“Will Alberta Health Services Cover the Cost of My Physio Treatments?”

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“Will Alberta Health Services Cover the Cost of My Physio Treatments?”

The Alberta Health Care Funding Model Explained

Some of the most common questions we field in physical therapy are concerning the funding model for assessment and treatment through Alberta Health Care.

A number of clinics in the Edmonton area are allotted a monthly and yearly allowance for community rehabilitation.  Wait times vary depending on demand, though clients typically are seen within the week for their initial assessment at Corona Station Physical Therapy.

Those clients who have undergone surgery or suffered a fracture are automatically approved for an additional six visits through Alberta Health Care.  Clients who are on certain government subsidy programs, or are considered to be low income will qualify for a one time per year allowance of six additional visits with three treatments covered for any subsequent injuries that are not fractures or surgeries.  Should further treatment be needed at the completion of these treatments, the physical therapist can complete a Request for Review Funding form, applications are reviewed on a case by case basis with some individuals receiving additional treatment if it is determined to be necessary.

Those clients who have not had a fracture or surgery or are not low income may qualify for an additional two visits as determined by the Determination of Need rubric that is completed by the physical therapist.  This tool takes into account the severity of the person’s injury, the benefit they are likely to receive from treatment and the impact that delay would have on a favourable outcome.  The funding is based on certain body areas so, for example, if a client fractures their wrist and has the misfortune of later injuring a second body part, they can again access Alberta Health Care funding.  The health care year renews annually in April.

If clients are dissatisfied with an assessment where they are deemed ineligible for funding, they are entitled to a second assessment through Alberta Health Care.  Those individuals injured in a motor vehicle accident or at work must access different funding sources for their treatment.  Some services, such as vestibular rehabilitation, women’s health, concussion management and running gait analysis are not covered by the community rehabilitation program and must be paid for privately.  For further information, visit http://www.albertahealthservices.ca/info/service.aspx?id=1028551 or contact us at the clinic at 780-424-4804.

Injury Prevention in Golfers

Injury Prevention for Golfers

As the weather gets warmer and the grass greener, the itch for golfers to begin their season inevitably grows stronger.  Unfortunately, this excitement to start the season right where they left off the previous year can lead to injury for amateur golfers.  The most common injuries seen in golfers include:

 

Shoulder

  • The shoulder complex is a complicated region of the body, trying to balance its large amount of mobility with stability. We rely heavily on the shoulder’s musculature to provide stability, especially when doing demanding tasks like swinging a golf club.  75 percent of shoulder injuries occur to the lead shoulder in golfers.  It is crucial that golfers train the proper muscles before their season starts, to prevent injury.

 

Elbow

  • Most people assume a common elbow injury in golf would be “golfer’s elbow”, however the more prevalent injury is tennis elbow, otherwise known as lateral epicondylitis. It is normally seen on the lead elbow and can be caused by gripping the club too hard, changing the grip, or bending the elbow on the follow-through or take-away phase of the swing.  Golfer’s elbow, or medial epicondylitis, will more often be seen on the trail elbow and is the result of “early casting of the club in the downswing” (Davies et al, 2010).  Strengthening the forearms pre-season can help prevent both golfer’s and tennis elbow.

 

Wrist

  • Wrist injuries most often occur when the club contacts something before it hits the ball; for example, the ground, a tree root or the mat at the driving range. The club and the wrist both decelerate rapidly which, without proper training, can cause stress and injury to the wrist.  Once injured, it is hard to continue playing as each swing will stress the wrist joints, therefore it is important to strengthen the wrist before injury occurs.

 

Low back

  • Low back pain accounts for 36 percent of injuries in amateur golfers. The golf swing incorporates high velocity end range rotation, with the spine in a flexed position, and this position puts golfers at higher risk for low back injury.  Any hypomobility or hypermobility at any of the involved joints can result in compensations in the kinetic chain and, thus, lead to injury. Having good core and back strength, along with full lumbar spine mobility, can help prevent injury.

 

Hip

  • Fast rotation of the hips, pelvis and trunk is crucial for a proper swing. When strength or range of motion is lacking in the hip, the body makes compensations that can “stress muscles, ligaments, tendons and joints in the area” (Davies et al, 2010) and can result in pain.  It becomes near impossible to have an efficient swing without proper hip rotation, without which, golfers risk further injury or even worse – a few extra strokes on the score card!

Golf is a wonderful low-intensity sport that can be played by all ages, however, the injury rate of 40% is a barrier for participation.  “A major factor in the development of injury is the lack of sport-specific training and inadequate preparation prior to golfing” (Brandon et al, 2009).  Having a proper stretching and strengthening program will help prevent injuries from occurring. At Corona Physiotherapy, we can provide you with a program so you can start your pre-season training, and assist you if you get injured during your season.  Contact us to book an appointment!

 

References:

Davies, C., & DiSaia, V. (2010). Golf anatomy. Champaign, IL: Human Kinetics.

Brandon, B., & Pearce, P. (2009).  Training to Prevent Golf Injury.  Current Sports Medicine Reports, 8(3), 142-146.

Q and A with Rise Up Challenge’s Cody Price – Prepping for your Adventure Race!

Interview with Cody Price –  Rise Up Challenge

Q) I am new to adventure racing, is this something I am going to be able to do?

A) Absolutely! Whether you are new to the sport, or to a fitness inspired lifestyle in general, you will be able to do it. Our courses and the obstacles laid out throughout them are designed to be tough and challenging, both from a physical and mental perspective. I’m not going to lie, there may be times when you’re on course and you ask yourself if you will be able to finish, or if it was a good idea to start this race in the first place. You may doubt yourself, but if you remember WHY you signed up and why you ventured past the starting line on to the course to take on this challenge, you will find the determination and motivation inside you to keep moving forward and finish. You can run a race or you can walk it. It doesn’t matter how you run a race, at the end of the day it all comes down to how you finish, not how fast.

Q) I would like to try adventure racing but where do I start?

A) Sign Up! Give yourself a tangible goal that is 3, 6 or 9 months from now and start working towards completing that goal. With the race and date on the horizon, you will be motivated to work towards it. Whether it is going for a walk or run, going to the gym, playing with your kids at the park or staying active in general; each step is a step forward in the right direction. You don’t have to start your journey already in tip-top shape, the journey is how you get there. Over time as you prepare you will notice yourself getting stronger, having more energy, and building self-confidence that accomplishing the goal is within reach.

Q) How can I be most effective with my training for Rise Up Challenge?

A) The simplest and easiest way I recommend people train for an event such as the Rise Up Challenge is to enjoy the outdoors. All the tools you need to get ready for an obstacle course race can be found in nature and within your city’s trails, river valley, parks and suburbs. These tools may include natural elements such as logs, rocks, water and varied terrain and hills. They could also include more man-made structures like stairs or playground equipment. After a few Google searches and YouTube videos it can be easy to learn how to workout outside and train for your first Rise Up Challenge or OCR event. OCR has a handful of basic moves you can focus on to train outside and prepare yourself for race day. These moves consist of lifting heavy objects, carrying the objects from point A to point B. Climbing on, under and over structures such as walls and cargo nets, grip strength for using your upper body and of course running on trails, through water and up and down hills.

Here’s an example of how you can use the outdoors as your training grounds. Take a fallen log or rock for example. These objects are great tools to build functional strength and endurance. They could be used for carrying up hills, or weighted hikes. They could become your new dumbbells for building strength in your back, arms, shoulders and legs.

Another example you may find outdoors are retaining walls or fences. It may seem silly at first but these are great tools for building your climbing abilities, calling on all types of functional strength in your legs, back, arms and hands.

One last piece of equipment you’re sure to find in any part of your neighbourhood or city is a Playground. These structures are great for all types of fitness and they’re a lot of FUN! The best part about playgrounds is that if you have young kids, they can play as you workout. Playgrounds are great spaces to work on tough obstacles like monkey bars, slippery walls (think running up a slide) and simply running through mud or sand.

When it’s all said and done, keeping these basic moves in mind will give you the ability to build your level of fitness and get ready for your first obstacle course race.

Q) What should I wear on event day?

A) I personally always wear shoes and clothes that I don’t mind throwing away afterwards if they get too dirty or wrecked as I run through the mud and over obstacles. Make sure you wear something that is comfortable when you’re dry and wet and can move freely in, at all different angles. Clothes that don’t retain water or act like a sponge when wet are also very advantageous. Depending on the type of person you are and how confident you are with staying hydrated, I would wear a camel-backpack or carry a water bottle. You never know when you will come across a water station, and it is important you can stay hydrated. The last thing you want to happen on a tough obstacle course is to run out of water.

Oh and remember, don’t take any valuables on course like earrings, wedding rings, car keys or cell phones.

Q) Any other tips on how I can make my run a success?

A) It’s simple, get outside, enjoy the fresh air and sunshine (even in the winter) and have fun! If you’re having fun, you won’t even notice how hard you’re working.

Therapeutic Ultrasound

Therapeutic Ultrasound

What Is Therapeutic Ultrasound?

Therapeutic Ultrasound is a treatment modality that uses sound waves to create deep heat in soft tissues of the body, including muscle, tendons, ligaments, and fascia (Sears, 2016).

How Ultrasound Works:

Ultrasound uses soundwaves which pass through the skin and cause vibration of the soft tissue. The vibration then causes deep heating within the tissue. This heat can produce a number of different therapeutic effects including: Increased flexibility/extensibility of scar tissue, tendons, and joints, relief of pain and spasm from muscles, and increased blood flow to the area which can help reduce inflammation (Paliwal, Mitragotri, 2008).

Common Conditions Treated with Ultrasound:

–  Bursitis

–  Tendonitis

–  Sprains/tears in muscle

–  Sprains/injury to ligament

Is Therapeutic Ultrasound Supported by Research?

There are some conditions that ultrasound has been found to be effective in treating, including Calcific Tendonitis and Carpal Tunnel Syndrome. For patients with Calcific Tendonitis, ultrasound can help to temporarily alleviate symptoms and can stimulate reabsorption of calcium deposits (Sil, Das, Chakrabarti, 2015). In patients with Carpal Tunnel Syndrome, ultrasound (when paired with wrist orthosis) can significantly improve their function and decrease severity of symptoms (Chang, Hsieh, Horng, Chen, Lee, Horng, 2014). Ultrasound has also been found to have a positive effect on osteoarthritis.  Zhang, Xie, Luo, Ji, Lu, He, Wang (2016), found that patients receiving ultrasound therapy for osteoarthritis of the knee experienced a decrease in pain and an increase in function.

Systematic reviews of the literature however suggest that ultrasound alone offers little benefit to overall healing. In a systematic review done by Chinn, Clough, & Cloughuse (2010) it was found that there was little difference between healing in individuals receiving real ultrasounds versus those receiving placebo ultrasounds. Interestingly, the majority of the studies included in the review showed minor positive results in both placebo and real ultrasound intervention groups. Multiple explanations have been suggested as to why this might be, including: Extra attention to the area, massage effect of transducer head, or possibly the placebo effect causing the positive change. Overall, ultrasound has been found to yield positive results in some conditions and may help injury healing in combination with an exercise program, but more research and randomized controlled trials are needed to determine the exact effects of ultrasound on soft tissue injuries.

Citations:

–  Chang, Y., Hsieh, S., Horng, Y., Chen, H., Lee, K., & Horng, Y. (2014). Comparative effectiveness of ultrasound and paraffin therapy in patients with carpal tunnel syndrome: a randomized trial. BMC Musculoskeletal Disorders15399. doi:10.1186/1471-2474-15-399

–   Chinn, N. E., Clough, A. E., & Clough, P. J. (2010). Does therapeutic ultrasound have a clinical evidence base for treating soft tissue injuries? International Musculoskeletal Medicine, 32(4), 178-181. doi:10.1179/1753615410Y.0000000003

–   Paliwal, S., & Mitragotri, S. (2008). Therapeutic opportunities in biological responses of ultrasound. Ultrasonics, 48271-278. doi:10.1016/j.ultras.2008.02.002

–   Sears, B. (2016, August 31). What Does Therapeutic Ultrasound Do in Physical Therapy? Retrieved from: https://www.verywell.com/therapeutic-ultrasound-in-physical-therapy-2696419

–   Sil, B., Das, T. K., & Chakrabarti, A. (2015). Calcific tendonitis: management by ultrasound therapy. Journal Of Evolution Of Medical And Dental Sciences, (70), 12252. doi:10.14260/jemds/2015/1766

–   Zhang, C., Xie, Y., Luo, X., Ji, Q., Lu, C., He, C., & Wang, P. (2016). Effects of therapeutic ultrasound on pain, physical functions and safety outcomes in patients with knee osteoarthritis: a systematic review and meta-analysis. Clinical Rehabilitation30(10), 960-971.

Q and A with Personal Trainer Devon Chang – Returning to the Gym Following Injury

Q and A with Personal Trainer Devon Chang – Returning to the Gym Following Injury

We get a number of questions from our clients who are eager to return to the gym and their other regular activities.  This month’s guest blogger, Devon Chang, is a CESP – Certified Personal Trainer at World Heath Club (Jasper Ave location) and has some excellent information for those looking to transition back to the gym after an injury!

 

Q) I’ve had an injury and my physiotherapist says I can start back at the gym; where should I start?

A) With the green light from your physiotherapist, it would be the best to start with the very basics. The goal here is to re-groove the basic movement patterns and muscle activation that you were doing prior to your injury; such as core and glute activation, squatting and hip hinging, and pushing and pulling movements to name a few. We want to avoid jumping right back into our old training as we need time to allow our bodies to rebuild what was lost during the healing process.
In summation, we are looking to regain our full range of motion, move effectively and start to rebuild our strength as a whole. Regardless of your experience, type of injury or goals moving forward, it would be in your best interest to consult a fitness/ post rehab professional.

Q) How often should I be working out once I am back to training?

A) Coming back from an injury is tough. Our habits are thrown off and our bodies don’t feel like working like they used to…yet.  It is important to rebuild those lost habits (or continue) and get back on track. Starting 3 times a week working with resistance training with the addition of 1-2 maintenance (focus on injured area; mobility/ flexibility; active recovery) days is a fantastic place to begin. From here we can look to increase our gym frequency and continue to progress to where we left off prior to injury. If you were training less than 3 times a week prior to injury then continue to move forward in your programming and coming back even strong than before.

Q) What is the advantage of consulting with a fitness/ post-rehab professional following an injury?

A) One of the greatest advantages to consulting and working with a fitness/ post-rehab professional is it takes the guess work out of the process. The job of your coach is to help you progress efficiently through your program and support you in rebuilding your habits and overall health and fitness.

Moreover, the main goal is to rebuild functionality and strength within your injured area and regain your confidence in that body part or parts. Whether that is guiding you through a program built by your physiotherapist or assessing you and building a program for you from scratch, your coach will help get you back to where you want to be and beyond.

A) What should I keep in mind to prevent re-injury?

Q) Injuries happen. Whether you’re a competitive athlete or a weekend warrior and casual gym goer, injuries still happen. Our responsibility is to prepare ourselves to avoid them the best we can.  Many injuries are freak accidents while others could have been prevented. However, we should keep in mind how we got injured in the first place and what plans we need to follow to build everything back up stronger and more stable.

More specifically, we target and strengthen the previously injured area and surrounding area.  I know that’s a very broad statement but keeping in mind the necessity of building a strong foundation stemming from your core and moving outwards and towards all areas; including the injured ones.  Be patient and ease back into your program while being extremely mindful of your form and muscle activation. The best approach is to consult a professional to help get you started on the right track.

Q) I’ve never lifted weights before but my physiotherapist recommended weight training to help prevent injury in the future; where should I start?

A) This right here is one of the biggest road blocks many people face. And that’s ok. You don’t know what you don’t know. So please don’t be afraid or too proud to ask for help. If your car broke down would you try and fix it yourself or would you call a mechanic? Now you mechanics out there shush, you know what I’m getting at. Same goes for bouncing back from an injury or simply learning how the gym works.

To avoid getting hurt again or falling off the wagon, it is imperative to learn the basics of human movement and functionality. I’m not talking about training for the next Olympic Games (unless you want to then by all means go for it!) but I’m talking about keeping your body happy and healthy. This is where consulting and if it’s a good fit, hiring a professional to teach you how to do it.  You learn. You apply. You learn. You apply. The internet can teach you theory and provide good instructional videos (make sure it’s a credible source) but being hands on with someone who knows what’s up will go even further to becoming knowledgeable and more independent. That is how you will build your foundation and understand how this whole gym and training thing works.

Q) I’m back at the gym following an injury and haven’t noticed any of my old symptoms, how quickly can I ramp up my training?

A) First and foremost, consult with your physiotherapist and/or the fitness professional you are working with. Better to be safe than sorry right? One rule of thumb that I personally apply is this:  if it hurts stop doing it!  Now that’s pretty vague but essentially I mean ease into increasing the difficulty and be patient. Make sure your body is stable and in proper position. The litmus test is pain or transitioning into bad form. That is where you dial it back and reassess.

Q) I would like to return to my group exercise classes now that my symptoms have almost been resolved; any tips for success?

A) Ah yes. Group exercise!  A fantastic place for camaraderie and getting your butt whooped by someone twice your age. Kudos to that person!  Group exercise is great and always a very diverse place of skill level and intensity. When getting back into the groove of group ex we have to keep in mind basically everything we just covered above and then some. It is important to push ourselves but also important not to compete with the other 40 people attending the class. We are coming off an injury and have to be diligent in performing the class with solid form and at the pace that is conducive to our post-rehab goals.
In group ex we lack the advantage of having someone analyze and cue our every move so it is up to us to follow and perform the movements led by the instructor to a tee. Otherwise we could jeopardize our recovery and perform the exercises with poor form and movement patterns. Go at your own pace and use the appropriate weights and movements for where you’re at in your recovery. If in doubt ask for help or advice from the instructor leading the class. Always consult with your physiotherapist or the professional leading your recovery.

 

Devon Chang is a 2013 University of Alberta graduate with a Bachelor of Physical Education and Major in Sport Performance and Physical Activity. Originally from Yellowknife, Northwest Territories, he came to Edmonton as a young teenager in pursuit of hockey excellence and ended up finding his passion for helping people with their health and fitness. Devon has been a CSEP-Certified Personal Trainer since 2012 and is currently working with the team at World Health Jasper Avenue as an Elite-Level Trainer and club Integration Manager.

 

Discover more at https://worldhealthedmonton.ca/clubs/jasper-avenue/

Workplace Ergonomics

Workplace Ergonomics

Workplace ergonomics is becoming an important consideration in injury prevention given the increasingly large number of people who spend the majority of their day working at a desk.  Some relatively easy and inexpensive adjustments in the workplace can have a significant impact on many postural and repetitive strain type injuries including chronic neck and back pain, tennis elbow, shoulder impingement and carpal tunnel syndrome.

 

The Chair

Ideally, a chair should be adjustable not only in a vertical direction but in all three planes of movement to accommodate various body types.  The height of the chair should be adjusted to be able to slide the chair under a desk while maintaining hip flexion of 90 degrees or slightly greater, a foot stool can be used to achieve this if needed.  An ergonomic chair will also include an area of lumbar support.  Used properly, this curve at the bottom of the chair helps to support the spine’s natural lordosis.  Depth of the chair will vary depending on leg length, a two inch clearance between the back of the knees and the chair is recommended.

 

The Desk

Sit to stand desks are becoming increasingly popular and are a great option for alleviating some of the health concerns typically associated with prolonged sitting.  Employers are becoming better educated on the advantages of sit to stand desks and will sometimes consider an upgrade if recommended by a health care professional.  Often however, these more expensive substitutes are not in the budget.  Desk set up can be optimized by having the monitor 20 to 30 inches from the eye with the top of the monitor at approximately eye height and centred in front of the face.  Having room under the desk to allow the legs to move and stretch is also advised.

 

The Keyboard and Mouse

A drop down keyboard allows a worker to keep the elbows close to the body and the forearm parallel with the floor, decreasing the amount of reach and subsequent strain on the shoulder, elbow and wrist.   Newer ergonomic mouses and keyboards keep the wrist in a more neutral position, lessening the risk of repetitive strain injuries to the wrist and hand.

 

These small changes can have a big impact but further consultation with a physical therapist can help to address additional factors that are specific to the individual.

Injury Prevention in Runners

Injury Prevention In Runners

50% of people who take up running will quit within the first year due to an injury! The majority of injuries suffered by runners are repetitive strain type injuries related to tissue overload with inadequate time for tissue adaptation. Most of these injuries can be diagnosed clinically and will respond well to conservative management with imaging and medical specialist referral often not required.

Most Common Running Injuries

  1. Patello-Femoral Pain Syndrome
    • characterized by anterior knee pain usually felt above the patella, worse with stairs, kneeling and prolonged sitting.
  2. Ilio-tibial Band Syndrome
    • characterized by lateral knee or hip pain, occasionally a click or catch at the lateral knee, onset often at specific mileage or duration of run
  3. Plantar Fasciopathy
    • arch pain, usually worse in the morning, may be related to the addition of plyometrics to training
  4. Achilles Tendonopathy
    • achilles tendon swollen or tender to palpation, may be related to the addition of hills to training
  5. Medial Tibial Stress Syndrome/stress fracture
    • anterior shin pain, overload type injury related to increased mileage
  6. Patellar Tendonpoathy
    • anterior knee pain below the knee cap, may be related to increased hill training

 

Runners presenting with any of these conditions would benefit from physical therapy treatment. Visiting a physical therapist who specializes in running analysis can facilitate a speedy recovery and help to maximize  performance as well as prevent future injury. Evidence based running analysis is now being offered at Corona Station Physical Therapy. Foot strike pattern, cadence, shoe choice, strength, biomechanics and training habits will all be evaluated to ensure that you are running safely and efficiently. If you have an upcoming race, training plans can be developed to maximize adaptation to mechanical and physiological loads.

Ashley Cripps and Ehryn Crane are both physical therapists certified through The Running Clinic as Specialists in injury prevention in runners.

The Cervical Deep Neck Flexors

The Cervical Deep Neck Flexors

A large percentage of skeletal stability is afforded by muscles.  Muscles are designed to stabilize the skeleton in mid range, functional positions and are the only system that can compensate for changes in articular integrity.

All muscles are important for motion and support, however, not all muscles function in the same manner but rather fill specialized roles.  The more superficially positioned neck muscles can maintain head position against gravity and have a greater torque producing capacity than their deeper counterparts.  These superficial muscles, however, are not suited to provide fine segmental motion control.  The deeper cervical muscles situated immediately adjacent to and spanning shorter sections of the spine, form a sleeve around the cervical and craniovertebral regions.  Their anatomical design allows them to provide effective segmental motion control and support spinal curves.  (Mayoux Benhamou 1994, Boyd-Clark 2002)  Segmental buckling would occur if the superficial muscles were to work on their own without adequate activation of the deep muscle network.  (Winters and Peles, 1990)  Balanced activation of the deep and superficial flexor and extensor muscle networks is necessary to optimize function and minimize the potential for a pain state.

Numerous studies of individuals with neck pain have identified changes in relative activity of the deep and superficial neck muscles.  Individuals with neck pain show decreased strength and endurance of their deep neck flexors (Longus Capitis and Longus Colli) when compared to control subjects.  They also exhibit increased superficial muscle activity (SCM and Anterior Scalenes) compared to control subjects.  (Jull et al 1999, 2000, 2004, 2009; Gupta et al 2013; Elsig et al 2014)  Decreased activation of the deep cervical flexors with concurrant increase in superficial flexor activity will typically result in altered movement strategies and increase the potential for dysfunction.

The craniocervical flexion test (CCFT) is a simple yet proficient test to screen for neuromotor control of the deep neck flexors.  It assesses for activation and isometric endurance of the deep cervical flexors.  In addition, it monitors for early or excessive activation of the superficial neck flexors.  The CCFT can serve as an effective retraining tool in cases where dysfunction is identified, progressing the individual through increasing levels of difficulty.  (Jull GA et al. 2008)  The CCFT is used routinely by physiotherapists at Corona Station as both an assessment and treatment tool with favourable results.

Stages of Tissue Healing

Stages of Healing

 

One of the most common questions we hear as physical therapists is “How long will it take for me to recover”?  Soft tissue injuries such as ligament sprains and muscle strains follow a characteristic pattern of healing with three general phases, the inflammatory phase, the proliferative or fibroblastic phase and the maturation or remodelling phase.  These stages may overlap and are not always linear, injuries may progress or regress through the phases depending on certain patient specific factors that may be either intrinsic (such as severity of the injury and age) or extrinsic (such as anti-inflammatory use or repeated re-injury).

The inflammatory phase is characterized by a complex cascade of events at the biomechanical and cellular levels.  The net result is clotting of any ruptured blood vessels with a return to homeostasis, followed by vasodilation and the introduction of antibodies, white blood cells, enzymes, nutrients and growth factors to the wounded area.  Pain, swelling and redness are typically noted during this initial phase, which lasts five to ten days.

Once the damaged tissue has been cleared with the inflammatory phase, the body can begin laying down new tissue during the proliferative phase.  This tends to be a relatively inelastic type of scar tissue that is different in make – up than the original tissue of the ligament, tendon or muscle.  This stage of healing can last from four to six weeks.

The final phase of healing is characterized by remodeling of the collagen fibers, which will become more parallel with the lines of stress applied to the injured tissue.  Tensile strength will continue to increase, providing greater mechanical integrity and reducing the susceptibility to injury in the future.  This process can continue for up to a year, the clinical implications being that a client may still feel some mild residual symptoms and may be prone to injury with lesser insult.

Given the stages of healing typical of a soft tissue injury, clients can expect a six to eight week recovery process, with the understanding that that the final phase of healing can continue for up to a year following the injury.  Also of note, the stages of healing are affected by client specific factors including age, the severity of the injury, previous injuries, co-morbidities, job demands and compliance with activity modifications recommended by the therapist.  For further information or to speak with one of our physical therapists, please contact Corona Station Physical Therapy directly at getwell@coronaphysio.com.

What is Manual Therapy?

What is Manual Therapy?

The term manual therapy is widely used in physical therapy practice but is perhaps less widely understood. Manual therapy is a broad phrase used to describe the “hands-on” work performed by physical therapists and can include soft tissue techniques, joint mobilization and mobilization with movement, manipulation and myofascial release. These techniques form a cornerstone of the physical therapy profession and all treatment plans typically include at least some form of manual therapy.

 

What are Mobilization and Manipulation?

These interventions are forms of manual therapy and aim to restore motion, decrease pain, improve function, and can indirectly decrease muscle tone. They are based on a biomechanical model. Along with the particular movement of a bone in space (an osteokinematic movement) there is a consistent associated glide at the joint (arthrokinematic movement). For example, when we flex the finger, the distal bone glides in a palmar direction on the proximal bone at each of the interphalangeal joints. Clinically, this means that if an individual is limited into flexion following a hand injury, a physical therapist can aim to restore motion by performing a palmar glide of the distal bone. Manipulation is defined as the skillful application of a high velocity, low amplitude thrust and is used when a joint is fixed, in cases where mobilization is no longer providing improvement, as a means of improving muscle tone via neuromuscular feedback, and in incidences where there is a loose body in a joint. Often there is a cavitation or popping sound as gas is released from the joint. Manipulations can be applied so that the force is perpendicular to the joint surface, causing a gapping or distraction of the joint, or so that the force is parallel to the surface of the joint, causing an arthokinematic type glide and restoring motion in a particular direction.

 

Is There Evidence to Support The Use of Manual Therapy?

There is a growing body of evidence addressing the efficacy of manual therapy. To date there is evidence to support the use of manual therapy in treating numerous conditions including ankle sprains, rotator cuff tendinopathy, cervical spine dysfunction and chronic low back pain (1, 2, 3, 4). Manual therapy is rarely used in isolation and is more often one component of a comprehensive treatment plan that will include education, therapeutic exercise, dry needling and modalities. For more information or to speak to one of our physical therapists, please contact the clinic directly.

 

References

  1. The Efficacy of Manual Joint Mobilisation/Manipulation in Treatment of Lateral Ankle Sprains: A Systematic Review. Loudon JK1,Reiman MP,Sylvain J. Br J Sports Med 2014;48:365-37
  2. The Efficacy of Manual Therapy for Rotator Cuff Tendinopathy: A Systematic Review and Meta- analysis. Ariel Desjardins-Charbonneau, Jean-Sébastien Roy, Clermont E. Dionne, Pierre Frémont, Joy C. Macdermid, François Desmeules. J Orthop Sports Phys Ther. 2015; 45(5):330-350
  3. Manipulation and Mobilization of the Cervical Spine: A Systematic Review of the Literature. Hurwitz EL1, Aker PD, Adams AH, Meeker WC, Shekelle PG. Spine (Phila Pa 1976). 1996 Aug 1;21(15):1746-59
  4. Manual Therapy and Exercise Therapy in Patients With Chronic Low Back Pain: A Randomized, Controlled Trial With 1-Year Follow-up. Aure, Olav Frode PT; Hoel Nilsen, Jens PT; Vasseljen, Ottar PhD. Spine: 15 March 2003 – Volume 28 – Issue 6 – pp 525-531

The Physiology of Fat

The Physiology of Fat by Jack Haworth MScPT, BSc

The World Health Assembly in May 2012 stated a goal of ‘no increase in obesity or diabetes levels’ from 2010 by 2025. Ezzat et al (2016) conducted a meta-analysis from 1975-2014 and now state that if trends continue there is zero percent chance of meeting the global obesity target. The correlation between chronic disease and sedentary lifestyles are well documented. Getting more physical activity and losing weight is something the majority of people would say they need, but whose job is it to tell you this medically, and who do you ask for advice? When does that advice become more than ‘eat less refined sugar and exercise more’?

How Does the Body Use and Store Energy?

Pancreatic release of the hormones insulin and glucagon dictate what gets used as energy and what is stored in reserve. The food we eat is broken down in the stomach and the energy floods into the blood stream at differing rates, depending on factors such as glycemic index and fibre content. Increased blood sugar levels trigger the release of Insulin which gathers the excess circulating metabolites for storage. They are then transported to the muscles and liver and stored as glycogen (which have a limited capacity), or lumped together as a TAG (3 free fatty acids-FFA, and a glycerol) and stored as adipose. So it makes sense that if our diets contain high concentrations of sugar and fat, then our body mass index will increase. When we haven’t consumed energy for a few hours, Glucagon is released as blood glucose levels are low. FFAs are liberated from the adipocyte to the bloodstream by the hormonal reaction – lipolysis. Transport proteins deliver the FFAs to the working muscles, where they are utilized inside the mitochondria as energy. If insulin is the storing hormone then glucagon is the mining hormone. That being understood, exercise can now be utilized to manipulate whether we burn off exogenous or endogenous energy by ensuring we don’t exercise immediately after food consumption.

Adenosine Triphosphate (ATP) is what we spend as energy and is a derivative of metabolites such as muscle glycogen and fat. ATP demand positively correlates with the power output of an exercise bout (Egan and Zierath 2012). Exercise intensity however, can be manipulated to determine where the ATP source derives from. Romijn et al. (1993), & Van Loon et al (2001) found both intra-muscular and extra muscular levels of FFA utilization are at their highest during low-moderate (<65% V02 and aerobic) exercise, and as the intensity increases, muscle utilization of the circulating FFA declines, whereas glucose utilization increases (anaerobic >65%). It therefore stands to reason that if we want patients to lose weight, exercising at lower intensities for longer periods of time is sound advice. This advice is also in line with the safety precautions we would take when prescribing exercise as an intervention in patients with HBP and CHO, and even AS, DM and angina. If the goal of exercise is weight loss, then knowing when and how to exercise is the key to being efficient and safe.

What Does This Mean for Those Looking to Lose Weight?

Consuming an energy drink high in glucose before exercise causes glucose to flood the blood stream and is readily transported to working muscles for conversion to ATP. So in this instance you are burning the sugars which you have just taken in, not your own reserve, therefore they are counterproductive if your goal of exercise is weight loss. Conversely, following a fasting period >3hours or overnight, the high levels of glucagon and low levels of insulin mean that adipocyte reserves have been liberated and increased blood concentrations of FFA are been transported to the muscle for ATP, thus you are burning fat as energy. This metabolic state is only achieved through a period of fasting, otherwise glucose and FFA levels in the blood are high due to a recent feed, along with high levels of insulin, so in this state if you are not exercising you are most certainly increasing your adiposity reserve. First thing in the morning glucagon release has been facilitating homeostasis via lipolysis throughout the course of the night, but relatively speaking we don’t need much energy to maintain a sleeping body. The notion of breakfast being the most important meal of the day does ring true, but why not capitalize on this perfect window of natural lipolysis first with some low intensity exercise? In low risk patients, how you capitalize and burn off more endogenous fat is patient preference, walking, jogging or intermittent exercise will all be effective. In higher risk patients we know we need to restrict intensity and duration boundaries via RPE, heart rate and blood sugar levels but all can be manipulated to facilitate efficient weight loss.

The purpose of the above was not to give prescription parameters of exercise but to establish the chain of metabolic events when we eat, fast and exercise and how it’s possible to manipulate these events to make exercise more efficient when weight loss is the goal. For the prescription of exercise parameters a comprehensive understanding of cooperating energy systems is needed, along with the potential co-morbidities of the patient.

 

Romijn. E., et al (1993). ‘Regulation of endogenous fat and carbohydrate metabolism in relation to exercise intensity and duration’. Am. J. Physiology. 266. pE380-E391.

 

Ezzati., M. (2016) ‘ Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants’. The Lancet. 387. p1377-96.

 

Egan., B & Zierath., J. (2012). ‘Exercise metabolism and the molecular regulation of skeletal muscle adaptation’. Cell Metabolism. 17. p162-184. World Health Assembly (2012). Resolutions and decisions. Geneva May 21-26.

De Quervain’s Tenosynovitis

De Quervain’s Tenosynovitis

WHAT IS De QUERVAIN’S TENOSYNOVITIS?

De Quervain’s tenosynovitis is a painful condition affecting the tendons in the first dorsal compartment of the wrist. The abductor pollicis longus and extensor pollicis brevis tendons as well as the synovium and tendon sheath become inflamed. The tendon then does not glide as smoothly in the sheath because of the increased friction and pain. This can cause a feeling of sticking, swelling, weakness and pain. De Quervain’s tenosynovitis can be aggravated or caused by repetitive motions, inflammatory arthritis  and severely limit a person’s ability to perform activities of daily living (ADLs).

SCREENING

De Quervain’s is most common in adult women. Those who are pregnant or caring for a small child or have rheumatoid arthritis are most at risk. Other risk factors include jobs and hobbies with repetitive hand movements.

Finkelstein’s test:

How to- passively pull thumb into flexion (ulnar deviation) and longitudinal traction

Eichhoff’s test: 

How to- fist around the thumb with neutral wrist position followed by ulnar deviation. A positive test is pain on the thumb side of the wrist.

Validity- Sensitivity: 0.89, Specificity: 0.14,

Wrist Hyperflexion and Abduction of the Thumb (WHAT) test: 

How to- Wrist flexion, thumb abduction, metacarpophalangeal and interphalangeal extension, followed by resisted thumb abduction/extension

Validity- Sensitivity: 0.99 Specificity: 0.29

DIFFERENTIAL DIAGNOSES

  • Tennis Elbow (lateral epicondylitis)
  • Arthritis
  • Carpometacarpal pathology
  • Cervical Radiculopathy
  • Median or Radial nerve pathology
  • Carpal tunnel syndrome
  • Scaphoid fracture
  • Intersection syndrome

WHAT CAN A PHYSIOTHERAPIST DO?

  • Determine useful stretches and exercises.
  • Review repetitive movements and provide suggestions to limit strain on these tendons.
  • Recommend a suitable splint if indicated.
  • Help reduce pain and swelling.
  • Determine if treatments are working. 

 

References: 

Goubau, J.F., Goubau, L., Van Tongel, A., VanHoonacker, P., Kerckhove, D., Berghs, B. (2014). The wrist hyperflexion and abduction of the thumb (WHAT) test: a more specific and sensitive test to diagnose de Quervain tenosynovitis than the Eichhoff’s Test. Journal of Hand Surgery; 39 (3): 286-92.

Magee, D.J. & Sueki, D. (2011). Orthopedic physical assessment atlas and video: Selected tests and movements. Elsevier Saunders.

Transversus Abdominus and Its Role in Lumbar Spinal Stabilization

Transversus Abdominus and its Role in Lumbar Spinal Stabilization 

Spinal stability is dependent upon three sub-systems: the active or contractile system, the passive or non-contractile system and the neural control system. (Panjabi, 1992). If dysfunction is present in any one or a combination of these sub-systems, the stabilizing capacity of the spine will be compromised and painful movement more likely to occur. While all muscles contribute to spinal stability and movement, some are better suited than others to provide dynamic stability. In the lumbar spine (L/S), the deeper muscles, close to the axis of joint motion, with a predominance of Type I muscle fibers, have proven more effective as stabilizers than the larger, more superficially located lumbar spinal muscles.

Research has shown that: 1) people with low back pain (LBP) present with atrophy and altered activation of the deep spinal muscles when compared with persons without LBP (Hodges et al., 1996; Hides et al., 1994) and 2) the deep spinal muscles play a key role in developing inter-segmental motion stiffness which translates into improved dynamic control of the spine (Hodges et al., 2003).

Transversus Abdominus (TA) is an important dynamic stabilizer of the L/S. TA is able to directly increase intra-abdominal pressure which converts the trunk into a more solid cylinder. This reduces compression and shear forces acting on the L/S and transmits them over a wider area (Twomey & Taylor, 1987). TAs attachment to the thoracolumbar fascia further increases its ability to stabilize the L/S.

The success of specific spinal stabilization training for TA and other deep muscles lies in: 1) teaching clients to activate the dysfunctional muscle in isolation of other muscles; 2) effectively retraining slow twitch muscle fiber function through isometric contractions (low loads, sustained hold times); 3) repetition: to aid motor reprogramming; 4) teaching co-contraction of the target muscle, first with other deep muscles, then the global muscle network and 5) training carryover for physical and functional tasks of increasing levels of difficulty.

“Exercises that target the deep abdominal muscles with minimal external loading in the spine have been shown to be effective in increasing lumbar stability, thus treating and preventing the recurrence of LBP.” (Teyhen et al., 2008; Axler & McGill, 1997).

The physiotherapists at Corona Station Physical Therapy recognize the importance of specific exercise prescription and a properly executed home exercise program to ensure optimal rehabilitation results. Time is spent educating the client as to the importance of the exercises they are given, while frequent review ensures proper exercise technique and allows for appropriate progressions. We believe it pays to be picky! For more information, please contact us at the clinic by phone or email and ask to speak to one of our physiotherapists.

To Stretch or Not to Stretch?

To stretch or not to stretch?

Most of us stretch at some point in our lives, whether it’s for athletics, to lengthen a sore or stiff muscle, or just to see if it really is impossible to touch your nose to your elbow. Over the past few years there has been a lot of information presented about stretching: is it good or bad? Should it be done before or after sports?  Should it be done at all? It can be hard even for health professionals to keep up with the latest research but here is a small snapshot of what current research is showing.

RESEARCH ON STRETCHING

ACTIVE v. PASSIVE

Meroni et al. (2010): In a comparison of active (using the body’s own muscles to stretch) vs. passive (completely relaxing all muscles) the active group had significantly greater increases in flexibility after a 6 week program and maintained the results for 4 weeks, while the passive group lost most of its gains.

SHOULD IT BE PART OF A WARM UP?

Chaouchi et al. (2010): Testing 8 different warm ups from static stretching to stretching combined with a dynamic warm up this study found no adverse effects from stretching in relation to an explosive jumping test. It did however state that research is not unanimous and that before an activity stretching should be light and performed in conjunction with a dynamic sport specific warm up.

CAN STRETCHING IMPROVE HEALTH?

Lacaze et al. (2010): A 10 min daily program of stretches and exercises mid workday decreased physical pain, as well as mental and physical fatigue in a group of call centre workers compared to a group that had a standard passive 10 min rest break.

PHYSIOTHERAPIST COMMENTARY

To say that we completely understand stretching and know everything about it would be misleading. There are still many different research articles coming out every year on stretching, many of them contradictory. What we do know is that when a muscle is too short it can affect its ability to contract normally, affecting performance and possibly leading to injury. We also know that stretching has been proven to be effective in relieving many injuries such as heel pain, even when compared to newer more technologically advanced methods (Rompe et al. 2010). Stretching can be an effective way to achieve normal muscle function, enhance the bodies ability to be mobile, and decrease pain. It is important to incorporate stretching into an active, healthy lifestyle to help promote maximal health and wellness. Physical Therapists prescribe stretching along with many other techniques to assist their clients in achieving optimal health For more information, please contact us at the clinic by phone or email and ask to speak to one of our physiotherapists.

Plantar Fasciitis

Physiotherapy Treatment of Plantar Fasciitis

What is Plantar Fasciitis?

Plantar fasciitis is a common condition causing pain in the heel, which can radiate into the foot. It is typically seen in people age 40-60 but can also occur in younger people who are on their feet a lot, like athletes or soldiers. Plantar fasciitis may present in one foot or both feet. The plantar fascia or arch ligament runs under the foot from the calcaneus to the metatarsal heads at the ball of the foot. It is thought to be an inflammatory condition as well as involving some degeneration of the collagen fibres close to where the plantar fascia attaches to the calcaneus. 

A variety of causes or contributing factors exist for plantar fasciitis. Some of the most common causes include:

  • excessive weight load on the foot due to obesity or prolonged standing
  • mechanical imbalances through the joints of the foot
  • sudden increase in walking or running (overuse)
  • tight calf muscles, which also insert into the calcaneus
  • wearing shoes with poor support, including flip-flops

The most common treatments for plantar fasciitis include:

* icing the affected area

* use of custom-made orthotics with your shoes

massaging the plantar fascia

* nonsteroidal anti-inflammatory drugs (NSAIDs)

* steroid injections

* strengthening the foot and lower quadrant muscles

* wearing a night splint

* wearing shoes with arch support

* stretching the calf muscles

* physiotherapy (which often includes many of the above)

Clinical Implications:

There is no single cure for plantar fasciitis. Whilst many treatments can be used to ease pain, in order to treat it effectively long-term, the cause of the condition must be addressed. A recent randomized controlled trial (2011) investigated the effects of trigger point (TrP) therapy combined with a self-stretching program for patients with heel pain. After one month, the patients receiving a combination of calf muscle and plantar fascia stretching and TrP release had significantly greater improvements in their calcaneal pressure pain thresholds, functional and pain scores as compared to those receiving only the self-stretching program.

Physiotherapy Treatment: 

For patients presenting with plantar heel pain it is important that all contributing factors be addressed. At Corona Physio-Rehab Centre, we are able to address the biomechanical factors and provide education, custom orthotics if indicated, and personalized home programs of stretching and strengthening. We also assess the gastrocs and soleus muscles for tight bands, knots, and trigger points and treat them using various deep tissue release techniques. Dry needling has also been found to be very effective in releasing these trigger points. For further information, please contact us at the clinic and ask to speak to one of our physiotherapists.


Reference:

Renan-Ordine R et al Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: a randomized controlled trial. J Orthop Sports Phys Ther. 2011 Feb;41(2):43-50. Epub 2011 Jan 31

Shoulder Impingement Syndrome

Shoulder Impingement Syndrome – Contributing Factors and Management

The primary function of the rotator cuff (RC) muscles is to stabilize, compress and provide fine motor control to the glenohumeral joint. The supraspinatus acts to compress the humeral head into the glenoid fossa and prevent excessive superior translation of the humeral head during functional activities. The subscapularis acts to prevent excessive anterior and superior translations of the humeral head, which is one of the leading biomechanical causes of impingement syndromes (Sarhmann, 2002). The infraspinatus and teres minor act to prevent excessive superior and posterior translations during activity.

The subacromial space houses the supraspinatus tendon, subacromial bursa and the biceps tendon. 

Factors that affect the subacromial space:

 anatomical variation: shape and size of the acromion or presence of osteophytes

 previous shoulder trauma that disrupts the stabilizing mechanisms of the joint, affecting the firing patterns of the RC muscles

 altered scapular positions due to muscles tightness, imbalance or poor stabilizer recruitment patterns 

Postural faults, scapular dyskinesis and muscular imbalance can also lead to RC impingement. Shortening and tightness of pectoralis minor can cause the scapula to sit in a downwardly rotated position at rest, bringing the acromion process closer to the humeral head (Borstad, 2004). Poor thoracic spine extension causes the scapula to be further protracted and downwardly rotated thus limiting the mobility of the scapulothoracic complex (Borstad, 2006).

Physiotherapy Management:

Typically, the subscapularis and supraspinatus need to be strengthened to reduce anterior and superior translation of the humeral head. Coupled with this, the posterior cuff with an overactive ingraspinatus and tight posterior capsule need to be released. Through specific neural and strength retraining, physiotherapy can influence the firing patterns of the RC as dynamic stabilizers and use manual therapy and/or needling techniques for the posterior cuff. Furthermore, the physiotherapist can address the scapular kinetics, releasing and stretching muscles causing downward rotation (the pec minor and levator scapulae) and strengthening muscles that work to upwardly rotate the scapula (serratus anterior). The physiotherapist will also address postural faults including thoracic hypomobility via mobilization/manipulation and postural endurance retraining of the rhomboids and middle and lower trapezius. For more information, please contact us at the clinic by phone or email and ask to speak to one of our physiotherapists.

Understanding Pain

Understanding Pain

What is this pain that I feel?

There are many definitions of pain. The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.” In the human body the experience of pain starts with the stimulation of a nociceptor (pain receptor). The stimulus may be noxious, inflammatory or due to disease. Nociceptors are located in the skin, joints, muscles and the walls of organs. The stimulus is changed to an electrical current which travels along the nerve to the spinal cord BUT this is not yet pain. In the cortex of the brain many areas are activated by the transmission of the stimulus including those associated with emotional learning, memory and reward. Here pain is perceived or interpreted from the complex interaction of electrical and chemical impulses from different areas of the brain. At the cortical (brain) level then a response is generated dependent on many interacting bits of information.

Is all pain the same?

Pain may be acute or chronic/persistent. Acute pain occurs when tissue is damaged as for example in a burn or sprained ankle. This type of pain usually goes away as the lesion heals or the cause of the pain is removed. Chronic or persistent pain refers to pain that is experienced after an injury heals. This may be the pain related to a degenerative disease, or long-term pain from an unknown cause. Chronic pain may be generated by the body’s response to acute pain. Repeated or intense stimulation of nociceptors may trigger changes within the nervous system. This can be in the periphery, or centrally in the brain and spinal cord. Some of the changes include hypersensitivity to stimulation or magnification of normal stimuli. This condition is described as a sensitized nervous system.

At Corona Station Physical Therapy, our registered physiotherapists stay up to date with the latest in Pain Sciences/Medicine. We manage acute and persistent pain. Persistent pain conditions often require team work with other health professionals. For more information, please contact us at the clinic by phone or email and ask to speak to one of our physiotherapists.

Gokavi Transverse Technique

Gokavi Transverse Technique (G.T.T.)

The Gokavi Transverse Technique (G.T.T.) was developed by Dr. Cynthia Gokavi, a physician with many years of experience treating myofascial pain syndromes. With an extensive background in both traditional acupuncture (AP) and dry needling, Dr. Gokavi herself has suffered from chronic pain for more than 25 years. Her quest, both personal and professional, for improved chronic pain treatment measures led to the development of this technique.

G.T.T. is a dry needling acupuncture technique used to treat myofascial pain (acute and chronic) and soft tissue restriction. G.T.T. differs from other dry needling AP techniques in that: A) it utilizes high frequency electrical stimulation pre-needling and B) advocates transverse orientation of the AP needle into target muscle tissue. Acupuncture needles are inserted in a specific transverse direction to form a closed circuit which encompasses the target treatment area. Needles are then electrically stimulated with two different high frequency currents. Electrical stimulation results in relaxation and analgesia of muscle tissue enclosed within the circuit. Muscles are then lifted and needled transversely through their entire thickness to release palpable trigger points and taut myofascial bands.

Advantages to using G.T.T. are many. They include: decreased dry needling pain. The relaxation/analgesic effects induced by the circuit, combined with the transverse orientation of the needle (generally recognized to be less painful than a perpendicular approach) results in less muscle cramping and spasm. This notably decreases both needling pain and post treatment soreness. Larger areas can be treated in a shorter period of time. Less needling is required during subsequent treatment sessions, fewer treatments are required and time between treatment sessions can be lengthened. Increased patient compliance is noted as a result. Muscle relaxation obtained with the circuit allows the practitioner to effectively target myofascial restrictions in deeper muscle layers. Results are immediate. The transverse orientation of the needle decreases the risk of injury (i.e.: perforation) to internal organs.

Possible side effects to any dry needling technique include the potential for: bruising/bleeding, discomfort, post treatment fatigue/soreness and syncope. Contraindications include: pregnancy, local infections/skin conditions, anti-coagulant use, bleeding disorders and cardiac pacemakers. Clients with pacemakers can be treated if the circuit is omitted.

Our physiotherapists at Corona Station Physical Thrapy are qualified to perform G.T.T., and it is frequently employed at the clinic in the treatment of individuals with chronic myofascial pain, fibromyalgia, adhesive capsulitis, muscle restriction post immobilization and total joint replacements (pre-surgical), to name a few. Results have been very favourable. For more information, please contact us at the clinic by phone or email and ask to speak to one of our physiotherapists.

Barefoot Running

Barefoot Running

Origins of Barefoot Running:

The evolution of the five-finger shoe (or “barefoot running shoe”eg. Vibram Five Finger) started when observers noticed that members of African (particularly Masai) and Polynesians did not suffer from low back pain and lower limb overuse injuries to the same degree as others in the Western world. The argument was that because members of these indigenous tribes did not wear shoes, they had more developed intrinsic foot musculature as well as more developed extrinsic musculature of the postural lower limb muscles than those who spent their lives wearing structured shoes. The Vibram five finger shoe provides almost no structural arch support, to simulate barefoot running with minimal protective covering over the sole of the foot. 

Does it Really Reduce Incidence of Overuse Injuries?

The most important link between claims of reduced injuries or the theory of strengthening the foot intrinsics is that is causes the runner to adopt a different running style. Barefoot running incorporates a forefoot strike (as opposed to the traditional heel-toe running style) and focuses on a concentric muscle activity in the hamstrings to ‘pick the foot up’ during the swing phase of running. Essentially a barefoot runner never allows their heels to hit the ground. 

Pros:

– Rather than joints taking the brunt of he load, the forces from the ground reaction force are dispersed throughout the muscle system to spare the joints from undue compression.

– This running style requires that the forefoot strikes under the hips, thus eliminating a ‘braking force’ on the lower limb that is characteristic of heel-toe running. 

– The running action becomes more efficient. 

– Decreased loading of the knee joint and eccentric forces on the IT band may decrease the risk of developing IT band friction syndrome

Cautions:

– It takes a bit of practice to master the barefoot style of running

– Because the heel never hits the ground, it requires extraordinary endurance in the calf muscles (particularly soleus) to be able to run significant distance using this style.

– Clinically, soleus strains are the most common complaint of runners switching to the barefoot style running. 

– Transition to barefoot running should be done over a period of several months, alternating between a structured shoe and a Vibram, increasing the amount of time spent in a Vibram. This allows time for proprioceptors, intrinsic foot muscles and supportive hip and postural muscles to adapt to the change in support.

Clinical Relevance: 

Barefoot running is not for everyone. Some people who have spent their lives in supportive shoes have so much foot atrophy that transitioning to barefoot is not worthwhile. In some cases, it may even be impossible, depending on the structural degeneration or anomalies of the individual’s foot. In some cases, extra support and orthotics are necessary and barefoot may be more damaging to that individual. In the case of an injury, it is advisable to seek assessment and treatment for the cause of the problem, which may include adapting your running style and strengthening of certain musculature. If there is any concern about transitioning to barefoot running, a biomechanical assessment of the foot and/or running technique would be prudent prior to adopting this new style.

For further information, please contact us by phone or email and ask to speak to one of our physiotherapists.

References

Crevier (2009) J. musculoskeletal Medicine 26 (7)