Strength and Power Training for Endurance Athletes

Most endurance athletes hate lifting weights. I know, I was that person. I had endless reasons why I would avoid strength training, but my greatest barrier was that I didn’t want to give up an endurance training session for a weight training session. And when I did get around to doing some leg weights, I wasn’t lifting heavy. At that time in my life I didn’t understand how strength training both improves fitness and prevents injury, so you can get more out of your endurance training sessions. Given the recent research on strength training with endurance sports, and what I have learned about injury prevention and rehabilitation, it is something I wish I would have started way back when I started running. In this blog I address the most common reasons why endurance athletes avoid strength training, and provide counter arguments for why they should be.

Top 4 Reasons Endurance Athletes Don’t Strength Train (And Why They Should)

1.  It’s boring.

Though I can’t influence what you find entertaining, I can sympathize that most endurance athletes find strength training to be boring. However, often if you dig a little deeper into this argument, these individuals have chosen a boring strength training regime. You have to incorporate proper periodization into strength training. As well, including power training and sports specific conditioning will both increase the benefits of the session and the diversity of the exercises.

Terminology Hack:

Periodization is the natural cycles in your training.  Consider for example, a marathon training program. Besides slowly increasing your long runs, you will also complete a sequence of hill repeats, speed work, and various tempo runs, all interspersed with strategically positioned recovery runs and low volume weeks.  Your strength training should follow a similar progression, changing weekly in weight, lift types, reps, volume, tempo and speed work. If you routinely lift the same weight for the same exercises with the same set and reps scheme, it is no wonder you are bored!

Power training is where things really get fun. If you are an athlete that has ever used watts to train or measure performance, then it shouldn’t be a stretch to understand that using strength training to increase your power output will benefit performance. This style of training includes traditional power lifting (squat, deadlift and bench press), olympic lifting (clean and jerk, snatch), and various explosive and agility exercises. Personally, I was surprised how satisfying it is to nail a clean, or finish a set of heavy back squats. Don’t let learning these lifts intimidate you. With the growing popularity of CrossFit, it is easy to find coaches familiar with teaching proper technique for power and olympic lifts. And it doesn’t have to be expensive one-on-one coaching either. Most CrossFit gyms have weekly classes dedicated solely to lifting technique, so you can drop in and take a few. CrossFit takes pride in its community culture, and these gyms typically have a very welcoming atmosphere, so I’m confident they will be happy to help you out.

Sports specific conditioning is any single exercise or group of exercises that are formatted to mimic your sport’s specific demands.  What these exercises look like and target varies greatly depending on the sport, and are only limited by your imagination.  I have seen some really inventive adaptations to challenge all kinds of athletes. Besides the obvious benefit of training to the demands of your sport, making your strength training as sports specific as possible has the extra benefit of mimicking the sport you already enjoy, so you will likely find it fun as well as beneficial.   

Taking my own advice.

2. They don’t want to get bulky.

This is a reasonable concern for serious endurance athletes as extra weight is extra load to carry on your race. However, you can actually tailor your strength training to limit or even prevent muscle mass gained from strength training, while still improving your strength and power output. (1,2,3) Want an example? Consider doing 1x20 back squats at 60-65% of your 1 rep max. It’s heavy enough to get the desired strength gains, but not enough reps to ‘bulk.’

Terminology Hack:

Your 1 rep max is the maximum weight you can lift for a single rep for that movement.  It’s extremely useful to know when building and progressing personalized strength training programs. However, this is a heavy lift to test, the heaviest really, so I would suggest doing it with a buddy or trainer so you have someone to help or spot you.

3. They don’t have time.

This myth is backed by many reasons, but can usually be broken down to a belief that time spent strength training will not provide as much benefit to sport performance as more endurance training.  However, research has consistently shown strength training to improve running economy, time trial results, and race performance.(3,4,5)  It does so by improving your body’s load capacity and power output.(6)  This means your body can work harder, for longer without hitting a wall. So, if you have time to train three or more days per week, dedicating at least one of those days to strength training is likely to improve your overall fitness, even more so than adding in another endurance workout. 

4. They feel running/ cycling is strength training for legs.

Aerobic exercise or endurance training is not strength training, sorry. The exercise your body gets from endurance training does not prepare your muscles for even the base strengthen required for your daily requirements for lifting and moving, never mind the taxing repetitive strain of endruance activity.  The highly repetitive nature of endurance activity is wearing on muscles and tendons, easily leading to injury.  When this occurs, guess what your rehabilitation will be focused on? Yup, strength exercises.  The stronger you are, the more load your body will tolerate. So why wouldn’t you include strength training as part of your regular fitness regimen and help prevent injuries from occuring in the first place? 

Do yourself a favour, and include some weekly strength training and power lifting in your training schedule. It will help you push your performance potential and enjoy your favourite activities injury free. And who knows, you may actually enjoy it ;)

References

1. Rønnestad BR1, Hansen EA, Raastad T. Effect of heavy strength training on thigh muscle cross-sectional area, performance determinants, and performance in well-trained cyclists. Eur J Appl Physiol. 2010 Mar;108(5):965-75. doi: 10.1007/s00421-009-1307-z. Epub 2009 Dec 4.

2. Mujika I, Rønnestad BR, Martin DT. Effects of Increased Muscle Strength and Muscle Mass on Endurance-Cycling Performance. Int J Sports Physiol Perform. 2016 Apr;11(3):283-9. doi: 10.1123/IJSPP.2015-0405.

3. Yamamoto LM1, Klau JF, Casa DJ, Kraemer WJ, Armstrong LE, Maresh CM. The effects of resistance training on road cycling performance among highly trained cyclists: a systematic review. J Strength Cond Res. 2010 Feb;24(2):560-6. doi: 10.1519/JSC.0b013e3181c86583. 

4. Beattie K1, Kenny IC, Lyons M, Carson BP. The effect of strength training on performance in endurance athletes. Sports Med. 2014 Jun;44(6):845-65. doi: 10.1007/s40279-014-0157-y.

5. Vikmoen O1, Rønnestad BR2, Ellefsen S2, Raastad T3. Heavy strength training improves running and cycling performance following prolonged submaximal work in well-trained female athletes. Physiol Rep. 2017 Mar;5(5). pii: e13149. doi: 10.14814/phy2.13149.

6. Beattie K, Carson BP, Lyons M, Kenny IC. The Effect of Maximal- and Explosive-Strength Training on Performance Indicators in Cyclists. Int J Sports Physiol Perform. 2017 Apr;12(4):470-480. doi: 10.1123/ijspp.2016-0015. Epub 2016 Sep 6.

When can I start exercise after an injury?

You're injured. Don’t worry it happens. You are pretty much guaranteed to experience injury at some point if you live an active lifestyle. Don’t let it discourage you though.  The benefits of exercise far outweigh the detriments of being inactive. Let’s assume you played it smart and took some time off training to rest and recover. But how do you know when it’s safe to start training after an injury? There is no specific timeline for this, but there are some simple guidelines to get you back to the activities you love.  I’ll cover two points here: how to safely return to activity, and how to know if you have ‘overdone’ it.

Before we get into these, it is important to note that you want to be out of the inflammatory stage of tissue healing before beginning a progressive return to activity.  This initial stage of healing is very recognizable with its constant, unrelenting pain.  It typically lasts from 3-14 days, though this can vary.  If you are ever in doubt of your stage of tissue healing, or your body’s ability to being a progressive return to activity after an injury, consult a health care professional.

Guidelines for return to exercise

When you are ready to start training after an injury, there are three guidelines to avoid doing too much too fast. These guidelines apply to all activities, even things that you may not have considered physical activity prior to your injury, think getting groceries, mowing the lawn, or cleaning the house. They will also apply to activities you are doing as stepping stones to your usual workouts (example: biking with the goal to get back to running).

1. Don’t add more than one new activity, or exercise at a time.  This includes everything that you have been modifying or avoiding because of your injury.  Pick one that seems gentle to start, try it, and monitor the effects. If it goes well, pick another one and repeat.

2. Take a day off in between workouts to evaluate the effects on your body.  If you have ever pushed a muscle group to its limits, you will have felt the two day soreness known as DOMS or Delayed Onset Muscle Soreness. DOMS is felt one or two days after a hard workout. Considering this delayed effect, it is best to take it easy two days after introducing a new activity. This will allow you a chance to fully evaluate its impact on your body before you try adding another one. It’s the safest way to make sure you don’t do too much too fast, which can cause relapse or reinjury.

3. Don’t change more than one variable at a time.  Such variables include frequency of the activity in days per week or times per day, intensity, duration of the workout session, and type of activity (including how many exercises you are doing at once).  Example: let's say you started with running 20 minutes easy, 2 times in one week.  You were happy with how it went, so you want to increase your training next week. Considering these return to sport guidelines, you have a decision to make. The next week you could: run 25 minutes 2 times, run 20 minutes a little harder, run 20 minutes at the same intensity 3 times, or run an easy 20 minutes 2 times plus an additional 15 minutes swimming as a third workout. In most cases, which scenario you pick is often up to you, and will depend largely on what is most important to you.  Would you be happier running less frequent but a bit harder because it is killing you to run super slow? Or would you be happier running a bit longer or more frequently. If your health care provider has left it up to you, you get to follow your heart. 

How to know you have “overdone it”

This part is usually pretty easy. Your body will tell you when you are overdoing it, just monitor for these signs:

1. Pain during the activity. When you start back to an activity, don’t expect to feel no pain at your injured area. It’s OK if you do feel a bit sore. This is a sign the injury is being stressed in a good way, which promotes tissue healing.  But don’t let the pain get very high, no more than 2 out of 10  (0 being I feel nothing, 10 being very extreme pain). If the pain starts to get more than a 2/10, stop, you are done being active for the day.

2. Pain after the activity. Let’s say you felt nothing during activity, but you started to feel the pain after. Again, that’s OK as along as it doesn’t last more than 20 to 30 minutes, and the pain doesn’t get too intense (think more like a 3 or 4/10).  If the pain settles down quickly, then we would still consider the activity a success, and you could proceed with your slow progressions back to activity as in point #3 above.  If the pain lasts longer, becomes more intense, or gets worse as the day goes on, then you overdid it. Take a couple days to recover, then decrease one of the variables from point #3 above, and try again.

3. Stiffness the next morning.  In this instance, you may not have felt any pain during or after your activity, but the injured area is tight or stiff when you get out of bed the next morning. Morning tightness or stiffness is a sign that you stresses the injured area. This is required for strengthening the injured tissues, so some morning stiffness is acceptable up to 15 minutes. Anything longer than that is a sign you overdid it the day before, which will including your hobbies, work, and regular household tasks. Often what happens when a person starts feeling better after an injury is that they don’t just start back to their workouts, they start back to their life, and the combination can occasionally be too much. If this happens, take a couple days to rest and try again.  It could also be helpful to keep an activity log to know exactly how much you did each day so you can look back and modify as needed.

Returning to activities after an injury is often a slow process. Exercise your patience along with your body.  Remember, setbacks happen. It is seldom a linear progression. Don’t let this deter you from your goals.  Ultimately, persistence pays off and you will get back to doing what you love.

Will Dry Needling Work For My Injury?

You are recently injured (or chronically injured), and one of your colleagues mentioned you should try dry needling.  You may be wondering “what is dry needling?” (See my blog post on how dry needling works)  Or maybe you are willing to try anything if it works, but want to know “will dry needling work on my injury?”

Functional Dry Needling (FDN), Trigger Point Dry Needling (TDN), or Intramuscular Stimulation (IMS) involves the insertion of a thin, filament-like needle past the skin and into muscle tissue. There are two main objectives with dry needling, depending on the nature of your injury.  If the muscle is tense or tight, such as with a strain or trigger point, it can reset the muscle back to its regular resting muscle tone.  If the muscle is under-active, or has trouble contracting, the twitch response can help get the muscle firing again.  You can think of this twitch like a computer reboot for your muscle.

Because dry needling has two types of effects, there is a wide range of conditions it can help with.  Some examples are muscle strains, muscle spasms, tightness, trigger points, tendon injuries, referred pain, muscle tightness that is compressing a nerve, unstable / loose joints, and chronic pain. 

How many sessions you will need depends on the cause of the injury.  For example, if you fell off your mountain bike, and it caused a muscle spasm in your back, it may take only one or two sessions of dry needling to resolve the issue.  Since it was an isolated event that caused the injury, you likely won’t require much treatment beyond those two sessions (note: dry needling should be used in combination with other treatment techniques.  In this example, you should use a personalized home exercise program at a minimum to help you recover to your full abilities). In another example, if you are repeatedly lifting weights wrong at the gym, or holding your toddler wrong, and the bad technique is causing some muscle tension or strain, you may get relief from the pain with one or two sessions of dry needling, but you will also need to fix the lifting or carrying problem and even out any muscle imbalances before you will resolve the pain completely.  Note that in both examples you will notice changes in one or two sessions of dry needling.  Yes, it is that instantaneous.  If you don’t feel a change with dry needling after 2 or 3 sessions, it likely isn’t going to be the treatment technique for you. 

If you have chronic pain, dry needling will not resolve your pain; however, it may be used as part of your pain management strategy to help you cope.  Physical therapy best practices for chronic pain should focus on movement, exercise, education, and techniques that provide useful strategies to address fears, build activity tolerances, and improve quality of life.

Dry needling can work like magic for some people, it should not be used in isolation, and will not work for all people or injuries. Speak to your doctor and physical therapist to see if dry needling is a treatment technique that could help your recovery.

Slips or Falls on Ice and Snow: Should you go to emergency, see a doctor, or consult a physiotherapist?

Winter is upon us, and with of all of this ice and snow, inevitably falls happen.  What should you do after a fall? See a doctor? Get an x-ray? Go to a physiotherapist?  There is no sure answer to that, but here are some guidelines to help you make a decision. 

When to go to the hospital emergency room (ER) after a fall

The most serious consideration after a fall is whether or not you hit your head. Smacking you head won’t always result in injury, but even a seemingly minor bump can suddenly turn into a life-threatening emergency. If you hit your head during a fall, go the ER immediately if you experienced one or more of:

     -  loss of consciousness

     -  seizure

     -  excessive bleeding that won’t stop with pressure applied for more than 15 minutes

     -  vomiting, especially if you vomit more than once, including several hours after the accident

     -  amnesia or memory loss

Symptoms may develop within the first 24-48 hours after your fall that should also be taken seriously. Go to the emergency room if you develop:

     -  an intense headache like you never had before

     -  difficulty breathing, have a feeling akin to a lump in your throat, or difficulty speaking or finding your words

     -  you start vomiting

     -  lose balance, coordination or control

     -  you lose or fade in and out of consciousness

There are reasons you should see a doctor if you fell and hit your head that do not require emergency medical attention, but more on that in the When to go to a clinic or see your family doctor after a fall section.

The most likely reason you will need to go to the hospital after a fall is if you have broken or fractured a bone.  Hospitals will do an x-ray and treat the break accordingly. Go to the ER if:

     -  you are unable to put weight on your injured side immediately after the fall

     -  your limb is obviously misshapen

     -  you have low bone density and are at high risk of fractures

     -  severe, unrelenting pain (this may not be indicative of a broken bone but it is best to rule it out after a fall)

     -  you are unable to move the injured body part

This is not an inclusive list.  When in doubt, error on the side of caution and go to the emergency room.

When to see your family doctor after a fall

There are lots of reasons you may require medical attention after a fall that aren’t medical emergencies.   Some reasons to go to a walk in clinic or see your family doctor will include:

     -  strong or lingering pain

     -  obvious swelling in a painful area

     -  dizziness, nausea, or vertigo

     -  headaches

     -  feeling weak, fatigued, unbalanced, or unsteady

     -  visual disturbances

     -  ringing in the ears

     -  if you hit your head and you are older than 65

     -  if you hit your head and are on blood thinners

Generally if you hit your head it’s a good idea to get check out by a family doctor within the first couple days.  A family doctor will examine you for signs of whiplash or concussion.  Family doctors will manage your incident and be your gateway to medication for pain management, imaging, and referrals to other health care providers. It is always a good idea to keep your family doctor in the loop. 

Do not underestimate the importance of pain management.  Fighting through excessive pain can alter the way your entire body perceives pain, and may contribute to difficulties with chronic pain.  Don’t be a hero, seek help if you are in pain.  And as always, error on the side of caution and consult a family doctor if you are unsure.

What you can do for yourself

In the absence of a medical emergency, much of the initial pain after a fall will be due to inflammation.  Treatment for acute or recent injuries is not overly complicated.  For the first few days:

     -  rest your body

     -  avoid any aggravating positions or activities

     -  ice the painful area 10 -15 minutes at a time for temporary pain relief.  You can ice often so long as you take an hour or two off between icing.  Ice or snow in a zip-lock bag will give you the best results.

     -  use a tensor to wrap, or brace or sling as required

     -  use a cane or crutches to avoid limping if you can’t put weight on your leg

     -  take pain medication or anti-inflammatories as required

When to see a physiotherapist after a fall

A week or two after a slip or fall is a good time to consult a physiotherapist. A physiotherapist can assess the injured areas and determine what has been aggravated and the extent of the damage. Your physiotherapist will use hands-on manual therapy and prescribe individualized exercises to help relieve pain, restore movement, and get you back to what you love doing.

As an important last point, any past injury can you put you at risk of re-injury.  Even if your pain was resolved, you may have residual weaknesses or imbalances from the experience which can put you at risk of injuring the same area again.  That’s why after any fall it is best to consult a physiotherapist to assess your strength, range of motion, and functional movements to help avoid any future issues.

So if you have experienced a slip or fall on the ice and snow, use the medical system and our knowledgeable health care providers to assist in your recovery.  We are here to help.

Exercises for Sciatica

As a physiotherapist, it’s a common occurrence to have someone walk into my office and tell me they have sciatica. Somehow ‘sciatica,’ the medical term for pain caused by the sciatic nerve, became an umbrella term for any pain that travels down the back of the leg.  In actuality, several different body structures or tissues can cause pain to refer down the leg, not just the sciatic nerve.  The problem is they all require different, often opposite, treatment. If you are experiencing leg pain and decide to Google ‘exercises for sciatica’ you can easily end up with exercises for the wrong diagnosis, and make your problem worse. Here are 5 distinctly different causes of sciatica pain patterns, and how to decide which exercises for sciatica are right for you.

1. Sciatic Nerve.  Let’s start with something familiar, the sciatic nerve.  This is a large nerve that starts in your buttocks and runs down the back of the leg.

Sciatic nerve pain is extremely intense, and can include: numbness, tingling, pins and needles, weakness, loss of sensation, or any combination of these symptoms.

Treatment for sciatica will depend on what’s causing the nerve irritation.  Typically, nerves get irritated because they have or had to much compression. Treatment will depend on what caused the compression and this can be tricky to distinguish. If you have nerve irritation of any kind it is best to consult a knowledgeable physiotherapist to get the best combination of treatment and exercises to resolve the issue. 

Here is one common exercise for nerve irritation called nerve flossing: 

Lay on your back and bring the knee of your affected side towards your chest. Hold your foot flexed while you bend and straighten your knee as much as possible without causing pain or other symptoms.  Do 15 reps slowly and smoothly with no holds. Repeat 2-5 times per day.

Note: This exercise is meant to be done pain free.  If it causes the pain or numbness in your leg to be exaggerated, stop the exercise and discuss it with your physiotherapist.

2. Facet Joints.  Facet joints are small spinal joints where two vertebrae meet.  In your lower back these are called lumbar facet joints.  These joints can get injured in a number of ways, often from forced compression or too much load which jams the joint surfaces together.  When lumbar facet joints get irritated they can refer pain into the gluts, hips, and occasionally down the legs.

These injuries usually have a directional preference for exercises and reliving positions.  In this case it is usually flexion-based or ‘joint-opening’ exercises.  You can find relief by using flexion-based bending exercises to take the pressure of the irritated joint surfaces. Here is one example of a gentle flexion based exercise:

Lay on your back and bring both knees to your chest.  Hold 30 to 60 seconds.  Repeat 2 -5 times per day.

Note: This exercise should always relieve symptoms, never exacerbate them.  If you find this exercise is making your pain or symptoms worse you may have a wrong or incomplete diagnosis. Stop the exercise and consult your physiotherapist.

3. Sacroiliac Joints (SIJ). The SIJ are a pair of joints that are part of  your pelvis.  The pain associated with these joints are most commonly found in the lower back and pelvis, but can refer all the way down your leg and into your foot. 

Treatment for this joint commonly involves mobilizing the joint to create good movement, and core exercises to stabilize it.  One exercise to mobilize the SIJ goes like this:

Place the foot of your affected side on a chair. Rock your hips forward and back into a lunge while keeping your body upright. Repeat this 15-20 times as a slow, rhythmical movement.

This exercise should be done every hour or two to keep the joint moving.  Do not perform this exercise through pain.  It should be relieving or neutral, but not irritate your symptoms.

If the SIJ is inflamed it can be very tricky to find the right combination of treatments to settle it down.  Once again it is best to consult a physiotherapist. 

4. Muscles. All muscles in the body can have painful tense spots called trigger points. Trigger points are hyper-irritable muscle fibres that have a problem with their neuromuscular system (the neuromuscular system is basically the connections between your brain, nerves, and muscles to create movement).  Trigger points commonly have referral patterns associated with them.  As you might have already guessed, the muscles of the low back and hips commonly refer pain into your bum, down the back or side of your leg, and commonly into the foot. 

It often surprises people to learn their leg pain is caused by muscle irritation as they don’t realize a muscle injury can be so debilitating.  If you have muscle trigger point pain, you will benefit from rolling.  Here is how to roll your glut muscles.

Sit on the floor with your knees bent and your affected side on a small sports ball (tennis ball or lacrosse ball will do).  Find the sore spot and stay stationary on it for 15-20 seconds.  Move only slightly and repeat.  Do not roll sporadically on the ball. Do this for 1-5 minutes every day or every second day.

Make sure not to ‘over-roll’ a trigger point.  There is a difference between rolling a trigger point and rolling an inflamed muscle.  The former feels more like an intense but reliving pain and you should feel better when finished.  The latter feels more like you are pressing on a bruise and can actually increase your pain.  If you feel you have over-rolled a muscle, take a few days off rolling and consult your physiotherapist to review rolling technique and revisit your diagnosis.

5. Discs. Intervertebral discs are the donut looking structures that are stacked between each vertebrae to make up your spinal column.  Injuries to these structures involve tearing, bulging or ruptures to the outer fibers of the disc. 

These injuries can result in pain down one or both legs. Disc injuries also tend to have an extension directional preference. You can use this preference to treat the injury and alleviate symptoms.

Lay on your stomach,  keeping your back relaxed do a mini push-up using just your arms.  Hold for 1-2 seconds, and repeat 10 times every few hours.   Do not push through pain.  This exercise should always be relieving.  If you are experiencing pain while doing this exercise, stop and consult a physiotherapist before continuing.

It takes quite a bit of knowledge and clinical experience to differentiate between causes of leg pain and prescribe the correct treatment.  The exercises given for one person with leg pain referral might be the exact opposite for another, despite there being a similar pain pattern.  Choosing the wrong treatment for leg pain can not only worsen your pain, but prolong the agony.  So don’t rely on Google to tell you how to resolve your sciatica pain.  Consult a local physiotherapist to help you decide what treatment is right for you.

Tips for Staying Consistent with Exercise while Traveling

As a physiotherapist, I spend a good part of each day discussing the importance of exercise. Physiotherapists use home exercise programs not only to decrease pain and help rehabilitate injuries, but to encourage people to take responsibility for their own health. The importance of exercise is generally not a hard sell, the hard part is committing to exercise. I get it though. Once you account for sleep, work, and the necessary survival tasks for yourself and your family, there is little time left for the finer things in life.  These few fleeting moments of  ‘me time’ can be even more precious while traveling, regardless if you are away for work or pleasure.  As someone who loves spending time abroad and advocates for more of it, here are a few tips to help you stay consistent with your rehab or fitness program while traveling.

1.     Make sure your exercises are ‘portable’.  This will address the issue of accessibility while traveling.  Trust me, I have seen more than my fair share of small accommodations both locally and internationally.  Limited space or lack of equipment can be an easy excuse to not do exercise.  It is best to plan for the worst and keep your requirements for space and tools small. This isn’t as difficult as you think.  First, ask for a physiotherapy exercise program simple enough to do on the floor or bed of a small hotel room, using no more equipment then you can take with you in the little remaining space of your carry on luggage (resistance bands and mobility balls work well here).  If you are creating your own travel workout program, keep these same stipulations in mind.  Plan on going for a walk or run (requiring only a light pair of shoes) or doing a small room high intensity training (HIT) workout (try 100 push-ups, 200 sit-ups, 300 squats for time). Have at least a few workouts ready requiring no equipment and space no larger than the width and length of your body.

2.     Plan to do your exercises at your preferred time of day.  Everyone has a time of day where they feel their most energetic.  This could be the morning, afternoon, or evening, and you likely already know where you naturally fit.  Personally, I am a morning person. I prefer to get up and do my workouts first thing.  I know myself well enough that if don’t get my exercise done in the morning, it isn’t happening at all.  This is a daily occurrence for me, and traveling is no different. So I plan to wake up 30 -60 minutes early to get my mobility or fitness done before the chaos starts.  For others, this may mean staying up 30 minutes later or scheduling a break in the day to do some exercise.  Either way, knowing your natural tendencies will increase your chances of being successful.   Plan to exercise, schedule it in, then execute your plan.

3.     Recruit a friend. When it comes to motivation, there is definitely power in numbers.  You actually might be surprised how easy it is to recruit workout partners.  As I previously mentioned, people understand the benefits of exercise, that’s not a hard sell.  However, the motivation to get it done when you are out of your normal routine is challenging for everyone.  If your travel companions know you are putting time aside to exercise, they might be interested in joining you. Accountability can then be built in – try if one person backs out, then lunch is on them, or if someone is more than 15 minutes late, they owe you a coffee.   So don’t be shy to lean on each other and just get it done.

4.     Be mindful of the give and take of traveling.  Travel often involves unfamiliar foods that are higher in calories, larger portions, and social drinking to boot.  And why not!? You should treat yourself and enjoy some local cuisines and different culinary experiences while on the road.  However, the guilt associated with over-consumption can take its toll on you both mentally and physically.  It’s helpful to adopt a +1/-1 philosophy in these instances, and try to even out over-consumption by doing something healthy for your body.  This can be as simple as spending some time stretching, going for a walk after dinner, or getting your physio exercises in for the day.  It will do you some good both mentally and physically knowing you aren’t completely neglecting your health.

(check out the fresh rats!)

So if you are out enjoying the world, or living out of a suitcase for work, don’t let the break in your regular routine impact your progress.  Present your best self to the world by staying consistent with your physical health.

Video Blog: How to properly lift a canoe without hurting your back

Amy Fahlman, a CAMPT-Certified physiotherapist, talks about how backcountry canoe camping is an excellent way to decrease stress and improve your mental health. However, if you don't lift a canoe properly you risk back injuries or making an existing back issue worse.

Physio In Your Pocket: Rolling the Foot to Relieve Foot Pain during CrossFit

Amy Fahlman, a CAMPT-Certified physiotherapist, talks about one of her passions CrossFit and how Plantar Fasciitis, foot pain, or foot cramping is a common condition as a result. In this video, Amy explains how to properly roll the foot to help relieve CrossFit foot pain and camping.

Video Blog: Shoulder Pain and CrossFit

Amy Fahlman, a CAMPT-Certified physiotherapist, talks about one of her passions CrossFit and shoulder pain or shoulder strain that may result. In this video, Amy will explain why CrossFit shoulder injuries can happen and how physiotherapy, manual therapy and exercise can help. 

When you need a physiotherapist

Most people over the age of 30 can relate to experiencing random pain when doing a certain movement.  Maybe it’s when you bend down to tie your shoes, checking your blind spot while driving, or pouring your morning coffee.  Stranger yet, it seems to have started for no apparent reason.  You didn’t slip and fall.  You didn’t hurt yourself.  You didn’t even do anything different than you usually do.  Yet sure enough, there it is and it doesn’t seem to be getting any better.   Well you are not alone, and I know exactly what to do about it.

This is when you should see a physiotherapist (or physical therapist if you prefer as they are different titles for the same profession).   You may have always wondered what a physiotherapist does, but never had a reason to look into it further.  Physiotherapists will analyze the cause of your pain and work to resolve it.  Our goal is to help you recover from an injury and give you tips to prevent it from coming back.  This is best achieved by identifying problems with your movement.  We then work to solve these movement issues with techniques such as hands-on therapy to reduce stiffness and improve mobility, and a personalized exercise program to improve strength and flexibility where you may be lacking.  Think of a physiotherapist as a movement analyst.  Our job is to resolve your pain issues and keep you active in the things you love doing.

So why might you see a physiotherapist?  When your back hurts while sitting, your shoulder hurts too much to sleep on your side, you sprain an ankle, or your knee is causing pain when you run.  These are just a few common examples, and there are many more aches, pains, and injuries physiotherapists treat.  By the way, it’s never too late or too early to see a physiotherapist.  There is good research to say you are likely to require less pain medication, fewer trips to your family doctor, and fewer treatments sessions from a physiotherapist if you start within the first month of your pain; however, you are always likely to benefit from consulting a physiotherapist regarding your movement problems. 

Maybe you aren’t sure if you should see a physiotherapist or another health care provider.  It’s not uncommon to see both a physiotherapist and massage therapist, or a physiotherapist and a chiropractor at the same time.  These are just a few possible combinations of health care practitioners you may decide to have as part of your health care team.  It is important to note you can over-treat a problem so ask your health care provider if it makes sense to see more than one practitioner at the same time.

Here is what a few other professionals said about referring their clients to physiotherapy:

“I believe a referral to a trusted physiotherapist that is willing to cooperate is critical in the case of a client who has a previous injury or developed one. To make sure that I am doing the right thing, at the end of the day I am a Strength coach/personal trainer and not a rehab specialist, the scope must be understood despite all the confusion out there nowadays of “I know it all” trainers. Working in cooperation maximizes the safety and efficiency in a client’s training and progress. Two horses pull a cart faster than the sum of both horses’ power. The client will also recognize your care as a coach and appreciates your initiative.”

                                                                                    - Hussain Samhat, Personal Trainer

 “As clients go through their own healing and treatment processes, I have found it extremely helpful to refer them to a physiotherapist for concurrent treatment. The combination of techniques and treatments consistently result in the client receiving more variety of homecare exercises, wider range of treatment protocols, and often a shorter recovery time. The use of physiotherapy in conjunction with registered massage therapy treatments helps to address all angles of a clients injury or condition thoroughly.``

                                                                                                   - Elise-Marie Walsh, B.A. Kin, R.M.T.

“Coaching competitive and recreational athletes in CrossFit, physiotherapy comes up often in conversation. Whether to ensure longevity in the sport by having regular ‘check-ups’ to make sure everything is running smoothly, or to know what could be improved to reach your fitness goals faster and safer (and making sure we're not just constantly aggravating an old injury). I know that reaching out to a physiotherapist is essential to maximize results and improve your training experience.”

                                                                                                       - Simon Buteau, Crossfit Coach

"I have worked along side Physiotherapists for 15 years, and have learned to really respect and value their opinions and skills when it comes to patient care.  If my client's progress becomes static, or I feel she could use further assessment, a very detailed exercise program, or benefit from modalities or specialties the Physios in my office possess, I do not hesitate to refer to my colleagues. I often have physiotherapy treatment myself, and have had great results as well."
                                                                                                       - April Magnan R.M.T.

You aren’t likely to require physiotherapy on a continual basis.  It is a physiotherapist’s job to help our patients and send them on their way as efficiently as possible.

So next time pain or injury is holding you back, consult a physiotherapist.  We can help you achieve your movement goals. 

What is Dry Needling?

Have you ever had a friend come from physiotherapy and tell you they were treated with ‘dry needling’?  You might think to yourself ‘What is dry needling?’ or ‘How does dry needling work?’ or maybe ‘That sounds painful, why should I try dry needling?’ The truth is, dry needling can be somewhat painful (or not at all depending on your pain tolerance), but we wouldn’t be recommending this method of treatment if it weren’t effective. 

This post covers where dry needling came from, how it works, why it works, and the recent research to support it.

The terms Functional Dry Needling (FDN), Trigger Point Dry Needling (TDN), and Intramuscular Stimulation (IMS) are all used interchangeably.  Note that Acupuncture is not included on this list.  Acupuncture has roots in eastern medicine philosophies, while FDN is a western medicine practice.  Though both practices use the same needles, the training, application, and philosophies are quite different; therefore, not considered synonymous. 

Dry Needling involves the insertion of a thin, filament-like needle past the skin and into muscle tissue.  It is termed ‘dry’ because no substance is injected or fluids removed from your body.  The needles are blunt-typed and very thin, meaning they are quite comfortable.  There is little to no pain caused from the needle penetrating your skin.  However, chances are if you have heard of dry needling you have heard it is painful.  That’s because it is painful.  Though the needles themselves are relatively painless, the practitioner is trying to elicit a ‘twitch response.’   This is a cramping, almost spasm-like, reaction of the dysfunctional muscle tissue.  It is a very short but intense contraction, lasting less than a second.   Multiple twitches may happen before the muscle is fully released.  This is the response your therapist wants to produce, so in the example of dry needling, pain is a necessary evil.  Pain tolerances vary widely person to person, so how much pain you experience is really something you would have to see for yourself.  The whole experience is over in approximately 10 to 15 seconds per needle. 

So what exactly is happening during this twitch response?  Dry needling targets muscle trigger points.  Trigger points are hyper-irritable muscle fibers that represent dysfunction or problems in the neuromuscular system (the neuromuscular system is basically the connections between your brain, nerves, and muscles to create movement).  When you have trigger points in a muscle you may experience pain if you use that muscle to move, touch the painful spot, or sometimes even if you aren’t doing anything at all.  Trigger points have been shown to make ‘noise’ on an EMG, be visible under ultrasound imaging, react stiffly to a vibration stimulation, and have a different pH balance and neurochemical makeup than normal resting muscle fibers.  Trigger points also produce the characteristic ‘twitch response’ to stimulation – either by needle or by deep palpation.  This twitch response resets the muscle fibers to their normal resting state.  Think of it as rebooting a computer.  FDN is an effective way to reach the exact fiber and depth required to induce a twitch response required to remove the trigger point completely.

FDN is a relatively new technique, so there is currently limited evidence to support its use.  A systematic review was released in March 2017 looking at the effectiveness of FDN. (A systematic review is a comprehensive study that gathers all the best available evidence on a specific research question and statistically combines the results of each article.  This is powerful research and the highest level of evidence you can achieve as it evaluates all the current studies to answer a question, not just a single study on its own). This systematic review started by gathering the 200+ articles published on FDN, and analyzed the results of 13 chosen for their superior quality.  In short, the results of this study reported dry needling to have a positive effect on pain over control or ‘sham’ treatment as well as various other types of therapies for short time periods - up to 3 months.  However, there is no evidence to say FDN is better than other physiotherapy interventions when considering long-term results (6 -12 months).  FDN did still prove superior to ‘sham needling’ and control (wait and see if it improves with time) groups in the longer-term studies.The results of this study reflect my experiences in clinical practice.  Personally, I have found that if dry needling is going to work for you the results will be apparent in 1 to 3 sessions.  You can often notice a positive effect immediately after the treatment.  A positive effect would mean decreased pain and increased range of movement within the first few hours or days after treatment.  If you do not see a positive change within the first few sessions, then dry needling might not be the treatment technique for you.  It is also not the only way to achieve a positive effect.  There are other techniques a physiotherapist can use to release a muscle. Though in some cases dry needling can get a muscle released faster.  When you consider goals or outcomes over the long term there are always several ways you can successfully get there.  So don’t worry if you don’t like dry needling or aren’t comfortable trying it for any reason.  If you are interested in trying it, I have found it to work well on acute muscle pain such as: strains from the gym, muscle imbalances, or muscle tension from poor posture just to name a few.   I prefer to use this technique on athletic injuries in particular.  Currently, I incorporate dry needling into treatment for about 50% of my patients, and I have had very good success overall with the technique.  However, dry needling is not for everyone, and is just one tool a physiotherapist can use to obtain the overall goal of improving your movements and getting you back to your favorite activities.  Talk to your physiotherapist to learn more about the benefits of dry needling, and see if it right for you.

Amy Fahlman, physiotherapist downtown Ottawa

BSc PT, MCl Sc (manip), FCAMPT

1. Gattie, E., Cleland, J.A., & Snodgrass, S., (2017).  The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther. Mar;47(3):133-149. doi: 10.2519/jospt.2017.7096. Epub 2017 Feb 3.