What Are The Health Benefits of Aerobic Exercise?

Regular aerobic exercise has a positive impact on every modifiable risk factor for heart disease.

Sitting involves low levels of energy expenditure and includes activities such as television watching, computer use, and sitting in a car or at a desk. Spending long periods of time in sedentary activities is associated with elevated risks of heart disease mortality and depression; increased waist circumference, elevated blood pressure, increases bad cholesterol. It also has a negative impact on chronic disease biomarkers such as blood glucose, insulin, and lipoproteins. Research has even shown that being sedentary is detrimental even among individuals who meet the minimal physical activity recommendations.

To counter these detrimental effects to health, it is recommended to take breaks, even just standing to break up sedentary activities. When looking at your activity level as a whole, it is important to look at how much your week is spent just sitting, even though you might be meeting the minimal activity guidelines.

What Are The Recommendations for Aerobic Exercise?

These recommendations are taken from The American College Of Sports Medicine.  ACSM Guidelines on Exercise

To achieve the health benefits of aerobic exercise it is recommended to accumulate moderate-intensity exercise (40-60% of Heart Rate Reserve [HRR]) for at least 30 minutes on 5 or more days a week, for a total of 150 minutes per week. Or, vigorous-intensity exercise (60-85% of HRR) for at least 20-25 minutes on 3 or more days a week for a total of 75 minutes per week. For weight loss, 50-60 minutes per day to a total of 300 minutes moderate exercise is recommended. Interestingly, they also recommend that intermittent activities in 10-minute increments have same health benefits as continuous activities. Durations of exercise in 10 minute intervals may result in fitness and health benefits, particularly in sedentary individuals however, the evidence is sparse and inconclusive.

Large prospective studies show that energy expenditure of 1000 kilo-calories per week produce the above benefits of aerobic exercise. Some studies have even shown health benefits starting at just 500 kilo-calories.

How to exercise at the right level for Aerobic Exercise?

One of the simplest and safest way of monitoring if you are working in your aerobic zone is to use The Rating Of Perceived Exertion Scale. The Table below shows a simple version of this scale. Exercising at a moderate intensity involves exercising between 40-60% of heart rate reserve, or 4-6 out of 10 of perceived exertion. At a vigorous intensity, you want to rate yourself between 6 and 8 out of 10 on the scale. The scale uses how difficult it is to converse while exercising. If you are exercising on your own. just use common sense on hard you feel you are working.

Rating of Perceived Exertion (RPE) On A Scale of 1 to 10

How To Calculate Your Heart Rate To Exercise In The Aerobic Zone.

The rating of perceived scale is enough for most people, but it useful to know the heat rate method as well. It is not complicated at all. Some people like to use heart rate monitors, but you need to check the reliability of these models. I would not recommend using the heart monitors on treadmills and cross trainers in the gym.

40-60% of (HRR) heart rate reserve is considered moderate intensity and 60-85% heart rate reserve is considered vigorous. Very deconditioned individuals may begin to improve at about 30-40% of HRR. Your heart rate reserve is calculated as follows:

Max heart rate at 220 (beats per minute), minus your age. This equals your estimated heart rate. You then subtract your resting heart rate to give you your heart rate reserve. Example:

Max heart rate 220 BPM minus age 50 = estimated max heart rate 170 beats per minute (BPM)
Estimated max heart rate 170 BPM minus minus resting heart rate 70 BPM = 100 BPM Heart Rate Reserve.

If I want to exercise at 40% of my heart rate reserve, I can calculate my target heart rate for aerobic exercise.

Heart rate reserve 100 BPM x 40% = 40 BPM
40 BPM plus 70 BPM resting heart rate is a target heart rate of 110 beats per minute.

You can then calculate the same for 60% of heart rate reserve, to give you a target heart range between 40% and 60%. This would be for moderate intensity exercise.

If you want to see this calculation in more detail, the following website link lays it out very well:

Calculate Your Aerobic Zone Heart Rate

I think it is a good idea to work out your heart rate zone and then you just know what it feels like in your body. Once you have that sense you don’t need to keep taking your pulse, you will just know you are in the right zone. My advice is to use this calculation with the above Rating Of Perceived Exertion. When you know what your target heart rate is in beats per minute, you can just calculate the equivalent in 10 seconds and then take your pulse.

You can check your hear rate easily and match it with the perceived exertion scale. This is another link to an easy explanation of how to do this:  Check Your RPE And Heart Rate

Putting it all together.

Using the guidelines from the American College Of Sports Medicine above, start with a workout of 10 to 20 minutes duration. If you are already used to cardio, you could do between 20 and 6o minutes.

If you are very de-conditioned you may even need to split it up into several 10-minute segments. Increase your duration by 5 minutes a week until you reach the minimal recommendations.

If you are starting out with cardio, pick something simple like walking, bicycling or cross trainer. A gym membership is ideal, as I think it is a good idea to combine your use of the equipment. Don’t get bored, take music with you!

Set your goal for the duration of each session and then work in your aerobic zone until you achieve the time goal. Then you can increase the intensity of your heart rate zone when you feel it’s too easy. Unfortunately, if training is discontinued, gains in fitness regress by approximately 50% within 4-12 weeks. So keep it up!

If weight loss is your goal, frequent, enjoyable exercise periods of low to moderate intensity and relatively long duration result in the largest weekly caloric expenditures.

Stay within your heart rate range. Monitor using a good heart rate monitor or manually at the carotid artery on the neck or radial artery on thumb side of wrist. Otherwise use the Rate of Perceived Exertion Scale above. Measure Your Heart Rate

If you have any questions about the heart rate zone, you can email me and I can work out your aerobic zone. I wont be able to provide specific training recommendations unless you are a patient and have a physiotherapy assessment.

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In this blog I am going to talk about how shoulder injuries can be simplified into three broad categories. I will also discuss the treatment for each group. Unfortunately in the physiotherapy world we tend to complicate things for patients and the shoulder is an example where simplicity can be just as effective. There are some difficulties with the shoulder, but this is the same as any other injury. With most shoulder rehabilitation the process just takes time. A lot of shoulder injuries do not need surgery and do well with the right rehabilitation.

Traumatic shoulder injuries:

I am not going to go into detail on these types of injuries as they deserve a separate blog. Fractures, large muscle or tendon tears need to be seen by an orthopaedic surgeon. X-rays and MRI may be necessary. Significant loss of movement and the mechanism of injury will determine the right care. Any traumatic injury should be investigated for possible fracture, tendon rupture and large soft tissue tears. A dislocation is a severe trauma and should be seen in emergency, so the shoulder can be repositioned in the joint.

Most shoulder injuries that can be treated in the physiotherapy clinic can be grouped into the three categories below:

1. Weak and Painful

2. Stiff and Painful

3. Weak and Unstable

I have borrowed these groups from a British physiotherapist (Adam Meakins) who does a great job in simplifying how we approach shoulder injuries. It makes much more sense to group shoulder injuries by their primary movement problem. It’s very difficult to determine in the clinic which specific structures are causing pain. By determining the primary movement problem, I can be more effective with the treatment options.

The Weak and Painful Shoulder:

In this group I include rotator cuff strains. These are the small stabilizing muscles in the shoulder joint. In the younger population this could be caused by lifting weights. If these muscles are overloaded beyond their strength they can tear. Degenerative rotator cuff problems start in the 50’s age group. They are caused by weakening in the muscle-tendon unit. In the clinic the shoulder will test weak with pain as the damaged tissues are stressed. Rotator cuff tears can be caused by repetitive use or a sudden overload into the muscle-tendon unit.

Most of these muscle-tendon injuries need strengthening. The rotator cuff gets activated with lots of different movements so there are plenty of options. When pain is high, I find ways to strengthen around this. Resistance bands and light weights are good for starters. In the gym setting, pulleys are ideal. The pulley rope can be adjusted so that the rotator cuff muscles can be worked in different positions. Keeping it functional is key, so that the exercises mimic normal movement patterns.

Shoulder injuries from lifting weights usually involve a tear or strain of the rotator cuff. Overloading the shoulder is the main cause. Gym goers really have to pull back on the weights and build up again. The rotator muscles and their tendons need to be reloaded again with lighter resistance.

The Stiff and Painful Shoulder:

In this scenario there are obvious limitations with movement and pain. The two common conditions in this category are the arthritic shoulder and frozen shoulder. The arthritic shoulder is one where there are limitations of movement due to joint degeneration. Sometimes the soft tissues around the joint become tight. There may some pain moving into the stiffness.

The frozen shoulder is another entity. This is where there is severe loss of movement in all directions and a lot of pain. There will be pain at night and with movement. We don’t know why a frozen shoulder occurs in some people. Sometimes it is caused by an underlying initial injury that produces inflammation.

For the stiff arthritic shoulder the treatment is to mobilize the joint using manual therapy and mobility exercises. The soft tissue restrictions can be mobilized with a general program of strengthening. Every shoulder is different depending on how stiff they are.

For a frozen shoulder, the treatment may last at least six months. It is important not to be too aggressive initally to avoid aggravating it and causing more pain. It is one of the most challenging shoulder injuries to manage as the pain is quite high. I tend to use a mix bag of treatment techniques as each shoulder will respond differently.

The Weak and Unstable Shoulder:

These shoulders tend to be the result of repeated dislocations. If dislocation becomes chronic then surgery is usually indicated. Regular dislocations tend to occur in contact sports. If surgery is not indicated then rehabilitation is aimed at strengthening the stabilizing muscles of the shoulder joint. Certain movements have to be avoided to reduce the risk of further dislocations. The treatment program should be progressed from basic strengthening to stabilizing exercises.

Shoulder Gym Workouts: What Exercises Should I Do?

EMG studies show that the rotator cuff muscles are activated with general shoulder movements. General pushing and pulling exercises will activate both sides of the rotator cuff. Arm raises to the the side activate both. I still think it is a good idea to do some specific rotator cuff exercises as well as compound movements. Pulleys and elastic bands are good for targeting these muscles. Whatever level you are in the gym, the key is to build up slowly so to not cause injury.

If you have any questions about this blog you can email me at the address below. If you need specific advice about an injury it is best to seek advice from a physiotherapist. You can also contact me for advice about incorporating shoulder exercises into your workouts.

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What is Sacroiliac Joint Pain?

Pain can come from either of the two joints between the sacrum and ilium and the muscles connected to the pelvis. The joint can be twisted causing a deep ache in the hip and buttock area. In some situations the joint can become inflamed if it is too mobile. Some of the muscles attached to the pelvis and hip can go into spasm and become quite achey.

Most patients will describe it as lower back pain because the pattern of pain can be similar. It can be a major cause of pain in the lower back and pelvic area in all age and activity groups. It can be particularly prevalent before and after pregnancy where the ligaments become lax causing the joint to be more unstable. Sacroiliac joint pain is usually felt lower than the lumbar spine and can be palpated over the joint.

Usually muscle testing shows weakness in the muscles that stabilize the sacroiliac joint. This may have been going on for a while and then a specific event pulls the joint out of alignment. In some patients it can be a specific trauma such as a motor vehicle accident or fall on the pelvis.

Apart from pregnancy and trauma being obvious causes, there is not one causal factor that explains pain and weakness in the sacroiliac joint. Each person demonstrates a combination of biomechanical factors that cause misalignment and the underlying muscle weakness. In the more insidious cases, the lack of muscle control is the underlying cause.

Getting the correct diagnosis that distinguishes it from lower back pain is essential for directed treatment. Sacroiliac joint pain is both a mechanical problem of the joint being misaligned and muscle imbalances.

Four Common Symptoms:

• Pain is felt at the back of the hip and pelvis, sometimes coming round to the front of the hip and groin. It is usually present on one side.
• The leg can feel shorter or longer, particularly if there is a significant misalignment.
• Pain can be felt in standing and walking, worse when using stairs.
• Pain can radiate down to the knee, but not usually below.

There are a number of tests in the clinic that can further diagnose a sacroiliac joint problem compared to a lower back issue. Most of the time we are able to find that the joint has been rotated or twisted, and also if the patient has a muscle control problem causing the joint to be unstable. Some tests can localize the pain to the joint whereas lumbar spine tests don’t produce symptoms.
The patient’s history of the problem and clinical tests will narrow it down to either a lower back or sacroiliac joint problem.

What is the Treatment for a Sacroiliac Joint Problem?

• The joint needs to be manually mobilized into the correct alignment.
• Taping or a sacroiliac belt maybe necessary to provide short-term stability.
• The muscles around the hip and pelvis need to be strengthened.
• Motor control patterns need to be retrained so that the muscles work in a stabilizing way. Pilates rehabilitation is ideal for this as it has a unique way of training the stabilizing muscles.

What is Motor Control in Rehabilitation?

Many patients, not surprisingly, seem a bit confused between the concepts of strengthening and motor control. Firstly, motor control is the coordinated pattern of how muscles stabilize a joint. Strengthening refers to an individual exercise for each muscle. Our muscular system is complex with each muscle and groups of them having different functions. The pelvic joints need to be trained just like an sprained ankle. Ankle joints need balancing exercises to retrain the stabilizing role of all the muscles acting on the joint. The pelvis is no different. Individual muscles need to be targeted and then trained to work in groups to stabilize the sacroiliac joint.

Summary:

• Sacroiliac joint pain has a similar pain pattern to lower back pain but can be differentiated with clinical tests.
• Sometimes manual therapy is helpful in realigning the sacroiliac joint.
• Strengthening and motor control exercises are essential to resolve muscle imbalances that act on the joint.
• Sacroiliac joint conditions can be managed effectively with a gradual exercise program that stabilizes the joint.

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Most new acute pain starts in the tissue affected. It could be the muscle or joint or in the case of the spine the disc. When there is inflammation in the area, the nerve tissue can also become hyper-sensitized and another source of pain. You don’t want a situation where an acute pain turns into something chronic lasting more than three months. When the nervous system is being irritated for a prolonged period the risk of the pain becoming amplified increases. This is through a process of central sensitization which involves the nervous system ‘off switches’ not functioning properly. In simple terms this just means that the threshold where the initial local pain is triggered is lowered so that the area becomes more sensitive. The normal inhibition of the nervous system is not functioning properly. This is why it is important to get the recent injury treated and not letting it linger. Not every new acute pain will turn into something more chronic, but we do know that certain injuries like whiplash can if they are not treated in the early stages.

A good example is lower back pain, coming from a bulging disc. This could then turn into a disc protrusion or herniation and then a bigger issue because of the sciatica that usually follows. A good physiotherapist can determine using bed-side tests which structures are likely affected and whether it is a disc-related injury. A disc bulge can be treated quite effectively with some manual therapy and certain exercises aimed at decompression and stabilizing the disc. By addressing it early on, you will avoid the more painful scenario of a disc protrusion or herniation.

If you find yourself with pain in the muscles or joints, you are better served by a physiotherapist that can offer a combined approach. Most injuries will require treatment of pain, inflammation and then later the underlying cause. Pain management (non-medicinal) can include acupuncture, manual therapy and massage, and use of heat and cold. Some electric-modalities like TENS can also be helpful. Education is also key. In the bulging disc example, simply guiding the patient on keeping their spine in the correct curve may alleviate their pain. By changing the position of the spine the painful tissues are off-loaded and can then start to heal.

So the take home message is, don’t let pain continue for long without getting treatment. Pain is your body telling you to take care of it. Our bodies give us valuable feedback and we can respond by taking care of ourselves.

If you have any questions about musculoskeletal conditions and pain, you can email Damian Wyard MSc PT (Physiotherapist) at: info@pilates4physio.ca

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When the hip muscles are weak the upper thigh can rotate inwards and move towards the mid-line of the body, so it appears as if the leg is collapsing inwardly under the pelvis. The muscles that are weak are the gluteals and core abdominal muscles. In the clinic, we find that this scenario occurs with over-use of the quadriceps muscle to stabilize the hip which results in tight, over-active quads and adds to the irritation of the knee cap. When the hip and upper leg fall inwards it creates mechanical problems at the knee. The knee cap is pulled out of its alignment and the cartilage underneath becomes irritated and painful.

When we use the single leg squat test, we also sometimes see the foot falling into pronation together with the hip falling inwards. When the gluteal muscles are cued to correct the hip, the foot pronation is lessened. Clinical studies show that patellofemoral pain can also be caused by excessive foot pronation.

Clinical studies have also demonstrated that the preferred treatment is a physiotherapy program that addresses all the mechanical factors that contribute to this kind of knee pain. Exercises should be provided for all the weak muscles in the chain, including the hip, knee, foot and trunk.

The Pilates approach to this condition is ideal for increasing the strength of the hip, knee and foot muscles, but more importantly the coordination of these muscles. It is important to strengthen weak individual musles and also all the muscles as a group, in functional patterns. The reformer and stability chair exercises allow the hip, knee and foot to work in a coordinated pattern.

Simple home exercises that focus on the gluteal muscles are side-stepping and the clam shell. It is important to progress to weight bearing exercises that focus on the coordination of the hip knee and foot. By focusing on the stability above and below the knee, the mechanics of the joint will improve and knee pain will resolve. Here are a couple examples to practice.

1, Clam Shell:

In this exercise the target muscle is the gluteus medius, an important stabilizer of the hip. The top leg rotates upwards without the pelvis or lower back moving. It is important to engage your deep lower abdominal at the same time. Do 15 repetitions.

2. Side stepping:

In this exercise the focus is to keep the knees pointing outwards. This works all the gluteal muscles together. You want to avoid the upper thighs collapsing inwards. Do 10 steps in one direction then reverse the direction.

When the knee pain is reduced the exercises can be progressed to simple daily functional patterns, such as squatting and lunging or sport specific exercises.

These are a few simple exercises you can try at home, and for a full regime it’s best to get a professional opinion of what will work best for you. I’d be happy to offer a consultation to anyone interested. Contact me at Core Studio.

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Some of my patients I see for lower back and pelvic conditions have been provided with standing desks by their employer. Although these patients have been using their standing desks before they start treatment,  standing at work has not solved their back problem. In one case, my patient was using a standing desk to alleviate upper back pain, but then developed lower back pain. Her lower back and pelvic muscles were weak and she did not have the strength in the core muscles to tolerate a standing desk. It is not the constant sitting or standing that is the problem, but the underlying condition the patient has and how they are affected by sustained positions.

Clinically we know that sustained siting postures can produce lower back problems. Disc related injuries with sciatica are common when the lower back is flexed in the sitting position. When we assess these patients, we usually find there are a number of joint and muscle related problems that cause their pain. We see a common set of muscle imbalances that can cause lower back pain, and this is different in each person.

If we told one of our lower back patients to just stand at work, they could potentially get worse or develop additional problems. Standing requires different muscles to work compared to siting. Lower backs that are weak, together with weak core abdominal, will still be painful in either sitting or standing.  Having a standing desk at work is going to be part of the solution but it won’t be a cure-all approach. Treating the lower back/pelvic muscles and joint imbalances are key to solving the underlying problems. Each patient should be rehabilitated to the point when they can sit or stand at work.

My advice to those who are already using a standing desk at work is to vary this with sitting, so that the body can adjust. Muscles that work more in standing will benefit from the rest when we alternate with sitting.  Also, if you still have problems in standing, there may be some muscle imbalances that require correction. Common muscles that need strengthening include the deep back muscles, pelvic floor and deep abdominal. We also find the pelvic muscles, such as the gluteals and adductors are weak. The hip flexors tend to be short and over-active.

Things to avoid when using standing desks are leaning on one leg and hitching up the pelvis on one side. Locking the knees into a sway back position can be avoided by slightly relaxing the knees. Good shoes with adequate support go a long way to reduce the stress into the knees, hips and lower back. A proper assessment by a qualified ergonomist will also ensure the height of the desk and screen are customized to your body.

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Most of us don’t think about how fit we are for work, but considering the repetitive nature of most of our jobs, it is worth thinking about. I’ve been seeing a lot of patients recently who have clearly tipped the balance towards work and no exercise, and many now cannot sit in a chair because of debilitating lower back pain.

One of the main problems with sitting for long periods of time is the constant rounding of the lower back. Ideal posture is to have a gentle curve so that the vertebral joints and discs are evenly loaded on each other. When the lower back loses its natural lordotic curve the posterior section of the discs weaken and become prone to bulging or herniations. Another effect from sitting is that the hip flexors become shortened, causing more compression on the lower back joints and discs. When these muscles become tight, they can pull on the lower back with walking, or even standing up from a chair. I’ve seen patients who report their back will ‘go out’ when they stand up, after sitting for a long period of time. When this pattern occurs over a long period of time, the hip flexors cannot even perform their role as a stabilizer of the lower back as they are now too tight.

Luckily there are plenty of preventive measures that you can do to avoid this scenario!

Hip flexor stretches.
In the position below, you tuck your pelvis under by tightening your buttocks, then move your pelvis forward slightly. If they are tight, the pelvic tuck is enough. Hold the stretch for 30 seconds and repeat it twice on each leg. Stretching should always be gentle, particularly the hip flexors, so aim for 4/10 intensity with the stretch.
It is better to hold onto a chair to the side, allowing the muscle to relax.

Take walk breaks.
As long as you don’t have a manager breathing down your neck, take some regular walk breaks to open up the front of the hips. If you can’t take regular breaks, then walking at the end of the day will lengthen these muscles.

Cross Trainers.
In the winter, these machines are great for hip movements, allowing the front of the hips to open. You want to stay away from the stair master machines which tend to shorten hip flexors, and find the ones that mimic a cross-country ski action.

Back supports.
A back support that encourages the normal arch in the lower back will help to balance the load through the vertebral joints and discs. Make sure your feet are flat on the floor or on a stool. If your feet are dangling off the floor, you will use your hip flexors too much to keep you upright.

In the case of my patient who had back pain standing at an ergonomic desk, we found she had weak lower back and abdominal muscles, and not enough gluteal strength supporting her pelvis. When this is achieved she will have more support in her back for both sitting and standing at work.

Take care of your posture, and live a healthy life!

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All of the joints in our body have core stabilizing muscles. The research shows us that muscles around our joints perform different functions. Some are involved in creating movement, like rotating your neck, while others have a stabilizing role to maintain joint position. These core muscles stabilize the joints in a similar way to ligaments. Another term we use for this is muscle control. In the neck we have small core muscles that stabilize each vertebra, and in the upper back we have the muscles that act on the shoulder blades.

Treatment studies for neck pain show that strengthening of the core muscles in the neck and shoulder blades is effective for tension headaches, and also for acute and chronic neck pain. Sitting at desks actually deactivates these important stabilizing muscles, which is why we see so many clients with head forward posture. When the core shoulder blade muscles are not performing their function the neck muscles try to over compensate. When this has been going on for a while, we see rounded shoulders and a head forward posture. Not attractive!

When we sit for prolonged periods of time, certain muscles over-stretch and some become too tight. In the neck the long superficial muscles can become shortened and too active. This can then pull on the joints in the neck, causing joint compression and irritation. The core muscles become deactivated or just lazy, just the same way as they can with the abdominal muscles.

With prolonged sitting and computer work, the shoulder blades can become rounded, weakening the muscles of the upper back. This leads to round shoulders so that the long neck muscles become over-active. The neck muscles then try to stabilize the shoulder blades and arms, which they are not designed to do. This can cause a number of clinical scenarios such as nerve impingement, carpal tunnel symptoms, neck/shoulder pain, and stiff joints. We then lose mobility in the upper back, causing the neck to protrude further forward and a vicious circle of muscle imbalances.
Over-active muscles leads to pain, shortening of superficial muscles and inhibition of the core neck muscles.

Correcting this scenario requires careful programming of exercises with very little resistance. Adding too much weight will just recreate the wrong muscle patterns. I have found over the years of working with this condition that the Pilates method is ideal. The preciseness of the exercises together with the specialized equipment, allows us to wake-up the core muscles. The muscles that need targeting are the lower and middles trapezius, and the deep neck flexors. Once these muscles are working then the program can be progressed to increase strength and integrate different movement patterns. Studies have demonstrated that activating core stabilizers in the neck can reduce activity in the superficial muscles that can cause neck pain. There are also good studies that help us identify which patients will benefit from this approach, depending on their assessment findings. Sometimes joint and soft tissue mobilizations together with the stabilization approach are necessary.

Lesson learned: keep proper posture, sit straight, and take frequent breaks from sitting in one position for too long

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Some hospitals still provide physiotherapy services to the community, however this is very limited and most hospitals have reduced this service because they are not mandated to fund it. For instance, if you endure a hand injury, you should be requesting treatment at a hospital out-patient hand clinic. The hospitals have had to continue to provide these clinics because the private sector cannot provide this specialty. However, if you have a serious hand injury, you may need a splint for a while, hence a referral to the hand clinic is essential.

I am not sure how these clinics are managing these patients with this level of financial constraint. One of the criticisms of OHIP physiotherapy clinics is that the perceived treatment is sub-standard. Patients are basically hooked up to machines and then told to go into a gym with support personnel. The level of one-on-one care is minimal as the private clinic has to process several of these OHIP patients to make a profit. Remember these are private clinics only receiving funding for OHIP patients, not public clinics.

There are some home-care and hospital out-patient physiotherapy services for patients having hip or knee replacement surgeries. The advice from the government is that these patients should not need further treatment in community OHIP clinics. I know from experience this is not realistic in most cases. I recently had a patient who had hip surgery and was given just four out-patient sessions at the hospital over a four week period. Definitely not enough to allow her to gain full strength and range of motion.

The following are the eligibility criteria for OHIP funded physiotherapy in the community. The eligibility requirements for patients remain the same as under the previous OHIP system. To be eligible for publicly-funded physiotherapy in a participating clinic, patients must have a valid Ontario heath card, a referral from their physician or nurse practitioner, and be:

• age 65 or older;
• age 19 or younger;
• any age after overnight hospitalization for a condition that requires physiotherapy (and for which they are not otherwise eligible through other publicly funded programs)
• a recipient of Ontario Works or the Ontario Disability Support Program (with or without a valid Ontario health card).

For additional information on this topic I would suggest you ask your doctor if they have a physiotherapist on staff. If you have any specific questions about OHIP funded physiotherapy, I am happy to answer them and point you in the right direction of further resources.

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When most people have a running injury they tend to address what they can control themselves, either their shoes or orthotics. New Balance seems to have good advice on selecting shoes based on foot type. Then there is the recent trend towards minimalist shoes that can be quite confusing to navigate. With shoes that have a thicker sole, the foot tends to become biased into a heel strike pattern. Heel strike has been associated with more knee and foot injuries because the ground impact is greater with that type of foot strike. The minimalist shoe debate arose out of the idea that heavy cushioned shoes have changed our natural foot pattern and ironically end up causing more injuries.

After reviewing some of the research on orthotics there isn’t anything conclusive about their ability to prevent running injuries. In my experience I find clients have been prescribed orthotics, but other biomechanical issues that predispose them to running injures, have not been assessed. For example, I see pronators of the foot improve when we target the hip muscles and make changes to their running gait. Orthotics make our foot muscles lazy and they can be strengthened and stabilized by strengthening the foot, knee, and hip.

So for shoes, it pays to get some good advice from someone who specializes in running injuries. Do not just go and see any practitioner in the hope they will be an expert. Ask questions and do some research on who you see. New Balance has some useful information on foot type and the right type of shoe. I have added some links below that I found useful for starters. The ideal approach is to have someone assess the mechanics of your running gait and test the strength and flexibility of your hip, knee and foot muscles. We can adjust heel strike to more of a mid-foot pattern by shortening your stride and increasing cadence. This is more efficient and reduces the impact forces through the leg. This has been associated with fewer running injuries.

There are a number of factors to examine with the injured runner: footwear, running gait, muscle strength and flexibility. Just having an orthotic can be as band-aid as solution as going out to buy an new shoe. Sometimes it really can be a simple factor of short muscles or weak hip muscles. The key piece in rehabilitation is to combine all the corrections in muscles length and strength by retraining your running gait.

Read these New Balance articles to learn about Running Gait and Arch Analysis.

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