Search Results: stretch

Check Your Stretch

Ask anyone why they stretch and you will usually get a pretty consistent answer.  We want to “loosen up”, improve movement in some part of the body, recover faster/reduce pain, and avoid sore muscles.  However, you may find it surprising that your trusty stretching routine you’ve been doing for years could be limiting your progress in the gym, field, or court.  Should we be surprised that a generic list of stretches probably won’t do much for these specific goals?

It is often misunderstood in fitness and health that in stretching, one size does NOT fit all.  Just like those exercises your trainer gave you to improve your game, your stretching program should meet your needs to help you reach your goals.

So if you’re feeling stiff or sore and it’s not getting better, take a minute to identify your goals for stretching.  Here are some of the major reasons I see in the clinic and on the field, and a look at some of the strategies to make them work for you.

  1. Stretching for pain relief and recovery
  2. Stretching for increased flexibility and range of motion
  3. Stretching for injury prevention and performance

Stretching for pain relief and recovery:

People who are recovering from a muscle tear, have had surgery, or a chronic condition such as stroke or Parkinson’s are often prescribed stretching to improve mobility and aid in recovery.  They experience muscle tightness and pain that is caused by overactive nerves holding the muscles in a tightened, protected, state.  Since the muscles are constantly under tension, these people have a much higher risk of muscle injury and inflammation during activities and exercise.

The goal of stretching for pain relief and recovery is to get the muscles to quiet down.  This involves gentle stretches that are low effort and free of pain.  A study by Kubo et al. (2001) showed that consistent gentle stretching caused something called “stress relaxation” of the muscle. Stress relaxation occurs when sensory receptors in the muscle, called golgi tendon organs (GTOs), react to increases in muscle tension.  As a response to protect against potentially damaging stresses, they send a message to the brain to lower the activity of the muscle, causing a relaxation and decreasing muscle tension.  In other words, after stretching the muscle allowed the joint to move more freely through its full range.  The authors suggested that this may be a possible mechanism for a reduced risk of injury with stretching exercises.

Stretch techniques for pain relief and recovery

In order to maximize the results of stretches for pain and recovery, start conservatively but work up to performing your stretches multiple times, as long as you avoid pain.  Always remember that the first priority is to not cause any more pain and swelling (inflammation) in the tissues.  As a muscle lengthens from a stretch, its tension will rise.  The key to stretching for pain relief is to ease the nervous system before muscle tension rises high enough to cause any pain.  That’s why it is very important to slowly progress the number of times you stretch to make sure you don’t get a negative reaction.

You can put this into practice yourself by holding your stretch for 20 seconds so that it you feel a gentle pulling in the muscle, but that does not cause discomfort.  After 3 consecutive days of doing this, you should be confident you can do more without irritating the muscles.  At that time, you can try performing the stretch a second time with at least a minute between stretches for the same muscle.  Continue this strategy until you are able to perform the stretch three times pain free on a daily basis.

Stretching for flexibility and  improved range of motion:

Prolonged postures and repetitive movements can cause our muscles to adapt at the cost of our mobility.  In these cases, the muscles are still normal and healthy, and may not even be sore or painful.  Yet some will have shortened to accommodate the body’s “new normal”.  Improving range of motion is possible by using prolonged stretching that is just “before” the onset of pain, and held for a longer duration than for pain relief.

Laboratory studies on stretching have shown that stretching can promote changes at the microscopic level and make your muscles actually longer.  Sarcomeres are the muscle fibre’s building blocks that are lined up end-to-end to give it its length.  Sarcomeregenesis is a term used to describe an increase in the length of the muscle fibre (Martins et al., 2013).  When applied enough times for long-enough duration, a stretch actually stimulates the body to build more sarcomeres. The more sarcomeres, the longer the muscle fiber, the looser the muscle, and the more flexible you will be.

In order to successfully increase range of motion, the focus must move toward the muscle itself, meaning that tissues need to be able to handle more tension for a longer duration without becoming painful.  Still, the most important rule is to avoid painful stretching habits at all costs.

Stretching to the point of pain makes the muscle fight back against the stretch as it contracts to stop the excessive movement.  In turn, golgi tendon organs won’t help lower muscular tension, and sarcomeregenesis becomes physiologically impossible.  In fact, five of seven studies evaluated in a recent meta-analysis (Apostopoulos et al., 2011) showed that stretching to discomfort and pain produced no improvement in range of motion regardless of the population studied.

Stretch techniques for flexibility and improved range of motion

If you have a muscle that is limiting your mobility but otherwise normal and pain free, you can try the following approach.  Find a comfortable body position that does not involve supporting your bodyweight over the part you are stretching, so that you can relax and use a minimum of effort to hold the stretch position.  Perform your stretch and hold it for approximately 1 minute, repeating it 3 times with at least a minute rest between each repetition.

Stretching for injury prevention & performance:

Despite popular belief for some, stretching doesn’t show any overall effect to reduce overuse injuries.  However, there may be a benefit in reducing acute muscle injuries in running, sports that involve sprinting, or other repetitive dynamic muscle contractions.

Surprisingly, the current research indicates that stretching before exercise may help prevent muscle injuries in sports with a sprint running component but not in endurance-based running activities, where overuse injuries are more common.  They key is to incorporate at least a 10-minute warmup that includes movements in your sport, just at a lighter intensity.

Stretch techniques for injury prevention & performance

Active people who participate in sports and exercise regularly generally don’t have limited movement and do not experience muscle pain as described earlier.  They can stretch more intensely before experiencing pain, and hold a stretch for a longer-duration may have a greater potential to decrease injury risk.  A meta-analysis by Behm et al (2016) observed that several studies on this topic have indicated a 54% risk reduction in acute muscle injuries associated with pre-activity stretching followed by a specific warmup.

Setting Your Stretching Goals

So if the problem is that you stretch and stretch, but never get better, then something in your program is not supporting this long-term adaptation of your muscle fibers.  Start by checking your body position, the intensity you are using to stretch, and the both the frequency and duration of the stretches.  For athletic events, make sure you are fully warmed-up by doing dynamic movements that mimic the sport itself, but are at a controlled speed.

Other important factors that can contribute to tightness and pain include imbalances in your muscles.  Imbalances can get in the way of the normal physical response to appropriate stretching, and should be assessed by a trained musculoskeletal therapist.

If you would like more information or would like to find out how you can improve your range of motion, reduce muscular pain, or improve performance, please feel free to contact John Gray at jgray@orthophysio.com, or call us at The Orthopaedic Therapy Clinic at 416-925-4687.

 

Stretching Myths and Facts

 

By: Svetlana Marianer, Reg. Physiotherapist, MSc. Pht

Most of us have been taught that stretching is an important part of our health and fitness program but do you know whether the following statements are true or false?

Stretching prevents injury?
Stretching enhances athletic performance?
Stretching is always good?
Stretching must be painful to be effective?

Whether to stretch or not is confusing particularly as the recommendations seem to change from year to year and from professional to professional. If we ask the average individual why and when to stretch, the typical answer would be: before and after exercise in order to protect muscles from getting injured. Seems reasonable, doesn’t it?

Unfortunately, the science behind stretching is not as simple as that. Although stretching has been strongly promoted as a way to decrease the risk of injury, prevent muscle soreness and improve performance, there is insufficient evidence to support these perspectives.

The Facts

Here’s a quick review of what current research shows:

1. The University of Sydney1 reviewed 10 studies on stretching before or after athletic activity and the conclusion was that stretching before exercise doesn’t prevent postexercise muscle soreness, and neither does it prevent overuse or acute sport injuries.

2. Additional research2 comparing runners who stretched prior to a race with those who didn’t showed surprising results. The group that didn’t stretch ran faster than those who did! The conclusion was that the ability to produce and power was decreased by stretching.

3. Furthermore, in 2012, researchers from the University of Zareg in Croatia reviewed 104 studies of people who only practiced static stretching as their warm-up and found that this practice reduced muscle strength by 5.5%.

1 Herbert & Noronha, 2012

2 Buresh & Trehearn, 2009

      

Lastly, an experimental trial conducted in 20133 found that it took almost 10 minutes to

      recover the strength lost by five minutes of static stretching. In other words, passive stretch prior to activity may actually be detrimental to sports performance.

When to stretch?

After reading this, you may be asking yourself why you were ever told to stretch, however the majority of this misinformation lies in a confusion of the understanding of the difference between stretching and warming up. Although these terms are used interchangeably they have very different meanings. Warming up is the act of raising the core or body temperature via external means or exercise. 4. In the context of exercise warming-up requires the performance of movement and the expenditure of energy to enhance the body’s readiness for exercise. This cannot be achieved with a passive act i.e. stretching. With a little more digging into the literature, a better clarification shows that warm up prior to exercise is what prevents injury, whereas stretching has very poor effect on it (Fradkin et al., 2006).[expand title=”Read more…”]

Nevertheless, let’s not forget about stretching completely. The latest studies show that the stretching is still important and is appropriate for different reasons. Stretching increases joint range of motion, improves joint function and increases performance of your daily activities and balance (Hong et al., 2012).

In summary, if injury prevention is the primary objective, the evidence suggests that stretching before exercise should be limited and the focus should be on warming-up. However if the goal is to maintain good range of motion and joint function then stretching should be done regularly after physical activity. This is why stretching is an integral part of most therapy programs.

Should stretching cause pain?

Although many people believe that to get the most from their stretching they need to feel pain this is one of the most common mistakes made with exercise. Feeling a low-level of discomfort or having a low-grade awareness of muscle activity for 20-30 minutes after exercise is acceptable however stretching is NOT meant to be painful. It should be pleasurable, relaxing and very beneficial. Stretching is only beneficial when you feel better during AND after the activity. If the pain increases or persists STOP the exercise and consult your physiotherapist for an evaluation to determine if stretching is the best approach for your goals and symptoms.

The Take-aways:

You can now answer the quiz knowing that research doesn’t support these myths and can quote the facts when the person next to you in the gym tells you that you are not doing the right exercise program.

3 Yishihisa et al., 2013

4 Oxford Dictionary of Sport Studies

 

1) Prevent injuries and improve range of motion and joint function, by warming up before an activity and stretching after.

2) Stretching should be pleasant, relaxing and pain free

3) If you feel pain either during or after a stretch, stop the activity and consult your physiotherapist.

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Basic Strength Training for Low Back Pain Class Six 1A

Healthy Back Basic Strength Training for Low Back Pain Class Six

Class #6 – Saturday June 5 at 10am.

EQUIPMENT NEEDED:          Mat & towel or pillow

Start position:  Standing

Waiter’s bow

Plie squat

Single leg waiter’s bow

Sumo squat

Alternating stationary side squat

Pistol squat

4-pint kneel arm lift + shoulder rotation

Kneeling hip flexor stretch with arm reach

Goalie Stretch

Floor Angels

Basic Strength Training for Low Back Pain Class Five 1A

Healthy Back Basic Strength Training for Low Back Pain Class Five

Class #5 – Saturday May 29 at 10am

EQUIPMENT NEEDED:          Mat & towel or pillow

Start position:  Standing

Plie-squats

Standing “Y’s”

Airplanes

Unilateral squat in Kickstand position

Kickstand deadlifts

Dying bugs

Arrow bridges

Side bridges

Kneeling hip flexor stretch with arm reach

Kneeling hamstring stretch

Goalie Stretch

Basic Strength Training for Low Back Pain Class Four 1A

Healthy Back Basic Strength Training for Low Back Pain Class Four

Class #4 – Saturday May 15 at 10am

EQUIPMENT NEEDED:          Mat & towel or pillow

Starting position: 4-point kneeling

4-point arm reach

Thoracic rotations

Fire Hydrants

Sumo squat,

kick stand position hip hinge

Stationary side squats,

Supine bent knee fallouts

Dying bugs

Knees to chest stretch

Figure 4 stretch

Supine hamstring stretch

Basic Strength Training for Low Back Pain Class Two 1A

Healthy Back Basic Strength Training for Low Back Pain Class Two

Class #2 – Saturday May 1 at 10am

EQUIPMENT NEEDED:          Mat & towel or pillow

Starting Position: 4-point kneeling

Alternating arm lift

Fire hydrants

Donkey kicks

Front plank

Bent knee double side leg lifts

Dying bugs

Single leg bridges

Marching Bridges

Supine piriformis stretch

Goalie stretch

4-point kneeling thoracic rotation

Basic Strength Training for Low Back Pain Class One 1A

Healthy Back Basic Strength Training for Low Back Pain Class One

Class #1 – Saturday April 24 at 10am.

EQUIPMENT NEEDED:          Mat & towel or pillow

Starting Position: Crook lying

Overhead Reach

Articulated Bridge

Slides Heel

Single leg bridges

Heel touches

Side Bridges

Bent-knee double side leg lifts

4-point arm walkouts to high plank.

Side lying quads stretch

Side lying thoracic rotation

Child’s pose stretch

Basic Mat On-line Class for Low Back Pain Class Six 1A

Healthy Back Basic Mat On-line Class for Low Back Pain

CLASS SIX: June 3 5:30 to 6:10 PM

NEUTRAL START POSITION

Breathing Visualization to activate TA

Transversus Abdominis: 2-: Double bent knee raise (modification heel hover or slide for 2nd leg)

4 point bird dog – (option to slide or hover)

Reverse clam with lift

Quad Stretch Side Lying

Basic Mat On-line Class for Low Back Pain Class Five 1A

Healthy Back Basic Mat On-line Class for Low Back Pain

CLASS FIVE: May 27 5:30 to 6:10 PM

NEUTRAL START POSITION

Breathing Visualization to activate TA

Transversus Abdominis: Grade 3: Single leg lift with one Leg Extension, (modification single knee lift or from lift hover down

Hinge Bridge with weight shift (option to lift leg if stable and using gluteus)

4 point position with leg slide into extension option to add opposite hand hover(bird dog)

Hip flexor Stretch upright kneeling

Basic Mat On-line Class for Low Back Pain Class Four 1A

Healthy Back Basic Mat On-line Class for Low Back Pain

CLASS FOUR: May 20 5:30 to 6:10 PM

NEUTRAL START POSITION

Breathing Visualization to get TA

Transversus Abdominis: Grade 3: Single leg lift with one Leg Extension, (modification single knee lift or from lift hover down)

Hinge Bridge with weight shift (option to lift leg if stable and using glute)

4 pt kneel position with Hand Hover

Hip flexor Stretch upright kneeling

Basic Mat On-line Class for Low Back Pain Class Two 1A

Healthy Back Basic Mat On-line Class for Low Back Pain

CLASS TWO: May 6 5:30 to 6:10 PM

NEUTRAL START POSITION

Breathing Visualization to activate TA

Transversus Abdominis: 1C: Single Knee Lift – Grade 3

Hinge Bridge with option to unload one leg*no lift yet* building towards 1 leg

Side Lying Reverse Clam

Quad Stretch Side Lying

Basic Mat On-line Class for Low Back Pain Class One 1A

Healthy Back Basic Mat On-line Class for Low Back Pain

CLASS ONE: – April 29 5:30 to 6:10 PM

NEUTRAL START POSITION

Breathing Visualization to activate TA

Bent Knee Fall Out

TA Supine Arm Reach

Hinge Bridge

Transversus Abdominis: Single Foot Hover – Grade 3

Quad Stretch Side Lying

Covid 19 Injuries – Rate your risk for injury!

Spring is traditionally the time we shed our hibernation lifestyles and start to get active.  Running, gardening, swimming, outdoor home maintenance all become part of the better-weather lifestyle.  Spring is also the busiest time for physiotherapists, as resuming these normal activities often causes injuries.  Unfortunately, the pandemic has raised our risk for injury even if we are just pursuing these normal springtime activities.  Before you go out and take back your new freedom, take a moment to rate your risk for injury and think about what you can do to prevent it. Watch our video

Why do I Injure? 

There is a science to the prediction of many injuries.  It is a formula that tells us that we will injure when the force we meet exceeds the capacity of our body.  When I was learning to ski my instructor summed this up with a succinct comment.  When it comes to trees you hope to hit a “bender”.  His on-the-nose remark summarizes this biomechanical principle.  Either the tree bends or your body bends – just ask my husband who has 13 pins in his elbow from a tree-incident!

The same goes for when you lift something that is obviously too heavy.  Many workplaces recognize this by limiting lifts to under 50 lb.  Heavier weights are a 2 person lift or use a mechanical assist.

These more traumatic causes of injury are relatively straight forward, however the ones that catch us off guard tend to be the more problematic ones.  Many of us know to avoid the heavier lift, or to not ski out of control, however we have less awareness of the impact that reductions in the capacity of our body increase our risk for injury.   Add to this the effects of the pandemic and we have a perfect storm for increasing our injury risk.

Three factors which predict your risk for injury

The three factors that make the spring of 2021 worse are:

  1.  Weight gain
  2.  Prolonged deconditioning
  3.  Lack of therapy

To help predict your risk, let’s take a look at these factors more deeply.  This should help us to understand what may be having an influence on you this spring.  At the end of each section I have included a quiz you can take which rates your risk and then summarizes some suggestions on how to manage them.

Risk Factor #1 – Are you injured?

Injuries set us up for reinjury.  We know that the biggest predictor of a having back pain is a previous episode of back pain.  Statistics tell us that having back pain just one time, puts you at a 78% rate for risk of recurrence.

I find that the biggest cause of this statistic is incomplete therapy.  When the pain finally abates, we feel 100% however at this stage in our recovery our strength may only be 40% of what it was before we injured.  Injuries weaken us and even when the pain is gone you don’t want to be fooled into thinking you are as strong as you were before the injury.  This means that returning to full activity, before you are ready, puts at at risk to re-injure.

This mismatch is one of the most common causes I see of a repeat injury and this year it will be made worse by the lack of therapy.  Many people have gone through COVID with injuries that were not addressed or  with therapy that was never completed.  If this is you, it’s critical to have a plan to avoid further injury – even if you no longer hurt!

How to stay active while injured 

Start by taking a page from the training book of athletes.  Their strategy for staying active includes selecting exercises and activities with little to no demand on the injured area.  Hurt your shoulder – consider cycling or walking, Painful knee – consider swimming arms only.

Need more motivation or guidance?  Read John Gray’s, Reg. Kinesiologist’s, two part article on how to return to sport after injury.

Complete your rehab by seeing your therapist to assess whether you need to specifically target the injured area.  Specific stretching, strength and coordination exercises are what is usually needed to complete the recovery.

Risk Assessment quiz

  • Score 3–  If you are still having pain from your injury and you have not started a general exercise program
  • Score 2 –  If you had an injury in the last year, that no longer hurts but you did not complete targeted therapy.
  • Score 1 – If you had no pain or injury in the past year.

Risk Factor #2 – Are you out of shape?

Be honest – how active were you this winter compared to years past?  There is no doubt it was harder!  The gyms were closed.  There was no indoor hockey, indoor tennis or downhill skiing.  Unless you made a conscious effort to stay fit you are probably more out of shape in spring 2021 than you were even last year.

Spring is the busiest time for a physiotherapist, as many people typically do less in winter and we decondition.  This deconditioning is enough to influence even workplace stats.  People doing the same job have more risk of injury in spring than summer and fall.

These injuries are not just because we get more active, it’s also because we think we can do the same in April as we could in October.  The truth is that unless we have done something to replace this natural period of inactivity, there will always be a mismatch between the deconditioning of winter hibernation and the sudden strength demands of spring.

Unfortunately, I anticipate this year will be worse, as many of us did not get back to typical levels of activity in the spring and summer of 2020.  This means that by spring of 2021 we will have deconditioned for almost 18 months and not the typical 5-6 months of most winters.

Check your Data

To limit your risk take a moment to honestly think about how active you have been since March 2020. Many of us have metrics we can compare to get a solid feel of what has changed.

  • Our Smart watch or Smart phone collects our steps data. Use the year-to-date screen to see how your annual step count compares to 2019.

 

  • Consider what you lost i.e. swimming, tennis, and what you replaced it with i.e. on-line classes or increased walking.

If your activity level has gone down then make a plan to increase it incrementally.  If you do not have an injury, most people can tolerate 10-15% increments. If you combine injury with lack of fitness you may need to take this down to 5-10% increments.

 

Consider seeing a Reg. Kinesiologist or certified personal trainer if you need more guidance on managing your return to activity or a fitness assessment to see what level you are really starting at.  See a Reg. Physiotherapist or other injury professional if you are recovering from an injury before you increase your fitness.

Risk assessment quiz

  • Score 3 – if you have had an exceptionally inactive all winter.
  • Score 2 – if you tried to stay active but know you have lost a bit of ground over the winter
  • Score 1 – if you have stayed active and fit this winter.

Risk Factor #3 – Weight Gain 

Many of us have gained weight in the past year.  I hear that COVID 19 can now mean the number of pounds gained during the pandemic.  Hopefully you haven’t put on a full 19, but as little as 6 lb. can increase your injury risk when you return to sport, particularly if you have put it on recently.

We all know that it’s easier to lose weight when you are active but it’s best to have a plan to get the weight off with a balance of eating and activities.  If you’ve gained weight, resume your activities a bit slower to reduce the influence of these extra LB’s.   Consider seeing a weight loss professional as well as working with your exercise/injury professional if you need to combine weight loss with activity or injury management.

Risk assessment quiz

  • Score 3 – if you have gained more than 6 lb.
  • Score 2 – if you have been active all winter but still gained between 1 and 6 lb.
  • Score 1 – if you have not gained weight.

Interpreting the results of your risk for injury assessment

The risk factors discussed in this blog are some of the most common causes of unanticipated injury.  The rating is a result of my experience as a therapist as well as what research tells us causes injuries.  Here’s some guidance on what I have found works to prevent injuries or recover without re-injuring.

Score Risk Safe Activity level Should you see a professional?
3-4

 

 

 

Low As tolerated.  Use effort as your guide. Professional guidance is always helpful however in this case it may not be essential.  If you start your spring activities a bit slower than usual you will usually be fine.
5-6

 

Moderate You should have a plan to gradually increase your activity level.   Follow it logically and don’t get carried away by the good weather! Before you return to high level activity consider seeking guidance from a Reg. Kinesiologist or Certified Personal trainer

If you decide to do this on your own, then try to limit the increases to 10-15% increments and judge your body’s response.  Adjust as needed.

7+

 

High Professional guidance is recommended before you get too active. The higher risk level requires a more complete plan to prevent injury.  You should limit increases in activity to  5-10% increments i.e. 5000 steps increase by 250-500 weekly.   Have your therapist identify imbalances and develop a plan for targeted stretching and strengthening.  Add in a plan for weight loss if needed.

If you need help with a plan for activity or for your injury please contact us at 416-925-4687 or physio@orthophysio.com

 

Basic Strength Training for Flexion Preference Low Back pain Class Five

Healthy Back On-line Exercise Class – Basic Strength Training for Flexion Preference Low Back pain Class Five

CLASS FIVE:  Saturday 10-10:35 AM

START POSITION:  Standing

Warmup: Eccentric glute mini-squats, Bilateral “Y’s”, airplane

Strength/coordination:  alternate twice between two exercise:  hip hinge in kick stand position, and supported single leg squats, followed by two sets of a mini-circuit with single side straight leg lifts (abdominals), arrow bridge, and shoulder taps from high front plank position.

Stretches/Posture: kneeling hip flexor/psoas stretch, kneeling hamstring stretch, pigeon stretch (hip external rotators), and goalie stretch (adductors)

Register by contacting us at 416 925 4687

Basic Strength Training for Flexion Preference Low Back pain Class Four

Healthy Back On-line Exercise Class – Basic Strength Training for Flexion Preference Low Back pain Class Four

CLASS FOUR:  Saturday 10-10:35 AM

START POSITION:  quadruped (hands & knees)

Warmup:  quadruped arm reach, quadruped thoracic rotations, hip circumduction

Strength/Coordination:  two sets of a mini-circuit with sumo squat, standing hip hinge (kick stand position), and stationary side squats, followed by two sets alternating between advanced knee fall-outs and single-side straight leg lifts.

Stretches/Posture: knees to chest stretch, Figure 4 stretch, Active hamstring stretch.

Register by contacting us at 416 925 4687

Basic Strength Training for Flexion Preference Low Back pain Class Three

Healthy Back On-line Exercise Class – Basic Strength Training for Flexion Preference Low Back pain Class Three

CLASS THREE:  Saturday  10-10:35 AM

START POSITION: Lying on Back

Warmup:  Overhead reach, marching bridge, articulated bridge

Strength/Coordination:  Side bridge, Reverse clam, Donkey kicks, dying bugs, advanced knee fall-outs.

Stretches/Posture:  side-lying thoracic rotations, side-lying quads stretch, supine floor angels

Register by contacting us at 416 925 4687

Basic Mat Class for Flexion Preference Low Back pain – Class Six

Healthy Back On-line Exercise Class – Basic Mat Class for Flexion Preference Low Back pain – Class Six

FLEXION START POSITION

Breathing Visualization to get TA

Transversus Abdominis: 2-: Double bent knee raise modification heel hover or slide for 2nd leg

Quadruped – opposite arm leg reach (option to slide or hover)

Reverse clam with abd/ext

Quad Stretch Crook Lying

***Less exercises if more time needed with TA2 and Quad bird dog***

Register by contacting us at 416 925 4687

Basic Mat Class for Flexion Preference Low Back pain – Class Five

Healthy Back On-line Exercise Class – Basic Mat Class for Flexion Preference Low Back pain – Class Five

FLEXION START POSITION

Breathing Visualization to get TA

Transversus Abdominis: Grade 3: Leg Extension, modification single knee lift or from lift hover down

Rolling Bridge/Articulated Bridge with weight shift or option to lift leg if stable and using gluteus

Quadruped position with leg slide into extension,  option to add opposite hand hover (bird dog)

HF Stretch kneeling

Register by contacting us at 416 925 4687

Basic Mat Class for Flexion Preference Low Back pain – Class Four

Healthy Back On-line Exercise Class – Basic Mat Class for Flexion Preference Low Back pain – Class Four

FLEXION START POSITION

Breathing Visualization to get TA

Transversus Abdominis: Grade 3: Leg Extension, modification single knee lift or from lift hover down

Rolling Bridge/Articulated Bridge with weight shift or option to lift leg if stable and using gluteus

Quadruped position with Hand Hover

HF Stretch kneeling

Register by contacting us at 416 925 4687

Basic Mat Class for Flexion Preference Low Back pain – Class Three

Healthy Back On-line Exercise Class – Basic Mat Class for Flexion Preference Low Back pain – Class Three

FLEXION START POSITION

Breathing Visualization to get TA

Transversus Abdominis: 1C: Single Knee From lift to Lower to Hover(not touching ground) – Grade 3

Arm extension over head while keeping ribs anchored and pelvis posterior ( add to previous exercise as applicable)

Rolling Bridge/Articulated Bridge

Side lying straight leg ABD modification reverse clam

HF Stretch kneeling

Register by contacting us at 416 925 4687

Basic Mat Class for Flexion Preference Low Back pain Class Two

Healthy Back On-line Exercise Class – Basic Mat Class for Flexion Preference Low Back pain – Class Two

FLEXION START POSITION

Breathing Visualization to get TA

Transversus Abdominis: 1C: Single Knee Lift – Grade 3

Rolling Bridge/Articulated Bridge with option to unload one leg, *no lift yet*, building towards 1 leg support, (theory 50/50 weight distribution  then 60/40 or 90/10)

Side Lying Reverse Clam

Quad Stretch Crook Lying

Register by contacting us at 416 925 4687

Basic Mat Class for Flexion Preference Low Back pain Class One

Healthy Back On-line Exercise Class – Basic Mat Class for Flexion Preference Low Back pain – Class One

FLEXION START POSITION

Breathing Visualization to get TA

Bent Knee Fall Out

TA Arm Reach

Rolling Bridge/Articulated Bridge

Transversus Abdominis: Single Foot Hover – Grade 3

Quad Stretch Crook Lying

Register by contacting us at 416 925 4687

Functional Fascial Therapeutics – a new type of Acupuncture.

A couple of years ago I learned about a new technique called Functional Fascial Therapeutics – a new type of acupuncture (FFT) .  When I started to study it, I liked that it is a unique acupuncture modality which allowed me to target the superficial layer of fascia.   This is the tissue that wraps around muscles & joints. What’s unique about FFT is that it’s a non-intramuscular technique, which means the needle is inserted much shallower.  It goes between the skin and the muscle and does not enter the muscle itself.

 

The shallower insertion has several advantages:

  1. It allows the treatment to be combined with movement whereas traditional acupuncture requires you to stay still.
  2. It has much less discomfort than traditional acupuncture as the superficial fascia is not innervated by the nervous system like the skin and muscles. This allows more people to benefit from this technique.

Who will benefit from Functional Fascial Therapeutics?

I have found that Functional Fascial Therapeutics is especially useful when you have chronic tightness.  I have seen better outcomes in people who have years of postural adaptations which have prevented them from progressing with other treatments and therapeutic exercises due to lack of mobility/tissue pliability.

This modality is especially beneficial for people who:

  1. have pain
  2. difficulty stretching tissues
  3. adhesions from scar tissue/trauma

Why does fascia matter to my treatment?

In order for us to understand why we would consider this modality, let’s first talk briefly about fascia, its relevance and importance within the musculoskeletal system.

Fascia is described as the ” Connective webbing tissue of the body”.  It is composed of collagen – the most abundant protein in the human body. Collagen is found in our bones, muscles, skin, and tendons. It binds every cell in the body to its neighbours and even connects the inner network of each cell to the mechanical state of the our body.

Part of its connecting nature may lie in its ability to store and communicate information across the entire body. Think of Fascia as a 3D Matrix that wraps around muscles, organs, other structures, giving them a scaffolding-like support, and providing their shape.

The purpose of fascia

There are several types of fascia, ranging from superficial to very deep.  The Functional Fascial Therapeutic technique targets the “superficial fascia” which is the tissues that wrap around  individual muscles.

The easiest way to understand the role of fascia in movement is that: Muscles generate force, and Fascia transmits those forces throughout the body.  If the integrity of the ability to distribute tension (Tensegrity) is compromised, it will change the way force is distributed through our body and can result in pain and imbalances in our tissues.

Another way to look at this is that fascia is plastic whereas muscles are elastic.  Fascia will adapt to its environment (posture), and because the muscles are encapsulated in fascia, they are going to have a hard time contracting and doing their job if the “wrap” they are in is preventing them from transmitting and communicating those forces optimally.

Fascial tightness and cellular nutrition

The human body is basically” a pump”, with the healthiest tissues getting constant replenishments of fluids/nutrients going in and out.  The means that the tighter the fascia the more difficult it is to get nutrients into the cells.  This is why people who move more, generally have less physical discomfort.

How easily nutrients get into the target cell is largely determined by the density of the fibrous matrix, a.k.a fascia.  When the fibers are too dense (might be caused by prolonged adaptation to short & tight, long and tight musculature, lack of tissue mobility), or too dehydrated and viscous, then these cells will be less thoroughly fed and watered. This technique helps restore this balance.

 My approach

As a manual therapist I firmly believe that there is no one magic technique, no best modality, or single best tool to use for a given problem. The approach should always be catered to each individual based on their health history, their pathology/condition, their tissue tolerance and their willingness to explore different therapeutic avenues.  No two bodies are alike, no two nervous systems are alike, therefore there should not be a single approach.

Functional Fascial Therapeutics – a new type of acupuncture

The FFS modality is one of many techniques I use as it allows me to target the superficial fascia directly, affecting its tension instantly.  When I combine it with movement, cupping techniques and tissue pumping, it can disperse the fascial clogs/adhesions/tugs which will allow the tissue to resume its specialized “social” function,.

Please contact me if you would like to learn more about Functional Fascial Therapeutics – a new type of acupuncture contact Igal Untershats at  igalu@orthophysio.com or call 416-925-4687 to book an appointment..

Safe Exercises for Back Pain – New On-line Exercise Classes

Healthy Back On-Line Exercise Series – Safe exercises for your back

One of the challenges in this pandemic has been to stay fit, particularly when you have pain or injuries.  Your therapists at The Orthopaedic Therapy Clinic recognized how difficult this has been for our clients and have been working on a number of initiatives to help you to exercise safely.  We are now ready to share the first in a series of new initiatives. (Watch the Video)

We know that many of you are selecting on-line programs.  Some of these programs are confusing and most are not back specific.  We would like our clients to exercise with people who understand how to get you stronger through exercise and to limit your risk for low back pain.

Beginning the last week in February, we are offering 2 on-line classes each week for people who have experienced low back pain when they exercise.  These classes are with Aniela Amio, Pilates/Yoga instructor and with John Gray, Registered Kinesiologist. These professionals have extensive experience in helping people who have back pain to exercise safely.

Please join us. Your 1st session for both classes is free of charge! 

Healthy Back On-line Exercise Class – Basic Mat Class for Flexion Preference Low Back pain

Aniela Amio, our Pilates/Yoga instructor, is providing a Basic mat flexion preference exercise session via Zoom.  This group class will be held on Thursday from 5:30-6:10 PM.

Maximum participation is 10 people.

CLASS ONE: Thursday Feb 25, 2021 5:30 -6:10 PM – Click Here for class details

CLASS TWO: Thursday March 4, 2021 5:30 -6:10 PM – Click Here for class details

CLASS THREE: Thursday March 11, 2021 5:30 -6:10 PM – Click Here for class details

CLASS FOUR: Thursday March 18, 2021 5:30 -6:10 PM – Click Here for class details

CLASS FIVE: Thursday March 25, 2021 5:30 -6:10 PM- Click Here for class details

CLASS SIX: Thursday April 1, 2021 5:30 -6:10 PM – Click Here for class details

 

Register by contacting us at 416 925 4687

 

Healthy Back On-line Exercise Class – Basic Strength Training for Flexion Preference Low Back pain

John Gray, Registered Kinesiologist will be offering a strength training session for people with flexion preference low back pain.  This group class will be held on Saturday from 10:00-10:40 AM

Class 1 Saturday Feb 27, 2021 10:00-10:40 AM Click Here for class details

Class 2 Saturday March 6, 2021 10:00-10:40 AM Click Here for class details

Class 3 Saturday March 13, 2021 10:00-10:40 AM Click Here for class details

Class 4 Saturday March 20, 2021 10:00-10:40 AM Click Here for class details

Class 5 Saturday March 27, 2021 10:00-10:40 AM Click Here for class details

Class 6 Saturday April 3, 2021 10:00-10:40 AM Click Here for class details

Maximum participation is 10 people.

Register by contacting us at 416 925 4687

 

Who should participate?

This class is targeted for people who have back pain with a diagnosis of  flexion directional preference.

If you have this diagnosis, your current physiotherapy program will likely include pelvic tilt positions and exercises.   If you are not sure if this is your diagnosis and wish to participate, please reach out to your therapist to determine if this is the right class for you.

What is the format?

Each class will last 30 minutes and there will be an additional 10 minutes at the end of the class for you to ask questions.

Each class will review:

  • finding your start position,
  • 3-5 strength and coordination exercises
  • 1-3 stretches and posture correction exercises

The emphasis will be on technique and helping you to know when you are doing the exercise correctly.

How much will it cost?

We are offering the 1st class free.

After that, the cost is $20.00 per session or you can sign up for the first 4 sessions in advance and get one class free at $60. The full price is $80 if sessions are bought individually.

How to register

Call our front desk team to register – 416-925-4687.  You will be sent a participation waiver and our Telehealth policy form.  Once these forms are completed, we will send you a Zoom link. These forms need to be received a minimum of one day in advance to ensure we can get the link to you in time.

Privacy

The sessions will be provided using Zoom pro.

Each participant will be allowed into the session once their registration is verified.

All participants cameras and microphones will be blocked during the exercise session as each session will be recorded for later viewing.  During the question period you can unmute and use your camera as this section will not be recorded, however you will be observed by other participants.

More information

If you have any questions about the program or would like more guidance on whether you should participate you can reach out to your therapist directly.  Or send an email to physio@orthophysio.com and this will be forwarded to the right person to assist you.

What to do if these dates and times don’t work?

Please let us know if these times and dates don’t work for you as we are planning to offer more classes once these dates have been launched.  Contact physio@orthophysio.com and give them the dates and times that work better for you.

We are looking forward to helping you to stay fit and healthy.  Look for our other new programs coming soon!

 

Healthy Back Video and On-line Exercise Program

Our healthy back on-line video exercise program is an extension of The Orthopaedic Therapy Clinic’s philosophy and attention to detail for our low back pain patients.

Our goal is to help you to recovery quickly and to limit future back pain reoccurrences.

Why develop an on-line video program?

The pandemic has helped us to realize that many people need fitness guidance specific to their injury.  Although there is a mass of on-line exercise programs, our client’s and their therapists have been finding it extremely difficult to determine which of these programs would be right for them.

In response to this need, we have developed this series to help you return to exercise, fitness and the activities you love.  Our goal is to limit the risk of inappropriate exercises slowing or even worsening your recovery.

Why is this program different?

This program is unique as it is based on your specific back’s needs and knowing when you are ready to begin exercise.

We have identified appropriate exercises and guide you through proper technique and progressions.

Our videos are based on the foundational structure of a system which many health care professionals ascribe to called Directional PreferenceOnce you know your back’s directional preference it is much safer to select exercises that match this preference.

This program is cost effective as it supports the work of your therapist and helps you to exercise safely without incurring substantial personal training costs for oversight. 

Directional Preference

The key to knowing you are in this stage of recovery is that your back pain changes depending on which activities you select.  Some activities are more irritating whereas others make you feel better.

In other words, your back “prefers” to do certain movements and feels worse when you do others.  For example, you may prefer to sit and feel worse when you walk.

Over the last 40+ years, research and clinical experience has shown us that preferences can typically be grouped into one of three categories. Your back prefers to:

  1. Flex or round forward
  2. Extend or sway backwards
  3. Stay in neutral – limit forward or backwards movements

As part of our focus group, you have been pre-selected because your therapist has identified your back prefers to flex or round forward.

When to start

You are able to start this program when your pain is intermittent and your health professional has provided you with a directional preference diagnosis.

How the program works

You will have received an exercise playlist.  There is an introduction video and then the exercise section is constructed into 4 sections. We recommend you start with section 1 and work through it sequentially.

  1. Finding your start position

This video helps you to understand and utilize the correct spine posture throughout each exercise.  Understanding and maintaining this throughout each video is critical to your success.

Your therapist will have built your start position into your current program however these videos go into extensive depth to help you find this posture on your own.

To assist you in understanding your specific start position we have:

    • Contrasted the 3 different back postures to help you to understand the difference and to be more confident on finding your specific posture i.e. flexion.
    • Emphasized techniques to help you be aware of whether you are maintaining the posture throughout each exercise.
    • Provided a trouble shooting video to assist you in executing the correct technique (see information button in video).
  1. Individual exercise technique videos

To prepare you for your 20-minute back pain exercise video, we have provided you with individualized technique videos, containing in-depth technique reviews for each exercise.  We recommend you master these techniques before you move into the faster pace of the exercise video loop.  Remember it is essential that you find and use the techniques that are right for your body.

These videos include tips and techniques on how to know you are doing the exercise correctly including:

    • How to maintain your start posture (directional preference).
    • Which muscles should you feel activate.
    • What sensations and muscle activations you shouldn’t you feel during the exercise.
    • Tips for finding the right muscle.
    • How much effort to use.
  1. Video exercise loop

As part of the focus group, you have been provided with only one 20-minute video.  Once we have incorporated your feedback, our plan is to develop a number of different videos to provide more variety and  to address different levels of difficulty.

Each video loop will have a structure that will continue throughout the series.  This structure reflects our experience of which muscles should be targeted to ensure back pain recovery.

Each video consists of 5 exercises.  The routine will be repeated twice.

In the video series you received three exercises were chosen to restore strength and muscle coordination.  These include:

    • Transversus abdominis – your core stability abdominal
    • Gluteus maximus – your powerhouse buttock muscle
    • Gluteus medius – your hip stability muscle

Two exercises focus on restoring length to the hip and thigh muscle. These include:

    • Quadriceps thigh stretch
    • Iliopsoas hip flexor stretch

Future videos will address different exercises, muscles and postures.

  1. Troubleshooting videos

Our troubleshooting videos are one of the hallmarks that makes our project unique.  These videos are designed to help you use the right muscle and to limit pain.

Each video reflects our experience of how we have helped our clients to know they are activating the right muscle and to recognize when they are using incorrect (compensatory) movement patterns.

These videos are key to helping you minimize pain during and after exercise.

Each exercise technique video and each exercise within the video loop has an information button (i) in the upper right corner.  When you click on the button it will take you to the Troubleshooting videos.

Our troubleshooting videos are structured into two sections.

    • Tips to ensure you are able to identify that the correct muscle is activating and techniques to activate it if you are not feeling the right thing.
    • Troubleshooting tips and techniques for common problems and pain.

The troubleshooting for common problems has been broken down into the most typical areas that people feel pain or difficulty correcting techniques.

For example, your Glut max bridge troubleshooting video consists of:

    • How to know you are using the right muscle
    • Trouble shooting these common problems:
      • Neck pain
      • Back pain
      • Knee pain

    Applying the program successfully

    To get the most out of your exercises it helps to understand these elements that are embedded in our program.

    1. Technique comes first

    To benefit from this program, you need to go through these exercises slowly and mindfully.

    Executing the right technique is key to your success and most difficulties come from incorrect tech nique, and not a lack of strength.

    1. More is not better

    To make sure you are working at the right level you should rate your effort level on a scale of 1 (easy) to 10 (maximal difficulty).  Throughout the video your effort levels should be rated at a 4-6/10 level.  If    you need to work harder, then these exercises may be too hard for you.  If you can’t reduce the effort or feel pain you should reach out to your therapist for assistance in correcting these concerns.

    This program starts at a basic level however you may still feel pain if you are working too hard.   Many people work too hard on their therapy exercises or progress too quickly.

    For some people it is in their nature to work harder.  If this is you, or you are convinced that the only way to get better is to work harder, then we cannot stress enough that you need to learn how to perform    your exercises with less effort.  Too much effort can get in the way of your back recovery.

    1. Pain is not good

    Mild discomfort, lasting less than 20 minutes, is usually not indicative of a need to change programs.  If over the next few weeks, the discomfort gets shorter and less intense, then this is usually indicative of  the benefit of the program.

    However, if you have sharp or lingering pain, pain which lasts longer than 20 minutes after the basic program, if your pain is getting worse or if you are unsure if what you are feeling is normal, then we          recommend you reach out to your therapist to guide you on what you should be doing.

    1. Take your time

    People tend to rush through their exercises and try to progress to the next level too quickly.  Doing less and performing each exercise correctly will get you more.

    Exclusively for clients of The Orthopaedic Therapy Clinic

    Currently we are providing this program exclusively to our clients.  We have made this decision to ensure that each participant has a proper diagnosis and a therapist to reach out to if they have questions or concerns.  We ask that you respect the limitations which were included in your participants waiver as this program, improperly applied, may increase back pain.

    Please reach out to your Orthopaedic Therapy Clinic therapist if you have any questions in relation to the program.  We are here to help this become a successful pillar of your recovery.