Kelowna Manual Therapy Centre Blog

SUSPENSION TRAINING

Over the past two years I have been using a suspension trainer both at home, in local parks and while coaching with the Telemark Nordic Ski club.  The most common suspension trainer is the TRX brand, though others are available.  Suspension trainers can be purchased from local fitness stores or online.  

The challenge of using the suspension trainer is that you have to stabilize your body while completing an exercise motion while partially suspended.  For example, a basic push can be made more challenging using the suspension training by having your hands hold onto the suspension trainer handles while performing the push up motion.  Alternately, a push up could be performed while your ankles are suspended while your hands are on the ground.

Depending on the type and difficulty of an exercise, the suspension trainers are adjusted by varying the length of the straps.  The adjustability of the straps allows the system to be used for a huge number of exercises as well as allowing for a large degree of variability within an exercise.   Keeping with the push up example;  A push up could be performed in a horizontal position or a more vertical position depending on strength and control.  

I own both a TRX brand and WOSS suspension trainer.  The TRX  is well built and is slightly easier to use than the other trainer. As well, there are less straps in the way as you adjust the length of the trainer.  The WOSS trainer is built with very rugged straps and metal buckles to adjust the height.  Unfortunately there isn’t a great way to get the extra straps out of the way while using the WOSS trainer, and the handles tend to slide to one side instead of staying centred.

Workout sheets and / or DVD’s are provided in the suspension trainer kits.  Other workouts or ideas can be found on Youtube or Pinterest.

Suspension trainers are thick non-elastic webbing that can be attached in one of three ways:

1) clipped onto a special U-Bolt hanger in the ceiling 

2) attached to a closed door 

3) wrapped over an overhead branch, goalpost, swing set, etc.  

Both of the suspension trainers I own came with all the components to be fastened in each way just mentioned.

Advantages:

Portable & relatively lightweight.

Can use in a variety of settings and locations.

Exercises all muscle groups.

Exercise can be made easy to very challenging.

Variety.

Strength train outdoors.

Great for younger athletes.

Disadvantages:

At roughly $250 to buy, a TRX  seems expensive for what they are.  Less expensive versions are available.

Requires some practice to be comfortable, with the ‘moving’ straps while performing exercise.

Strength building requires more ‘overload’ than the TRX can provide.

Riding Silverstar Mountain’s Beowulf Mountain Biking Trail

Silverstar Mountain fully opened it’s Beowulf mountain biking trail this July.  The trail is reported to be 35km long with a mix of blue and black skill level riding.  The Silverstar website has a nice description of the trail, along with the trail’s background.

There is nothing very technical on this trail i.e. no rock drops, roots, etc. I think the black rating comes from the trail length rather than technical difficulty.  This trail is incredibly well built.  It is about 3 feet wide with no stumps that I could see. The trail is primarily dirt and fine sand.  Each switchback has a wide and high berm to carry speed.  The day I rode the trail it was very dry and dusty but not to the point that the front wheel lost traction on the corners.  There are a number of well built, wide bridges across the creeks.

The trail is nicely shaded except for a few sections that cross the ski runs early on and then again towards the end of the trail.  I couldn’t enjoy any views as it was quite smokey the day I did the trail, however the trail scenery is very nice, and is especially beautiful in the cedar forest.  

The trail starts on the ‘cross the mountain’ paved bike path to the start of the single track on the Silver Shack trail.  The Silvershack trail twists and turns along a flowing trail with a few double track sections out to Alder point.  The adventure of the Beowulf single track descent starts after the trail sign and gate.  The trail descends for roughly 10km, with the start of the climb back up the mountain starting after the Putnam Creek bridge crossing.  The trail then continues for approximately 10km up to the pre-existing Silverstar trails for around 4km, then gets back on the paved bike path to the Village.

The climb back to the village though long, is gradual.  It comes after the descent and about 20km into the ride.  I was able to ride every climb, though the ‘Lombard St.’ (named after the famed San Francisco street) switchbacks added a big challenge after a 10km climb. 

The Putnam Creek Bridge before the climb...

How long did it take:

Riding steadily I did the trail in 3 hours and 20 minutes on Strava.  This time was ‘moving’ time and didn’t include stops for snacks, water and picture.  Silverstar suggests giving yourself 4-6 hours.

What to take:

Lots of water.  I had a 2L camelback and 750ml bottle, that was just enough on a hot Okanagan day (due to the fire risk we couldn't start until after 10am).

Snacks.  Plan on burning 2000+ calories and plan accordingly…

Tools. 

You need to be self sufficient as there is no cell service and it would be a long long walk back to the Village.  A multi tool, C02 inflator and/or a pump and spare tubes are a must.

Extra clothes. 

Be prepared for mountain weather!   As the fall weather rolls in you must be prepared for all weather, especially considering there is a 10km descent followed by a 10km climb.

Check trail conditions:

Checking trail conditions on trailforks.com. is a great idea before heading out although trail updates can probably be found when buying your trail pass for the day.

What is IMS?

Intramuscular Stimulation (IMS) is an effective treatment for musculoskeletal pain syndromes caused by nerve irritation (termed neuropathy). Neuropathy is described as a nerve that is not functioning properly but has normal structure. The neuropathy results in pain, muscle shortening and spasm, localized tenderness in the muscle, and localized swelling around the spinal segments. Temperature changes, sweating changes and/or altered sensations around the spine and extremities can also be present.

Spring Biking Tips

Starting biking in the Okanagan is a wonderful thing after the winter.  This article will provide some tips on how to safely transition to spring time biking.

Tune-up your bike:

If you put your bike in storage without a fall tune-up your bike will need some checking and adjusting.  You can either take your bike to a local bike store or, if you are competent and you have the tools, tune it up yourself. 

A Tune up should include:

Tire inflation to the correct PSI (check the sidewall and then adjust for your weight/riding style).

Test the shifting.

Check brake pads/rotors for wear.  Ensure that the brakes pull to close evenly without rubbing and that there is good power.

Lubrication of chain and jockey wheels.

Visual inspection of the frame for cracks, etc.

Bolt Check. Check that all the bolts are still tight (a torque wrench designed for bikes is a great investment, especially for a bike with carbon fibre components).  You never want to experience a handlebar loosening on a downhill!  Also check that the quick release or bolts on the wheels are properly adjusted.

Check that the rubber on your tires is in good condition i.e. there is no cracking or significant loss of tread. 

Clean your bike, especially the drive train.  

Consider replacing your chain and or cassette (gears).  These components wear together and if they are too worn you will need to replace both.  If you replace the chain often enough (depending on how much you ride) you can get by with replacing only that component.

If you ride with clipless pedals, check the cleat and replace if worn.  Also replace the bolt that holds the cleat onto the shoe if they are starting to wear down.

Check your comfort:

If you had discomfort on your bike last year or you are riding a new bike, get your bike properly fitted for you.  If you had discomfort last year, it will probably return again this year once you start to increase the length of your rides.  A thorough bike fit should include an examination of your flexibility and strength, as well as your position on the bike and pedalling technique.  Addressing the muscle impairments, pedalling technique and adjustments to the bike will make a huge difference in comfort.

Start Slow and Spin:

Make sure to build up your kilometres in a gradual fashion even when the sun is shining.  Pick a distance or length of time roughly half or your usual ride from the previous year and build on that.  A 10% increase in riding time per ride is a good rule of thumb.  Make sure you redevelop your spin, aiming for 90+ RPM’s on the flats.  Focus on trying to make completes circles with your legs.  Pay attention so that each leg is working the same.  Avoid a lot of big hills to start to avoid over stressing your knees

Check your helmet:

There doesn't seem to be a consensus on when to replace your helmet.  Some helmet companies recommend every three years, other companies have no recommendations.  Personally, I replace my helmet every three years as buying a helmet is a small price to pay for a healthy head!  All the companies will agree that a helmet should replaced after a crash where you hit your head.  At all times the helmet should fit properly according to the company’s user manual.  I hate to see both and adults and kids wearing helmets that don't fit properly and are essentially useless in a crash.  Buy the lightest helmet you can afford to take the load off your neck.

Invest in bike shorts:

Yes, that chamois does wear out and get thin.  I am a huge fan of great shorts even if you have a great seat.  Invest in the best shorts you can afford!

Top 12 Tips for Plantar Fasciitis / Heel Pain

Heel pain is a common condition.  Pain in the arch of the foot, where it meets the heel, is most commonly diagnosed as plantar fasciitis.  Typically the pain is worse with the first few steps in the morning, or the first few steps after inactivity.  The pain maybe worsened while running or prolonged walking and standing  The pain can be, but is not always, reduced with light activity.  The heel pain typically comes on gradually and progressively.  On examination there is local tenderness on the bottom of the heel bone towards the arch.  The tenderness may extend into the arch itself.  

A manual physical therapy examination will identify the root causes of the heel pain.   Typically the heel pain is brought on by a sudden increase in the amount or intensity of weight bearing activities i.e. a large increase in running distance or standing longer than usual at work.  The strain on the plantar fascia can be exaggerated by the bony alignment of the lower limb as well as muscle weakness and tightness of the foot, ankle, lower limb and spine.  Commonly there is a lack of mobility in the joints of the ankle and muscle tightness around the ankle.  It is also common that an increase in pronation, which flattens the arch, can put extra strain on the plantar fasciitis.  It is very common for the plantar fasciitis to be increased in the fall after a change to less supportive summer footwear.

Manual physical therapy treatment of plantar fasciitis is multifactorial:

Manual therapy:

Manual Therapy techniques are used to improve joint mobility and improve soft tissue flexibility around the foot and ankle.  This is done through hands-on joint and soft tissue mobilization/manipulation.  The soft tissue techniques typically include trigger point release which have been proven to help reduce plantar fascia pain.

Check the rest of the leg and lower back:

A manual therapist will check the rest of the spine for other underlying biomechanical faults and muscle imbalances in the leg and lower back, pelvis and hip.  A manual therapist will also check for altered mobility of the nerves and soft tissue in the leg and spine.

Tape to unload:

It is very helpful to unload the plantar fasciitis with sports tape.  This type of taping is termed ‘low dye’ taping.   Typically the pain relief felt is significant and immediate.  Taping the plantar fasciitis is also helpful in determining if orthotics will be beneficial.  With low-dye taping a 50% improvement in pain is expected before recommending custom or non-custom orthotics.

Custom or non-custom orthotics:

Both custom and non-custom (over the counter) orthotics have been proven to be helpful. Some individuals will do well with over the counter orthotics while others, due to the shape and biomechanics of their foot, will need a custom made orthotic.

Assist healing with physiotherapy modalities:

A manual therapist may assist the plantar fascia in healing through use of physiotherapeutic modalities such as ice, electrical stimulation and ultrasound.

Exercises for mobility:

A manual physical therapist will provide an individualized exercise program to improve mobility.  An exercise program would also address any other muscle tightness and/or lack of mobility in the low back, pelvis, hip and leg.  Stretching of both the calf muscles and plantar fascia has been proven to reduce plantar fascia pain.

Strengthen the plantar fascia:

There is evidence that a specific plantar fascia ‘high load’ strengthening program can be beneficial in reducing pain and improving the health of the plantar fascia tissue.   In the research study individuals who undertook the specific strengthening program along with stretching and arch supports had better outcomes than only stretching and arch supports.

Strengthen the rest of the leg:

Quite often limping to avoid heel pain creates muscle imbalances through the lower limb.  Through examination of your walking pattern and manual muscle testing the changes can be addressed by specific therapeutic exercise.  Recent research has demonstrated strength deficits in the toe, arch and ankle muscles in individuals with plantar fasciitis.

Education:

Education is provided to reduce strain on the plantar fascia through changes in footwear, work habits, activities and training factors.  It is important to gradually resume weight bearing activities in a systematic manner appropriate for the stage of healing.

IMS dry needling:

Another treatment option with more ‘stubborn’ cases is IMS dry needling of the foot, calf and lower back muscles.

Night splint:

A night splint, which keeps the foot held at a 90° angle all night can be used.   The night splint allows the plantar fascia and calf muscles to be positioned under slight tension, to improve mobility and make the first few steps in the morning less painful.

Medication:

Another option is to see your family doctor to discuss the use of medication or a referral for further investigation and treatment if you are not improving as expected with manual physical therapy treatment.

WHAT TO DO IF YOU HURT YOUR BACK

Low back pain is a very common occurrence and is said to affect 80% of people at some time in their life.  Common causes of acute low back pain are sudden unexpected movements, such as bending and lifting while twisting, or trauma, such as a fall or a motor vehicle accident.  Other back injuries can occur in some individuals simply by bending over to brush their teeth, sneezing, or while doing other simple tasks.  The low back pain can either come on instantly, with acute muscle spasm or ‘locking' (sometimes it is impossible to move or to straighten to an upright position), or it can come on more slowly (up to 2 days post injury, as swelling and muscle spasm gradually accumulates) .

What to do:

1) Relax! 

No matter how bad the pain is it will get better.  Back pain is very common and while it can be debilitating the more anxious and stressed you are, the more the pain will increase.  Focus on staying positive.  Keep reminding yourself that you will improve.  Find a comfortable position and use relaxation breathing techniques.  This can very helpful in reducing pain .

2) Ice or heat.  

If the pain is less than 48 hours old, use ice.  Use heat if the pain has been present for more than 48 hours. Heat can be in the form of hot showers,an electric heating pad, a microwaveable pad or hot water bottle.  Heat works best when an area is achy.  The ice can work to numb the area and is especially good if the injured area feels hot and burning.    Some people find relief alternating between ice and heat provided the best relief.

3) Stay Mobile

Try to remain as active as the pain will allow. Some discomfort with moving around is normal. Research has proven that keeping active i.e. puttering around (stand a little, sit a little, walk a little) will allow you to get better faster.  Strict bed rest, while once commonly prescribed, will typically slow down your progress.  

4) Find the best positions to rest and sleep.

If you are unable to move or movement greatly increases the spasm and pain, then you may require more rest.  Finding comfortable positions for sleep and rest is important to unload your back as it gets tired or the pain starts to increase.  See the sleep position article for some advice on the best resting positions.  

5) Get treatment.  

There is good evidence that manual physical therapy will get you better faster. Research has proven that manual physical therapy for acute low back pain performed in the first 16 days is most effective. 

6) Leg Pain? Learn the right exercises and positions and try traction.  

Pain radiating down the leg will also improve with manual therapy but also requires specific exercises and/or positioning to relieve the pain. Traction can be of benefit especially when the leg pain is radiating below the knee.

7) Pain relief with physiotherapy modalities.

Physiotherapy modalities such as electrical stimulation, i.e. TENS or IFC, can be of benefit.  Electrical stimulation works to block the pain impulses that are being transmitted, providing an analgesic effect.  As the impulses are blocked the muscle spasm will relax.

8) Prevent a reoccurrence. 

Talk with a manual physical therapist about recommendations to try and prevent the acute pain from happening again.  This can involve education on posture, sport techniques, lifting, etc.  It can also involve learning a specific therapeutic exercise program to improve mobility, improve joint stability and improve strength.

9) Medication?  

If the pain is constant you may benefit from anti-inflammatory medication.  If the pain is keeping you from sleeping you might consider a muscle relaxant.  If the pain is unbearable then you might consider a pain reliever. It is best to discuss this with your physician or pharmacist.

How to Prevent Back Pain 

Though it can be difficult to entirely prevent back pain, you will reduce the likelihood of injuring yourself by following these tips.  If you are already suffering from low back pain they can help prevent a recurrence.

Work smart – one of the biggest risks for back injuries is repetitive bending and twisting.  Learn how to bend using your hips rather than your back.   Make sure that when you pivot, either standing or sitting in a rolling chair, you turn with your whole body, not just your trunk.

Posture, posture, posture – There has been a lot of news lately about how unhealthy prolonged sitting is for our general health. It also is unhealthy for our backs.  The soft tissue in our back, i.e. muscles and ligaments, gradually lengthen while they remain in one position.  This is a phenomenon called ‘creep’.  This gradual elongation can begin to cause stiffness and pain once you are in a position for too long.  So stand and sit properly, use a proper chair and change positions every 15-20 minutes.  Consider a sit/stand desk if you have an office job to allow frequent changes in position.

Avoid unusual strenuous activity – It is common to injure the back after or during unusually strenuous activity, i.e. gardening all weekend in the spring or shoveling after a heavy snowfall.  Don’t push yourself to exhaustion.  Make sure to take breaks during an activity and reverse the position you have just been working in.

Maintain a healthy weight – Carrying excess weight puts more strain on the spine.

Regular exercise - Regular exercise is one of the best methods to prevent low back pain.  Regular exercise should include a cardiovascular component like walking, hiking, biking, etc.  This should be done at least 3 times per week for 30-40 minutes.  You should work up a sweat and huff and puff a little.  Develop a stretching routine that helps you work properly and allows you to participate in your sport with minimal strain.  Sitting and bending properly requires good hip flexibility in the muscles in the back of the hip.  Walking and running require good flexibility through the back of the hip.  Strengthening exercises are also important and should work all the major muscles groups.  Make sure that the exercise is at an appropriate level for your fitness.

Exercise sensibly – Regular exercise is crucial for good health and keeping your back healthy.  However make sure that the exercise is at an appropriate level.  Unfortunately many people are so enthusiastic at starting an exercise program that they can injure themselves.   Take an honest evaluation of your health and proceed in a sensible manner.  A ‘good rule of thumb’ is that you shouldn’t increase either the intensity or length of an exercise session by more than 10% at a time.

Do those exercises properly – Learn how to do strengthening exercises with correct technique.  Physiotherapists spend a lot of time working with clients on how to perform exercises properly and at an appropriate level of challenge.  Squats, dead lifts and core exercises are the three most improperly performed exercises.

Activate the core – A combination of old injuries, postural habits, the sports and activities we take part in, our posture and body type can result in muscle imbalances.   These muscle imbalances can have the effect of not allowing us to activate our core properly.  Very often there are muscles that don’t activate correctly and need specific exercise to be re-activated.  Working with a manual physical therapist can help you identify what are the best specific exercises to learn to reactivate your core. 

Stop smoking – Recent studies have concluded that that development of back pain was significantly associated with smoking, high blood pressure, and high cholesterol.  See your doctor for help in stopping smoking if you need it.

Sleep – If you are suffering from poor sleep you aren’t utilizing your natural recharging system.  A good sleep restores our body’s chemicals that help us stay healthy. You can try some of the positions mentioned in this article.  Try to avoid napping during the day, as it can disturb nighttime sleeping.  Avoid stimulants such as caffeine, nicotine, and alcohol close to bedtime.  Stay away from large meals close to your sleep time. Get regular exercise, as it is important for a proper sleep cycle.  However, strenuous exercise should be avoided in the evening. Relaxation exercise like gentle yoga, gentle stretching and relaxation breathing can be done before bed to help initiate a restful sleep.  Make sure to get outside in the daytime.  Establish a regular relaxing bedtime routine. Avoid using electronics such as computers, laptops, phones and iPads before bed. These devices have been linked to altering our sleep pattern by reducing a sleep chemical called melatonin and increasing our brain activity.

Hip Pain - Impingement ?

Knee pain is a common complaint at Kelowna Manual Therapy Centre. This article deals with knee pain that gradually increases, rather than knee pain that is caused by an acute injury.  Treating knee pain must involve taking a thorough history as well as physical examination.  A Thorough history-taking and physical examination will help determine whether the knee pain is the primary problem or the ‘victim’. In other words, a manual therapist will look for the root of the problem.  The knee pain can be the source of the problem, or caused by problems in the lower back, pelvis, hip and/or foot and ankle.

Commonly, non-acute knee pain is brought about by about by stresses transferred from other areas.  For example, tightness and weakness around the hip can cause a lack of control and an increased angulation of the knee with bending.  This is termed “Valgus collapse”.  This is one of the most common causes of knee pain seen with ‘overuse’ injuries.

PIC: Poor knee control as a result of hip muscle tightness and/or weakness

Another example is tightness in the calf muscles or stiffness in the ankle joint will put an increase in stress on the knee by causing an increase in twisting forces on the knee.  Excessive pronation can also contribute to increased knee stress.

Manual Physical Therapy treatment will use a combination of manipulation, mobilization, IMS dry needling, soft tissue work, stretching and strengthening to help restore normal mechanics.  Orthotics can be used if it is determined that increased foot pronation is contributing to the knee pain.  A specific therapeutic exercise program will be taught to reinforce correct movement patterns.

The therapeutic rehabilitation program will follow one or more of the following principles:

• Correct knee, lumbar, pelvis, and hip alignment with exercises. This involves good control of the ankle, knee, hip, pelvis and lumbar spine with movement.  Movement patterns that mimic the activities that were painful are focused on as part of the rehabilitation.  Rehabilitation exercises must be kept pain free.
• Initially, exercises will be used to minimize ‘sheer’ stress on the knee. If the knee remains centered over the foot rather than allowed to move forward this will reduce stress on the knee.  As the exercise program progresses increased loading will be used.  There are a varieity of methods used to increase that load i.e. moving from both legs to one leg, adding weight, adding speed, adding unstable surfaces, etc.
• An emphasis on eccentric (muscle and tendons working and lengthening) exercises are used for sports that require this type of loading i.e. downhill trail running.  Eccentric exercises are useful to prevent and treat knee tendinopathy.
• Attention to the type of activities and training previously discussed here.