OttawaPhysiotherapy

Tenderpoints and IMS (Ottawa Physiotherapy)

2011-05-25T05:33:00.000-07:00

Below is an article about IMS (intramuscular stimulation) from the Ottawa Physiotherapy and Sport Clinics. We offer IMS at our Orleans physiotherapy, Barrhaven Physiotherapy and Westboro Physiotherapy locations.

Tenderness at Motor Points(Extract from an article that was printed in the Journal of Bone and Joint Surgery September 1976)

A DIAGNOSTIC AND PROGNOSTIC AID FOR LOW-BACK INJURY
BY CC GUNN, MA, MB, B.CHIR*, AND WE MILBRANDT, MD*,VANCOUVER, BRITISH COLUMBIA, CANADA

From the Workers’ Compensation Board, Rehabilitation Clinic, Vancouver

The following extract is included because it was the first physical sign we discovered that is related to neuropathy.

ABSTRACT: In patients with low-back injury the motor points of some muscles may be tender. Of fifty patients with low-back “strain”, twenty-six had tender motor points and twenty-four did not, while forty-nine of fifty patients with radicular signs and symptoms suggesting disc involvement had tender motor points, and the one without such tender points had a hamstring contusion which limited straight leg raising. Of fifty controls with no back disability, only seven had mild tender points after strenuous activity, while forty-six of another fifty controls with occasional back discomfort had mild motor-point tenderness. In all instances the tender motor points were located in the myotomes corresponding to the probable segmental levels of spinal injury and of root involvement, when present.

Patients with low-back strain and no tender motor points were disabled for an average of 6.9 weeks, while those with the same diagnosis but tender motor points were disabled for an average of 19.7 weeks, or almost as long as the patients with signs of radicular involvement, who were disabled for an average of 25.7 weeks. Tender motor points may therefore be of diagnostic and prognostic value, serving as sensitive localizers of radicular involvement and differentiating a simple mechanical low-back strain from one with neural involvement.

It is often difficult, if not impossible, to establish the cause of disability and to assess its degree in patients with low-back pain. While in some patients the diagnosis can be made with no difficulty on the basis of the clinical history and physical examination, in others additional diagnostic tests including myelography and electromyography may be required. As a general rule, however, such tests are reserved for patients whose diagnosis is not clinically apparent or who are expected to require surgery. There remain, therefore, many patients with no localizing physical findings for whom ancillary tests are not considered necessary. The injuries in these patients are conveniently labeled “low-back sprain”.

The physician, unable to make a firm diagnosis, may rightly or wrongly relate the pain to socio-economic and psychophysiological factors, or may even suspect malingering. Therefore, many patients with genuine discomfort may not be treated appropriately simply because there are no significant physical findings.
The Workers’ Compensation Board of British Columbia operates an Outpatient Rehabilitation Clinic to provide treatment after industrial injuries. So-called low-back sprain, a vague term encompassing a multitude of disorders, is one of the most common disabilities seen at the Clinic. In 1974, the total number of admissions for all types of injuries was almost 5,000, and 1,630 (33 per cent) of these were for injuries to the lumbar spine. Of these lumbar-spine injuries, 1,401 (86%) were given a working diagnosis of low-back sprain. The remainder were fractures and postoperative conditions after laminectomies and spine fusions 8.

While performing electromyographic examinations in this Clinic, we discovered that some patients had tenderness at the motor points. Initially, these tender areas were confirmed as being located at the motor points by showing that they were at sites where the minimum electrical stimulus evoked muscle twitches using a standard calibration-stable stimulator with variable control of outputs. These studies established that the motor points of certain muscles are frequently tender in patients with low-back pain. Electromyography also showed evidence of neuropathy in the nerves supplying these tender muscles, including increased insertion activity, more polyphasic action potentials, and prolongation of the mean duration of the motor-unit action potentials, their mean amplitude remaining normal or decreasing and a partial interference pattern being obtained even during maximum voluntary effort6,7.

Tenderness parallel the severity of the symptoms and varied from week to week and even from day to day. Localized tenderness was not found in patients having hysteria or malingering. Because of these findings, we had to revise many previous diagnoses. For example, a dull ache localized to a small area in the upper lateral quadrant of the buttock, which previously had been attributed to gluteal bursitis, was found to be a tender gluteus medius. Similarly, tenderness at the gluteus maximus had been mistaken for sciatic-nerve tenderness. Tenderness described as trochanteric bursitis was found to be located at the tensor fasciae latae motor point, while tenderness thought to be caused by “adductor strain” and “rider’s sprain” was found to be located at the motor points of the pectineus and adductor longus 3. Tenderness was rarely limited to one motor point and a search for other points in muscles of the same myotome usually revealed their presence.
Methods and MaterialExamination for Tender Motor Points

Representative muscles of the second through the fifth lumbar and the first two sacral myotomes are examined. Trauma to a nerve root causes irritation or degeneration of nerve fibers, or both. These lesions may be detected during electromyography as increased insertional activity, polyphasic action potentials,
fasciculation potentials, fibrillations, and positive sharp waves, or in the procedure described here as tender motor points. Examination of the paraspinal muscles innervated by the posterior primary rami is also necessary to confirm the pathological process involves the segmental nerve at the root level.

SEGMENTAL INNERVATION OF MUSCLES OF THE LOWER LIMB
TABLE I

Muscle (Segmental Innervation) Peripheral Nerve points of both heads of the gastrocnemius and of the soleus.

With a little practice, any tenderness at these motor points may be quickly elicited, although some points are
L2 Sartorius (L2, L3), Pectineus (L2. L3), Adductor longus (L.2, 1.3), L3 Quadriceps femoris (L2-L4) L4* Quadriceps femoris (L2-L4), Tensor fascise lame (L4, L5), Superior gluteal, Tibialis anterior (L4, L5), L5 Gluteus medius (L4-S1), Semimem>xanosus (L4-S1), Semitendinosus (L4-S1), Extensor hallucis longus (L4-S1) , S1 Gluteus maximus (L4-S2), Biceps femoris, short head (L5-S2), Semitendinosus (L4-S1), Medial gastrocnemius (S1, S2), Soleus (S1, S2) S2 Biceps femoris, long head (S1, S2), Lateral gastrocnemius (S1, S2), Soleus (S1, S2)

* Muscles receive innervation from more than one segment. The segments listed on the left are those generally accepted as the predominant source of innervation of the muscles in question. All are innervated by the anterior rami; the posterior rami go to corresponding levels of the erector spinae muscles, but there is extensive overlapping of the posterior rami.

In this prospective study, 100 patients and 100 control subjects were examined and followed. They were divided into four groups:

Patients with Low-Back Pain (Groups A and B)100 patients with low-back symptoms were selected from 147 consecutive patients. 47 patients were excluded with compression fractures, advanced degenerative osteoarthritic changes, and previous laminectomy or spine fusion.

All patients were managed with the standard Clinic regimen 8 including physiotherapy followed by graduated remedial exercises as well as occupational therapy or industrial activities as tolerance improved. Patients also received instruction in the care of the back and in proper bending and lifting techniques.
Control Subjects (Groups C and D)We decided to use 100 members of the lay staff of the Workers’ Compensation Board as controls. Their combined age and sex distributions were comparable to those of the patients in Groups A and B.

The control subjects were divided into two groups: Group C, fifty men and women who had no back disability; and Group D, fifty men and women who considered themselves normal, without back discomfort at the time although they had had occasional low-back discomfort after unusual activity.
Results

Group A - Low-Back SprainNo history of previous back surgery, no radicular symptoms, and no feeling of weakness, numbness, or paresthesia. No radicular signs, reflex changes, sensory changes, motor weakness, or muscle atrophy. Roentgenograms were normal or showed no more than minimum degenerative changes consistent with age or minor congenital abnormalities. No spondylolysis or spondylolisthesis. Of these fifty patients, there were twenty-six (52 per cent) who had tender motor points and twenty-four (48 per cent) who did not. These two subgroups were compared with respect to roentgenographic changes, mechanism of injury, and duration of disability. 15 of the 26 patients with tender motor points had roentgenographic abnormalities, while only two of the twenty-four without tender points had such findings.
The duration of disability ranged from 12 to 34 weeks (average, 19.7 weeks) in 25 of the 26 patients with tender motor points. In the 24 patients with no tender motor points, the disability period ranged from 3 to 13 weeks (average, 6.9 weeks).

Group B - Disc InvolvementThis Group had radicular symptoms and signs. All but one had tender motor points. The exception sustained a contusion of the hamstring muscles and this, rather than radicular involvement, was responsible for the limited straight leg raising. Although many of the patients with tender motor points had unilateral symptoms, as often as not their tender motor points were bilateral.
The duration of disability of the 49 patients in Group B with tender motor points ranged from 14 to 72 weeks (average, 25.7 weeks), while the one patient with no tender motor points was disabled for only 8 weeks.

Group C - No Back DisabilityThese subjects with no back disability showed no positive findings, developed Grade-1 tender motor points after unusual activity, such as jogging, or shoveling snow; their tenderness disappeared a few days later, only to recur whenever they increased their activities.

Group D - Occasional Back Discomfort

Physical examinations in Group-D subjects with occasional back pain were negative at the time of examination. But 46 (92%) had Grade-1 or Grade-2 tender motor points.
No correlations were evident between the locations, numbers, and grades of the tender points and the location of the degenerative changes visible on the roentgenograms.

Discussion

It is generally agreed that virtually everyone eventually has some degenerative joint disease in the low back, but that as a rule problems arise only when the degeneration has reached a certain degree and some incident, which may be minor, precipitates symptoms.
In this study it was found that an injury involving flexion combined with rotation of the lumbar spine is most likely to cause prolonged disability and that tender motor points may be useful in assessing back problems, particularly when no positive physical signs are detectable.
Tender motor points of a mild and transient nature may occasionally be found in asymptomatic individuals, especially after unusual activity. Moderately tender motor points are usually present in so-called vulnerable backs or lesser degrees of trauma. The presence of tender motor points might be significant in pre-employment medical examinations. Moderately to acutely tender motor points are almost constantly found in patients with disc degeneration. The degree of tenderness and the number of tender points tend to parallel the patient’s condition and may serve as indicators of progress.
An important finding was that low-back patients and no tender points were disabled for an average of 6.9 weeks, while those with tender points were disabled for an average of 19.7 weeks, almost as long as patients with radicular signs, who were disabled for an average of 25.7 weeks. Tender motor points, may, therefore, be a sensitive indicator of radicular involvement. Recovery time may be related to the degree of trauma sustained. Patients seen for the first time, who show no physical signs except tender motor points, deserve attention and continued surveillance.

Conclusions

Low-back pain without significant physical signs may present a diagnostic challenge. Tender motor points may be a clue under these circumstances.
This study suggests that muscle tenderness, maximum at motor points, can be elicited during the routine examination of the back and be a useful diagnostic and prognostic sign in this enigmatic group of low-back sprains.

Patients diagnosed as having simple low-back sprain but demonstrating acutely tender motor points will have a period of disability approaching that of patients with radicular signs, while patients with no tender motor points can be expected to do well.

References

1. Chusid, JG: Correlative Neuroanatomy and Functional Neurology. Ed. 15, pp. 236-237. Los Altos, California, Lange Medical Publications, 1973.2. Coers, C: Note sur une technique de prelevement des biopsies neuro-musculaires. Acta Neurol. Psychiat. Belgica, 53:759-765, 1953.3. Cyriax, JH: Textbook of Orthopaedic Medicine. Ed. 5, p. 646. London, BaiUierc, Tindall and Cassell, 1969.4. Denny-Brown, D, and Brenner, Charles: The Effect of Percussion of Nerve. J. Neurol•, Neurosurg., and Psychiat., 7: 76-95, 1944.5. Goodgold, Joseph, and Eberstein, Arthur: Electrodiagnosis of Neuromuscular Diseases, pp. 3 and 164. Baltimore, Williams and Wilkins, 1972.6. Gunn, CC, and Milbrandt, WE:Tennis Elbow and the Cervical Spine. Canadian Med. Assn, J., 114: 803-809, 1976.7. Gunn, CC, and Milbrandt, WE: Unpublished data.8. Milbrandt, WE, and Gunn, CC: A Comprehensive and Progressive Rehabilitation Programme for Low Back Strain as applied at the Workers’ Compensation Board of British Columbia. In Proceedings, International Symposium on the Rehabilitation of the Industrially Injured. Vancouver, British Columbia, Canada, April 1973.9. Nassim, Reginald and Burrows, HJ: Modern Trends in Diseases of the Vertebral Column, p. 268. London, Butterworths, 1959

IMS (intramuscular stimulation) from the Ottawa Physiotherapy and Sport Clinics

IMS and Chronic Low Back Pain

2011-03-09T08:25:00.000-08:00

Intramuscular Stimulation (IMS) of Muscle Motor Points in the Treatment of Chronic Low Back Pain: A Randomized Clinical Trial
Here is another article discussing IMS an lower back pain. FYI this is a service we offer at our Orleans physiotherapy, Barrhaven Physiotherapy and Westboro Physiotherapy locations.

Simple or mechanical low back pain, as defined by the Clinical Standards Advisory Group (CSAG 1994), is the commonest and most rapidly increasing cause of loss of work, demand for health care and need for state benefit in society today (Fordyce 1994).
In most recent population studies 36-37% of the adult population reported back pain in the last year and approximately 60% would report back pain at some time in their lives (CSAG 1994). The annual cost of this back pain to the NHS was estimated to be £480 million (This does not include private consultations or medicines outside the control of the NHS).
Tulder (1997) carried out a systematic review of RCT’s of the commonest forms of treatment in use for back pain, including Acupuncture (Dry-needling). This review concluded that the overall methodological quality of RCT’s on the efficacy of treatments for back pain was very poor. Acupuncture in particular appeared to have poorly designed trials to support its use in a clinical setting.
However, acupuncture still remains a common and a popular form of treatment for back pain and although described as being of poor quality some evidence does exist for its use. Gunn (1980) in a study of chronic low back pain found that patients treated with dry-needling had significantly better outcomes than controls with respect to return to work (P > 0.005). Garvey (1989) compared dry-needling to injection of local anaesthetic in patients with low back pain. Dry-needling resulted in a 63% improvement rate (P=0.09). The use of dry-needling as opposed to injection of trigger points is further supported in other studies (Hong 1994).
This study aims to address the lack of evidence and to support the use of acupuncture (Intramuscular Stimulation) in the clinical setting for the treatment of chronic low back pain. To achieve this a randomised controlled trail was conducted to test the hypothesis that: Dry-needling of muscle motor points for chronic low back pain in conjunction with a program of exercise produces superior outcomes to the use of an exercise program alone.
Patients who had simple, chronic low back pain, as defined by the CASG report (1994), were randomly selected from a total of 6 months of referrals made to the Physiotherapy Department at St. Leonards Hospital. These referrals were from the patients General Practitioners. A total of 45 subjects, 24 in the experimental and 21 in the control were recruited.
Once it was established that these subjects fit the study’s inclusion criteria and their written consent was obtained, they underwent the clinics standard back pain assessment, this was used to calculate a range of movement score (Stankovic and Johnell 1990). Subjects were also asked to complete two questionnaires as part of the study’s outcome measures,
• The McGill Pain Questionnaire.
• The Roland Morris Physical Disability Scale.
A further Questionnaire was used at initial assessment to rule out any obvious Depressive overlay.
• The Distress and Risk Assessment Method.
At this point an independent clinician randomly allocated each patient to either the experimental or the control group. The experimental group was treated with instruction in a home exercise program and also started on a course of Intramuscular Stimulation (IMS). This consisted of up to ten treatments.
The control group received similar instruction in a course of home exercise but received no treatment with IMS. At termination of treatment both groups were asked to complete the questionnaires again and receive a physical re-examination of the spine.
A follow up appointment for 3 months post discharge was then arranged to physically re-assess each patient and to complete the two outcome questionnaires. The results were analysed, using the non-parametric Mann-Whitney U test.
The results supported the hypothesis that intramuscular stimulation and an exercise programme are superior to an exercise programme in isolation. At the pre-treatment measurement stage there was no significant difference between either the experimental group or the control group at any of the three outcome measures.
At both the discharge and the three month follow up stage there was a significant difference noted in the Roland Morris scores (p = .005). Similarly, significant differences existed with the range of movement scores (p = .005) and the McGill pain questionnaire scores (p = .005).
This study proposes that the use Intramuscular Stimulation in the treatment of chronic low back pain be considered a serious alternative to other conventional therapies. Further studies with longer term follow up and larger numbers of patients are now needed to confirm this assumption.

Intramuscular Stimulation

2011-02-03T05:16:00.000-08:00

IMS and tennis elbow

Below is an article talking about intramuscular stimulation (IMS) which is a treatment offered at all three locations at the Ottawa Physiotherapy and Sport Clinics (Orleans physiotherapy, Barrhaven physiotherapy and Westboro physiotherapy sites).

Tennis Elbow and the Cervical Spine

C. Chan Gunn, MD

The exact cause of tennis elbow, a common condition, is still obscure. While the condition may well be entirely due to a local disorder at the elbow, the results of a study of 50 patients whose condition was resistant to 4 weeks of treatment directed to the elbow suggest that the underlying condition may have been (at least in these patients) a reflex localization of pain from radiculopathy at the cervical spine. Clinical, radiologic and electromyographic findings supported this suggestion. The pain was demonstrated to be muscular tenderness, which was maximal and specific at motor points. Treatment directed to the cervical spine appeared to give relief in the majority of patients. The more resistant the condition, the more severe were the radiologic and electromyographic findings in the cervical spine.
Tennis elbow, a common affliction, the exact cause of which is unknown, has been considered to be a self-limiting condition, seldom persisting for longer than 12 months, yet symptoms may continue longer despite all types of conservative treatment or even surgery.
This paper reports a new approach: in a series of 50 patients treatment was directed to the cervical spine after at least 4 weeks of treatment of the elbow had failed, and it was successful in most.
Patients and symptoms
The 50 patients with tennis elbow, 37 men and 13 women, were referred by attending physicians to the rehabilitation clinic of the Workers' Compensation Board of British Columbia for management. In many the condition had not responded to the usual conservative office measures, such as injections of steroids and local anesthetics, manipulation, ultrasound, friction massage and immobilization. Their age distribution was as follows: 21 to 30 years, 8 patients; 31 to 40 years, 10; 41 to 50 years, 13; 51 to 60 years, 15; and over 60 years, 4.
All were right-side-dominant, but three had only left-side complaints. Eleven had bilateral lateral epicondylar symptoms, 12 had concurrent medical epicondylar symptoms and 7 had bilateral medical and lateral epicondylar symptoms. The time lapse between onset of symptoms and referral to the clinic was 8 weeks or less in 24, 8 to 12 weeks in 11 and more than 12 weeks in 15.
The clinical types of tennis elbow, classified by onset and injury, were the following:

Acute type, precipitated by indirect trauma (Cyriax's typeI) - - for example, probable avulsion due to acute pull of forearm extensor muscles at their origin (four patients).
Subacute type, following indirect trauma (Cyriax's type II), from repeated and forcible extension movements at the wrist (six patients).
Insidious onset (Cyriax's type III), with no specific single incident (11 patients).
Acute onset following blunt trauma (Cyriax's type IV) (six patients).
Associated with cervical "strain", with history of phyerextension or flexion injury to cervical spine or neck "strain" (13 patients).
Associated with jolt or traction to shoulder (three patients).
Not classified elsewhere - - for example, as part of multiple injuries, when exact mechanism is not determined (seven patients).

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Examination
In addition to eliciting the classic signs, the examiner palpated carefully the entire elbow region with a blunt point or the tip of a finger. Points of maximal tenderness found (usually four) were accurately determined and marked. These points seemed to correspond to the sites of muscle motor points in the region and were confirmed as such by electric stimulation. A motor point is defined as the site where a muscle twitch may be evoked in response to minimal electric stimulation. This point, a fixed anatomic site, lies close to where the motor nerve enters the muscle. Many of the motor points of the wrist extensor lie around the lateral epicondyle of the humerus, where there is also a rich supply of sensory nerve fibre endings (Fig I). Other upper-limb motor points where tenderness might be found were likewise examined (Figs. 2, 3 and 4). Since the tender muscles have common root derivations of their motor nerves (Table I), the cervical spine was also examined.
Electromyographic examination was performed in 42 patients, and in all patients with a history of acroparesthesia or in whom carpal tunnel syndrome or ulnar nerve tardiness was suspected, motor nerve conduction velocity tests were done to exclude such conditions.
Physical findings
The wrist extensor motor points generally found to be tender were those of the brachioradialis, extensor carpi radialis, supinator, extensor digitorum and extensor carpi ulnaris; these points are closely situated in an area of about 5 cm in diameter. Tenderness in other areas was of similar quality and often equal intensity; frequently both sides were involved. The frequency of tenderness at the various motor points is shown in Table II.
Eighteen patients showed slight limitation of lateral rotation or lateral tilting of the cervical spine to the affected side. On that side, in all patients, the apophyseal joints of involved levels were tender to digital pressure (commonly C5 and C6) when carefully examined showed resistance to passive motion.
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Table I - Spinal cord root derivations of motor nerves supplying arm and shoulder muscles.

Muscle

Infraspinatus, supraspinatus
Deltoid
Biceps
Brachioradialis
Pectoralis major
Triceps
Extensor carpi radialis
Flexor carpi radialis
Pronator quadratius
Flexor carpi ulnaris
Dorsal interossei

Motor nerve root derivation

C5,6
C5,6
C5,6
C5,6
C5-8, T1
C6-8, T1
C6-8
C6-8
C8, T1
C7,8, T1
C8, T1

Table II - - Frequency of tenderness at various motor points.

Muscle of tender motor point

Trapezius
Supraspinatus
Infraspinatus
Deltoid (any of three points)
Pectoralis major
Biceps branchialis
Extensor carpi radialis
Extensor carpi ulnaris
Extensor digitorum
Branchirradialis
Triceps (any of three points)
Adductor pollicis brevis
Flexor carpi ulnaris

Frequency* of tenderness

36
39
12
28
13
15
57
57
50
12
6
13
16

*Out of a possible 100 -- that is, 50 X patients X 2 sides.
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Muscle atrophy, especially of the trapezius, supraspinatus, triceps and deltoid, was noted in 15 patients, and partial loss of sensation to pinprick over the associated dermatome was detected in 1 patient.
In 10 patients an autonomic (pilomotor and sudomotor) reflex was elicited when the patient was exposed to cold air: the skin over the dermatome involved - generally C5,6 - showed "goose pimples" or an erector pili effect (cutis anserina). This reflex (sometimes accompanied by excessive perspiration in the axillae) could also be induced by digital frictional pressure over many of the tender motor points. Deep reflexes were always normal.

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Radiologic findings
Radiographs of the elbow invariably showed no significant findings, but radiographs of the cervical spine in 34 patients (average age, 47 years) showed changes commensurate with age.
Electromyographic findings
All 42 patients showed some abnormal electromyographic findings of early neuropathy or radiculopathy in affected myotomes. Discharge of action potentials due to mechanical excitation was often increased, and with voluntary activity the mean duration of the action potentials appeared prolonged, but the amplitude was normal or reduced. Typically, polyphasic potentials appeared in abnormal numbers. The interference pattern was reduced and in severe cases lost altogether. In some patients, action potentials of individual units could be identified even during maximum contraction.
Treatment
When first assessed, the condition of 23 of the 50 patients had not improved with at least 4 weeks of standard treatment measures. Two had had bilateral surgical procedures but pain had persisted. In view of the apparent relation of elbow symptoms to disorders of the cervical spine, our approach to relieving the symptoms in this group (group A) was directed immediately to the neck.
The other 27 patients (group B), who had not previously received local treatment of the elbow, were first given ultrasound, friction massage, ice and other therapy, and when symptoms persisted after 4 weeks, treatment was directed instead to the neck.
Treatment of the cervical spine included one or more of the following:

Mobilization (Maitland's grades I to IV).
Cervical traction.
Isometric cervical exercises.
Heat or ultrasound, or both, applied to apophyseal joints if excessive tenderness was spresent.

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Response to cervical treatment
Of the patients in group A the average duration of cervical treatment in the 22 who responded was 4.7 weeks; 1 patient still had symptoms on discharge after 9 weeks. Of the patients in group B the average total duration of treatment (elbow and neck) at the clinic in the 25 who responded was 11.1 weeks, and the average duration of neck treatment was 5.8 weeks; 2 patients still had symptoms on discharge after 18 to 20 weeks. The time lapse between onset of symptoms and beginning of treatment did not appear to influence duration or outcome of treatment.
Relation to electromyographic findings: Of the 42 patients who had an electromyographic examination the average duration of treatment in the 39 who responded was 5.3 weeks (4.7 weeks in the 20 with mild electromyographic abnormalities and 7.2 weeks in the 19 with moderate to severe abnormalities); 3 patients with moderate to severe abnormalities continued to have symptoms.
Relation to radiologic findings: The average duration of treatment was as follows: in the 16 patients with normal radiologic findings, 4.8 weeks; in the 19 patients with minor radiologic abnormalities (restricted motion, early degenerative changes), 4.7 weeks; and in the 12 patients with moderated to severe radiologic abnormalities (severe osteoarthrosis, narrowing of disc space, foramina encroachment), 7.31 weeks. The tree patients who continued to have symptoms had moderate to severe radiologic abnormalities.
Results on discharge from the clinic

Good: These 29 patients were able to resume their previous occupation.
Satisfactory: These 14 patients returned to light duties or changed to a suitable, nonaggravating occupation.
Fair: Four patients were discharged with residual discomfort. Some relief was obtained with a cervical traction apparatus used at home. All returned to a suitable, nonaggravating occupation.
Poor: Three patients, with severe radiologic and electromyographic abnormalities, continued to complain of symptoms on discharge.

Follow-up
Of the 47 patients who responded to treatment 44 were assessed at 3 and 6 months (time of writing) after discharge. They had had no further symptoms and had not sought further medical attention. Of the three who had symptoms on discharge, two were asymptomatic within 3 months and one, with severe cervical spondylosis, continued to have symptoms, even at a 1-year follow-up.
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Discussion
It is obviously not possible to draw definite conclusions from this small series because the condition of tennis elbow is often self-limiting, yet the findings challenge some current concepts.
For instance, women in this series were proportionately affected more than twice as often as men. Although the proportion of women affected was only 26% (13 patients), this is more than twice the usual proportion of women attending the clinic for other injuries - - 12% (598 of 4990 patients in 1974).
Bilateral and medial epicondylar symptoms are said to be unusual, yet 22% (11 patients) in this series had bilateral lateral epicondylar symptoms and 24 % (12 patients) had concurrent medial epicondylar symptoms; 14% (7 patients) had bilateral lateral and medial epicondylar symptoms.
In this study a force overload to the extensor muscles, direct or indirect, was found to be not the only precipitating factor; in 26% (13 patients) cervical "strain" was associated, and 84% (42 patients) showed some electromyographic evidence of cervical radiculopathy as well as physical signs in muscles of the myotomes involved.
While the pain may have presented at the bony epicondyle, maximum tenderness was more commonly found in the muscles at the several motor points that are close together and situated over bony prominences, where they are subjected to tension or pressure.
Other physical signs found, related to the cervical spine, were selective atrophy of muscles, especially the triceps and supraspinatus (15 patients), altered dermatomal sensation (1 patient) and presence of an autonomic reflex (10 patients).
These findings led us to conclude that, at least in this group of selected patients, the condition of tennis elbow was related to disorders of the cervical spine; therefore, when treatment to the elbow failed, neck treatment was tired - - with good results. It is probable that in many patients some degree of cervical degeneration preceded the elbow condition.
In this series, treatment of the cervical spine was followed by good or satisfactory relief of elbow symptoms in 86% (43 patients) in an average of 5.25 weeks. In four patients the continual use of a cervical traction apparatus at home provided relief. Tow of the three patients who had symptoms at the time of discharge subsequently improved within 12 weeks. Recovery time may be related to the degree of trauma sustained. Denny-Brown and Brenner have shown that mild percussive trauma to a nerve leads to swelling and local edema of the nerve, together with dissolution of the myelin, and recovery takes at least 4 to 5 weeks; however, if the trauma is sufficiently severe to lead to Wallerian degeneration, recovery takes at least 12 weeks. In the one patient in this series with persistent pain, treatment probably failed to relieve the causative factor (severe cervical spondylosis). The time lapse between onset of symptoms and beginning of treatment bore no relation to the outcome of treatment.
We are grateful to the commissioners of the Board and Dr. A.S. Little, director of medical services. Workers' Compensation Board of British Columbia, for their support and advice; and to Mr. G. Page, supervisor of the physiotherapy department. Miss C. Patterson. Mrs. J.E. Gunnyon and the other members of the staff for their cooperation and involvement in the project.

Best Time to Exercise

2011-01-12T07:43:00.000-08:00

Best Time to Exercise to Make
Fat Burning Workouts Most Effective

When is the best time to exercise to get the benefits of physical exercise and make fat burning workouts the most effective? Finding time for exercise can be challenging – no matter when you do it, as long as you do your cardiovascular exercises for at least 30 minutes, you will burn the fat anyway. But to get the best possible result for investing your time and effort into your fat burning workout plan, you should get up early in the morning and do your cardio exercises such as running, walking, cycling, aerobics, etc before breakfast. Exercising in the morning has major advantages compared to exercising later in the day. So, why is the morning the best time to exercise? At our Barrhaven physiotherapy, Orleans physiotherapy and Westboro physiotherapy locations we have qualified health professionals that can create programs to reach your goals.

Best Time to Exercise and Burn Fat is in the Morning

Here are the reasons why:

In the morning, before breakfast when your blood sugar levels are low and it is ideal for fat burning exercises ,you will use up energy for exercising from fat stored in your body instead of energy from carbohydrates you have just eaten. If you exercise immediately after breakfast you will still burn the fat but only after you burn the calories from breakfast first. You can burn as much as 3 times more fat when cardio exercises are done on an empty stomach.
When you do your cardiovascular exercises in the morning, not only do you burn the fat during the session, but the fat burning process lasts for hours after the workout session. This is because speed training workouts boost metabolism naturally. If you exercise in the evening you still burn the fat during the workout but as soon as you go to sleep at night, your metabolism slows down rapidly - it is significantly lower than during any other time of the day, so you would not benefit from an evening workout as much as the morning.

The other reason why you should do your fat burning exercise in the morning is getting it out of the way early, especially if you consider it difficult and unpleasant. Putting it off as a chore will make you feel guilty, stressed and you are more likely to skip it if you had a busy day at work, tired or something more interesting came up. Maybe you are not a “morning person” and find it difficult to wake up early and have the motivation to exercise, but if you remember the time in your life when you challenged a difficult task and finished it and how great you felt afterwards!
After your morning cardiovascular exercises you will feel fantastic, not only because you accomplished a difficult task and can be proud of yourself but also because endorphins released in the body after a good workout plan will make you feel happy and euphoric as they create a natural “high”! Endorphins not only improve your mood and release stress but also relieve pain. Isn’t it a great start to the day?! Knowing that the most difficult part of the day is behind you, you can start your day and feel happy and satisfied for the rest of the day. So just get up in the morning and do it! The effort is well worth the result! Of course it will be difficult first, but after a few weeks you will become addicted to the feeling of the buzz you have after your exercise routine. Make a commitment to do it just for 1 month and cardio exercises will become your new habit before you know it, give a metabolism boost and making you feel great!
Whether you're trying to build muscle, burn fat, or increase your overall health, whey protein can certainly help. The best whey protein can increase your performance in the gym, and boost your lean body mass.

P.S. If you still insist after all, on exercising later in the day – the second best time to exercise (cardio exercises) will be after your weight training.

Lose Weight Walking

2011-01-12T07:39:00.000-08:00

At all three of our locations which are the Orleans physiotherapy, Westboro physiotherapy and Barrhaven physiotherapy sites we get a lot of questions regarding how to loose weight.

To lose weight walking is probably the easiest way to lose weight, the quickest way to lose weight and one of the simple ways to lose weight.

It is certainly the best exercise to burn fat especially at the start of your weight loss program if you are a beginner to fat burning workouts and your fitness level needs improving slowly.

Of course, the best way to burn fat is to perform exercises which will burn fat directly. How many calories burned walking? In average 2 to 3 calories burned by walking per minute, which is not a lot, but 80% of the total calories burned are from fat burned directly and only 20% from carbohydrates you consumed throughout the day. Walking is the best exercise to lose weight permanently.

Health benefits of walking include boosting energy levels, increasing body fat burned, decreasing health risks which are associated with overweight conditions (such as high blood pressure, heart disease, stroke, etc.). Also, the benefits of walking – can be performed any where, any time, while talking with a friend or walking a dog, easy to start, no skills needed, no need of equipment.

Lose Weight Walking is a Good Start of Weight Loss Exercise Programs

Unfit people new to exercise have low fitness levels. This is because a lack of exercise leads to muscle loss and a loss of efficiency to fat burning. That is why many exercises will be too intense and too energy demanding to start a weight loss program. If exercises are too intense for you, your body will be taking energy from burning carbohydrates which came from food you have eaten rather then from fat stores in your body. That is why jogging and running to lose weight is not a good idea at the beginning, as you would not be able to prolong it for a long time to burn calories efficiently, and it will increase your appetite too. Many beginners are doing their best and push the limits to feel that they have done a proper job, as a result they are out of breath, their heart rate is too high, and have deficit of oxygen – not a good condition for burning fat. Once your fitness level improves, you would be able to utilise fat as energy even when running, but at the beginning walk to lose weight.
Fat burning mode requires steady workout with consistent pace and good oxygen supply to muscles, so even overweight or unfit people can achieve this during walking to lose weight.

Lose weight by walking is one of the fun ways to exercise: you can take your friend, child or dog with you, do shopping or window shopping just keep moving continuously to support your fat burning zone. What about other fun exercise ideas – a walking holiday - you can walk across your country discovering new places and attractions every day!

Lose weight walking is the best beginning to your weight loss program if your doctor approves it.

Endurance Exercises to Increase Cardiorespiratory Endurance for Long Distance Running, Improve Running Speed

2010-10-21T13:33:00.000-07:00

And now here is the final part from our Ottawa Physiotherapy bloggers:

It is time for endurance exercises to increase cardiorespiratory endurance and improve running speed! You have started your running training program 8 weeks ago and progressed from getting the workout motivation to start with, right up to running for 30 minutes without stopping. If you've accomplished everything so far, well done! Now it is the time to increase running speed and running endurance for long distance running training.

Improving Endurance and Average Running Speed

Week 9:

This week you will be getting used to 25-30 minute runs. Remember to start and finish each session with a 5 minute walk. Do 3 sessions this week.

Week 10:

Do 3 sessions this week starting and finishing each session with a 5 minute walk. First session - 35 minute run without stopping; second – 20 minutes, third – 30 minute run.

Week 11:

Try and do a 40 minute run for one of the sessions, with your other runs about 25 to 35 minutes. With the quicker runs, try and inject some pace. I.e. run a bit faster just for a minute, if possible, try and do that several times. Start and finish each session with a 5 min walk.

Week 12:

Follow a similar pattern, with this time one run of 45 minutes. With the longer runs don't try to inject pace as it will be too hard. The objective being to run for that length of time without stopping. With your other shorter runs of 25-35 minutes this week, hopefully you'll find yourself running faster and further as you increase your fitness with the running endurance exercises. You have all the support from our Barrhaven physiotherapy, Orleans physiotherapy, and Westboro Physiotherapy locations!!!!

So what is next? That's really up to you. If we've left you behind a bit, take your time in catching up. If you are happy with the 30 minute work out plan then that is also fine. Maybe you want to join your local running club, progress to a 10k run, or run a marathon.

Hopefully you feel great and are starting to tell your friends how much you've achieved. Maybe your excitement has become infectious and your friends want to run with you. The most important thing is that you now keep running. Best of luck!

Running Training Schedule

2010-09-29T05:28:00.000-07:00

Beginner's Program

The running training schedule below is Step 2 of our Beginners Running Program which will help you to learn how to start jogging if you have never done it before. This running training program aims to increase you endurance or fitness to run for a long period of time. I'm hoping that these beginner tips helps to answer the questions from all clinics at the Ottawa Physiotherapy sites including Barrhaven physiotherapy, Westboro physiotherapy, and Orleans physiotherapy locations.

hings you should know about running shoes, clothes, running cramps and running stretches before you start your daily workout schedules.

So, you have clearance from your doctor, bought a good pair of running shoes and full of motivation to lose weight, get fit and better yourself, so let’s get started!

Duration of the program – 12 weeks

Always warm up properly before you start by walking for 5 – 10 minutes. You should always finish running with cool down – 5- 10 minutes walk.

Running Training Schedule

Week 1:

Ready for your first 30 minute jog. OK, walk for the first 5 minutes at a good pace to warm up. Then mix jogging at an easy pace for 1 to 2 minutes with walking for 5 minutes at a time. Repeat 3 times with the last 5 minutes walking as part of your cool down routine. How was that? If you are out of breath – you are going too fast. Your breathing during your running training schedule should not be heavy and you should be able to carry on a conversation during running.
Unfortunately depending on your age, and your fitness level, we all develop at different rates, so you'll need to judge when to step things up or down a bit. Repeat the above 2-3 times in a week. But take 1-2 days off in between each jog, and make sure you drink lots of water.

Week 2:

We'll stick with 30 minutes, but this time, after your 5 minute walk out, mix jogging at an easy pace and walking for 2 minutes at a time, repeat 3 times with the 5 minute cool down walk at the end. Aim for 3 sessions in the second week.

Week 3:

Walk for 5 minutes to warm up then mix 3-5 minutes jog with a 2 minute walk, repeat 4 times with 5 minutes walk at the end to cool down. Aim for 3 sessions in week 3. Week 4: Walk for 5 minutes then mix a 7 minute jog and 2 minute walk, repeat 3 times with a 5 minute walk at the end. Do 3 sessions in week 4.

Week 5:

Warm up with a 5 minute walk, then run for 8 minutes and walk for 2 minutes – repeat 3 times. Do not forget to walk at the end for 5 minutes to cool down. Do 4 sessions per week.

Week 6:

Walk for 5 minutes, then jog for 9 minutes and walk for 2 minutes – repeat 3 times with 5 minutes walk at the end. Aim for 4 sessions in week 6.

Week 7:

After your first 5 minutes walk, run for 11 minutes and walk for 1 minute, repeat 3 times finishing with a 5 minute walk to cool down. Do 4 sessions this week.

Week 8:

If you have managed to keep up with this running training schedule so far great, your target this week is 3 sessions with a 30 minute run at the end of the week. If you haven't kept up, do not feel bad or demotivated. Just progress at your pace, and believe me you will get there. So walk for about 5 minutes, and then jog for about 20 minutes with another 5 minutes walk at the end. The goal here is to jog for 20 minutes without stopping. In the next session, move onto 25 minutes, starting and finishing with 5 minutes walk. During session 3, you can do your first 30 minute run without stopping, starting with 5 minutes walking as usually. After a 30 minute run, that's enough! Just walk home to cool down.

How to Start Running

2010-09-22T07:48:00.000-07:00

I have been asked a lot of questions on how to start running at our Orleans physiotherapy and Westboro physiotherapy locations. So I'm going to break things down in a series of articles to cover the basics to give people ideas on what to think about or try.

Get approval from your doctor – you do not want nasty surprises!

Running shoes. Getting a pair of good running shoes is very important for injury prevention and your comfort. Get expert advice from a proper running shop - not some fashion chain on the high street. In the running shop, a sales person will encourage you to do to the running test to find out your foot type and level of support you need to help to choose the right pair. The proper running shoes come at a price (normally expect to pay $70 - $140), but they will be worth it!

Get the best sports bra you can find if you are a lady.

Clothes. Should be comfortable, how fashionable you want to look it is up to you – you might just go for t-shirt and running shorts or you might want to buy clothes such as CoolMax or Lycra which take sweat away from the body.

Plan your route. Try to keep your route on reasonably flat ground. One steep hill at this stage will be too difficult. Stick to the pavement or sidewalk if you can, roads made of dirt or asphalt are better then concrete which is hard on the body. If you are using a treadmill, a cushy surface gives you more protection from injuries.

Running at night. Always remember about your safety - wear reflective clothing, run towards traffic.

Running cramps. Can be avoided by following a few simple rules:

Leg cramps running. Running too fast too soon causes muscles cramps. If it happens just gently stretch the muscle.
Stomach cramps. Running before your meal has digested causes stomach cramps – wait 2-4 hours after a big meal (dairy, meat and fat –takes time to digest).
Side stitches (a sharp pain below the rib cage) can be prevented by taking evenly spaced deep breaths. If your breathing is not deep the diaphragm does not have enough time to lower for the ligaments to relax. The diaphragm tenses and causes a stitch.

Keep yourself hydrated. Before running - Drink 3- 4 cups of water a few hours before running. During running (especially in hot weather) - 8 to 10 ounces of water recommended for every 15 to 20 minutes of strenuous exercise. Replenish your fluid after running; drink as much water as you like.

Running stretches help to improve muscles flexibility and feeling less fatigued, also to prevent injuries. Always stretch after your running workouts.

Running Tips Breathing. A correct breathing technique during running is very important for delivering enough oxygen to the muscle which helps to increase your endurance.

Summer time, and the livin's ACTIVE!

2010-07-12T08:00:00.000-07:00

If you're like me, the recent heat wave may have left you wanting to have an afternoon siesta more than go for a run!

Fortunately for all of us who prefer to exercise in non sauna-like conditions this past weekend brought on some relief. The huge difference in my surroundings from Saturday's workout (indoor gym) to Sunday's Gatineau Park fun had me reflecting on encouraging everyone to get outside and play.

We are truly fortunate here in Ottawa to have such an incredible diversity of great summer activities to get excited about. From organized festivals like this past weekend's Hope volleyball event, to the myriad of provincial parks and recreational trails in the region to explore, there really is something for everyone.

After pushing through an indoor workout staring at the duct work on the ceiling of my gym on Saturday, it got me thinking that at this time of year there's really nothing that you can't do outside.

As a sample here's what I got up to on Sunday:
7:30 am - 2k open water swim at Meech lake - Blanchet Beach http://www.canadascapital.gc.ca/bins/ncc_web_content_page.asp?cid=16297-16299-90645&lang=1: At this time of year there isn't much more refreshing than an outdoor swim workout. After not having been in the pool for nearly 5 months, I decided to bring up my short wetsuit for some flotation help. The water was just so nice that after 1 lap around the island off Blanchet Beach I jumped out of the water and got rid of the wet suit. Coming from a triathlon background in chilly Thunder Bay, man, what a treat!

If you feel like you want to sharpen your skills a bit more before taking to the open water, check out Swim Ottawa and their outdoor sessions at the JCC https://secure.leda.lunarmania.com/~anzai0/swimottawa/Forms/Reg-MastersSummer.html .

Keeping on the idea that what can be done at the gym is even better outside, after 45 minutes in the water I moved onto the beach for some outdoor core strength.

Sneaking in a few sets of your favorite core exercises (today it was front/side plank, oblique V-sits, bird-dog arm/leg extensions, vertical heel pushes and push-ups) comes much easier I think when you get to stare up at the leaves and clouds passing instead of air ducts! And even better, once your done you get to jump in the lake to cool off!

Men's Health Magazine had some good ideas for getting summer exercises in with this section "Your Body is Your Barbell" suggesting some good exercises to do even while on the sidelines of your kids sporting events. Love the idea... http://www.menshealth.com/gear-up-for-summer/workouts/Your-Body-is-Your-Barbell.php

1:00 pm Gatineau Loops with Fortune repeats: Follwing a quick brunch at home (with fresh bread from the fantastic bakery in Old Chelsea http://chelseabakery.com/ ) it was time to meet up with some of the guys from my cycling team Nine-2-Five Pro http://nine2fivepro.com/wpmu/ back in Gatineau Park at the Gamelin gates. As soon as our little pack was shredded going up Pink, I knew I was in for a bit more than an easy loop with fortune repeats.

Group training is a great way to get the competitive fuel to fire a killer workout. Round up your friends, head out and have fun pushing each other with whatever you're doing outdoors. It's a great way to spice things up and push your limits. A huge thanks goes out to my N2F crew for making me hurt-so-good, again and again!

As you'll often hear me say around the clinic - there's more to life than physio! After 4+ hrs on the bike, I was in need of some serious chilling and recharging. I was lucky enough to have that need more than satisfied by the gang over at DiVino wine studio, http://www.divinowinestudio.com/ with a stellar dinner party and wine tasting showcasing the Puglia region of Italy. The tasty wine, mouth-watering food and great company must have done the trick - after stretching this morning my legs feel amazingly fresh!

I know that for me anyway, life really can't get much better than it did yesterday. So get out there and enjoy yourself in and around this great city, summer's here - for a limited time only!

- Shane

Upgrade your Bike with Ottawa Bike Fitting

2010-06-29T14:58:00.000-07:00

Bike fitting is the best upgrade

Fit is the most important consideration when it comes to deciding on a bike. Forget the fancy wheels and carbon fiber bits. If the fit isn’t right you won’t be comfortable, you won’t perform up to your potential and it could lead to overuse injuries. At out Westboro Physiotherapy location, bike fitting is done here.

Do you suffer from numb hands or feet?
Is your back or butt sore after a ride?
Are you as comfortable as you could be?
Are you positioned to put out the most power you can?
If you have a road bike and weren’t fitted, ask yourself are you getting all the performance you could?

Before you think about frame material or what wheels you want, think about bike fit. Consider the fact that a 60 km ride equals more than 10,000 pedal strokes. If you are riding an ill fitting bike you will be at best uncomfortable and slower than you could be, and worst case it can lead to injury.
We operate on the philosophy of adapting your bike to you, rather than the other way around.
For recreational riders it’s all about comfort. The right equipment with the right set up for you, leads to an enjoyable ride. Your butt and back don’t have to hurt.
For performance oriented riders and racers, it has to be a balance between performance, comfort and bio-mechanical alignment. I’ve been refining our fitting system for 12 years, using the most up-to-date research combined with use of fitting technology from Bikefitting.com and Lemond Fitness.
To get the your bike adjusted to you, we look at more than just your measurements. There is an interview where we find your athletic and injury history, comfort issues on the bike, riding goals and anything you might have done to try to fix any problems before coming to us.
Then we do a structural assessment. Most people have imbalances, whether in flexibility, strength or stability. By assessing which muscles may be tighter or weaker we can find and address the root cause of alignment and performance issues.
Only then do we get your on the bike. Starting with your feet we work up until you have a total body alignment on your bike. When your bike is fitted properly, you feel like you could fly. Hill climbing is easier. 100 mile rides are much more enjoyable because your hands and neck aren’t hurting. More speed, less aches and pains.
Do you want have up to 10% more power in one day?
I’ve had customers gain this much of an increase in sustained power just by having there bike adjusted to match their bio-mechanical structure. Even riders who are fitted pretty well can see improvements that would take months of training to accomplish. And this is in just a few hours of repositioning on your bike.
Each Ottawa Bike Fitting session works with your measurements, cycling history, flexibility and preferences to dial in your position for maximum performance while still being comfortable for the long haul.
A quality road bike is like a suit, it only looks good on you when it is tailor fit. By getting the three contact points ( handlebars, pedals and saddle) in the right position you will find your self riding faster and longer with less soreness. Add to this foot and knee alignment for optimal power output and injury prevention.
Getting your alignment and balance right on the bike will make riding faster and more comfortable.

Our list of fit factors includes:

Saddle shape and position
Saddle height and fore-aft balance
Handlebar shape and angle
Choice of type of handlebar tape
Brake lever angle
Cleat alignment and shimming
Knee and foot alignment
Leg length imbalances
Pedal stroke mechanics
Custom molded orthotics
Crank length
Pedal stance width

Ottawa Bike Fitting process

2010-06-29T14:56:00.000-07:00

Serious cyclists, who spend big bucks on their bikes and log lots of hours in the saddle, will often invest in a personal fitting, available at more and more quality bike shops. A fitting, almost always done by appointment, can take over an hour and cost upwards of $100, though some are complimentary (usually with the purchase of a very expensive bike).
There are several schools of bike fit. The older theory is machine-based. It involves adjusting a universal, bicycle-like machine to each rider, taking measurements, and applying the measurements to that rider’s own bike. The newer, “organic” school is more movement-based and yoga-influenced, in that it takes the rider’s physical range of motion into account. It relies much more on the skill and experience of the fitter than on a fit-bike machine.
Ultimately, there are a few basic tenets of bike fit, and these center around the contact points with the bike: pedals, saddle, and bars. The process begins by getting the rider is on the right frame for his or her size.

Bike Fit and The Right Frame

To get the rider on the right frame, a fitter will first look at "standover height," the distance between the top tube (the horizontal frame member) and the rider's crotch. On a traditional road frame or fitness hybrid, there should be about an inch or so of clearance. A mountain bike rider may prefer a little more. While this measurement is general, the fitter will take into account eccentric frame geometry, the rider's purpose and goals, and any physical limitations or anomalies.

Fitting Bicycle Pedals

A good fit starts at the pedals and works upwards. The ball of the foot should be positioned approximately over the pedal axle. The joints where the toes meet the foot is usually (for a road bike) positioned a centimeter or so forward of the axle, which alleviates pressure on the sensitive nerves between the toes. A fitter will usually position the foot by dropping a plumb-bob from the knee to the axle and moving the saddle forward or backward to adjust the foot position.
To achieve and maintain this positioning, some form of foot retention is mandatory to keep the shoe in one place. Clipless pedals are the best option, but toe clips and straps will suffice for the rider who is intimidated by clipless pedals. Choice of pedals should be made before the fitting.

Saddle Position

The saddle’s fore-and-aft position should have been determined when the foot was placed, as it is dependent upon the length of the rider’s femur.
Saddle height is trickier, depending more on rider preference, though many fit experts will say that most cyclists, especially “serious” road riders, ride with their saddles too high. The old wisdom that the leg should be slightly bent when at the bottom of the pedal stroke is correct to a point. How much the leg is bent remains problematic and shouldn't be just loosely estimated.
The fitter looks at the heel in relation to the pedal axle when the downward knee is locked in a stationary position; the heel should be a centimeter or two below the ball of the foot. Also, when pedaling, the angle between the rider's foot and the front of his/her leg should not open at the bottom of the stroke. Nudging the saddle downward will eliminate this unwanted action.

Handlebars and Hand Position on The Bike

This last adjustment may seem the most important, as it affects the rider's angle of lean, stretch of the shoulder muscles, reach, and perceived comfort. But it can only be set after the feet and the saddle are positioned correctly.
While road racers still prefer their bars in a low position, well below the saddle, the trend today is toward a more relaxed hand position. A few centimeters of bar height can go a long way toward putting the rider in a comfortable, yet ergonomically correct, posture on the bike.
A good fitter will have a selection of stems (the piece that attaches the handlebars to the bike) in varying length and angle of rise. The right stem length and rise will put the rider in the perfect position.

Finding a Bike Fit Expert

The rider seeking a good fit should find out his local shop's philosophy of fit and its fitters' accreditations. If possible, talk to someone who has been helped by the fitter – satisfied fit customers are usually quick to talk about their experiences.

Benefits of a Good Bike Fit

The benefits of a "dialed" fit cannot be overestimated, especially in road riding, where the rider often stays in the same position for long periods of time. In addition to enjoying ergonomic and aerodynamic efficiency, a well-fit rider will have fewer pains in the back, neck, and hands. Comfort is more important to most riders anyway, so investing in a professional fit session is often seen more as a necessity than an extravagance. (Think of how much money golfers spend on lessons.) The elusive "all day position" on the bike can be just one fit session away.

Basics of Bike Fitting

2010-06-13T16:32:00.000-07:00

Here is a brief summary of Ottawa Bike Fittings that we offer at the Ottawa Physiotherapy and Sport Clinics at our Westboro Physiotherapy location.

Fitting systems based on body measurements can provide a good starting position. To get a position really "dialed-in" to perfection, most riders will need to "tweak" the position - make small adjustments, up, forward, back, down, to accommodate their personal flexibility, range of motion, and other bio-mechanical variations.

Time-trial, triathlon, crit, downhill and other specialized riding events require different positions because the emphasis on various criteria such as power, endurance, comfort and aerodynamics change. However, the basic principle, that the geometry of the position is a function of the rider's anatomy remains the same. To my knowledge, these differences have not been published anywhere, but are embodied in many commercial fitting systems and fitting calculators.

Cyclemetrics can be used both for measuring a rider's anatomy, and position tweaking (a well-known pro dubbed it a "truing stand for your riding position").

FRAME SIZE AND SEAT HEIGHT - The "LeMond Formulas"

The frame and seat height tables on the back of the use formulas originated by engineer, Wilfried Hüggi, and one of Greg LeMond's cycling coaches, Cyrille Guimard. I first saw the formulas in Greg's book, Greg LeMond's Complete Book of Bicycling, published in 1987. For a thorough discussion of the formulas, and a broad overview of fit, Greg's book is recommended. Further discussion of these formulas (and other generally sound fit advice) can be found on the Bike Fit Page of the Colorado Cyclist's Web Site.

BIKE FRAME SIZE (in cm) = Inseam (cm) x .67
This gives the recommended size for a road bike frame, measuring from the center of the bottom bracket to the top of the seat tube (also called center-to-top or c-t sizing)*.
Larger riders (6'0" and up) who want a frame that allows them to stretch out, may be better off selecting a frame 27-28cm less than their inseam length. In general, this will be a cm or two larger than the frames the formula recommends.

Mountain Bike frame sizes are generally 10 to 12 centimeters (4-5 inches) smaller than road frames.

On both mountain & road bikes, if it comes down to choosing between two sizes, choose the one that matches the length requirement most closely.

I.E., bikes on either side of the suggested size allow the same saddle position, but tend to be shorter or longer than the suggested size. Choose the one which allows the rider to bend over to the desired degree. As a general rule, larger riders tend to be more comfortable with a slightly larger frame, while smaller riders often do better with a slightly smaller frame.
* The original formula used a factor of .65 times inseam to give a size measured as center-to-center (center of the bottom bracket to center of the top tube). These days many bikes use odd-sized tubing, sloping top-tubes and other non-traditional geometries, so center-to-center sizing is less meaningful. Accordingly, the factor was adjusted slightly to yield the center-to-top. Remember: if the length of the top-tube is right, you can usually adjust the seat height and setback to obtain a good fit.
SEAT HEIGHT (cm) = Inseam (cm) x .883
This formula assumes that at the bottom of the pedal stroke, the knees should be slightly bent, about 15 degrees. Riders who pedal slightly toe-down will find the resulting number a bit short. Riders with reduced flexibility or other special considerations want the saddle slightly lower to start (This tends to change as the rider gains experience).
In general, the resulting number will be within a cm or two of "correct". So, use this as a starting point. Many riders may never need to alter this setting. For the rest, make small adjustments as needed. Use the FitStik to track changes so you can return to a previous setting if need be.

KNEE OVER PEDAL SPINDLE

While promoted as Natural Law by some, and Hype by others, the consensus seems to be that your knee should be more or less over the pedal spindle when the cranks are level. Truth is, the "rule" evolved because most riders find that this setting works for them. If it doesn't work for a particular rider, so be it. As always, if the rider doesn't like it, it's wrong...

Note: Most fitting systems first set the saddle height, then position the knee by sliding the saddle fore and aft. Catch is, when you slide the saddle back and forth, it also moves up and down because the rails are angled in relation to the saddle's top. But when you move the saddle up and down, it also moves back and forth because the seat tube is angled. In other words, it takes some trial and error to get the saddle in exactly the right spot.

TOP TUBE AND STEM LENGTH

The FitStik can also be used for torso and arm length measurements. Many well-known formulas convert torso and arm length measurements to total reach (length of top tube + stem). One such common formula, for a road bike sport/racing position is:

( (Torso Length + Arm Length) / 2) + 4 = ( Top Tube + Stem)

Reasons for Bike Fittings

2010-06-05T12:29:00.000-07:00

At our Westboro physiotherapy location in Ottawa, we provide bike fitting services by one of our physiotherapists.

Bike fitting is very useful in the prevention of possible injuries that might occur during cycling and below are a few examples.

Cycling is seen by some^[who?] to be an inherently high-risk, dangerous activity although use of appropriate safety equipment and obedience of road rules can reduce risk of serious injury. In the UK, fatality rates per mile or kilometre are slightly less than those for walking.^[18] In the US, bicycling fatality rates are less than 2/3 of those walking the same distance.^[19]^[20] For a child cyclist the rate per mile or kilometre travelled is around 55 times that for a child occupant of a car^{[citation needed]}, while the fatality and serious injury rates per hour of travel are just over double for cycling than for walking (due to the reduced travel time), in the UK.^[18] It should be noted that calculated fatality rates based on distance for bicycling (as well as for walking) can have an exceptionally large margin of error, since there are generally no annual registrations or odometers required for bicycles (as there are with motor vehicles), and this means the distance traveled must be estimated.
Most cycle deaths result from a collision with a car or heavy goods vehicle, both motorist and cyclist have been found responsible for collisions ^[21]^[22]^[23] However, a very high proportion of non-fatal injuries to cyclists do not involve any other person or vehicle.
A Danish study in 2000 concluded that "bicycling to work decreased risk of mortality in approximately 40% after multivariate adjustment, including leisure time physical activity".^[24]
Injuries (to cyclists, from cycling) can be divided into two types:

Physical trauma (extrinsic)
Overuse (intrinsic).

Acute physical trauma includes injuries to the head and extremities resulting from falls and collisions. Since a large percentage of the collisions between motor and pedal vehicles occur at night, bicycle lighting is required for safety when bicycling at night.

Bicyclist pedals uphill at the Taroko Gorge in Taiwan

The most common cycling overuse injury occurs in the knees, affecting cyclists at all levels. These are caused by many factors:^[25]

Incorrect bicycle fit or adjustment, particularly the saddle.
Incorrect adjustment of clipless pedals.
Too many hills, or too many miles, too early in the training season.
Poor training preparation for long touring rides.
Selecting too high a gear. A lower gear for uphill climb protects the knees, even though your muscles are well able to handle a higher gear.

Excessive saddle height can cause posterior knee pain, while setting the saddle too low can cause pain in the anterior of the knee. An incorrectly fitted saddle may eventually lead to muscle imbalance. A 25 to 35 degree knee angle is recommended to avoid an overuse injury.^[26]
Overuse injuries, including chronic nerve damage at weight bearing locations, can occur as a result of repeatedly riding a bicycle for extended periods of time. Damage to the ulnar nerve in the palm, carpal tunnel in the wrist, the genitourinary tract^[27] or bicycle seat neuropathy^[28] may result from overuse. Recumbent bicycles are designed on different ergonomic principles and eliminate pressure from the saddle and handlebars, due to the relaxed riding position.
Note that overuse is a relative term, and capacity varies greatly between individuals. Someone starting out in cycling must be careful to increase length and frequency of cycling sessions slowly, starting for example at an hour or two per day, or a hundred miles or kilometers per week. Muscular pain is a normal by-product of the training process, but joint pain and numbness are early signs of overuse injury.
Cycling has been linked to sexual impotence due to pressure on the perineum from the seat, but fitting a proper sized seat prevents this effect.^[29]^[30] In extreme cases, Pudendal Nerve Entrapment can be a source of intractable perineal pain.^[31] Some cyclists with induced pudendal nerve pressure neuropathy gained relief from improvements in saddle position and riding techniques.^[32]
The National Institute for Occupational Safety and Health (NIOSH) has investigated the potential health effects of prolonged bicycling in police bicycle patrol units, including the possibility that some bicycle saddles exert excessive pressure on the urogenital area of cyclists, restricting blood flow to the genitals. NIOSH is investigating whether saddles developed without protruding noses (which remove the pressure from the urogenital area) will alleviate any potential health problems.^[33]
A Spanish study of top triathletes found those who cover more than 186 miles (300 km) a week on their bikes have less than 4% normal looking sperm.^[34]
Despite rumors to the contrary, there is no scientific evidence linking cycling with testicular cancer in men.^[35]

^ ^a ^b "Road Casualties Great Britain 2007 - Annual Report (page 82, "Fatality rates by mode of travel")" (PDF). Department for Transport. http://www.dft.gov.uk/adobepdf/162469/221412/221549/227755/rcgb2007.pdf.
^ "Daily Travel by Walking and Bicycling". Bureau of Transportation Statistics. http://www.bts.gov/publications/transportation_statistics_annual_report/2004/html/chapter_02/daily_travel_by_walking_and_bicycling.html. Retrieved 2009-09-29.
^ "Fatality Analysis Reporting System". National Highway Traffic Safety Administration. http://www-fars.nhtsa.dot.gov/. Retrieved 2009-09-29.
^ "Cycling in Great Britain". Department of Transport. http://www.dft.gov.uk/pgr/statistics/datatablespublications/personal/articles/cyclingingreatbritain1. Retrieved 2009-09-29.
^ "44 tonne articulated trucks and towns don't mix". Cambridge Cycling Campaign UK. http://www.camcycle.org.uk/newsletters/53/article4.html. Retrieved 2009-09-29.
^ "Lorries and Towns Don't Mix (video)". Robert Webb. http://showcase.commedia.org.uk/article/articleview/390/1/13/.
^ Andersen LB, Schnohr P, Schroll M, Hein HO (June 2000). "All-cause mortality associated with physical activity during leisure time, work, sports, and cycling to work". Arch. Intern. Med. 160 (11): 1621–8. doi:10.1001/archinte.160.11.1621. PMID 10847255. http://archinte.ama-assn.org/cgi/content/full/160/11/1621. Retrieved 2009-09-29.
^ "Knee Pain in Cycling: New Twist on an old Injury". BioMechanics. July/August, 1996. Archived from the original on 2007-09-28. http://web.archive.org/web/20070928070212/http://www.biomech.com/db_area/archives/1996/9607sports.bio.html. Retrieved 2006-11-24.
^ "Avoid Repetitive Knee Injuries While Riding A Bike". http://www.nasm.org/nasmpro/library/showarticle.aspx?id=14202.
^ Leibovitch I, Mor Y (March 2005). "The vicious cycling: bicycling related urogenital disorders". Eur. Urol. 47 (3): 277–86; discussion 286–7. doi:10.1016/j.eururo.2004.10.024. PMID 15716187.
^ "Bicycle Seat Neuropathy, follow up". eMedicine. February 8, 2006. http://www.emedicine.com/SPORTS/topic12.htm. Retrieved 2006-03-20.
^ "Cycle of despair". BBC News. 1998-08-12. http://news.bbc.co.uk/2/hi/health/149268.stm. Retrieved 2009-09-29.
^ "Cycling linked to impotence". BBC News. 1999-06-07. http://news.bbc.co.uk/2/hi/health/363070.stm. Retrieved 2009-09-29.
^ Ramsden CE, McDaniel MC, Harmon RL, Renney KM, Faure A (June 2003). "Pudendal nerve entrapment as source of intractable perineal pain". Am J Phys Med Rehabil 82 (6): 479–84. doi:10.1097/00002060-200306000-00013. PMID 12820792.
^ Silbert PL, Dunne JW, Edis RH, Stewart-Wynne EG (1991). "Bicycling induced pudendal nerve pressure neuropathy". Clin Exp Neurol 28: 191–6. PMID 1821826.
^ "NIOSH -Bicycle Saddles and Reproductive Health". United States National Institute for Occupational Safety and Health. http://www.cdc.gov/niosh/topics/bike/. Retrieved 2007-10-10.
^ BBC: Elite cyclists 'risk infertility'
^ "Testiclar Cancer Fact Sheet" (PDF). Monash Institute of Medical Research. http://www.andrologyaustralia.org/library/TesticlarCancerFactSheet.pdf. Retrieved 2008-09-30.

Elements of good running technique

2010-05-28T19:29:00.000-07:00

I thought I would talk about the elements of good running technique.

At our Orleans physiotherapy location one of our physiotherapists provides one on one consultation on a track to help improve your running technique which are as follows to be brief.

Upright posture and a slight forward lean

Leaning forward places a runner's center of mass on the front part of the foot, which avoids landing on the heel and facilitates the use of the spring mechanism of the foot. It also makes it easier for the runner to avoid landing the foot in front of the center of mass and the resultant braking effect. While upright posture is essential, a runner should maintain a relaxed frame and use his/her core to keep posture upright and stable. This helps prevent injury as long as the body is neither rigid nor tense. The most common running mistakes are tilting the chin up and scrunching shoulders.^{[citation needed]}

Stride rate and types

Exercise physiologists have found that the stride rates are extremely consistent across professional runners, between 185 and 200 steps per minute. The main difference between long- and short-distance runners is the length of stride rather than the rate of stride.^[4]^[5]
During running, the speed at which the runner moves may be calculated by multiplying the cadence (steps per second) by the stride length. Running is often measured in terms of pace^[6] in minutes per mile or kilometer. Fast stride rates coincide with the rate one pumps their arms. The faster one's arms move up and down, parallel with the body, the faster the rate of stride. Different types of stride are necessary for different types of running. When sprinting, runners stay on their toes bringing their legs up, using shorter and faster strides. Long distance runners tend to have more relaxed strides that vary.

^ Hall, C., Figueroa, A, Fernhall, B & Kanaley, J.A. (2004) Energy expenditure of walking and running: Comparison with prediction equations. Medicine & Science in Sport & Exercise, 36 (12), 2128–2134. Abstract
^ Bramble, D., Lieberman, D. (2004) Endurance running and the evolution of Homo. Nature, 432, 345–352. Abstract
^ Biomechanics of distance running. Chapter 6. Muscle Activity in Running. The Extensor Paradox Experiment. I. McClay, M. Lake, R. Cavanagh 1990
^ Hoffman, K. (1971). "Stature, leg length and stride frequency". Track Technique 46: 1463–69.
^ Rompottie, K. (1972). "A study of stride length in running". International Track and Field: 249–56.
^ Pacing chart for running

Ottawa Marathon Running Tips

2010-05-18T12:19:00.000-07:00

Here are some tips from our Orleans physiotherapy, Westboro Physiotherapy
and Barrhaven Physiotherapy locations for our local Ottawa Marathon Runners:

Most participants do not run a marathon to win. More important for most runners is their personal finish time and their placement within their specific gender and age group, though some runners just want to finish. Strategies for completing a marathon include running the whole distance^[33] and a run-walk strategy.^[4] An intermediate approach is to run from water stop to water stop, and walk through the water stop area to ensure the fluids are consumed instead of spilled. In 2005, the average marathon time in the U.S. was 4 hours 32 minutes 8 seconds for men, 5 hours 6 minutes 8 seconds for women.^[34]
Another goal is to break certain time barriers. For example, recreational first-timers often try to run the marathon under four hours; more competitive runners may attempt to finish under three hours.^[35] Other benchmarks are the qualifying times for major marathons. The Boston Marathon, the oldest marathon in the United States, requires a qualifying time for all non-professional runners.^[36] The New York City marathon also requires a qualifying time for guaranteed entry, at a pace slightly faster than Boston's.^[37] A qualifying time is also needed for Washington D.C.'s National Marathon.^[38] However, unlike Boston, where the qualifying times serve to attract a more talented field and limit participation, the National Marathon is motivated more by the need to reopen city streets in a limited amount of time.

Training

MoonWalk is a nocturnal charity marathon to raise money for breast cancer research

The long run is an important element in marathon training.^[39] Recreational runners commonly try to reach a maximum of about 20 miles (32 kilometres) in their longest weekly run and a total of about 40 miles (64 kilometres) a week when training for the marathon, but wide variability exists in practice and in recommendations. More experienced marathoners may run a longer distance, and more miles/kilometres during the week. Greater weekly training mileages can offer greater results in terms of distance and endurance, but also carry a greater risk of training injury.^[40] Most male elite marathon runners will have weekly mileages of over 100 miles (160 kilometres).^[40]
Many training programs last a minimum of five or six months, with a gradual increase (every two weeks) in the distance run and finally a little decrease (1 to 3 weeks) for recovery. The decrease, commonly called the taper, should last a minimum of two weeks and a maximum of three weeks, according to most trainers. For beginners wishing to merely finish a marathon, a minimum of 4 months of running 4 days a week is recommended.^[41] Many trainers recommend a weekly increase in mileage of no more than 10%. It is also often advised to maintain a consistent running program for six weeks or so before beginning a marathon training program to allow the body to adapt to the new stresses.^[42] The marathon training program itself would suppose variation between the hard and the easy training, with a periodization of the general plan.^[43]
Training programs may be found at Runner's World,^[44] Hal Higdon,^[33] Jeff Galloway,^[4] Boston Athletic Association ^[45] and from numerous other sources.
Overtraining is a condition that results from not getting enough rest to allow the body to recover from stressful training.^{[citation needed]} It can result in lowered endurance and speed and place a runner at a greater risk of injury.^[40]^[46]

Before the race

Samuel Wanjiru raises his hand in acknowledgment of the crowd as he runs to a gold medal in the 2008 Olympic marathon

During the last two or three weeks before the marathon, runners will typically reduce their weekly training, gradually, by as much as 50%-75% of previous peak volume, and take at least a couple of days of complete rest to allow their bodies to recover from any strong effort. The last long training run might be undertaken no later than two weeks prior to the event. This is a phase of training known as tapering. Many marathon runners also "carbo-load" (increase carbohydrate intake while holding total caloric intake constant) during the week before the marathon to allow their bodies to store more glycogen.
Immediately before the race, many runners will refrain from eating solid food to avoid digestive problems. They will also ensure that they are fully hydrated beforehand. Light stretching before the race is believed by many to help keep muscles limber. Some runners will wear an ice vest before the race to reduce their core temperature so as to avoid overheating later in the race.

During the race

2007 Barcelona Marathon

Coaches recommend trying to maintain as steady a pace as possible when running a marathon. Some advise novice runners to start out slower than their average goal pace to save energy for the second half of the race (negative splits).^[47] As an example, the first five to eight miles (8–13 km) might be run at a pace 15–20 seconds per mile slower than the target pace for later.
Typically, there is a maximum allowed time of about six hours after which the marathon route is closed, although some larger marathons (such as Myrtle Beach, Marine Corps and Honolulu) keep the course open considerably longer (eight hours or more).

Etiquette

Modern marathons such as New York, Chicago, London and Berlin have tens of thousands of runners and millions of spectators. Common courtesy for other runners becomes necessary when running in a densely packed crowd.^[48] Those employing a walk/run strategy or who are simply walking are encouraged to stay to one side, leaving the middle of the street for faster runners.
Runners in groups are encouraged not to block the entire street, preventing other runners from passing them. Two or three runners abreast is recommended. Large groups may consider single or double files.

4..^ ^a ^b ^c "Retreats — Athens". Jeffgalloway.com. http://www.jeffgalloway.com/retreats/athens.html. Retrieved 2009-08-22.
^ "The Moon and the Marathon", Sky & Telescope Sept. 2004
^ "Ancient Olympics FAQ 10". Perseus.tufts.edu. http://www.perseus.tufts.edu/Olympics/faq10.html. Retrieved 2009-08-22.
^ Moralia 347C
^ A slip of the tongue in Salutation, Chapter 3
^ Persian Fire by Tom Holland
^ SPARTATHLON ::: International Spartathlon Association^{[dead link]}
^ "The Great Marathon Myth". Coolrunning.co.nz. http://www.coolrunning.co.nz/articles/2002a007.html#appendix. Retrieved 2009-08-22.
^ "Olympic Champion Joan Benoit Samuelson To Be Guest of Honor at Manchester Marathon — Registration Closed". Cool Running. http://www.coolrunning.com/engine/3/3_1/olympic-champion-joan-ben.shtml. Retrieved 2009-08-22.
^ Wanjiru and Gharib break OR in Men's Marathon
^ "Olympic Games Records - Women". International Association of Athletics Federations. http://www.iaaf.org/statistics/recbycat/location=O/recordtype=CR/event=OLY/age=N/area=0/sex=W/records.html. Retrieved November 28, 2009.
^ J.Bryant, 100 Years and Still Running, Marathon News (2007)
^ "The Marathon journey to reach 42.195km". european-athletics.org. 25 April 2008. http://www.european-athletics.org/index.php?option=com_content&task=view&id=6235&Itemid=2. Retrieved 2009-07-23.
^ Martin, David E.; Roger W. H. Gynn (May 2000). The Olympic Marathon. Human Kinetics Publishers. p. 113. ISBN 978-0880119696.
^ "IAAF Competition Rules 2008" (pdf). IAAF. pp. 195. http://www.iaaf.org/mm/Document/imported/42192.pdf. Retrieved 2009-04-20.
^ British Olympic Council Minutes
^ ^a ^b ^c ^d ^e . Bob Wilcock, The 1908 Olympic Marathon, Journal of Olympic History, Volume 16 Issue 1, March 2008
^ The Princess of Wales' private diary and press reports
^ Bob Wilcock, "The 1908 Olympic Games, the Great Stadium and the Marathon, a Pictorial Record" (2008 ISBN 978-0-9558236-0-2)^{[page needed]}
^ Martin & Gynn, "The Olympic Marathon" (2000 ISBN 0880119691)^{[page needed]}
^ http://www.iaaf.org/mm/Document/Competitions/TechnicalArea/04/95/59/20090303014358_httppostedfile_CompetitionRules2009_printed_8986.pdf IAAF Competition Rules 2009 - Rule 240
^ http://aimsworldrunning.org/about.htm
^ Runner's World Top 10 Marathons
^ http://www.travelchannel.com/Travel_Ideas/Adventure_Travel_and_Sports/ci.Marathons_in_the_U.S..artTravelIdeasFmt?vgnextfmt=artTravelIdeasFmt
^ Craythorn, Dennis; Hanna, Rich (1997). The Ultimate Guide to International Marathons. United States: Capital Road Race Publications. ISBN 978-0-9655187-0-3.^{[page needed]}
^ "All-time men's best marathon times under 2h 10'30"". Alltime-athletics.com. http://www.alltime-athletics.com/mmaraok.htm. Retrieved 2009-08-22.
^ "All-time women's best marathon times under 2h 30'00"". Alltime-athletics.com. http://www.alltime-athletics.com/wmaraok.htm. Retrieved 2009-08-22.
^ http://www.iaaf.org/statistics/toplists/inout=o/age=n/season=0/sex=M/all=y/legal=A/disc=MAR/detail.html
^ http://www.iaaf.org/statistics/toplists/inout=o/age=n/season=0/sex=W/all=y/legal=A/disc=MAR/detail.html
^ ^a ^b "Bot generated title ->". Hal Higdon. http://www.halhigdon.com/. Retrieved 2009-08-22.
^ "2005 Total USA Marathon Finishers". Marathonguide.com. http://www.marathonguide.com/features/Articles/2005RecapOverview.cfm. Retrieved 2008-04-24.
^ "Running a sub 3 hour marathon | allaboutrunning.net". allaboutrunning.net. http://www.allaboutrunning.net/sri-chinmoy-racesblog/running-sub-3-hour-marathon. Retrieved 2009-08-22.
^ "Boston Athletic Association". Bostonmarathon.org. http://www.bostonmarathon.org/BostonMarathon/Qualifying.asp. Retrieved 2009-08-22.
^ The ING New York City Marathon^{[dead link]}
^ National Marathon - Qualifying Standards^{[dead link]}
^ http://www.mcmillanrunning.com/rununiv/marathonlongrun.htm
^ ^a ^b ^c Daniels, J. PhD (2005). Daniels' Running Formula, 2nd Ed.. Human Kinetics Publishing. ISBN 0-7360-5492-8.^{[page needed]}
^ Whitsett et al. (1998) The Non-Runner's Marathon Trainer. Master's Press.
^ Burfoot, A. Ed (1999). Runner's World Complete Book of Running : Everything You Need to Know to Run for Fun, Fitness and Competition. Rodale Books. ISBN 1-57954-186-0.^{[page needed]}
^ Marius Bakken. "Training For A Marathon". Marius Bakken's Marathon Training Schedule. http://www.marathon-training-schedule.com/training-for-a-marathon.html. Retrieved 2009-04-17.
^ "Marathon Training at Runner's World".

Safe Gardening

2010-04-29T20:03:00.000-07:00

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

2010-04-25T08:09:00.000-07:00

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 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/

^ Phys Ed: Why Doesn’t Exercise Lead to Weight Loss?
^ Exercise Could Slow Aging Of Body, Study Suggests
^ Exercise 'can reverse ageing'
^ Boecker H et al., Cereb Cortex (2008); 18(11)2523–31. The Runner's High: Opiodergic Mechanisms in the Human Brain
^ "Health benefits of running". Free Diets. http://www.freediets.com/endurance-training/the-benefits-of-running.
^ 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)

2010-04-18T06:22:00.001-07:00

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.

^ The painful truth about trainers: Are running shoes a waste of money?
^ Superglue for Blisters, Cuts and First Aid
^ After Exercise - Does an Ice Water Bath Speed Recovery?
^ 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
^ Stretching and running injuries
^ ^a ^b Tara Parker-Pope, The Wall Street Journal
^ Amy Cortese, Wiggling Their Toes at the Shoe Giants, New York Times, Aug. 29, 2009.
^ The Egoscue Method of Health through Motion, Pete Egoscue and Roger Gittins
^ 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.
^ 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)

2010-04-15T05:15:00.000-07:00

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 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.

^ The painful truth about trainers: Are running shoes a waste of money?
^ Superglue for Blisters, Cuts and First Aid
^ After Exercise - Does an Ice Water Bath Speed Recovery?
^ 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
^ Stretching and running injuries
^ ^a ^b Tara Parker-Pope, The Wall Street Journal
^ Amy Cortese, Wiggling Their Toes at the Shoe Giants, New York Times, Aug. 29, 2009.
^ The Egoscue Method of Health through Motion, Pete Egoscue and Roger Gittins
^ 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.
^ 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

2010-04-11T15:28:00.000-07:00

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.

^ Plantar Fasciitis A Degenerative Process (Fasciosis) Without Inflammation http://www.japmaonline.org/cgi/content/abstract/93/3/234
^ 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.
^ ^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
^ Buchbinder R. Clinical practice. Plantar fasciitis. N Engl J Med. 2004;350:2159-2166. http://dx.doi.org/10.1056/NEJMcp032745
^ Plantar fasciitis: evidence-based review of diagnosis and therapy. Cole C, Seto C, Gazewood J. Am Fam Physician. 2005;72:2237-2242
^ Landorf et al., Arch Intern Med 2006:166:1305
^ Porter et al., Foot Ankle Int 1999:20:214
^ 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.
^ J Orthop Sports Phys Ther. 2008;38(4):A1-A18. doi:10.2519/jospt.2008.0302
^ 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.
^ 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
^ 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.
^ 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.
^ 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.
^ 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.
^ Kauffman, Jeffrey (2006-09-21). "Plantar fasciitis". MedlinePlus Medical Encyclopedia. National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/007021.htm.

Our third clinic

2010-02-02T13:14:00.000-08:00

The OPSC is happy to announce the opening of the third location in Orleans. We are anticipating a March 2010 opening date and are looking forward to serving the Eastern Region of Ottawa. This will be a full service physiotherapy clinic in Orleans providing physiotherapy, massage therapy, running evaluations, bike fittings, cross country ski evaluations, custom knee bracing, and Intramuscular Stimulation (IMS) all at one facility for the ease of our clients.

Introduction

2009-12-20T15:30:00.001-08:00

The Ottawa Physiotherapy and Sport Clinic is a new company in Ottawa that has three locations . They have an Orleans Physiotherapy, Westboro Physiotherapy, and Barrhaven Physiotherapy location covering the Ottawa Carelton Area.

THEIR GOAL IS TO BE THE FINEST PHYSIOTHERAPY AND SPORTS REHABILITATION FACILITY IN THE OTTAWA AREA. THE RELAXED ATMOSPHERE OF THEIR CLINICS PROVIDE AN IDEAL ENVIRONMENT TO RECOVER FROM AN INJURY AND IMPROVE FUNCTION AND QUALITY OF LIFE.

This is my first post and hope to start discussing physiotherapy and rehabilitation topics among others with people and be able to share ideas.

OttawaPhysiotherapy

Tenderpoints and IMS (Ottawa Physiotherapy)

IMS and Chronic Low Back Pain

Intramuscular Stimulation

IMS and tennis elbow

Below is an article talking about intramuscular stimulation (IMS) which is a treatment offered at all three locations at the Ottawa Physiotherapy and Sport Clinics (Orleans physiotherapy, Barrhaven physiotherapy and Westboro physiotherapy sites).

Tennis Elbow and the Cervical Spine

Best Time to Exercise

Best Time to Exercise to Make Fat Burning Workouts Most Effective

Best Time to Exercise and Burn Fat is in the Morning

Here are the reasons why:

Lose Weight Walking

Lose Weight Walking is a Good Start of Weight Loss Exercise Programs

Endurance Exercises to Increase Cardiorespiratory Endurance for Long Distance Running, Improve Running Speed

Improving Endurance and Average Running Speed

Week 9:

Week 10:

Week 11:

Week 12:

Running Training Schedule

Beginner's Program

Running Training Schedule

Week 1:

Week 2:

Week 3:

Week 5:

Week 6:

Week 7:

Week 8:

How to Start Running

Summer time, and the livin's ACTIVE!

Upgrade your Bike with Ottawa Bike Fitting

Bike fitting is the best upgrade

Ottawa Bike Fitting process

Fitting Bicycle Pedals

Saddle Position

Handlebars and Hand Position on The Bike

Finding a Bike Fit Expert

Benefits of a Good Bike Fit

Basics of Bike Fitting

Reasons for Bike Fittings

Elements of good running technique

I thought I would talk about the elements of good running technique.

At our Orleans physiotherapy location one of our physiotherapists provides one on one consultation on a track to help improve your running technique which are as follows to be brief.

Upright posture and a slight forward lean

Stride rate and types

Ottawa Marathon Running Tips

Training

Before the race

During the race

Etiquette

Safe Gardening

Benefits of running

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

Running Injuries (Part 2)

Running injuries (Part 1)

Running injuries

Plantar Faciitis

Our third clinic

Introduction

Best Time to Exercise to Make
Fat Burning Workouts Most Effective