There is a new kind of doctor in Whistler!  Dr Ryan Oughtred will help you take your health to the next level, prevent illness or become a better athlete.  Dr O is a Naturopathic Physician and X – World Cup ski racer; he understands the wants and needs of Whistler residents.

Dr Oughtred offers services suitable for elite athletes to the elderly.  Services offered include:

Health and Fitness Assessments

Manual Therapies

Exercise (High performance and ‘prehab’ type exercise)

Nutritional therapies

Hormonal therapies

Botanical and Chinese Medicine

Come on in Whistler!  See what the doctor can do you for you.

The 2 supplements that I recommend the most are Fish Oil and Vitamin D. Lately, its seems that the evidence for supplemental Vitamin D is mounting at a rapid rate, and I thought it would be appropriate to write about it.

Vitamins are called vitamins because our body’s cannot function without them – they are vital to life. Almost all of them have to be consumed in the food we eat, or we will get deficiency syndromes and die. Vitamin D is different; our primary source of vitamin D is from the sun.

Vitamin D functions as a hormone in the body, which makes it unique from other vitamins. The human body can make it, but unfortunately it needs a little help to be switched on. This is the where sunlight comes in; circulating vitamin D close to the surface of the skin is altered by the sun’s radiation, converting it from D2 to D3, the active form of the vitamin.

The active form of Vitamin D governs the absorption and metabolism of Calcium in the body, and calcium is used by all cells in the body. Thus it allows for proper functioning of the entire body, but in particular the immune system, the nervous system and the skeletal system allowing for strong bones and teeth.

Right now, research is demonstrating that lower levels of Vitamin D are associated with a variety of problems. For instance, experts agree that the increased incidence of Multiple Sclerosis and other autoimmune conditions at higher latitudes is at least partly due to a lower supply of Vitamin D from the sun. People with darker skin who live in higher latitudes are more susceptable to deficiency because dark skin acts as natural sunblock, and prevents the activation of Vit D. It is no coincidence that people with lighter skin live at higher latitudes.

It’s a catch 22: direct sunlight can lead to skin cancer, and the lack of direct sunlight can lead to more cancer, weak bones, insomnia, dementia, autoimmune disease and who knows what else. I don’t recommend tanning beds because it is too easy to burn your skin with them. Dietary sources of Vitamin D are usually not adequate on their own.

The solution is to either supplement your sunlight or supplement your diet. You would need at least 30 minutes of direct sunlight sunlight on at least 3 days of the week to get it from the sun, and even with that amount you are not guaranteed optimal intake. Because I live in Vancouver, where sun is hard to find in the winter, I recommend supplementation for most patients. Walter Willet from Harvard’s school of public health recommends 1000 IU for all people, regardless of where they live, and he says that the recommendation may increase pending further research. I recommend 1500 IU per day during the dark winter months and 1000 IU per day during the brighter/ sunnier months. When in doubt with your dosage, you can have your blood tested to fine tune your optimal dosage. I shoot for 60-100 pmol/L with my patients.

Review:

Supplement 1000 IU – 1500 IU Vit D per day, or ensure > 30 minutes of direct sunlight on 3 or more days of the week.

If in doubt, have your Vit D levels tested to see what your optimal intake is.

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.

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