Lynda McClatchie, Author at Elevation Physiotherapy & Wellness

Pelvic Organ Prolapse—What Can Be Done?

It is really common for women to have some descent in their bladder, uterus or bowel, and it is not just women who have had babies—this condition can be an issue for women who have never had kids as well. Research supports physiotherapy as a first-line treatment for pelvic organ prolapse (POP). A 2016 Cochrane review of the physiotherapy studies for POP found that pelvic floor muscle training significantly decreased symptoms and improved the stage of prolapse when compared to control groups (Dumoulin et al., 2016).

Many women diagnosed with POP had no idea it was even possible for prolapse of the pelvic structures to occur, had no idea where to seek treatment (or that treatment even existed!), and were scared to discuss their concerns with their friends or healthcare providers. Additionally, many people’s concerns are written off as a “normal” part of aging by their practitioners; this leads to people living with potentially modifiable symptoms because they simply don’t know where to go or who to see.

Sometimes the advice given to a woman to help a prolapse is not very practical. For example, a young mother being told not to lift anything heavier than 5 or 10 pounds and to stop all exercise beyond swimming and those performed in lying down positions. While this might be important in the early stages of healing, the exercises and movements would have to progress to the point that this woman could comfortable lift and carry her baby, and get back to the activities that she finds meaningful and fulfilling. No two pelvic floors are the same and everyone experiencing POP has different goals and abilities.

Research has supported that different people manage intra-abdominal pressure during activity differently, and each woman needs to understand how their own body will respond to the exercises and activities that they are interested in returning to. Some women who are looking to resolve or manage their symptoms tend to do well with the help of physiotherapy and lifestyle modification/education. A physiotherapist who works in this area will have advanced training to help pelvic floor issues, and will likely do an internal assessment to gauge the strength, endurance and control of the pelvic floor, and address the pelvic floor engagement with proper breathing to manage pressure changes.

If you’re noticing pressure or heaviness in the vaginal area, or you can feel a bulge in your vagina in the shower, get checked by your doctor or a pelvic health physiotherapist—there is much that you can do to help this problem!

Could Low Impact Sports like Cycling and Swimming Put your Bones at Risk?

A new study in the British Medical Journal looked at the bone density of elite cyclist and runners, and found that the cyclists had thinner bones than the runners, even though many of the cyclists also lifted weights. The sports we do make our skeletons adapt in different ways over time.

Exercise is necessary for bone health—studies have long shown that children who are consistently active develop thicker, stronger bones than those who are sedentary. Many scientists agree that activities that involve sprinting or jumping will make the body increase the number of bone cells to prepare the bones to tolerate those forces. Even middle-aged or older people can maintain strong bones if they maintain activities that put more force through the skeleton.

Researchers are still not sure what activities build the bones enough—some studies show that running generates enough force to remodel bone, and other research says that it does not. It’s the same with weight training. Several studies have raised concern that non-weight bearing exercise like cycling and swimming may actually be helping the bone to get thinner because they put so little pressure through them.

A Norwegian study looked at the bone density of 21 elite runners and 19 road cyclists in their 20’s. Despite the fact that the cyclists trained much more than the runners and many more of them did weight training, they had noticeably different bones. All of the cyclists had thinner bones than the runners, and more than half of them met the criteria for low bone mineral density.

This research can’t tell us why the cyclists’ bones might be thinner—both eating too little and sweating too much have been shown to cause bone loss. This research points to serious cyclists needing to combine other activities that are weight-bearing through the bones.

Physiotherapists are experts on optimal cross-training for athletes to prevent overtraining certain muscles or building imbalances from those sports or activities that use the same muscles over and over. If you’re a serious athlete, check in with your Physio to find individualized activities and exercise to complement your own sport

The Fascination with Fascia

New research indicates that certain cells found in the fascia communicate directly with the nervous system, each other, and with every other organ in the body. If this is true, this thinking challenges what we thought we knew—the central nervous system may not be the one in control of all of the body systems.

It used to be thought that the fascia was just a wall of tissue that surrounds everything—lining the walls of the trunk and pelvis, wrapping around muscles and organs. This new research is showing that the fascia is more like a highway where cells live and where nutrients and waste can travel to other cells or directly to the lymphatic system. If true, it makes sense that the fascia would play a significant role in our immune system and overall wellness.

There are different types of fascia—superficial or deep, dense or non-dense. The fascia of the nervous system is called meninges, the fascia surrounding the lungs is plurae, and the pericardium surrounds the heart. Are all of these different types of fascia connected and working together on some deeper level? Do they communicate amongst each other, and to the body as a whole? We don’t know that yet for sure.

Sue Hitzmann, creator of ‘The Melt Method’ to address fascia, feels that it is key to keep fascia hydrated, and not just by drinking a lot of water. Injury to the fascia through trauma or injury can cause it to become stiff, and just drinking water would be like running a faucet over a dry sponge. It would take gentle manipulation of the fascia to “loosen” or mobilize the tissue and increase the intracellular fluid.

The research shows that our fascia is filled with proprioceptors which tell us where our body is in space. When proprioception goes awry because of injury to the fascia from muscle overuse, improper movement, and/or posture, the fascial layers no longer glide smoothly or work properly. The central nervous system would then take over, and if this goes on for too long, it becomes overworked and can contribute to neurological disorders or autoimmune disease like lupus, rheumatoid arthritis and fibromyalgia.

Wouldn’t it be great to use non-pharmacological treatments that could tap into our bodies’ own natural defenses against degenerative diseases. We know that eating right and moving help keep us healthy into old age, but we must move well and keep our fascia pliable and nourished.

Exercises for Lower Back Pain Are NOT Created Equal!

Research has shown that people suffering from lower back pain should focus on just two things: keep moving, and be careful with sitting posture and avoid slouching. There has been more recent research studying if specific directional exercises are more valuable to get rid of pain, or if general stretching and strengthening around the spine is more effective.

A directional preference is described as when repeated lower back movements in one specific direction (eg. arching the back) demonstrates quick improvements in pain and range of motion that remain better as a result. This phenomenon doesn’t always happen, but when people’s back pain responds so nicely to repeated movements into one direction, they often progress faster than those who do not demonstrate any directional preference. Long et al (2004) developed a brilliant study where they identified those people who showed a directional preference to a lower back movement, and asked would happen if the person did not continue with exercise in their direction of preference?

Three hundred twelve people with lower back pain had an assessment to determine who demonstrated a directional preference with lower back movements. Those who did (n=230) were placed into one of three directional subgroups: flexion (rounding), extension (arching) or lateral (sideways) preference. Each subgroup was then randomized into a matched (n=80), opposite (n=70), or non-directional exercise program (n=80). All 3 groups were given education on posture and keeping active as able. For example, if one person showed a directional preference for lumbar extension (arching back) during their assessment, they were then randomly allocated to continue with exercises into lumbar extension (matched preference), or lumbar flexion exercises (opposite), or a third control group of generalized strengthening and stretching exercises of the lower back, hips and thighs (commonly prescribed multi-directional mid-range exercises).

Elevation Physiotherapy & Wellness :: Lower Back Pain Testing

After two weeks, 95% of the people doing the exercises in their preferred matched direction were improved or completely better and no one was worse. Yes, you read that right—95%!!!

This was over four times better than the group performing the opposite movement to their direction of preference (23% better or resolved and 15% reported being worse). The control general exercise group had 45% report they were improved and 15% were worse, but interestingly, 55% of these control group did not feel they were improved despite performing commonly prescribed exercises and general movement. This study strongly demonstrates how individualized directional exercises can be very powerful to improve or resolve back pain quickly. One does not have to suffer for weeks or longer to help the source of the problem. A proper mechanical assessment can determine the proper course of action to help get better, faster… and stay that way!

Reference:

Long, A. et al.. Does it matter which exercise? A randomized control trial of exercise for low back pain.2004, Spine 29(23): 2593-2602

Why Would You Strengthen Your Hips When It’s Your Knees That Hurt?

Elevation Physiotherapy & Wellness :: Why Strengthen Your Hips When It's Your Knees that Hurt?

Pain at the front of your knee is often called patellofemoral syndrome, and can be a nagging ache or a sharp pain that you might feel after exercising or even sitting too long. Over time, your knee might start to hurt during exercise or throughout your day, and may cause you to limit your activities.

Recent research showed that in people with patellofemoral syndrome, strengthening the thigh muscles can be helpful, but it is even more helpful to strengthen hip muscles. One study followed 33 women who did consistent knee or hip strengthening exercises over four weeks: the group that strengthened their hip muscles reported 43% less pain than the group who did knee/ thigh strengthening exercises—they reported only 3% decrease in their knee pain.

Pain relief and function were similar for both groups by 8 weeks.

Why?

The power for you to move your body around is supposed to come from your hip muscles, specifically the “outer” butt muscles. Often people are fairly weak through these muscles and your brain makes your thigh muscles take over and do more of the work than they should. It is thought that getting or keeping the hip muscles strong helps to improve the mechanics of the whole leg and therefore reduces stress on the knee itself.

Strengthening your hip muscles can help decrease knee pain faster, but it is also thought that keeping those muscles strong can actually prevent knee pain from beginning. Examples of targeted hip strength exercises are clamshells, lateral walking with a resistance loop around your legs, and even squats—these exercises need to be done properly and should not be painful. It is always best to see your Physiotherapist who can determine specifically what is causing knee pain, and can then design a program individualized to help you.

Snow Shoveling … Canada’s “Other” Winter Sport!

Elevation Physiotherapy & Wellness :: Snow Shoveling Tips for Canada's "Other" Winter Sport!

With winter comes snow, and with snow comes shoveling. Snow shoveling can be the cause of muscle and ligament injuries, as well as back pain. It should be treated the same way as any sport—warm-up and cool down with some basic stretches and movements to increase your heart rate.

7 Steps to Easier Shoveling

Start Slowly – shoveling can increase your heart rate and blood pressure, so warm up and cool down with stretches.
Clear Off Snow as Soon as Possible – fresh snow is lighter than packed snow, so the job is easier.
Push Snow Out of the Way – when possible, push snow off to the side rather than lifting and throwing the load.
Don’t Overload the Shovel – fill the shovel half full and step forward when loading the shovel.
Don’t Stoop and Lock Knees When Shoveling – that position increases the pressure on your low back, so bend your knees and keep your back straight.
Take Breaks – if it’s a heavy job, rest awhile and return later to finish
Stop to Stand Upright – make sure you regularly stand up straight and even stretch backward during shoveling to give your spine a break; repeat a few times in a row.

Choosing a Shovel

“Ergonomic” shovels have a bent shaft that allow you to keep your back much straighter, as you can get a good grip on the shaft without having to reach down too far. Often these shovels have an aluminum shaft, making it lighter and helping to minimize the stress that shoveling imposes on your back. Also look for a small, lightweight, plastic blade to help reduce the amount of weight that you are moving. When shopping for such ergonomic snow shovels, pick them up first and go through the motions of shoveling to see if they’re the right length for you.

Proper Lifting

When lifting even a light load, be sure to keep your feet wide apart and put your front foot close to the shovel. To lift, shift your weight to the rear foot and keep the load close to your body; turn your feet in the direction toward which you are throwing the snow rather than twisting your body. After you’re done, try to keep moving for a short time afterward—allow your muscles and your lower back to stay limber.

The Shoe Story (for Runners)

Ten years ago, research showed that there was no evidence to show that modern running shoes prevented injuries, and such shoes should be considered “unproven technology with the potential to cause harm.” Then in 2009,the rise in barefoot or “minimalist” running created the thinking that more traditional runners were not as good, as the minimalist shoe would make a runner adopt a more natural gait pattern.

As years go on, there is still no evidence to speak about how running shoes prevent injury—and that goes for traditional shoes, minimalist shoes, the super-cushioned maximalist shoes,or even that you should simply choose a shoe based on comfort.

The false argument that exists for the newer maximalist model states that since there is no evidence around more traditional shoes, then the newer version must be better. Also, the thinking that a more natural foot motion is best, as represented by the minimalist model, is also not backed up by evidence. Plenty of people who properly train in these shoes report injuries.

Some researchers have argued that the best way to choose a shoe is comfort, and that your own legs have a unique“preferred movement path” that will minimize injury. There are plenty of studies that show how different types of shoes, or no shoes at all,affect the way your joints move and the forces that impact them – but no one can say if those changes actually affect injury rates.

What research actually does show is some of the best ways to avoid injury are to be cautious about how to increase the training load, and maybe to make small adjustments in running form to avoid problems such as excessive braking with muscles on the front of the thigh.

Someone newer to running might want to try on several different shoes at their local running store to find what feels best. Running shoes should not have a “breaking in” period, so if they aren’t comfortable right out of the gate, then try a different make or model that feels good to run right away. Check with your physiotherapist for specific exercises or gait analysis to help you build up some miles safely and stay injury-free!

How to Keep Your Fitness Goals Rockin’ this Winter

Winter is here, and although it’s not bad yet, we know what is in store for the upcoming months. It’s dark, it’s cold, it’s icy— all conspiring to suck any motivation to keep up your fitness goals right out of your body!

But here’s the thing. We know it’s coming, so now is the time for a few easy preparations to keep your workouts loaded through the next few months.

Keep your gym/yoga studio/dojo close to your home or work. If you have to travel more than a few kilometers out of your way, you won’t go. At least not regularly like you should. Make your workouts easily accessible to go first thing in the morning before work, at lunch, or right after work before you go home and settle in for the night. Or train at home. It only takes a few basic piece of equipment to get in a solid workout in your own space. Some resistance bands, dumbbells or kettle bells, maybe an exercise ball or suspension system, and you’re gold.
If you’reworking out outside, dress appropriately. Layers are the key. You will still sweat if it’s -20° and you’re running outdoors. No cotton, including socks, as that will hold the moisture close to your body. Clothes that wick the moisture away from you is best, and won’t restrict your movement.
A warm-up is actually important. Even if you’re inside at the gym, you’ve probably just arrived from outside and changed into shorts and a t-shirt. When it’s cold out, blood flow to muscles decrease and joints can get stiff. Even a short warm- up will better prepare your body for the work you’re about to do. Some dynamic stretches, a few bridges and body-weight squats, 5 minutes on a treadmill and you’re good to go!
Use the winter months to try something new. Why not try out the kickboxing studio you pass each day on your way to work? You’re more likely to do “inside” workouts during the winter months, and why not mix it up with something you haven’t tried before?

The bottom line: keep yourself moving! The pull to hibernate can be strong, but think of the next few months as an opportunity to keep yourself fit so you can hit the ground running (literally!) in the spring.

Kegels are your Friend—Get to Know Them!

If you’re leaking urine when you cough, sneeze or laugh, it’s no laughing matter—but there is a lot that you can do to help it. It is not normal to leak even if you’ve had kids, nor is it an inevitable part of aging.

The muscles of the pelvic floor work like every other muscle in your body, they are just tucked up inside, so people don’t given them much thought. Due to this weakness, they often don’t work to squeeze effectively around the urethra, and leaking can happen. They also work to hold up organs like the bladder, uterus and colon, and need to be kept strong to keep these organs from sinking down.

It’s not just women who have had kids that have problems with their pelvic floor—it can happen to any woman. A decrease in hormone levels with menopause can cause irritability in the bladder and pelvic floor muscles, and gravity can help things descend if there is poor external support.

The good news is there is so much that can be done before and after you notice any problems. It is important to get to work on strengthening your pelvic floor muscles, and of course, it is necessary to make sure you’re doing them correctly. A proper pelvic floor contraction is a lift—for example, imagine a ping pong ball sitting outside your vagina and you want to lift it inside. Once you have the lift movement down, try to do 10 contractions in a row. Keep practicing—you will get better strength and control as you practice.

It is worth seeing a physiotherapist who works in pelvic health who will do an internal assessment to make sure that you are engaging the muscles properly, and then give feedback on the strength, endurance and control. A pelvic physiotherapist can also give you exercises to work your other core muscles along with your pelvic floor and proper breathing—breath is very important to train with your pelvic floor muscles. Working the pelvic floor regularly –and properly—can help you get to the point where you can cough or laugh without leaking, and that is nothing to sneeze at!

Are Our Brains Making Us Sit Too Much?

A recent study in the journal Neuropsycologia finds that our brains tend to be wired towards being lazy. People know that they should exercise and even may plan to work out, but electrical signals in the brain may be motivating them to be sedentary. Relatively few people exercise regularly, even though most know that it is important for our health. Earlier research shows that many people sincerely wish to be active, but few people actually follow through.

Scientists wondered if there was something going on in the brain that lessened the motivation to exercise, so they recruited 29 healthy and fairly sedentary young men and women who said they wished to be more active. Each volunteer was fit with a helmet that had multiple electrodes that read and recorded the brain’s electrical activity.

Each person was given a computer test where they had an avatar they controlled by pushing a keyboard key, and they were instructed to move their avatar as fast as they could toward either the active images and away from the sedentary ones, and then vice versa.

If people respond more quickly to one kind of image, moving their avatars to it faster than they move them away from other types of images, then it is thought that they are drawn to that subject. The people in this study were almost uniformly quicker to move toward the active images than the sedentary ones–they all consciously preferred the figures that were in motion.

But at an unconscious level, their brains did not seem to agree. The electrical tests of brain activity showed each person had to use much more brain resources to move toward physically active images than toward sedentary ones. Brain activity there was much slighter when people moved toward couches and hammocks, suggesting that our brains are naturally attracted to being sedentary.

The results were explained in that our ancestors needed to conserve energy, so they had fewer calories to replace when food was not easily available—it was a survival strategy.

Of course, this study was small and looked only at electrical activity in the brain, but the authors feel that it would be helpful for some people who are reluctant to exercise to know that they are not alone. It is also very important to note that we can consciously choose to move, despite what our brains might think.