all athletes and has worked extensively in hockey, volleyball and ultimate frisbee.  ​She uses Swedish massage techniques accompanied with trigger point therapy, fascial release and craniosacral techniques.

We know that getting rapid and expert care after a sports injury can be difficult and frustrating in today’s medical system.   That is why we are introducing out Acute Care Rapid Access Program.
 
If you have any musculoskeletal injury that has happened within the last 10 days, you qualify.  This means that any new injury (or re-injury) of a muscle, bone or joint will allow you to jump the waiting list for our physiotherapists and sports medicine specialist physicians as we know that immediate and high-quality care not only gets you stronger and better faster, but results in better healing and reduces the chance of future injury and arthritis.

We do not need a referral from your family doctor, and we do not need X-rays or Ultrasound.  Call the clinic directly, state that you have a new injury, and the process will get started.   Please note that at times your insurance will ask for a referral for physiotherapy or chiropractor services.   If you see our physicians, they can help with this.
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We look forward to working with you and keeping Oakville active and healthy.

Pelvic floor issue in men could be as a result of surgery, infection, traumatic events, being overweight, repeated heavy lifting and poor posture. Some of the most common symptoms include

• pelvic pain/tailbone pain
• low back/groin pain
• urinary urgency
• interrupted flow of urine
• constipation/diarrhea
• pain with bowel movement

Some of the common conditions men may experience include:

1. Chronic Prostatitis also known as Chronic Pelvic Pain syndrome
   Defined as inflammation of prostate gland for 3 months or longer due to a bacterial infection and associated with pelvic pain and urinary problems including urinary urgency/frequency , burning feeling during urination or urinary retention .
   
   
2. Prostatectomy - A surgery to remove part or the whole prostate which could be due to prostate Ca or enlarged prostate
   Urinary incontinence is commonly experienced after surgery due to increased tension in pelvic floor muscle or scar tissue present

How can Pelvic Physiotherapy Help

We can provide you with detailed pelvic floor examination, offer manual therapy to assess tone in pelvic floor muscles, mobilize scar tissue, teach you to either relax or strengthen your pelvic floor and strategies to manage your symptoms.

At Physio Sport Med Pelvic Health is one of our specialties.  Call for an appointment. 905 257-3456.

At Physio Sport Med of Oakville quality personalized care is our primary focus.   We encourage our practitioners to continue post graduate education.   This ensures that our clients get the most effective care based on current research and best practices.   To reflect this value, we will be introducing tiered pricing for our physiotherapy clients starting on Monday September 23rd.   The tiers will be defined as follows:
 
Associate  Physiotherapists who are licensed to practice in physiotherapy in Ontario.   These therapists are continuing to participate in post graduate studies and develop their specialty.

Our current associates are: Christine, David, George, Ansu (for orthopedic clients)  

Senior Associate Therapists have achieved highest level of education/certification in a discipline including Orthopedic Mobilizations and Manipulations (FCAMPT), McKenzie  Mechanical Diagnosis and Treatment,  Sports Physiotherapy (Diploma Level),  Pelvic Physiotherapy (Level 3) or Canadian Physiotherapy Association.

Our current senior associates are:  Paul, James, Ansu (for pelvic physiotherapy clients)

Partner  Therapists have achieved at least one of these education levels and have demonstrated leadership in the company or the therapist has achieved 2 or more of the qualifications above in different specialties.

Our current partner therapists are:  Trish

Effective September 23 the following rates will apply. 

The Canadian Academy of Manipulative Physiotherapy (FCAMPT) recently published some great Q&A pages on Physiotherapy generically, and on some specific treatment topics.  Check them out!

• Physiotheraphy Q&A
• ACL Rehab
• Dizziness and Nausea
• Pulled Groin
• Rotator Cuff Injury
• Strained Muscle

Check out our FCAMPT accredited physiotherapists at Physio Sport Med of Oakville and make an appointment to get the help you need!

NHL, NBA and MLB are on TV.   I am inspired by the new NIKE “Can’t stop us ad.”  (If you haven’t seen it, follow this link:  https://www.youtube.com/watch?v=WA4dDs0T7sM).  Gyms across the province have opened.  And my family is returning to the ice and warming up for fall field lacrosse.   Sports are back.  They are different, but they are back.
There are few things to keep in mind as we return to the playing fields, courts, and workout centers.

1. The Canadian Academy of Sports and Exercise Medicine does not recommend exercising with a mask on.   Please wear it when you can, including walking around the space, changing and between bouts, but current recommendations are that it should be removed while exercising.
2. Your concussion base test may no longer be valid.   We have been off for longer than most of us realize and although feels like you may have just been baseline tested for your spring sports, sports stopped approximately 5 months ago.   For children less than 18 years of age, baseline testing should be performed every 6 months.
3. Watch your intensity.   For some us, time off has inspired us to create a home gym, start running and cycling and use the extra time to become stronger.  For others, we baked and caught up on all of our Netflix.   If you are the later, make sure to start slowly with workouts.  Although muscle lost will reappear quickly, a slow steady approach is important to prevent injury.   Even if you have been using a home gym, body weight exercises are less demanding, and you should be cautious before lifting heavy weights.
4. Warm up with some sport specific drills.  In the sports medicine world, knowing where your feet are in space and being to coordinate their movement is called proprioception.   This skill is critical for making quick cuts and sudden stops.   And this is a skill most of have not used at all for a few months.  Take time to run some sport specific drills on the ice or court to warm these reflexes to prevent ankle and knee sprains.
5. Have fun, but be careful.   We are all happy to have our recreational activities back.  Remember to approach with a guarded caution and to comply with all of the regulation so they remain open and available for us to enjoy. 

 We have now been seeing patients in the clinic for two full months and while things are a little different, providing first class care remains the same.

During the shut down we took this time as an opportunity to revamp our internal software system.  This dramatically improved our ability to take online bookings for many practitioners.  You can start by going here to see all your options.  We also started providing "virtual appointments", which we continue to provide as an option for those patients who feel more comfortable starting with an online visit.

1. If you are not feeling well, please stay home and give us a call.  We have options to "see you" virtually, and if that doesn't work we will waive any cancellation fees that might otherwise apply.
2. We are staggering appointments to avoid clinic congestion on arrival and departure.
3. Call us when you arrive, and we will let you know when it is safe to enter.  You can wait in your car or outside and when ready we will show you directly into one of our treatment rooms. If you do enter the clinic before your practitioner is ready we do have limited room in our waiting area which respects physical distancing.
4. When you enter the clinic you will be required to wear a mask, and sanitize your hands.  Practitioners will wear masks during the treatment, and will wear face shields as appropriate for close face to face examination and treatment.  They also wash hands between patients or wear gloves.  Please respect other patients and staff by keeping a 2 metre separation.  Avoid the clinic washroom where possible.
5. For your safety we complete regular cleaning that supersedes Public Health standards.  We sterilize each room after each patient and change linens.  We also regularly sanitize other clinic surfaces.
6. When you are done we are able to bill private insurance directly and/or take touchless payments using debit, Visa and Mastercard.  We can also provide you with receipts emailed directly to you.

While Ontario has done very well so far to bring Covid numbers down, we continue to recognize the need to be vigilant to help avoid local outbreaks and the feared second wave.  Please help us in this endeavor when you come to visit.

As you get back into your regular exercise routine rest assured that we are here to help with any issues or injuries that you encounter.

Thank you very much for your continued business!

When your doctor tells you that physiotherapy would be a good way to reduce the pain and increase the function of your sore joint or muscle, it can be overwhelming.   Some physicians will refer you to a clinic that they prefer.  Some own the clinic they refer you to and therefore have reasons other than your health to refer you there.   We find that most people go home, do a google search, read the reviews and pick a clinic that is convenient, but still seems to be a strong candidate.

But what should you look for in terms of proper treatment?

Recently, the British Journal of Sport Medicine printed an article by Lin et al.  to help answer that question.     They looked at 6232 records and 44 practice guidelines to determine what the best practices are for treating musculoskeletal injuries.    They found that there were 11 things that should be considered when treating injuries:

1. Care should be patient centered.  Decision-making should be shared, taking in the patient’s lifestyles and goals.
2. A screen should be done for serious pathology or red flags.
3. Psychosocial factors should be assessed.   How is this injury affecting your lifestyle – can you still work, take care of your family and enjoy leisure activities?
4. Imaging should be limited – use only if a serious pathology is expected, or if the patient is not responding to conservative treatment.
5. Physical examination including a neurological screen and assessing mobility and strength should be completed.
6. Progress should be evaluated using outcome measures.
7. Education should be provided regarding the problem and how to manage it.
8. Management should address physical activity and exercise.
9. Manual therapy should be used in addition to other treatments.
10. Non – surgical care should be attempted prior to surgical care
11. Facilitate continuation or resumption of work.

​Take this information and ask questions during your assessment.  A high-quality therapist will be able to answer all of your questions confidently, and will be able to address the items above.   If your treatment consists solely of machines and hot packs, or even hands on therapy without exercise, you may not be getting all of the benefits of treatment.  This not only wastes time and money – but keeps you from being the best that you can be. 

I thought that I would spend today answering some of the most common questions that we get about physiotherapy.   If you have a question, please feel free to comment below or reach out to one of our staff.

1. Is physiotherapy covered by OHIP? 

The medical services at Physio Sport Med of Oakville are the only services that are covered by OHIP.   This means that if you are booked in to see one of our medical doctors (not chiropractors), we are able to bill the provincial services.   If you need an injection, there will be a charge as we cannot bill OHIP for the cost of the medication.
 
There are some physiotherapy clinics in Ontario that are covered for qualified patients.  However, they have a different model of service and you will not get the quality one on one time with your physiotherapist.   For more information, please go to:  http://www.health.gov.on.ca/en/public/programs/physio/pub_clinics.aspx
 
2. Do I need a referral?

Our physicians are specialists, and although it is not mandatory, it is preferred that you get a referral from your family doctor to see them.   This helps with communication between professionals and makes sure that our physicians have all the information they need to give you the best quality care.
 
Our other professionals do not need a referral.  However, please note that your insurance may require a referral for it to be covered.   Please check your personal plan or with your human resources department to determine if a referral is needed for insurance coverage.
 
3. How does billing the insurance work?
At Physio Sport Med, we can bill many insurance companies directly for you, as long as your plan allows it.   This means that you are only pay the co-payment at the time of your visit.  
 
4. How do I know that physiotherapy/chiropractic will work for me?
The physiotherapists and chiropractors at Physio Sport Med are experts in injuries and illness of the bones, joints, muscles and how they work together.   If you have any problems with the musculoskeletal system, there is probably something that we can do to help.  However, if you are still uncertain, we ask you to book a free 15-minute consult where we can discuss your concerns directly.
 
5. What can I expect from the first treatment?
Your first appointment should take almost a full hour, your therapist will look at your range of motion, strength and movement patterns.   A range of special tests will be done to determine which structures are damaged and what is causing the damage.   A complete assessment will involve the joints below and above the pain and may also look at joints far from the injury.    After the assessment is complete, you will start your treatment right away.
 
6.Do I need to wear special clothes?
You might.  We do need to have access to the joint that is sore, and usually that means being able to get right to the skin.   This means that if it is your shoulder or arm that is sore, a loose t-shirt or tank top is preferred.   Shorts are necessary to treat your knees and hips.   Do not worry if you forget, if have a small supply of items that you can borrow if you need to.
 
7. Will it hurt?
Some people find that the assessment is a little unpleasant.   We do need to determine what structure is sore and what movements cause the pain.  However, if you provide your therapist with a lot of feedback and let them know as soon pain starts, your discomfort will be minimal. 
 
There are some treatments that can be tender.   Again, feedback to your therapist is necessary to keep this to a minimum.    Remember that you are in charge.  All treatment, including risks, will be discussed with you before they begin.   If you are not okay with it, just let your therapist know and an alternative will be found.
 
8.What if I don’t want to get acupuncture needles?
That is okay.   The risks and benefits of all treatments, including acupuncture, will be discussed before treatment begins.  If you are not comfortable, then just let us know and we will seek another tool.   With over 50 years of combined practice, we have a lot of experience to draw from. 

Many individuals feel like they have their nutrition under control, and then BAM, it’s the holiday season. The holiday season usually means lots of rich, sweet, and high fat foods that don’t necessarily fit with a healthful diet.
 
One of the biggest problems for many people is the development of an all-or-nothing mindset. You’re either on track with your healthy eating efforts or you give up on them all together and get back on track when the New Year passes. This binary way of thinking doesn’t account for shades of grey, and can be responsible for a great deal of negative evaluation of yourself.
 
The reality is, you can remove yourself from both of these categories, because it’s totally possible to stick to your healthy eating plan while fully enjoying the food and festivities this holiday season.
 
Use these tips to help make the holiday season stress-free when it comes to food.
 
1. Balance your plate and make it colourful
Create a balanced plate by filling 1/2 your plate with vegetables and fruit, 1/4 of your plate with whole grains, and the last 1/4 of your plate with lean protein.
 
With vegetables and fruit, aim for colour and variety! And remember,  potatoes don’t count as vegetables.
 
Whole grains include whole wheat, barley, wheat berries, quinoa, oats, brown rice and foods made from them. Whole grains offer a “complete package” of health benefits, unlike refined grains, which are stripped of valuable nutrients during processing.
 
Fish, poultry, and beans are all healthy, versatile protein sources—they can be mixed into salads, and pair well with vegetables on a plate. Limit red meat, and avoid processed meats such as bacon and sausage.

It has happened - the first snowfall of the year.  In my house, it is always an event filled with excitement and promise.  Promise of hitting the slopes in the days (okay, months) to come.  For me, that means tuning the skis and endless reps of squats and twists to prep the quads.   But my boys are snowboarders, how does their prep differ from mine?  How do they prep for the slopes to keep up with their Mom?

The number one difference is the calves.   Working the toe edge of your board can really take a toll on your calves.    Calf raises are a great way to work the muscle in your calf.    Standing on one foot, slowly raise up onto your toe and lower.  For a little extra work, hold onto a 10- to 20-pound dumbbell.  To get a little bit of bonus balance work, stand on a foam pad or boscu ball while doing the exercise.

Obliques are working a little harder as well.   I am not saying that skiers don’t need to work those twisting muscles, but the demands are higher in boarding.    I am currently a big fan of the standing twist exercise as muscles are very position specific and generally, we are trying to avoid laying on our backs on the hills.   For this exercise, you will need a partner.   Grab a medicine ball that is the right weight for you,  stand in a slight squat position on the “ball” side of the boscu ball.   Have your partner stand behind you, twist to one side and hand the ball to your partner.   Twist fully to the other direction and grab the ball from your partner.  Keep going for 30 reps.  Make sure to repeat the exercise to the other side.

Of course, there is one big similarity.   Quads! Boarders need to be doing their squats and lunges too.   Adding a jump squat is a great way to improve performance on the jumps or in the parks.  

How do you prep for the season?  Let us know by commenting below.
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See you on the slopes!

We are pleased to announce that our physicians are now doing Platelet Rich Plasma injections, more commonly known as PRP, at our clinic.  You may have heard about PRP in the news as it is commonly used among professional and elite athletes. 

However, PRP is not just a treatment option for athletes. There are many people who could benefit from PRP injections. 

PRP involves injecting a more concentrated level of platelets from the patient’s blood back into the area of concern.  Blood consists of liquid, known as plasma, as well as solid particles such as red and white blood cells and platelets.  Platelets contain many growth factors which play an important role in the healing process.  The purpose of PRP is to create a higher concentration of platelets in the blood, hence the name – Platelet-Rich Plasma.

In order to increase the concentration of platelets, blood is drawn from the patient, spun in a centrifuge, and separated into it’s components.  The platelet-rich portion is then injected back into the area of concern.

It is thought that by increasing the concentration of platelets in the injured area, and therefore increasing the number of growth factors, it will speed up the healing process.

PRP can be effective in treating arthritis, tendon and ligament injuries in the elbow, shoulder, and knee, among others.  The research into this method is ongoing.     
​
If you are interested in PRP, you can call us at 905-257-3456 for more information.  You will need a consultation with one of our sports medicine physicians prior to receiving PRP treatment to make sure that this is an appropriate treatment option for you. The consultation is covered by your provincial health plan (such as OHIP).

As an athlete, there are many reasons why you may choose to play through an injury.  Firstly, as an athlete, your love for the game makes it devastating to sit out and watch your team from the stands.  You may also feel bad that you are unable to help your teammates reach their goals.  Finally, you may feel pressure from coaches, teammates, parents, or trainers to return to sport before you are ready. 

As a former athlete, I understand this predicament first-hand.  In my second year of varsity lacrosse at the University of Guelph, I experienced a chain of injuries starting with a pulled quad during training camp.  As I played through each injury, my body compensated for the weak/injured area and a new issue would appear.  As a result, I woke up the first morning of our championship weekend completely unable to bend over without my legs giving out because of a back injury.  Had I taken the appropriate amount of time to recover from the minor pulled quad, I would have been able to help my team and play in our championship weekend.

​I spent the next two seasons at countless physiotherapy appointments so that I could make it through game days with as little pain as possible.  It’s been 5 years since my last season and I still experience back pain to this day.

Since Durant’s recent quick exit from the NBA series, calf injuries have been a hot topic of conversation.  What was the initial injury?  How did it change so drastically?

First, a little anatomy lesson is needed to understand what happened.  The calf is made up of two or three muscles.  The deepest is a very small muscle called the plantaris.  About 20% to 30% of the population do not even have this muscle, however they do not have any change in function or athletic ability.   More critical to function, are the soleus and gastrocnemius.   These muscles are large, powerful muscles that propel the body up (as in jumping) and forward (as in running).  They blend together to form a strong tendon called the Achilles tendon.    

The initial injury was called a calf strain.   This is a small tear or fray of the muscle of the calf.   Although technically it can occur anywhere in the gastrocsoleus complex, it most commonly occurs where the head of the gastrocnemius gradually blends into a tendon.   If you were to look at a muscular calf, the surface muscle, the gastric, is made up of two circular heads that come together about two-thirds of the way down the shin bone.   Where these circular heads come together is where the tendon starts.   This is the most common location for a strain.   Medically, we grade strains as first, second, or third.   A first-degree strain is when the muscle pulls and stretches beyond what is comfortable, but there is no tear of the fibers.   A second-degree strain is where the stretch tears some of the muscle fibers, but the muscle is still securely connected to the bones at each end.   A third-degree tear is when the muscle tears in two.
​

The injury suffered by Durant during the finals was an Achilles tear or rupture.   This is very similar to a Grade three strain.  The tendon has been torn in two and is no longer connecting the two bones.   This means that the muscle is no longer able to generate any power.  Thus, Durant can no longer run or jump.   Surgery or serial casting is needed to repair this injury.  Each case is analyzed by an orthopedic surgeon and the most appropriate way of completing the repair is decided.   Factors considered include age, athletic demands, time span until return to sport, and severity of tear.   Complete rehabilitation of this injury typically takes 6 months to return to sport, although we all know that a professional player may bend this rule slightly.
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I think the critical lesson for those of us in sports medicine is that we need to make sure that we are not encouraging our athletes to return to sport too early.  Proper strengthening and healing is critical because although the risk of reinjury may be small, the consequence is huge. ​

Concussion is a hot topic in schools.  Thousands of students from Kindergarten to university suffer concussions each year. This can be from a fall, a car accident or from sports.   Following a concussion, cognitive and physical rest is prescribed.  Recent studies have shown us that this rest should be limited to approximately 24 to 48 hours.   After that amount of time, sub-symptomatic activities can actually be beneficial in restoring brain function and reducing symptoms. 

We often hear about athletes returning to sports.   Our professional athletes will have “red jersey” practices where they get back to their technical and fitness skills but refrain from contact.  When tolerated, they begin contact and eventually return to the games they love.

But how does a student return to school?  What are the steps?

There are some simple guidelines:

1. For student athletes, return to school should precede any attempt to return to sport

2.  Like return to sport, return to learn should be coordinated by a trained medical professional.  Ideally, a team of professionals including therapists and doctors is best.

3. There are four stages to return to learn.  A student progresses through each stage when the current demand is met without any increase in symptoms for a minimum of 24 hours.

4. If symptoms increase as they progress, they are to return to the previous level for a minimum of 24 hours. ​

The stages of return to learn include:

1. Light cognitive activity: this includes reading and games done at home

2. School type work/light physical activity:  this is work done that is similar to the demands of school, but in 30-minute blocks.   Some light activity, such as going for a walk, is encouraged.

3. Part time school:  this can be divided into light load and moderate load, indicating the time spent in school, including hours per day or days per week

4. Nearly normal workload progressing to full time demands: Time and homework are increased as tolerated.   At this point, accommodations are often needed as only certain aspects will increase symptoms (ie: reduced computer time).  Physical Education class is not included as it should be increased during the return to sport phase. 

For more information please visit: 
http://horizon.parachutecanada.org/wp-content/uploads/2017/06/RTL-Parachute-2018May.pdf.  
 
The staff at Physio Sport Med work as a team to help guide you through these challenges.  If you think that we could help you or someone you love, please give us a call.  ​

Habits of musicians are often compared to elite athletes.   They practice for hours a day to perfect their skills to achieve success in a very competitive environment.  Like the athlete, these habits can cause damage to the body and result in injury.   Injuries that mean time away from gigs, income, and in the worst-case scenario, a change of career.   So, what can be done?

There are two main factors that contribute to overuse injuries in musicians.
 
1. Repetition:  As it sounds, this means that the body is performing an act over and over again until it is perfected.  However, damage begins when there is not adequate rest.   Initially, the musician will complain of fatigue and tension near the end of the session.   This develops into pain during the session, and then lingering pain when one is away from their instrument.   The most common overuse injury is tendonitis. 

2. Asymmetry: This refers to the need to hold the body in an unbalanced position for an extended period.  An example is a violinist tilting their head to support the instrument as they play.    This can alter the movement patterns of a joint, increasing the risk of injury.  For example, our violinist may develop a nerve impingement on the side towards her violin due to neck posture and reduced space for the nerves to travel from the neck to the arm.
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1. Reduce time. I know that sounds difficult, but it can be done.   Use a desktop and full keyboard whenever possible.  Even a laptop is less stressful on your hands than a handheld device. 
2. Break the habit.  This is part of reducing time.  If you find yourself checking social media for the third time in an hour, it may be time for a break.
3. Lift it up.   Hold your device higher.   This reduces the amount that your neck must bend.   Always holding your device in your lap creates a lot of stress on the neck.  Ideally, hold it at chest level, or even higher.
4. Roll the neck.   You can look down two ways.   The first is letting your chin jut out making most of the work come from the upper back and lower neck.   This is very stressful for the muscles of the neck.   When looking at your device, think about bringing your chin to your throat or Adam’s apple, this will curl the upper spine and stretch the back of the neck.   Try it and feel the difference.  It is a current adage that should become as important as “lift with the knees.”
5. Put it down.   Whenever possible, place your device on a table or a desk.   Not only does this reduce wrist stress from holding it, but you can then use both hands and all your fingers for typing.
6. Avoid the thumb scroll.  Commonly, smartphone users will use the thumb of their dominant hand to scroll through their screen.   This is very difficult for the thumb and can add up over time.   Think about it, the strength of our thumbs is for gripping.  This motion is very different than most other demands on the thumb.  Instead, hold the device in both hands and use the index finger to scroll.  
7. Talk and listen.  When possible, use a talk to text command to avoid typing and sweeping.  A blue tooth connection prevents the urge to hold the phone between your shoulder and ear, preventing neck cramping and injury.

If you do notice pain and swelling in your hands, heat and slow motions through range can help restore blood flow and reduce pain.  If the problem persists, see your physiotherapist.  We are here to help. 

So now, here is the real question.  How do I maintain or continue to progress my training while dealing with an injury?

First, I took a couple of days rest.  Although fitness will decrease quickly with complete rest, healing was necessary.   Since I am training for a triathlon, swimming is an obvious first choice.     My ankle and foot quickly returned to full range-of-motion.  This is something that should be achieved before returning to any activity involving the injury.    If not, your technique will suffer, and you risk an injury to the compensating joint.   Now, I have already stated that I love to swim.  So, hitting the pool with a few extra laps of freestyle was not an issue for me.  But if you are not a swimmer, consider doing a leg only pattern to keep the legs strong and the heart rate high.   The other option is water running.   Holding a pool noodle under your arms, run through the water with the same mechanics as on land.   It is slow and arduous, but again your heart and lungs will work hard, while keeping the foot healing.

Next came cycling, which has been difficult this spring due to cold rainy days.  Due to this, my initial training happened on a stationary bike.   This was a good place to return.     Stationary bikes offer more control with intensity.   You can also stop if you notice symptoms returning.   This can be difficult to do if you are 1.5 km from home, but we won’t bring that up again.    Now the sun has come out and I have returned to cycling outside.   It is going well, but I was unpleasantly surprised how much work your foot does when you are out of the saddle.   This means that I plan my routes carefully.  I want to hit some hills so that I am increasing the workload of my training, without causing too much discomfort.  Slow gradual hills seem to be the answer.   Luckily in Halton Hills, these are easy to find. 

​Medical testing - not usually the best place to start:

Traditional testing such as MRI and X-rays are not typically useful when treating low back pain.   Your doctor may order tests to rule out serious pathology, but these results are used to rule out serious issues and are typically less valuable at pinpointing the actual cause of pain.   For example, it may clearly tell you that there is no fracture of the bone, or tumour in your spine.   However, it is misleading to say that the Degenerative Disc Disease (DDD) or disc bulge is the cause of your pain.  

​Studies have tested people with and without pain.  The results are the same – prevalence of DDD and disc bulges were evident in symptomatic and asymptomatic patients (people in pain, and not in pain).   Furthermore, the most common age to complain about low back pain is 40 -59 and as people age DDD continue to progress whereas the pain typically resolves.  If DDD were the direct case of pain, the pain should increase as we age instead of getting better.  This supports the belief that pain is actually a result of other, possibly related, factors.

What to do?  Have a trained physiotherapist, registered massage therapist or chiropractor look at your movement patterns.  If you are not moving ideally, muscle and joints can be stressed resulting in pain.  X-rays, CT scans and MRIs are pictures taken when you are VERY still.   They do not indicate how well things are moving.   In life, we need to keep moving.

Change of attitude:

We need to get away from thinking that bedrest is helpful for low back pain.   Although reduced activity may be necessary in an acute situations it is important not to stop completely.   Gentle movement and strengthening can help to break up spasm and decrease inflammation.   Perhaps more effectively then ice and heat, and definitely better than bed rest. 
With mild to moderate low back pain, exercise and strengthening decreases back pain significantly.   This is done partially by adding muscular support to your spine.   However, pain responses are much more complex then that.    Simple movement and strength teaches your brain what normal movement feels like and helps your nervous system adapt to tissue changes.     Knowing how your back moves and exercises that reduce discomfort, gives people control over their pain.   It may not resolve completely but having the knowledge to reduce the severity and frequency of bad days is great power.
Non-Steroidal Anti-inflammatories (NSAIDS – Like Aspirin, Advil, Voltaren etc.), surgery or more complex medical care is useful in only a few cases and typically should only been prescribed when exercise and education have not been successful in returning function and controlling pain.

Tricia Hayton is a Registered Physiotherapist and Partner at Physio Sport Med

Stephanie MacNeill, Registered Dietitian, Sports Dietitian, MHSc.

So you’re New Year’s resolution is to eat healthier. That’s awesome! But let’s be real, ‘I’m going to eat healthier this year’ is one of those well intentioned, but too-hard-to-define goals that’s easier said than done.

1. Choose a method of eating that is enjoyable, sustainable and fits with your lifestyle
   The reason that so many diets fail is that they’re just not sustainable in the long run Diets tend to approach nutrition and weight loss as a temporary state of mind. I mean we can only endure juicing cleanses or eat cabbage soup for so long!! The reality is, there’s no such thing as a one-size-fits-all diet. Different methods work for different people. Find an approach that you’re actually going to enjoy and be able to stick to over time.
   
   
2.  Identify your values and rise to the challenge
   Changing your eating habits can be difficult! Get over this road block by reflecting on why you want to change your eating habits. Is it to have more energy? To be able to be more active? To have more self-confidence? No matter what the reason, write it down and refer back to it when you feel like giving up. Yes, it may be challenging, but you are worth it!
    
   
3. Meal prep-seriously, it’s a game changer!
   Meal prepping can be as simple as preparing freezer smoothie packs for breakfast or more complex like cooking complete dinner for the upcoming week. No matter how you slice it, there’s no one right way or method to meal prep-it’s about what works best for you. Too often people get bogged down by the details, when in reality, sticking to the basics will probably do more good. Set aside an hour or so each week to plan your meals, grocery shop and do some basic food prep (chop of veggies, etc). This little time investment will make it much easier to stay on track.
    
   
4. Make enough at dinner so you have leftovers for lunch
   This could almost be a part b) to the last tip. When choosing your dinners for the week, plan to make a little extra so you can take the leftovers for lunch the next day. Some foods actually taste better the following day since it allows more time for the flavors to combine and develop.
    
   
5. Don’t force foods you don’t like
   Find healthy foods that you actually like. Don’t force yourself to eat foods that you don’t enjoy just because they’re ‘healthy’ (what does that word even mean anyway). Keep experimenting with different foods until you find options that work for you.
    
   
6. Enjoy your favorite foods
   If you love chocolate, allow yourself to enjoy it in moderation. Otherwise you’ll leave yourself feeling deprived longing for a taste of that mouth-watering, rich, milky, creamy, bitter delight!  Remember that healthy eating is not about denying yourself your favorite treat foods, it’s about enjoying them along side nourishing, whole foods.
    
   
7. Get friends and family on board
   Invite your friends and family to join you on this journey. Healthy eating becomes a lot easier when you have support and people to share your experiences with along the way. Create a recipe swap or a meal exchange group and have weekly check-ins to hold each other accountable.
   
   

So there you have it, seven tips to help you with your ‘Eat Healthier’ resolution. Working with a registered dietitian can help you navigate these tips so you can start the year off on the right foot.

Dr. Eric St-Onge

You've heard the term before, overtraining, but maybe you haven't or maybe you're just not quite sure what it really means.  

If you prefer to watch the video instead of reading the blog - click on the YouTube video below.

Often in our training schedule, we will purposely increase volume and/or intensity of training load in order to potentiate physiological adaptations that would result in longer term increase of performance.  This is called overreaching.  Yes, this is a good thing, but we must plan a proper recovery period or else this may lead to something called overtraining syndrome. 
 
In a nutshell, overtraining involves the accumulation of stress, leading to a decrease in physical and mental performance in sport.  Most often, there is a mismatch between the load (the training stimulus) and adaptation (or I should say, maladaptation).  Not only can we see performance changes, but it's also associated with hormonal, immunologic, neurological, and psychological disturbances.  
 
Before we go over this list, it's important to note that it is always OK to visit your healthcare provider when you are not feeling well.  That's what we are here for!
 
Here are 11 signs and symptoms that you may be overtraining:
 

1. Immune system alterations.  
2. A loss of appetite.
3. For the gents, a loss of virility
4. Fatigue
5. Being in a depressive state
6. Increased irritability
7. Loss of motivation
8. Lack of mental concentration
9. Heavy, sore, stiff muscles
10. Losing weight
11. Decreased performance despite increase in effort

 
Please be aware that this is not an exhaustive list as there can be other signs and symptoms as well associated with overtraining.  Additionally, some of these signs and symptoms may be related to more sinister conditions, which is why it is always a good idea to visit your healthcare provider if you are not feeling well!
 
However, if you are feeling any of these symptoms, it is important to realize that you must take a step back and re-evaluate.  Recovery must be your emphasis.  Make sure your nutrition is on point, reduce your training load, implement meditation to keep the stress down, and I would also urge you to visit your healthcare provider to tailor specific recovery methods to you.
 
THE best way to treat and injury or illness is to avoid it all together!  Here is a short list of things that you can monitor about yourself that may provide hints if you are on the road to overtraining.
 

1. Heart Rate Variability (HRV).  This would involve you buy a heart rate monitor that has Bluetooth and link it to an app on your phone. There are several apps to choose from (I personally use Elite HRV).  When your HRV is getting low, this can be a sign that you may need to increase your recovery.  Remember, HRV is something that's more accurate when you measure it every single day.
2. If you do not want to get a heart rate monitor, you can simply take a morning resting heart rate.  Measure your heart rate when you first wake up while you are still laying down. Log this number daily.  If your heart rate is significantly higher than your norm, you may need to increase recovery.
3. Monitor training load.  Try not to increase in load more than about 10% per week.
   
4. Monitor your weight.  Are you unintentionally losing weight?
5. Just like how you have routine checkups with your dentist, I recommend having routine checkups with your manual therapist.  

 
To conclude, I leave you with these final words:
 
If you train hard, recover harder. 

Tricia Hayton, Registered Physiotherapist

On November 25th,  I was off again with Cycling Canada.  This time to the Tissott UCI World Cup in Berlin, Germany.   Competing in this 3rd world cup of 6 through the season, Canada sent a full team to participate in the endurance and sprint events.   More specifically, for those familiar with racing, the team was participating in Team Pursuit, Omnium, and Madison on the endurance side.   The sprinters would compete in Team Sprint, Kieran and Individual Sprint.    It was a large crew and we were determined to make our mark on the international stage.

Personally, I left with three goals.   I wanted to see some of the Berlin wall and learn more of the history of this fascinating city.  I wanted to spend some time at one of Germany famous Christmas markets.  And finally, following an unfortunate accident in August at an event in Mexico , I wanted an injury free and successful trip for the team…   without a hospital visit.   I am happy to say that I achieved all three. 

The first 2 -3 days of our visit were training days, with each country scheduled with a 90-minute block of track time.   This allows the athletes to become familiar with the track – the corners and the banks.   For the staff it provides time to explore as our commitment to the team is only for a few hours.   I took advantage of this time to run errands and see a little of Berlin.  Brief stops were made at Checkpoint Charlie and the East Side Gallery.   The gallery was an accidental find of a kilometer of wall that now plays canvas to over 100 paintings.

The day was topped off with a staff dinner and the Alexander Platz Christmas Market. 

As for the team, they continue to progress to Tokyo 2020.   Both the men’s and women’s teams proudly stood on the podium winning bronze in the Team Pursuit.    Including, taking 2 seconds off the Canadian Record.

Our single racers had top 10 finishes in the Omnium.   Although the sprinters had a more difficult time, personal bests were achieved, and we continue to learn from mistakes and technical errors.

Next up is a 17 day stint in New Zealand, where the team will continue to train and excel in the Track Cycling World.

Eric St-Onge, Chiropractor

The cold season is among us!  Left and right, it seems just about everyone is getting sick.  One of the unfortunate results of feeling under the weather is that we miss out on our physical activity.  And rightfully so!  No one enjoys exercising when they are sick.

(by the way, if you prefer to WATCH instead of reading, click the link here or view the embedded video below!)

There are many different variables that can help and hinder your immune system.  For the sake of this article, we will focus on 5.

1. Nutrition
2. Exercise
3. Life Stress
4. Sleep
5. Environmental Extremes

 
Nutrition.  This should not be a big surprise! If we are not feeding the body what it needs, it will not be working optimally.  Chronically not eating enough calories is also a part of this mechanism. 

WHAT TO DO:

• Eat a well-balanced diet
• Consider Vitamin D supplementation (especially during the cold seasons)
• Replenish what you expend (make sure you eat enough calories!)

 
Exercise. After very long and heavy exercise bouts (>90 minutes), it’s not uncommon to have a small dip in your immune system to take a bit of a dip for up to 24hrs. 

WHAT TO DO:

• Use gradual increments in load (~10% per week)
• Have more frequent shorter training sessions rather that fewer very long sessions
• Implement recovery strategies post-workout
• Schedule a de-load week every few weeks

 
Life Stress.  Being in a state of constant low-level stress can impact your sympathetic/parasympathetic nervous system and your neuroendocrine system, all of which can impact your immune function.

WHAT TO DO:

• Monitor mood and anxiety levels
• Implement stress management techniques, such as meditation

 
Sleep.  Although one night of missed sleep may not impact your immune function, chronic sleep disturbances can raise inflammation markers in the blood.  Disruption of your normal circadian rhythm (AKA, your biological clock) can also negatively impact immune function.  This is most often seen in shift-workers and those travelling to new time zones.

WHAT TO DO:

• Sleep at least 7hrs/night
• Monitor quality of sleep with wearable devices
• Nap during the daytime
• No electronic screens close to bedtime - if not possible, invest in pair of blue light blocking glasses
• If travelling to new time zone, acclimatize to new sleep schedule ahead of travel departure

 
Environmental Extremes.  Being in either very hot of very cold weather for long periods challenges your central nervous system, the hypothalamic-pituitary-adrenal axis and sympathetic nervous system.  These systems also play a huge role in producing your immunoregulatory hormones.  Thus if they are already under lots of stress, immune function may be impacted. 

WHAT TO DO:

• Contrast baths can help boots immune system function
• Avoid breathing large amounts of cold dry air, especially if exercising outdoors during the colder climates

 
 
“I’m a shift worker and it’s not possible for me to change jobs.  Does this mean I’ll always be prone to get sick?”
Not necessarily!  It is my opinion that we can mitigate certain factors by “overcompensating” in the other factors.  For instance, because in your case, sleep will always be a problem.  Thus, we need to investigate the other factors that we talked about and find ways where we can “overcompensate”.  For example, make meditation part of your routine (even if you are not feeling stressed), be a little stricter with your nutrition and make sure you implement naps as often as you can.  (the linked video has a great visual representation of this concept of “overcompensating” – I recommended giving it a watch!)