During my athletic career, I was impressed by the knowledge and understanding of the physical therapists that helped me.  Unfortunately, I almost always had to be injured before I would benefit from their expertise.  It made no sense to me to wait until I was hurt before addressing my physical weaknesses ; I wanted something more pro-active.  Prehabilitation (prehab) is the act of applying rehab principles to healthy individuals in order to prevent injury and enhance physical performance.

Rehabilitative principles are applied in a step-by-step fashion, to ensure that the body is not forced to do anything that it is not ready for.  I will outline some of these steps, and give you examples of why each could be important to you:

Reduce Pain and Inflammation

Pain or inflammation in a joint causes key muscles to be deactivated, as well leads to patterns of avoidance.  Running with a sore back for instance can train key stabilizing muscles not to work, leading to instability of the back long term, and can cause you to adopt habits that could make you a slower runner in the long term.

Ensure Proper Joint Motion and Stability

Tight ankles, especially one sided, can cause rotation through the entire body, cause unequal wear and tear of joints, overuse of other joints, and poor balance.  Weak hamstring muscles can increase your likelihood of tearing ligaments in your knee.

Efficient Movement and Posture

Your technique when you exercise determines which muscles get strong, which ones stay long and supple, which joints get stressed, and how tired you get.  Anti-inflammatory herbs or medications may help for your knee pain, but if the cause of the knee pain is the way you walk or run, then your pain will always recur.

Notice that none of the above steps have much to do with general fitness; someone can be very strong or fit, and still fail some of these steps.  Every day, people are exercising or performing simple daily tasks with limitations in the above categories, and those seemingly healthy activities can be making them unhealthy.  Don’t wait until you are unsatisfied with your physical health; learn about your physical limitations and what you can do about them right now.

Exercise and sleep can help to prevent cancer

A study in Maryland found that people who had less sleep had a greater chance of getting breast cancer.  The CDC recognizes sleep deprivation as a serious health problem with fewer and fewer people getting the sleep that they need to be healthy.  Lack of sleep is associated with many chronic ailments, including obesity, depression, cardiovascular disease, hypertension, and cardiovascular disease.  Where are the studies that demonstrate effective techniques to get people sleeping and exercising more?

Another reason to sleep longer – short sleepers and cardiovascular disease

In most people, blood pressure decreases while they sleep – a phenomenon that is thought to decrease the strain on the heart and blood vessels during the night.  Japanese researchers showed that individuals who had less sleep also had higher sleeping blood pressure, and consequently had more cardiovascular disease.

Vit B3 prevents the progression of alzheimers in mice

Nicotinamide (Vit B3) has long been used by Naturopathic Physicians as a treatment for neurological problems, and to enhance cognition.  This recent study suggests it may limit the progression of alzheimers disease in mice, but it is too soon to recommend it in humans because Vit B3 is toxic if taken in too high a dose.  Which begs the question…should I stop drinking water because it could kill me if taken in too high a dose?  B3 is very safe when taken in the right form and the right dose – consult your physician before using it.

You mean there is more to heart disease than blood pressure and cholesterol?

Cholesterol is a good measure of cardiovascular disease risk, but it is definitely not the only story behind heart disease.  With the widespread use of statin medications, cholesterol is becoming better controlled, but other risk factors like body weight and blood triglycerides are still increasing – evidence that we need to start treating the causes of heart disease instead of trying to mask its symptoms with costly medications that come with side effects.

Watch what you eat – for your children’s sake

A recent pediatric study proves that children will mirror the eating habits of their parents, underlining the importance of learning healthy eating habits not just for your own health, but for the health of your children as well.

British study associates coffee drinking with low birth weight babies

In light of a recent study, Britain has decreased its guidelines for caffeine intake to a maximum of 200mg/ day.  This is probably the equivalent of 2 small cups of coffee.  This same article from the BBC also mentions that the FSA may actually relax its guideline for alcohol consumption during pregnancy, as alcohol consumption is currently not recommended.

Another possible role for the hormone seratonin – controlling bone density?

A recent paper published in the journal Cell, discusses how Seratonin that is formed in the gut actually promotes the breakdown of bone in genetically modified mice.  Commonly referenced for its relationship to positive moods, seratonin is actually most plentiful in the human digestive tract, and the full scope of its effects have yet to be discovered.

Waist measurement – a simple and very effective risk analysis

Researchers in Europe are doing a good job at discrediting the old body mass index (BMI) model for cardiac risk analysis, in favor of a simpler and more effective waist to hip ratio.  It is the size of your waist (the area around your belly button) and your body shape that really matters when it comes to predicting your risk of dying from heart disease.

Probiotics – Good for your gut…and your curtains…?

Simply applying ‘good bacteria’ to curtains and other surfaces in hospitals has shown to cut down on infection rates, and the effects are comparable to that of antibiotic solutions.

Dr Oughtred has moved his clinical practice from it’s old location to it’s new home at Sage Clinic.

Located in Yaletown in the heart of Vancouver, BC, Sage Clinic is a natural healthcare clinic with naturopathic medicine and acupuncture.  The clinic is located at 487 Davie Street, across from Choices Market at the corner of Richards and Davie.

He is seeing patients there on Mondays and Wednesdays for any of his clinic services including the new Biophysical 250, health assessments, diet management, Chinese medicine, counseling, and joint stabilization therapy.

Injury to the lower back is one of the more common injuries incurred by the alpine skier. Waiting for back problems to happen before doing anything about them is probably a bad idea; the discs and bones of the spine generally only have nerves on their outermost portions, which means that damage to the inner portions of the vertebrae and discs can occur without experiencing any pain at all. The spine can degenerate ‘from the inside out’ for many years without any warning signals, and by the time an athlete is 26 years old-in the peak of a career-the spine can have significant amounts of permanent wear-and-tear. Here are the 5 most important preventive measures I think athletes and support staff can take to prevent back problems:

Build progressions in training schedules:

1. The risky forces for the spine are flexion, rotation, compression, and sheer; all of which are involved in skiing. Because avoidance of these risky forces is not possible, the athlete must be exposed to them gradually over time. Both on-snow and dry-land training should gradually involve progressions in both volume and intensity of activities that involve bending forward, twisting, weight lifting, and eccentric loading.

2. The adolescent spine may be especially vulnerable because the growth plates of the vertebrae are softer than in an adult, making them more prone to injury from compression and sheer forces.

Sit less, and never lift heavy after sitting:

1. Any time the spine is flexed forward for a period of time, such as with sitting, a phenomenon called ‘creep’ occurs in the tissues. The tissues are melded toward a shape that is different than normal. Heavy lifting or other compressive activity (such as ski racing) should be avoided immediately following a prolonged period of sitting or forward bending.

2. To combat the effects of creep from sitting on planes, in cars, or on chairlifts, athletes can perform extension exercises like McKenzie press-ups or other extension movements any time they have been prolonged to excess flexion.

3. When traveling – I would never allow athletes to lift heavy bags immediately after riding in a van or on a plane for hours. Stand up, walk around, and maybe bend the spine back a couple of times before lifting anything heavy.

4. When riding the chair lift – athletes should take time after every chair lift ride to stand up, bend back a little, and warm up before diving into another race run. While riding the chair, a relaxed upright posture is probably best.

Compress and twist the spine judiciously:

1. Twisting while you lift heavy weight doubles the load through the back. Athletes should be taught to never twist while they are lifting, unless it is an exercise specifically designed to prepare them for skiing.

2. Discourage athletes from packing heavy bags, and encourage them to share the work of lifting with other people.

Keep your spine neutral and stable:

We know that stability of the spine will prevent injury, but applying that to practice is not a simple task.

1. Maintain a neutral spine as much as possible when training, especially when lifting heavy weights or twisting.

2. Focus on endurance of the spinal related muscles, not just strength.

3. Integrate components of instability, unpredictability and precision into dry land training.

4. Full body exercises are probably better than isolated muscular activities. Even if the athlete feels like the exercise is too easy, it is still doing something for them.

5. Make sure athletes can breathe evenly throughout entire exercises.

6. Encouraging the athlete to lightly draw in their tummy, or ‘feel like they are stopping a pee’ while working out, might add to their spinal stability. Train everything. All the muscles of the core probably contribute to injury prevention in some way, as does the lower body and upper body. Search for balance, find weaknesses and eliminate them.

Proper biomechanics-the earlier better:

1. Taking the time to consult with someone who understands normal spinal mechanics and how to assess it could be a valuable investment.

2. If one area of the spine is not moving well, other spinal regions may be forced to work too hard, or in an unbalanced fashion. Detecting these kinds of imbalances early in a career may prevent future injury or even enhance athletic performance.

The field of low back problems is a difficult area. I have done my best to consider some of the evidence so far, and apply it to the ski racing athlete. I hope it was helpful!

Ryan Oughtred

More to read:

• Panjabi MM. The stabilizing system of the spine. Part 1. Function, dysfunction, adaptation, and enhancement. J Spinal Disord 1992; 5(4):383-9

• Richardson CA, Jull GA, Hodges PW, Hides JA. Therapeutic exercise for spinal segmental stabilization in LBP: scientific basis and clinical approach, Edinburgh: Churchill Livingstone; 1999

• McGill S. Low back disorders: evidence based prevention and rehabilitation, Champaign, IL: Human Kinetics Publishers, Inc.; 2002

• N. Bogduk, B. McGuirk. Medical Management of Acute and Chronic Low Back Pain. An Evidence Based Approach. Elsevier Science. 2002