Monthly Theme:  Flexibility

June’s theme is flexibility.  The high volumes of activity in June will add tension to the body – often in the wrong places.  Joint irritation from overuse and repetitious movements like running and cycling can make your flexibility even worse.

Poor flexibility can lead to increased tension in tendons, which leads to less blood flow, which can lead to poor healing of tissues, which leads to injury.  Poor flexibility also affects your posture, which can cause pain and muscle fatigue over time.  When your joints lack flexibility, the body has to compensate for those inflexibilities by overusing other joints and changing the way that it moves – this often creates pain in other joints for seemingly no reason.  Whenever something starts to hurt and you don’t know why, take a look at the neighboring joints and you may find the cause!

Flexibility becomes exceedingly important as we age; tasks that seemed simple when you were 50 can quickly become difficult at 70.  Maintaining a component of your fitness is always easier then improving it.  “Use it or lose it” is a good rule of thumb for every person as they age.

Notes for all stretches:

Stretches for healthy joints should typically be done at least 3 times per day to get improvements, and at least 2 times per week for maintenance.  Passive stretches should be done after exercise or when the body is warm, and held for 30-60 seconds at a time.  Before exercise, it is better to use active versions of these stretches where you use exercises that naturally stretch these joints while warming up the nerves and muscles at the same time.

Hip flexors:

The hip flexors are a group of muscles in the front of the hip.  They become tight with endurance types of activities like running, biking, or rowing and they also become tight with sitting.  Almost everyone would benefit from stretching his or her hip flexors more often.

When the hip flexors are tight, it puts more compression and torsion through the low back and pelvis while also putting more strain on the lower extremities making injury to the knees, ankles and feet also more likely.

How to do the stretch:

With one knee down and directly underneath you, turn your hips back like you are trying to pour water out the back of your pelvis.  This should create enough of a stretch for you; if not, you can lunge your hips slightly forward.  If you have to lunge far forward, you aren’t using your tummy enough!

Where to feel the stretch:

In the front of your pelvis and upper thigh.

Ankle Extension (Calf/ Achilles Stretch):

Proper ankle extension is essential to maintaining proper form for walking, running and squatting activities.  When they are tight (they are tight very often), it puts additional stress on the foot, knee, hip and pelvis.  Stretching the ankles into extension is a key treatment for many foot and ankle problems, the most common of which is plantar fasciitis.  Proper ankle flexibility can also allow the foot to sit more naturally on the ground and allow for better balance and coordination for sports.

How to do the stretch:

Place your foot onto a ramped surface and then move the knee toward the toe.  Do not let the knee move to the inside or outside, keep it in line, and be sure the arch of the foot does not collapse.   Do the stretch with a bent knee sometimes and with a straight knee sometimes.  This stretch may need to be performed more than other stretches in order to get results, as the ankle can be very stubborn to improvements.

Where to feel the stretch

Deep inside the ankle and in the back of the lower leg.

Shoulder Flexion:

Shoulder flexion is basically reaching the arms over the head.  Loss of shoulder flexion comes primarily from poor posture and not actually doing the motion enough.  Tight chest and back muscles make it even more difficult to do proper shoulder flexion.

The result of poor shoulder flexion is overuse of the neck, back and shoulder joint – which causes painful syndromes in each of these body parts.  It also makes doing overhead tasks at home very tiring; changing a light bulb or building some shelves at home can all of a sudden become an embarrassing activity to perform if you don’t keep up your shoulder flexibility!

How to do the stretch

Point the thumb up in the hitch hiking position, keep the arm perfectly straight, and raise the arm straight in front of you and over your head.  Use a doorway if you are standing or use a chair or Swiss ball in front of you if you are kneeling and add passive overpressure to push the arm back over your head.  Keep your tummy tight so you don’t just bend back in your back instead of the shoulder.

Where to feel the stretch

Different people will feel this stretch in different places, but in general you will feel stretching deep in the shoulder, in the chest, and also in latissimus muscles.

In the December 2007 issue of Scientific American, Body, there was an article titled, “The Ultimate Blood Test”.  The article was a review of a new blood test called the Biophysical 250, the most comprehensive blood test available to date.  I was intrigued, and eventually I decided to call Biophysical Corp to learn more about the test.  After a few conversations, I was convinced that this was a test that I would be comfortable offering to my patients.

It’s called the Biophysical 250, because it measures 250 things in your blood, all at once.  For those afraid of having blood drawn, you can rest assured that the test requires only 2 tablespoons of blood.  The test covers blood markers for cancer, heart disease, autoimmune disease, infectious disease, nutritional status, hormonal status, inflammation, blood diseases, osteoarthitis, and organ dysfunction.  Biophysical Corp does not advocate testing anything that there is no treatment for, so they don’t test markers for alzheimers for instance.  Biophysical reports that in a trial of 120 clients who received the Biophysical, 27 clients had a moderate health risk, and another 15 had a major health risk.  The Biophysical 250 can help discover problems before they become problems, and there are many markers that wouldn’t normally be tested for until the disease was already apparent.   Some examples are:

• H-pylori (a bacteria associated with stomach ulcers)
• Autoimmune markers (For lupus, scleroderma, or rheumatoid arthritis)
• Insulin (high insulin levels are thought to precede type 2 diabetes)
• Cancer markers (Breast, Prostate, Colon, Pancreas, Liver, Testicular)
• Ferritin (high ferretin can be assymptomatic, and represents high iron stores, which can be harmful to the body over time)
• Thyroid Markers (thyroid disease is common, and can go a long time before being diagnosed)
• Hepatitis markers

The trouble with waiting until you get a disease, is that you stand the risk of not being able to reverse the disease process once it is diagnosed.  Cancer and autoimmune diseases are classic examples of diseases that have much better outcomes if treated earlier.

The Biophysical 250 does not replace a comprehensive annual health screen with your physician, but for those who can afford it, it can be a great, low risk adjuct to a comprehensive medical assessement for the patient that wants to know more about their existing state of health.

To learn more about the test, visit: http://www.biophysicalcorp.com/ .  The company has also come up with an abreviated version of the test that is priced more competitively, and still screens for several of the same markers.

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.

During my 7 years of competition with the Canadian alpine ski team, I experienced several injuries, the most frustrating of which were the insidious injuries that seemed to appear out of nowhere. These injuries could last for months to years, and usually required multiple treatments to heal. Because one treatment alone was rarely effective, I began to think that there was more than one cause for these problems. It was for this reason that I decided to become an integrated health care professional, utilizing expertise from several different areas to help people experience better health.

Many chronic problems have more than one cause: type 2 diabetes, heart disease, autoimmune disease, asthma, headaches, overuse injuries, back and neck pain, irritable bowel, PMS, and psoriasis, are all examples of problems that have more than one cause or contributing factor. Common sense dictates that the assessment and treatment of such problems should be multifactoral. For example, an integrative assessment of the patient with chronic headaches would consider the following factors:

• Inactivity or obesity

• Overweight individuals that don’t exercise experience more health problems, including headaches

• Blood pressure

• High blood pressure or sudden changes in blood pressure can increase your likelihood of head pain

• Hormonal imbalance

• Migraines occur more in women, and they will often notice their pain fluctuates with menses

• Blood sugar imbalance

• Fluctuations in blood sugar can lead to the vascular constriction or dilation that is often associated with headaches

• Stress and cognitive influences

• Those who experience anxiety or depression, experience more headaches

• Neck problems

• The upper two vertebrae in your neck can cause an increase in head pain when they are dysfunctional

• TMJ problems or dental problems

• Food sensitivities

• Environmental sensitivities

• Poor posture and work position

• Poor vision or eye problems

• Infection or cancer

• Drug interactions

• Inflammatory disease

• Past trauma/ accidents

A multifactoral assessment allows the health provider to look at your health from a ‘bird’s eye view’, and focus treatments on the areas of your health that might contribute to your pain. Treatments could include physical therapies, supplements, therapeutic exercise, specific herbs, a special diet, or cognitive behaviour therapies. However, without an integrated assessment of your health, your treatment may be one sided, and may fail to address weaknesses in your complete health picture. It is for this reason that I recommend an integrated approach for your chronic problems, the prevention of disease, and for the pursuit of your optimum health status.

Ryan Oughtred

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