Stretching - why do it and how to be safe.

Here are some of the benefits….

1.     Increased muscle length and flexibility

2.     Increased range of motion in our joints

3.     Reduced risk of injury from tight muscles.

4.     Increased circulation

How to be safe…

1.     Learn how to stretch with proper body mechanics

2.     Make sure you stretch both sides equally

3.     Stretch large muscle groups – focus on hips, thighs, calves, lower back, neck and shoulders.

4.     Don’t bounce – this can cause the muscle to tighten rather than lengthen.

5.     Don’t cause pain when you are stretching. You should only feel a stretch.

How long should I hold a stretch?

Hold for a minimum of 30 seconds. If there is a problem area, increase to 60 secs.

How many repetitions?

One good stretch is usually sufficient. You can do one or 2 more if you feel the muscle is still tight.

When should I stretch?

Stretch after you have performed an activity, when your muscles have warmed up, or at the recommendation of your Physiotherapist if you are recovering from an injury.

A Physiotherapist can design an appropriate stretching program for you (along with strengthening and cardiorespiratory exercise), and tailor it to the activity that interests you.

R. Sian Owen PT

Registered Physiotherapist

The Benefits Of Physiotherapy For Those Recovering From A Stroke.

Stroke is a medical emergency that affects thousands of Canadians each year. Whether due to internal bleeding or a blockage, stroke damages and kills brain tissue. Depending on where the damage occurs, and its extent, stroke can be fatal, but recent advances in the emergency treatment of stroke have greatly increased our chances of surviving one. (1.)

However, survival alone is not enough: 400,000 Canadians live with long term disabilities from stroke. (2.)

These disabilities can include weakness, poor control of movements, paralysis, memory and thinking problems, speech and communication problems, poor control of emotional expression, swallowing problems, altered perception of one’s body, or of everyday objects, reduced peripheral vision. The impact of stroke on our ability to function normally can’t be under-estimated, so it’s really worth taking note of the Heart and Stroke Foundation’s advice about how to reduce the risk of stroke through healthy directions in lifestyle. (2.)

Physiotherapy is a key resource for anyone battling the physical effects of stroke, and outcomes are better if clients are admitted for rehabilitation within 30 days of having a first one-sided stroke. (3.)

Treatment approaches vary, and each person’s stroke is a unique challenge that requires highly customized intervention, but the aim is always the same. Physiotherapists and other rehab professionals, like Occupational Therapists and Speech and Language Pathologists, strive to maximize independent function by tapping into the vast potential of the human brain, so that it may learn to take on functions that the damaged tissue can no longer handle.

The stroke survivor who is unaware of one half of their body, or who has low muscle tone in one leg and arm will have a treatment program aimed at reconnecting those pathways into the brain. Using weight -bearing, stimulation of weak muscles, repetitive exercises, and functional activity, the physiotherapist can help the person become more aware of what their body is doing, and how to correct imbalances in posture and muscle tone.  Whatever the stroke’s effects, physiotherapy is a proven and trusted tool for the hard job that lies ahead. There are several approaches and many techniques available, and your Physiotherapist will select the most appropriate for you. Here are a few examples

·      The Bobath/Neurodevelopmental approach uses specialised handling techniques to help restore movement.  This means that functional activities such as walking or dressing can be done more independently.

http://www.bobaththerapy.org.uk/therapy/what-is-bobath-therapy/

https://www.ndta.org/whatisndt.php

·      Constraint Induced Movement Therapy

This is therapy works by restricting the good side so that the affected side is forced to re-learn movement. It has been shown to be successful with mild to moderate stroke survivors.

http://www.strokeassociation.org/STROKEORG/LifeAfterStroke/RegainingIndependence/PhysicalChallenges/Constraint-Induced-Movement-Therapy_UCM_309798_Article.jsp#.V1Se086cFdg

·      Task –Specific Training, (practice of a specific task in a real life setting, Functional Electrical Stimulation, Treadmill training and Body Weight Support training may all be used to improve gait quality, speed and distance.

http://www.strokebestpractices.ca/index.php/stroke-rehabilitation/providing-stroke-rehabilitation-to-maximize-participation-in-usual-life-roles-lower-limb-and-gait/lower-limb-mobility-and-transfer-skills/

What has your experience been? Do you have any tips that would help other stroke survivors? We’d love to hear from you. 

R. Sian Owen PT

References

1.     http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.8968559/k.D7D3/Creating_Survivors.htm

2.     http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.3483991/k.34A8/Statistics.htm

3.     http://www.physiotherapy.ca/getmedia/63b49e56-5fc4-42fd-a86f-93faa772e957/CPA_TheValueOfPhysio2012_Stroke-v1.pdf.aspx

Physiotherapy and Guillain-Barre Syndrome (GBS)

This serious, but relatively rare condition has been in the news lately, linked to the Zika virus outbreaks in Brazil (1). At Sian Owen Physiotherapy we offer a number of therapies to clients who are dealing with the aftermath of this debilitating illness.

Most people in North America (2) who are in the earliest stages of GBS will feel tingling and muscle weakness, often in their feet and legs. This can spread very quickly throughout the body and turn into complete paralysis. Unchecked, the disease can make it impossible to breathe on your own. GBS happens when our own immune system attacks our nerves, which control all of our muscles. The symptoms usually get worse over a two to four week period after the disease begins, and the amount of damage done to the nerves during this time will affect the degree of disability the person experiences, and their chances of a full recovery. That is why early diagnosis and treatment, usually in hospital, is essential. (3)

Physiotherapy is important in every stage of the disease process, from helping the person with breathing difficulties to assisting with the recovery of physical function once the condition has stabilised.

What can physiotherapy do to help once the condition has stabilised?

1.     In the early stages, when the person can’t move by themselves, the physiotherapist will set up a passive range of motion program. They will also teach family members how to gently move the joints to keep them flexible.

2.     When the nerve starts to recover, and can communicate with the muscle again, strength and control slowly begin to return. At this stage the physiotherapist will engage the person in doing as much active movement as possible, but will assist where necessary.  From this “active assisted” exercise, the physiotherapist will progress the person’s program to independent strength training.  

3.     Physiotherapy will help the person regain normal movement of limbs. In my experience, clients will move any way they can, and the movement may be abnormal. For example, the client may lift their foot too high when walking. This is because the foot is not working properly and they will catch their toes and fall if they don’t compensate. The physiotherapist can help retrain the small muscles in the foot to work correctly so that this “high stepping gait” is not necessary.

4.     Perform functional tasks such as standing up, standing still and walking. Those who were completely mobile before GBS, and who lost their mobility, will know how difficult these apparently simple tasks can be. There may be good active range of motion in the legs, but this doesn’t always mean you can get up from a chair! It takes the right kind of practice.

5.     Improve balance and control during standing and walking. For example, the physiotherapist might work on standing with your legs closer together, or one foot in front of the other, or even one leg off the floor! Walking practice may include walking sideways, turning or walking on an incline.

6.     Most important, whatever the physiotherapy program consists of, it should be a positive, motivating reflection of the client’s goals. I have one client who, before GBS, didn’t exercise in a formal way, for example in a gym, or following a set routine. She loved keeping her home and garden beautiful, cooking and baking. This was how she exercised. It’s been hard for her to commit to a regular exercise routine, even standing just for the sake of it. But when I suggest going into the kitchen and chopping vegetables, she has absolutely no problem. She becomes highly motivated and can stand for longer this way. She has helped me understand there are many ways to reach the same end!

7.     As the client progresses, frequency of sessions will decrease with a plan towards discharge. However, some clients will need a long term relationship with a physiotherapist, perhaps for years, if they haven’t returned to full function.

And of course physiotherapy isn’t the only profession involved. We will liaise with other team members, such as the Occupational Therapist, to ensure we are all working together.

Physiopedia lists a detailed account of physiotherapy management for GBS. (4)

Let me know what your experience of GBS has been!

R. Sian Owen PT

1.     http://www.cdc.gov/zika/qa/gbs-qa.html

2.     http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3939842/

3.     The Mayo Clinic has a nice summary of this condition and treatments http://mayoclinic.org/diseases-conditions/guillain-barre-syndrome/basics/treatment/con-20025832?p=1

4.     http://www.physio-pedia.com/Guillain-Barre_Syndrome

Cardiorespiratory Fitness

Cardiorespiratory fitness allows our circulatory and respiratory systems to efficiently supply oxygen to our muscles when we exercise. If our cardiorespiratory fitness is good, we are able to do moderate to vigorous exercise without too much fatigue.

What are the benefits?

-    Cardiorespiratory fitness helps to

-    Reduce the risk of heart disease and lengthen life,

-    Reduce the risk of chronic diseases such as hypertension, diabetes, stroke and cancer

-    Promote healthy cognitive and psychosocial function

-    Promote a sense of wellbeing

What are the recommendations?

To achieve health benefits, the Canadian guidelines for cardiorespiratory fitness are:

-     Adults should accumulate at least 150 mins of moderate to vigorous intensity aerobic physical activity per week, in bouts of 10 mins or more.

-     If exercise is a new venture for you and/or if you have any medical conditions you should get advice about how to start exercising from your doctor.

-     The guidelines for 18-64 years old are here: ·       

www.canada.ca/en/public-health/services/health-promotion/healthy-living/physical-activity/physical-activity-tips-adults-18-64-years.html

·      The guidelines for 65 years old and over are here:

www.canada.ca/en/public-health/services/health-promotion/healthy-living/physical-activity/physical-activity-tips-older-adults-65-years-older.html

What is moderate intensity aerobic exercise?

Examples are: brisk walking, water aerobics, riding a bike slower that 10 miles/hour, doubles tennis, general gardening, hiking, skateboarding, rollerblading. 

What is vigorous intensity aerobic exercise?

Examples are: race walking, jogging or running, swimming fast, riding a bike fast or on hills, singles tennis, skipping rope, hockey, aerobics, gymnastics, martial arts, energetic dancing, heavy gardening. 

How healthy is your heart?

This free tool from McGill University will give you an estimate:

https://myhealthcheckup.com/

Always remember to stretch after any exercise. See my blog Feb 2018 for more information on stretching OR click HERE! 

R. Sian Owen PT

Registered Physiotherapist

7 Benefits of Resistance Training

7 Benefits of Resistance Training

1.     It makes you feel good.

When we exercise, the body releases endorphins which reduce pain and make us feel great!

2.     It maintains healthy bones.

Our bones anchor our muscles. As we strengthen our muscles, the bone quality improves, which is a win-win. Less risk of osteoporosis!

3.     It gives you great posture.

Core exercise and a program that involves all your major muscle groups (front and back) will set you up to hold your head high, walk tall and avoid that slumped shoulder look.

4.     It makes everyday life easier.

For example, work on quadriceps and hamstrings (thigh) and take stairs in your stride.

5.     It helps with pain.

Bad pain stops us doing exercise, then we get weak and unfit, and the pain just gets worse. But you can do a program specifically designed to accommodate your pain. And remember those endorphins!

6.     It improves your balance.

I’ve written about balance in other blogs. Resistance training helps our muscles stay strong and that helps balance.

7.     It gives you a good night’s sleep.

A good work-out uses up energy, deals with stress and gets your body and mind ready to sleep. For best results make sure you don’t exercise too late in the day.           

Stay tuned for more on resistance training!

If you have any medical problems consult your MD for recommendations or restrictions to exercise, and then your physiotherapist for the program that is right for you.

R. Sian Owen PT

References

For more information on the health benefits of resistance training and types see

https://www.betterhealth.vic.gov.au/health/healthyliving/resistance-training-health-benefits

https://www.ncbi.nlm.nih.gov/pubmed/11676593

We all need Vitamin N!

Richard Louv is the best-selling author of ‘Last Child in the Woods’ (Algonquin Books 2005). In it he coins the term “Nature Deficit Disorder” to describe the multiple harms that come from living a life devoid of nature: lives that are increasingly common in our urbanized, digital age.

Louv has just published another book ‘Vitamin N: The Essential guide to a Nature-Rich Life.’ (Algonquin Books 2016) in which the benefits of Vitamin N, or nature, are clearly set out.

Here are my top four. What are yours?  I’d love to hear from you.

·      Vitamin D production. Vitamin D is a soluble vitamin naturally present in very few foods. It is produced when ultra-violet rays from sunlight strike the skin and trigger its synthesis in our bodies. It is vital to our bone health as it enables calcium to be absorbed from our gut. Taking Vitamin D (in food or as a supplement) has to be balanced, as we can take too much. However, there is no risk of producing too much from the sun. The body doesn’t allow for this to happen.

There is some evidence (not conclusive) to show that a lack of Vitamin D may be a risk factor in certain diseases involving nerve tissue like Multiple Sclerosis.

https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/

·      Improved cognition and mood. Dr. Marc Berman and his colleagues have researched this intensively. They have found that spending time in nature refreshes our brain, improves attention and memory performance. They are also finding that the same effects apply for individuals with depression.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3393816/

·      The shade of trees helps keep us cool in the heat.  Have you noticed when you walk in the city in the summer it can be overwhelmingly hot with no respite. I often see people crowded under one tree.  Trees also absorb carbon dioxide and other harmful gases such as sulphur dioxide and carbon monoxide; they produce oxygen. Having enough trees around your home will certainly reduce cooling costs in the summer, and clean the air!  

https://www.ncsu.edu/project/treesofstrength/benefits.htm

·      Biodiversity. When nature is in balance, many species will co-exist. Over long periods of time, if nature is left alone, species come to co-exist in a harmonious, mutually beneficial manner. If radical disturbances occur, however, (e.g. clearing land for building), one or two species will come to dominate for a while until nature can re-assert its balanced view of things. In the plant kingdom we will often call these dominant plants weeds. If the disruption is big enough (e.g. removing a whole forest), then animals may not survive, as their source of food has disappeared.

How do we benefit from biodiversity? A diverse, stable ecosystem provides us with food, fuel, shelter, medicine and allows for our continued survival.

Now is the time of year to plant. If you are interested in planting for biodiversity look for native species. These have adapted to survive in our region over many years.

For more information contact the North American Native Plant Society   http://www.nanps.org/index.php/home/what-is-nanps

R. Sian Owen

Registered Physiotherapist

February Fitness, Keeping Up With Exercise During Colder Months.

(image sourced from bustle.com)

Well, it’s certainly been a different kind of winter in Toronto. Not as cold as normal, but not as sunny either, and not as bright, as there hasn’t been any lasting snow.

In fact I’m finding it a bit of a blah time of year, and that can make it difficult to keep going with my exercise program. New Year’s resolutions about exercising regularly are especially difficult to sustain but I have found it helps to allow myself the flexibility of when and where I exercise. If I don’t feel like going to the gym I can exercise at home (or even outside this year!). I also try to vary my program –this not only keeps my interest, but it is good for the body to cross train. For example, it’s good to know a few different exercises for one muscle group. Quads (thigh) strengthening can be done sitting or standing, and with a weight, a resistance machine or pulley. The same is also true for cardiorespiratory exercise, for example, using the bike one day, swimming another and walking will help to keep your body adaptable.

Exercise programs should be extremely flexible. One of my clients uses soup cans for weights and stands at the kitchen counter for support and away she goes. She varies her program by choosing to strengthen a different muscle group each day and introduces a cardiovascular element by walking in the mall 3 times a week or working on her stationery bike. When the weather is fine she simply goes for a walk outside.

As well as having a varied program, she’s learned how to pace herself and so avoids injury.

How does she do this?

1.     She gradually increases her program and she/we monitor any discomfort or pain following the work out. Then we adapt the exercise as needed.

2.     She listens to her body, stopping if there is any pain, and rests if she is getting tired.

3.     She has learned to maintain a good posture throughout.

4.     It is only when she can perform the exercise with good posture, no pain and with ease that she increases.

This client is an elderly lady who has intensified her program in very small increments, but I would apply the same principles to a young athlete. It’s tempting to push ourselves to our limit – adverts for sports drinks and running shoes show people doing just that-and they always seem fine doing it. If that’s how you exercise be aware that you are more likely to injure yourself (and so have to stop the sport you love for a while) if you don’t listen to your body and pace yourself.

Take a look at some of these resources and let me know what you think.

Happy exercising!

R. Sian Owen PT

The Cardiac Health Foundation of Canada has a great resource for mall walking in the GTA

http://www.cardiachealth.ca/templates/content/pages/didyouknow1.html

This link lists various spots for seniors to exercise:

http://seniortoronto.ca/topics/walking

MUSCLE STIFFNESS, STRENGTH LOSS, SWELLING AND SORENESS FOLLOWING EXERCISE-INDUCED INJURY IN HUMANS

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1175380/

How To Walk Correctly With A Cane.

If you ever watched House MD, you may have noticed how awkwardly Dr. House walked with his cane. That's because it was the wrong height for him, and he was holding it in the wrong hand. 

Canes must fit your body height and proportions. See last month's blog for how to make sure your cane is the correct height.

Then, 

1. Put the cane in the opposite hand to the injured leg. If you have a problem with the right leg, put the cane in your left hand. This is important because it allows normal arm swing when we walk, and normal biomechanics. Thus, we reduce the risk of injuring other parts of our body. Remember how twisted House's body looked when he walked? He was at risk of back and/or shoulder pain. 
2. Put the cane forward in line with your right leg. Weight bear through the cane at the same time as you take weight through the leg. Try and keep good posture throughout, and you will minimize the risk of other problems. 

How do I walk with 2 canes? 

There are 2 ways of doing this, depending on your balance and how bad your injury is. 

1. Put both canes forward at the same time as weight bearing through the injured leg. This works well if your injury is severe or your balance is not so good.
2. Start as for one single point cane. Left hand with right leg, then the second cane in the right hand with left leg. This takes a bit of practice, but if you can master it, it is close to normal walking and will help your body minimize the risk of any injuries from using the canes. This method is easier if your injury is less severe and your balance is ok. 

You'll be able to check out my video on this - coming soon! 

Next time, I'll talk about how to go up and down stairs with a cane. 

R. Sian Owen PT, Registered Physiotherapist 

Why do we use a cane and what types of canes are there?

Cane tip, single point cane, mini quad cane, wide base quad cane. 

1)    Why do we use a cane?

A cane is used to assist with walking or standing, when our legs are compromised in some way, such as with a fracture or a stroke. It allows us to use our arms to help take the weight that would normally go through our leg. 

2)    Types of canes.

·      Single Point Cane (SPC)

These can be metal or wood. The benefit of the metal cane is it can be adjusted up or down to the correct height, whereas wood can only be cut down.

·      Quad cane. (Four legs)

These are used when more support is needed; perhaps balance is compromise as well. There are different sized bases, with the bigger base providing more stability. The down side of having a bigger base is it can catch in narrow spaces/doorways, and cannot be used safely on slopes or uneven ground.

·      Tripod. (Three legs)

This is used for more support, as for a quad cane above, but less stable.

Other considerations

·      Make sure the cane tip is not worn down and has some traction when you weight bear through it.

·      Be sure to buy a cane with a comfortable handle for you so that your hand doesn’t get sore while you are using it.

See http://www.walkingaidreview.com  for more detailed information

In my next blogs, I will talk about how to measure and adjust the height of a cane, and how to walk with your cane.

R. Sian Owen

Registered Physiotherapist