Dec 5, 2013 / 5:00 am
Walking is considered the most commonly reported form of physical activity. It is a self-regulated activity and because of its low impact it has a low risk of injury. Pole walking incorporates the use of handheld poles, which are planted toward the ground with each step. Pole walking originated in the early 19th century in Finland, where it was developed as a conditioning exercise for cross-country skiers in the summer months. This type of dry land training for athletes soon became popular among recreational athletes in Scandinavian countries. Over the past 20 years pole walking has become increasingly popular among North Americans. There are two types of pole walking: Exerstriding and Nordic walking. Exerstriding was developed by Tom Rutlin who was the first to design specialty poles for this type of exercise. These poles have an ergonomic hand grip and do not have a wrist strap as the walker is required to grip the pole continuously, planting the pole with the arm in a hand shake position, applying force as they step forward. Nordic walking poles have a less ergonomic hand grip, but have a hand strap that allows the walker to release the pole at the end of the back stroke and then grip the pole again as the arm moves forward. Walkers using the Nordic pole technique use the poles in a backward angled position, planting the pole with a bent arm, and then step forward applying force to the pole. The differences in the hand grip result in variations of pole planting, pole length, and arm swing for both Nordic and exerstriding pole walking.
Regardless of the type of poles used, it is clear that pole walking contributes to a variety of health benefits. Research has shown that walking with poles increases heart rate, oxygen uptake, and energy expenditure by up to 15-20% greater than walking without poles. Studies have also shown an increase in muscular work in the arms, shoulders, neck, and upper back. Earlier this year a study reviewed the health benefits of pole walking. Researchers found that 18-22% more calories were burned with pole walking than walking alone and that this increase in caloric expenditure was likely due to the higher amount of muscle mass that was required for additional activity of the upper body when using the poles. In addition, researchers also reviewed a previous study in which 12 weeks of Nordic walking resulted in a decrease in BMI, total fat mass, low-density lipoproteins, triglycerides, and waist circumference in healthy post-menopausal women.
People that suffer from chronic diseases such as diabetes, obesity, hypertension, and coronary artery disease are most likely to benefit from a simple and safe form of exercise such as pole walking. In addition, conditions such as Parkinson's Disease, Multiple Sclerosis, and people with total hip and knee replacements may also respond favourably to the use of poles for mobility. Overall the use of walking poles has been shown to improve balance and confidence, reduce the risk of falls, improve endurance, energy and posture, as well as reduce stress on joints such as knees and hips.
Please consult with your health care practitioner to determine if pole walking would be of benefit to you.
Nov 7, 2013 / 5:00 am
The term "Laser" is an acronym for Light Amplification by Stimulated Emission of Radiation. Lasers were first used for therapeutic purposes in the 1970s when Dr. Mester began using lasers for wound healing. Today low level laser therapy (LLLT) is used by physicians, physiotherapists, chiropractors, dentists, and veterinarians for a number of conditions including: Soft tissue injuries, arthritis, musculoskeletal pain, inflammation, and wounds. Clinical usage of LLLT by Canadian physiotherapists varies with different areas of practice. A 1996 study of private practice physiotherapists in Alberta indicated that 51% of physiotherapists use LLLT on a daily basis. LLLT is a class of therapeutic lasers that typically use Gallium Aluminum Arsenide (Ga Al As), with a radiation of red to infrared light, and a wavelength of 630-1550 nM. Depth of penetration for the Ga Al As lasers is approximately 2-4 mm. These types of lasers are hazardous to the eyes and therefore protective glasses are required for both the patient and the health care practitioner providing the treatment.
Low level laser therapy is based on the principles of photochemical and photobiological reactions within the tissues being subjected to the laser. These processes involve the ability of the light to speed up cellular activity and wound healing. Therapeutic effects of LLLT are complex in nature. A simplified explanation involves the stimulation of immune system cells and collagen production. There are also many clinical studies that suggest that LLLT can help reduce pain, yet a physiological explanation is not well understood. There are several proposed possibilities for the reduction of pain, which are as follows: 1. LLLT may inhibit pain receptors (specifically a-δ and c-fibers) , 2. LLLT may stimulate the release of endorphins in the body, 3. LLLT may accelerate healing by stimulating the production of cells and collagen, as well as the formation of new blood vessels, 4. LLLT may also reduce inflammation in the body, using much the same mechanisms as anti-inflammatory medications. What is important to note is that only cells that are damaged by injury are likely to respond to LLLT as described in a 2003 study. Healthy cells and tissues with normal metabolic activity will not be as responsive to LLLT. Overall, LLLT helps to decrease pain and inflammation, and accelerate healing via many immune system processes.
The World Association of Laser Therapy (WALT) guidelines indicate specific points and energy doses for particular conditions and areas of the body. These guidelines also suggest daily treatment for 2 weeks or treatment every other day for 3-4 weeks to reduce inflammation.
There are a few contra-indications and precautions to consider prior to under-going low level laser therapy. Some of the contra-indications include laser to the eyes (eye protection is required), pregnancy (laser over the uterus area), tumors, hemorrhage, and laser to the cardiac region of patients with heart disease. Precautions include infections, history of epilepsy, altered or impaired sensation, and the testicular region.
Please check with your health care practitioner to determine if low level laser therapy is an appropriate treatment for your injury or condition.
Oct 24, 2013 / 5:00 am
What is Acupuncture?
Acupuncture involves the insertion of fine needles through the skin and tissues in specific points in the body. Acupuncture is based on the idea that living beings have an inner energy, or Qi (pronounced chee). According to traditional Chinese medicine, optimal health involves a balanced Qi throughout the body, while an imbalance of Qi results in illness or injury. Insertion of the needles helps to restore the balance of Qi in the body and therefore help to return the body to optimal functioning and health. Although first described in the medical literature as early as 200 BC, acupuncture has only been recently studied over the last several decades by scientific and medical communities to determine the extent of its effectiveness.
Who Performs Acupuncture?
Traditional Chinese acupuncturists, as well as health care practitioners, such as doctors, dentists, physiotherapists, and registered nurses can perform acupuncture. Each health care professional must undergo substantial training in order to practice acupuncture, and regulations exist for each province in Canada. "Anatomical acupuncture" which combines the knowledge of anatomy, physiology, and pathophysiology, allows trained health care practitioners to use acupuncture effectively. Most practitioners undergo training with the Acupuncture Foundation of Canada Institute (AFCI).
How Does Acupuncture Work?
There are many theories that may explain how acupuncture works. Acupuncture needles work to stimulate the body to produce its own pain relieving chemicals, known as endorphins, which result in relief of pain, general relaxation, and restoration of biochemicals in the body. This stimulates the body's natural healing abilities, reducing inflammation, and improving physical function. Another theory that may help explain acupuncture's therapeutic effects involves inhibition of pain signals. It is thought that acupuncture helps to stimulate fibres that inhibit pain and therefore reduce signals of pain to the brain. Acupuncture can also have a systemic effect on the body, influencing respiration, heart rate, blood pressure, circulation, and immune function which can aid in the healing process.
What Conditions can be Treated with Acupuncture?
As a physiotherapist who practices acupuncture, the conditions I treat are typically musculoskeletal or neurological in nature. Examples include headaches, frozen shoulder, tennis elbow, tendonitis, arthritis, sciatic pain, and neck and low back pain. Traditional Chinese acupuncturists can also treat digestive, respiratory, urinary, reproductive, addiction, and insomnia disorders to name a few. When treating any condition or disorder, a correct diagnosis is important before starting acupuncture. A qualified health practitioner will ask a series of medical questions and perform a physical examination prior to determining if acupuncture is an appropriate treatment for the patient.
Does it Hurt?
This is one of the first questions I am asked by my patients. The answer to this question depends on each individual's perception of discomfort. Most people report that they experience only minimal discomfort when the needles are inserted, while others feel no pain at all. Most people describe the discomfort as a "slight pinch". As the needles are inserted to the optimal depth, several sensations may be felt, which include: pressure, heaviness, and warmth at the site of the needle. Once the needles are in place no discomfort should be felt.
How Many Treatments will I Need?
As with any therapeutic intervention, the number of treatments will vary from person to person. For some people only a few treatments are required, however, chronic (longstanding) conditions may require several treatments. It is recommended that 6 to 10 treatments be performed, and then re-assessment may be necessary to determine an alternate treatment plan if there is no improvement in symptoms. Relief of symptoms may be immediate or occur within hours or days. Approximately 80-90% of patients respond well to acupuncture treatment and have noticeable improvements. As with any type of treatment, it is possible that acupuncture may have no effect on the injury or condition. Acupuncture can be used alone or can be combined with other forms of treatment, such as physiotherapy.
Please check with a qualified health care practitioner to determine if acupuncture may be an appropriate treatment plan for your condition.
Oct 10, 2013 / 5:00 am
Calcifying tendonitis of the shoulder is a common, yet painful disorder, that is attributed to calcium deposits in the rotator cuff tendons of the shoulder. This calcific material is composed of calcium hydroxyapatite, which can be considered crystal in nature. Calcifications typically occur in the supraspinatus tendon (51-90%), while the least affected muscle in the rotator cuff is the subscapularis tendon (3%). The supraspinatus tendon is 2 to 3 cm in length and lies in a compartment below the acromion (tip of the shoulder). Most calcifications occur in a specific area of the tendon, which is approximately 1 to 2 cm from its insertion on the greater tuberosity (boney part) of the humerus (upper arm bone). The cause of calcific tendonitis of the rotator cuff is largely unknown, however recent research suggests that a lack of blood flow (hypovascularity) and necrosis (cell death) within the tendon may lead to its degeneration, ultimately resulting in calcification. There are 4 stages of this disorder, which include: 1. Pre-calcific stage, 2. Formative stage (calcium deposits form), 3. Resorptive stage (deposits disappear and are absorbed by the tissue), 4. Healing and rotator cuff repair. This is a natural cycle in which the tendon typically repairs itself, however, if the condition is chronic (i.e. ongoing symptoms), the cycle can be blocked in any one stage.
Approximately 2.7% to 6.8% of people who experience shoulder pain will have calcific tendonitis of the rotator cuff. In turn, only 50% of people with calcification have shoulder pain. People of 30 to 50 years of age are most likely to develop this condition and women are two times more likely than men to be affected. In 10% to 25% of cases, the condition is present in both shoulders (bilaterally). Calcific tendonitis is often seen in people who must sustain specific arm positions for long periods of time, such as shoulder abduction (arm out to the side away from the body) and internal rotation. This is often the case in assembly workers or those who type on a keyboard for long periods of time.
Recent literature suggests that conservative treatment of calcific tendonitis can be of benefit for this condition. A 2009 study recommended that 6 months of conservative treatment should be considered prior to surgical intervention. This study cited physical therapy (including manual therapy and modalities), pain medications, anti-inflammatories, and corticosteroid injections as conservative treatments. More specifically, physical therapy can help to reduce stiffness of the shoulder by performing passive range of motion exercises. When pain has decreased, active range of motion and strengthening of the shoulder can be implemented. In addition, the use of therapeutic ultrasound has also been shown to help dissolve calcifications of the shoulder. In a 1999 study, ultrasound was administered (25% duty cycle, 0.89 MHz, 2.5 W/cm2) to the rotator cuff tendons for 15 minutes for 24 treatments. The first 15 treatments were administered 5 days per week for the first 3 weeks, and the remaining 9 treatments were given 3 days per week over the last 3 weeks of the study. This double-blind study was composed of two groups of patients: one group that received the ultrasound therapy and a second group that received a sham therapy (ultrasound with no effectiveness). The researchers determined that the patients who received the therapeutic ultrasound had greater decreases in pain and greater improvements in quality of life than those who had received sham treatments. However, nine months following the study the differences between the two groups were no longer significant. These results indicate that ultrasound treatment can help to resolve calcific tendonitis of the rotator cuff and is associated with short term improvement in symptoms. Furthermore, a more recent study in 2007 also suggested similar results in that 100% of subjects showed significant decreases of pain and restoration of shoulder movements after 12 treatments of therapeutic ultrasound. Although this was a smaller study (only 26 participants), results indicate clinical improvement with the use of ultrasound.
Always check with your primary care provider to determine the best course of treatment. Diagnostic tests such as x-rays may help determine if you may have calcific tendonitis of the rotator cuff. Physiotherapy treatments, such as those listed above may be of benefit for symptoms of this condition.
Read more Physio Matters articles
- Compartment syndrome of the thigh Sep 26
- Hockey injuries Sep 12
- What is Sciatica? Aug 29
- Whiplash Associated Disorders (WAD) Aug 15
- Choosing a walker to suit your needs Aug 1
- Meniscal injuries: Part 2 Jul 18
- Meniscal injuries: Part 1 Jul 4
- Medial collateral ligament strains Jun 20
- Inversion ankle sprains Jun 6
- Plantar fasciitis May 23
- Osteoarthritis of the knee May 9
- Kinesio tape Apr 25
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