Choosing a school backpack

Hating to be the bearer of bad news, I feel almost guilty in pointing out to my children that the school year is about to start anew. So it’s new shoes and school supplies and for at least one of them, a new backpack.

When used correctly, backpacks make an excellent school bag and can be a good way to carry the necessities of the school day. They are designed to distribute the weight of the load among some of the body’s strongest muscles. To choose the right backpack for your child, look for the following:

•  Wide, padded shoulder straps. Narrow straps can dig into shoulders. This can cause pain and restrict circulation. Backpacks with one shoulder strap that runs across the body cannot distribute weight evenly. Try and have the padded straps each at least 2 inches wide.
•  Padded back. A padded back protects against sharp edges on objects such as text books inside the pack and increases comfort.
•  Waist strap. A waist strap can distribute the weight of a heavy load more evenly. This is especially for smaller children. On the same idea, keep the backpack light. The backpack itself should not add much weight to the load.
•  Rolling backpack. This type of backpack may be a good choice for students who must tote a heavy load. Remember that rolling backpacks must be carried up stairs.

 Always use both shoulder straps. Slinging a backpack over one shoulder can strain muscles, especially those around the neck.

 Adjust the shoulder straps so that the pack is close to the body. The straps should hold the pack around two inches above the waist. Too low and your child will end up hunching forwards.

 Pack lightly. The full backpack should never weigh more than 15 percent of the student’s total body weight.

 Organize the backpack to use all of its compartments. Pack heavier items closest to the center of the back. There, the larger back and trunk muscles can manage the load easily.

 Remind your child to stop often at school lockers and remove items they don’t need, if possible. Don’t have them carry all of the books needed for the day to every class. Overloading also causes the muscles of the back to work so hard, that they become strained and fatigued. This makes the back more susceptible to injury and pain.

Putting The Backpack On

Check that your child is aware of using proper body mechanics when lifting the backpack and putting it on. They should face the backpack and bend at the knees to grab it, hold it close to them, and then lift it using their legs. Teach them to bend using both knees, when they pick up a heavier backpack. They should not bend over at the waist when wearing or lifting a heavy load.

Encourage your child or teenager to tell you about pain or discomfort that may be caused by a heavy backpack. Pain that is persistent is a warning that something is wrong so if they are complaining, get assessment and advice from a physiotherapist. It is always easier to correct problems at an early stage than to be treating real injury later on. I’ve prepared a PDF of this post which you are welcome to download from our library here.   http://www.west4thphysio.com/resources/library/

Please feel free to print and pass it on to others you think may benefit.

Trouble in high heels…

It’s summer on the west coast. Here in Vancouver, BC, the sun shines and most of us take vacation of some sort (hence the lack of posts over the past few weeks). But of course I’m not the only one who gets to take a break. Many of my fashionable clients (you know who you are) do the same thing, ditching their habitual high heels for something altogether flatter and more modest. For most people it’s a fairly easy transition with barely a whimper from their perpetually tight calf muscles. But every year there are a few whose activities at the beach or lake involve lots of barefoot running around and the result on the tight calf is a muscle tear or a connecting achilles tendon strain. Both options are painful and can take several weeks to recover. So, a general plea for those of you who live in the highest of  heels to take pity on your calf muscles. Vary your footwear and at least do some spring stretching before the beach vacation.

More serious is a study I came across from the Iowa State University which showed that regular wearing of high heels increases the chance of developing knee osteoarthritis. Even worse, the higher the heel the greater the possible damage. The study author, kinesiology masters student Danielle Barkema, measured the forces travelling across the knee joints of 15 different women while they wore shoes of different  heel heights (flats, 2 inch and 3.5 inch). The higher the heel, the greater the compression forces measured on the inside compartment of the knee. Excessive compression and joint load is recognised as a major contributor to eventual joint damage and breakdown. She additionally measured postural changes at the ankle and  hip which contributed to increased strain and possible discomfort in the lower back. Not a huge deal if it is very occasional but significant if it becomes more frequent.

So should you throw all those stunning high heels out? That, I am assured by those who know about such things, would be a tragedy and is unlikely to ever occur. So, just a little moderation and if possible go with a regular heel lower than 2 inches. Save the stilettoes for a party where you can sit down. And remember, although high heels are legal in Carmel, California, you do require a permit. Apparently true as a left over law from long ago. I couldn’t make that up if I tried.

Ride to conquer cancer – thanks!

So we made it!

Saturday 19th and Sunday 20th saw us cycling our way through the lower mainland and into Washington state en route to Seattle as part of the BC Cancer Association 2010 Ride to Conquer Cancer.

Because of the support of friends, family and clients West 4th Physio was able to contribute over $8000 to the grand total of 9.2 million which will go towards research and equipment needed in the foundation’s work. A big thankyou to all of you who supported us.

This was a well organised event that was both hard and fun to be a part of. A 7:00am start on the first day of 130km saw us at Mt Vernon for around 2:00pm for a hot shower, a good meal and a nights sleep in the tent city set up by an army of willing volunteers. Next day was another 120km in the rain, rain, rain. Slightly less pleasant but a tremendous spirit all round.

Special thanks to my team mates Jen Macpherson, Lauren Watson and Mike Kane for their good humour and willing participation. Hopefully we will be able to do it all again in 2011.

Matt

2010 Ride to conquer cancer

This weekend is Vancouver to Seattle 2010 Ride to Conquer Cancer. This terrific event was first held last year and raises a huge amount of money for the BC Cancer Foundation. This year four of us got on board and so Matt, Mike, Jen and Lauren will complete the ride over 2 days, cycling around 120km each day. I’m thrilled to say that we have raised just over $7500 which will go to benefit the BC Cancer Foundation and a huge thankyou to all of our friends, colleagues and patients who have kicked in and made a donation. In the end it all adds up and goes to a fantastic cause. Now all we need is some nice weather and your best wishes for a safe and enjoyable ride. I’ll post something next week to let you know just how we made out!

Exercise for osteoporosis

While reading and researching for the other posts in the Osteoporosis category,  http://www.west4thphysio.com/category/osteoporosis/ , I came across an interesting article outlining the results of a strength training program from the University of Arizona. I am often asked in my clinical work exactly which exercises are able to reliably build bone mass. The difficulty for researchers, in pinning down exactly which exercises are best at building bone density, has been a variability in results. Multiple studies have shown that aerobics, weight bearing, and resistance exercises can all maintain or increase BMD in postmenopausal women and the same principles will benefit men with diminished bone density. But which exercises to do?

The U of A BEST (Bone Estrogen Strength Training) project helpfully identified 6 well known weight training exercises that they found gave the largest improvements in bone mass density. They were:

• standing squat
• military press
• lat pulldown
• leg press
• back extension
• seated row

I was pleased to see that  these are all exercises commonly done in any gym environment. Any competent trainer will be able to demonstrate good form for each exercise and give you on site pointers for both the specific equipment, which varies from gym to gym, and to avoid injury.

To follow the project guidelines, exercises are done three times a week with 2 sets of each exercise  done at each session. The key to successfully build bone mass was to work at the right intensity. A moderate load set of 6-8 reps is done at 70% of a one rep maximum. This is alternated with a heavy set of 4-6 reps at 80% of a one rep maximum.

A trainer at your local gym or community centre can help you establish your one rep maximum and then it’s a simple matter of doing the math for your percentages. Be sure to retest your maximum every few weeks as it will increase with training (and naturally diminish with slacking off) so to keep your training accurate and effective, keep an eye on that baseline number. Remember also that as you strength train, you have the additional bonus of  helping brain function.   http://www.west4thphysio.com/osteoporosis/strength-training-can-make-you-smarter/ So good results on every level with this type of training. Together with the additional benefits of improvements in balance, gait, and a reduction in risk of falls it seems something to be encouraged with all older men and women.

Improving your golf game

It’s already tee time on the west coast and elsewhere in Canada regular golf is getting underway. So what can be done to improve your game this season? There has been some interesting work done by exercise physiologists and coaches in answering the question of what it takes to be a successful golfer. In an article which appeared in the Journal of Strength and Conditioning Research in Feb 2009, researchers took some detailed physical measures of  24 national team golfers. Specifically they looked at flexibility, strength and aerobic fitness. Some of the findings seem obvious, such as being stronger in your upper body gave a longer drive, but there are a few correlations that were more surprising.

Better Balance = more greens hit  This was measured by time in a one legged, tip toe stand. The better the balance, the more greens were hit in regulation play. The conclusion was that because second and third shots are often hit from sloping or otherwise awkward angles better balance lets you cope with the uneven positioning and yet still produce accurate play.

Better core stength = more accurate chip shots and longer drives  Measured by front plank and side plank endurance. (FYI: The national team members averaged just over 150 seconds for the front plank test), this showed to be significant for both short and long play. As a physio who treats golfers of all ages on a regular basis, I found it most interesting  that better core strength resulted in fewer low back injuries. A golf swing puts a large compressive load through the spine of up to eight times bodyweight so it’s no surprise that the commonest site for injury in golf is the low back. Good core strength can help control your swing by limiting excessive side to side motion which,with repetition, can become an injury producing problem.

Higher aerobic fitness = better performance  Golf is not necessarily leisurely. For the duration of the round, if you are pulling a cart around the fairways, you will sustain a metabolic rate of around eight times your resting rate. Improved cardiovascular fitness will lessen the sense of fatigue and keep you at the top of your game right through the round. You can also practise for longer and as always, practise at least makes you better, if not perfect.

So in summary:

•  improve your balance – try one legged standing on tip toe. Then stand on one foot and try a slow half swing. Alternate between feet and try this a few times a day 
• develop core strength – there are many ways to do this but include some planks and side plank exercises. Aim for three to five repeats of 30 seconds and keep your breathing even and steady
• improve your cardiovascular fitness – running, cycling dancing hiking. Anything that gets a moderate sweat going and that lasts for at least 30 minutes. Remember to check with your doctor if you’ve had any history of chest pain or chronic respiratory conditions.

No guarantee that this will get you to the national team level but it will help your game improve and points the way for you to continue enjoying your golf for many years to come.

Strength training can make you smarter

Recent research from the University of British Columbia (UBC) showed some interesting results in the field of strength training and cognitive benefits for seniors. There has been a lot of previous research that shows the positive effects that aerobic, cardiovascular exercise ( think walking, swimming, dancing ) plays in keeping people alert and mentally sharp into their senior years. Strength training however has not been studied from this point of view. Most strength studies concerning seniors have focused on osteoporosis and the overall effects of muscular strength improvements. In the UBC study, 155 women aged 65 to 75 were randomly assigned to one of three groups. Two of the groups did resistance exercise either once or twice a week while the third group did balance and toning exercise.   The researchers ( head researcher Dr Liu-Ambrose ) were able to demonstrate positive cognitive changes of up to 12.6% for the group who participated in the resistance training as opposed to a slight decline in the group who did a balance and toning routine.

The strength training was not terribly complicated. Resistance training machines and free weights, with weight and repetitions slowly and steadily increased over the months of the study. With time, more difficult exercises were introduced so that more neuromotor planning was engaged. Because the exercises can be simple, they are a good alternative for seniors with limited mobility. In addition to the known benefits of bone building and preventing the age related loss of muscle mass, it appears that this type of exercise can specifically help towards preventing decline in mental abilities.

Unfortunately, statistics show that only a low percentage of seniors engage in strength training. This is a shame as better strength training would improve the ability to try other forms of exercise such as cardiovascular and balance training, which are necessary for preventing falls and the myriad problems associated with that trauma. http://www.west4thphysio.com/seniors-health/fall-prevention/

Strength training has multiple benefits beyond the obvious changes in muscle development and bone strengthening and should be encouraged amongst the senior population, perhaps through special classes at community centres and gyms, at any opportunity. Review our osteoporosis series under the blog category Osteoporosis for further exercise and health information.

Low Back pain and specific exercise

Following on from my last post on low back pain treatment options where we considered the use of manipulation, today we’ll look at some specific types of exercise

Stabilization Exercises

If your physiotherapist finds three or more of the following factors then a good choice for treatment would be stabilization or core exercises.  The factors associated with success in this treatment group were: age less than 40, presence of abnormal active movement patterns, straight leg raise of more than 90 degrees and a positive lumbar prone instability test.  The participants in this study attended therapy twice per week for 8 weeks of supervised exercises and also performed home stabilization exercises prescribed by a physiotherapist.  Two thirds of the group showing three or more prediction factors, benefitted from the stabilization exercises. This seems low but when this treatment was applied across the board only 1/3 of participants benefitted.  In the clinic the success rate could probably be increased by adding additional treatments such as joint mobilization or manipulation, education regarding positions to avoid and review of their movement and positioning habits at work.

Mechanical Traction & Extension Exercises

The profile of the treatment group who responded well to mechanical traction followed by extension exercises, was that they had symptoms below their buttocks (pain, tingling or numbness), signs of nerve root compression (reduced or absent reflex, sensation and or muscle weakness, straight leg raise less than 45 degrees),  improvement of symptoms with extension exercises or extension positions and reproduction of back pain when the therapist performed a passive straight leg raise on their opposite side.  This treatment was also combined with extension exercises.

Extension Exercises

A Canadian physiotherapist, Audrey Long of Alberta published a research paper in 2004 showing that the type of exercises prescribed combined with the participant’s individual assessment findings predicted treatment success in a group of patients with low back pain.  Eric Parent and a group of physiotherapy researchers from the University of Utah looked specifically at predictors of success with extension exercises. They found that physiotherapy consisting of 2-3 visits per week for up to one month and focusing on extension exercises improved function by at least  50 % in 87 % of patients who had four out of 6 of the following factors: no additional health problems limiting their function, restriction of active motion towards the painful side, no signs of nerve root compression on the painful side,  no limitation of hip mobility when the foot was placed on the opposite thigh and the knee pushed towards the floor, symptoms worsened with repeated forward bending , symptoms improved with passive or active backward bending.

Summary

This line of research is exciting for therapists and people with low back pain. The bottom line is that your physiotherapist should be taking a thorough history and performing a detailed physical examination prior to deciding the best treatment for you.  Please be aware that even if you don’t fit one of the patterns described here, there is a strong probability that you can benefit from physiotherapy. If you have more questions feel free to contact one of our highly trained team of physiotherapists at West 4^th Physiotherapy.

Low back pain and manipulation

I recently participated in an excellent teleconference sponsored by the Canadian Physiotherapy Association and presented by Eric Parent, physiotherapist and researcher with the University of Alberta.  The title was “The treatment-based classification system for low back pain: Updated with a prediction rule to identify responders to extension exercises”.   The topic was using research to predict which clients are most likely to respond to spinal manipulation, stabilization or “core exercises”, traction and extension (backward bending) exercises.

The good news is that research supports what physiotherapists have said for many years. When treatment for low back pain is varied according to the findings seen during a thorough assessment, pain relief and return to function is much greater than when the same treatment is applied across the board.

Manipulation

For example, if your physiotherapist finds you have 4 of the following 5 factors: symptoms of low back pain for less than 16 days, pain which is not radiating below your knee, not experiencing high levels of fear of moving about, passive hip internal rotation mobility of more than 35 degrees (in at least one hip) and stiffness of at least one segment of your lumbar spine, then spinal manipulation would be a good choice for your physiotherapist to use. Your chances of having pain relief and improved function resulting from the manipulation, in combination with mobility exercises and remaining active within tolerance , would be 93 %.  You would not have to meet these criteria to benefit from manipulation. Participants in this study received 3 treatments within a one week time period and then were followed up one week and one month after treatment.

Summary

This line of research is relatively new but exciting for therapists and people with low back pain. The bottom line is that your physiotherapist should be taking a thorough history and performing a detailed physical examination prior to deciding the best treatment for you.  Please be aware that even if you don’t fit one of the patterns described there is a strong probability that you can benefit from physiotherapy. If you have more questions feel free to contact one of our highly trained team of physiotherapists at West 4^th Physiotherapy.

In my next post I will review some of those other treatment options which contribute to successful low back therapy.

Running shoes – when to replace?

As you work into your running program you will need to keep an eye on how much wear has occured with your shoes. Running in shoes that have passed their prime is a sure fire way to develop running injuries such as plantar fascitis, achilles tendonitis and knee pain. Knowing that you can expect to get around 1000km from your shoes (+/- 200km ), tracking your shoe mileage will help you anticipate shoe failure and avoid injury. Here are a few commonly used tips and things to look for regarding shoe wear.

• When you buy new shoes, write the purchase date on the insole or tongue.  After that it’s just a little number crunching to figure when they should be changed. For example, if you run 25km a week that equates to 100km a month and in 10 months you’ll have hit the 1000km mark. Some of my running clients go the extra step and write the expected change date on the tongue as well. Up to you.
• If you find a shoe you really like, consider buying 2 pairs and alternating them in your training. Many runners will do this so that the shoe’s cushioning mid sole has more time to rebound and recover it’s bounce. Although it’s more money up front, you can actually get more mileage overall as the shoes will last longer.
• Check for folding and creasing of that shock absorbing mid sole. It is the part of the shoe that wears the fastest and when it starts to break down it is definitely time for replacement. They are still fine to wear as a walking around shoe or to walk the dog but don’t continue to run in them.
• Remember that your running shoes are for the forwards - backwards  stresses of  running, not the side – side stresses presented by other sports such as tennis or basketball. Using them for these types of activities strains the shoe in it’s weakest direction and shortens their life span dramatically.
• Listen to your feet! If you have been fine and seem to be suddenly developing foot pain or focused skin friction, your shoes are often at the end of their life and are no longer supporting you properly. For many experienced runners, this will become the main way they assess how their shoes are wearing as the same problem will crop up as their personal “shoe wear indicator”. They have also learned not to ignore the signs and will change shoes within the week.

Running shoes should fit as soon as you buy them. They do not really stretch so there should be no need to break them in. Remember to leave a finger breadth between the end of the longest toe to the end of the shoe. Dedicated running shoe shops can help with proper fit and selection to match your individual foot. We have many excellent retailers on the west side of Vancouver, some of whom are listed in our business links. http://www.west4thphysio.com/resources/business-links/ Most of these retailers also offer running clinics to help with training and motivation. Consider joining a clinic to meet like minded people who will happily share your running goals.

See you on the trails and happy running!