Safe Gardening

If April showers bring May flowers, what do you think brings April flowers? With the early arrival of spring this year, there have already been great opportunities to get out and enjoy the pleasant weather and an enjoyable hobby, gardening!
To help get people in the excited about the season, A Channel’s ‘A’ Morning is celebrating with a spring garden special, check it out here –http://morning.atv.ca/ottawa/index.php .  Ottawa Physiotherapy and Sport Clinic’s Westboro physiotherapist Shane Maley will be on the show with some helpful tips to protect your body and make gardening more enjoyable.
The first thing you should consider is that gardening fits in great as part of a healthy, active lifestyle.  It is an enjoyable way to get outdoors and moving around, and being physically active in general will also help you in the garden.
Before you get your hands dirty, there are a few things you can do to warm up and protect your body.  Start with some gentle dynamic stretching (stretching with movement).  Swing your arms, lightly bend and twist to help get some blood flowing and loosen any tight muscles.  Once you feel limbered up, perform a few squats to engage the strong muscles in your legs and bottom, keeping your back straight and protected.  This helps teach your body how to properly perform heavy lifting as well as warming up your heart and muscles.
Now that you’re ready to tackle some projects, start by making a plan.  A common mistake is to work too hard and try to do too much.  With heavy items like large bags of soil or patio planters, it’s always best to ask a friend for some help to avoid lifting too much.  Plan out smaller lifts with the help of a wheelbarrow or try dragging items with the help of a spade.  Always remember to make more smaller trips instead of trying to tackle one big move. 
Breaks are important, as well as changing positions while working.  Instead of digging or planting for 2 hours straight, plan to alternate between activities every 20 or so minutes.  This reduces the stress on any given muscle group, helping to prevent repetitive strain injuries.
Once you do start working, as the saying goes, the right tool for the job can make all the difference.  These days there are a wide variety of light weight, ergonomic tools to choose from.  Always wear a good pair of gardening gloves, and use long-handled tools to prevent bending and reaching when possible.
When it comes to lifting, this is where caution and common sense should always be exercised.  As mentioned above, if something seems a bit heavy for you, never be too proud to ask for a hand!  It’s always fun to garden with a buddy anyways.  When you are lifting, the old adage ‘lift with your legs, not with your back’ still rings true.  To protect your back, lower yourself into a deep squat, bending your knees and drawing in your lower abdomen.  Draw the object in as close to you as possible and without forcing, smoothly push up using the strong muscles of your legs and bottom.  Always avoid bending at the waist and trying to straighten up.  The force on your low back can be 5 to 10 times as much as the weight of the object.  In a match between you and a 50 pound bag of soil, your back isn’t going to win with 500 pounds levering against it!  Remember, sometimes the smartest way to lift something is not lifting it at all.   Drag heavy objects or once again, partner up!
When it comes to weeding and planting, once again, use your legs not your back.  If you have to choose between bending sitting or kneeling, kneel whenever possible.  Sitting can be a good option, but your still spend much or your time hinged at the waist.  Whether or not you suffer from knee problems, a foam kneeler can be one of the best tools in your garden. 
Instead of reaching, try to move around and re-adjust often.  This give your body (especially your knees) a break and also protects your back.  Tricks like using mulch to avoid weeds and planting in raised beds or planters are other great ways to reduce the strain on your body.
Finally, one of the most dangerous activities of the spring is trying to pull start that old mower.  If you have a history of back problems your best option is to trade in your pull start mower for a model with an electric push-button start.  Not only will your back thank you, but so will the planet, as newer more efficient equipment emits less carbon as well.  Sounds like a win-win situation!
Even with careful, deliberate action, we can all get ahead of ourselves sometimes.  If you feel that something isn’t quite right, or you have a nagging ache or pain keeping you from enjoying some time outside, it’s always best to check things out with your neighbourhood registered Physiotherapist – http://www.westborophysiotherapy.ca/locations/.  Your body will probably thank  you!

Whether you’re a seasoned horticulturalist, or a gardening newbie, getting your hands dirty and having fun outside has something in it for everybody.  Happy spring and happy planting!

Benefits of running

While there is the potential for injury in running (just as there is in any sport), there are many benefits. Some of these benefits include potential weight loss, improved cardiovascular health, increased muscle mass, increased bone density, and an improved emotional state[17]. Following a consistent routine of running can increase HDL levels, reducing the risks of cardiovascular disease.[citation needed] Running, like all forms of regular exercise, can effectively slow[1] or reverse[12] the effects of aging.
Running can assist people in losing weight and staying in shape. Different speeds and distances are appropriate for different individual health and fitness levels. For new runners, it takes time to get into shape. The key is consistency and a slow increase in speed and distance. While running, it is best to pay attention to how one’s body feels. If a runner is gasping for breath or feels exhausted while running, it may be beneficial to slow down or try a shorter distance for a few weeks. If a runner feels that the pace or distance is no longer challenging, then the runner may want to speed up or run farther.[citation needed]
Running can also have psychological benefits, as many participants in the sport report feeling an elated, euphoric state, often referred to as a “runner’s high“.[3] Running is frequently recommended as therapy for people with clinical depression and people coping with addiction.[4]
In animal models, running has been shown to increase the number of newly born neurons within the brain.[5] This finding could have significant implications in aging as well as learning and memory.
There are many places that offer running evaluations such as if one is interested in learning how to improve their running techniques with a physiotherapist. 

For more information please feel free to contact our Westboro physiotherapy, Orleans physiotherapy, or Barrhaven physiotherapy locations our contact information can be found at http://www.orleansphysiotherapy.com.

http://www.ottawasportphysiotherapy.com/services/runningevaluation/
http://www.barrhavenphysiotherapy.com/services/runningevaluation/
http://www.westborophysiotherapy.ca/services/runningevaluation/
http://www.orleansphysiotherapy.com/services/runningevaluation/

  1. ^ Phys Ed: Why Doesn’t Exercise Lead to Weight Loss?
  2. ^ Exercise Could Slow Aging Of Body, Study Suggests
  3. ^ Exercise ‘can reverse ageing’
  4. ^ Boecker H et al., Cereb Cortex (2008); 18(11)2523–31. The Runner’s High: Opiodergic Mechanisms in the Human Brain
  5. ^ “Health benefits of running”. Free Diets. http://www.freediets.com/endurance-training/the-benefits-of-running. 
  6. ^ van Praag H, Kempermann G, Gage FH (March 1999). “Running increases cell proliferation and neurogenesis in the adult mouse dentate gyrus”. Nat. Neurosci. 2 (3): 266–70. doi:10.1038/6368. PMID 10195220.

Running Injuries (Part 2)

Some runners may experience injuries when running on concrete surfaces. The problem with running on concrete is that the body adjusts to this flat surface running and some of the muscles will become weaker, along with the added impact of running on a harder surface. Therefore it is advised to change terrain occasionally – such as trail, beach, or grass running. This is more unstable ground and allows the legs to strengthen different muscles. Runners should be wary of twisting their ankles on such terrain. Running downhill also increases knee stress and should therefore be avoided. Reducing the frequency and duration can also prevent injury; three 20–30 minute sessions a week should suffice.
A runner who finds himself injured should not continue to run because continuing could further damage the injury and prolong the recovery. A common acronym used to help the recovery process is RICE: Rest, Ice, Compression, and Elevation.
Another injury prevention method common in the running community is stretching. Stretching is often recommended as a requirement to avoid running injuries, and it is almost uniformly performed by competitive runners of any level. Recent medical literature, however, finds mixed effects of stretching prior to running. One study found insufficient evidence to support the claim that stretching prior to running was effective in injury prevention or soreness reduction.[10] Another, however, has demonstrated that stretching prior to running increases injuries, while stretching afterwards actually decreases them.[11] The American College of Sports Medicine recommends that all stretching be done after exercise because this is when the muscles are most warmed up and capable of increasing flexibility. Recent studies have also shown that stretching will reduce the amount of strength the muscle can produce during that training session.
Recently, some runners have concluded that barefoot running reduces running related injuries. “Some experts now believe that most athletic shoes, with their inflexible soles, structured sides and super-cushioned inserts keep feet so restricted that they may actually be making feet lazy, weak and more prone to injury. As a result, barefoot training is gaining more attention among coaches, personal trainers and runners.”[12] “Research has shown that wearing shoes to exercise takes more energy, and that barefoot runners use about 4 percent less oxygen than shoe runners. Other studies suggest barefoot athletes naturally compensate for the lack of cushioning and land more softly than runners in shoes, putting less shock and strain on the rest of the body. Barefoot runners also tend to land in the middle of their foot, which can improve running form and reduce injury.”[12] However, this position on barefoot running remains controversial and a majority of professionals advocate the wearing of appropriate shoes as the best method for avoiding injury.[13]
Additionally, there have also been claims that improved posture reduces injuries and helps to cope with existing injuries.[14] For example, one 2004 study showed that improved running form can significantly reduce eccentric loading of the knee.[15]
Recent studies have shown that runners do not have more osteoarthritis than people who do not run.[16]
Although it is not an injury, people with asthma suffer sometimes from running, especially if they have exercise-induced asthma. Asthma becomes more a problem with colder weather, increased speed, and uphill running. 

  1. ^ The painful truth about trainers: Are running shoes a waste of money?
  2. ^ Superglue for Blisters, Cuts and First Aid
  3. ^ After Exercise – Does an Ice Water Bath Speed Recovery?
  4. ^ Herbert, R.D. & Gabriel, M. (2002). Effects of stretching before and after exercising on muscle soreness and risk of injury: systematic review. British Medical Journal, 325 p. 468. online
  5. ^ Stretching and running injuries
  6. ^ a b Tara Parker-Pope, The Wall Street Journal
  7. ^ Amy Cortese, Wiggling Their Toes at the Shoe Giants, New York Times, Aug. 29, 2009.
  8. ^ The Egoscue Method of Health through Motion, Pete Egoscue and Roger Gittins
  9. ^ Arendse, Regan E. et al., Medicine & Science in Sports & Exercise: Volume 36(2) February 2004 pp 272–277. Reduced Eccentric Loading of the Knee with the Pose Running Method.
  10. ^ Chakravarty et al. (2008) American Journal of Preventive Medicine. (Vol. 35, Issue 2, Pages 133–138.) Long Distance Running and Knee Osteoarthritis: A Prospective Study.

Running injuries (Part 1)

Running injuries

Due to the spring summer season I thought talking about running injuries would be a good start so I found an article that briefly touches upon running in general and thought I would start from there.  For more information please feel free to contact our Westboro physiotherapy, Orleans physiotherapy, or Barrhaven physiotherapy locations my contact information can be found at http://www.orleansphysiotherapy.com.

Because of its high-impact nature, many injuries are associated with running. They include “runner’s knee” (pain in the knee), shin splints, pulled muscles (especially the hamstring), twisted ankles, iliotibial band syndrome, plantar fasciitis, and Achilles tendinitis.[citation needed] Stress fractures are also fairly common in runners training at a high volume or intensity.[citation needed] Repetitive stress on the same tissues without enough time for recovery or running with improper form can lead to many of the above. Runners generally attempt to minimize these injuries by warming up before exercise,[7] focusing on proper running form, performing strength training exercises, eating a well balanced diet, allowing time for recovery, and “icing” (applying ice to sore muscles or taking an ice bath).[citation needed]
Foot blisters are also common among runners. Specialized socks help to prevent blisters greatly. For existing cases, lancing the blister with a sterile needle and applying a cyanoacrylate glue (such as Superglue or Krazy Glue) may help to protect the wound and enable further running. This is common practice among hardened endurance athletes.[8]
Another common, running-related injury is chafing, caused by repetitive rubbing of one piece of skin against another, or against an article of clothing. One common location for chafe to occur is the runner’s upper thighs. The skin feels coarse and develops a rash-like look. A variety of deodorants and special anti-chafing creams are available to treat such problems. Chafe is also likely to occur on the nipple.

A cold bath is a popular treatment of subacute injuries or inflammation, muscular strains, and overall muscular soreness, but its efficacy is controversial.[9] Some claim that for runners in particular, ice baths offer two distinct improvements over traditional techniques. First, immersion allows controlled, even constriction around all muscles, effectively closing microscopic damage that cannot be felt and numbing the pain that can. One may step into the tub to relieve sore calves, quads, hams, and connective tissues from hips to toes will gain the same benefits, making hydrotherapy an attractive preventive regimen. Saint Andrew’s cross-country coach John O’Connell, a 2:48 masters marathoner, will hit the ice baths before the ibuprofen. “Pain relievers can disguise injury,” he warns. “Ice baths treat both injury and soreness.” The second advantage involves a physiological reaction provoked by the large amount of muscle submerged. Assuming one has overcome the mind’s initial flight response in those first torturous minutes, the body fights back by invoking a “blood rush”. This rapid transmission circulation flushes the damage-inflicting waste from the system, while the cold water on the outside preserves contraction. Like an oil change or a fluid dump, the blood rush revitalizes the very areas that demand fresh nutrients.
Some runners may experience injuries when running on concrete surfaces. The problem with running on concrete is that the body adjusts to this flat surface running and some of the muscles will become weaker, along with the added impact of running on a harder surface. Therefore it is advised to change terrain occasionally – such as trail, beach, or grass running. This is more unstable ground and allows the legs to strengthen different muscles. Runners should be wary of twisting their ankles on such terrain. Running downhill also increases knee stress and should therefore be avoided. Reducing the frequency and duration can also prevent injury; three 20–30 minute sessions a week should suffice.
A runner who finds himself injured should not continue to run because continuing could further damage the injury and prolong the recovery. A common acronym used to help the recovery process is RICE: Rest, Ice, Compression, and Elevation.
Another injury prevention method common in the running community is stretching. Stretching is often recommended as a requirement to avoid running injuries, and it is almost uniformly performed by competitive runners of any level. Recent medical literature, however, finds mixed effects of stretching prior to running. One study found insufficient evidence to support the claim that stretching prior to running was effective in injury prevention or soreness reduction.[10] Another, however, has demonstrated that stretching prior to running increases injuries, while stretching afterwards actually decreases them.[11] The American College of Sports Medicine recommends that all stretching be done after exercise because this is when the muscles are most warmed up and capable of increasing flexibility. Recent studies have also shown that stretching will reduce the amount of strength the muscle can produce during that training session.
Recently, some runners have concluded that barefoot running reduces running related injuries. “Some experts now believe that most athletic shoes, with their inflexible soles, structured sides and super-cushioned inserts keep feet so restricted that they may actually be making feet lazy, weak and more prone to injury. As a result, barefoot training is gaining more attention among coaches, personal trainers and runners.”[12] “Research has shown that wearing shoes to exercise takes more energy, and that barefoot runners use about 4 percent less oxygen than shoe runners. Other studies suggest barefoot athletes naturally compensate for the lack of cushioning and land more softly than runners in shoes, putting less shock and strain on the rest of the body. Barefoot runners also tend to land in the middle of their foot, which can improve running form and reduce injury.”[12] However, this position on barefoot running remains controversial and a majority of professionals advocate the wearing of appropriate shoes as the best method for avoiding injury.[13]
Additionally, there have also been claims that improved posture reduces injuries and helps to cope with existing injuries.[14] For example, one 2004 study showed that improved running form can significantly reduce eccentric loading of the knee.[15]
Recent studies have shown that runners do not have more osteoarthritis than people who do not run.[16]
Although it is not an injury, people with asthma suffer sometimes from running, especially if they have exercise-induced asthma. Asthma becomes more a problem with colder weather, increased speed, and uphill running. 

  1. ^ The painful truth about trainers: Are running shoes a waste of money?
  2. ^ Superglue for Blisters, Cuts and First Aid
  3. ^ After Exercise – Does an Ice Water Bath Speed Recovery?
  4. ^ Herbert, R.D. & Gabriel, M. (2002). Effects of stretching before and after exercising on muscle soreness and risk of injury: systematic review. British Medical Journal, 325 p. 468. online
  5. ^ Stretching and running injuries
  6. ^ a b Tara Parker-Pope, The Wall Street Journal
  7. ^ Amy Cortese, Wiggling Their Toes at the Shoe Giants, New York Times, Aug. 29, 2009.
  8. ^ The Egoscue Method of Health through Motion, Pete Egoscue and Roger Gittins
  9. ^ Arendse, Regan E. et al., Medicine & Science in Sports & Exercise: Volume 36(2) February 2004 pp 272–277. Reduced Eccentric Loading of the Knee with the Pose Running Method.
  10. ^ Chakravarty et al. (2008) American Journal of Preventive Medicine. (Vol. 35, Issue 2, Pages 133–138.) Long Distance Running and Knee Osteoarthritis: A Prospective Study.

Plantar Faciitis

Hello there since the running season is starting up I wanted to bring up some common injuries that are starting to come into the clinic these days.  I am starting to get a lot of people showing up at our Westboro physiotherapy and Orleans physiotherapy clinics.

Plantar Faciitis

There are many options for treatment of plantar faciitis and below are a few

Orthotics, i.e., foot supports, are the only non-surgical therapy to have been supported by studies rated by the Center for Evidence-Based Medicine as being of high quality.[3] Landorf et al.[6] performed a single-blind experiment in which patients were randomly assigned to receive off-the-shelf orthotics, personally customized orthotics, or sham orthotics made of a soft, thin foam. Patients receiving real orthotics showed statistically significant short-term improvements in functionality compared to those receiving the sham treatment. There was no statistically significant reduction in pain, and there was no long-term effect when the patients were re-evaluated after 12 months. Off-the-shelf orthotics were found to be as effective as customized ones for acute (short term) plantar fasciitis. There is some evidence that taping may supply short-term relief, but the evidence is weaker than the evidence suporting orthotics.[3]
Some evidence shows that stretching of the calf and plantar fascia may provide up to 2–4 months of benefit.[3] One study has shown improvement over a four-month period with stretching.[7] In cases of chronic plantar fasciitis,the ultrasound therapy with 3 MHz for 10-15minutes/day is beneficial.One study has shown high success rates with a stretch of the plantar fascia,[8] but has been criticized[3] because it was not blinded, and contained a bias because the analysis did not use the intention to treat method. Because it is impractical to do double-blind experiments involving stretching, such studies are vulnerable to placebo effects. The Center for Evidence-Based Medicine has not rated any study of stretching as being of high quality.[9]
Pain with the first steps of the day can be markedly reduced by stretching the plantar fascia and Achilles tendon before getting out of bed. Night splints can be used to keep the foot in a dorsi-flexed position during sleep to improve calf muscle flexibility and decrease pain on waking. These have many different designs. The type of splint has not been shown to affect outcomes.
To relieve pain and inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are often used but are of limited benefit.[10]. Dexamethasone 0.4 % or acetic acid 5% delivered by ionophoresis combined with low dye strapping and calf stretching has been shown to provide short term pain relief and increased function.[11]
Local injection of corticosteroids often gives temporary or permanent relief, but may be painful, especially if not combined with a local anesthetic and injected slowly with a small-diameter needle.[12] Recurrence rates may be lower if injection is performed under ultrasound guidance.[13] Repeated steroid injections may result in rupture of the plantar fascia. While this may actually improve pain initially, it has deleterious long-term consequences.
There is mixed evidence regarding the effectiveness of extracorporeal shockwave therapy.[14][15] A non-controlled study by Norris et al. showed positive effects. A controlled study by Buchbinder et al. showed no benefit for shockwave therapy compared to a placebo. Proponents of shockwave therapy argue that the doses used by Buchbinder were too low.
In refractory cases, surgery is sometimes indicated.

  1. ^ Plantar Fasciitis A Degenerative Process (Fasciosis) Without Inflammation http://www.japmaonline.org/cgi/content/abstract/93/3/234
  2. ^ Risk factors for Plantar fasciitis: a matched case-control study. Riddle DL, Pulisic M, Pidcoe P, Johnson RE. J Bone Joint Surg Am. 2003;85-A:872-877.
  3. ^ a b c d e Heel Pain – Plantar Fasciitis. J Orthop Sports Phys Ther. 2008:38(4)http://www.orthopt.org/ICF/Heel%20Pain-Plantar%20Fasciitis%20-%20JOSPT%20-%20%20April%202008.pdf
  4. ^ Buchbinder R. Clinical practice. Plantar fasciitis. N Engl J Med. 2004;350:2159-2166. http://dx.doi.org/10.1056/NEJMcp032745
  5. ^ Plantar fasciitis: evidence-based review of diagnosis and therapy. Cole C, Seto C, Gazewood J. Am Fam Physician. 2005;72:2237-2242
  6. ^ Landorf et al., Arch Intern Med 2006:166:1305
  7. ^ Porter et al., Foot Ankle Int 1999:20:214
  8. ^ Digiovanni, Benedict F.; Deborah A. Nawoczenski, Daniel P. Malay, Petra A. Graci, Taryn T. Williams, Gregory E. Wilding, and Judith F. Baumhauer (2006). “Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up”. The Journal of bone and joint surgery (American) 88 (8): 1775–81. doi:10.2106/JBJS.E.01281. PMID 16882901. 
  9. ^ J Orthop Sports Phys Ther. 2008;38(4):A1-A18. doi:10.2519/jospt.2008.0302
  10. ^ Lynch, D.; Goforth, W., Martin, J., Odom, R., Preece, C., & Kottor M. (1998). “Conservative treatment of plantar fasciitis. A prospective study”. Journal of the American Podiatric Medical Association 88 (8): 375–380. PMID 9735623. 
  11. ^ Treatment of plantar fasciitis by Low Dye taping and iontophoresis: short term results of a double blinded, randomised, placebo controlled clinical trial of dexamethasone and acetic acid. Osborne HR, Allison GT. Br J Sports Med. 2006;40:545-549; discussion 549. http://dx.doi.org/10.1136/bjsm.2005.021758
  12. ^ Genc, Hakan; Meryem Saracoglu, Bans Nacir, Hatice Rana Erdem and Mahmut Kacar (2005). “Long-term ultrasonographic follow-up of plantar fasciitis patients treated with steroid injection”. Joint Bone Spine 72 (1): 61–5. doi:10.1016/j.jbspin.2004.03.006. PMID 15681250. 
  13. ^ Tsai, Wen-Chung; Chih-Chin Hsu, Carl P. C. Chen, Max J. L. Chen, Tung-Yang Yu, Ying-Jen Chen (2006). “Plantar fasciitis treated with local steroid injection: comparison between sonographic and palpation guidance”. Journal of Clinical Ultrasound 34 (1): 12–16. doi:10.1002/jcu.20177. PMID 16353228. 
  14. ^ Norris, Donald M.; Kimberly M. Eickmeier and Bruce R. Werber (2005). “Effectiveness of Extracorporeal Shockwave Treatment in 353 Patients with Chronic Plantar Fasciitis”. Journal of the American Podiatric Medical Association 95 (6): 517–524. PMID 16291842. 
  15. ^ Buchbinder, R, et al. (2002). “Extracorporeal Shock Wave Therapy for Plantar Fasciitis:A Randomized Controlled Trial.”. Journal of the American Medical Association 228: 1364–1372. doi:10.1001/jama.288.11.1364. 
  16. ^ Kauffman, Jeffrey (2006-09-21). “Plantar fasciitis”. MedlinePlus Medical Encyclopedia. National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/007021.htm.