Particularly after an injury, illness, or period of disability, this question comes up often. How can we return to the things that we enjoy? How can we do all of the things that we used to do? ​

~ Trent Rempel, Physiotherapist

This has certainly been an interesting spring so far and I have had the opportunity to speak with a great many people who are learning new skills and reconnecting with their bodies, their families, and their hobbies, if their situation allows.

The staff at Donald Physiotherapy have been learning new things as well, working with people with virtual visits, and connecting with our community through technology and video content. I have been behind the camera and the scenes helping put together some of our current YouTube videos and decided that this would be a good time to work on a project that I’ve wanted to do for some time.

I recently wrote about one of my favourite exercises, the squat, which you can read more about here.

I would like to announce a new video series called “Zero to Squat” which will begin next week. It will cover a gradual progression of exercises to take nearly anyone from not having done a squat, to performing their version of a bodyweight squat over the course of 8 weeks and 8 videos. I am excited to create something that may help people improve their strength and mobility on their schedule and at their own pace, hopefully even prior to an injury or dysfunction.

The editing will be a work in progress, but I hope that you enjoy some of the information that is coming your way!


-Trent, PT

With Family Day and the February break coming up, I am looking forward to some much-needed rest. Personally, I feel like the past few months have gone by so quickly that I haven’t had time to sit back and reflect on all that has happened. In the past three months, I graduated from university, took a whirlwind trip around Australia and New Zealand, started a new job and continued to provide medical coverage for sports teams around Saskatoon. It's safe to say it has been busy. During these three months, what I most often neglected was rest, and it has shown.  We often hear about the importance of exercise and physical activity on our mental and physical well-being, but what we don’t learn is how equally important rest and relaxation can be. In this blog post I am going to talk about how you can gain improvements in the gym and everyday life by taking some time to rest.

The purpose of training or physical activity is to overload the body in order to gain improvements in strength, endurance, muscle mass, etc. Most people think that exercise is when we build muscle and become stronger, but actually it is the complete opposite. When strength training (ex. Lifting weights, body weight exercises, banded exercise) we break down muscle, creating micro tears in the tissues. It isn’t until we rest that the body can repair, rebuild and strengthen those muscles – this is known as adaptation. If we don’t allow our body to rest and recover, we can actually do more harm to our body than good – in the exercise world this is known as under recovery.  What this means is that if we don’t give ourselves enough rest, our bodies will continue to break down, preventing adaptation and impacting our performance. Continually overloading the body without rest may lead to a decrease in training quality and the possibility for injury.

What are some signs of over-training?

• Decrease in performance
• Persistent fatigue – Constantly drained, lack of energy or motivation.
• Persistent mild muscle soreness
• Loss of appetite
• Poor sleep

What are some forms of recovery?

• Sleep – We should be aiming for at least 8 hours of sleep every night.
• Rest Day – Avoid further loading for physical and psychological recovery. Example: Binge watching your favourite Netflix series on a Sunday afternoon.
• Active Recovery – Low intensity exercise such as walking, cycling, swimming or yoga.  
• Proper Nutrition – What we eat plays an important role in how we train and recover. Be sure to talk to a Dietitian on how you can ensure you are getting proper nutrition to optimize your performance.

This idea of a proper work to rest ratio isn’t just for physical activity but can be applied to all aspects of life. Take school for example – as a student you often spend your entire day in class, frantically trying to take in as much information as you can. Once class is over, it is on to a late night at the library, cramming for those four midterms in one week, running only on energy drinks. Studying and going to class would be like training or working out. Staying up late and poor nutrition would interfere with your ability to rest. This cycle continues week after week and is what my classmates and I would call “surviving, not thriving”. In the end you continually stress and break down your body until it can’t function properly (ex. worsening test scores, persistent fatigue, sickness, etc.).

​This February break I challenge you to not only get active, but take time to rest and recover. For myself I plan to sleep in, spend time outside exploring our amazing city, and end up on the couch watching my favourite show on Netflix. Rest and recovery can take many forms, but if we don’t make it a priority, we may never reach our full potential.

~ Alex, Physiotherapist

​First of all, what is a squat? At a very basic level, it is the movement that allows us to change the position of our body from up to down, or from down to up. Examples abound throughout our daily lives, including but not limited to getting up and down stairs, in and out of cars, up and down from chairs and couches and toilets. Getting up from the ground or the floor will at some point have a modified squat or lunge unless you can walk on your hands (Impressive, but not a squat).
 
 
Most times, when I try to introduce a squat to someone who could benefit from more strength, better balance, and improved function (i.e. nearly everyone), there is an audible groan or sigh at first. A lot of people have had some negative experiences with squats or fitness in general, and by the time people get to an office like ours, they’re not usually in their best shape or condition. There’s no doubt about it, squats can be very challenging. On the other hand, they also have so much to offer us in terms of benefit. The squat uses nearly every muscle group and joint from your low back to your toes in the way they were built to be used. This gives us the opportunity to change and adapt all of these tissues in a fraction of the time it would take to perform a dozen or more isolated exercises and has the added benefit of being instantly translatable to life and sport and activity in general.
 
The squat can be overwhelming for some people, particularly with all of the potentially conflicting information that exists online. Really though, it can be very simple and straightforward. Toddlers are fantastic squatters. Because all they are trying to do is get to whatever interesting thing is on the floor. They’re not thinking about their knees or their heels, the position of their head or their hips. And they are very, very good at it.
 
Now, this isn’t just for the young or fit. Any age group is appropriate for some version of a squat, particularly if they are interested in things like walking, standing, stairs, or changing postures throughout the day. One of the most wonderful things about the squat is that it can be modified to nearly any difficulty or fitness level and then can be progressed at a gradual pace to allow for further strength and adaptations to occur. Without even touching a weight or going to a formal gym, people can achieve benefits that will translate into their everyday lives.
 
One of the best parts is that it doesn’t even take a lot of time or initial investment to get started. Over a long enough time period, doing appropriate squats even 2-3x/week can develop muscles and bones. Sometimes finding the appropriate difficulty is the hardest part, but that’s where a whole group of professionals would love to help. Whether it be you personal trainer, physiotherapist, or physician who has a particular interest in sport or strength, there are a lot of options to get you started.
 
Personally, I enjoy showing people how approachable movements like this can be, and revel in the success that people can enjoy once they feel confident in their own bodies. If anyone has questions about the squats, its variations, or exercise in general, please feel free to contact the office by phone or e-mail at [email protected].

​~ Trent, PT

Aging results in many different effects on our bodies.  Of these, one of the most undesirable is often changes in body composition and physical appearance. On average, men and women add 10 lbs of bodyweight every decade during the midlife years.  In addition to this we can lose more than 5 pounds of lean body mass (mostly muscle) every decade due to disuse.  Therefore, 10 lbs per decade increase in bodyweight represents a 15 lbs problem in body composition.

Each decade = 5 lbs less muscle, 15 lbs more fat.

Muscles burn calories at a high rate.  With the decrease in muscle mass as we age, our resting metabolic rate decreases which means we burn less calories.  It’s the same as going from an 8 cylinder engine in your car to a four cylinder engine – it burns less fuel. Our bodies need to do something with this excess fuel (calories) so it stores it as fat instead.

This explains why dieting is often not successful.  Dieting aims to reduce the number of calories we intake.  However, in this case the problem is not the number of calories we are taking in.  The problem is that the calories we have taken in, cannot be used and then get stored as fat instead.  Dieting can actually make the problem worse because dieting can further reduce muscle tissue and in turn, further reduce the resting metabolic rate.

If losing muscle is such a big problem, then what is the solution?  Enter – strength training. Several studies have shown that strength training can increase muscle mass at essentially any age. Strength training exercise can add muscle, lose fat, increase resting metabolic rate, and increase daily energy expenditure. 

As an added bonus strength training has been shown to increase bone density, decreasing the risk of osteoporosis.  Another benefit is enhanced glucose metabolism which may decrease the risk of adult onset diabetes.  It can increase gastrointestinal transit speed, thereby, decreasing the risk of colon cancer.   Strength training has also been proven to reduce low back pain and arthritic pain.  It has been shown to help reduce resting blood pressure and blood cholesterol levels. Finally, strength training has been proven to have positive psychological effects such as reducing depression in older adults.  There is no medication that can produce all these benefits!

If you need help with starting to strength train, let us know.  We can help you choose safe methods of strengthening and how to properly progress over time.
 
 

Jumping ability is critical to many sports.  The first sports that often come to mind are basketball and volleyball.  However, it is an important skill in many other sports including dance, gymnastics, and baseball – yes baseball.  I’ll explain shortly.

We often get asked by young athletes or parents how to increase an athlete’s vertical jump.  One of the common misconceptions out there is that this can just be achieved through calf muscle strengthening.  Although stronger calf muscles can assist with jumping, there are more important areas to address.

Consider this – if we could strengthen the largest muscle in our body and use it to jump, do you think our vertical would increase? The answer is yes.  Gluteus maximus is the largest muscle in the body and it works alongside its 2 partners, gluteus medius and gluteus minimus, to form the muscle group commonly known as the glutes.  The glutes work with the hamstring muscles to create a significant impact on our vertical jump due to the tremendous force they can produce to extend (straighten) the hips. Variations of squats and deadlifts are great options for exercises to strengthen the glutes.

One of the next largest muscle groups in our bodies is the quadriceps.  The quadriceps work to extend (straighten) the knees. Squats, lunges, and step ups can be used to strengthen the quadriceps and thus work on improving the vertical jump.

Now we can go back to the calf muscles.  Calf muscles work to extend the ankle, also called plantarflexion.  Variations of heel raises are generally the most common exercises used for strengthening the calf muscles.

If we look at the 3 joints we just discussed and find what happens with a vertical jump we notice that all 3 of the joints must extend or straighten.  This is called triple extension of the lower body and the timing of this extension at each joint needs to be coordinated to maximize the vertical force produced.  When optimal timing of triple extension is combined with great strength of the glutes/hamstrings, quadriceps, and calf muscles, then a good vertical jump will result.

Strength training of these muscle groups should involve different types of training to optimize the muscle force produced.  Strength is important to improve but an element of speed is essential as well.  Power training combines strength and speed to create the explosiveness required for a great vertical jump.

But hang on, we can do more. We can use the physiology of the muscles to our advantage as well.  Muscles are essentially a specialized group of elastics.  When we stretch an elastic and then let go, it will snap back with quite a bit of force.  We can use this mechanism to further improve our vertical jump.  Instead of jumping from a still position, we can create something called a counter-movement.  A counter-movement is a relatively small movement in the opposite direction of the direction we want to move.  This counter-movement uses the elastic energy in the muscles to produce a recoil effect which unleashes greater force yet in the jumping muscles. For example, before we jump up, we can drop into a bit of a squat and then quickly change direction to explode up into our jump.

Guess what? Yep, there is even more yet we can use to jump higher.  Let’s not forget about the upper body.  We can use arm swing to create upward force that will assist our body to lift off the ground.  As we drop into the partial squat we want to swing our arms down.  Then as we quickly change direction to jump up, we also quickly change our arm direction and swing them up as high as we can and this will assist the lift-off from the ground.

These concepts not only apply to vertical jumping but also distance jumping.  A dancer may not only need to jump high as part of his or her routine but may also need to jump forward, backward, or sideways just like a baseball infielder does when diving for a ball (see I told you we would come back to baseball).  Some sports such as volleyball will require the upper and lower body movements to create the jump whereas other sports such as Irish Dance may rely solely on the lower body.

Our experienced team at Donald Physiotherapy can help guide you through jump training.  From choosing appropriate exercises to combining strength and power training to improving timing and coordination, we would be happy to assist any level of athlete.  To book an appointment or ask any questions, call us at (306) 933-3372 or send us an email at [email protected]

~Trevor, PT
 

Persistent knee pain is something that I myself am no stranger to and it is something that I treat very commonly in our clinic and with my athletes outside of the clinic.

There are many potential causes for knee pain without a specific injury that causes it, but today I would like to narrow my discussion to persistent pain in the front of the knee, aka patellofemoral pain syndrome. In the absence an underlying issue such as osteoarthritis, ligamentous injury, tendinopathy, Osgood-Schlater disease, or bursitis among other issues, patellofemoral pain may be a diagnosis that your physiotherapist may make for the pain in the front of your knee. This can be caused by slight differences in your anatomy, muscular imbalance that can create tracking issues for your kneecap or physical over activity (1).  

Let’s talk a little bit about knee anatomy associated with the patellofemoral joint, or the joint between the kneecap and femur, which is the long bone in your thigh. The kneecap has a groove in the femur that it tracks along as you bend and straighten your knee. The kneecap movement is created by surrounding muscles and is stabilized by ligaments and other connective tissue that attach to bone and to those muscular structures.  The kneecap actually serves as a part of a pulley system for our quadriceps muscle, and the quads blend into a common tendon and attach to the shin bone below the kneecap. Therefore, if there are issues with any of the stabilizing structures or the moving structures, frontal knee pain can occur!

For example, weakness or issues for contracting the quad muscles and hip muscles that help with hip rotation and stabilization can create issues and pain in the front of the knee. These muscles are active A LOT! They are active with every step that we take, and pretty much every time we are on our feet. Therefore, frontal knee pain can be experienced with many forms of physical activity which can include running, walking, squatting, climbing stairs and even sitting with a bent knee due to tension in the pulley system or inflammation. On top of pain, knees may also make more popping or crackling sounds with the above-mentioned activities. If frontal knee issues get really cranky, inflammation can even wake a person up at night (been there)! 

What should you do if you are having pain with your activities but you still need to do them? If it is a more strenuous activity like running or participating in sports, try to reduce the intensity once pain is present or becomes higher than your average pain. Continuing to “push through the pain” will not help you in this situation. Your body is trying to tell you that it is not liking what is happening and it is asking for a change to be made. Although there are some situations where pain may be present as a baseline and learning to function with that pain is important without ramping it up and creating a new injury on top of a present pathology (i.e., in some cases of knee arthritis), this is pain that can be modified in the long run and structural issues can be improved. That is where your physiotherapist comes in.
 
We know that exercise is an important part of the recovery of frontal knee pain and helps to reduce pain levels and improve function for the short and long-term (2). I like to use a combination of therapy tools including hands-on techniques to reduce muscular tension or over-activity, instructing on specific strengthening and lengthening exercises for the hips and knees where these things are lacking to promote balance and coordination in muscular structures, and getting joints, ligaments and other passive structures moving well around the knee. Consideration of the way that the core, the back, the feet and the ankles are moving is also important because everything is connected! All of these things can improve a person’s ability to do the physical activities that they enjoy with good knee form, and then I can help a person return to doing what they love. This is the best part of the therapy process <3

On a personal note, I can relate closely to those who experience frontal knee pain. I have intermittently had this type of pain in my life since 7th grade, and it often flares with changing or increasing and sometimes decreasing my physical activity. For example, I maintain single leg squat and calf strength while staying loose with foam rolling, quad and gluteal stretches while I run. With having two kids under the age of 4, I have also had periods with decreased activity (haven’t we all?), and have noticed increased knee pain with normal life activities like walking up and down stairs. Slowly getting moving and strengthening more always helps this.

As you can tell I could talk about this subject at length, but if you have questions about your frontal knee pain and you are wondering if physiotherapy may help, please feel free to give me a call or you can call the clinic and set up an appointment with one of our excellent therapists.  Here’s to helping everyone get happier knees!

~ Kristyn Froc, PT 

​
References:
1.      Thomee R, Augustsson J, Karlsson J. Patellofemoral Pain Syndrome: A Review of Current Issues. Sports Med. 1999 Oct: 28(4):245-62.
2.      van der Heijden RA, Lankhorst NE, van Linschoten R, Bierma-Zeinstra SMA, van Middelkoop M. Exercise therapy for adolescents and adults with pain behind or around the kneecap (patellofemoral pain). 20 January 2015. https://www.cochrane.org/CD010387/MUSKINJ_exercise-therapy-for-adolescents-and-adults-with-pain-behind-or-around-the-kneecap-patellofemoral-pain.

I hope you enjoy this blog post I wrote to share with you all some observations I have made over the past year working as a physical therapist. As I continue to learn and support others I have been making observations and have slowly been adding to a list of skills from my physio brain perspective that are important to not only maintain but enhance quality of life!

• Getting on and off the floor. Why? Because to get on and off the floor means that our lower bodies joints have to be flexible and our leg muscles have to be able to lower and lift us. This in my opinion is also a functional task because with this ability we are confident and strong enough to get down low to reach something we dropped on the floor, get something from the bottom shelf if we need to be on our hands and knees, as well as allows us to play with littles ones who frequently are on the floor.
• Spine Mobility. Why? I can’t tell you how important is it to have a spine that is able to move in all directions. There are few things that are worse than neck pain or back pain and in many cases untreated pain in the spine at one level manifests into troubles up or down the system. Our spine is our “back bone”, one of the more major joint systems in our body that allows us to function and accomplish the tasks we want to!
• Glute strength. Why? Our glutes support us in some many ways - they support the pelvis, the low back, and are even working when we are reaching for an item on the top shelf, or swinging a golf club. Our glutes/buttocks muscles are mover muscles and we use them constantly to support our everyday movements.
• Maintenance of Balance. Why? Without our balance we are unable to move safely and poor balance predisposes us to falls. Balance is something I feel we take for granted because it is a skill for most of our life that we don’t have to practice, but as we get older, if our activity levels decrease and our joint range of motion and strength becomes limited we naturally are not challenging our balance. This meant that slowly over time our balance decreases. One of the best ways to maintain balance is to keep active, keep moving!
• Health and Well-being goals. Why? When we have goals it means that we are working towards something, and this generally means that we are active. Having movement or fitness goals for yourself as we progress through life I believe are truly some of our most valuable goals. Movement supports our ability to get out and socialize, participate in the activities we love, supports or physical health, as well as our mental and emotional health. This goal can be as simple as “until the end of my days I will always be able to get on and off the floor”. Having a goal of this nature allows us to check in with our health status and supports everything else we wish to achieve.