Burlington Chiropractic and Physiotherapy Clinic

Introducing Lucy Mae McIntyre

Kevin — Mon, 01 Mar 2010 01:00:11 +0000

Although this area of our website has been primarily used for research reviews and pointers, it is also intended for relaying important notices to our patients. What’s more important than this?

Lucy Mae McIntyre was born three weeks early on Thursday, February 25th 2010 weighing in at a whopping 6 pounds 3 ounces. She enjoys crying, sleeping and eating. Thankfully, she has already told us that she wants to be a soccer player!

Surfing Exercises Anyone?

Kevin — Sun, 14 Feb 2010 21:42:14 +0000

Recently I was lucky enough to go to Costa Rica for a week of surfing. Needless to say it was a great time, but as I’ve experienced in the past, my shoulders are now paying the price. For this week’s blog I thought I’d suggest a few exercises for any fellow novice / occasional surfers out there. With some diligence, you’ll either catch waves easier or avoid the type of pain I’m currently experiencing!

Standing Extension - Stand with the elbows close to straight, squeezing the shoulders back and down. From the approximate height shown, extend the arms to a neutral position, primarily activating the latissimus dorsi muscle.

Prone Paddle - While lying with the arm outstretched overhead, pull the resistance down the length of your body, mimicking the surfing paddle. The resistance can be moved up and down to challenge different components of the paddle movement.

Disclaimer
The purpose of this blog is to educate our patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Burlington Sports Therapy, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site.

Patellofemoral Pain - Risk Factors

Kevin — Sun, 31 Jan 2010 13:00:07 +0000

According to the literature, the incidence of injury among distance runners is between 37-56%. Of these, pain in the area of the patellofemoral joint is one of the most common complaints. Thankfully, some recent research has uncovered some of the risk factors for this condition.

Traditionally, it has been understood that the risk factors for patellofemoral pain have been related to different aspects of the knee. Some of these include malalignment of the patellofemoral joint, imbalance in the muscles around the joint, weakness in the quadriceps or abnormalities in the bone. Interestingly, the scientific research has not been able to agree on whether over pronation or supination in the arch of the foot has any bearing on this condition.

A 2008 study published in the British Journal of Sports Medicine has helped to identify that patellofemoral pain can be related to impact. Specifically, they found that those who developed patellofemoral pain ran with a higher impact (at footstrike) in the outside of the heel and in the second and third toes (during push-off). So what does this mean? Traditionally, patellofemoral pain has been attributed to alignment factors. Given the new literature, we now know that it can also be related to impact. Although we don’t recommend that you change your running technique without the help of a qualified professional, you may want to lighten your step if you’re known to be heavy on your feet!

Questions? Comments? Please post them right on the site! Want more? Sign up for our complimentary email feed on the right of this page!

References

Powers CM, Chen PY, Reischl SF et al. Comparison of foot pronation and lower extremity rotation in persons with and without patellofemoral pain. Foot and Ankle International 2002; 23: 634-640.

Thijs Y, Clercq D, Roosen P, Witvrouw E. Gait-related intrinsic risk factors for patellofemoral pain in novice recreational runners. British Journal of Sports Medicine 2008; 42: 466-471.

Wen D, Puffer JC et al. Lower extremity alignment and risj of overuse injuries in runners. Med Sci Sports Exerc 1997; 29: 1291-1298.

More on ACL Injury Prevention

Kevin — Sun, 17 Jan 2010 17:00:26 +0000

Last June we posted an entry on the prevention of anterior cruciate ligament (ACL) injuries. In that article, we learned that muscular co-contraction was very helpful in preventing an acute tear of this ligament. Today’s blog is going to review some of the more current understandings in sports medicine with respect to ACL injury and prevention, including some practical ways that coaches, parents and players can help identify those athletes at risk.

Most ACL injuries are non-contact, occurring during deceleration, landing or pivoting. In soccer, 58% of injuries are non-contact.

Athletes who run and change direction in a more upright position are at more risk of ACL injury.

Females are 4 to 6 times more likely to injure their ACL (some of the points below will help to explain this difference).

Hormonal changes have been shown to influence ligaments (like the ACL). Such hormonal changes occur during monthly cycles and growth spurts.

Having “loose” joints can predispose you to ACL injury. For example, a positive measure of knee hyperextension increases the odds of anterior cruciate ligament injury status five-fold. Greater knee laxity and increased general joint laxity are more prevalent in girls. As boys get older there is a trend toward decreased joint flexibility and ligament laxity. Relative to boys, girls show more joint flexibility and ligament laxity with age.

A trend toward knee valgus (pictured below) has been well established in the literature as a risk factor of ACL injury. Females tend to land from jumping in a more valgus position than males. They also tend to land harder, suggesting less muscular recruitment and thereby less stabilization of the knee.

Prevention of ACL injuries would significantly reduce the chances of arthritis in adulthood. There is an estimated ten fold increase (incidence) after ligament injury.

Active and passive flexibility training may be contraindicated for preventing ACL injuries. Flexibility training does not provide protective effects from injury as has been previously reported in the literature.

Prevention works. According to a recent study of 1435 female varsity soccer players, those who did the proper preventative exercises showed a 3 fold reduction in non-contact ACL tears. There is a growing body of research validating ACL prevention programs.

References

Barber-Westin SD, Noyes FR, Galloway M. Jump-land characteristics and muscle strength development in young athletes. The American Journal of Sports Medicine 2006: 34(3); 375-384.

Chappell JD, Limpisvasti O. Effect of a neuromuscular training program on the kinetics and kinematics of jumping tasks. The American Journal of Sports Medicine 2008: 36(6); 1081-1086.

Gall F, Carling C, Reilly T. Injuries in young elite female soccer players: an 8 season prospective study. The American Journal of Sports Medicine 2008: 36(2); 276-284.

Garrick JG. Preparticipation orthopedic screening evaluation. Clinical Journal of Sports Medicine 2004: 14(3); 123-126.

Gilchrist J, Mandelbaum B, Melancon H et al. A randomized controlled trial to prevent noncontact anterior cruciate ligament injury in female collegiate soccer players. The American Journal of Sports Medicine 2008: 36(8); 1476-1483.

Gioftsidou A, Ispirlidis I, Pafis G, Malliou P, Bikos C, Godolias G. Isokinetic strength training program for muscular imbalances in professional soccer players. Sport Sci Health 2008: 2; 101-105.

Hagglund M, Walden M, Ekstrand J. Lower reinjury rate with a coach-controlled rehabilitation program in amateur male soccer: a randomized controlled trial. The American Journal of Sports Medicine 2007: 35; 1433-1442.

Hewett TE, Myer GD, Ford KR, Slauterbeck JR. Preparticipation physical examination using a box drop vertical jump test in young athletes. Clinical Journal of Sports Medicine 2006: 16(4); 298 - 304

Hewett TE, Myer GD, Ford KR et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes. The American Journal of Sports Medicine 2006: 33(4); 492-501.

Lehance C, Binet T, Croisier JL. Muscular strength, functional performances and injury risk in professional and junior elite soccer players. Scandinavian Journal of Medicine & Science in Sports 2009: 19; 243-251.

Myer GD, Ford KR, Hewett TE. Methodological approaches and rationale for training to prevent anterior cruciate ligament injuries in female athletes. Scandinavian Journal of Medicine & Science in Sports 2004: 14; 275-285.

Myer GD, Ford KR, McLean SG, Hewett TE. The effects of plyometric versus dynamic stabilization and balance training on lower extremity biomechanics. The American Journal of Sports Medicine 2006: 34(3); 445-455.

Myer GD, Ford KR, Paterno MV, Nick TG, Hewett TE. The effects of generalized joint laxity on risk of anterior cruciate ligament injury in young female athletes. The American Journal of Sports Medicine 2008; 36(6): 1073 - 1080.

Wingfield K, Matheson G, Meeuwisse W. Preparticipation evaluation - an evidence based review. Clinical Journal of Sports Medicine 2004: 14(3); 109-122.

Disclaimer - The purpose of this blog is to educate our patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Burlington Sports Therapy, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site.

Degenerative Lumbar Spondylolisthesis - Newer Concepts

Kevin — Mon, 04 Jan 2010 00:23:17 +0000

Quite often we have new patients come to our clinic with a diagnosis of “sciatica”. This term has become popular for describing any condition that involves leg pain related to lower back dysfunction. Believe it or not, “sciatica” is not a diagnosis and there are many different conditions that involve symptoms of nerve irritation in the legs. For a treatment to be effective your condition must be diagnosed properly. Has degenerative lumbar spondylolisthesis been considered as a potential diagnosis for your leg symptoms?

Lumbar spondylolisthesis is a condition in which one vertebra “slips” forward on the one below. There are many different types of spondylolisthesis, one of the most common being degenerative. In this type, the slippage is linked to wear and tear in the joints of the lumbar spine. But what has some of the more recent research uncovered about degenerative lumbar spondylolisthesis?

The 4th and 5th lumbar level is the most commonly effected, with the quadratus lumborum muscle and the iliolumbar ligament often playing a role.

The orientation of certain joints in the lumbar spine (called the facet joints) can predispose the lumbar spine to slippage.

Although frequently seen with this condition, disc degeneration is not an important predisposing factor for slippage. In fact, certain progressions of degeneration in other areas of the vertebrae can actually help to stabilize the slippage!

Other risk factors for degenerative spondylolisthesis in the lumbar spine include being older than 50, being female, having previous pregnancies, being African American and having generalized joint laxity.

Effective treatment for degenerative lumbar spondylolisthesis involves maintenance of proper motion in the hips and other areas of the lumbar spine. Ensuring that certain muscles in the lumbar area assist in stabilizing the spine is also important. As previously mentioned, diagnosis is the key to proper care. After this, the patient with degenerative lumbar spondylolisthesis can be educated on the postures and exercises that are helpful and those that can exacerbate the situation. These care instructions can be quite different from the care instructions for “sciatica”!

Questions? Comments? Please post them right on the site! Want more? Sign up for our complimentary email feed on the right of this page!

References

Kalichman L, Hunter D. Degenerative lumbar spondylolisthesis: anatomy, biomechanics and risk factors. Journal of Back and Musculoskeletal Rehabilitation 21 (2008) 1-12.

Sengupta DK, Herkowitz HN. Degenerative spondylolisthesis: review of current trends and controversies. Spine 30 (2005) S71-S81.

Healthy Gift Ideas

Leslie — Sun, 20 Dec 2009 22:53:03 +0000

It’s that time of year when we’re all out getting some last minute shopping in for our friends and loved ones. For this weeks blog, we thought we would help out with some gift ideas for the health conscious…

Dual Purpose Hot and Cold Packs - These are always good to have around the house. For kids, you can even find ones that are stuffed animals with a removable internal cold pack.

Automatic Jar Openers - For the elderly or those with arthritic hands.

Memory Foam Pillows - We usually tell our patients that pillows are personal preference. Perhaps a memory foam pillow is worth a try for those with chronic neck pain.

Memory Foam Bed-Toppers - Unless a new mattress is within your gift buying budget, a memory foam mattress topper may be worth a try for your loved one with back pain.

Massage Therapy Gift Cards - Who doesn’t like a relaxing massage?

Massage Device - From the hand held thumpers to the wooden kneading tools, there’s lots of these to choose from. Which one is the best? Your guess is as good as ours on this one!

Insoles - Custom foot orthotics are probably not in everyone’s gift budget, so some good over-the-counter foot supports may be helpful for the person with foot pain. Although this one really depends on the persons foot-type and specific needs, something like a “Superfeet” insole can be helpful and a relatively safe bet. Check out your local running store for these!

Exercise Equipment - We would recommend steering clear of gimmicky abdominal exercise devices. Instead, an inflatable exercise ball, some tubing or dumbbells and a soft mat can serve as a good starting point for a home gym.

Lumbar Support - For the loved one with back pain, a lumbar support can be very helpful in the car and at work.

Ergonomic Friendly Mouse - There are lots of ergonomically sound devices for the person who spends plenty of time on the computer. This may be a great way to keep your loved one pain free!

Travel Pillow - For the frequent traveler who has woken up at the end of a long flight with some serious neck pain.

Pedometer - Brisk walking has been shown to be helpful for many back pain sufferers. Allowing the muscles and joints to function with less impact than running is a great way to recover from pain.

Heart Rate Monitor - To make sure your loved one’s new years resolution will be effective.

Personal Training Consultation - If ongoing personal training is outside of your gift budget, perhaps a consultation for program design would be a great way to get your loved one on the right track to a more effective exercise plan.

Wishing you and your family a happy and safe holiday!

Dr. Kevin McIntyre & Dr. Leslie McDowall

Jumpers Knee

Kevin — Sun, 06 Dec 2009 20:07:06 +0000

Jumpers knee is a common term used to describe an overuse injury to the patellar tendon. The technical term for this tendon injury is patellar tendinosis or patellar tendinopathy and is estimated to affect 45% of elite volleyball players.

According to the most current literature, patellar tendinosis is largely due to the eccentric load placed on the patellar tendon. That is, the tendon is lengthened under load when lowering for a jump and when bending the knee upon landing. (For an explanation of “eccentric contraction” please refer to our previous post about the prevention of hamstring strain). According to a study published in the British Journal of Sports Medicine, athletes who experienced patellar tendinosis had a tendency to land with a lesser degree of ankle and knee joint flexion on initial impact. That is, they didn’t bend their knees or ankles during landing to the extent of other athletes. The study also found that the rate at which the knee is forced into flexion upon landing may be a risk factor in the development of patellar tendinopathy.

So how do we apply our newest understandings of “Jumper’s Knee” to the athlete at risk? If a coach or trainer notices any of the above findings in one of their athletes they should be urged to try a soft landing technique, bending both the ankles and knees as much as possible to absorb the force of landing. If symptoms are present, frequency and intensity of jumping may need to be reduced. Of course, we always recommended that you consult with a doctor so that your condition can be diagnosed prior to any treatment.

Questions? Comments? Please post them right on the site! Want more? Sign up for our complimentary email feed on the right of this page!

References

Bisseling RW, Hof AL, Bredeweg SW, Zwerver J, Mulder T. Are the take-off and landing phase dynamics of the volleyball spike jump related to patellar tendinopathy? British Journal of Sports Medicine 2008; 42: 483-489.

Bisseling RW, Hof AL, Bredeweg SW et al. Relationship between landing strategy and patellar tendinopathy in volleyball. British Journal of Sports Medicine 2007; 41: e8.

How To Tie a Shoe

Kevin — Sun, 15 Nov 2009 22:45:08 +0000

Most experienced runners have a preferred brand of running shoe. Mizuno, Asics, New Balance and Saucony seem to be common choices among our patients, but the jury is still out as to which manufacturer truly makes the best shoe. Since there are no objective, scientific guidelines to direct your purchase, it seems to boil down to personal preference. Thanks to some recently published research, lacing up your chosen shoe is a different story…

This past February, an interesting paper was published in the Journal of Sports Sciences which investigated the various lacing patterns in running shoes. Using force plates, pressure transducers and accelerometers attached to the leg, the authors measured how different lacing patterns would influence pronation of the foot, tibial acceleration and pressure distribution in the bottom of the foot. The authors laced the shoes using one, two, three, six or seven eyelets in addition to investigating the tightness of the laces (weak, regular or strong). The interesting results were as follows…

When shoes were laced tighter, using all the eyelets, there was a lower rate of loading and the foot pronated slower (which is a good thing). This lacing pattern also showed the lowest peak pressure under the heel and the outside of the foot.

When a six-eyelet / cross lacing pattern was used, a higher loading rate and higher peak heel pressure was observed when compared to the seven eyelet method. Interestingly, the participants did not report a difference in perceived comfort between these two lacing patterns.

Reduced impact and lower peak pressures were observed under the third and fifth toes when only the lower eyelets of the shoes were used. This interesting finding was explained by the foot sliding within the shoe during the stance phase.

Therefore, the findings of this interesting study suggest that using each of the eyelets in a running shoe (and lacing them up firmly) allows your foot to experience the full benefit of what the shoe was designed for. Under most circumstances, good running shoes are designed to reduce impact and control excessive rear foot pronation. Lace them up properly and they might actually achieve that!

Like what you’ve read? Sign up for our automatic email feed on the right of this page! Questions? Comments? Feel free to post them!

References

Hagen M, Hennig EM. Effects of different shoe-lacing patterns on the biomechanics of running shoes. Journal of Sports Sciences 2009; 27(3):267-275.

One Explanation For Non-Contact Injury

Kevin — Sun, 01 Nov 2009 22:36:25 +0000

Like the various musicians in a symphony orchestra, athletic movements require different muscles to activate and deactivate in a very co-ordinated fashion. When disrupted, this orchestra of muscular activity can not only affect athletic performance, but can also lead to different injuries.

Functional instability of the ankle is an example of an injury that has been shown to affect muscular activity in other areas of the lower limb. With functional ankle instability, many people have a history of repeated ankle sprains. Although their “bad ankles” are not painful, these athletes feel like their ankles may “give way” at any time. Several studies have shown that these athletes can have hamstring, tensor fascia lata and peroneal deficiency during double leg to single leg jumps. The significance of this can be show through an example…

Imagine a soccer player with a previous ankle sprain who moves from standing on two legs to standing only on their previously injured leg (like when they plant their stabilizing leg to kick a ball). Given the findings mentioned above, these players may not have normal muscle activity in the standing hip because of their ankle dysfunction. As a result, they may injure their lower back (for example) because there wasn’t a co-ordinated muscular response to adequately stabilize the spine. This is a case where an athlete incurred a non contact injury to the lower back because of “bad ankles”. Thankfully, identifying functional ankle instability and prescription of individualized exercises can help to prevent these injuries. Feel free to contact us!

Questions? Comments? Please post them right on the site or email us directly. Like what you’ve read? Sign up for our complimentary email feed on the right side of this page so that you can receive these posts every two weeks.

References

Solomonow M. Sensory-motor control of ligaments and associated neuromuscular disorders. Journal of Electromyography and Kinesiology 2006; 16: 549-567.

Van Deun S, Staes FF, Stappaerts KH et al. Relationship of chronic ankle instability to muscle activation patterns during the transition from double-leg to single-leg stance. American Journal of Sports Medicine 2007; 35: 274-281.

Zampagni ML, Corazza I, Molgora AP, Marcacci M. Can ankle imbalance be a risk factor for tensor fascia lata muscle weakness? Journal of Electromyography and Kinesiology 2009; 19: 651-659.

Gluteal Activity During Various Exercises

Kevin — Mon, 19 Oct 2009 00:20:01 +0000

This past July, an interesting paper was published in the Journal of Orthopaedic and Sports Physical Therapy which investigated gluteal muscle activation during different exercises. Whether you’re a rehabilitation professional looking to assist someone with an injury or simply looking to tone up the appearance of these muscles, you may be surprised at some of the results found in this study.

The gluteus medius (pictured on the left) is a gluteal muscle that is best described as being on the “side” of our gluteal area. It assists in several motions, including abduction movements (moving the thigh away from the midline) and stabilizing the pelvis during activity. This muscle was definitely most active during side lying abduction. Interestingly, this exercise was approximately twice as effective as side lying clam exercises. In descending order, other useful exercises were single limb squat, lateral band walk, single leg deadlift and sideways hop. Other exercises studied but deemed as being in the lower “tier” of effectiveness for this muscle were (in descending order of muscle activation) the transverse hop, transverse lunge, forward hop, forward lunge, clam at 30 degrees, sideways lunge and clam at 60 degrees.

The gluteus maximus (pictured on the right) is a large gluteal muscle that performs hip extension. This muscle was found to be most active during the single leg squat and the single leg deadlift. This finding is in agreement with other research which found that gluteus maximus activity is greatest during exercises that require single leg balance with hip flexion / extension. Interestingly, the gluteus medius was activated to a similar extent during these exercises, suggesting that they are a great “bang for your buck” in terms of overall gluteal strengthening.

Questions about the exercises? Comments? Please post them right on the site or email us directly. Like what you’ve read? Sign up for our complimentary email feed on the right side of this page so that you can receive these posts every two weeks.

References

DiStefano LJ, Blackburn JT, Marshall SW, Padua DA. Gluteal muscle activation during common therapeutic exercises. Journal of Orthopaedic & Sports Physical Therapy 2009; 39(7): 532-540.

Disclaimer

The purpose of this blog is to educate our patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Burlington Sports Therapy, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site.