Hip Mobility and Strength for Ultimate

Outdoor ultimate season is upon us.  Hip mobility as well as hip strength are important parts of both performance and injury prevention. I had the pleasure of running this part of the injury prevention clinic for new and intermediate players with Ultimate NL this week.

Great hip function is a necessity during sprinting, direction changes, jumping and lunging. This comes from a combination of the passive flexibility to achieve the positions needed but more important the strength and coordination to control those positions. Trying to achieve or control positions you don’t already own is a recipe for poor performance and eventually injury.

The mobility and strength drills in the video above are not for everyone and you may not feel comfortable performing each and every one. There should be no pain during or after the movements. You should feel better when they are done compared to when you started them. Loose, relaxed and comfortable. Take the simplest variation or make modifications so they can be completed comfortably and successfully.

Welcome Aleasha Kettle, RMT

Aleasha Kettle

We’re happy to announce that Ms. Aleasha Kettle, RMT has joined the St. John’s Back Pain Clinic team. As a recent graduate Ms. Kettle has a fresh view on injuries, treatment techniques and the recovery process. After her first week she is already building a name for herself and her appointment times are filling quickly. Within your first few minutes of meeting Aleasha you will quickly appreciate her passion for helping people recover from their injuries and also teaching them how to prevent those injuries from returning in the future.

Aleasha is accepting new massage therapy clients. Her current hours are Monday through Thursday mornings from 8:30am to 12:30pm and Fridays from 8:30am to 4pm. You can set up your first appointment online using our appointment requests tool, via email at [email protected] or call 722-2300.

Basics of gym strength training

This is a conversation I have regularly with people who are experienced with strength training at a typical gym (Goodlife, the Works, MAX, reps etc). They’re picking exercises they feel they can execute safely and correctly but aren’t sure how to organize their workout, sets, reps, etc. Here are some key points that I try to convey in that conversation.

1. Intensity

This refers to how many repetitions you can perform of an exercise based on the movement, resistance, speed/tempo and rest time. To keep things simple I consistently give this rule of thumb for appropriate intensity:

With appropriate intensity it should be challenging to complete an exercise 10 times

This means you’ve picked a movement, weight and rest time that allows you to complete it 10 times in a row where the last few repetitions were far more challenging than the first few. More intensity will allow fewer repetitions, once you pass 10 repetitions the intensity may be too low to stimulate muscle growth. High intensity requires more rest time and has a higher risk of muscle strain. Lower intensity allows less rest time and lower risk of muscle strain.

2. How many sets and exercises

Your muscles respond well to the stress that comes from at least 15 sets of exercises for a body region. This doesn’t mean 15 sets of one exercise. I’d suggest spreading that out over 2-3 sets of 4-6 exercises per body region.

3. Recovery time between exercises

This is an important part of training with a lot of numbers thrown around by trainers, bloggers etc. It relates back to intensity and your own aerobic fitness. As a simple rule of thumb I’d expect at least 30 seconds between the sets of any exercise. If you are still catching your breath from an exercise give yourself longer. If the next 10 repetitions at the same intensity become very difficult that may dictate your recovery time as well. Don’t assume every exercise needs 2-3 minutes rest between every set. You may be cheating yourself out of a great cardiovascular challenge with too much recovery time between sets.

4. Recovery time between workouts

An incredibly important factor that is often missed. This refers to the between workouts for a particular body part. Your muscles need 48-72 hours to appropriate repair and improve before they’re stressed again.

5. How do I gauge progress?

Gauge success by knowing you completed the desired volume of training 2-3 set of 4-6 exercises and with an intensity that challenged you to complete 10 repetitions. Over the coming weeks maintain the volume and see the intensity start to creep up and hopefully your required recovery time between exercises lower down closer to 30 seconds. Don’t base your success on how sore you’ve made yourself.


In summary a good organization for weight training would involve 2-3 sets of 4-6 different exercises for a body region. For each exercise aim for an intensity that makes 10 repetitions challenging. Give yourself 30 seconds or more to recover between sets and 48-72 between complete workouts for a body region.

Shovel Right, Shovel Light

Most people warn that shoveling to hard will give you a heart attack. While that risk is present the most common result of snow shoveling is a sprain or strain injury and it affects more people than you’d expect. Here are some tips to better prepare you for that next day in the driveway.

Shoveling is exercise

Accept this fact and you’ll fair much better. Getting out for a good shoveling session starts with the right gear. Warm, comfortable clothes and shoes with good traction is an important start. Like any other exercise it’s best to begin with a warm up. Take a brisk walk up and down your street and follow that with some light stretching. This could be as simple as giving yourself a nice big hug to jump start those shoulders, some light bending from side to side to loosen up that torso and take a few long strides steps to get those legs prepared.

Know your limits and rest when you need it. Each lift of the shovel should not feel like you’ve just set a personal best in weight lifting. Stay within your limits. Once you’ve done a dozen or so snow pushes or shovel lifts take a short break and strike that classic ‘elbow on shovel’ pose. This will let you recharge for the next round.

Finally, end that workout with an appropriate cool down. Take another stroll down the street and let those muscles relax with a light stretching session.


Out-smart snow

Your trusty shovel may be your greatest ally or leave you feeling better off with a spoon. Selecting a good shovel is key. Consider these points when selecting your shovel.

  • push style shovels are your best bet
  • a modest size blade helps you lift light
  • an ergonomic handle does make a difference
  • pick a handle length that lets you stay upright as your work
  • a slippery blade coating will keep snow from weighing you down

Plan ahead for the next snowfall and be proactive by heading out for a light shoveling session every 5cm or less. This will let you shovel lightly more often and take good size breaks in between. This will help you avoid trying to take 20cm or more of snow at once. Most often it’s large snowfalls that lead to shoveling related injuries.

Finally, there is always bad techniques in shoveling that can lead to injury even with the best of shovels. These technique tips can help you become more efficient and reduce your risk of injury.

  • Keep your nose between your toes to avoid twisting your back
  • Push the snow instead of throwing when possible
  • Bend your knees to let your legs do the work
  • Keep your head up to help you maintain good back posture

If done right shoveling can be a rewarding and healthy activity. Remember to treat shoveling like exercise by using the right gear, warming up and cooling down. Outsmart the snow by planning ahead, shoveling small amounts often and using the right shovel to it’s full potential. Like all activities you can expect some mild soreness that day and the next, if it goes beyond a couple days, seek professional care.

Vacation time

We have two excellent Registered Massage Therapists at the St. John’s Back Pain Clinic. One of our therapists, Crystal North will be on an extended holiday until September 22nd, 2014. Judy Batten will be continuing her usual hours during that time and is happy to see any of Crystal’s existing clients. Feel free to call or use our appointment request feature to book your appointment today.

My strength training is cardio

People at the gymI’ve had this conversation with numerous patients. We talk about the need for strength development and their response is “I go to the gym already”. I ask them to describe their work out and its something along these lines “20 minutes on the treadmill, 20 minutes on the elliptical and 10 minutes on the stepper”. I’ve come to learn that its a common assumption that anything that happens within gym walls will make you stronger. Here are some key concepts I pass along to patients:

1. Time under Tension

Tension is a major stimulator for strength changes. Enough tension in a focused period of time produced through a muscle contraction and you’ll get a cascade of events that lead to larger muscle fibers. The right amount of tension varies for every muscle and every movement but here is a simple rule of thumb.

With appropriate tension it should be challenging to complete an exercise 10 times

It can be that simple. From the opening example 20 minutes on the treadmill gives about 2000-4000 footsteps (people range from 100-200 steps per minute). To accomplish 2000 steps your body is generating far less muscle tension than is required to stimulate growth and your body uses many passive spring like tissues to supplement the muscle work.

2. Muscles become fuel

A very relevant point about cardio focused training is that if you calorie intake is less than your workout demands you will start breaking muscles fibers down to fuel the run. In a pinch proteins from muscle will give you about the same energy as the same volume of carbs. Once you burn up those energy reserves you’ll switch to a catabolic state when muscles are broken down for fuel rather than built up for strength.

3. Range of motion

The last point about strength is range of motion. Even if we ignored the effects of tension and muscle catabolism, cardio moves you through a very specific motion. If strength gains could be made they’d only apply to that movement meaning it won’t make you stronger to lift that box on to a shelf or smoke someone in a pushup contest.

That’s the usual discussion. If we have time I’d certainly expand on why strength is essential to good musculoskeletal health and the basics of a gym training program.

Heat or ice for back pain

heating padThis may be the most common question that comes up during a new patient visit. So doc, should I use ice or heat on my back when it hurts? My answer, with consideration of the literature that has been published over the last few decades, my clinical experience and the understanding of patient preferences is to use heat for diffuse muscular stiffness and ice for sharp localized pain.


How does heat help 

Heat is a natural by-product of muscle activity and the support systems for that muscle (blood/oxygen supply, nerves, lubricants, hormones) act differently to help as the heat rises. Heat opens blood vessels which means more blood carrying oxygen and nutrients to fuel and rebuild injured muscle as well as take away toxins and damaged tissue. A warmed muscle is more able to slide along muscles/bones/tissues in the area giving you decreased resistance or stiffness. Much like a warm up for sport heat can help bring muscles to a point where the muscle contraction and release is more efficient, bringing relief to that sense of stiffness.



How does ice help

Ice is very effective as a numbing agent to reduce localized pain, especially near the skins surface. Rather than popping pain killers and waiting, ice can often provide immediate pain relief to superficial regions like your tail bone. Opposite to heat, ice encourages blood vessels to constrict and reduce blood flow which can be valuable if swelling or bruising is an issue.


effective delivery

Your body is excellent at regulating its temperature. So that hot water bottle may bring your skin temperature up but an inch below the surface that extra heat is dissipating quick. The same idea applies for ice. If your target is superficial an ice or heat pack will work well with continuous heat for up to 30 minutes or ice applied in intervals of 10 minutes on, 10 minutes off. If the target is deeper or thicker tissue you may want to drive up your whole body temperature with a hot shower.


Quick summary

Heat works well for diffuse muscle stiffness when used for up to 30 minutes continuously.
Use heat packs for smaller superficial areas and a hot shower for deeper/thicker muscles.

Ice works well for superficial sharp localized pain.
Use ice packs in intervals of 10 mins on, 10 mins off for pain relief and to reduce swelling/bruising.

Always be cautious applying extreme temperatures directly on your skin.


Updated: Snowfall Warning for January 29, 2014


3:00 PM: We will be closing the clinic at 5pm. Those will appointments after 5pm will be contacted personally to reschedule. The storm should clue up overnight and we will be operating as usual tomorrow, January 30th. The roads are slick and a heavier snowfall is expected after 4pm. Drive safe.

11:00 AM: Skies are clear and winds are under control. Most weather centers are predicting heavy snow by 4 or 5pm. We will provide another update at 3pm.

After weeks of rain mother nature has dropped her temperatures to bring back winter. We’re expecting a heavy snowfall later in the afternoon on Wednesday January 29th, 2014. We’re planning to open in the morning before the potential storm. An update will be made at 11am and if necessary again at 3pm regarding afternoon and evening appointments. Those with affected appointments will also be contacted personally.

The Canoe

Think about this situation and what you might do differently.

John loves to go fishing in his canoe. He’s got a great canoe. Lately when he launches his canoe it rubs on a few jagged rocks coming on and off the water. At first he didn’t see the wear, now he can see the worn surface and torn fiberglass. When he pushes on the worn area he feels the weakness in the structure. John kept on the same routine day after day. Finally the side wall gave and water would leak through, slowly sinking his canoe. Even with a little leak he could stay out 2 hours. When the leak got bigger could barely do any fishing before there was too much water.

At what point does the damage become more difficult to repair?
What if John just started launching his canoe away from the jagged rocks?

More importantly what if you were the canoe?
Would you think differently about how to care for your own injury?

Let’s flip the story:

John works building cabinets. He’s a great craftsman. Lately he’s had to bend awkwardly to pull some materials from behind a saw they’d recently moved. At first he didn’t notice his back, now he feels a pull along his spine. He feels tenderness when he presses on his low back. John kept on the same routine day after day. Finally during one awkward bend he felt a stronger pain that wouldn’t go away. Despite the pain he could get through about 2 hours work. When the pain worsened he needed help operating the machinery and could barely work.

Caring for your own health can be as simple and as logical as caring for anything you hold dear.

Strength is essential: part 1

Strength is an essential part of staying healthy. Having a better understand of how your body becomes and stays strong can help you stay healthy. In the first part on our series on strength we’ll look at how your body adapts to become stronger.

Strong Enough

Our physiology demands that we conserve energy and resources. It takes significant resources creating and maintaining excessive amounts of muscle tissue so we will only become strong enough to handle our regular exertions. If we don’t regularly lift 50 lbs then there is no reason to keep the extra muscle tissue for heavier lifting around. Eventually it shrinks away. If once or twice a month you lift heavy things your body will react and lay down new muscle but within a week if that stress isn’t applied again that new muscle will shrink away to conserve energy and resources. Over the many years of your life your body has fine tuned itself to only ever be strong enough for what you do week to week. There’s no prediction or anticipation that you’re planning on moving next month and will be lifting many 50lb boxes.


Intensity Matters

Yes, walking is exercise. Walking will not make you stronger. Being able to take 1000 steps without needing to stop is low intensity. Low intensity will not spark new muscle growth. If doing 10 lunges is difficult and makes your legs burn with fatigue it will spark new muscle growth. To your muscles those lunges are 100 times harder than walking so it should make sense for them to adapt.

Imagine walking was the extent of your regular exercise for your legs. It doesn’t really prepare you well for climbing stairs, bending towards the floor or lifting from the car trunk. Then for several weeks you did lunges on a regular schedule. Now they have become the new strength expectation for your legs. You have become far stronger and better prepared for more challenging tasks since lunges are already fairly intense.


What’s the frequency?Pretty young girl fitness workout

Remember that those adaptations are not permanent. Your body is always ready to reclaim resources (like new muscle fibers). So if you do one round of lunges and take a week off chances are you’ve lost some of those new fibers. The general rule is 48 hours between stresses. Less than that and you run the risk of over training. 72 hours (or every third day) is very acceptable and you’ll clearly see improvement. It just won’t happen as quickly. 4 or 5 days between exercise sessions and you’ll certainly maintain any new strength you’ve gained but improvement will be very slow. Stretch it out to a week or more and you’ll potentially lose any gains you’ve already made.

Keep in mind this applies to a specific muscle not exercise in general. If you’re lunging to strengthen legs one day but then working planks for your abs the next day that isn’t going to negatively affect your leg recovery and strengthening.


Change your story

You can’t get through your week without being faced with a strength challenge. It often leaves you wondering why you’re not as strong as you used to be. Change your story. Stop assuming that low intensity exercise like walking your dog or cleaning up around the house will keep your strong. Appreciate that your body will only ever become as strong as the challenge it faces. This doesn’t have to mean 2 hours a day in a gym lifting heavy. But it does mean regular efforts above your typical day.