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Monday, 22 February 2010
Patrick Wall, one of the world’s most respected researchers in the physiology of pain, once asked, “what are the appropriate motor responses to the arrival of injury signals [and pain]?” In other words, what movement is required to help someone avoid or relieve pain. To me, this ought to be the central question of physiotherapy for painful conditions. Thankfully, an increasing body of knowledge in neurobiology and pain science, is now available to help us answer this question.
Wall essentially outlined three phases of response to a signal of pain:
Reflexive withdrawal occurs when the body automatically reacts to remove or reduce the offending stimulus. This is obvious when we touch something hot, for example, but a similar muscular reaction occurs when pain results from certain movements. Overloading or excessive stretching results in muscle spasm.
Guarding or avoidance are more conscious responses chosen to protect oneself from further injury or pain. While this may be helpful if tissue is actually damaged, very often pain occurs in the absence of injury and if movement is avoided the problem may worsen. Examination is important to help determine the underlying cause of pain and prevent it from becoming a chronic issue.
Resolution often requires moving in a certain way to reduce sensitivity and improve mobility. This active phase is always required beyond relief from passive treatments like massage and manipulation if you want to achieve lasting results.
Patrick Wall identified these three phases as instinctive responses; however, many people continue to experience persistent pain well after the time expected for healing of injuries. In our experience, people often remain stuck in phase one or phase two because they misunderstand pain and fear it means danger. In reality, a lot of pain results from tightness and sensitivity of the nervous system and the best response is actually working to restore normal mobility. This is not the same as a ‘no pain, no gain’ philosophy which can exacerbate symptoms. Rather it is carefully looking at the factors contributing to pain and moving in a way that helps transform the pain experience.
Wednesday, 17 February 2010
Well that’s what we want to avoid, especially for our seniors. Did you know you that one-third of Nova Scotian seniors experience a fall each year? As well, 90% of the hip fractures experienced by seniors are a result of a fall, and for every hip fracture 20% of the elderly will die within a year.1,2
These are some devastating stats and the consequences of such falls place a heavy burden on our health care system and the families of seniors. A fall, even without injury, can psychologically damage the confidence of seniors and cause a downward cycle into inactivity and disuse atrophy.1-2
There are multiple reasons why an individual is at risk of falling or experiencing a fall. Fall prevention requires a multi-factorial approach to address the multiple risk factors and potential causes.3 A fall prevention program requires a multi-disciplinary focus and a team of professionals so when you are searching for help, make sure your provider can connect you with the services you need. Fall prevention is a highly underserviced area and my personal mission of mine is to implement a program to help as many people as possible. A fall prevention program should include the following components:
1. History & Screening/Evaluation:
2. Reduction, Management, and Education on Pain.
3. Lower Extremity Function (Strength, Gait, Range of Motion, Neurological Status)
4. Cardiovascular Screen & Care
5. Supervised Exercise Program
6. Medication Review
7. Vision Assessment and Appropriate Treatment
8. Home & Environment Safety
9. Nutritional Coaching
10. Behavior Modification (Reducing risky events) 3-5
Recent systematic reviews revealed that exercise does reduce the rate of falling. But what exactly do they mean by “exercise”? It appears that the rate of falls is reduced by an exercise intervention which includes any two of the following: strength, balance, flexibility and endurance training.6-8 Evidence also suggests that an exercise program of value for fall prevention should include balance training, a high exercise dose, and the absence of a walking program.8
Balance training appears to be a gold standard for obvious reasons. As well, it makes sense that a high dose (respecting muscle recovery) of strength training, which is proper exercise, would be an appropriate choice and a win-win (by also preventing sarcopenia) for the elderly. Lastly, the absence of a walking program, in a fall prevention plan is a beneficial component. The authors concluded that a walking program contributes to less time spent balance training, recovering, and exposes the individual to higher risks of walk related falls.8 This may seem contrary to conventional thinking, but is what the evidence suggests.
To recap, a fall prevention program of great worth would include a high dose of balance training, high intensity strength training, and a decreased emphasis on a walking program. If you know anyone that has a balance issue, has experienced dizziness, or has fallen within the last year, refer them to a qualified physiotherapist who can help.
References:
1. A Report on Seniors’ Falls in Canada, 2005 (Canadian Community Health Survey, Cycle 2.1 - data from 2002/2003, for those over 65 years)
2. Marika Salminen, Tero Vahlberg, Sanna Sihvonen c, Noora Sjo, Maarit Piirtola a,d, Raimo Isoaho, Pertti Aarnio, Sirkka-Liisa Kivela. (2009) Effects of risk-based multifactorial fall prevention on postural balance in the community-dwelling aged: A randomized controlled trial. Archives of Gerontology and Geriatrics 48, 22–27
3. Guideline for the Prevention of Falls in Older Persons. 2001. Journal of American Geriatrics 49, 664-672.
4. Marika Salminen, Tero Vahlberg, Sanna Sihvonen, Noora Sjo¨ sten, Maarit Piirtola, Raimo Isoaho, Pertti Aarnio & Sirkka-Liisa Kivela. 2009. Effects of risk-based multifactorial fall prevention on postural balance in the community-dwelling aged: A randomized controlled trial. Archives of Gerontology and Geriatrics 48, 22–27.
5. Gene Feder, Colin Cryer, Sheila Donovan, & Yvonne Carter. 2000. Guidelines for the prevention of falls in people over 65. BMJ VOLUME 321 21 OCTOBER.
- Interventions for preventing falls in older people living in the community, Cochrane Review 2009
7. John T Chang, Sally C Morton, Laurence Z Rubenstein,Walter A Mojica, Margaret Maglione, Marika J Suttorp, Elizabeth A Roth, Paul G Shekelle. Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. BMJ VOLUME 328 20 MARCH 2004
8. Catherine Sherrington, PhD,_wz Julie C. Whitney, MSc,§ Stephen R. Lord, DSc,w Robert D. Herbert, PhD,_ Robert G. Cumming, PhD,z and Jacqueline C. T. Close, MDwk. 2008. Effective Exercise for the Prevention of Falls: A Systematic Review and Meta-Analysis. JAGS 56:2234–2243.
Wednesday, 17 February 2010
Sunday, 14 February 2010
My name is Trudy MacKinnon and I am the massage therapist at One to One. I absolutely adore the month of February! It conjures up thoughts of and “warm fuzzies” for those near and dear to my heart. When you come across a significant other, family member or friend, why not offer a hug? Touch can augment one’s overall health and wellness.
In keeping with the “warm fuzzy” theme February presents, I thought it might be fitting to review a few important ways massage therapy can facilitate one’s quest for optimum health. Here are just a few examples of how massage therapy can be an integral part of your wellness plan:
1) Several clients book treatments to follow their training sessions. Not only does this help in the recovery phase immediately following the strength training (...it’s always nice to lay down and catch one’s breath), it also integrates the gains achieved during training by soothing the musculature, increasing circulation, and re-enforcing the messages delivered via the central nervous system as one’s body becomes stronger and more in balance.
2) Some clients book bi-weekly treatments as a reward for attaining their goals regarding nutrition. Instead of reaching for the comfort food/beverages, a massage treatment can act as a reward.
3) Massage therapy modalities (neuromuscular, strain-counter strain, myofascial, various relaxing techniques) all compliment Physiotherapy. Many clients observe, and feel for that matter, marked improvement for acute and chronic conditions.
4) Stress reduction! Making yourself a priority and booking a massage at a frequency of just one session per month can really help combat the work and life stressors we all face.
At One to One, we all feel that empowering our clients is as important in achieving wellness as the services we provide. That being said, I’d like to remind everyone of a technique that is often overlooked. This is a simple tool that you can use at home to help counteract the effects of chronic pain, muscle soreness, and life’s stressors. The “Epsom Salt Bath”!
Just follow these simple instructions: For the bath to be therapeutic, place 1-3 cups of Epsom salt in a tub of very warm water (Epsom salts can be purchased in the first aid section of any drug store and it’s very inexpensive.) Anywhere from 12-20 minutes soak time is considered optimal as it takes at least this much time for the human body begin absorb the electrolyte through the skin pores. Try adding some essential oils to enhance your experience. If you are suffering from a cold or flu- add eucalyptus and use lavender to counteract stress and tension. Keep a cold glass of water handy because it’s important to maintain hydration and homeostatic balance as you sweat. An ecological tip: take the water from the cooled Epsom salt bath and water your plants…it will make them bushier, greener and help them to produce more flowers (love for the planet and ourselves!)
A final “warm fuzzy” to share with you: call our office and mention this blog to receive ½ off a massage treatment when booking before the end of February.
Tuesday, 09 February 2010
To be effective, exercise must be hard. You need to challenge your body if you want it to change. If you are going to work hard, you need to ensure that you are working safely. Although speed can vary, slower movement makes muscles work harder by eliminating momentum and minimizes joint impact. Pain and injury are common side effects from performing exercise improperly. Controlled motion allows you to focus on form and engage adequate resistance with minimal risk.
Sunday, 07 February 2010
Sarcopenia is a condition characterized by age related muscle loss. This effect becomes more apparent starting in the 4th decade of life where we can lose on average a half pound to two pounds of muscle per year. With the loss of skeletal muscle come many adverse health effects which include but are not limited to: increased risk factors for cardiovascular disease, increased risk of diabetes, increased risk of falls, decreased endurance and tolerance for activity, and decreased functional independence with daily activities. Preservation, or reclamation, of skeletal muscle mass is crucial for long-term health and lowering risk for the aforementioned conditions.
As we age, many events can negatively affect health, cause significant pain and dysfunction, and leave us deconditioned. As well, many will experience suffer from cardiovascular issues (high blood pressure, cardiovascular disease, post-stroke, chronic heart failure, post-heart attack/cardiac ischemia, arrhythmia). This often causes many people to feel they are to fragile, frail, or elderly to do resistance training and they may fall into a trap of becoming less active for fear of injury or pain, lack of endurance, or fear of triggering another event. However, the musculoskeletal system has a certain level of plasticity, which means that it has the ability to continuously change (add or subtract), regardless of age.1, 2 Therefore, it is never too late to start exercising.
To see significant strength gains, resistance training must be of a sufficient intensity. To believe that the elderly cannot exercise at a higher intensity is false. Studies show that older subjects not only tolerate very high intensity workloads but will exhibit intramuscular, cardiovascular, and metabolic changes similar to younger subjects.1-5 Studies also show subjects with cardiac conditions tolerate and benefit from high-intensity strength training.3, 4, 5 These studies concluded that supervised high-intensity strength training is well tolerated by cardiac patients and allows them to aggressively gain the strength and endurance they will need to complete daily living tasks at lower perceived efforts. Throughout these studies, none of the subjects had evidence of cardiac ischemia or arrhythmia during the training sessions.
In summary, supervised high-intensity resistance training will stimulate positive health effects in people of all ages, even in people who suffer from cardiac deficiencies. Hence, it is never too late to reap the benefits of exercise.
REFERENCES:
- Hagerman et al. Effects of High-Intensity Resistance Training on Untrained Older Men. I. Strength, Cardiovascular, and Metabolic Responses. J Gerontol A Biol Sci Med Sci; Jul;55(7):B347-54, 2000. (website link: http://www.ncbi.nlm.nih.gov/pubmed/10898248 )
- Makrides et al. High-intensity endurance training in 20- to 30- and 60- to 70-yr-old healthy men. J Appl Physiol; 69: 1792-1798, 1990. (website link: http://jap.physiology.org/cgi/content/abstract/69/5/1792 )
- Beniamini et al. High-Intensity Strength Training of Patients Enrolled in an Outpatient Cardiac Rehabilitation Program. J Cardiopulm Rehabil; Jan-Feb;19(1):8-17, 1999. (website link: http://www.ncbi.nlm.nih.gov/pubmed/10079415 )
- Dubach et al. Effect of High Intensity Exercise Training on Central Hemodynamic Responses to Exercise in Men With Reduced Left Ventricular Function. J Am Coll Cardiol; 29:1591–8, 1997. (website link: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T18-3VH801R-11&_user=10&_coverDate=06%2F30%2F1997&_rdoc=29&_fmt=high&_orig=browse&_srch=doc-info(%23toc%234884%231997%23999709992%2347331%23FLA%23display%23Volume)&_cdi=4884&_sort=d&_docanchor=&view=c&_ct=40&_acct=C000050221&_version=1&_
urlVersion=0&_userid=10&md5=c264a372f2cf6bf1e0756ae164b555fc )
- Brochu et al. Effects of resistance training on physical function in older disabled women with coronary heart disease. J Appl Physiol; 92: 672–678, 2002. (website link: http://jap.physiology.org/cgi/content/abstract/92/2/672 )
Monday, 01 February 2010
“… but I did a lot of walking” is one of the most common statements I hear from clients coming off of a break from training, whether from vacation, or any other hiatus. While this line of thinking is good intentioned, walking, unfortunately, cannot provide even a fraction of the stimulus imparted from a properly conducted strength training session. Walking and most forms of steady-state activity are NOT interchangeable with strength training and will not increase strength to help your next workout. If you perform better on Monday’s workout, it is not because the walking on the weekend made you stronger, but rather that your diligent hard work during regular strength training is paying off and causing your body to adapt in a favorable manner. While regular walking will condition your muscles to perform better at walking, it does not send an adaptive response to change the tissues of your body (muscle, tendon, bone) to improve your performance in any other activity.
For decades people have been bombarded with the idea that any amount or kind of physical activity counts as exercise. Government campaigns like “Participaction” have told people to take the stairs, park further away from the shopping centre, or just get out to walk 30 minutes a day. What person growing up in Canada in the 80’s and 90’s doesn’t know Body Break? In fact, I think this campaign is still happening today. While I also encourage people to be active provided there is no harm to their health as a result, the general public has received the wrong message about what it actually takes to produce a meaningful change in our bodies. The fact of the matter is everyone will lose muscle tissue with aging through a process called sarcopenia. This has a significant impact on an individual’s functional ability later in life, as well as contributing to many other degenerative conditions. Unfortunately no amount of walking, running, swimming, or cycling will be intense enough to incite a growth response in the body, as these types of longer duration, steady state activities do not address the type II muscle fibers shown to atrophy through the sarcopenic process. Even some popular activities like yoga and pilates will only address this issue to a small degree at first. This is because the involvement of these fibers are load dependent. If you are not regularly participating in some kind of high effort exercise, particularly strength training, than you will not be providing a sufficient message to your body to increase it’s current physical capacity. While the walking that a client does on vacation can be an enjoyable use of their current resources, it will not help their next strength training session and cannot stop or reverse the gradual decline of strength and function with age. Most activities will use resources WITHIN your current level of functional capacity. Strength training done properly will INCREASE your functional capacity and making activity easier, more enjoyable, and perhaps most importantly, more enduring throughout your life.
For this reason, some kind of strength training program should be the absolute foundation of a fitness program. It is not interchangeable with other activities. It may not be fun, but that’s why you do those other things. It just has to be effective. One of the benefits of a high intensity approach to strength training is that it requires far less time to stimulate the desired response, which leaves you much more time for any recreation you wish to pursue, while addressing the aspects of health and fitness those same activities do not.
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