Tag Archives: Oakville Physio

Raising Awareness about Mental Illness

Yesterday was Bell Let’s Talk day, whereby for every text, call, tweet, Instagram and Facebook post, Bell contributed 5 cents to mental health initiatives. One in five Canadians suffer from mental illness; however, more than two-thirds of these individuals never seek help because of the stigma surrounding mental illness. Bell’s goal was to educate people about mental illness in order to help change the negative stereotypes surrounding it, and hopefully encourage people to seek help.

Physiotherapists may feel more like psychologists as patients tend to develop a positive relationship with their therapist and feel that they can be honest and open about struggles outside of their physical injury. Although it is out of the scope of physiotherapy to treat mental illness, physiotherapists play a vital role in educating patients about different avenues they can explore to seek help, as well as recognizing when someone is a danger to themselves or others around them.

Sheddon Physiotherapy and Sports Clinic treats a large number of athletes, and one would think that this population is fairly immune to mental illness. Exercise and physical activity have long been shown to help with mood disorders, depression and anxiety. Athletes are generally very driven, goal-oriented individuals, in exceptional shape physically. So it’s understandable that most people assume they are also mentally strong and healthy. However, athletes are still vulnerable to mental illness for many of the same reasons as the general population. Some common risk factors for mental health disorders in athletes include:

Overtraining/Burnout

 Athletes devout a large amount of their time and energy to their sport. With this comes the pressure to perform and excel, which can lead to stress, anxiety and depression. The heavy training schedule of many sports, combined with school, and in some cases work, can lead to fatigue and burnout in a large number of student athletes. Unfortunately, athletes rarely seek help for their psychological problems, for fear that they will be seen as weak and possibly lose their spot on a team. Athletes who do seek help will often be diagnosed with “overtraining.” The physiological, immunological, hormonal, and metabolic changes of over-training are very similar to those associated with depression. As such, some researchers have debated whether athletes with depression are actually being misdiagnosed with overtraining.

Eating Disorders

Many athletes feel the pressure to maintain a certain weight and body composition in order to be successful in their sport. Studies show that the prevalence of eating disorders in male athletes is roughly 18%, and anywhere from 32-60% in female athletes. Eating disorders are considered to be a mental illness caused by a number of psychological and sociocultural factors. In addition, eating disorders can occur with other mental health disorders, such as anxiety, depression, OCD and other mood disorders.

Injuries

An injury can bring a lot of stress and anxiety to athletes. They oftentimes feel pressure from coaches, teammates and parents to return to the game as soon as possible and in tip top shape. If athletes are playing on a scholarship or looking to get scouted to the next level, an injury can make them feel like their chances are at stake. They occasionally are unable to train/practice at the same level of their teammates and the longer the injury takes to heal, the more an athlete starts to feel they are slipping behind mentally and physically. Whether an injury is career ending or a minor sprain it will bring a host of negative emotions and can lead to further psychological issues.

Retirement

Since athletes commit all of their time and energy to training, their social circle and identity becomes strongly interconnected with their sport. As such, once their career is over they have lost their outlet, friends and identity. Retirement for athletes can be a time of great psychological distress, whether it is a decision made by the athlete or they are forced to retire due to aging, competitive failure or career ending injuries. Most athletes are not prepared for this life transition of entering into a world without extensive hours of practice, strict daily schedules and the adrenaline of competition. Athletes can feel a sense of emptiness, leading to depression and other mental health issues. Furthermore, retirement also shrinks your social support network, as athletes are no longer part of a team or group to which they can turn to for help.

Whether you are an elite athlete or an average Joe, we are all susceptible to mental health disorders. Keep in mind that mental illness can be treated and that you do not have to live through it alone. If you or someone you know may be suffering from a mental illness, please seek the appropriate assistance. If you’re not sure who to turn to, talk to a family member, friend, therapist or someone you trust that can help guide you in the right direction. Acknowledging that there is an issue is the first step to recovery.

Hughes et al., (2012). Setting the bar: athletes and vulnerability to mental illness. British Journal of Psychiatry. (2) 95-96.

 

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Beat the Heat

With the hot and humid weather ramping up this weekend, many individuals will be wondering how to alter their training so that they can stay active. A review recently came out by Pryor et al., (2013) examing how to maximize athletic performance in the heat. The article discusses a variety of different elements from hydration to clothing with practical tips from which athletes of all levels could benefit.

Hydration

Sweating is the body’s main defense against overheating while exercising. Excessive sweating can lead to dehydration, if fluids are not replenished, which in turn will lead to an increase in body temperature, as the body can no longer effectively regulate its temperature. This increased strain on the body can have a negative impact on athletic performance in terms of strength, power and endurance. Unfortunately, thirst is not an adequate predictor of hydration. The best way to know if you are hydrating yourself properly is to weigh yourself before and after exercise in order to gauge how much water you are losing. Roughly 1 lb. of weight loss represents 450 ml of fluid loss. As your stomach can only handle so much water at a time without causing gastric issues, guzzling a tonne of water at once isn’t helpful. Be sure to consume 150-250 ml of water every 15 minutes during exercise in the heat to prevent dehydration and gastric issues.

Body Cooling

A variety of different body cooling methods have been examined in the research, such as cold water immersion, neck cooling collars, ice slurry drinks, facial spray and menthol mouth rinses. Research has shown that all of the above methods have their benefits, whether used prior to exercise or during; however, the exact mechanisms remain unclear. It is possible that these methods decrease one’s core temperature, allowing for a longer period of exercise without added physiological strain from the heat. Practical tips: plan ahead of time, have a cooler on the sideline with ice slurry drinks and ice towels. If you are running a race, pre-cooling (e.g., an ice cold bath) may be beneficial and/or have someone meet you halfway with an ice slurry drink.

Heat Acclimatization

Running in the August heat always feels a lot easier than your first hot run in June. Your body will naturally adapt to training in hot environments, and repeated bouts of exercise in the heat will improve ones tolerance and physiological capacity. Studies have shown that it takes roughly 10-14 days (longer for children) to acclimatize to exercising in the heat. The first several training days should be light and last only 20 minutes. The length of training and intensity can increase thereafter. Be aware that benefits of acclimatization will be lost after 6 -10 days of training at cooler temeratures.

Protective Equipment and Clothing

Research has shown that the first few days of football training camps experience the most heat related injuries. This is partially related to the athletes not being acclimatized to the heat, with the added strain of having to wear football equipment, which in turn prevents cooling and increases heat production. The first few days of practice in hot weather for sports such as football should be without equipment and gradually adding equipment for part of the practice after the first 5 days.

Clothing in the heat should be lightweight, light-coloured and loose. Although you may be tempted to switch to a dry shirt during halftime, it is pointless, as dry clothes will prolong sweating and cooling.

Signs of Heat Exhaustion

  • Thirst;
  • Fatigue;
  • Grogginess;
  • Nausea and vomiting;
  • Headache;
  • Dizziness;
  • General Weakness

If any of these symptoms are felt during exercising in the heat, you should stop, hydrate yourself and move to a cooler environment. Heat exhaustion should be taken seriously, as it can lead to heat stroke. If you’re not used to training in the heat, move your workout indoors.

Pryor et al., (2013). Maximizing Athletic Performance in the Heat. Strength and Conditioning Journal. 35, 24-33.

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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.

Post-injury:

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.

Concussion and Risk of Suicide: Beware of Misleading Information

Concussions are a hot topic, especially regarding the potential for long term health issues. The recent Hollywood movie “Concussion” is based around some current research that has looked at concussions and its association with long term depression and suicide in NFL athletes. With the growing media coverage around concussions, and numerous professional athletes stating long term debilitating effects due to concussions, parents are starting to doubt putting their kids in high-risk sports such as football and hockey. A recent poll in the States found that roughly 40-45% of parents are considering pulling their kids out of contact sports such as football, hockey and wrestling, due to the higher risk of sustaining a concussion. Fortunately, there is lots of research and public awareness surrounding concussions, which is educating parents, coaches and athletes. Unfortunately, along with this increase in concussion knowledge comes potentially misleading information, which is either not fully supported by research or in the early stages of development.

Last month a group of researchers out of the University of Toronto published a study on the risk of suicide post concussion (Fralick et al., 2016). Their results were not very optimistic, as they found that adults with a diagnosis of concussion had an increased long term risk of suicide 3 times the population norm. These results quickly got picked up by the media, adding more fuel to the concussion crisis and putting fear into the public. Although the article was only recently published, there has been some criticism that the results of the study may not be accurate due to methodological flaws. Their results showed an astonishingly high association between concussions and suicide compared to past studies; therefore, criticism has addressed a number of factors which may have biased the sample group, thus causing these high numbers. If you are interested in the detailed critical analysis, you can read more here.

Another major flaw of the study is not fully excluding individuals with a history of mental illness (depression, substance abuse, etc), which is one of the known leading causes of suicide. With the current study, in order to exclude concussed patients with prior mental conditions, physician notes from the year prior to injury were examined. Unfortunately, this method has its limitations, since roughly 45% of people with mental issues, such as depression or anxiety disorders, are either non-diagnosed or have not yet sought treatment. Including concussed patients with a prior mental disorder will skew the results, since the cause of the suicide may have had nothing to do with the concussion.

Unfortunately, anyone in the general public coming across the results of this study in the news will not likely seek out the article and read through the methods section in order to look for flaws. They will quickly look at the results and likely jump to the conclusion that anyone with a concussion is doomed. The overall goal of the present study was to gather some longitudinal data and answer a question in which many are interested. Please use caution when coming across such articles, and until further research emerges, there still is no definitive answer as to whether or not a concussion directly leads to an increased in suicide risk.

Take home message:

What do we know about concussions and long term health issues?

  • Long term complications following concussion are still not fully understood;
  • Determining who will have long-standing concussion symptoms is also not fully understood;
  • The causes of suicide involve many factors and likely cannot be directly related to a single specific cause;
  • Pre-existing mental health issues is one of the strongest predictors of post concussion depression and anxiety (Yang et al., 2015);
  • Depression scores will increase post concussion; however research shows that even mild musculoskeletal injuries will increase depression scores post injury. Mainwaring et al., (2010) showed that athletes with ACL injuries reported higher emotional disturbances, such as depression and anxiety, and for a longer period of time, compared to the concussed athletes;
  • Football players are likely not doomed. Many studies have examined the risk of depression and suicide in former NFL players and the risk is either similar to that of the general population or even lower;
  • Proper management of concussion is key for full recovery;

 

The Sticky Truth Behind Kinesio Tape

Kinesio tape, that colourful elastic athletic tape, has been used for over a decade in the treatment of musculoskeletal injuries. It probably became most popular after the 2008 Olympics, where it was donated to team therapists, which resulted in almost every athlete using it. The majority of the people who have used this tape LOVE it! However, the research on the effectiveness of the tape isn’t so wonderful. There have been hundreds of research studies done on kinesio tape, so we’ll examine some of the more recent systematic reviews that outline what exactly the tape has been proven to achieve.

How the tape works

Kinesio tape is different from regular white athletic tape because it is flexible and 20160217_141404allows for full range of motion, (and it looks a lot cooler). Below are the main functions of kinesio tape:

  • Decrease pain;
  • Improve range of motion;
  • Increase proprioception;
  • Correct joint alignment;
  • Improve swelling and lymphatic drainage;
  • Facilitate or inhibit muscles

In order to achieve any of the desired effects above, the tape MUST be properly applied, including the direction of pull of the tape and the amount of tension applied.

What does the research say?

  • Overall, most studies show that kinesio taping for pain reduction, function and proprioception is better than no treatment, yet it is no better or worse than other traditional treatment options (Choon Wyn Lim et al., 2015)
  • Good support for reduction of pain in individuals with musculoskeletal injuries, (Montalvo et al., 2014)
  • Some support that it may improve painfree range of motion (Taylor et al., 2014).
  • Some support that it may help correct alignment i.e., patellar tracking (Barton et al., 2013).
  • Inconclusive support for improved swelling and lymphatic drainage (Kalron et al., 2013).
  • No support for the facilitation of muscle strength. A review of 19 studies that examined if kinesio tape increases muscle strength or facilitates muscle contraction showed no difference compared to a control group (Csapo et al., 2015).
  • A lot of the research discusses a potential placebo effect to help explain the benefits of kinesio tape

Take home message:

Kinesio tape is inexpensive, noninvasive, and has little to no side effects (there is a potential for skin irritation). Therefore, it is a safe and effective treatment option for pain relief, improvement in range of motion and correction of joint alignment. Future research may show beneficial effects on swelling, lymphatic drainage and facilitation of muscles.

References:

Choon Wyn Lim et al. (2015). Kinesio taping in musculoskeletal pain and disability that lasts for more than 4 weeks: Is it time to peel off the tape and throw it out with the sweat? A systematic review with meta-analysis focused on pain and also methods of tape application. British Journal of Sports Medicine. 

Montalvo, E. Cara and G. Myer. Effect of kinesiology taping on pain in individuals with musculoskeletal injuries: Systematic Review and Meta-analysis. Physician and Sports Medicine.  2014. Vol 42. Issue 2. P. 48-52.

Taylor et al. (2014). A Scoping Review of the use of Elastic Therapeutic Tape for Neck and Upper Extremity Conditions. Journal of Hand Therapy.

Barton, et al. (2014). Patellar taping for patellofemoral pain: a systematic review and meta-analysis to evaluate clinical outcomes and biomechanical mechanisms. British Journal of Sports Medicine, 48(6), 417-424.

Kalron and S. Bar-Sela. A Systematic Review of the Effectiveness of Kinesio Taping-Fact or Fasion? European Journal of Physical and Rehabilitation Medicine. 2013. Vol. 49. Issue 5. P. 699-709.

Csapo et al. (2015). Effects of Kinesio taping on skeletal muscle strength – a meta-analysis of current evidence. Journal of Science and Medicine in Sport, 18(4), 450-456.