Physio Articles
It’s that beautiful, sunny time of year again. It’s time to hit the tennis court, walk the golf course, hop onto the bike, or participate in other active ways of enjoying the Okanagan spring weather. As you increase your strength and endurance through these activities, be sure to also keep flexible. Make stretching a part of your routine.
Stretching describes a maneuver used to increase flexibility of soft tissue, lengthening the structures that have become shortened or stiff. Shortening can occur from situations such as immobilization (i.e. being in a cast), prolonged postures, weakness or imbalances of muscle groups, injury, or developmental conditions. Vigorous activity can also lead to shortening and tightening of muscles.
Benefits of stretching
Stretching improves flexibility by increasing the range of motion of a joint and decreasing stiffness in a muscle. This improved flexibility can improve performance in some sports, such as gymnastics, dancing, martial arts, or goalies in hockey. In other situations, improved flexibility can help obtain better posturing or help with pain. Other goals of stretching are to reduce the risk of muscle strain, reduce muscle soreness, and enhance mental and physical relaxation.
The risk of injury from stretching exercises is low when done correctly (described below), and when held for a short duration pre-exercise (less than 8-10 minutes of stretching per area), won’t compromise muscle strength.
When to stretch
It is important to ensure that you are warmed up prior to stretching. It is best to do so actively, such as by doing a light jog, bike, or quick walk for 5-10 minutes. If you are stretching pre-activity, do so after your warm-up regime. If stretching post-exercise, it follows the active cool-down.
The American College of Sports Medicine (ACSM) recommends stretching to be a part of overall fitness program, performed for the major muscle groups at least 2-3 times a week. In some cases, stretching should be performed daily.
How to stretch
Two of the more common kinds of self-stretching are static and dynamic. Dynamic stretches are usually performed pre- rather than post-exercise. These take the joint through the range of motion rather than being sustained at an end position. These exercises should be performed as instructed by a physiotherapist or your coach.
For static stretching, go into the position slowly, just to the point of feeling tension, not pain. Hold the position for 15-30 seconds if pre-activity, and the full 30 seconds if post. It is a low intensity stretch—it should not feel strong. If you feel like you are unable to hold the full duration, back out of the position slightly. Don’t bounce while here—just hold the position. When the 15-30 seconds is up (I recommend using a stop watch, or sing the ABCs—you’d be surprised at how long it actually is!) slowly release the tension, not allowing the muscle to recoil. The ACSM recommends 3-5 repetitions per stretch.
In order to avoid injury, it’s important not to overstretch, by taking the posture too far. The position should not cause discomfort or pain, and should be within a normal range of motion for the joint being exercised (don’t hyperextend).
Overstretching can do harm by causing strain, hypermobility, or even instability. Make sure that proper alignment is used—if you are unfamiliar with a stretch, seek assistance. Otherwise the exercise may not target the proper muscle, and can even cause stress to other structures
In some cases, extra help is needed. A trained individual, such as a physiotherapist, can use manual (hands-on) techniques to help you through the maneuver. Sometimes special techniques, such as ‘contract-relax’, will be used.
What to stretch
Post-activity, you’ll want to focus on the muscles that were just exercised.
Typically the muscles most frequently shortened are the hamstrings, calves, hip flexors and pectorals (front of the chest).
If unsure of how or what to exercise, or if you have an injury, be sure to seek advice from a trained individual to ensure you’re getting the maximum benefit from your stretching program, safely.
Physio Articles
Core Stability
One of the most common reasons people require physiotherapy is for low back pain. Treating low back pain usually centers on the common goals of decreasing pain, increasing range of motion and improving function. For the majority of low back injuries a core stability exercise program is beneficial for improving function and returning to activities of daily living, work and sports. Core stability exercises are a common and often successful treatment in physiotherapy for recovering from an injury, preventing a further injury, improving general health and optimizing athletic performance.
So what exactly is core stability?
We have three different systems that aid in the stabilization of our spine. One is the passive system which includes non-contractile tissues such as bones and ligaments. The second is the active system which includes contractile tissues such as muscles and tendons. This active system of muscles that attach to the spine and pelvis is necessary for stabilizing the spine and producing motion. The third is the motor control system. This can be thought of as our ability to turn on and off the required muscles to the correct degree at the appropriate time.
What causes someone to have poor core stability?
A lack of stability is often seen when one of the above three systems is affected. This could include factors such as: an injury to the tissue itself, insufficient muscle endurance, muscle imbalance or poor motor control. In fact, in many people with low back pain it is common to see atrophy of the spine stabilization muscles, poor muscle endurance, a muscle imbalance or delayed activation of the stabilization muscles. Physiotherapy focuses primarily on motor re-learning, or learning to activate the correct muscles at the appropriate time, and improving the endurance of these muscles.
What exercises should I be doing to improve core stability?
It is important to begin by understanding what exercises to avoid, exercises that may be doing you more harm than good. We determine the quality of a core stability exercise not only by how well it turns on the correct muscles but also by the amount of stress it puts through the spine, known as compression and shear forces. For example, while a sit up may be a great exercise to strengthen the core, specifically the rectus abdominis muscle, it requires excessive bending (or flexion) of the low back and results in a high compression force on the spine. Repeated bending of the back and high compression forces on the spine is a common mechanism of injury for tissue damage to the vertebral disc. This would make it a poor choice when designing a core stability program. It would also be unwise to do this exercise alone, as it will most likely result in a muscle imbalance which could potentially lead to injury. It is advisable to start a core stability program with exercises that keep the spine in a neutral position and avoiding excessive bending and twisting. Common exercises that I often teach to improve core stability include a front plank, a side plank and a squat. Along with other exercises, these three challenge different muscle groups and have lower compression and shear forces through the spine which minimizes the risk of injury.
When designing a core stability exercise program it is important to focus on improving motor control and muscle endurance rather than trying to improve muscle strength at higher loads. It would also be beneficial to include a cardiovascular exercise, such as walking, to your program. The exercises you include should be comfortable and should not cause any low back pain. One exercise program is not appropriate for everyone. Exercises should consider your training goals (injury rehabilitation, injury prevention, general health or improving athletic performance) and your past medical history (including general health and specific history of low back injury).
Sports
With the start of a new year, you may have made New Year resolutions to start running, or to take your running to the next level by completing your first marathon or half marathon. There are many factors to consider when you start to run or train for longer races. One major consideration is to avoid injuries. Shin splints are a common injury that physiotherapists see in clinic.
Shin splints are an umbrella term used to describe pain and discomfort in either the front or back portion of your shin. It usually presents in the lower 1/3 of the leg in the muscles around the tibia (shin bone). It typically has a dull ache but can be sharp and severe pain. Shin splints often start at the beginning of the workout, it may or may not disappear during the workout, and then returns after you finish your workout. Patients may also complain of soreness to touch and swelling.
Shin splints are often associated with running injuries, especially for long distance runners, novice runners, overzealous fitness fanatics, and for those just increasing hill training. You may also see it with dancers, tennis players, basketball players, or high divers, but it is not exclusive to these athletes.
Some of the major causes of shin splints include: changes in running surface and terrain, changes in training regimes, poor foot or ankle biomechanics, poor running mechanics, muscle imbalances, being overweight, or unconditioned athletes doing too much, too fast.
Typically your healthcare professional will want to rule out several conditions with the most serious being stress fractures and compartment syndrome. Once a diagnosis is made, treatment usually starts out conservatively with ice, ultrasound, and interferential current to control pain and swelling. Your doctor may also try to control inflammation with the use of some medications. There will be discussions about activity modifications such as no hill running. There may be other treatments to try such as taping or orthotics, and your physiotherapist may focus on some stretching and strengthening exercises. If conservative treatment does not appear to be helping, aggressive treatment may be considered. This may include a cessation of activity altogether, immobilization, or in some cases, surgery.
Recovery from this injury can be long and frustrating and it can really impede your goals – whether that includes getting back in shape or completing your first marathon. So remember to progress your training at a reasonable rate and make changes in your routine slowly. Happy running!
