Sports
Cycling is considered a low impact activity but some cyclists do experience pain the the back, knees, feet, saddle region, neck, wrists and hands.
The Physiotherapy Association of British Columbia (PABC) recently outlined some simple steps, call the Physio-4, that cyclists can use to reduce their chances for injury, prevent pain, and cycle more effectively.
The Physio-4 for Cycling:
Select a bike that fits. An ill-fitting bike causes pain. A bike that fits – frame size, pedal alignment, handlebar position and saddle height – promotes good posture. Your physiotherapist can provide tips on correct bike fit and can correct poor mechanics before pain and injury develop.
Choose cycling if you have osteoarthritis in your hips, knees or feet. The non-impact, rhythmic motion helps reduce joint pain and stiffness and keeps your muscles strong. Your physiotherapist can prescribe a cycling program and help you choose the right bike.
The aerobic benefits of cycling help to manage high blood pressure and reduce the risk of heart disease. Cycling builds stamina. Your physiotherapist can help determine the right level of aerobic exercise and develop a program to meet your goals.
Stretch and strengthen off your bike to improve on-bike performance. Your physiotherapist can create a program to treat muscles that are prone to tightness as well as help you strengthen areas such as your core to dramatically improve your cycling efficiency.
It’s also important to remember to always wearing a helmet and fluorescent clothing by day and reflective clothing at night. After dark and in the rain, cyclists should ensure they have lights that work – white for the front and red for the back. Cyclists should also be vigilant about what’s on the road and be on the lookout for car doors being opened by motorists.
Shoulders
Do you lie awake at night with an aching shoulder? Do you feel sharp grabs of pain while reaching up into the cupboard or into the back seat of your car? Did your shoulder pain start one day without any injury that you can remember? Shoulder pain can keep us awake at night and limit our day-to-day activities – even the most basic ones like washing our hair or getting dressed. In this article we are going to talk about how shoulder problems can start and what there is to do about it.
First let’s talk about what is inside your shoulder. The shoulder is what we call a ‘ball and socket’ joint. This means that the top of the upper arm bone has a ‘ball’ like surface, and this ball connects with the concave surface of the shoulder blade, similar to a golf ball sitting on a tee. This type of joint (like your hip joint) is build for maximum mobility. Having so much mobility is a good thing because it allows our shoulder and arm to reach in all different directions. However, this excess mobility can also predispose the shoulder to injury.
Almost everyone has heard of the rotator cuff. The rotator cuff is a group of 4 muscles responsible for protecting the shoulder. These are often the muscles that are injured in the shoulder because they can become pinched inside the joint (referred to as ‘impingement’). The rotator cuff muscles work alongside the muscles of your shoulder blade to ensure that the ball is always positioned in the centre of the socket so as to avoid pinching, inflammation and pain. Impingement can occur if any of these shoulder muscles become tight or weak or if the neck and upper back are too stiff to allow for proper arm movement.
People that spend a large portion of their days sitting often become very weak in their shoulder blade muscles while at the same time also becoming tight in their chest, upper back and neck. Others spend a lot of their workday doing repetitive movements with their arm that also can create irritation and muscle imbalances in the shoulder. At night many of us tend to lay on our ‘favourite’ side while sleeping which squeezes the blood out of the shoulder thus causing further irritation and preventing recovery from the strain during the day.
If you start to have shoulder pain the best strategy is to avoid the movement that is creating the pain and to ice the shoulder for 15 minutes 2-3 times per day for the initial 3 days (after 3 days switch to heat for 20 mins, 2-3 times per day to increase blood flow/healing). Make sure to continue to move the shoulder in motions that don’t hurt in order to prevent your shoulder from getting stiff. Also try as best as you can to not sleep on the painful shoulder at night in order to allow healing.
If the pain does not subside within a week it is advisable to see your health care professional so that the specific reason for the shoulder pain can be diagnosed. In physiotherapy, pain control and stretching out tight muscles are usually the initial goals. Treatment then fairly quickly progresses to focusing on strengthening specific muscles as well as increasing overall flexibility. Often the conversation of prevention will focus on daily stretching or Yoga as well as emphasizing good posture while sitting.
I hope that you have learned a little bit about how the shoulder works and what can cause shoulder pain. If you are starting to have nagging shoulder pain or tightness, remember that it is much easier to deal now then ‘down the road’. Happy spring (summer) everyone!
Graham Gillies is a registered Physiotherapist at Sun City Physiotherapy Winfield and is a fellow of the Canadian Academy of Manipulative Therapy and a certified Gunn IMS and acupuncture practitioner.
Hips and Knees
Your Hips: The ‘Core’ of the Problem?
I think most of us by now have heard about the importance of strengthening your ‘core’. But did you know that the most important part of your core for preventing hip, knee, and ankle injuries are your hip muscles? Your hip muscles or ‘glutes’ are the largest group of muscles in your lower body and are a part of your core that are often much weaker than they should be.
So what exactly are the hip muscles responsible for? Strong hip muscles keep your spine, pelvis, knees and ankles in alignment. If your glute muscles aren’t strong enough your hips rotate and drop, your knees move inward and your feet flatten (pronation). All of these motions create more strain on the joints, ligaments and tendons of your lower body. This excessive strain often leads to injury and persistent pain. Achilles tendinosis, patellofemoral knee pain, iliotibial band (ITB) syndrome, and piriformis syndrome are all common injuries linked to weak hip muscles. Research is also showing that hip weakness is a major risk factor for non-contact ACL (knee ligament) injuries.
So why do our hip muscles become weak in the first place and what can we do about it? The latest research done by Dr. Powers who is a physiotherapist in Los Angeles, shows that our brains have only a very small area dedicated to controlling the hip muscles. It is unclear why this is the case but it may explain why the majority of us don’t naturally use our hip muscles during activities such as: running, walking and hiking. The good news is that the same research shows that exercise can change the way our brains work.
In the study, patients that took part in specific hip strengthening exercises, actually showed changes in brain function. The areas on the brain controlling the hip muscles became larger after only a week of exercise! This is important because the larger the area of your brain dedicated to a certain muscle group is, the easier it is to ‘turn on’ and strengthen that muscle. Keep in mind though, these strengthening exercises need to be done for a minimum of 3 months in order to get significant strength improvements in the muscle.
So if you suffer from ongoing hip, knee or ankle pain, strengthening your hips may be the key to getting over your injury problems. Visit your local physiotherapist and ask for an assessment on your hip strength. If your muscles are weak your physiotherapist will give you the proper home strengthening exercises to address the weakness. Through these exercises you can change your brain to help change your pain.
Graham Gillies is a registered Physiotherapist at Sun City Physiotherapy Winfield and is a fellow of the Canadian Academy of Manipulative Therapy and a certified Gunn IMS and acupuncture practitioner.
Foot and Ankle
There are four main ligaments that provide stability of the knee joint – the medial and lateral collateral ligaments on either side of the knee, and criss-crossing deep inside the joint are the posterior and anterior cruciate ligaments. The anterior cruciate ligament (ACL) is a thick ligament that attaches from the lower surface of the femur (thigh bone) onto the upper surface of the tibia (shin bone) in a way that will resist the tibia from slipping too far forward or rotating too far inwards on the femur. If – as can happen during sports that involve twisting, jumping, or pivoting – the knee twists too far with a lot of force, then part of all of the ACL can be torn.
ACL injuries are one of the most common knee injuries and they are managed in different ways depending on the severity of the injury and the age and activity level of the person.
Non-operative management consists of physiotherapy treatment with focus on reducing the inflammation and working through a strengthening protocol in order for the muscles around the knee to support the knee joint as much as possible. In these cases the surrounding muscle support is crucial as the knee will be lacking some stability if the ACL hasn’t been repaired. A knee brace may also be useful to provide extra support once the person is taking on more activity at the end of the rehab and beyond.
In many cases surgery will be required. The repair is normally made with a graft taken from the persons own hamstring or patellar tendon. Once the surgery is done, the rehab begins immediately. Whereas in the past the knee might have been put in a cast and rested, current protocols involve early weight bearing and range of motion exercises. It is very important to regain the knee range of motion early on otherwise it can be hard to progress and achieve goals further down the line.
A strengthening program, developed by your physiotherapist, will be started post operatively in order to begin to regain some of the knee strength and stability. The strengthening program for ACL reconstruction rehab is quite specific because the exercises need to strengthen all of the important muscles without placing too much stress on the healing ACL graft. A gradual progression of strengthening is done, beginning with simple light exercises and building up until eventually more complex exercises that are specific to your sport can be achieved.
By the end of the rehab the goal is to have sufficient strength in the muscles and ACL graft to give the knee the functional stability it needs to cope with the demands placed on it during activity. A return to sport is typically achieved in around 9-12 months following surgery.
