Thursday, 10 November 2016

Shoulder Impingement Syndrome

As a physiotherapist, I see many clients who come into The Sports Clinic with shoulder pain and discomfort. Most people don’t realize that shoulder pain is a very common complaint and occurs with those who have everyday jobs or who are involved with sports and exercise. As a previous competitive swimmer, I fully understand the impact that shoulder pain can have on one’s ability to complete the activities they enjoy most. Among the most common causes of shoulder pain, especially with overhead activities, is shoulder impingement syndrome.


Shoulder impingement can affect approximately one in three people at some point throughout their lives. This condition occurs when some of the soft tissue structures surrounding the shoulder get compressed on top of the shoulder. Most commonly, the supraspinatus (part of the rotator cuff), the long head of the biceps, and the subacromial bursa (a fluid-filled sac meant to reduce friction between two surfaces) are the structures that can be pinched through certain movements. To fully understand the mechanism behind impingement syndrome, let’s look at the anatomy of the shoulder. The shoulder girdle consists of:
  • The glenohumeral joint: the connection between the upper arm bone and the shoulder blade
  • The acromioclavicuar joint: the connection between the shoulder blade and the collarbone
  • The sternoclavicular joint: the connection between the collarbone and the breast bone
  • The scapulothoracic “joint”: the connection between the shoulder blade, rib cage and upper back; this joint is connected mainly through muscular attachment
In order for the shoulder to have full, pain-free range of motion, there must be full movement in each of these joints in the shoulder girdle. Any restrictions within these joints can lead to the soft tissue structures becoming compressed between the shoulder blade and upper arm, causing local irritation and inflammation, and ultimately leading to pain and decreased mobility in the shoulder.

Common causes for shoulder impingement:
  • Poor posture 
  • Muscle imbalances in the rotator cuff or muscles controlling the shoulder blade 
  • Poor neuromuscular activation leading to irregular motor control of the muscles
  • Joint restrictions in the cervical and thoracic spine or the rib cage 
  • Myofascial restrictions/muscle tension of the muscles
  • Visceral (organ) mobility restrictions 
  • Acute trauma 
  • Previous injury 
Symptoms of shoulder impingement:
  • Pain occurring in front or side of the shoulder while lifting arm overhead 
  • Pain worse during overhead movements or activities
  • Reaching across or behind the body
  • Pain that radiates into the elbow
  • Trouble or pain while sleeping on affected shoulder 
  • Gradual weakness 
  • Loss of range of motion 
So what can we do about it? A thorough orthopaedic assessment that involves looking at the whole body in order to find out where the problem may be coming from. Finding the correct mechanical and movement restrictions is the key to allowing the shoulder to move freely and without pain. After a thorough assessment, treatment may include: manual therapy techniques from a physiotherapist, chiropractor, massage therapist or athletic therapist to clear restrictions; a comprehensive, individualized home exercise program that focuses on correcting muscular imbalances, tightness within the muscles and joints, or motor control issues; and postural education.

Conservative, non-operative treatment through physical therapy has shown to be highly beneficial in decreasing pain and increasing function in the shoulder. Consider seeing a physical therapist, chiropractor, massage therapist or athletic therapist at The Sports Clinic to begin your journey to recovery!

Megan Provost, Registered Physiotherapist
The Sports Clinic


Friday, 30 September 2016

Knee Pain - Patellofemoral Pain Syndrome

This is a general term to describe pain in the front of the knee and around the patella (kneecap). Often people with patellofemoral pain complain of difficulty with running, jumping, sitting for long periods, kneeling, and climbing stairs.


The major causes include:
  • Patellar Malalignment/Maltracking: This is an abnormal position and tracking of the patella on the femur, which can be caused by many factors, including:
    • Muscular imbalances (example: weakness/tightness between the quadriceps and hamstrings, weakness/tightness in the hip musculature)
    • Alignment issues between the pelvis, hip, ankle, and knee
    • Dysfunction in the joints above and below the knee joint
    • Generalized ligamentous laxity (hypermobile joints)
  • Overuse: Often patellofemoral pain is brought on by activities that put repeated stress onto the knees (ex: jogging/running, climbing stairs, squatting). Patellofemoral pain can occur if there is a sudden increase in training, improper form or technique, or changes in footwear or playing/running surface.
Patellofemoral pain often occurs as a combination of both causes, generally in the young athletic population, but can occur in non-athletes as well. It requires a holistic assessment to determine the origin of the issue. Physiotherapy management of patellofemoral pain is tailored to the individual by an assessment. Studies have shown that physiotherapy is effective in treating patellofemoral pain, but there is not one specific program that will be effective for treating all patients. Treatment often includes manual therapy, modalities (acupuncture), strengthening/stretching, soft tissue work, and a home exercise program.

There are many contributing factors to patellofemoral pain. At The Sports Clinic, our therapists provide comprehensive assessments that will help you get to the source of your knee pain and guide you into recovery!

Katie Anselm, Registered Physiotherapist
The Sports Clinic

References
  • Hettrich, C. & Liechti, D. (2016). Patellofemoral Pain Syndrome-OrthoInfo - AAOS. Orthoinfo.aaos.org. Retrieved 28 September 2016, from http://orthoinfo.aaos.org/topic.cfm?topic=A00680
  • Patellofemoral Pain Syndrome - Physiopedia, universal access to physiotherapy knowledge.. (2016). Physio-pedia.com. Retrieved 28 September 2016, from http://www.physio-pedia.com/Patellofemoral_Pain_Syndrome

Wednesday, 31 August 2016

Heather, would smoking pot help with my concussion?”

I’ve been asked this little gem of a question several times in the past year. With the high number of concussions I see each year, combined with the prevalence of marijuana in the news lately, I’m not surprised quite frankly. Cannibis and concussion …. The debate continues. Does it help? Does it harm?


Well, there isn’t a lot of research performed in this area. BUT, looking at several research papers and having experience with patients who have tried putting toxins in their bodies while still compromised, in my opinion the conclusion is, smoking pot (and drinking alcohol or smoking cigarettes) is a bad idea.

“Why would someone want to smoke pot while concussed?” you ask? There are several reasons that I have come across. Sleep regulation is the first reason. Often with concussion, a patient’s circadian rhythm is affected, especially if they resort to napping during the day when they can’t sleep at night. Patients in turn, don’t receive the restorative sleep that they need and think that smoking marijuana will give them that relaxing effect and allow them to sleep. The second reason is appetite control. Appetite can be negatively affected after a concussion and often patients resort to different means to increase their desire for food ie. marijuana.

Whatever reason you have for smoking cannabis, research has shown that whatever “positive” effect you think you’re getting, you’re not. Putting a toxin into your body when your system is already compromised is never a good idea. Research has shown that alcohol, cigarette, and marijuana users had far greater length of recovery time. There are far better treatment options and each of them is different depending on the patient. Simply put, there is no “cure-all”. Concussion is complicated enough without adding something that will significantly impact the result.

Heather Marchment, The Sports Clinic

Monday, 20 June 2016

Dr. Julia Alleyne - "Most Influential Women 2015"

The Toronto Pan Am & Parapan Am Games held in 2015 were the first Pan American Games to select a woman as Chief Medical Officer, Dr. Julia Alleyne. Julia works at Toronto Rehab and the University of Toronto and is a highly valued member of the team at The Sports Clinic at UTM.

For her highly successful contribution to the Pan Am Games, Julia was recently recognized nationally as one of the "Most Influential Women 2015" by the Canadian Association for the Advancement of Women and Sport and Physical Activity (CAAWS).

Dr. Alleyne with Pachi - the Pan Am / Parapan Am Mascot

It was her vision, inspiration, and guidance that provided over 2,000 medical and anti-doping professionals with an incredible opportunity to volunteer their services to athletes, coaches, officials, spectators and workforce.

Thanks to Julia for her work at the Pan Ams and congratulations on being selected for this prestigious award.

Your First Appointment with a Sports Dietitian


Sports Dietitians are Registered Dietitians that have received additional training and have specialized in sports and physical activity.  The body processes and uses the nutrition you get from your food and supplements differently when your body is physically active. Knowing this, here’s a list of things that you need to prepare before your first assessment with a Sports Dietitian:

Basic Info

The Basic Info includes your age, height, weight (Measured first thing in the morning after you pee), food allergies, intolerances, religious or cultural practices involving food, past medical history and any medications, including birth control for women.  I also like to benchmark clothing size, even if it is measured by how you fit into a specific outfit, to provide a baseline comparison of future development.

Supplements

Athletes usually take many supplements to help them improve their performance, this includes protein powders, protein bars, multivitamins and even herbal supplements.  Bring a list of supplements you take.  Your Sports Dietitian can help ensure you are taking the right supplements and avoiding potential harmful (or banned) substances.

Workout Schedule

Providing your training schedule will help the Sports Dietitian best time your meal intakes to fuel your training sessions and to better help you recover from your workout or training session.  It’s also helpful to know the purpose of the training session.  For example, a hockey player may have a training session focusing on stick handling or speed skating; these are very different training goals and have to be fed differently.  For a runner, targeting hills training, tempo run or speed run would also help the Sports Dietitian know how to identify the right fuel. Knowing the Perceived Rate of Exertion also helps the Sports Dietitian make better recommendations.

Sport History

It’s important to know how long you’ve been active in your sport.  Athletes develop muscle maturity, which can impact how effectively your body uses nutrients and calories.  The longer you’ve been active in your sport, the more efficient your muscles may become at using calories, which impacts the food targets set by your Sports Dietitian.

It’s also important to bring long-term data of your performance to see trends and patterns in your competitive results.  The Sports Dietitian will work together with you to get your body ready for competitions by trying different nutrition strategies at different times to see what works best for you.

Past Injury

Many athletes have experienced some form of injury at some point in their career, it’s important to share this with your Dietitian.  The type of injury can indicate different nutritional issues that need to be addressed.  For example, many runners tend to get shin splints, cramps and knee or lower back injury.  These can all tell very different stories as to what the athlete needs in their diet to prevent these injuries from re-occurring.

Athletic Season

Sports Nutrition needs to match your athletic season.  A Triathlete training for their first Ironman race will need different nutritional recommendations at different points of their training schedule to get in the best possible shape possible for race day.  For Physique competitors and Body Builders, nutritional goals in the bulk phase are extremely different than in the cut phase.  Furthermore, make sure you let your Sports Dietitian know if you’re in your competitive season or if you’re in the off-season.


Summary

There’s a lot of information that a Sports Dietitian needs in order to help you reach your maximum potential in your sport.  Giving more information could mean the difference between First and Second place, or in attaining a new personal best.  Remember, everyone is different and so are their needs.  The more information you bring the better your Sports Dietitian will understand your unique nutritional needs.

Perhaps the most effective time to see a Sports Dietitian is in your off season as it’s very likely that they will need to get in touch with your coach to see what their goals are for you for the upcoming season and believe it or not, the off season is the best time to reach those goals in order to ensure you have the best competitive season possible.


Benjamin Sit, RD, Sports Dietitian.
The Sports Clinic - www.sportsclinic.ca

Monday, 13 June 2016

Healthy Recipes - Check Out Ben Sit's June Recipe

Ben's recipe this month is The High Protein Iced Capp.  Just in time for summer.


Check it out, along with Ben's other healthy recipes on the Sports Clinic Website by clicking here.

Cool down!

Wednesday, 18 May 2016

Welcome Dr. John Haverstock, MD, FRCSC

Dr. John Haverstock, MD, FRCSC, is an orthopaedic surgeon with fellowship training in upper extremity surgery.  Based at Oakville Trafalgar Memorial Hospital, he specializes in arthroscopic and reconstructive surgery of the shoulder, elbow and wrist.

John is a graduate of Dalhousie University, where he studied Kinesiology and Medicine.   After a surgical residency at the University of Western Ontario, he trained at the Roth McFarlane Hand and Upper Limb Centre in London, Ontario.

He will be consulting at our Winston Park location once a month starting Monday, June 27 from 9:00 am to 12:00 pm.

The Sports Clinic is very pleased to have Dr. Haverstock on the team!