What kind of stretching is best for a warm up?

By Lauren Orser, Athletic Therapist, Concussion North

Stretching is an important activity for everyone who moves a lot, wants to move better or would like to return to full, pain-free movement. The benefits of stretching are well known but there is some disagreement about what kind of stretching is best before, during and after physical activity.

There are now two main types of recommend stretching: (1) static, and (2) dynamic stretching. (Ballistic stretching is another form that is no longer recommended because the “bouncing” nature of this type of stretching increases the risk of injury).

Static Stretching

During a static stretch you hold a position for 15-30 seconds to lengthen and release the tension in a given muscle. You are doing a static stretch when you do seated hamstring stretch or a standing quad stretch. A dynamic stretch is where you lengthen and release the tension and tightness in a muscle through movement with exercises like arm and leg circles, shoulder circles and side bends.

When you include stretching as part of your warm up, you reduce the stiffness in your muscles and increase your range of motion. According to research, static stretching is most beneficial for athletes requiring flexibility for their sports (i.e. gymnastics, dance). It should be noted, however, that research also shows that static stretching during a warm up can reduce a muscle’s strength, which may not be ideal for competition.

Dynamic Stretching

Dynamic stretching is better suited for athletes like basketball players or sprinters who need running and jumping performance during their sport. You can accomplish dynamic stretches by doing exercises like knee highs and butt kicks that stretch your muscles while you go through full range of motion required for your sport.

If you’d like to design a warm-up routine that includes that right type of stretches for your sport or favourite physical activity, get in touch. One of the Athletic Therapists at Concussion North would be happy to help!

Research Reference: “Current Concepts in Muscle Stretching for Exercise and Rehabilitation”, International Journal of Sports Physical Therapy. 

I’m a long distance runner with shin pain so bad I can’t run around the block. Help!

By Dr. Marnie Lavigne, Sports Medicine Physician, Concussion North

Shin pain is the curse of runners everywhere and it can be incredibly frustrating when you’re committed to going the distance, and instead you can barely walk.

There are number of reasons you can experience shin pain. For runners, it can flare up if you increase your distance too quickly, if you change your running routine abruptly, don’t stretch properly or if you’re wearing worn out shoes. For non-runners, a shift from low impact to high impact exercise can lead to screaming shins.

In terms of what is causing the pain, there are a few possibilities:

Medial tibial stress syndrome, commonly referred to as shin splints, is one of the more common causes for shin pain. Shin splints are thought to be caused by a combination of muscle overuse or straining, inflammation around the bone and too much bone stress.

Compartment syndrome creates shin pain when the muscles swell and cause excess pressure in the lower leg.

Stress fractures, a condition in which the bone actually starts to have very small breaks, is also a possible cause of shin pain that cannot be missed.

So, what should you do if your shins are screaming?

The very first and most important thing to do when you experience shin pain is to reduce your running training to give your shins a rest. You can try low impact cross-training activities like swimming or biking to maintain your fitness while your shins heal. Icing the affected area to reduce inflammation is also a good early step. Introducing new stretches like tracing the alphabet with your foot while in a seated position can also help. Beyond that, you will need to book a consult with a sports medicine professional to confirm proper diagnosis and treatment.

If painful shins are affecting your distance running training, please come and see us. We’d love to help you hit the road again!

Do I have to be an athlete to see an Athletic Therapist?

by Lauren Orser, Athletic Therapist, Concussion North

Absolutely not! Athletic therapists treat a wide range of people, from professional and amateur athletes to active adults, teens and children to anyone who has sustained a musculoskeletal injury. It doesn’t matter where or how an injury occurred, if it involves muscles, bones or joints, an Athletic Therapist can help.

We have specialized training in on-site emergency care and we’re often the first to respond when someone gets hurt during a game. Athletic Therapists are experts at injury assessment so we’re a great resource to have standing by to support your team. We also have extensive experience in taping, bracing and various rehabilitation therapies so we can help you stay mobile and active while you get back to your regular activity level after an injury. It’s this combination of on-site treatment at sporting events and after-injury rehabilitation skills that make us really good at treating you when you’ve strained a muscle lifting a box, bruised a bone due to a fall or twisted a knee while playing hockey.

Athletic Therapy is covered by some insurance plans. Insurance companies that provide coverage in Ontario include:

• Great West Life
• Standard Life
• Blue Cross
• Desjardin
• Claim Secure
• Sun Life
• Manulife
• Empire Life
• Greenshield

There are also some organizations that provide coverage for Athletic Therapy treatment. Here is a partial list:

• Hockey Canada
• Ontario Hockey Association
• Ontario Soccer Association
• Ontario Football Alliance
• Ontario Baseball
• Alpine Canada
• Snowboard Canada
• Judo Canada
• Canadian Ski and Snowboard Association
• Ontario Volleyball Association (listed as physiotherapy but Athletic Therapy accepted)
• Ontario Speed Skating Association
• Ontario Slo-Pitch Association (listed as physiotherapy but Athletic Therapy accepted)

We encourage you to verify with your insurance company that your services will be covered prior to receiving treatment. Many insurance companies will actually approve Athletic Therapy if you call and request it.

If you have any questions about how an Athletic Therapist might support you or your team, we’d be happy to chat. Give us a call at the clinic to book a consultation. 

How do I stay active when I'm struggling with knee pain from osteoarthritis?

By Dr. Marnie Lavigne, Sports Medicine Physician, Concussion North

I get this question a lot, especially from older patients and women, who tend to receive osteoarthritis diagnosis more than men.

Osteoarthritis (or OA) is a common condition that affects the cartilage, the rubbery cushion covering bones in the joints that keeps them flexible. Over time, the cartilage begins to stiffen and damages more easily and gradually loses its "shock absorber" qualities. Bones start rubbing against each other and the discomfort begins.

While there is no cure for osteoarthritis, there are many ways to manage symptoms and stay active after you receive a diagnosis. Physiotherapy can help decrease pain and swelling and strengthen the muscles around the knee. Weight loss is also important to decrease the load through the knee. Certain braces can also be helpful.

Oral pain relief and topical medications can be used for pain management. It's best to consult your doctor about the options that will work best for you. Injection therapy, such as an anti-inflammatory called cortisone or a medication called viscosupplementation, can also provide pain-relief and improve function by delivering the medication directly to the joint that needs it.

If one (or both) of your knees is now painful during the activities you've always enjoyed, make an appointment with a Sports Medicine doctor. We can help determine a treatment plan and connect you with other practitioners who can help with diet and exercise programs that will keep you active and well.

The questions raised by the movie "Concussion"

By Dr. Shannon Bauman, Medical Director, Concussion North

Last week, the Concussion North team went to see the new film Concussion. The movie stars Will Smith as Dr. Bennet Omalu, the physician who has been credited with finding evidence of CTE (Chronic Traumatic Encephalopathy) in the brains of deceased NFL players.  

According to research at Boston University, “Chronic Traumatic Encephalopathy (CTE) is a progressive degenerative disease of the brain found in athletes (and others) with a history of repetitive brain trauma, including symptomatic concussions as well as asymptomatic sub-concussive hits to the head.”

Not surprisingly, we’ve been getting a lot of questions about CTE since the Concussion movie came out, especially from parents concerned about the value of contact sports and the long term impact concussion injuries might have on their children. These are important questions to explore and address so I wanted to share my perspective as a sports medicine physician:

Sports support health. I believe strongly in the positive benefits of participating in sports. There are numerous health benefits for people of all ages, including cardiovascular fitness, a healthy BMI (body mass index), reduced insulin resistance, management of high cholesterol and hypertension and the reduction of symptoms associated with migraines, osteoarthritis, depression and anxiety and fibromyalgia. Playing team sports also leads to improved self-esteem, increased confidence, leadership skills, discipline and a sense of belonging.

Safe participation is key. As a community, we need to encourage safe participation in sports and recreational activities. This includes working with sports organizations, coaches, parents, schools and athletes to develop protocols that will keep sports safe. We need to:

• Establish and maintain environments that facilitate safe play;
• Ensure rules of the game are respected and enforced;
• Provide education to that will create awareness of sports-related injuries, including concussions; and
• Ensure there are procedures in place to help parents, coaches and family physicians recognize concussions and refer them to proper specialized medical support and care.

Concussions are serious. Concussions are brain injuries and they need to be taken seriously. An athlete needs to report a head injury to a coach or parent immediately. This is not the time to try and “push through the pain" or "tough it out”. A concussion is a medical diagnosis so an injured athlete needs to be seen by a medical doctor promptly after an injury occurs.  The good news is most concussions resolve within two or three weeks. If concussions symptoms persist beyond two weeks, an athlete can be referred to a physician with a specialty in concussion care for treatment and support.

Preventing long-term damage requires short-term patience. A well-managed concussion is the best prevention against ongoing chronic effects of a concussion. While science may not yet know how many concussions are too many, we do know that the prompt diagnosis and treatment of concussions are crucial. Returning to sport before a brain has fully recovered is dangerous. It can lead to prolonged recovery and in some cases, a fatal outcome. An athlete may appear “fine” and a parent or coach can feel strongly that a player is ready to resume play. But determining a return-to-sport clearance is a medical decision that can only be made by a physician (MD) with expertise in concussion treatment. The right diagnosis at the right time followed by the right treatment matters. It can be the difference between life and death.

Each concussion is unique. No two athletes are alike and the same is true for their concussion injuries. Every concussion results in a different constellation of symptoms that are experienced in very specific ways unique to each person. To facilitate complete and sustained recovery, an athlete needs an individualized, medically supervised treatment plan that will identity each aspect of their concussion so the injury can be addressed in an integrated way.

So, do the benefits of playing sports outweigh the risks? Yes, in a general sense, they absolutely do. But if you or your child is struggling with a concussion, the decision to return-to-play is one you have to make in consultation with a physician-led health team that specializes in concussion care. This is the best way to minimize the long-term effects of sports-related brain injury.

If you have any questions about concussion prevention, testing or treatment, don’t hesitate to get in touch with us at clinic. And if you’d like to know more about CTE, I recommend this excellent article: On Concussion: Separate Hype from Science.