Here she is doing 187lbs. The new record she set is at 215lbs!!! Her current weight class is at the 97lbs division.
Check out her 187lbs squat here: http://www.youtube.com/watch?v=mQHrAjb1tzk&feature=player_embedded
Friday, 23 March 2012
There's a new World Champion.. and she's only 10 years old!!!
Just seen this news: a 5th grader just beat the previous world-record holder for raw-squat! Little miss Naomi Kutin of New Jersey beat the past record held by a 44 year old women with over 20 years of practice!
Here she is doing 187lbs. The new record she set is at 215lbs!!! Her current weight class is at the 97lbs division.
Check out her 187lbs squat here: http://www.youtube.com/watch?v=mQHrAjb1tzk&feature=player_embedded
Here she is doing 187lbs. The new record she set is at 215lbs!!! Her current weight class is at the 97lbs division.
Check out her 187lbs squat here: http://www.youtube.com/watch?v=mQHrAjb1tzk&feature=player_embedded
Wednesday, 21 March 2012
Flexor Hallucis Longus: FHL, Muscle of the Day
Seeing as the last anatomical post that I had took quite awhile to write out, I'm going to make things a little more manageable by giving some nice in-depth info about a single muscle that you may not know you have (rather than going through the layers of the shoulder!)
Today: The FHL or flexor hallucis longus. Hallucis or hallux is another term for your big toe (the reason they sometimes call bunions hallux valgus/rigidus), flexor because it flexes the toe, and longus (lt: long) to differentiate it from brevis (lt: short).
Anatomy
The FHL starts in the posterior calf as one of the deepest muscles, attaching it's muscular contractile unit to the posterior fibula (mid-level) and spans down the calf. The distal attachment of the tendon is to the inferior (plantar) distal phalanx of the great toe (hallux). From start to finish, this tendon makes its way through 2 narrow gateways:
- The fibro-osseus tunnel behind the medial malleolus (inside heel bone point)
- The tunnel between the small circular seasmoid bones of the FHB (flexor hallucis brevis)
The tibial nerve (a section of the great sciatic) is what innervates the FHL.
Taken from: http://www.lisanorden.com/flexor-hallucis-longus-inflamed/
Action
If you picture where the FHL runs to and from, you can see how this muscle will plantarflex the toe in a non-weight bearing position (in addition it will plantarflex the ankle - but very weakly). In weight-bearing, the muscle is active through mid-stance, supporting and slowing the ankle segment through motion.
Pathology
When does this become a problem? If you are a dancer that spends some time doing jumping and landing (particularly ballet) there is a good chance you've already had an issue with the FHL. Another sport that can have issues with this are those who run on hard surfaces with poor shoe support (think: soccer on hard ground or sprinters on cement). A recent case study was on a 42 year old male client with FHL irritation during racquetball.
Taken from: http://mylilballerina.blogspot.ca/2010/09/new-york-city-ballet-pointe-shoe.html
Injury can happen from the constant friction through the aforementioned gateways, or by muscular overuse (especially if there is a decreased activation of other plantarflexors of the ankle!).
Deep pain in the posterior calf, behind the medial malleolus, or a the bottom of the foot. Sometimes it can appear as a calf irritation, or even plantar fasciitis, though without specific treatment to the FHL, rehab would likely be poor.
Proper diagnosis by your physiotherapist is extremely important, especially since this issue can mimic other injuries. Treatments should include assessment of footwear and possible addition of metatarsal pad or arch support, as well as manual myofascial release of the FHL and manual stretching. Ultrasound may have some benefit especially during the early stages to help with swelling.
Howard, P.D. (2000) Differential Diagnosis of Calf Pain and Weakness: Flexor Hallucis Longus Strain. Journal of Orthopaedic & Sports Physical Therapy 30(2). pp. 78-84.
Travell, J.G., & Simons, D.G. (1993). Myofascial Pain and Dysfunction: The Trigger Point Manual, The Lower Extremity (VOl 2). Philadelphia: Lippincott Williams & Wilkins.
Friday, 16 March 2012
Diastasis Recti Abdominus
Over the last few days, I was asked some questions about care for diastasis recti abdominis (DRA). How long is this condition supposed to last for post-pregnancy? Should I get surgery to correct this issue? Will the surgery help my low back pain, to is it just a cosmetic procedure? My physiotherapist tells me that I cannot do sit-ups or else I could end up making things worse, but my surgeon says that those exercises are totally okay, what should I do?
As always, I want to give you a good clear definition of that the condition is. DRA is central splitting of the rectus abdominis (RA) muscle and thinning of the linea alba fascia. Lets looks at a picture:
It's important to note that there is also a few other abdominal muscles running into the linea alba for support: the transversus abdominis (TA - the deepest layer, with fibers running horizontally), and the internal and external oblique muscles (IO and EO - fibers running in a cross pattern diagonally).
So why does DRA happen? What are the risk factors for developing DRA?
Close to the 14th week of gestation, there is a peak of a hormone called relaxin in the system. This hormone, in combination with progesterone (another pregnancy hormone) will soften the body's connective tissue. Decreased strength of the connective tissue is very important because it will allow the fetus to grow in the uterus and push onto the abdominal wall without being restricted, AND it allows more motion at the sacroiliac joints and pubic symphysis to allow the child to exit though the vaginal canal (natural child birth). The linea alba is connective tissue, and the abdomen obviously increases in size through pregnancy. As the abdomen increases in size, the rectus abdominis may split to allow more room for the child. Gilleard and Brown measured a 115% increase in the length of rectus abdominis - another problem that may lead to decreased stability in the anterior abdomen. Some studies have shown upwards of 67%-100% (Boissonault & Blaschak, Hannaford and Tozer, respectively) of women having DRA during and/or post pregnancy.
Lo, T et. al. went to discover what were the risk factors to development of DRA. Listed are:
Sometimes it is obvious to you that there is bulging occurring anteriorly (over the stomach) with activities such as getting out of bed, but sometimes it may not be as apparent. To be sure, it is best to book an appointment with your OB/GYN specialist or a physiotherapist that is knowledgeable in post-natal care.
The degree of DRA is based on a measurement, sometimes referred to as the inter-recti distance or IRD. There are a few ways of your clinician to measure this, but some methods have poor inter- and intra-rater reliability (ie: if I the clinician measures it once, my measurement shows a completely different result (intra) and if I the clinician measures the space, and another clinician measures the space, we have again different results).
The least reliable (as shown in a study by Bursh, G. in the Journal of the American Physical Therapy Association) is measurement by finger breadth. If the clinician is only measuring with the hands, your classification for how pronounced the DRA is, may be off.
More reliable results come from measurement through use of calipers (Chiarello C.M. et. al), and better yet through ultrasound (Liaw, L.J. et. al.). I've read some studies that measure the distance with CT, but that's just too much radiation in my mind.
Measurements through care by the clinician are important, especially in the case of physiotherapist, when we can then progress your exercises as the space becomes smaller.
How long does DRA last?
Totally variable. Some DRA's are resolve within 6 months of the pregnancy, but there is substantial numbers whose DRA does not resolve (Ranney et. al. looked at 1738 post-pregnant women getting hysterectomies several years after their last birth, and found that 39% still had DRA).
Is it the DRA that is causing my back pain?
A study by Parker, M.A. et. al. in the Journal of Women's Health Physical therapy in 2008 looked into this.
They initially noted a study by Thornton et. al. that had a case report of a women at 22 weeks gestation having low back pain feel relief during a family ski trip while wearing tight compressive ski pants with overalls. The pain eventually returned post-trip after not wearing the support. Was this because of the added anterior support from the pants? Or maybe it was the compressive forces on the sacroiliac joints (SIJts) that relieved the pain.
Interestingly in the study of Parker et. al., they found that there was no significant difference in VAS (visual analogue scale) pain rating between groups that had DRA and those who did not. This study also showed that those with a IRD of 2.5cm or more had the same pain levels as those with separation of 2cm-2.5cm.
The significant difference was only noted with those who had DRA had a higher level of pain anteriorly in the pelvis and abdominal areas.
What can I do?
A small study (with it's own limitations) by Chiarello C.M. et. al. found that those who have exercised during pregnancy (basic stabilization and pelvic tilt exercises) had less of a gap than those without the program. The exercise program consisted primarily of activation of the TA muscle with pelvis tilts and extremity involvement.
If you go see a physiotherapist who specializes in women's health, there is a good chance that their focus will be on TA activation and core stabilization. One renowned physiotherapist, Diane Lee, gives some great therapy based information on her website: http://dianelee.ca/education/article_diastasis.php as well has handout http://dianelee.ca/articles/Diastasis-rectus-abdominis.pdf.
While reviewing the current journal articles, I have yet to see the substantiating evidence on why a post-natal woman can not do situps. I can understand mechanically that during pregnancy the RA is longer and is bowing to the sides and why this could be further damaging to the DRA, but I am not convinced it is not important to re-include these into workouts at a certain point post-natally.
Why is there so much concern around pregnancy and exercise?
An article that was published last year made a slight comment on the reasoning (Borg-Stein, J.P. et. al.). The medical profession did not know the effects of exercise on pregnancy, and were worried about birth outcomes. As a result, the American College of Obstetricians and Gynecologists (ACOG) released conservative guidelines (1985) because of lack of research evidence. Since then, research has begun to show the positive benefits of exercise during pregnancy and postpartum. I suggest reading the article Exercise, Sports Participation, and Musculoskeletal Disorders of Pregnancy and Postpartum (Borg-Stein) for an overview of current literature.
What is the take-home message?
DRA is a very common concern of pregnant and postpartum women, though does not have strong evidence outlining the best treatment/therapy for it. Your therapist/clinician should be able to answer questions concerning your DRA. Exercise has shown some benefits to DRA size, but studies are small and may be skewed by race and class.
Although there have been recent studies showing the benefits of exercise during pregnancy and postpartum, it is still very important to consult your physician, your OB/GYN, and/or your physiotherapist. Complications during pregnancy may exclude you from obtaining benefits of exercise and may actually be harmful to your baby.
Be persistent with your medical professional to be sure all your questions and concerns are answered, and do your own research.
Bibliography:
Borg-Stein, J.P. et. al. (2011). Exercise, Sports Participation, and Musculoskeletal Disorders of Pregnancy and Postpartum. Seminars in Neurology 31(4). pp.413-422.
Chiarello, C.M. et. al. (2005). The Effects of an Exercise Program on Diastasis Recti Abdominus in Pregnant Women. Journal of Women's Health Physical Therapy 29(1). pp. 11-16.
Parker, M.A. et. al. (2008). Diastasis Rectus Abdominus and Lumbo-Pelvic Pain and Dysfunction - Are They Related?. Journal of Womens's Health Physical Therapy 32(1). pp.15-22.
Lo T. et. al. (1999). Diastasis of the Recti Abdominus in Pregnancy: Risk Factors and Treatment. Physiotherapy Canada 51(1). pp. 32-37.
Collie, M.E. et. al. (2004). Physical Therapy Treatment for Diastasis Recti: A Case Report. Journal of the Section on Women's Health 28(2). pp.11-15.
Bursch, S.G. et. al. (1987). Interrater Reliability of Diastasis Recti Abdominis Measurement. Journal of the American Physical Therapy Association 67(7). pp.1077-1079.
Liaw, L.J. e.t al. (2011). The Relationships Between Inter-recti Distance Measured by Ultrasound Imaging and Abdominal Muscle Function in Postpartum Women: A 6-Month Follow-up Study. Journal of Orthopaedic & Sports Physical Therapy 41(6). pp.435-443.
As always, I want to give you a good clear definition of that the condition is. DRA is central splitting of the rectus abdominis (RA) muscle and thinning of the linea alba fascia. Lets looks at a picture:
http://www.pilates-pro.com/pilates-pro/2008/8/18/pilates-and-pregnancy-safe-ab-exercises.html
It's important to note that there is also a few other abdominal muscles running into the linea alba for support: the transversus abdominis (TA - the deepest layer, with fibers running horizontally), and the internal and external oblique muscles (IO and EO - fibers running in a cross pattern diagonally).
So why does DRA happen? What are the risk factors for developing DRA?
Close to the 14th week of gestation, there is a peak of a hormone called relaxin in the system. This hormone, in combination with progesterone (another pregnancy hormone) will soften the body's connective tissue. Decreased strength of the connective tissue is very important because it will allow the fetus to grow in the uterus and push onto the abdominal wall without being restricted, AND it allows more motion at the sacroiliac joints and pubic symphysis to allow the child to exit though the vaginal canal (natural child birth). The linea alba is connective tissue, and the abdomen obviously increases in size through pregnancy. As the abdomen increases in size, the rectus abdominis may split to allow more room for the child. Gilleard and Brown measured a 115% increase in the length of rectus abdominis - another problem that may lead to decreased stability in the anterior abdomen. Some studies have shown upwards of 67%-100% (Boissonault & Blaschak, Hannaford and Tozer, respectively) of women having DRA during and/or post pregnancy.
Lo, T et. al. went to discover what were the risk factors to development of DRA. Listed are:
- Increased age of mother
- Larger weight gain with pregnancy (other authors state >30lbs is enough)
- Larger infant size (just "googling", there are claims of massive birth-weights of 20lbs!!! Obviously not the norm, but I can imagine the pressure put on that linea alba!)
- Carrying multiples (more inside = more size)
- Multiple births (A 2nd child, especially with no exercise training or stability training between births may hold that stretched position on the rectus abdominis for longer periods. I could speculate that back to back births (that women with 19 kids and counting, yikes!) does not allow adequate "healing" time).
- Cesarean Section (the surgeon/OB/GYN is cutting right through that linea alba)
Sometimes it is obvious to you that there is bulging occurring anteriorly (over the stomach) with activities such as getting out of bed, but sometimes it may not be as apparent. To be sure, it is best to book an appointment with your OB/GYN specialist or a physiotherapist that is knowledgeable in post-natal care.
The degree of DRA is based on a measurement, sometimes referred to as the inter-recti distance or IRD. There are a few ways of your clinician to measure this, but some methods have poor inter- and intra-rater reliability (ie: if I the clinician measures it once, my measurement shows a completely different result (intra) and if I the clinician measures the space, and another clinician measures the space, we have again different results).
The least reliable (as shown in a study by Bursh, G. in the Journal of the American Physical Therapy Association) is measurement by finger breadth. If the clinician is only measuring with the hands, your classification for how pronounced the DRA is, may be off.
More reliable results come from measurement through use of calipers (Chiarello C.M. et. al), and better yet through ultrasound (Liaw, L.J. et. al.). I've read some studies that measure the distance with CT, but that's just too much radiation in my mind.
Measurements through care by the clinician are important, especially in the case of physiotherapist, when we can then progress your exercises as the space becomes smaller.
How long does DRA last?
Totally variable. Some DRA's are resolve within 6 months of the pregnancy, but there is substantial numbers whose DRA does not resolve (Ranney et. al. looked at 1738 post-pregnant women getting hysterectomies several years after their last birth, and found that 39% still had DRA).
Is it the DRA that is causing my back pain?
A study by Parker, M.A. et. al. in the Journal of Women's Health Physical therapy in 2008 looked into this.
They initially noted a study by Thornton et. al. that had a case report of a women at 22 weeks gestation having low back pain feel relief during a family ski trip while wearing tight compressive ski pants with overalls. The pain eventually returned post-trip after not wearing the support. Was this because of the added anterior support from the pants? Or maybe it was the compressive forces on the sacroiliac joints (SIJts) that relieved the pain.
Interestingly in the study of Parker et. al., they found that there was no significant difference in VAS (visual analogue scale) pain rating between groups that had DRA and those who did not. This study also showed that those with a IRD of 2.5cm or more had the same pain levels as those with separation of 2cm-2.5cm.
The significant difference was only noted with those who had DRA had a higher level of pain anteriorly in the pelvis and abdominal areas.
What can I do?
A small study (with it's own limitations) by Chiarello C.M. et. al. found that those who have exercised during pregnancy (basic stabilization and pelvic tilt exercises) had less of a gap than those without the program. The exercise program consisted primarily of activation of the TA muscle with pelvis tilts and extremity involvement.
If you go see a physiotherapist who specializes in women's health, there is a good chance that their focus will be on TA activation and core stabilization. One renowned physiotherapist, Diane Lee, gives some great therapy based information on her website: http://dianelee.ca/education/article_diastasis.php as well has handout http://dianelee.ca/articles/Diastasis-rectus-abdominis.pdf.
While reviewing the current journal articles, I have yet to see the substantiating evidence on why a post-natal woman can not do situps. I can understand mechanically that during pregnancy the RA is longer and is bowing to the sides and why this could be further damaging to the DRA, but I am not convinced it is not important to re-include these into workouts at a certain point post-natally.
Why is there so much concern around pregnancy and exercise?
An article that was published last year made a slight comment on the reasoning (Borg-Stein, J.P. et. al.). The medical profession did not know the effects of exercise on pregnancy, and were worried about birth outcomes. As a result, the American College of Obstetricians and Gynecologists (ACOG) released conservative guidelines (1985) because of lack of research evidence. Since then, research has begun to show the positive benefits of exercise during pregnancy and postpartum. I suggest reading the article Exercise, Sports Participation, and Musculoskeletal Disorders of Pregnancy and Postpartum (Borg-Stein) for an overview of current literature.
What is the take-home message?
DRA is a very common concern of pregnant and postpartum women, though does not have strong evidence outlining the best treatment/therapy for it. Your therapist/clinician should be able to answer questions concerning your DRA. Exercise has shown some benefits to DRA size, but studies are small and may be skewed by race and class.
Although there have been recent studies showing the benefits of exercise during pregnancy and postpartum, it is still very important to consult your physician, your OB/GYN, and/or your physiotherapist. Complications during pregnancy may exclude you from obtaining benefits of exercise and may actually be harmful to your baby.
Be persistent with your medical professional to be sure all your questions and concerns are answered, and do your own research.
Bibliography:
Borg-Stein, J.P. et. al. (2011). Exercise, Sports Participation, and Musculoskeletal Disorders of Pregnancy and Postpartum. Seminars in Neurology 31(4). pp.413-422.
Chiarello, C.M. et. al. (2005). The Effects of an Exercise Program on Diastasis Recti Abdominus in Pregnant Women. Journal of Women's Health Physical Therapy 29(1). pp. 11-16.
Parker, M.A. et. al. (2008). Diastasis Rectus Abdominus and Lumbo-Pelvic Pain and Dysfunction - Are They Related?. Journal of Womens's Health Physical Therapy 32(1). pp.15-22.
Lo T. et. al. (1999). Diastasis of the Recti Abdominus in Pregnancy: Risk Factors and Treatment. Physiotherapy Canada 51(1). pp. 32-37.
Collie, M.E. et. al. (2004). Physical Therapy Treatment for Diastasis Recti: A Case Report. Journal of the Section on Women's Health 28(2). pp.11-15.
Bursch, S.G. et. al. (1987). Interrater Reliability of Diastasis Recti Abdominis Measurement. Journal of the American Physical Therapy Association 67(7). pp.1077-1079.
Liaw, L.J. e.t al. (2011). The Relationships Between Inter-recti Distance Measured by Ultrasound Imaging and Abdominal Muscle Function in Postpartum Women: A 6-Month Follow-up Study. Journal of Orthopaedic & Sports Physical Therapy 41(6). pp.435-443.
Friday, 2 March 2012
Paris Orthotics Seminar
Each year, the Paris Orthotics company assembles a conference for heather care providers that prescribe and cast for foot orthoses. We get an update as to what is new in the Paris laboratory, as well as some of the newest research concerning certain populations that benefit from custom foot orthoses.
This winter's session was conducted by Dr. Chris MacLean, Ph.D of Paris, and concentrated on new developments of the Richie Brace and custom insoles for different sports.
The Richie Brace was first realized and designed by Dr. Doug Richie, a pedorthist, in 1996. Since then, the brace has been prescribed and cast for thousands of individuals with a wide array of lower limb pathologies.
Taken from: http://comfortfitlabs.com/richiebrace.htm
The Richie brace is an AFO - an ankle-foot orthosis. The difference with this brace from most others is that it is completely custom for your foot. Using STS-sock casting technique, the clinician will take a cast from the toes, all the way to mid-shank.
Taken from: http://driveit.clickspace.com/webpage/1000367/1000107
When would I need a Richie brace rather than a standard custom insole?
The Richie is an orthotic with a deeper heel-cup, and lateral shank stability by way of upright semi-rigid supports.These AFO's are used for patients with more severe changes in the foot and ankle. The common indications are:
- Severe adult-acquired flatfoot
- Lateral ankle instability
- From continual ankle sprains or a traumatic ankle dislocation
- Degenerative joint disease (DJD) of the ankle joints
- Osteoarthritis of the subtalar or talocrural joints
- Rheumatoid arthritis of the above joints
- Previous sepsis in the ankle joints
- Chronic ankle gout
This brace allows maximal control of pronation of the rear and fore foot and maintains a pure sagittal (up-down) motion at the ankle and restricts the foot from collapsing, or the ankle from rolling.
Feel free to call us at Paragon Physiotherapy to find out more information: 204-421-9177.
If you would like to read more about the Richie brace, check out www.richiebrace.com
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Do you play any sports? Having pain the hips, knees, ankles during your sport? You may benefit from a custom sport orthosis designed for your specific sport. At the seminar, we recapped lower limb biomechanics in sport, and then applied those parameters to design orthotics to maximize support and minimize injury all while making sure that these inserts will fit into your shoes!
As you know there are orthotics that you can easily fit into your running, basketball and possibly your golf shoes, but what about your soccer cleats? Your ski boots? Your skates
Streamline and shallow orthotics can be custom made to fit in those tiny little road and mountain cycling shoes! Do you get knee pain on the way up the hill, or nearing to the end of your ride? How about pain in the ball of the foot when you are in the push phase of peddling?
How about those skaters out there that find their feet being uncomfortable after 20-30 minutes on ice. Are you a hockey player that likes keeping the laces tied low to allow ankle movement, but get cramping foot pain? The inside of skates does not give any arch support, but with orthotics, you can gain some structural control to the foot.
This is just the tip of the iceberg as far as benefits and application of custom foot orthotics. Paragon Physiotherapy uses Paris Orthotics as its technical lab because of the quality of product, the personal care given into the construction, the costumer support, as well as being a Canadian Company. If you would like to find out more about Pairs Orthotics check out: www.parisorthotics.com
I would also like to wish Paris Orthotics a happy 25th anniversary! Congratulations!
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