I will be working with the Whistler Mountain Ski Club this 2014/15 season to assist with physical assessments, fitness and dry-land programming, transitional support and other sports medicine related initiatives. The first assessments have been completed and the athletes are ready to get to work on their fitness and workouts.
[gallery] My Northlands Medical Clinic team won the Peak to Valley ski race again this year, and I took the fasted time on Friday, it was a great weekend.
I look forward to seeing new patients out of the Northlands clinic starting in May of this year. Finally there is a Naturopathic Doctor in Whistler that is here to stay!
httpvh://www.youtube.com/watch?v=E5MoSCrm-lI&feature=player_embedded Take a look at this clip which highlights some of the exercises that Mike did during his recent visit with Dr Oughtred, in Vancouver, BC.
During my 7 years of competition with the Canadian alpine ski team, I experienced several injuries, the most frustrating of which were the insidious injuries that seemed to appear out of nowhere. These injuries could last for months to years, and usually required multiple treatments to heal. Because one treatment alone was rarely effective, I began to think that there was more than one cause for these problems. It was for this reason that I decided to become an integrated health care professional, utilizing expertise from several different areas to help people experience better health.
Many chronic problems have more than one cause: type 2 diabetes, heart disease, autoimmune disease, asthma, headaches, overuse injuries, back and neck pain, irritable bowel, PMS, and psoriasis, are all examples of problems that have more than one cause or contributing factor. Common sense dictates that the assessment and treatment of such problems should be multifactoral. For example, an integrative assessment of the patient with chronic headaches would consider the following factors:
• Inactivity or obesity
• Overweight individuals that don't exercise experience more health problems, including headaches
• Blood pressure
• High blood pressure or sudden changes in blood pressure can increase your likelihood of head pain
• Hormonal imbalance
• Migraines occur more in women, and they will often notice their pain fluctuates with menses
• Blood sugar imbalance
• Fluctuations in blood sugar can lead to the vascular constriction or dilation that is often associated with headaches
• Stress and cognitive influences
• Those who experience anxiety or depression, experience more headaches
• Neck problems
• The upper two vertebrae in your neck can cause an increase in head pain when they are dysfunctional
• TMJ problems or dental problems
• Food sensitivities
• Environmental sensitivities
• Poor posture and work position
• Poor vision or eye problems
• Infection or cancer
• Drug interactions
• Inflammatory disease
• Past trauma/ accidents
A multifactoral assessment allows the health provider to look at your health from a ‘bird's eye view', and focus treatments on the areas of your health that might contribute to your pain. Treatments could include physical therapies, supplements, therapeutic exercise, specific herbs, a special diet, or cognitive behaviour therapies. However, without an integrated assessment of your health, your treatment may be one sided, and may fail to address weaknesses in your complete health picture. It is for this reason that I recommend an integrated approach for your chronic problems, the prevention of disease, and for the pursuit of your optimum health status.
Injury to the lower back is one of the more common injuries incurred by the alpine skier. Waiting for back problems to happen before doing anything about them is probably a bad idea; the discs and bones of the spine generally only have nerves on their outermost portions, which means that damage to the inner portions of the vertebrae and discs can occur without experiencing any pain at all. The spine can degenerate ‘from the inside out' for many years without any warning signals, and by the time an athlete is 26 years old-in the peak of a career-the spine can have significant amounts of permanent wear-and-tear. Here are the 5 most important preventive measures I think athletes and support staff can take to prevent back problems:
Build progressions in training schedules:
1. The risky forces for the spine are flexion, rotation, compression, and sheer; all of which are involved in skiing. Because avoidance of these risky forces is not possible, the athlete must be exposed to them gradually over time. Both on-snow and dry-land training should gradually involve progressions in both volume and intensity of activities that involve bending forward, twisting, weight lifting, and eccentric loading.
2. The adolescent spine may be especially vulnerable because the growth plates of the vertebrae are softer than in an adult, making them more prone to injury from compression and sheer forces.
Sit less, and never lift heavy after sitting:
1. Any time the spine is flexed forward for a period of time, such as with sitting, a phenomenon called ‘creep' occurs in the tissues. The tissues are melded toward a shape that is different than normal. Heavy lifting or other compressive activity (such as ski racing) should be avoided immediately following a prolonged period of sitting or forward bending.
2. To combat the effects of creep from sitting on planes, in cars, or on chairlifts, athletes can perform extension exercises like McKenzie press-ups or other extension movements any time they have been prolonged to excess flexion.
3. When traveling - I would never allow athletes to lift heavy bags immediately after riding in a van or on a plane for hours. Stand up, walk around, and maybe bend the spine back a couple of times before lifting anything heavy.
4. When riding the chair lift - athletes should take time after every chair lift ride to stand up, bend back a little, and warm up before diving into another race run. While riding the chair, a relaxed upright posture is probably best.
Compress and twist the spine judiciously:
1. Twisting while you lift heavy weight doubles the load through the back. Athletes should be taught to never twist while they are lifting, unless it is an exercise specifically designed to prepare them for skiing.
2. Discourage athletes from packing heavy bags, and encourage them to share the work of lifting with other people.
Keep your spine neutral and stable:
We know that stability of the spine will prevent injury, but applying that to practice is not a simple task.
1. Maintain a neutral spine as much as possible when training, especially when lifting heavy weights or twisting.
2. Focus on endurance of the spinal related muscles, not just strength.
3. Integrate components of instability, unpredictability and precision into dry land training.
4. Full body exercises are probably better than isolated muscular activities. Even if the athlete feels like the exercise is too easy, it is still doing something for them.
5. Make sure athletes can breathe evenly throughout entire exercises.
6. Encouraging the athlete to lightly draw in their tummy, or ‘feel like they are stopping a pee' while working out, might add to their spinal stability. Train everything. All the muscles of the core probably contribute to injury prevention in some way, as does the lower body and upper body. Search for balance, find weaknesses and eliminate them.
Proper biomechanics-the earlier better:
1. Taking the time to consult with someone who understands normal spinal mechanics and how to assess it could be a valuable investment.
2. If one area of the spine is not moving well, other spinal regions may be forced to work too hard, or in an unbalanced fashion. Detecting these kinds of imbalances early in a career may prevent future injury or even enhance athletic performance.
The field of low back problems is a difficult area. I have done my best to consider some of the evidence so far, and apply it to the ski racing athlete. I hope it was helpful!
More to read:
• Panjabi MM. The stabilizing system of the spine. Part 1. Function, dysfunction, adaptation, and enhancement. J Spinal Disord 1992; 5(4):383-9
• Richardson CA, Jull GA, Hodges PW, Hides JA. Therapeutic exercise for spinal segmental stabilization in LBP: scientific basis and clinical approach, Edinburgh: Churchill Livingstone; 1999
• McGill S. Low back disorders: evidence based prevention and rehabilitation, Champaign, IL: Human Kinetics Publishers, Inc.; 2002
• N. Bogduk, B. McGuirk. Medical Management of Acute and Chronic Low Back Pain. An Evidence Based Approach. Elsevier Science. 2002