Conclusion

Pickleball is an enjoyable sport that can be played by people of all ages and fitness levels. However, like any physical activity, it comes with some inherent injury risks.

By following the prevention tips outlined in this blog, you can significantly reduce your chances of sustaining common pickleball injuries and ensure a safer and more enjoyable playing experience.

Remember that staying injury-free is not only about physical preparation but also about practicing good sportsmanship, maintaining a positive attitude, and having fun on the court. So, play smart, stay safe, and savour every moment of your pickleball journey!

If you are struggling with an injury, or have a question about you Pickleball journey, be sure to contact us today!

~ Rahim Ramji, Physiotherapist, YWCA Saskatoon Location
​

Have you ever started a new activity or increased your time spent doing an activity you love, only to find yourself feeling a new pain or soreness that you don’t typically have?

If so, it’s possible that you were experiencing an overuse injury.

​In physiotherapy, we use the term “overuse injury” to talk about injuries that occur due to repetitive use of a certain structure or body part over time, rather than an injury that occurs from one single incident (like an ankle sprain from a fall, for example). When a structure experiences repetitive stress without getting adequate rest or without having an appropriate amount of time to get accustomed to a new activity, it can become irritated or even damaged. ​

Because every person’s body is different, and overuse injuries can happen in many different structures or places in the body, not all overuse injuries will present in the same way. These are some typical symptoms associated with overuse injuries:

• Stiffness
• Swelling or inflammation
• Weakness
• Numbness
• Dull, achy pain
  
  

It is important to know that these symptoms could be coming from another type of injury as well, so be sure to consult a healthcare professional like a physiotherapist if you aren’t sure what is causing your symptoms!

~ Elise Harrison, Physiotherapist

“There is only one way to eat an elephant: a bite at a time.” - Desmond Tutu.
 
How do you tackle a complicated situation or a more severe injury?
Much like the elephant described above, one step at a time. Something that comes up on a regular basis in the office is the discussion around timeframes. Timeframes for change, timeframes for recovery, timeframes until “this pain stops and I can move on with my life”.

I will be the first to admit that I, like nearly everyone else, would prefer it if things could be fixed today or even yesterday if that would be convenient.
 
However, it turns out that this is rarely the case.

It turns out that we can’t skip the steps from where we are to where we want to be.

It occurred to me while I was on a walk last week that it’s not so different from the hopscotch boxes carefully placed on the sidewalk by a neighbourhood children, or the actual panels of sidewalk that span down the street. If I want to step on the piece of sidewalk twenty feet down the street, I have to walk across all of the other tiles first. I can’t just skip right to the end. I think this also applies in rehabilitation.
 
There are no shortcuts, there are no cheats or hacks.
What we are applying is the concept of gradual, but sustainable change. That’s not to say that people can’t feel dramatically different in a short span of time, but for the entirety of our adult lives the body operates under the idea of steady and gradual change. As I have said in the past, I would argue that this is a good thing.

The human body is incredibly strong and robust, it can take years of stress or a high-velocity crash/trauma to really injure a person.

The body is truly remarkable. The trade off for this resilience is that it also takes a while for us to heal and produce positive change. Think about it this way, if the body could fix everything in a single day, it would have to be so flexible and changeable that it could also be injured quite easily.

I think most would agree that we’d like to be resilient and difficult to injure.
 
The effort that is required to change the human body can be quite intimidating.
To build muscle or lose fat is not the task of the day, but the task of the week, the month, and the year.

While every day absolutely matters, you don’t get to see the results until the body has had a chance to be exposed to diet or exercise long enough for a number of physiological changes to occur.

One of my favourite analogies is that of an ice cube in a freezer. Imagine a freezer that is set to -20 degrees Celsius and the ice cube is unsurprisingly solid. Each day, you raise the temperature in the freezer by one degree. To -19 degrees, then -18 degrees, and so on. What does the ice cube do for the first 10 days? The first 19 days? It sits there in the freezer, happily remaining frozen and box-like.

But what happens on Day 21? When we turn the thermostat from 0 degrees to positive 1?
The ice begins to melt. Slowly, because of the residual cold and because 1 degree is not that warm, but it begins to melt. All of the 21 days led to this moment, and each day leading up to it was absolutely necessary to achieve the desired outcome.

This equates to exercise, lifestyle change, and education.

When we are injured, or in pain, or frustrated, we want the change to happen now, we want the difference to be felt right now.
It is often possible that we can affect change in the moment and improve a situation with the right idea, movement, or technique. However, the long lasting change we seek can be more elusive without the commitment to stick something out for the days or weeks it can take to move the proverbial thermostat for a condition.

Sometimes this means we have to start before it feels good, before we think we’re ready. And that’s scary, but there are so many people out there who would like to help, offer advice, and guide the process alongside you.
 
When walking on the sidewalk, it’s not possible for someone to step on the tile 20 feet down the street, even with a running jump. But we can take the step to the next tile, and new options appear once we have taken that first step. In rehabilitation this is no different than the exercises and education that is provided.

You can learn the next step,
followed by the next step. You can teach your body one exercise, followed by another. Once you have the basics down, your options open up. There is more freedom, more opportunity, more ease of movement and possibility. But those early steps and that commitment to the process cannot be understated.
 
Much like a diet, we need to consider not only what we are willing to do this week, or this month, but what we think we can sustain for the long haul.

The body is adapting every day of our lives and as we age, we have to ask ourselves what it is adapting towards? Is it becoming stronger, more agile, more capable week by week? Or do we see it declining and are unsure of what to do next?

While some people may start with their freezers stuck at -50 degrees, that’s still only 50 degrees from the melting point. There is so much that can be done if we can get this perspective at the forefront and not shy away from hard conversations.
 
So what can we do then? We can start a process that can lead to long term, sustainable change. We can keep one eye on the final goal while putting one foot in front of the other.

One small, simple step at a time.

~ Trent Rempel, Physiotherapist

It’s been over a year since I last wrote about tendons, so it’s time for an update! Tendon injuries are a very common condition that can affect your work, sport, and daily life on a regular basis. The original post on the topic can be found here.
​

Tendon Structure:

The tendon is the portion of the muscle that attaches directly to the bone. It is less elastic than the muscle tissue and has significantly less blood flow as well.

In a healthy tendon, the fibers are aligned well and have a good mix of collagen that allows it to fulfill its function.

In an injured tendon, this alignment becomes more disorganized and tiny blood vessels try to penetrate into the tendon to provide nutrients and blood flow for the repair/healing process. (These small blood vessels are thought to be quite sensitive and a possible explanation for some of the chronic pain that comes from tendon injuries). 

Tendon Regulation:

Normally, the tendon and most of the tissues in our body are going through a regular amount of both breakdown and repair (think like the top layers of our skin that are replaced by fresh skin on a regular basis).

When a tendon is unable to keep up with the regular breakdown of our tissues, it can lead to tendon injury. There are number of risk factors that are considered, such as:

• Advanced age
• Cholesterol
• Diabetes
• Overuse

 
But you also need to consider the internal factors as well. This includes:

• a lack of oxygen and nutrients and
• the ongoing presence of inflammation,

Both of which adds stress to the system.
 
One theory is that while your body is trying to keep everything equal, these factors can push our tendons towards a tipping point -  the rate of breakdown is greater than the rate of repair.

The tipping point is where you see a decrease in the function of the tendon.

This tipping point helps to explain how your rotator cuff or hip pain can develop gradually or spontaneously without doing anything different or special in your day.

The tendon did the best it could, until it couldn’t cope any further. And that’s when you first recognize the symptoms. 

nce the tendon is in this predicament, what do you do?
 
Exercise.
Love it or hate it, this is one of the first-line interventions that can provide changes to the tendon with almost no downside. What you may be happy to know is that there is no exact type of exercise that is better than the rest.

The most important factors appear to be

• keeping up with exercise long enough for tissues to change/grow and
• do something that is challenging enough to make the body work hard enough.

When compared to various surgeries and injection of medications, exercise does just as well in the long term. Exercise can be painful to perform at first, but this is not associated with any long term downsides that we know of.
 
Nutrition
Another powerful, but difficult to change part of your life. Avoiding diabetes and high cholesterol complications can be very important for tissue health. If this is well managed, it should be something that can be worked around.

Supplements are hard to recommend specifically.  But you may hear of such things as

• Vitamin C
• Vitamin D
• Leucine
• Glucosamine and Chondroitin sulfate

 
According to research it is too soon to tell in a complex environment if these will have the desired effect.
 
Drugs/Passive Interventions
Because the deepest parts of the tendon do not have much blood flow, taking medication by mouth seems to have a poor effect overall.

Injection treatments are encouraging, but require more study before they could be recommended for all cases.

Modalities like ultrasound, low level laser therapy (LLLT), and various other devices seem to be able to provide short term relief for some people, but more research is required to know how they best fit into the picture on a more general level.

It seems likely that this type of treatment needs to be used in combination with other aspects of care to get the best result.
 
We have just scratched the surface regarding active care of tendons.

There will be a following post in the future that goes deeper into the exercise models that currently exist for tendon rehabilitation.

If you have any questions or comments about today’s post please feel free to contact the office directly.

If you have ever injured yourself, often times it was referred to as a ‘sprain’ or a ‘strain’. These two words are often used interchangeably, but actually have different meanings. It is the type of tissue that is injured that differentiates a sprain from a strain.
 
A sprain is defined as a tear to a ligament. Ligaments are strong bands of tissue that connect bones to one another (AKA a joint). Ligaments are important because they help keep joints stable and prevent excessive movements from occurring. When a ligament is torn or damaged, it may affect the stability of the joint.
 
A strain is defined as a tear to a muscle and/or tendon. The bulky part of the muscle is called the muscle belly, and it transitions into a cord like structure called a tendon, which connects muscle to bone. Unlike ligaments, muscles are able to contract creating movement of a body part.
 
Severity of sprains and strains are classified in the same was using a 3-point grading system.
​
Grade 1

• Minimal loss of structural integrity
• No abnormal motion
• Little to no swelling
• Minimal bruising
• Minimal loss of function
  
  

Grade 2

• Moderate loss of structural integrity but tissue is still intact
• Some abnormal motion (ligament injury)
• Increased swelling and bruising
• Moderate loss of strength, range of motion and function
  
  

Grade 3

• Complete tear and loss of structural integrity 
• Significant abnormal motion (ligament injury)
• Significant swelling and bruising
• Significant loss of strength and function
• May require surgical repair

 
For the first 2-3 days following a sprain or stain, it is advised to follow the PRICE principle to allow for adequate healing and prevent further damage to the injured tissue. PRICE stands for Protection (ex. bracing, crutches), Rest, Ice, Compression, Elevation. Be sure t to contact a physical therapist who can help you progress your rehab process, even when the injury first happens. A physical therapist will provide education and prescribe safe and effective exercises to improve range of motion, strength and function of your injured muscle, tendon or ligament and help get you back to living your best life. 

~ Alex, Physiotherapist

Neck pain and back pain are extremely common in our society and have been so for a long time.

However, as physiotherapists, we have experienced that the most common causes of neck and back pain have changed over time. Over the past few years we are seeing more and more neck and back pain that is originating from office work. One of the issues people are facing is the prolonged time periods they are spending sitting while working at a computer, in meetings, using their cell phone, etc.

Positioning at your workstation is very important to allow the curves of your spine to be as close to their  natural alignment as possible. This can be accomplished through the set up of your office chair, desk, and computer. Here are some general guidelines to follow:

1. Your Chair

•  Ensure your bum is as far back as it can go in the chair
• 90-90-90-90 Rule
  • Feet flat on floor, so that ankles are at 90°
  • Knees bent 90°
  • Hips bent 90° (although could also recline slightly)
  • Armrests are adjusted so that elbows can be comfortably bent 90°

2. Keyboard

•  Articulating keyboard/mouse trays are ideal
•  Adjust keyboard position so that it is close to your body and at a height to maintain the 90° elbow bend
  
  

3. Monitor

•  Center the monitor directly in front of you
•  Top of the monitor should be ~2-3” above your eye level while seated
  • If you wear bifocals, lower the monitor to a more comfortable level
•  Sit at least an arm’s length away from screen
  
  

These are just some general guidelines to help you get set up. Our team of physiotherapists can help you out with more details and how to adjust for special circumstances.

The most important thing to remember is that no matter how good your set up is, our bodies are built to move. We need to move to prevent muscle tightening, help lubricate joints, and improve the blood circulation to our tissues. It is a good idea to take short, mini-breaks every 20-30 minutes to get out of the sitting position and do some quick stretching. We have even gone so far as to have people set timers at their desk to remind them to move.

On a final note, do not forget about your eyes. They have a group of small muscles that control them, just like the other muscles in our body. A good rule of thumb is the 20-20-20 rule – every 20 minutes, look at an object at least 20 feet away from you for 20 seconds. Alternatively, after 20 minutes of work, cover your eyes with your palms for 20 seconds. This can help reduce some of the eye strain from looking at the computer screen for prolonged periods.

~ Trevor, Physiotherapist

Tendons are the strong connecting tissues that anchor our muscles into the bone during our daily activities. They are not truly separate from either tissue, gradually blending into the muscle and bone at either end. Tendons rely on highly structured collagen fibers to handle the heavy demands that are placed on them during our lives. The most common sites of injury include the Achilles tendon at the ankle, the patellar tendon at the front of the knee, and the rotator cuff tendons of the shoulder.
 
Injuries to tendons are common at all stages of life. There are a number of factors that can increase the risk of suffering a tendon injury including age, sex, genetics, concurrent diseases (i.e. diabetes, rheumatoid arthritis, smoking, obesity), and inadequate rest and recovery between bouts of exercise/work. Inactivity and lack of loading have a powerful effect on the maintenance of tendon health as well. 
 
Tendon injuries can occur for a wide variety of reasons and have three classifications that are commonly used:
 
Tendonitis - Characterized by inflammation. (covered below)
 
Tendonosis - Characterized by degenerative changes to the tendon structure. Repetitive strain that does not heal fully over a longer period of time.
 
Tendinopathy - An inclusive term that relates to the pain and reduced function of tendons during injury and recovery.
 
Injury to a tendon can be due to both to a single event or due to a repetitive stress over time. A single event could be an accident at high speeds, or a tissue under a heavy load. The other end of the scale is injury caused by repetitive stress that adds up over time, leading to a situation where the tendon fails to cope. This can lead to an increased risk of tendon injury during relatively normal daily activities.
 
There are two main types of collagen inside the tendon, referred to as Type 1 and Type 3 respectively. Type 1 is thicker and able to handle heavier forces. Type 3 collagen is thinner and helps to develop the framework for the tendon. Several theories exist as to what may actually cause the change in tendons that lead to injury, the most popular involves a lack of oxygen in the tissues and the effect that inflammation has when it occurs repeatedly over a longer period of time. This boils down to an inability for the tendon to maintain the balance between new collagen fibers and the natural loss and change that happens with age and activity. Over time, the structure will change in a way that makes the tendon less able to handle stress and load.
 
What is quite interesting is that these structural tendon problems are relatively common in the general population. Up to 13% of people in their 50s, 25% of people in their 60s, and 50% of people in their 80s will demonstrate a full thickness rotator cuff tear. More importantly, is that some of these people will have minimal or no symptoms at all. Ultrasound and imaging only tells ua a part of the story. Painful symptoms are poorly matched to Ultrasound findings, meaning that a high percentage of patients that show positive findings on imaging do not have any related pain or symptoms.
 
Typically, tendon healing will go through three different stages of recovery during the healing process.
 
Inflammation - Days. Immediately after acute injury, the body will release certain chemicals and molecules that bring immune cells to the injury site. Their first job is to remove any dead or damaged tissue that will not recover and to make room for the next phase of recovery. These chemicals have the unfortunate side effect of making the area tender and sore on average, but is necessary for our body to move forward.
 
Proliferation - Weeks. Once the body has completed the inflammatory phase, new cells will be laid down in the tendons to repair the damage. Depending on the extent of the injury this process can take up to several weeks. These new tissues will be immature and not yet used to the stresses of daily activity. During this time there may be some more sensitivity in the area as new blood vessels and nerve endings are developed as well.
 
Remodeling - Months to Years. Once the new tissues have been incorporated into the existing tendon, the remodeling process can begin in earnest. This period of time actually encompasses our whole lives as we are constantly changing our bodies as we grow, age, and engage in meaningful activities. From a healing perspective, this can take months or even years to fully develop the tendons that were a part of the injury. While this can seem daunting in its scale, it is also a huge source of optimism as even older injuries and complaints can often be improved with effort.
 
Despite the various options that exist to treat tendon injuries, they can sometimes result in reduced function and disability for months. Even with successful treatment, some will be left with a tendon that is weaker than previous and potentially more susceptible to injury in the future. While tendons have the ability to regenerate to a degree, the current thought is that the highly ordered structure that it began with will likely not return to preinjury levels after injury and recovery. After the healing process, tendons contain a higher concentration of the Type 3 collagen, which are typically thinner fibers, resulting in an overall weaker tendon. This can be changed to a degree over time by developing the strength of that tendon, but how much depends on the severity, location, and circumstances of the injury.
 
So what can be done about this then?
 
1.    Manage and guide the inflammatory process. Everyone will have different needs when it comes to this. Inflammation is a natural and necessary part of recovery. However, if this period is prolonged, it does not allow for transition into the later stages.
 
2.    Maintain movement and mobility. While immobilization has been demonstrated to be useful in post-surgical tendon recovery and for other types of tendon injuries, this must be balanced with keeping the affected area moving and functional.
 
3.    Develop structure and strength of the tendon. Once the tissues enter the remodeling stage it is important to introduce loads and activities that will help that tendon to grow and adapt to each person’s needs and environment. Muscle loading is necessary for the development and maintenance of tendon size and strength, but this needs to be done carefully at times.
 
I hope that this information will assist in the understanding of this very common condition. As always, if there are any questions or comments regarding this material, please feel free to contact our office directly.
 
-Trent, PT
 
References
 
●     Tendinopathy: injury, repair, and current exploration. Lipman, K et al. 2018. Drug Design, Development and Therapy.
●     Mechanisms of tendon injury and repair. Thomopoulos, S., Parks, W., Rifkin, D., Derwin, K. 2015. J Orthop Res.
●     Review: Emerging concepts in the pathogenesis of tendinopathy. Dean, B., Dakin, S., Millar, N., Carr, A. 2017. The Surgeon, Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland.
●     Tendon Basic Science: Development, Repair, Regeneration, and Healing. Andarawis-Puri, N., Flatow, E., Soslowsky, L. 2015. J Orthop Res.

Now that school is in, summer holidays have wrapped up and routines are taking shape again there may also be a few unwanted side effects to our “back to work” routine. One condition that we commonly see is Carpal Tunnel Syndrome.  

WHAT IS IT?? 
Carpal tunnel syndrome is a common condition that can cause pain, numbness, tingling and weakness in the hand. The carpal tunnel is a u-shaped passage/tunnel through the wrist that the median nerve and the flexor tendons (tendons that bend the fingers) travel through. 
 
Carpal tunnel syndrome is caused by pressure on the median nerve as it travels through the carpal tunnel. Typically this pressure occurs when the tunnel becomes narrowed or when tissues in the area swell.
 
COMMON SYMPTOMS??
1. Numbness, tingling and pain in the hand

• most commonly the thumb, pointer and middle fingers
• may experience pain in the forearm or upper arm as well
  
  

2. Weakness and/or clumsiness in the hand

• dropping things, difficulty doing up buttons, reduced grip strength
  
  

3. Night time symptoms

• numbness/tingling due to the wrist being in a bent position when we sleep
  ​

CAUSES and or RISK FACTORS??
1. Repetitive use of the hand

• May aggravate the tissues and tendons causing swelling in the carpal tunnel.
  
  

2. Prolonged positions of the hand and wrist

• Aggravation and compression of the median nerve.
  
  

3. Pregnancy

• Hormonal changes/increased fluid can increase pressure on the median nerve.
  
  

4. Heredity

• Variations of the shape and size of the carpal tunnel
  
  

5. Gender

• Typically affects females more commonly
  
  

6. Other health conditions

• Such as diabetes, rheumatoid arthritis, thyroid gland imbalance
  
  

TREATMENT??
Early detection and treatment is important to prevent symptoms from worsening. Non-surgical treatment methods are typically the first line of defence, however if symptoms are severe enough surgery may be recommended.

Most common conservative, non-surgical methods of treatment may include physiotherapy, such as exercises, muscle stretching, manual therapy to get tissues moving better, and acupuncture and dry needling techniques. 

Any of this sound like you? There are numerous things that can be done before surgery, and we can elaborate on with a thorough assessment to tailored treatment plan to improve your quality of life. Early proactive treatment is the best line of defence!!

~ Jacquie - PT
​
References:
1.      OrthoInfo. American Academy of Orthopedic Surgeons.
https://orthoinfo.aaos.org/en/diseases--conditions/carpal-tunnel-syndrome/
2. National Institute of Neurological Disorders and Stroke
https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Carpal-Tunnel-Syndrome-Fact-Sheet

August long weekend is now behind us, retail stores are setting out their fall displays and back to school preparations are kicking into high gear. With the birds no longer chirping their 3 am alarm outside our bedroom window, it’s hard to ignore that the season of less daylight hours but definitely more spectacular color on the trees is fast approaching.  For all of you yard and garden enthusiasts, this means that it’s not only time to reap the rewards of your summer labour, but it’s also time to put in even more effort as you head into the home stretch toward hibernation. 
 
Has anyone else noticed that when it comes time to rake leaves, there appears to be way more leaves in the yard in proportion to the number of trees you actually have?  For those of you who don’t have any trees but still find yourself raking up a significant bounty, this can seem even more puzzling or even down right frustrating. Well here’s a fact that will make having to rake those extra leaves this season, no matter where they come from, a much easier pill to swallow. The Canadian Physical Activity Guidelines recommends, that in order to stay healthy adults 18-64 years of age and older are to do at least 150 minutes of moderate to vigorous activity per day, and raking the lawn is included in the list of activities that count toward this extremely important goal.  So, in addition to having a tidy yard and collecting valuable compost material, studies show that you are also helping to reduce your risk of:

• Overweight and obesity
• Osteoporosis
• Heart disease
• Stroke
• High blood pressure
• Type 2 diabetes
• Certain types of cancer
• Premature death

and can lead toward improved:

• Fitness
• Strength
• Mental health (morale and self-esteem)

 
Now that we’ve determined working in your yard and garden can undoubtedly benefit your health and well-being, here are a few tips to help keep your fall harvest this year safe and injury free.
 
Tip # 1:  Warm up- Whether you work it into your schedule before you head out the door, or you incorporate it into a walk through your yard and garden before you hit the ground running, it’s never a bad idea to give your body a heads up as to what you have in store for it. It doesn’t have to be complicated. Something as simple as marching with your knees high to warm up your lower body, followed by a few big arm circles to loosen your upper body can go a long way in prepping your major joints and muscles for the task ahead. Of course you may need to hold onto a chair or railing for support with balance, if you are having challenges of this nature.
 
Tip # 2: Match your tools to your task- Ensure handles are long enough for you to avoid awkward and unnecessary bending and twisting at the waist. Use gloves. Padded gloves are even better, as they help to lessen the impact that digging, cutting or trowelling can cause to your hands. Go even further toward protecting the joints in your hands, by selecting tools with thicker handles to lessen the force gripping imposes on them. You can even create a DIY (do-it-yourself) ergonomic handle for any of your current gardening tools, by purchasing varied lengths of pipe insulation from your local hardware store.  Just apply it wherever you need a bit of extra support with a non-slip type tape for improved handling.  Using a foam pad is a great way to reduce pressure on your knees while kneeling, if this is a position that is tolerable for you.   However, a small stool works even better if you have longer periods of low level work like weeding to tend to.  Larger digging tasks can often require significantly more force, especially if your ground has a high proportion of clay in it like ours.  It’s best to get yourself a pair of firm soled garden boots, with steel shanked boots being the ideal option. This helps to reduce the impact that repetitive use of a garden spade or fork can impose on your feet.  After all, not paying attention to the safety of your feet now, can impact a lot more than your functioning as a gardener in the long run.
 
Tip # 3: Use proper body mechanics- Lifting heavy pails of potatoes or moving those planters still full of soil can actually be considered a great resistance workout if done right, provided you don’t have any pre-existing injuries or medical conditions to take into consideration. First off, keep your base of support wide with your feet at least hip width apart, and one slightly ahead of the other. Keep your spine in neutral with shoulder blades pulled back just enough to feel that your muscles are engaged. Lean forward from your hips as if reaching back to sit on an invisible chair while at the same time bending your knees and lowering your upper body still maintained in neutral to reach the object you are lifting. Reaching further back with your hips than forward with your knees, will help guard your knees against unnecessary loading.  Remember to counterbalance with the forward lean of your upper body to ensure stability and control. Also, as mentioned in my last blog post, don’t forget to exhale as you apply effort. Not only does this help you avoid holding your breath, but it also helps engage more deep core muscle support to protect your spine.  Position yourself as close in front of the object you are lifting as possible.  This reduces the amount of force transmitted through your low back.  You’ll also want to keep this close proximity principle in mind when doing tasks like raking or hoeing. Avoiding extended periods of reaching beyond arms-length by keeping your task in front of you, not only increases your chances of lasting the day, but also improve your chances of building endurance to last the rest of the season.  Low level work is no different.  When it comes to picking weeds or pulling produce, having a choice between kneeling, ½ kneeling, crouching, squatting, and sitting leaves you with enough possibilities that there is sure to be a position that can keep you close to your task no matter what your level of mobility.  Having a chair designated for use in the garden, is another great option to assist you in getting up and down into some of these positions if you find this to be challenging.  Admittedly, my next point is one that I have to remind myself of most often.  Don’t get so focused on the weeds that you forget to notice the alignment of your neck.  After all, your garden hose wouldn’t function properly for very long with a kink in it, so why would you expect your neck to?  Frequent posture checks, taking the time to stop and smell the flowers, can be just as therapeutic for your mind as it is for your body.
 
Tip # 4: Pace and vary tasks- If you’ve been gardening on a regular schedule all summer, you may be able to extend the amount of time you spend in it during harvest, similar to when you’ve trained to compete in a particular sport.  However, if you are often a weekend warrior gardener like myself, it is even more important to take regular breaks and change your position and task often. You’ll be giving one set of joints and muscles a chance to recuperate, while at the same time giving others a chance to catch up, which in turn creates balance.  Smaller, more frequently used muscles in the forearms, hands and even shoulders are susceptible to repetitive strain injuries.  By adding in more frequent trips to the compost, to the garden shed or even to your water bottle, you are engaging larger muscle groups in your hips and legs more often.  This will assist in improving circulation to those smaller muscles, which reduces your risk of overuse injuries.
 
Tip # 5: Hydrate- Perhaps the temperatures aren’t quite as hot as July, but don’t forget that digging and raking can expend a lot of energy, so keep yourself hydrated. Dr. Julian Seifter, a kidney specialist and associate professor of medicine at Harvard Medical School indicates that “older people don’t sense thirst as much as they did when they were younger, and that could be a problem if they’re on a medication that may cause fluid loss, such as a diuretic.” (2) I like to keep my water bottle handy on the deck, to remind myself that it’s time top up often.
 
Tip # 6: Stretch- Finish off your yard and garden workout strong with some much deserved stretches.  Your day is done, and not only do you see the fruits of your labour, but you can also feel them. The muscle soreness you are feeling is hopefully just enough to let you know that you have done your body some good.  Reward yourself with some stretches that include your upper and lower back, your hips and knees, as well as your shoulders and neck.  My favorites are the cat and cow on all fours, the single and double knee to chest and single straight leg stretches in lying, the figure 4 stretch for your hips in sitting, the quadriceps and calf stretches near a support in standing, the chest stretch in the doorway or a corner and finally a sitting tall ear to shoulder stretch.  I’ll hold each stretch for 30 seconds to where I feel a comfortable pull, repeating twice if I have the time.  Over the years I’ve found these stretches extremely beneficial in helping to minimize my post gardening muscle soreness and maintain my current level of flexibility.  Of course a good soak in a hot tub following a day of digging in the dirt is always an added treat if you have that option. Don’t forget to always check with your medical health care provider before starting any new activity, or before contemplating a soak in the hot tub if you have any underlying medical conditions.  Also, stretches that work best for one person, may not be the ones that are most appropriate for your state of health. 
 
To help you set up a program that is specific to your needs, feel free to drop by the clinic and book an appointment with any one of our therapists.  You can be sure that we will do our best to fit you with a program that’s right for you.  Happy harvest everyone!
 
~ Elizabeth Stefanyshyn-Alonso PT
 
References:
(1) Canadian Physical Activity Guidelines
 http://csep.ca/CMFiles/Guidelines/CSEP_PAGuidelines_0-65plus_en.pdf 
 
(2) How much water should you drink?
https://www.health.harvard.edu/staying-healthy/how-much-water-should-you-drink
 
(3) The Diaphragm/Pelvic Floor Piston for Adult Populations:  Part One Julie Wiebe, PT, MPT,
BSc

For the most part it’s free, it’s something that every one of us shares and most importantly it’s something that not one of us can live without – Breath 
 
There have been several major events in my life causing me to stop and appreciate the miracle of life and the breath that sustains us.  On top of that, being amongst colleagues who are expectant mothers in the clinic right now, one such event that I’ve been reflecting on lately, is the birth of my daughter.  On memories of her taking her first breath, or rather gasp of air upon entering the world, the delivery that felt like it required every ounce of breath I had to offer, never mind trying to focus on all the prenatal breathing techniques I’d learned prior, and my husband beside to support us, breathing words of encouragement, while at times I’m sure holding his breath in anticipation of what was to come. If it weren’t for occasions such as these in life, that heighten our awareness of breath’s true value, we probably wouldn’t give it much thought otherwise.  After all, for most of us this process happens automatically.
 
“There are only two ways to live your life.  One is as though nothing is a miracle.  The other is as though everything is a miracle.” – Albert Einstein
 
The Science - basics of breathing and respiration:
Simply stated, we breathe in and oxygen enters our lungs with the aid of respiratory muscles through a signal from the brain.  Oxygen diffuses into our blood, hemoglobin takes it to our working muscles and energy is produced to sustain healthy function, at the same time carbon dioxide (as waste) is carried back to the lungs for removal as we exhale.  Though a complex process in theory, this reaction is seamless and automatic for most of us who don’t have significant pulmonary complications. However, as eluded to in my example above, not every breath is created equal.
 
 
The Diaphragm – lead role and anatomy:
By far, one of the largest contributors to this automatic process of breathing, is our diaphragm,, “mainly recognized as the primary respiratory muscle of the body responsible for about 80% of all of the respiratory work in normal… (restful) breathing.” (1) As a dome shaped muscle within the chest cavity, your diaphragm extends below at the 1st to 3nd vertebrae in your low back along the inner surface of your lower six ribs and lower surface of your breast bone, through to its’ peak central tendon at the 3rd vertebrae in the low back.  These extensive attachments surrounding the base of the lungs make it our most effective respiratory muscle. However, “like many structures in the body, the diaphragm has more than one function, and has links throughout the body…” (2) And it is through two of these links that the diaphragm has another important lead role as a coordinator for stabilizing our postural core.
 
The Diaphragm – it’s other lead role:
As stated by Julie Weibe, PT, MPT, BSc in her course The Diaphragm/Pelvic Floor Piston for Adult Populations: Part One, “(The diaphragm) is the gateway to the rest of the core” (2)
The diaphragm, along with the deep stabilizing transversus abdominal muscle, the pelvic floor muscles and the lumbar multifidus muscles, together make up what she refers to in her course as “the anticipatory core”.  Within this group, the diaphragm can be considered a key player in how these muscles work together as a team, to efficiently stabilize the core in a way that can be managed by how we breath.   In other words, you might consider the diaphragm as the conductor, in charge of directing the orchestra (transverse abdominal and pelvic floor muscles) in preparation or anticipation of the performer (peripheral limbs) taking the stage to execute movement. It is by working within this natural sequence of events in the body, that we are able to tap into increased efficiency when performing our daily tasks or exercises.
 
The research/proof - activation sequence of the anticipatory core
 “On exhale, the diaphragm ascends, relieving the pressure from above on the abdominal contents. The TA and pelvic floor engage concentrically (in response) recoiling to resting length (pelvic floor rises 1-3 cm on exhale) and more actively contribute to spine and pelvic stabilizer functions.” (2) It is by working within the basic mechanics of the breath cycle in this process that we are able to utilize its’ normal pattern of recruitment, taking advantage of the diaphragm’s multifunctional role as a way to access balanced control of our inner core muscles. We are then able to apply this principle to exercise prescription to be utilized according to the demands of the task at hand, with increased control and efficiency.
 
Application to exercise prescription - timing the breath with the task:
In her course, Julie Weibe presented us with a tangible way to tap into our body’s normal breath mechanics, and use them as a “gateway” to accessing “…central stability and postural control,” factors that are considered to be key ingredients in developing safe and effective exercise programs for our clients.  In using this principle to prepare for performing a functional task, whether it be rolling over in bed, transitioning from lie to sit or from sit to stand or dead lifting 200 kg, we can use the timing of our breath to make sure we have the most optimal access to our core muscles for support. By simply exhaling prior to initiating your task, or as Julie Weibe would say “BLOW BEFORE YOU GO,” we are reminded by a simple key phrase how to safely, effectively and efficiently complete our task which allows us at the same time to increase our focus on form and technique. Though this may seem like a small thing, it can have significant impact on effort, efficiency and safety among all patient populations but especially among our more senior population, of which I now include myself.  Holding your breath when learning new things or when an increase in physical effort is required is often a natural reaction for people, particularly as the complexity of the task increases.  However, “don’t forget to breath!” Considering your entire body relies on a steady supply of oxygen to function at its’ best, decreasing the risk of breath holding or other adaptive breathing strategies on a regular basis should be considered of high importance. 
 
Adaptive breathing strategies - potential consequences:
Without the diaphragm fulfilling its’ role as a primary respiratory muscle, and balancing the proper activation of the anticipatory core muscles through its’ lead, “…adaptive breathing strategies can develop, such as relaxation of the abdominal muscles more than necessary on inspiration… or increased use of accessory muscles of respiration,” (1) These strategies “can in turn lead to several negative consequences, among which can include:

• shortness of breath
• decreased respiratory efficiency
• decreased exercise tolerance
• increased lumbo-pelvic instability
• increased activity of paraspinals
• low back pain
• thoracic outlet syndrome
• sacroiliac joint pain
• headaches and
• asthma” (1)

 
Well, even knowing all this information I still find it challenging at times to sustain an efficient breathing pattern when I’m learning something new, when I find myself in a situation where I feel less that comfortable and when I get into my zone of concentration on a specific task. Can anyone else relate to catching themselves bracing their abdominal or other core muscles and relying on shallow breathing from time to time?  So I continue to rely on cues throughout the day to remind me to STOP for a moment and check in to where I’m at. A tool that I’ve found very useful to incorporate into a busy day, is the “One-Minute Breathing Space” https://palousemindfulness.com/docs/STOP.pdf

On slowly expanding through the lower rib cage during each “in” breath, and allowing my diaphragm to do what it does best, I am usually able to achieve a calming and energized effect to carry on with my day with much less effort.  This increased awareness and practice can then be carried over into all my activities of increased physical effort. 

Though this post scratches only the surface as to the wealth of knowledge contained within Julie Wiebe’s neuromuscular-based clinical model, which also includes postural, pelvic floor and abdominal cueing strategies that are important in accessing the power that is contained within our core, I felt that the breathing component can make a significant difference in the prescription of regional and functionally specific exercises, and was an important springboard from which to start.  

For more information on achieving a balanced core strategy and transferring it to functional tasks and sport specific exercises, keep an eye out for future blog posts or contact our office directly.  You can also visit Julie Weibe’s website at https://www.juliewiebept.com

~ Elizabeth, PT


References:
(1) Network of breathing.  Multifunctional role of the diaphragm: a review. Janusz Kocjan, Mariusz Adamek, Bozena Gzik-Zroska, Damian Czyzewski, Mateusz Rydel. Adv. Respir. Med. 2017; 85: 224-232
(2) The Diaphragm/Pelvic Floor Piston for Adult Populations:  Part One Julie Wiebe, PT, MPT,
BSc
(3) Anatomic connections of the diaphragm: influence of respiration on the body system.  Bruno Bordoni, Emiliano Zanier. Journal of Multidisciplinary Healthcare 2013: 6 281-291