Exercising from Home: Optimize Exercising Using Bodyweight & Limited Equipment

Stay Active: Not having access to a gym is not the end.

With many gyms temporarily closed and an explosion of bodyweight workout routines popping up on social media, we want to help you figure out what you should be doing. Keeping active is important during this time for many reasons including for physical health and mental health (1), and to make sure you can stay on track with your fitness goals. If you are uninjured and otherwise healthy, and want to keep active and busy, do whatever is fun and enjoyable to you. However, if you have specific goals you want to stay on track with, here are some guidelines to help you continue to reach your goals without being able to get to a gym.

If you have chronic or acute injuries that require special consideration for the exercises, or if you cannot find a way to exercise without pain, please contact info@acesportsclinic.com to set up a training session (virtual sessions are available!).

DO NOT DO ANY EXERCISE THAT CAUSES PAIN.

Why are you working out?

It is first important to understand why you are working out so that you can make sure you are exercising in a manner that is appropriate for your goals. It is also important to understand the restrictions of working out with limited equipment and/or bodyweight only. The old adage of “if you don’t use it you lose it” is quite appropriate for these circumstances. Your body develops fitness specific to the format in which you exercise. Therefore, while random workouts you see on Instagram are potentially great ways to keep active and healthy, they may not help you continue progressing towards YOUR fitness goals.

General Health & Fitness

If your health and fitness goals are non-specific, and instead are to reap the general benefits of physical activity, then here are some guidelines for how you can maintain cardiovascular health and develop muscular strength-endurance for healthy living and aging.

1. Cardiovascular Health Workout

Accumulate at least 30 minutes of steady state activity with an HR of 135-155 BPM 3x a week. These 30 minutes can be accumulated in either 3x 10-minute or 2x 15-minute bouts.

  • Run or power walk on a treadmill
  • Use a stationary or recumbent bike
  • Climb the stairs continuously
  • Use workout rubber bands for tempo runs

2. Muscle Strength & Endurance for “Functional Tasks”

Perform muscle strengthening exercises at least 2x per week (1). Use weights or resistance bands if you have access to them. Try to incorporate all of the fundamental movement patterns;

  • Squat
  • Hip Hinge
  • Push
  • Pull
  • Carry

Try the workout format outlined in the “Weight loss Workout” section.

Weight Loss – Don’t Lose Momentum

Key considerations for staying on track for weight loss goals without being able to get to a gym include: maintaining/increasing lean muscle mass and exercising to increase caloric expenditure.

Maintain Lean Mass & Exercise to Increase Caloric Expenditure

Strength training exercises that create a high-tension stimulus are required to maximize muscle mass retention (2). This means that you must find a way to increase external load creatively or modify the tempo of the exercises you are doing.

  • See muscle gain section for ways to increase tension during the strength exercise circuit listed below.

We also want to stimulate protein synthesis and elevate it as high as possible to increase or at the very least, maximize muscle mass retention. The circuit training format outlined below will work both to maximize caloric expenditure through short rest periods, and to drive protein synthesis via metabolic pathways (5).

Circuit Training:

  • Choose 6-10 Exercises.
    • Alternate between 1 lower body and 2 upper body exercises.
  • Set a repeating timer for 30s.
  • Try to do 15 reps with full range of motion in the 30s.
  • The next 30s are a rest period to get ready for the next exercise.
  • Do 15 reps in 30s of each exercise.
  • Repeat this circuit 3-6 times without resting between rounds.
  • Do this type of circuit 3-4x a week.

Aerobic Exercise:

Do some form of aerobic exercise at least 2x per week; see cardiovascular health workout guidelines above.

Muscle Gain & Building Strength

To grow muscles, we need to recruit/stimulate as many muscle fibres as possible AND fatigue those fibres (2)(5). To fatigue as many fibres as possible with bodyweight exercises, exercise as close to muscular failure as possible (4). To simply maintain muscle you have developed, continue exercising with approximately 30% of the volume (weight*reps*sets) you were using (3). You must be realistic with what you can accomplish from training at home. To give yourself the best chance to continue building muscle, you must work very close to muscular failure. This is difficult and uncomfortable and can take a lot more reps than you think. When working towards or close to failure, technique also starts to break down, making it important to be cognizant of your posture and positioning to avoid injury. If you are newer to exercise, working to failure may not be safe or necessary.

Beginner & Intermediate Exercisers

If you are a beginner or intermediate exerciser, you will likely be able maintain muscle that you have gained for up to 32 weeks if you just keep exercising (3). You may even be able to make progress in muscle mass if you are now doing unfamiliar exercises consistently, (exercises you have not done before, but repeating them over the next few weeks) and working hard (probably close to muscular failure) (4).

Advanced Exercisers

If you are an advanced lifter (>3 years training), there is a good chance you will lose some muscle mass and that strength will regress. This is simply because the more trained you are, the more tension and volume is required for further muscle growth. However, that muscle will come back relatively quickly when you begin retraining (3). In order to maximize increases and retention of muscular strength and mass, you will need to present a high-tension stimulus to the muscles (5). Simply working to failure is likely insufficient at bodyweight due to the amount of volume and muscular tension required for advanced adaptations.

Maximize Muscular Tension:

There are a few things you can do to influence muscular tension, and to present some external load to maximize your ability to retain muscle mass. 1) Emphasize working close to failure, 2) exercise your full range of motion, 3) modify tempo, 4) lift heavy objects around the house, 5) emphasize technique to increase muscular tension. These strategies may help to increase muscular work through higher tension and muscular recruitment.

Increase External Load:

  • Spare tire – hold a squat or lunge, press it overhead.
  • Bag of garden soil/pet food/bag of sand – hold and squat or lunge.
  • Find random heavy objects or weights around the house that you can lift and hold during exercises to add external load.
  • Use isometrics (muscular contraction without muscle length change) during warm up/muscle prep to increase muscular recruitment.
  • Use slow, controlled eccentrics (muscular contraction while the muscle is being lengthened, loaded stretching) to increase muscle tension during working sets.
  • Work close to failure when it is safe.

Circuit Training:

  • Choose 6-10 Exercises.
    • Alternate between 1 lower body and 2 upper body exercises.
  • Do all 6-10 exercises for 10 reps with a tempo of 4.0.4.0 or slower.
  • Repeat this circuit 3-6 times.
  • Do this type of circuit 3-4x a week.
  • Use methods listed in the “Maximize muscle tension” section for exercises where you can.

Just like in the “weight loss” workout format, we are going to take advantage of circuit training. Use weighted objects from around the house to increase muscular tension and stimulate muscle retention and growth (4). We will also use metabolic stimulus of the circuit format to drive protein synthesis for growth (5).

If you experience any pain during exercising, do not continue without consulting a professional. If you have exercise equipment at home and would like a more personalized program, please contact info@acesportsclinic.com to set up a virtual training session so we can help you.

DO NOT DO ANY EXERCISE THAT CAUSES PAIN.

Written by: Josh Downer, Strength & Performance Coach

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(1) “ACMS’s Guidelines for exercise testing and prescription 10th Ed.” (2018). American College of Sports Medicine. Wolters Kluwer

(2) “Scientific Principles of Strength Training” (2016). Dr. Mike Israetel, PhD., Dr. James Hoffmann, PhD., & Chad Wesley Smith.

(3) “Exercise dosing to retain resistance training adaptations in young and older adults” (2011). Bickel CS., Cross JM., & Bamman MM. Journal of Medicine and Science in Sports and Exercise. https://www.ncbi.nlm.nih.gov/pubmed/21131862

(4) “Muscular adaptation in low- versus high-load resistance training: A meta analysis.” (2016). Schhoenfeld BJ., Wilson JM., Lowery RP., & Krieger JW. European Journal of Sports Medicine. https://www.ncbi.nlm.nih.gov/pubmed/25530577

(5) “Mass 2” (2017). Dr. Pat Davidson PhD & Dr. Ben House PhD.

Have you heard of ELDOA™?

ELDOA™ is a French acronym that stands for Etirements Longitudinaux Decoaptation Osteo-Articulaire. It is an exercise approach that combines the philosophy of osteopathy and movement. The term is complicated, but the postures are very simple. The objective is to contract in depth the muscles around the different segments of the spine to create a decompression effect and restore space between the bones or the joints. And, ultimately, relieve pain and improve posture.

Regulars of Yoga or Pilates will not be confused with these stretches. It is very similar in that it is a postural technique where you go pose to pose. It is grounded in controlled movements and incorporates low-impact postures designed to decompress the discs in the spine and stretch the suspensory muscles and connective tissue for organs. We work sitting cross-legged, or lying on the back, then we contract certain muscles in depth by performing different stretches that are held for 1 minute. We aim for precision and posture maintenance rather than high intensity effort.

History of ELDOA™:

Created by world-renowned Osteopath, Guy VOYER, DO, the ELDOA™ method has been around for more than 30 years, but it is a newcomer in the regeneration scene. He was looking for a tangible solution to the recurring pains of his clients. Obsessed with diagnosing the causes of the problem, he developed the ELDOA™ method of teaching movement and exercises which “normalizes” bodily and vertebral tensions in connection with myofascial chains. Mr. VOYER, DO is internationally known for his osteopathic expertise and his extensive background in the field of sports, manual therapy and medicine, which includes degrees in physical education, physiotherapy, sports medicine and traumatology.

Benefits of ELDOA™:

  • Spinal Strength and Mobility 
  • Improved Muscle Performance and Tone
  • Improved Athletic Performance and Recovery time
  • Injury Recovery and Prevention
  • Relief of Back, Neck, and Shoulder Tension
  • Reduced Joint Inflammation
  • Improved Posture and Increased Flexibility

What to Expect:

Every session is designed to alleviate physical pain and improve overall posture through intelligent sequencing, cueing, and hands-on adjustments. No two bodies are alike; therefore, we adapt the ELDOA™ exercises to work within a person’s limitations so that over time those limitations become strengths. Our tailored approach allows us to observe and monitor your movement as you progress.

Kick start your new year by adding an ELDOA™ into your schedule to maintain your body’s youthfulness and relieve stress.

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Ace Sports Clinic is excited to introduce you to our new team member Ashley Frejlich, a certified yoga instructor and ELDOA™ practitioner. It is a perfect session for before or after your treatment with us to enhance and gel results and put a new tool in your toolbox!

CLICK HERE to book your private ELDOA™ session today.

Blood Flow Restriction Training

What is blood flow restriction (BFR) training?

BFR training uses FDA approved cuffs that are applied to your arms or legs.  These cuffs are inflated to control the amount of blood and oxygen being delivered to your muscles.  With the use of these cuffs, you can exercise at a low intensity but still experience the gains of a high intensity work out. 

What is the difference between a low intensity work out and a high intensity work out?

During a low intensity work out, you are training at 20-35% of your one rep maximum.  During a high intensity work out, you are training at 65-90% of your one rep maximum.  For example, the maximum weight you can squat is 100 lbs.  BFR training allows you to exercise at a low intensity (i.e. squatting 30 lbs; 30% of your one rep maximum) to have similar gains of a high intensity work out (i.e. squatting 70 lbs; 70% of your one rep maximum).

What are the benefits?

There are over 820 research articles published on BFR training.  BFR training has been shown to increase strength, prevent muscle wasting, increase muscle size, improve cardiovascular function and supports soft tissue repair by indirectly triggering the release of Human Growth Hormone and IGF-1.

How is this helpful for my pre-habilitation / rehabilitation?

BFR training is effective for situations when you are unable to exercise at a high intensity and are restricted to a low intensity work out.  This can include several situations such as being in a cast due to a bone fracture, restricted to a partial weight bearing status, limitations due to pain, pre and post joint replacement surgery, strains, sprains, chronic concussion symptoms, osteoporosis, muscle deconditioning & many more.

How is this different than wrapping Voodoo floss bands or exercise bands around my arms or legs?

There is more consistency with amount of blood being delivered to your limbs.  Voodoo floss bands or excise bands are wrapped around the limb without knowing the actual amount of blood being occluded to the limb.  With BFR training, a cuff pressure is calculated specifically for you and is based upon the optimal occlusion rate determined by research studies.  This will ensure that the amount of blood being delivered to your arms or legs will mimic a high intensity work out.

Optimize your training and rehabilitation through purposeful movements

Maybe you’ve heard about this concept as “Dynamic Neuromuscular Stabilization” (DNS). The basis of DNS is on developmental kinesiology; early in childhood your movement patterns are automatic and predictable and are formed as your nervous system matures.

This article will show you how we can take advantage of the pre-programmed postures we possess to improve your quality of movement patterns.

DNS is necessary to optimize the movement system for both pre-habilitation and rehabilitation of athletic injuries and performance. This is not achieved by having strong abdominals, spinal extensors, gluteals or any other musculature; rather, it’s accomplished through the precise coordination of these muscles and intra-abdominal pressure regulation by the central nervous system.

Supine 90/90 position (4.5 month old)

If we fail to activate our deep core muscles before movement, our body will compensate by typically overloading superficial muscle groups, this can cause excessive loading of spinal joints, discs, and muscles.

In this developmental kinesiology exercise, I’m focusing on maintaining control through my deep core muscles. The ball is used as a cue to make it easier to recruit your core muscles. The second example is a progression using a resistance band to challenge your core even further.

High oblique sitting (7.5 month old)

Oblique sitting occurs when the shoulder joint is strong enough to support this position, this occurs to children who are 7.5 months of age.

In this video, I demonstrate a high oblique sitting followed by its progression. This exercise will improve scapular stability, core strength, hip abduction, and work on your hip external rotation mobility.

Supine to low oblique sit

In this exercise you will work your shoulder stability, hip abduction, and core strength. Make sure you’re keeping your chin tucked to help improve your cervical spine stability!

Once you achieve low oblique sitting, you can try the following variations:

In this video I’m reaching out with my arms and continue to reach further and further away from me. To challenge your core, hips, and shoulders even more, lift the leg up and continue to reach as far as you can.

Bear crawl (14 month old)

The bear crawl corresponds to a 14-month-old child.

A key prerequisite to lifting heavy in a safe and effective style, as well as helping you excel in your sport, is having great core stability. Core stability is your ability to control your torso to prevent excessive movement of your spine.

In the first part of the video, I begin with 4 points of contact (both hands and feet). I then progress to 3 points of contact by elevating 1 hand or 1 leg. Once you feel comfortable with this, you can progress into a 2-point contact bear crawl. Hold this position isometrically first and once you have that under control you can begin to crawl. The main thing you want to consider is to maintain a neutral spine, try and resist rotation, flexion and extension.

Conclusion

These exercises will help strengthen and optimize your movement patterns through purposeful movement. If you feel limited while doing any of these exercises, don’t be too worried, the exercise is just demonstrating the weak link in the kinetic chain.

If you want a more comprehensive approach to improve your movement patterns, get rid of pain, prevent injury, and optimize athletic performance, come see one of our Registered Kinesiologists!

Written by: Franco Floris, Registered Kinesiologist

References:

5 Tips to Help Prevent Running Injuries

  1. Progressive load tolerance: the majority of running injuries occur from doing too much too soon! Whether a tendinopathy, plantar fasciitis, patellofemoral syndrome, IT band syndrome, stress fracture, muscle strain, you name it, your body needs to learn to accept load gradually over a period of time so you don’t exceed the tissue’s capacity to adapt. Gradual progressions are important whether you are learning to run, returning to run after some time off, after a rest period following a race, or coming off of another injury. This will likely look like some form of run-walk progression – for best results, speak to your healthcare practitioner! (And a word to the wise runner, ALWAYS consult a healthcare practitioner who is also a runner themselves).
  2. Cadence of 180 steps per minute: research has shown that running with a cadence of 180 steps per minute (range from 170-190), regardless of pace or speed, is beneficial in terms of injury prevention. A slightly faster cadence than perhaps you are used to will be helpful in reducing the amount of contact time with the ground while taking a step, which reduces the amount of force transmitted through your foot, knee, hip and into your body. Transitioning to a different cadence than usual should also be done gradually!
  3. Run lighter: Perhaps this one seems over-simplified, but by taking quieter steps, you are also reducing the amount of force transferred through your body. You want to hear as little sound as possible when your foot contacts the ground.
  4. Run a minimum of 4 days/week: your body needs to learn to adapt to the stimulus of running, and will only do so if running occurs with enough frequency. Running only a couple of times per week will not allow for the appropriate adaptations in your muscles, bones, tendons and other tissues, thus resulting in a greater likelihood of injury. This does NOT mean that every run has to be fast or long! How frequently you run is the important factor here. Including speed and longer runs will vary depending on your running goals.
  5. Appropriate footwear: make sure to consult your healthcare provider on this one, but research has shown that running in shoes with a lot of cushioning and arch support can actually reduce your body’s capacity to regulate how much force is being transferred from the ground to your foot, ankle, knee, hip, lower back, etc. Ensure you have the right pair of shoes specifically for you!

For more advice on running injury prevention, treatment and return to run, consult one of our healthcare providers at Ace Sports Clinic.

Check out our Ace Running Programs here.

Written by: Hilary Mallinger, Registered Physiotherapist

Sports Physiotherapy

We bring our health, high performance knowledge & experience and personalize it to your needs when recovering from a sports injury.

What is a Sport Physiotherapist?


A Sport Physiotherapist has a background in orthopaedics and has skills like advanced athletic taping, emergency first response, return to play protocols, assessment of protective equipment and footwear, in addition to manual therapy and exercise rehabilitation.  Sport Physiotherapists also have a thorough understanding of the signs and symptoms of concussion and post concussion syndrome, and are educated in up-to-date research in return to play or return to life protocols following a head injury, thus reducing risk of further injury.  The use of athletic taping can be applied not only court or field side, but additionally in the clinical setting.  A sprained ankle, whether occurring on the soccer pitch or while walking the dog, will feel better after treatment with supportive athletic taping!  The training for a Sport Physiotherapist involves over 1600 hours of on-field or on-court medical care in a variety of sports.


How is a Sport Physiotherapist regulated?

Sport Physiotherapy Canada (SPC) – a Division of the Canadian Physiotherapy Association – oversees and regulates the education and on-field experience of a Sport Physiotherapist.  The education system of SPC allows the graduate physiotherapist to gain experience and education through a variety of specialized courses. Through a mentorship program with current Sport Diploma holders, graduate physiotherapists gain valuable on-field experience.  The Sport Physiotherapist Diploma holder is qualified to work with Canada’s High Performance athletes in all International settings including daily training and competitions such as world championships and the Olympic Games, while the Certificate holder is qualified to work at the National level with High Performance athletes. 

Common Sports Injuries we can treat

Some of the most common sports injuries include ankle sprains, muscle strains, shin splints, tennis or golfer’s elbow, knee and shoulder injuries.  If you or someone you know is injured, schedule an evaluation with one of our team today.

Book today at acesportsclinic.com

3 Pillars of a healthy and balanced body and how Massage Therapy can help?

Our body is a very complex and balanced bio mechanism.  So many systems are interconnected with each other, working together to create a unique and highly adaptable structure.  But in our competitive world, days of high stress and fatigue can really put our body and these interconnected systems to the test, potentially causing overload to the point of break down.  For example, a corporate office job with strict deadlines and an insurmountable workload can cause a person to skip meals (causing improper digestion), stay overtime (causing mental fatigue) and keep incorrect posture for prolonged periods of time (causing pain in multiple areas of the body due to overuse or underuse of certain muscle groups).

Therefore, to keep our bodies from malfunctioning and to avoid unwanted aches and pains we need to build and balance the 3 basic Pillars of good health.  The Pillars are good nutrition (healthy diet), proper rest (Sleep ~ 8 hours / night) and exercise (³ 150 minutes of moderate-intense exercise / week).

Our skillful, Registered massage therapists can positively influence the body to help improve each of these categories.

  1. How can Massage Therapy help to improve digestion?

Massage therapy can help regulate and improve digestion through different ways:

  • Massage can influence the body’s nervous system to switch from SNS (Sympathetic Nervous System) to PNS (Parasympathetic Nervous System). SNS is responsible for the “Fight & Flight” mechanism.  When activated it puts our body on guard to fight off external or internal stimuli, which make our senses acute and body tense.  On the contrary, PNS is responsible for the “Rest & Digest” mechanism.  When our body is in this state, it relaxes, starts healing processes and digestion can function optimally.
  • The digestive system can also be influenced directly through massage & manual work on abdominal wall muscles, fascia (connective tissue), and hip flexors. These structures can commonly become tight and compress or pull on our intestines, which in turn can slow down normal digestive processes.  Scar tissues from abdominal surgeries or traumas can also be a reason of such tightness which massage can also help.
  1. How can Massage Therapy help to improve sleep?

Sleep is important for the optimal function of every system in our body.  Loss of sleep is often connected with the amount of stress in our life and how we handle it.  Increased levels of Cortisol hormone are noticed with people who are constantly under stress and can’t get enough sleep.

Studies show that massage can decrease the amount of cortisol in our system by 31% and increase the release of dopamine by 31% and serotonin by 28% (“The happiness hormones”). Therefore, by influencing the biochemistry of the body, Massage Therapy can help to reduce daily stress which can improve our sleep quality.

  1. How can Massage Therapy help with exercise & optimal physical activity?

Massage Therapy is most beneficial for the musculoskeletal system of our body and can help people with various fitness and wellbeing goals.

  • For athletes and people with active lifestyles, massage therapy can be beneficial to warm up muscles and fire up the nervous system before an event or competition. Massage can also help during the cooldown period, when toxins stored in muscles and connective tissues need to be flushed, muscles stretched and our nervous system calmed down to help recovery.
  • During training periods, massage can help keep muscular tone under control to prevent strain type injuries and also maintain muscle balance and prevent abnormal compensations from previous injuries.

So, think of Massage Therapy as an essential support tool to build and balance your 3 Pillars of good health.  We generally find that people who proactively invest time in taking care of their body through regular massage have less injuries and live healthier lives.

Neurogenic pain

Nervous system basics

The nervous system is an electrical system that carries information and messages throughout the body.  It can be grouped into two very broad categories:

Central nervous system (CNS): Brain and spinal cord

Peripheral nervous system (PNS): Branches from the spinal cord to the limbs and internal organs.

The brain is the computer, the body is the machine.  All information is sent from the CNS out to the PNS, and in turn the PNS feeds back information to the CNS about what’s happening at the periphery (i.e stepping on a nail = danger signal)

Symptoms of the nervous system

  • Numbness/tingling
  • Burning, sharp pain
  • Reduced strength
  • Loss of balance/coordination
  • Headache
  • Visual disturbances (blurriness, eye fatigue)
  • Poor reflexes
  • Severe pain

Common injuries

Neuropathic pain differs to neurogenic pain as it is the direct disease or damage of a nervous system structure (such as the thalamus in stroke victims).
Neurogenic pain is more common and much more treatable by an Osteopathic Practitioner.

Osteopathic Practitioners treat a range of neurogenic pain syndromes such as:

  • Nerve root compression (fig.1)
    • Pain radiates from the spine into the limbs
  • Neuropraxia
    • Blunt force injury – hockey stick to forearm causing pain/loss of sensation
  • Peripheral weakness
    • Information from the brain to the periphery isn’t being conducted adequately – generally unaccompanied by pain
  • Headaches
    • Many sources but often related to compression of nerves under the base of the skull or a source within the brain (such as the eyes)
  • Digestive issues
    • Broad diagnoses of IBS or other digestive “syndromes” that have varied symptoms without any evidence of pathology (such as a stomach ulcer) can often be attributed to a range of nervous system dysfunctions that reduce the function of the parasympathetic nervous system responsible for digestion.

Fig.1

Illustration of compression of the spinal cord by a herniated disk that will commonly cause pain to travel down the leg.

Treatment and recovery

The nervous system is incredibly complex and is still not fully understood. Testing the reflexes, muscle strength and ocular function are useful and reliable tools in identifying underlying problems that are directly related to pain production.

Conservative treatment including both osteopathy and physiotherapy can reduce symptoms (4-6 weeks) and improve function (6-12 weeks) through both manual treatment and rehabilitation programs that educate and train the sufferer to avoid future injury or relapse.

Is this a serious condition?

Treatment of the underlying cause of pain is paramount and must be assessed for severity.  Often a low-grade injury can cause severe pain if affecting the nerves.  Further investigation such as imaging (x-ray, MRI) may be warranted depending on examination findings.

Long term compression or untreated nerve damage may result in permanent loss of function and extended periods of pain.

Management

  • Initial Phase (weeks 1-4)
    • Reduce inflammation and pain. Anti-inflammatory medication may be advised.
    • Treating pain generating structure (such as a disk bulge)
  • Intermediate phase (weeks 4-6)
    • Once pain has subsided, increase load bearing and exercises as tolerated
  • Advanced phase (weeks 6-12)
    • Return to full capacity exercise, challenging injured structure (with physiotherapist monitoring)

 

 

Neurogenic Thoracic Outlet Syndrome – Making big headlines lately

If you even remotely follow the NBA you might have heard the ongoing drama regarding the health of Philadelphia 76ers’ young guard, Markelle Fultz. The former number one overall draft pick has begun his once-promising career with a bizarre sudden inability to properly shoot a basketball. You don’t need to be an expert to understand that a player who mysteriously loses his jump shot is both equally unheard of as it is concerning for their future career. After over a year of endless speculation Fultz recently saw a specialist and was diagnosed with neurogenic thoracic outlet syndrome (nTOS).

What is Thoracic Outlet Syndrome?

Thoracic Outlet Syndrome (TOS) is a complex and controversial disorder. Generally speaking, it refers to a very broad group of conditions that stems from the compression of nerves and blood vessels between your collarbone and first rib. As both nerves and blood vessels are potentially affected, TOS can be further subcategorized as either neurogenic thoracic outlet syndrome or vascular thoracic outlet syndrome.

How do I know if I have it?

TOS can be a very difficult diagnosis to make even from a clinician’s standpoint. The number of structures that can cause TOS is enormous as it includes all sorts of different muscles, bones, nerves, etc. Compression of your vessels and nerves can also occur at multiple points in your upper extremity and symptoms of TOS can mimic symptoms of other shoulder and nerve-related pathologies. Consequently, the symptoms for one person will not necessarily be the same for another. Often times the condition is diagnosed by ruling out all other potential pathologies. Statistically, if you do have TOS you are far more likely to have neurogenic thoracic outlet syndrome than its vascular counterpart.

Below are some of the most common symptoms of nTOS:

  • Numbness and/or tingling down the arm into the hands
  • Fatigue of the arms particularly with overhead movements
  • Weak grip
  • Vague shoulder pain

What causes it?

There can be many different causes for developing nTOS. It can range from something as simple as poor posture to something more traumatic such as whiplash from a motor vehicle accident. Certain jobs can also predispose an individual to developing TOS – particularly those involving repeated overhead movements such as hairdressers or assembly line workers. Interestingly, women have been found to be up to four times more likely to develop TOS than males.

Treatment

Before doing any treatment, it is important to first seek out a physiotherapist to get a thorough assessment done to rule out any other potential causes. A multidisciplinary approach involving clinicians from varying healthcare disciplines is generally recommended for both assessment and treatment given how complex TOS can be. If TOS is indeed suspected, then treatment typically involves targeting whatever structures are at fault through rehabilitation, manual therapy and exercise. Education regarding eliminating any behavioural or environmental causes is another important component of treatment.

If you are experiencing any symptoms of thoracic outlet syndrome, come into see one of our Registered Physiotherapists for an accurate clinical assessment today.

References:

https://www.sbnation.com/nba/2018/11/13/18090592/markelle-fultz-jump-shot-history-injury-free-throw

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101069/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3526474/

Orthopaedic Physical Assessment 6th Edition. Magee.

Acute Ankle Sprain: What does it mean and Where to from here?

What does ‘ankle sprain’ mean?

A sprain is a term used to describe a ligament injury, where the ligament has been over-stretched or sometimes torn. They typically occur due to joint trauma, or a joint being taken past its range of motion. An ankle sprain is therefore, an injury to the ligaments connecting the bones of the ankle joint.

What are normal symptoms?

  • Tender to touch
  • Sudden and intense pain
  • Swelling and bruising
  • Joint stiffness
  • Walk with a limp

What ligaments have I sprained?

The ligaments injured, depend on how you have sprained your ankle

Rolling your ankle inwards

Rolling your ankle outwards

How long until I get better?

Sprains are graded from 1 to 3 based on their severity, with 1 being the lowest and 3 the highest.

Grade 1 indicates mild stretching and damage, with 1-2 weeks for recovery

Grade 2 indicates partial tearing, with 4-6 weeks for recovery

Grade 3 indicates complete tearing, with 3 or months for recovery

Is this a serious condition?

Although painful, this is not a condition you should worry about, as ankle sprains make up 40% of all sporting injuries. However, if you have the symptoms depicted above you should go to the hospital for X-rays.

Management

  • Initial Phase (Limit inflammation and bleeding)
    Rest, with the ankle elevated and compressed
  • Crutches, for the first 24 hours to allow for weight-bearing, without being excessive
  • Gradual weight-bearing, to promote ankle motion

Intermediate Phase (Restore pain free motion)

  • Begins when you no longer experience pain at rest
    Involves moving your ankle actively in all pain free directions
  •  Strengthening exercises can begin slowly
  • An ankle brace can be used to help manage pain with work, however, it is important to not become dependent on it

Advanced Phase (Restore function)

  •  Begins when pain free and swelling is no longer present
  •  Involves advanced exercises that aim to strengthen and reduce the chance of re-injury
  • They should be advised by and done in the company of a trained professional

Avoid

  • Alcohol
  • Cigarettes
  • Stress
  • Overwork
  • Complete rest

Reduce Stress

  • When injured, the body produces stress hormones
  • This places strain on the body, prolonging the healing period
  • This response can be reduced through treatment focusing on the nervous system

Restore Ankle Motion

  • Mobilization techniques directed to the foot and ankle joints will promote movement
  • With this, it may also promote a faster healing time

What if I do nothing?

Doing nothing may result in a longer recovery time.  The tissues may not reach the strength they would have otherwise. The ankle joint may become chronically unstable, which can increase the likelihood of:

  • Re-injuring the ankle
  • Developing osteoarthritis

Osteopathic Treatment

Reduce Pain and Swelling

  • Pain and swelling cause discomfort and limited motion
  • If drawn-out, this can result in a longer than usual healing time and increased risk of re-injury
  • Massage and mobilization can be used to minimize these effects

Written by James Goetz for acesportsclinic.com

 

Reference:

1. Adelaide Crows Sports Medicine Clinic [Internet]. 2017 [cited 2 September 2017]. Available from: http://www.adelaidecrowssportsmedicineclinic.com.au/ankle-sprain/

2. Dubin JC, Comeau D, McClelland RI, Dubin RA, Ferrel E. Lateral and syndesmotic ankle sprain injuries: a narrative literature review. Journal of chiropractic medicine. 2011 Sep 30;10(3):204-19. doi.org/10.1016/j.jcm.2011.02.001

3. Ankle Sprains” When should you be concerned? [Internet]. 2017 [cited 2 September 2017]. Available from: http://www.sportdoclondon.co.uk/ankle-sprains-when-should-you-be-concerned/

4. Inversion Ankle Sprains [Internet]. 2017 [cited 31 August 2017]. Available from: https://gymnasticsinjuries.wordpress.com/2012/10/11/inversion-ankle-sprains/

5. Medial ankle sprain [Internet]. 2017 [cited 2 September 2017]. Available from: https://www.slideshare.net/AwiniMohamed/medial-ankle-sprain-53753126

6. Different Grades Ankle Sprain [Internet]. 2017 [cited 2 September 2017]. Available from: http://iwalk-free.com/injury-resource-center/sprained-ankle/

7. Chan KW, Ding BC, Mroczek KJ. Acute and chronic lateral ankle instability in the athlete. Bulletin of the NYU hospital for joint diseases. 2011 Jan 1;69(1):17.doi: http://www.presentationgrafix.com/_dev/cake/files/archive/pdfs/238.pdf

8. Tiemstra JD. Update on acute ankle sprains. Am Fam Physician. 2012 Jun 15;85(12):1170-6. Available from http://familymed.uthscsa.edu/residency08/MMC/Ankle.pdf

9. Ottawa Ankle Rules [Internet]. 2017 [cited 2 September 2017]. Available from: http://www.bmj.com/content/326/7386/417

10. When It Comes To Physical Therapy, Patients Have To Do The Work [Internet]. 2017 [cited 2 September 2017]. Available from: http://www.chelseafootandankle.com/blog/when-it-comes-to-physical-therapy-patients-have-to-do-the-work

11. Kemler E, van de Port I, Backx F, van Dijk CN. A systematic review on the treatment of acute ankle sprain. Sports medicine. 2011 Mar 1;41(3):185-97. doi.org/10.2165/11584370-000000000-00000