What's New at Physio Sport Med

Physio Sport Med was honoured to be invited to the Oakville Golf Club to take part in their Wellness Lunch and Learn Series.  Stephanie MacNeill, dietitian, and myself, Tricia Hayton, sport physiotherapist, discussed what can be done during the off season to benefit your game next year.

I specifically talked about low back injuries and what can be done to prevent them.  Did you know that up to 30% of golf injuries are low back injuries, and that professional golfers have more low back injuries that ANY OTHER PROFESSIONAL ATHLETE?    On average, an amateur golfer misses four weeks for each injury.   When we are talking about the short Canadian summer, that can be a large percentage of your season.

So, what are the top five things you can do to avoid missing your weekly tee off time?
 

1. Work on low back flexibility: Particularly being able to rotate.   To stretch it well, lie on your side, and extend the top leg out.   From this position, twist your upper back to lay your shoulders flat on the bed.  Hold this position for 15 sec.  For best results do both sides.
2. Increase Hip Internal Rotation:    Making the large strong hip joints do the work is a great way of reducing stress on your lumber spine.   To increase hip rotation, sit on a table top or bar stool so your feet are dangling.   Squeeze your knees together and hold them there with your hands or forearms, maintain this position as you take your ankles as far apart as possible.
3. Mobilize your thoracic (rib cage) spine:   This can be done using two tennis balls or lacrosse balls.  Place them on either side of the bony prominence of the back and gently roll back and forth.  Concentrate on the area between the shoulder blades as this is where we are generally the stiffest.
4. Don’t side bend:  make sure to keep your hips under you during your swing.   An increase hip swing greatly adds stress to your back, and nothing to the distance.  If you have (or have had) considerable low back pain in the past, it may be worth having a pro look at your technique
5. Build up your core:   This does not mean sit ups and external oblique crunches.  These are dynamic muscles that create power.  Although logic may suggest this is what you need to hit the ball further, studies demonstrate that lack of stability strength is the limiting factor.  Working on planks and side planks are a simple and great way to increase core strength.

Give these suggestions a try, but if you would like a specific program to maximize your game, we are here to help. 
  
What did Stephanie have to say about diet….  Stayed tuned for more information to come!

​The start of the New Year is a common time for everyone to take a closer look at their health. Those of us that hit the gym have probably noticed that it is busier than ever! While being physically active is important, our diets also play a large role in our health. Anecdotally, I have often had patients and friends opt for sweeteners in their food and drinks (aspartame, sucralose, stevioside, etc.) as they are calorie neutral compared to sugar. We like to think that this will help us lose weight (which comes with a host of health benefits!), but are non-nutritive sweeteners better for your health?

Will they actually help you lose weight?

A recent study was published in the Canadian Medical Association Journal in December 2017 on this very question. It combined the results of multiple studies that looked at the effect of non-nutritive sweeteners on body mass index, weight, obesity and other cardio metabolic outcomes such as the incidence of hypertension (high blood pressure) and diabetes (poorly controlled blood sugar). Interestingly, consumption of non-nutritive sweeteners was associated with weight gain, increase in waist circumference, and higher rates of obesity, hypertension, and diabetes. It should be noted however, that the study did not take into account family history, individual behaviours with respect to health and exercise, total daily calorie consumption, and other variables that would influence the outcome. Basically, people who choose non-nutritive sweeteners may have other health conditions or behaviours that predispose them to these negative outcomes. Further studies are needed to investigate these variables in relation to non-nutritive sweeteners and other health behaviours in the population.

At the end of the day, it seems that we cannot have our cake and eat it too. Although the above study shows that non-nutritive sweeteners are not helpful when it comes to weight loss and improved cardio metabolic health, we need to remember that there is more to our diet then just relative sugar consumption and that exercise is also an important factor. While non-nutritive sweeteners have been approved by Health Canada and are safe for consumption, it is important to remember that although the cake sweetened with stevia may not contain calories from glucose (sugar), it will contain calories from all the other ingredients. Opt for a smaller piece or replace it entirely with a much healthier fruit.

A healthy approach to weight loss is a plan that combines proper diet and regular exercise. Please speak with a healthcare professional if you have any questions or concerns about healthy weight loss.

There are members of the medical community that have added competencies that recognize additional expertise and skill sets which allow them to have a focused practice.   In a recent article from The Journal of the College of Family Physicians of Canada, Marni Wesner wrote, “the leaders in Sports and Exercise Medicine in Canada have been identified and awarded certificates of added competency.”

Does this mean that Sports and Exercise Medicine Physicians only see elite athletes?  No

Again, to quote Wesner, “Sport and exercise medicine (SEM) physicians have specialized training and skills directed towards assessment, diagnosis and treatment of acute, sub-acute and chronic injury and illness as they pertain to participation in an active, healthy lifestyle.  More than expert musculoskeletal assessment, the knowledge and expertise of the SEM physician extends to fracture management, joint reductions, joint and soft tissue injections and interpretation of imaging studies, as well as rehabilitation of injury, nutrition, concussion/head injury, sport psychology and orthotics/braces.  SEM physicians have a keen interest in sport, but also in the lifelong promotion of physical activity for wellness and the prevention and treatment of chronic diseases (i.e. diabetes, hypertension, obesity and arthritis)". 

What does this mean for those of us who are not elite athletes, but are just trying to stay active and enjoy sports with our friends to keep moving and stay healthy?   Our doctors are here to make this easier for you.    They are experts in assessing injuries to muscles and joints to give you a solid diagnosis as well as advice regarding how to minimize damage while also continuing to stay active.   This expertise moves beyond strains and sprains, to advice regarding concussions, osteoarthritis, and chronic joint issues that are preventing you from being as active as you can be.   We have seen a wide variety of patients – from those who are preparing to travel internationally to represent Canada, to the executive that plays squash with friends on the weekend, to the older gentleman who is now struggling to walk through the grocery store due to foot pain. 
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We often get phone calls asking, “Can I come see you even if I am not an athlete?”  The answer is a resounding - YES!   Give us a call and we can book you with one of our Sports Medicine Physicians. 

It is that time of year again.  There is a lot of rushing to and from the mall, holiday concerts, and social gatherings.   And although this time of year can be fun, it is often very difficult to stick to a healthy lifestyle.  This includes diet, exercise, and relaxation.  Here are some helpful hints to help.

1. Make it a priority:  I do realize that this is easier said (typed) than done.  But the conscious effort to prioritize yourself will yield good results.  This doesn’t mean that there won’t be times of indulgence, but overall, the balance of good habits vs bad will be in check.
2. Water:  The elixir of life.   Bring a favourite sparkling or flavoured water to your social gathering and even your healthy drinks will feel like a treat.   Does this mean that you can’t slip in an egg nog or two – of course not, but try to alternate with water to minimize your calories… and your hangover.
3. Make exercise fun:   Make some of your social and family gatherings active.   A feisty family game of laser tag, a scavenger hunt, or hockey on an outdoor rink (weather permitting) can be a great and active start.  If you are not as competitive as my family, go for a hike, tobogganing or walk to see the lights in your neighbourhood.
4. Plan Ahead:  If you’re hosting a party, make sure to have a veggie or fruit platter.  I’m sure that you are not the only one who will appreciate the healthy option.  Also, make sure that you eat a healthy dinner prior to the party.  This will prevent you from filling up on the rich foods that are often served.
5. Don’t be tricked:  It can be helpful now that restaurants are including calorie counts.  Make sure to pay attention.  I was stunned when I first realized that some salads have more calories than the tasty(ier) Asian noodle dish I was eyeing.

My final piece of advice, don’t expect to be perfect.  After all, the holidays only come around once a year.  On this note, I’ll end with a useful quote.

“Giving up on a whole day of healthy eating because you allowed yourself one treat, is like dropping a cell phone, then stomping on it just to make sure it is broken.” 

It is that time of year again.   We are back in the rinks and the kids (and kids at heart) are playing hockey.  Did you know that upper body injuries happen more frequently than lower body injuries during hockey? 

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Let’s break down what happens.

1. Head trauma:  Obviously the most common injuries are concussions, and that is a post or two all on its own.   For a great run down on concussions, please see our learn article:   http://physiosportmed.ca/learn.html.  There can be other, more serious forms of head trauma, but this is extremely rare, especially with modern helmets.
2. Lacerations:  These are cuts that often occur to the face.  One of the more common spots is the chin – make sure that your strap is done up and fitted correctly.   Once you graduate from a face mask or shield, the eyebrow region can also be easily damaged.   Although the face is the most common location for lacerations, they can also occur at the wrist in the gap between the jersey and the glove.   This region can be more serious, especially if it is due to a skate blade.
3. Sprains and Strains:  This is when a muscle or ligament gets stretched, resulting in pain and lack of movement of a joint.   If the ligament or muscle is stretched too far, it can tear.   This should be treated with ice, compression, and rest.   If it is still sore in 2 days, visit your doctor or therapist.   One of the more common sprains is a separated shoulder, which results from hitting the boards shoulder first. 
4. Contusions:  This is the medical term for bruise.  It is by far the most common injury in hockey and is usually caused by hitting another player or the boards.  Bruising usually responds to ice and rest, however, if the bruising is severe, firm to the touch, or restricts movement, it is wise to seek medical advice.
5. Fractures:   A medical term used for any break or crack to a bone.   Look for swelling, loss of ROM (range of motion), bruising, and tenderness along a bony prominence.   Seek medical attention as soon possible.

As always, the best treatment for any of these injuries is prevention.  For a quick reference sheet in preventing upper body injuries follow this link from ProStock Hockey (Upper Body Injuries) and check out their website for more information!  In general,  make sure you are strong, use good technique, and have all of the proper equipment that is certified and well fitted.

When I look outside, I know what I will be doing this weekend.  Beyond packing up the Halloween decorations, it’s time to clean up the backyard for winter.   However, raking and trimming can be very stressful on your body.  It is one the leading causes of low back and shoulder injuries at this time of year.     Here are some helpful hints to keep you going and keep you healthy.

1. Warm up:  Raking is more exercise than some of us are used to.  Walk around for 5 minutes to increase the blood flow to your limbs.  This can be a walk around the neighbourhood, or just around the yard to assess how much work there is to do.
2. Pick the right tool for the job:   There are ergonomic rakes that can reduce the risk of injuries, particularly of the lower back.
3. Change it up:  Switch activities every twenty minutes or so.   For example, rake, then bag, and then trim the garden.  The change in posture and movement will change the muscles and joints that are under the most stress.  
4. Keep it light:   Although there may be more room in the garden bag, remember to consider the weight of the contents, especially if you must carry it from the backyard to the curb.   If the leaves are wet, or there is considerable soil in the bag, it will be heavier, adding stress to your back and knees.
5. Wear good shoes: There are often sticks and other obstacles under the leaves (or in my case, dog toys).   Shoes or boots with good foot and ankle support will help you to keep your balance and prevent ankles from rolling
6. Step it up:  Stepping forward and back with a rake will reduce how far you have to stretch your shoulders to gather the leaves.   The further our arms move away from the body, the more vulnerable they are.   Sharing the work with the large strong joints of the legs is a good way to reduce the risk of shoulder injury.

​Hopefully these tips will help keep you strong and injury free this season.    After all, it won’t be too long until we are shovelling snow… 

Introduction
Hi, my name is Kimberly Fernandes and I am the new sports physician at Physio Sport Med. I want to take some time to introduce myself, as well as the role of sport medicine physicians, in helping you, whether you are a full-time athlete, a weekend warrior or are just looking to treat chronic musculoskeletal issues.

Education
I completed my Doctor of Medicine degree at McMaster University’s Niagara regional campus in 2015. I then moved back home to Mississauga to complete my Family Medicine Residency training at the University of Toronto’s Trillium Mississauga site. I acted as chief resident during my final year and did research on wellness among medical trainees. I have also attended the Ontario Medical Association’s Sport Med Conference in the last few years to keep up with current innovations in the field.

Experience
During my many years of medical training, I have always been interested in sports medicine. I have spent time in many sports clinics, and with many rehabilitation specialists including physiatrists, neurologists, physiotherapists, athletic therapists, and chiropractors. I have also provided medical coverage at sporting events including the Skate Canada World Junior Synchronized Skating Championships and the Little League Ontario Baseball Provincial Championships.

How I Can Help You
As a sports physician, I treat a variety of issues that range from sports-related injuries to chronic musculoskeletal conditions such as osteoarthritis. Whether you are looking to overcome an injury and get back into sport, or to find alternative solutions to long-standing issues, I, as a sports physician, am here to guide you. I am also trained to do joint and other soft tissue injections as indicated for treatment. If you have an issue you would like to discuss, call or drop by the clinic to inquire about an appointment. Visits to a sport medicine specialist are covered fully by OHIP, and while a referral note is always appreciated (as the referring doctor can provide necessary information about your current health status and imaging results), it is not required to book an appointment with me. 

​I look forward to meeting you!

Over 25 Oakville Rangers games were played between 7:30 AM and 7:30 PM including the kick off of the House League season, a slate of Rep games and more.  
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​Just after noon presentations were made which included Ron MacLean, Paul Henderson, Vic Hadfield and Mayor Rob Burton.

At the end of the day the Oakville Blades battled the Burlington Cougars in Junior A action.  The Blades defeated the Cougars 4-2.

​Physio Sport Med of Oakville was proud to provide sponsorship to this great local event.

About 18 months ago, a friend of mine contacted me to ask if I wanted to be a lead for the Invictus Games.   At the time, I did not know much about the games, but I said yes, as I’m always willing to help a friend.   I asked if I could be the medical lead for Wheelchair Rugby, and that is how this adventure began.

If you Google the Invictus Games, you will see that Toronto is hosting the third ever games.   Invictus Games is the inspiration of Prince Harry, who stated during his opening ceremony speech that his life changed forever during his time in the British Armed Forces.  It was then that he decided to use his position of power to assist with wounded warriors’ recovery. 

If you look a little deeper, you will find that Toronto is hosting veterans from 17 nations including Iraq, Jordan, and Georgia, with Romania and Ukraine joining this year.  These men and women, all injured in the line of duty, will compete in 14 sports throughout the Greater Toronto Area.  Many of these warriors have not only physical injuries, but mental injuries as well.  

What you will not find when you Google the Invictus Games is the gratitude, the tears, and the stories that come from working with these amazing athletes.  They have all suffered a loss, and being selected to be part of the games is just part of their recovery as they adjust to new abilities, new expectations, and for some, new dreams and goals.   The focus of these games is not to win – although they are very competitive people by nature – but to use organized sport to rehabilitate mentally and physically.

I have been part of many games, but I have never had an experience like this.  I encourage everyone in the Toronto area to take advantage of the last few days of competition to come be a part of it.   Take the time to thank these men and women for their service.    Personally, I know that I will never be quite the same.  

Did you know that there are 23 summer Paralympic sports and 6 winter Paralympic Sports? 

Did you know that there has been a vast improvement in the science of prosthetics over the last few years?

Did you know that the current fastest Para-Sprinter can run 100 meters in 10.57 seconds? 

This is just a little bit of what I got to experience over the last week attending the Vista 2017 Conference that focused on the opportunities and challenges in Paralympic sport science and sport medicine.   These researchers have looked at the biomechanics of the athlete, equipment, socioeconomics, and new technology to help these athletes improve their performance and create a safe environment.

This conference came at the perfect time since the Invictus Games have begun in Toronto this past weekend.  These games are about men and women who have honoured their country at war and have returned with a disability.  They are now representing their country again, but in the form of sport. 

After this week at the conference and listening to all the research being done, I find myself studying the   movement of these athletes and the challenges of the sports, some of which I have never watched before.  I find my myself asking “how is that affecting or contributing to their performance?”.  Also, as I watch these athletes, I admire them for what they have gone through to be standing on the playing field or court representing their country.  I wonder if I would be able to have the same strength to achieve greatness with something that many would see as a negative. After giving it some thought, my answer is: I don’t know, but I hope I could.   

On the last day of the conference, we got to visit the CSIO (Canadian Sport Institute of Ontario) in Scarborough, and I got to see the amazing facilities that our athletes get to train in.  It is facilities like this that are a product of Own the Podium – a not-for-profit organization that focuses on investment strategies to improve Canada’s high-performance sport system.  Financial support from Own the Podium allows facilities like CSIO to create ISTs (Integrated Sport Teams) to help support national sports, athletes, and coaches.  Each IST will differ based on the needs of the team, but could include physiologists, mental performance experts, dietitians, strength and conditioning coaches, biomechanics experts, sport medicine practitioners, physiotherapists, and massage therapists.  This combination of experts will support the athletes through their athletic journeys. 

Many have asked me, “I have arthritis.  How can I be considered an athlete?”

The fact of the matter, is that exercise can greatly help with the signs and symptoms of arthritis.   Exercise has been proven to decrease the pain, depression, and fatigue that is often associated with systemic arthritis such as rheumatoid arthritis, fibromyalgia, and lupus.   Will it take the disorder away?  No.  But it will help give you control of the symptoms.    You must grade the intensity to respect the limitations of your body.  Try a specialized yoga class or water exercise to maintain flexibility and strength while minimizing the stress on your joints.

One in 6 Canadians have arthritis and the vast majority of that is Osteoarthritis.  The joints most typically affected are the knees, hips, and hands.   Once thought to be simple wear and tear of the joints happening earlier than expected, current research shows that there are cellular changes to the cartilage of the joints indicating that the problem is more complex than initially thought. 

The number one treatment for osteoarthritis is a program that combines education and strengthening.  The education component assists with understanding what is happening to your body and how you can prevent it through change of active level, proper nutrition with and without weight loss, and joint conservation techniques.   Exercises should focus on form and very slowly progression to strengthening with weights, if at all.   This way of strengthening is call neuromuscular training.  That is a fancy way of saying that the program focuses on correcting the movement pattern of the body to maximize the efficiency of the joint and the muscles surrounding it.    A study in 2015 showed that completing a 12-week program reduced pain, reduced pain medication use, increased activity, and reduced sick leave significantly.   
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So what makes you an athlete?   As long as you are using exercise to make yourself stronger, healthier and more active – you are an athlete in our books.  

The number one goal we should all have with an exercise program is to prevent injury.
 
This must come before any goal of fat loss, weight loss, muscle building, or performance enhancement, because if you get hurt, then none of those goals even matter. You can’t train.
 
The primary cause of athletic injuries is neither weakness nor tightness, but rather muscle imbalance. Just because you can squat three hundred pounds doesn’t mean you won’t tear your Achilles during a squash game. Raw strength does not equal functional strength, and ignoring whole-body stability in favor of isolated muscle mass and power is a recipe for disaster.
 
We enter the world as limber, symmetrical babies but over time, we develop muscle imbalances and asymmetries. These can make us less efficient and more prone to injury. Think of it this way: Even if a car has a flat tire, you can still drive it, but that tire uses up extra energy and will eventually alter the overall alignment of the car.
 
We need to ask ourselves:

1. Are we moving correctly?
2. Is our body stable when we move?
3. Is our body balanced?
4. Are we moving as nature intended?

 
Most of us have probably answered “I think so”, but how can we really know for sure?
 
That is where the Functional Movement Screen (FMS) comes in. It is a seven-part test which helps identify muscle asymmetries, tightness, weakness and other risk factors for injury by examining the mobility and stability of the hips, core, shoulders, knees, spine and ankles. It is different from other screens as its focus is on dynamic movement.
 
                                     “Movement never lies” (Martha Graham).
 
The FMS lets us know how the brain is controlling the body and how the joints and muscles communicate.
 
You may find the movements are a bit awkward and challenging to do. That is by design - each isolates a different area of the body to prevent you from compensating and hiding weakness. It’s not magic — it’s simply good mechanics. The main purpose of the FMS is to seek out poor movement patterns so you can retrain the body to move in the most stable, efficient way possible.
 
It is essentially a quick and easy way to screen fundamental movement before you train it. If you train with a baseline of a poor quality of movement, the risk of injury is significantly increased. If, however, you correct baseline movement in a methodical, corrective exercise strategy prior to advancing performance training, the risk of injury is significantly reduced.

The FMS is designed for all healthy, active people as well as for healthy, inactive people who want to increase physical activity. It is designed for those that do not have pain or injury. 
 
With the increased desire to be fitter, stronger, and more athletic, people need to realize the importance of having fundamental movements before advancing into higher-level activities. What often happens is people are putting exercise and performance on top of dysfunctional movement, which can impair performance and cause injuries.
 
I personally believe it is very important to know how your body is moving so that you are exercising at your full potential and not increasing the risk of injury.  Movement Matters! Come in and see us for a movement analysis.
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I find that the beginning of September brings as many resolutions and promises to improve people’s health as January 1st.  The advantage of starting your active lifestyle in September, is that it is still warm enough to get outside and enjoy Mother Nature.  Veggies are fresh and the farmers markets are still in full swing, so eating healthy is simple and tastes great.   So, what are some tips to making your new lifestyle count?

1. Start small:  In order for your changes to make a difference, you need to make a lifestyle change – not take part in a diet fad or exercise trend.   Making huge reductions in your calorie count or hitting the gym 5 days a week can be difficult to maintain over the long haul.    Start by slowing changing the nutritional quality of your food, or reducing portion sizes.   For exercise, start with a daily walk or a simple exercise class available in your local community centre.  
2. Reward yourself: not all changes have to be removing something from your life that you enjoy.  Add in a hobby or an activity that you have always wanted to try such as an art class, a new hair cut or regular pedicures.    Take a look at that bucket list and see what is possible.
3. Work healthy habits into your lifestyle:   You have a life that works for you, so try to incorporate changes into what you already do.   Are you a sports parent?  Take a walk in the community around the arena during practice to kill time.   Do you commute?  Try walking from the train station or park at a parking lot a little further away while the weather is nice.  Do you order a gourmet coffee every day?  Try ordering something with low fat milk and skip the whip cream.

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You can do this!  Yes, you are probably going to occasionally couch surf or sneak in that tasty treat, but that is all part of the gradual lifestyle change.   Allow yourself these exceptions, then get back on track.   Remember – We are all athletes!

Pop quiz!  Which picture below depicts the best sitting posture?

 
Before we go over that, try this out.  Place your hands together (as if you are holding a piece of paper between your hands) and squeeze them together as hard as you can. Keep squeezing.  Notice that after a certain amount of time, your muscles became tired and gave out?  Now imagine you squeezed these muscles (at a lower intensity) but for 13 hours a day, every day?  Do you think those muscles would be stiff and sore? 

Well, this is what happens when we choose a single sitting position and never move out of it!

Staying in the same position for an extended period of time can lead to sore muscles and/or back pain.

So maybe the better question is, how often should we be changing positions? 

Best-case scenario – stand up and go for a small walk / take a stretch break / visit the water cooler every 20 minutes.

Second best-case scenario – change your sitting position every 20 minutes. 

The idea here is that we want to give your muscles a break by changing positions.  Simple as that. 
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Try this out and leave a comment below to let me know how it goes!

Last week, we had a client come into our clinic and say, “I’m not sure if I can come here, I'm not an athlete.”     Our quick response was, “We are all athletes".

At Physio Sport Med our definition of athlete is: “Any person who is interested in achieving or maintaining an active lifestyle.”  

Who does this include?

The 70-year-old woman who walks her dog everyday?    Always welcome!

The 45-year-old man whose work demands lifting and walking?   You bet!

The middle age lady who is rediscovering her love of tennis now that her kids have grown?  Yes!

The young boy who just loves hockey – but can’t quite skate?  Definitely!

The young adult who wants to walk around the grocery store without painful feet? Sure thing!
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The diabetic patient who has been told to lose weight, but can’t because their legs hurt? Come on in!
 
The fact of the matter is that Exercise is Medicine. We all need to move during the day.  However, if your muscles and joints hurt, you are far more likely to be sedentary.   Getting treatment so your body moves easier is just the start to increasing your activity.   It can also be very overwhelming to start activity – especially if exercise has lead to injury in the past.    We are here to help!  Remember that every little bit helps – you may start with just walking the length of your driveway or to the mailbox.   It all counts!

For more information follow us on Facebook for our “We are all Athletes” series. 

Evenings are cooling down and store shelves are stocked with school supplies.  This means fall is just around the corner and it’s time to get ready for back to school!  Making sure that your kids are well-nourished will help set them up for success this school year. 

Breakfast
There’s a reason why they say, “breakfast is the most important meal of the day”.  Obviously, lunch, dinner, and snacks are important too, but there are many benefits to starting your day off with a healthy meal. 
First and foremost, consuming a healthy breakfast will help your child meet their nutritional needs for the day.  This will contribute to proper growth and development.  Additionally, studies have shown that breakfast consumption leads to improved memory and concentration during class as well as improved academic performance. 

Some great breakfast ideas include:

1. Greek yogurt parfaits – kids can assemble them and choose which fruits they want to include
2. Peanut butter and banana roll-up - spread peanut butter on a whole wheat tortilla, add sliced bananas, roll up and eat!
3. Egg muffin cups with a slice of whole grain toast – Scrambled eggs with veggies cooked in a muffin tin.  Can be frozen and reheated for breakfast.
4. Oatmeal topped with berries

Lunch
Packing lunch is a struggle for many parents and children, but it doesn’t have to be.  Read on for solutions to common problems that parents and children face when it comes to school lunches.

1. Kids get bored with the same lunch every day
Even if you are sending them with a sandwich every day, switch up the grain product and the toppings.  One day you could do chicken on whole grain bread with some veggies and the next day you could send tuna in a whole grain pita.  The concept is the same, but it gives your child more variety so that they don’t get bored.

2. Kids don’t like the food being sent for lunch
Children, especially picky eaters, can be difficult to pack lunches for.  Allow them to participate in the process to ensure they are getting food that they want to eat.  Take your child grocery shopping with you so they can pick out healthy foods that they will eat for lunch.  You can also have them help with packing their lunch.  Let them choose what they want on their sandwich.  Let them pick their own snacks.  Working with your child to pack lunch will make sure they get something they like and will allow you to spend more time together.

3. Sandwiches get soggy
No one likes a soggy sandwich.  If your child opens their lunch bag to find a soggy sandwich, chances are they won’t eat very much of it.  If this is a problem, try packing the sandwich toppings separately and have your child assemble it at lunch time.  This could be too difficult or time consuming for the younger children, so they can eat it as a deconstructed sandwich – just as tasty!  Finally, avoid putting sauces directly onto the bread which will make it soggy as it sits throughout the morning. 

Ensure that you keep hot foods hot, and cold foods cold.  Use a thermos to keep foods hot.  For cold foods, use an ice pack in an insulated lunch bag to keep everything at a safe temperature. 

Finally, don’t forget to keep it nut free! If you’re a nut butter lover like myself, try Sun Butter or Wow Butter.  I’ve never tried Wow Butter, but Sun Butter is a peanut-free alternative that tastes very similar to peanut butter and has a similar amount of protein.

Happy eating!

​Now that I am back, I wanted to spend some time talking about my experience at the 2017 Canada Summer Games.   

I could tell you about the fantastic job that Winnipeg did hosting the games.   From the music festivals, to the restaurants and sporting facilities, it was a job well done.

I could tell you about how great it is to network and learn from some of the greatest sport medicine minds across Canada.   As one of 45 sponsored medical staff, we had colleagues from Victoria to Halifax, Yellowknife to Toronto, including physicians, physiotherapists, massage therapists, athletic therapists and one amazing, very overworked chiropractor. 

But instead, I would like to share a story that reminded me of why I am involved in competitive sports -  once on a personal level, now as a therapist and a Mom.   I want to tell you the story of Matt.

Matt is a kayaker from New Brunswick.   In 2015, his goal was to come to the Canadian Summer Games to paddle the K1 200 race.   His dream was to represent Canada on the Olympic stage.  Unfortunately, in early 2016, Matt had a snowboarding accident that fractured his neck and left him with paralysis of the legs and arms.   However, even from early on in his recovery, as he was learning how serious the accident was, Matt said, “But I can still go to the Olympics as a paddler.”

Thanks to the help of the Manitoba Canoe and Kayak center, team New Brunswick, and family and friends, Matt was equipped with a kayak, assisted onto the water, and completed his K1 200 race. The crowd of approximately 200 cheered and clapped the entire time, knowing that they were watching something special and witnessing someone discovering that dreams can overcome obstacles.  Matt’s quote at the end of the race was “It just feels right being out on the water where I really feel at home.”

An important aside, Matt also competed in shot putt and discus prior in the Games during the integrated track and field competition.
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This is why we do it.  To create support of a community, friends, and family – even if they are not biological.    I know that this is a moment I will never forget. 

Can you imagine a world without chocolate? I certainly can’t.  Should I feel guilty every time I eat it, especially if it’s not on a “cheat day”? Absolutely not.
 
The Problem With Cheat Meals
Honestly, I don’t have a problem with cheat meals.  I have a problem with the term “cheat meal”.  As I’m sure many of you have learned throughout your life, cheating is bad.  If you cheat on a test at school, punishments can range from detention to expulsion.  If you cheat in sports, you can be disqualified.  For most of us, doing something “bad” elicits feelings of guilt.  Using the term “cheat meal” implies that your meal is bad and may make you feel guilty for eating it.  I am a firm believer that food should be enjoyed. If food is meant to be enjoyed, why do we attach a word with such a negative connotation to it?

Now don’t get me wrong, I’m not telling you to indulge in your favourite sweets or greasy/salty foods regularly.  But I am telling you that there is space for these items in a healthy, balanced diet - and you should not feel guilty about it. 

A healthy lifestyle is more than just physical health.  In fact, there are 7 dimensions of wellness that contribute to an overall healthy lifestyle: 

1. Physical Wellness: The ability to perform daily activities with minimal fatigue by adopting healthy habits such as exercising and following a balanced diet.
2. Social Wellness: The ability to form positive, lasting relationships with others.
3. Emotional Wellness: The ability to acknowledge and cope with the emotions that we face such as happiness, anger, stress, sadness, etc.
4. Spiritual Wellness: The ability to identify your personal values and live in accordance with them.  Additionally, the ability to identify your purpose.
5. Environmental Wellness: The ability to acknowledge the impact of our behaviours on the environment and make positive choices regarding air, land, and water quality. 
6. Occupational Wellness: The ability to strike work-life balance while enjoying your career.
7. Intellectual Wellness: The ability to participate in continuous learning, including learning new skills, concepts, etc. 

​We often think about physical health when we think about food.  However, food plays a role in multiple areas of our health.  Will cake contribute to improving physical health? No. However, having some cake while celebrating a friend’s birthday can contribute to your social health. 

Some people follow the 80/20 rule where 80% of the time they eat healthy, and 20% of the time they choose foods that are considered less healthy.  However, this is just a guideline and you will find what works best for you.  Maybe you are more comfortable with a 90/10 split, or maybe you would prefer 70/30.  Regardless, it is important to remember that taking care of your social and emotional health is arguably just as important as your physical health.

So, to answer our original question, the term “cheat meal” doesn’t have a place in a healthy lifestyle, but the foods typically eaten during “cheat meals” can definitely have a place if eaten in moderation.    

Proud to be part of team Canada.  Our Olympians travel with a support team of coaches, managers and often healthcare specialists.   The team at Physio Sport Med is proud to be part of the elite therapists and doctors who get the honour of wearing the Canadian colours.

Most recently, Trish, one of our physiotherapists travelled to Pietsi Romania with Canoe Kayak Canada’s team to the ICF (International Canoe Federation) Junior and U23 World Championship.  While travelling, the therapist’s role is to provide physiotherapy, including exercise, massage and mobilization.  Emergency first aid and general health care advice is also provided if needed.   Our job is to keep them healthy and pain free so they can perform at their highest level possible.

​Oakville is proud to host the Little League Ontario Provincial Championship at the Junior and Minor Levels.   We are proud to be sponsoring them by supplying all of their first aid and therapy needs.​

Little League baseball involves over 3 million youths in over 100 countries. Canada has been part of the action since 1951. It is the largest amateur sporting organization in the world and is mostly run by volunteers and dedicated parents.  Junior players are 12 -14, and while the Minor players are slightly younger, they are still serious about the game. 

The Junior Provincial Championship is being held from July 22nd to July 26th and involves 4 teams from across Ontario.   In addition to the Oakville team, players are welcomed from Windsor, Nepean, and Glebe.   The winner of this championship will travel to Lethbridge, Alberta to fight for the national trophy.  

Immediately after, the minors’ tournament will be held from July 27th to August 4th, with 7 teams coming to join Oakville.  Not all division champions have been determined as the teams battle hard to make it to the next round.   We do know that Oakville will host team from Timmons, Toronto, Windsor, and Ottawa. 
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Here at Physio Sport Med of Oakville, we are proud to be giving back to the community and appreciate that Oakville Little League has let us be a part of the excitement.   We welcome all visitors, and wish the players good luck!

The evidence….

For years there has been controversy surrounding running and knee health.  The research is inconclusive, but it looks positive for runners.  In 2013, Paul Williams authored a study saying that recreational runners had less risk of osteoarthritis and credited this to a decrease in BMI (body mass index).   In 2017, this was supported by Alentorn-Geli et al, who concluded that recreational runners had a lower occurrence of osteoarthritis compared to elite runners and those with a sedentary lifestyle.

We do know that weakness and poor muscle control is associated with osteoarthritis.  In 2016, Deasy et al published a study reporting that significant hip weakness exists in people with knee osteoarthritis.  She further commented that hip evaluation should be part of clinical assessment.  Research also indicates that hip and knee strengthening can reduce the symptoms of knee arthritis (Bennell et al).  The area with the biggest gap in research is PREVENTION.

But what does all this mean?

Simply stated, if you keep your knees and your hips strong and moving in the correct way, running should not hurt your knees.  

How do you know if you know if your hips are weak?

Here are a couple of quick tests.

1. Sit on the side of a bed with your feet hanging.  Squeeze a pen between your knees.  Keeping you knees squeezed, take your ankles as far a part as you can.   You should not feel any pain in the hips this exercise.   Look at your feet, or have a friend take a look.   Your shins should be a minimum of a 45-degree angle to your thighs, and should look equal side to side.
2. Stand on one leg in front of a mirror, do a single leg ¼ squat.  Not only should you be able to keep your balance, but your knee should stay directly over your second toe, not drift in towards the big toe.

 
If either of these tests are positive, give us a call.   After a complimentary consultation, we will be able to tell you if there is a strength deficit and get you started with strengthening.   

“No pain, no gain” does not apply to your joints.    If you are hurting, let us help!
 
References:
Alentorn-Geli, et al  “Running and Osteoarthritis: Does Recreational or Competitive Running Increase the Risk”,  JOSPT, 2017, 47:6:391
Bennell et all Hip strengthening reduces symptoms but not load in people with medial knee osteoarthritis and varus malalignments: a randomised controlled trial: 2010, DOI: 10.1016/j.joca.2010.01.010
Deasy et al  “Hip Strength Deficits in People with Symptomatic Knee Osteoarthritis: A Systematic Review with Meta-analysis: BMC Musculoskelet Disord. 2007; 8: 121.
Paul T. Williams, “Effects of Running and Walking on Osteoarthritis and Hip Replacement Risk”  Med Sci Sports Exerc. 2013;45(7):1292-1297.

Do you find yourself getting tired, slowing down, or losing focus by the time you reach the second half/third period/fourth quarter of your game?This is a common complaint that we hear from many athletes. Fortunately, proper nutrition and hydration can help you finish the game as strong as you started.



First and foremost, carbohydrates are the main fuel source in moderate-to-high intensity sports such as hockey, lacrosse, soccer, and basketball. When people think about carbohydrates, they typically think of breads, pastas, and rice, but those aren’t the only food sources of carbohydrates. You will also get carbohydrates from fruit, milk, yogurt, and sweets/snack foods such as ice cream, cookies, donuts, etc.  With this being said, you want to ensure that you consume enough carbohydrates to fuel your body throughout the entire game. When we eat carbohydrates, it gets stored as glycogen in the body. During
games, the body turns to these glycogen stores for energy to fuel the exercise. Unfortunately, our bodies can only store a limited amount of glycogen. As your glycogen is depleted, your performance will suffer because your main fuel source is no longer available. Proper hydration is also important for performance. Losing as little as 2% of your body weight in fluids due to dehydration can cause fatigue and negatively impact performance.

Everyone is unique, so what works for one person may not work for another. However, there are some general recommendations that can help you perform at a high-level for the whole game.

1. Drink water throughout the day so that you can start your game completely hydrated or at least close to hydrated. It may be difficult to meet fluid needs during the game or event due to digestive tolerance, therefore, you want to start as hydrated as possible (without overhydrating).
2. Eat a meal 3-4 hours before the game/event with more carbohydrates, moderate protein, and a limited amount of fat. The carbohydrates from this meal will help to fuel your body. Although protein and fat play an important role in the diet, they take a bit longer to digest and may cause GI upset if eaten in large quantities before exercise.
3. Try adding a small carbohydrate rich snack 1 hour before the game if tolerated. Examples are fresh or dried fruit, pretzels, or crackers.
4.  Introduce a sports drink, such as Gatorade, during the game. Sports drinks contain fast digesting carbohydrates to help fuel your exercise. You may not need a sports drink throughout the whole game, so trial alternating between sips of sports drink and water.

Finding what works best for you can be difficult. If you need help navigating your diet, contact me at the clinic and I’d be happy to sit down and chat with you.

Following injury, or as we age, gardening and yard maintenance can seem daunting.    The demands placed on our back, knees, and hands can lead to hours or days of aching and stiffness – but this can be avoided at all ages and states of health.   Over time, staying active will keep your joints and bones healthier.   It is easy to fall into a cycle of inactivity leading to joint pain leading to more inactivity.    The key is moderation and movement patterns.  Learning to listen to your body and knowing how to use it efficiently will let you return to your garden.   Take Control.

However, taking control on your own can be tough.  Often our clients state that they don’t know where to start.    Others say that they are nervous of making a mistake and causing more pain.   We are here to help!   The staff at Physio Sport Med are trained to look at the movement patterns and strength imbalances allowing us to teach you how to move your body more efficiently.    We will start you at your specific level of exercise and break the cycle of pain and get you back to hobbies that you love.   Our goal is to keep you active longer into the season and as you age. 

Although every patient is assessed and analyzed individually, here are some healthy habits that everyone can benefit from:

1. Switch it up:   Change activities every 15 minutes to avoid over working one joint or muscle.  If you are stooped pulling weeds, then change to raking or another activity in standing.
2. Ergonomic aids:  From grips on your hand tools, to the shape of the rake, to squatting and sitting stools there are hundreds of aids out there that can reduce the energy and effort of yard work.
3. Bend appropriately:  For years, we have heard that bending at the knees is essential to save stress on your back.   This is true, but for many squatting creates knee pain and is difficult to do.  Sitting, kneeling or even bending at your hips can be used to spread out the stress on your legs, back and knees
4. Spread it out:  Rather than doing hours of gardening in one day, spend a short amount of time frequently through out the week
5. Stretch it out:  Gardening is exercise.   It is helpful to warm up a little before starting and to stretch after you are done.   Walking around your space for five minutes before starting will not only let you assess the work ahead of you, but will increase muscle and joint flexibility.