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Squats!

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Squatting is a fundamental biomechanical motion and, as such, we all end up performing squats daily. This manifests during daily actions such as sit-to-stand (and vice versa) transitions from a chair, couch or even a toilet! That said, some of us challenge the squat motion during specific exercise activity. This can be accomplished in many ways by performing, for example, goblet squats or using a squat rack with an olympic bar. Since squatting is such a fundamental daily activity, let’s go over some squatting basics by discussing the joints primarily involved in squatting!

 

The 3 joints primarily involved in the squat motion, from bottom to top, are the ankles, knees and hip joints. A problem with any of these joints (or combination thereof) can dramatically alter the biomechanics of your squat. Even a slight change could place an individual at risk for serious injury. For example, limited motion at the ankle joints could result in over flexion of the lumbar spine during the doward motion of a squat. In this scenario, given that a person is using an olympic bar on their back during the squat, this could result in the bar rolling dangerously close to the head. I’ve personally witnessed this in a gym and a weighted olympic bar almost rolling over someone’s head!  

 

In order to address the ankle, knees and hips prior to squatting exercises or even for day-to-day activity, you want to get them moving! I recommend self mobilization/ballistic warm-up activities. These recommendations generally involve 3-4 sets of 10 of the following:

 

-ankles: clockwise and counterclockwise circles as well as up/down motions

-knees:  bend and straighten

-hips:  in and out’s and flexion and extensions

 

If you intend to perform squatting exercise activity, after warming up the aforementioned joints, I then recommend performing 3-4 sets of 10 of an unweighted squat motion. The idea is to warm up the joints then get the body ready for a weighted activity by performing the unweighted biomechanical motion of the activity you are about to perform.

 

Given that there is no existing issue with the knees, hips, ankles or low back/pelvis, your squats should operate smoothly. However, if you should have questions regarding your squats, how to properly perform them or even concerns about the health of the joints involved in squatting, do not hesitate to contact your healthcare provider today for a thorough assessment!

 

Happy squatting!



Author:  Dr. Paolo De Ciantis, B.Sc.(Hons.), M.Sc., D.C.

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Lace Up Those Skates

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It’s finally winter!  That means many of us will be participating in fun winter activities outdoors like skating.  That said, in order to minimize the likelihood of injury, it is important to perform a few basic warm up activities specifically geared for skating prior to lacing up those blades!

 

  1. Prior to skating, get active first by simply walking around the rink/ice surface for 5-10 mins.  This will get the major joints moving and prepped for work while also getting your cardiovascular system primed.

 

  1. The primary joints involved in skating are the ankle, knee and hip joints.  As such, prior to lacing up the skates, I recommend 3 sets of 10 of the following for each joint:

-ankles: up/down and clockwise/counterclockwise rotations (perform while sitting)

-knees: bend and straighten (perform while standing)

-hips:  move the legs forward-back and in-out motion (perform while standing)

 

  1. After lacing up, I recommend a few minutes of a mild skate around the rink before you really dig in and let loose!

 

EXTRA TIP:  Wear comfortable clothing that will allow for the body to move easily in an unrestricted fashion while skating.

 

If you have specific concerns regarding skating or need further guidance, do not hesitate to contact your healthcare provider today for advice and recommendations.  Safe skating!



Author:  Dr. Paolo De Ciantis, B.Sc.(Hons.), M.Sc., D.C.

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Myositis Ossificans

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Myositis Ossificans!  That’s a mouthful!

 

“Myositis Ossificans” (MO) sounds like a fictional term but it is by no means a rare condition.  MO, for lack of a better term, is when muscle tissue begins to ossify (i.e. turn to bone) following a traumatic injury.  Generally, a direct, forceful trauma is involved (eg. a hockey player receives a knee-on-thigh injury during a game).  Typically a large, deep muscular group is involved, such as the quadricep or hamstring muscles.  In most cases, one would see a large discoloured area associated with a very significant bruise following the trauma.  Internally, the body will begin to turn muscle to bone at the healing site.  Over time, a “hard” lump can be palpated (as the body lays more and more bone) at the injured area.  The reason why MO occurs is not well understood at this time.  The thought is that following the injury the body gets “confused” and as a result it begins to lay bone at the site of injury.  As more bone is laid down, the function of the muscle may become affected leading to pain as the muscle is used.  This can prevent athletes from returning to sport or even end careers!

 

In order to minimize the likelihood of developing and/or exacerbating MO, after an acute traumatic event to a muscle, an individual should not return to sport and should ice and immobilize the affected area.  I also recommend immediately booking an appointment with a healthcare provider so that the injury can be thoroughly examined and assessed.  The healthcare provider can determine  if you are at risk of developing MO or if it is in progress.  Also, the healthcare provider can provide advice and offer conservative (i.e. “non-surgical”) interventions to manage the tissue trauma.  However, in serious or not properly managed cases, surgery may be indicated in order to remove the bone from the affected muscle. 

 

If you think you may be at risk of developing MO, please contact our office to book an assessment with one of our amazing therapists!

 

Author:  Dr. Paolo De Ciantis, B.Sc.(Hons.), M.Sc., D.C.

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Bone Contusion!

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A “contusion” is the medical term for a bruise.  Bruises usually occur at the site of an injury where blood vessels have been damaged resulting in leakage of blood from these vessels.  This leakage produces the characteristic discolouration we all associate with bruising. 

 

A “bone contusion” (i.e. “bone bruise”) is when there is trauma to bone, but not severe enough to result in a fracture.  Bone is wrapped in a thin tissue called “periosteum” (kind of like a “bone skin”).  The periosteum is composed of dense connective tissue and does not cover the articular (i.e. “joint”) surface of bones.  Periosteum is rich in nerve endings (which can result in pain) and blood vessels.  With a significant enough trauma, you can damage the periosteum leading to a bone bruise.  Symptoms can include, but are not limited to, pain (generally more severe and longer lasting than a solely soft tissue injury), swelling, stiffness and possibly discolouration.  Generally speaking, bone contusions will not present on x-ray examination but x-rays  may be required in order to rule out a fracture. The soft tissue surrounding the bone contusion may also be injured in the same traumatic event.  A bone contusion can be present for days, weeks or even months! 

 

If you think you may have received a bone contusion, don’t waste time to book an appointment with one of our talented therapists who would be able to examine you today!

 

Author:  Dr. Paolo De Ciantis, B.Sc.(Hons.), M.Sc., D.C.

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Plantar Fasciitis

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Plantar Fasciitis (PF) is a common foot condition affecting the plantar (i.e. sole) aspect of the foot.  The “plantar fascia” is thick fibrous connective tissue that runs along the sole of the foot the length of the heel to the toes.  PF occurs when the plantar fascia is inflamed.  This is primarily experienced as pain in the heel of the foot. The plantar fascia can become inflamed for a variety of different reasons ranging from wearing ill-fitting shoes to trauma associated with sports activity.  Very commonly, sufferers will experience the most pain with the initial steps out of bed in the morning with progressive reduction of pain over the course of the day as they move around.  However, pain can intensify after rise form a prolonged sitting period or movement following a prolonged standing period.  Sufferers can also experience PF in both feet simultaneously!

 

The good news is that manual therapists such as a Chiropractor or Physiotherapist are trained to determine the presence of PF and to treat it conservatively.  This can involve manually working directly on the plantar fascia and surrounding tissue as well as incorporating lifestyle modifications and rehabilitation.

 

If you think that you may be suffering from PF, don’t hesitate another moment to contact our office and book your examination today!

 

Author:  Dr. Paolo De Ciantis, B.Sc.(Hons.), M.Sc., D.C.

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Sprain vs. Strain!

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Is it a sprain or a strain?  What’s the difference?!

 

I am confident that most of us have been told at one time or another that we have experienced a “sprain” or “strain”.  However, what do these terms really mean?

 

Quite simply, a “sprain” refers to injury of a ligament (i.e. dense fibrous connective tissue that connects one bone to another bone) while “strain” refers to injury of a tendon (i.e. dense fibrous connective tissue that connects a muscle to a bone).  Medically, injury to a ligament (“sprain”) or a tendon (“strain”) is classified on a scale of 1 to 3.  Grade 1 or “first degree” refers to minor injury of the ligament or tendon.  Generally, there is little to no actual tissue compromise and, as a result, little bruising, bleeding or swelling but some pain.  Grade 2 or “second degree” sprains or strains result in tearing of the ligament and/or tendon.  As you can imagine, there is generally more pain and some moderate swelling and bruising.  Finally, Grade 3 or a “third degree” injury refers to a complete tear of the ligament and/or tendon.  This generally results in the most pain as well as significant swelling and bruising.  Depending on the area affected, there may also be mechanical compromise of the joint or limb.

 

Your Chiropractor and Physiotherapist are trained to assess for the presence and degree of ligament and tendinous injury. They can also determine if the severity of your injury may warrant a referral to a medical specialist.  If you think you have a “sprain” or “strain”, don’t hesitate to contact our office to book your next appointment and have one of our therapists assist you today!


Author:  Dr. Paolo De Ciantis, B.Sc.(Hons.), M.Sc., D.C.

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Floss Your Joints

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How often do you brush and floss your teeth?

Every day, right? You know it is important for the health of your teeth, and they go yellow and fuzzy if you don’t. Your partner will tell you when you need to brush your teeth, if you haven’t. But what about your joints? How often do you floss your joints for their health so you can move better and feel your best?

Having a daily mobility routine immediately improves and maintains your joint movement, reduces soft-tissue stiffness and allows for easier access to your active available range of motion (ROM). Everyday, just like brushing your teeth, you need to facilitate movement of every joint to keep it healthy until you are 100 years old. What if I told you that at the age of 70 we could get you back doing the splits again within a year? Yes, your body is malleable! 

When you were born, your body was at its most malleable. You can take a baby’s ankles and move them to do the splits in every direction with minimal resistance. Then as we grew up to start walking, running, playing soccer and sitting – we created the range of motion that our body now uses today based on our individual movement patterns and postures. If you don’t use it, you loose it! Those sitting positions restrict and don’t allow you to use your hips and their surrounding muscles and soft tissues to their optimal potential. What does your current ROM look like for your neck, shoulder, hips, ankles?

Your mobility is indicative of your quality of life. Do you have control of the range of motion that you have access to?

I believe in coaching through assisted stretching of Fascial Stretch Therapy in combination with Functional Range Conditioning with the goal of decreasing back pain, injury prevention in athletes, reducing stiffness in older adults and improving the quality of life of every patient on my table. Strength + control + breathe are prioritized as the pillars in order to expand upon usable ranges of motion, articular resilience and overall joint health and facilitate alterations in blood flow parameters as well as relative tissue glide. These principles in your prehab, rehab and training can be a game changer!

If you don’t brush your teeth, you get cavities. If you don’t articulate your joints, you get pain, decrease ROM and even joint degradation. Don’t just move more, move better and feel better!

Author:  Adriana Renton

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Heat vs. Ice!

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I get this question too many times a day to even count. So, I thought I would spend some time laying out why I might recommend heat for one person and ice for another.

Both heat and ice are helpful tools in pain management. Although there are many theories as to why they work, the research is incomplete and there is still much that is unknown. One main theory for icing, for example, is that the reduction in temperature reduces the conductive ability of your nerve to relay information back and forth, therefore not allowing the ‘alarm signal’ of pain to be expressed as quickly. It is also understood to be helpful for inflammation as blood flow to the area is decreased. Heat, on the other hand, promotes blood flow to the area, which is helpful for healing. Heat activates certain neurotransmitters which blocks the ability for our body to perceive pain.

WHEN TO USE ICE
You have an acute injury (e.g. ankle sprain), within the first 48 hours
Inflammatory conditions (e.g. rheumatoid arthritis, ankylosing spondylitis)
Red, hot, swollen tissue

WHEN TO USE HEAT
Acute low back or neck pain
Chronic pain
Muscle stiffness

HOW TO USE ICE
Make sure the ice is covered or wrapped in a wet cloth, and not against your bare skin to protect from frostbite (I’ve done this before. It’s not fun – I promise!)
Use the 20:20:20 rule – 20 minutes on, 20 minutes off, 20 minutes on. This can be repeated several times a day

HOW TO USE HEAT
If you have sensory issues, be careful not to burn your skin
Heat can be applied much longer than ice and there’s really no guideline – just make sure you are awake and aware of the sensations you are feeling so as not to become injured

Having said all that, each person and each body is different; what works for one person might not work for someone else. So, if you love ice and find it’s super helpful for your chronic pain – GO FOR IT!

As with everything, there are precautions and contraindications to all forms of therapy. Make sure you speak with a regulated health care professional to make sure that ice and/or heat is safe for you before using it.

Author: Dr. Allie Dennis

RESOURCES:
Algafly AA, George KP. The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. British Journal of Sports Medicine. 2007;41(6):365-369. doi:10.1136/bjsm.2006.031237.
Nadler SF, Weingand K, Kruse RJ. The Physiologic Basis and Clinical Applications of Cryotherapy and Thermotherapy for the Pain Practitioner. Pain Physician. 2004;7:395-9.
Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate Medicine. 2015; Early Online: 1-9.

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What is Fascia?

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Many of you may have heard of the term “fascia” before. Over the last few years, “Fascial Stretch Therapists” (F.S.T) have gained popularity in the fitness and Kinesiology fields. In fact, your Registered Massage Therapist (R.M.T) may have already thrown around the term myofascial release or even suggested incorporating fascial techniques into your hands-on sessions. It’s possible you might have even suffered from a common condition called plantar fasciitis. So, the question remains, what is fascia?

To best explain fascia, try picturing a form of netting, webbing, a sort of glue or bandage. It’s actually a dense sheet, or band, of irregular connective tissue that lines the body wall and limbs, supporting and surrounding muscle groups that perform similar functions. It is strong yet mobile. Picture a spiderweb, intricately interwoven silk threads; this intricate interwoven network runs throughout our entire bodies acting like a web, holding us together.


The appearance of fascia throughout the body can differ greatly, ranging from quite thick, mimicking muscles such as the fascia making up the plantar fascia of the foot; it can also be quite thin and broad such as the thoracolumbar fascia of the lower back. Important to note is that when fascia is tight and inflexible it can pull on other structures within the body, causing tension, pain and decreased range of motion.


Factors that can affect fascia:
⦁ Repetitive movement
⦁ Sedentary lifestyle (little to no daily movement)
⦁ Trauma including surgery or injury (ex. post C-section)
⦁ Postural imbalances
⦁ Inflammation
⦁ Pathology

The benefits of regular body work, or preventative maintenance as I like to describe to patients, is so important in maintaining the health of your muscles, tissues and fascia. Keeping these integral tissues in consideration for your fitness and overall health, and getting manual work done, the fascia will become more pliable, your range of motion will increase, you will begin to experience a decrease in pain and discomfort and it will eventually increase the flow of the lymphatic fluid. This can lead to decreased inflammation and swelling.

Regardless if you are feeling specific discomfort in a particular bodily area, preventative work can be performed. Each individual responds differently to each modality (ex. myofascial release, trigger point therapy, cupping, active release therapy, acupuncture and so on). Whether you see a Chiropractor, Physiotherapist, Acupuncturist, Registered Massage Therapist or Fascial Stretch Therapist, listen to your body!

At your next appointment ask your practitioner about fascial work or try a session with a Fascial Stretch Therapist – I’m sure you will not be disappointed!

Author: Lesley Andress R.M.T

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The DOMS

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Why does my body hurt after a workout?
You know that feeling a day or two after a really tough or new workout? The one where everything just hurts? Well that pain has a name! You might be suffering from something called DOMS (aka Delayed Onset Muscle Soreness).

What is DOMS?
DOMS is muscle pain that typically begins approximately 12-24 hours after a particularly difficult or new workout. The pain tends to peak between 24-72 hours after the offending exercise routine and can sometimes last up to 1 week!

Why does DOMS happen?
For many years it was believed that a build-up of lactic acid was the cause of this post-workout pain; however, more recently this has been proven untrue. Although there is still some controversy and unknown variables surrounding the exact mechanism of DOMS, the current general consensus is that it is related to the healing of microtears or microscopic damage to your muscle tissues that occur during eccentric contractions. Eccentric contractions are what happen when your muscle is both contracting and lengthening at the same time (for example, when bringing your arm back down in a slow controlled manner during a bicep curl, you are eccentrically contracting your bicep – keeping that contraction while bringing the muscle into a position of length).

How do I make it feel better?
Again, for this, the evidence is conflicting. Mostly, just giving your body some time to heal will help you out. This isn’t to say you should go sit on the couch and wait it out! Out of all of the poor evidence on treatment for DOMS, exercise has been found as one of the most effective methods (MOTION IS LOTION!). Instead of another gruelling workout right off the bat, try some lighter movements like a light jog, some light yoga and stretching for a few days before getting back into it. Things like ice or an Epsom salt bath might help speed things along as well but the evidence is poor on these. Make sure you are always hydrating!

Can I prevent DOMS?
While DOMS may not be entirely prevented unless you just don’t move ever (in that case, you’ll likely end up with worse problems than just some good ol’ DOMS), there are some ways to reduce the severity. When you’re starting a new exercise, make sure you progress slowly into it to give your muscles time to react to their new demands. Some evidence shows a proper warm-up and cool down might also be beneficial in prevention.

What if it isn’t DOMS?
If the pain occurs DURING the workout, if the pain persists beyond 1 week, or it is preventing you from doing your activities of daily living, then it might be something else. Make sure to seek care if things aren’t progressing the way you think they should. Of course, you always need to trust your own body and seek care if something doesn’t feel right.

Author: Dr. Allie Dennis

Resources:
Cheung K, Hume PA, Maxwell L. Delayed Onset Muscle Soreness: Treatment Strategies and Performance Factors. Sports Med. 2003; 33 (2): 145-164.
American College of Sports Medicine: https://www.acsm.org/docs/brochures/delayed-onset-muscle-soreness-(doms).pdf

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