Tag Archives: injuries

Cold therapy Sheddon Physio Sports Clinic Oakville Mississauga

Cold Schmold

As the temperatures drop and the snow accumulates, many individuals will slowly start to hibernate indoors and become less and less active. Outdoor exercise in the winter can become a challenge due to ice, snow and freezing temperatures. While the cold winter months aren’t for everyone, outdoor exercise and physical activity can still be enjoyed with some extra planning, winter-specific gear and layers. Common winter-related injuries include hypothermia, frostbite and cold- induced asthma, as well as injuries sustained while slipping and falling on ice.


            Hypothermia develops when heat loss exceeds heat production. Mild hypothermia is characterized by shivering, dizziness, nausea, quick breathing, confusion, increased heart rate, lack of coordination and fatigue. Coaches and athletes need to be aware of these signs and symptoms in order to prevent further injury. As moderate to severe hypothermia sets in, you will notice lack of coordination, slurred speech, slow-shallow breathing, weak pulse, drowsiness and confusion. Moderate-severe hypothermia can be life-threatening and requires immediate medical attention.

Risk Factors:

  • Energy depletion/fasting: Shivering is a protective response to produce heat through muscle activity. Food restriction and energy depletion have been shown to impair the shivering response, thus increasing the risk for hypothermia;
  • Lack of sleep/fatigue;
  • Wet clothing from sweat, wind, immersion in water and exercise in rain;
  • Low body fat – Athletes with a higher percentage of body fat can maintain core temperatures better than leaner athletes;
  • Age – People over the age of 60 and young children are both at increased risk for hypothermia.


Clothing: Clothing plays a major factor in the prevention of hypothermia. Layers are the best option in order to avoid overheating and prevent excessive sweating, while staying warm and dry. Your base layer should be lightweight polyester/polypropylene, which should not readily absorb moisture (cotton would be a bad choice for a base layer), but should wick moisture to the outer layers where it can evaporate. The middle layer should be polyester fleece or wool, which provides the insulation and warmth. The outer layer should be a shell, which will repel wind and rain and have venting to allow for moisture to escape.

Food and Fluid Intake: Surprisingly, all those extra layers, heavy gear and shivering can make you expend more energy compared to the same exercise done in warmer weather. Furthermore, dehydration in cold weather is common, since thirst is normally less noticeable in colder weather. Ensure adequate fluid and food intake prior to, during and after exercise.


Frostbite is most common in exposed skin, such as the nose, ears and cheeks, as well as the fingers and toes. The first sign of frostbite is numbness in the body part. While warming up of the area, people will experience pain, burning, tingling and aching. The skin will appear red, then turn white, with possible blisters, depending on the severity.

Risk Factors:

  • Inadequate clothing;
  • Wetness;
  • Tight boots or constrictive clothing;
  • Wind chill and cold temperatures.

Prevention: Windchill plays a major factor in temperatures below -27, whereby frostbite can occur in less than 30 min. Clothing is your best option for prevention with dry, warm clothing and layers being the most important. Mittens provide more protection than gloves. Also remember to keep your gloves, socks, scarves and hats dry. If exercise has made these garments sweaty and damp, you will be at an increased risk for frostbite. Have extra gear if you get wet or sweaty, or take off some layers as you start to overheat.

Cold-Induced Asthma

Cold-induced asthma is caused by a narrowing of the airways while exercising in cold weather. It can occur to individuals with asthma, as well as those who don’t have it, but are sensitive to changes in temperature and humidity. Symptoms include shortness of breath, tightness in the chest and coughing/wheezing.

Risk Factors:

  • Athletes working out at high intensities;
  • Athletes in indoor ice rinks.

Prevention: Although there are not many preventive measures, one way to help combat this issue is to wear a scarf that covers your mouth and nose in order to help warm the air before being breathed in.

Slips and Falls

Slips and falls on ice can hurt your ego and lead to a number of injuries, including broken wrists, pulled muscles and bruised tailbones. The icy/slippery sidewalks and roads can make outdoor exercise tricky. Make sure your footwear has good traction and grip. Be extra cautious, slow your pace and focus on the ground ahead. Adding some balance and proprioception exercises into your daily regime can also help keep you on your feet when you hit slippery terrain.


Young et al., 2006. American College of Sports Medicine position stand: Prevention of cold injuries during exercise. Medicine and Science in Sports and Exercise.

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Run Less, Run Faster

What would you say if I said that you could run less miles and get faster just by adding a couple of short high intensity interval workouts into your running program?

If you have ever trained for an endurance event, then you know that part of the training involves long, slow runs in order to build up your mileage. These types of runs are essential for physiological and psychological reasons. However, in order to become a faster, more efficient runner, you need to do more than just long runs. Three main factors determine endurance performance:

  1. Maximal oxygen uptake (VO2max): the maximum amount of oxygen that an individual can use during exercise. Elite endurance athletes have a higher VO2max and the body is better able to utilize and supply oxygen to muscles;
  2. Anaerobic threshold: the level of exercise intensity at which lactic acid accumulates faster that the body can get rid of it;
  3. Running economy: basically how efficient of a runner you are.

In order to become a faster/better runner you need to improve one or all of the above factors. The million-dollar question is how? Although most runners think running longer is better, research has shown that this is not the case.

A recent systematic review examined the short- and long-term effects of interval training on performance in recreational distance runners, compared to traditional long continuous running. All of the intervention studies used interval training for a minimum of 4 weeks and maximum of 10 weeks. Interval training consisted of repeated short to long bouts of running at close to 100% VO2max, interspersed with recovery periods. They all included 2-4 interval sessions per week, combined with traditional long, slow runs.

Overall, they discovered that interval training had beneficial effects on endurance performance, despite reductions in overall training mileage. Specific benefits of interval training versus a training program, which focused solely on long runs at low-moderate intensity included:

  • Improved VO2max;
  • Improved anaerobic threshold;
  • Improved running economy;
  • Delayed muscle fatigue;
  • Ability to sustain muscular performance at faster speeds
  • Activated a greater number of muscle fibers
  • Runners were less likely to get injured, which could be related to increased strength, as well as decreased training volume and time.

So where do you start?

Adding at least two days of short interval runs into your running plan will improve your performance. The above authors found that the most beneficial results were with intervals of less than a minute, with a work:rest ratio of 1:1 or 1:2, performed at close to maximum intensity.

Sample Interval program:

10-minute warm-up of jogging at an easy pace, followed by 4 x 30 sec. repetitions (covering 90-200 m), with a one min. rest, repeating 4 sets. Follow this with a 10 min. cool down jog.

Interval training must be integrated into a running program with long, continuous runs. Both training regimes are needed to improve endurance performance. Workload and intensity of the interval program should change throughout the training program, according to training goals and periodization.

Garcia-Pinillosa et al. (2016). How does high-intensity intermittent training affect running performance in recreational endurance runners? Acute and chronic adaptations. A systematic review. Journal of Sport and Health Science. In press


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When and Why to Brace an Injury

Braces are available for a number of different injuries. Bracing has been shown to decrease pain, improve function, reduce swelling, and psychologically provide more confidence in the injured body part. However, how do you know when it would be appropriate to use a brace? Below we will discuss the benefits of bracing and address some common questions about using a brace.

Prevention of injury:

There is some research which has examined whether bracing a non-injured joint will prevent injuries. Studies have looked mainly at knee and ankle bracing in sports such as soccer and football in order to shed light on whether or not it helps prevent injuries such as ACL, MCL and lateral ankle sprains. Overall, the evidence is controversial, with studies suggesting that it may only be effective in certain positions in football, while being most effective for individuals with prior injuries.


Braces are used most often following an injury to:

  1. Limit movement;
  2. Provide compression to help with swelling;
  3. Reduce pain;
  4. Provide support;
  5. Provide proprioception (increase awareness of the joint);
  6. Increase confidence as the athlete will feel more secure and stable

Common Injuries that bracing can help:

  • Tennis elbow;
  • Ankle sprain: Research has shown that an ankle brace post injury can decrease the chance of reinjury by 71%;
  • Patellar tracking;
  • ACL/MCL/LCL/PCL knee injuries;
  • Osteoarthritis of the knee: Research has shown that bracing to unload an arthritic knee joint is effective in decreasing pain, joint stiffness and medication use. It also improves proprioception, balance and function;
  • Wrist injuries (i.e., carpal tunnel syndrome)

Common questions about bracing:

  • Will a brace make my muscles lazy and weak? 

Studies have shown that long-term use of a brace has no negative effect on muscle strength, function or proprioception. A recent study examined the use of wearing a knee brace for 7 hours daily over a 6-12 week period, and actually found an increase in quadriceps strength and decreased muscle inhibition after the 6 week period (Callaghan et al., 2016).

  • Will a brace hinder my performance?

As long as the brace fits properly and isn’t too bulky, it shouldn’t have a negative impact on sport performance. Research has shown ankle and knee braces do not impede vertical jump, speed tasks or dynamic balance. However, studies do mention a “break in” period, lasting roughly 3 days, in which initially athletes will have a decrease in performance as they get used to the brace. 

  • Is it worth the extra money to get a custom brace?

If an off-the-shelf brace doesn’t fit properly, then your best option is a custom brace. A brace that is too tight or too loose won’t be able to work properly.

  • Will my insurance cover the cost of the brace?

Most braces are covered under extended health care plans. In most cases, in order for an insurance company to cover the cost of the brace, you will need a doctor’s note stating that the brace is for daily wear (a brace intended just for sport, may not be covered).

The staff at Sheddon is knowledgeable in different bracing options and since we carry a large selection of different brands and styles, we can better determine which brace would best suit your needs. If you have any questions about bracing, please ask your Sheddon Therapist for more information.

Callaghan et al., (2016). The effect of knee braces on quadriceps strength and inhibition in subjects with patellofemoral osteoarthritis. Journal of Orthopaedic & Sports Physical Therapy.

Margarita et al., (2010). A systematic review on the effectiveness of external ankle supports in the prevention of inversion ankle sprains among elite and recreational players. Journal of Science and Medicine in Sport.

Raja et al., (2010). Efficacy of knee braces and foot orthoses in conservative management of knee osteoarthritis: A systematic review. American Journal of Physical Medicine and Rehabilitation.