Embed Size (px)
Citation preview
PLUS: Empowering Figure Skaters to be Competition Ready
CanadianPhysiotherapy Association
Congress 2015Vol. 5, No. 3
Treating injuries in the dynamic sport of fencing
Everything You Never Knew You Wanted to Know
About Fencing
+An accurate look at CrossFit training: Injuries and training safely
Ultra-Maximalist Shoes
V-100 Bobath V-333 Sterling V-330 Drop End
Seers MedicalWorking for You Everyday in Every WaySuperior quality,
maximum flexibility
and patient-focused
features are built into
all V-Series models,
making treatment
sessions more efficient
and frustration-free,
and patients more
comfortable and safe.
Our treatment tables
provide diversity in
design and make
therapy really work
for you.
The V-335 is a
3-Section Mobilization
Table with 90° Drop
End and electric
perimeter foot switch.
The V-120 is a Bobath
Deluxe Treatment
Table that features
electric backrest
operation and large
wheel design with
steering facility and
central locking.
The Advanced Physio Equipment Experts
C
M
Y
CM
MY
CY
CMY
K
Seers Medical Ad ENG copy.pdf 1 2014-09-22 11:13 AM
PHYSIOTHERAPY PRACTICE | CONGRESS 2015 3
President’s Message 5Ultra-Maximalist Shoes 6Everything You Never Knew You Wanted to Know About Fencing 10CrossFit Injuries and Training 18A Model Of Care For Interdisciplinary Spasticity Management 24 Empowering Canadian Skaters to be Competition-Ready 27
106 18
Congress 2015 | Vol. 5, No. 3
We are Canada’s local, national, global rehabilitation product source
Making physiotherapymore profitablePure Care, Canada’s only national Physiotherapy product wholesaler, has provided creative, profitable solutions to new and existing Physiotherapy clinics and public healthcare rehabilitation facilities since 1998.
With a reputation for combining excellent value and exceptional service, Pure Care’s national supply infrastructure ensures that products are sourced closer to our customers. As the only manufacturer to distribute directly to our customers, Pure Care offers over 1,000 superior product lines for delivery within a 48-hour timeframe, alleviating the need for our customers to stock excess inventory or engage in advance ordering, and resulting in improved profitability and business viability during challenging economic times.
Pure Care manufactures most of the products we supply. As the primary product source for new Physiotherapy clinic openings - clinics with Private, MVA, ICBC, WSIB, and WCB patient caseloads – Pure Care is committed to helping you realize significant savings for reinvestment into your business and its future.
At Pure Care, we value our professional relationships. Let us help you realize your financial dreams.
We invite you to visit us at:
www.purecareinc.comRichmond, BC | Langley BC | Edmonton, AB | Calgary, AB Brampton, ON | Toronto, ON
Managing EditorsKim TytlerJamie Noonan
Art DirectionShift 180
Cover Photo:Zurab Kaisidi
ContributorsBlaise DuboisDinah HampsonYuri FeitoScotty ButcherFelicia WongJosée MatteauAgnes Makowski
Advertising SalesDonna [email protected] Publication of advertise-ments does not represent an endorsement by CPA.
PublisherCanadian Physiotherapy [email protected]
ReprintsMaterial in Physiotherapy Practice is protected by copyright and may not be reprinted without the per-mission of the publisher.Canadian Physiotherapy Association
Publication MailAgreement No. 40065308
Return undeliverable Canadian addressed mail to:Canadian Physiotherapy Association955 Green Valley Crescent, Suite 270Ottawa, ON K2C 3V4
On behalf of the Board of Directors, I would like to welcome you to this edi-tion of Physiotherapy Practice.
Congress 2015 programming has been revamped and revitalized with exciting changes in response to suggestions made by you, our members. Be sure to visit the CPA website for detailed descriptions of all the events occurring in Halifax (www.physiotherapy.ca/Congress). One of the many exciting changes for this year is the introduction of a mini-symposium which is themed Exercise Prescription in Physiotherapy. By design, there is a greater focus on content and sessions directed to frontline clinicians. A special thank you to the Congress Planning Committee for crafting what is sure to be a Congress to remember! The Committee’s commitment to ensuring a balance of academic/research and clinical offerings is noteworthy.
Aside from the formal programming at Congress, there is wealth of informal knowledge to be gained, from the social intermingling that occurs during the networking breaks through to the vari-ous social gatherings and receptions. If Congress was viewed as a martini it would consist of one part Physiotherapists (Cana-dian and international), one part Physio-therapy Assistants and one part students... lightly stirred, never shaken... resulting in a refreshing explosion of youthful enthu-siasm tempered with a hint of experience sure to satisfy even the most discriminating palates. Oh yes, I forgot... all served with a twist of FUN... cheers!
Finally...I would suggest that Congress is more than a knowledge translation venue. I would proffer that it is to some degree a place where knowledge is manufactured. Congress offers an unparalleled opportu-
nity for leading Canadian and international researchers, along with cutting edge clini-cians, to congregate for the purpose of the exchanging of ideas, findings and tech-niques. It is through this harmonization of academic and clinical energies that knowl-edge is manufactured. Come to Halifax and be a part of something special.
Your ongoing support through member-ship and engagement enables the Canadian Physiotherapy Association to work towards its mission: to advance the profession of physiotherapy in order to improve the health of Canadians. For this, the Board of Direc-tors thanks you.
Stay well, and see you in Halifax!
Doug Treloar B.M.R.,P.T.PresidentCanadian Physiotherapy [email protected]
Manufacturing Knowledge
PRESIDENT’S MESSAGE
PHYSIOTHERAPY PRACTICE | CONGRESS 2015 5We are Canada’s local, national, global rehabilitation product source
Making physiotherapymore profitablePure Care, Canada’s only national Physiotherapy product wholesaler, has provided creative, profitable solutions to new and existing Physiotherapy clinics and public healthcare rehabilitation facilities since 1998.
With a reputation for combining excellent value and exceptional service, Pure Care’s national supply infrastructure ensures that products are sourced closer to our customers. As the only manufacturer to distribute directly to our customers, Pure Care offers over 1,000 superior product lines for delivery within a 48-hour timeframe, alleviating the need for our customers to stock excess inventory or engage in advance ordering, and resulting in improved profitability and business viability during challenging economic times.
Pure Care manufactures most of the products we supply. As the primary product source for new Physiotherapy clinic openings - clinics with Private, MVA, ICBC, WSIB, and WCB patient caseloads – Pure Care is committed to helping you realize significant savings for reinvestment into your business and its future.
At Pure Care, we value our professional relationships. Let us help you realize your financial dreams.
We invite you to visit us at:
www.purecareinc.comRichmond, BC | Langley BC | Edmonton, AB | Calgary, AB Brampton, ON | Toronto, ON
6 PHYSIOTHERAPY PRACTICE | CONGRESS 2015
THE MINIMALIST SHOE CRAZE having run its course, the next big thing appears to be “ultra maximalism”. Led by Hoka™, other big names in footwear have quickly flooded the market, all heralding new, oversized product lines. This time however, if the market has done a complete 180, it isn’t because of a bestseller or the advice of health professionals or scientists.
Consumers see the oversized area between the foot and the ground as space for extra cushioning, and therefore protection, as well as a feature that makes the shoe more comfortable. These are the pivotal points on which the success of this type of shoe depends. Add to the mix effective marketing—an eye-catching design that visually highlights the shoe’s ultra-technical characteristics—and a narrative (not evidence-based) expounding the shock-absorbing virtues of ultra-maximalist shoes and you end up with a resounding commercial success.
It is interesting to note the similarities in the popular sales pitches for both minimalist and traditional shoes. In fact, ultra-maximalists claim that this type of shoe respects the natural movement of the foot while being super lightweight, and that it boasts protective reinforcements that improve ankle movement, stability and support. A perfect combination of technologies… or simply an opportunity to reach a greater number of consumers?
Despite a sharp increase in sales of ultra-maximalist shoes, this is still a relatively insignificant niche, accounting for only a small percentage of the running shoe market.
The minimalist movement has led to major changes in the production of footwear. Lighter, more flexible models with a lower drop (the difference between the height of the heel and the forefoot) have dominated product lines over the past four years. These shoes are classified on a continuum based
on 5 aspects: sole thickness; drop; flexibility; weight; and stabilizing technology. This formula is referred to as the Minimalist Index (MI). A Minimalist Index of 100%, for example, can be found in certain Vibram™ FiveFinger models. On the opposite end of the spectrum, ultra-maximalist shoes, including some Hoka™ models, have an MI of almost 0%.
Science demonstrates the effects of oversized footwear on biomechanics, as well as the stress placed on tissues. The current data can be summarized as follows: larger shoes increase the probability of a heel-strike, slow your cadence, and increase the force of impact with the ground. Furthermore, even if the mechanical stress applied to the foot decreases, it increases in the knees and back.
By learning about these biomechanical effects, informed health professionals can prescribe the type of shoe that corresponds to the suggested treatment. Why not protect chronic metatarsalgia with an ultra-maximalist shoe, thereby allowing the patient to continue practicing their sport? On the other hand, minimalist shoes, known to improve impact-moderation behaviours, are highly recommended for low back pain.
Instead of being swept away by this new trend, try relying on these evidence-based recommendations: • If you are new to running, start with
minimalist shoes.• Don’t change your habits unless you
are injured or looking to improve your performance.
• Children should only wear ultra-minimalist shoes.
• A runner’s arch and weight should not influence shoe choice.
• Low Quality Evidence with High Risk of Bias that experienced minimalist shoe wearers have a lower risk of injury than experienced traditional/maximalist shoe wearers
• Low Quality Evidence with High Risk of Bias that new minimalist shoe wearers have a higher risk of injury than experienced traditional/maximalist shoe wearers
• No Evidence that new traditional/maximalist shoe wearers have a higher risk of injury than experienced minimalist shoe wearers
• Moderate Quality Evidence with Low Risk of Bias that different midsole densities within traditional/maximalist shoes have no influence on injury risk
• Moderate Quality Evidence with High Risk of Bias that traditional/maximalist shoes equipped with pronation-control technologies are inefficient in reducing injury risk when compared with traditional/maximalist shoes without pronation-control technologies.
Ultra-Maximalist ShoesBlaise Dubois PT, The Running Clinic, CPA member since 2013
PHYSIOTHERAPY PRACTICE | CONGRESS 2015 7
RECREATIONAL> 6 months of experience
www.therunningclinic.com
Pronation control, Elevated Cushioned Heel running shoes.
Transitional running shoes between PECH and racer.
Light and close-to-the-ground racing flats.
Running shoes with minimal inter-ference and without cushioning.
Average suggested transition time (in months)
for runners used to PECH shoes.
Age and health status are other factors that can influence
the transition time.
PECH light trainer minimalistracer
No change of habits
For training and racing
Flow
char
t bui
lt a
cco
rdin
g to
cur
rent
ly a
vail
able
sci
enti
fic
evid
ence
. Sug
gest
ed t
rans
itio
n ti
me
is c
ons
erva
tive
and
can
var
y fr
om
one
ind
ivid
ual t
o an
oth
er.
For a
per
sona
lize
d p
resc
rip
tio
n, p
leas
e co
nsul
t a r
unni
ng s
pec
iali
st. C
onc
epti
on:
Bla
ise
Dub
ois.
All
righ
ts re
serv
ed, T
he
Run
ning
Cli
nicTM
201
2.
For training and racing
Muscle or tendon injury (high healing potential)
Fascia, shin or bone injury(moderate healing potential)
Neuroma, metatarsalgia or osteoarthritis(low healing potential)
Injuryfoot or posterior leg
9
02
6
9
6
3
12
9
02
6
9
6
3
12
9
02
6
9
6
3
12
9
02
6
9
6
3
12
9
02
6
9
6
3
12
9
02
6
9
6
3
12
9
02
6
9
6
3
12
For training and racing
9
02
6
9
6
3
12
Injuryanterior leg, knee or higher
Not injured
COMPETITIVEObjective: Performance
No change of habits
Same shoes for training and racing
9
02
6
9
6
3
12
9
02
6
9
6
3
12
During season
Off season or start of season
- heel - cushioning
9
02
6
9
6
3
12
Injuryanterior leg,
knee or higher
Injuryfoot or posterior leg
BEGINNER< 6 months of experience
No history of injury
History of injuryfoot or posterior leg
History of injuryanterior leg, knee or higher
9
02
6
9
6
3
12
9
02
6
9
6
3
12
9
02
6
9
6
3
12
Injured
+ heel
+ heel + cushioning
+ heel + stability
+ heel + cushioning
+ stability
Achilles tendonitis or calf problem
Metatarsalgia or metatarsal
stress fracture
Tibialis posterior tendonitis
or shin splint
Plantar fasciitis or posterior compartment
syndrome
9
02
6
9
6
3
12
9
02
6
9
6
3
12
9
02
6
9
6
3
12
9
02
6
9
6
3
12
Acute< 6 weeks
Satisfied with performance
Efficient biomechanics* running cadence > 170 * little wear under running
shoe heels
Less efficient biomechanics* running cadence < 170 * excessive wear under
running shoe heels
Wish to improve performance
Persistent> 6 weeks
How to select your running shoes
Get with the times and log in to Physiotec’s revolutionary way of showing patients how to do home exercises.Put Physiotec at the heart of your patient wellbeing, and see how our custom-de-signed video exercise program can empower them and speed up their recovery time. With thousands of videos available plus our made-to-measure video option, we are redefining the way in which patients exercise their way back to health.
Get the full story on how we’re changing the world of exercise programs on stickmen.tv
1 866 [email protected]
WHO ARE THEY KIDDING?
Stickmen 6 hours - HELP US SAVE OUR JOBS. SHARE IF YOU CARE!#WeWantToWork
@Stickmen - 01.04.15
Please support our cause
and RT ! #UnfairFiring
#StickmenArePeopleToo
NEWEASIER AND BETTERResponsive interface
Available with:
Take care of your patients.Submit their insurance claims quickly and efficiently.
With the TELUS Health eClaims solution, you can now benefit from direct
billing capabilities to various insurers. This means your patients will be able to
enjoy a service similar to the one they receive at the pharmacy or the dentist.
It’s quick to register, it’s easy to use and it’s free.
Is it any wonder so many healthcare providers rely on it?
Register now telushealth.com/eclaims
Register now at www.acupuncturecanada.org
We’re committed to training safe, effective practitioners.
Competency-based program delivered with a fully online component facilitated by instructors, followed by onsite hands-on workshops taught in small groups
Access to a multidisciplinary faculty with hundreds of years combined experience
Acupuncture Canada - formerly AFCI - has been teaching acupuncture to regulated health profes-sionals for over 40 years.
COURSE SCHEDULEFlexible and easily accessible, with online and on-site practical sessions offered in cities across Canada.
Everything You Never Knew You Wanted to Know About Fencing
PHO
TO: Z
urab
Kai
sidi
PHYSIOTHERAPY PRACTICE | CONGRESS 2015 11
COMPETITIVE FENCING IS ONE OF ONLY FIVE SPORTS TO HAVE BEEN FEATURED IN EVERY
MODERN OLYMPIC GAMES. Male and female fencers train and compete in one of three weapons: foil, épée
and sabre. Each weapon lends itself to slightly different equipment, technique, rules and injuries. Foil uses a light, thrusting weapon that targets the whole torso, neck, and groin. The foil weapon has a small circular hand guard
that serves to protect the hand from direct stabs. A lamé, or conductive vest is worn over the target area to register touches from the opponent’s foil. Épée uses a thrusting
weapon like the foil, but much heavier. In épée, the entire body is a valid target. The hand guard on the épée is a
large circle that extends towards the pommel, effectively covering the hand, which is a valid target in épée. Like
foil, all hits must be with the tip and not the sides of the blade. Sabre uses a light cutting and thrusting weapon that
targets the entire head and body above the waist, except the weapon hand. The hand guard on the sabre extends
from the pommel to the base of where the blade connects to the hilt. This guard is generally turned outwards during sport to protect the sword arm from touches. Hits with the entire blade are valid. A conductive mask, neck bib, and a conductive lamé worn over the torso and arms all register
the opponent’s touches.
Dinah Hampson BA, BScPT, FCAMTDiploma of Manual and Manipulative Therapy
Diploma of Sport Physiotherapy, CPA member since 1994
Marc-Antoine Brodeur and Anthony Prymack, Men’s Foil,competing at Kitchener Canada Cup 2015
12 PHYSIOTHERAPY PRACTICE | CONGRESS 2015
A fencer’s protective equipment includes a jacket and breeches made of ballistic fabric mixed with cotton or nylon to withstand 180 pound-force, a mask withstanding 55 pound-force punch and neck bib withstanding 360 pound-force. In addition, shoes, socks, sous-plastron (under arm protector), a glove and chest plate are also worn. Equipment regulations are enforced by the governing body of fencing, the Federation International d’Escrime (FIE). Competition takes place on a 14 x 2 meter strip called the Piste. In general, fencing involves a series of explosive attacks, spaced by low-intensity movements and recovery periods. During an elimination bout (lasting 3 x 3 minutes), a fencer may cover between 250 and 1000 meters, attack 140 times, and change direction approximately 200 times. (Turner et al. 2013) A fencer uses the “En Garde” position (knees flexed, dominant arm and same foot forward, contra-lateral lower extremity in external rotation) as a “ready” stance. From this position, a fencer can advance and retreat using a series of steps and lunges to gain distance on their opponent for an attack.
Treating injuries Medical personnel covering a fencing competition need to be aware that fencing rules allow each athlete one
Fencing is a unilateral sport, which can lead to muscle imbalances, incorrect body alignment and poor coordination when executing fencing technique
FENCING
Dinah Hampson, treating Igor Gantsevich, Men’s épée, 2011 Pan American Games in Guadalajara, Mexico
Dinah Hampson with Senior Women’s foil team (Shannon Comerford, Kelleigh Ryan, Alanna Goldie, Eleanor Harvey) at 2014 Pan American Zonal challenge, San Jose, Costa Rica
PHYSIOTHERAPY PRACTICE | CONGRESS 2015 13
10-minute “injury time” per new injury per competition. Medical personnel also need to be aware of common injuries, treatments and preventative strategies for the athletes’ training programs. Although penetrating injuries are low (2.7% of reported injuries), it is important to be aware of the potential for severe puncture wounds. Penetrating injuries have most commonly been the result of broken blades, however the vast majority of fencing injuries are related to the dynamic movement of fencing action rather than equipment issues (Harmer, 2008). Injury rates in competitive fencing are, overall, quite low. In a prospective, 5-year study by Peter Harmer of 78,223 competitive US fencers, the overall rate of time loss injury was reported at .3/1000 athlete exposures. The most common reported injuries were strains and sprains (52%), followed by ruptures and contusions. Although the knee was the most commonly injured body part reported, thigh strains (hamstrings>quadriceps) and ankle sprains were the most frequently reported injuries. Finger injuries are the most common upper extremity injury, most often due to hits from the opponent’s weapon or contact with the bell guard. Women have a higher rate of injury than men, and overall, sabre fencers show 62% higher risk of sustaining
a time loss injury than épée or foil fencers (Harmer, 2008).
The physical demands of the lunge attack require the athlete’s rear leg to produce a powerful concentric action propelling the athlete forward. However, the front leg must produce a rapid braking action on landing to stabilize the fencer and prepare for the next attack. This stop-start, rapid change in direction movement contributes to the most common injuries: strains and sprains.
It is not surprising that 14.5% of fencers identify tendonitis as their worst injury, both acutely and over the course of their fencing career (Carter et al, 1993).
Medical personnel working with fencers should apply injury prevention strategies with the athletes. Proprioceptive training and strengthening of the lower extremities should be employed to prevent hamstring strains and ankle sprains in the same way as the FIFA 11 program has positively influenced soccer to prevent ACL injuries (Harmer, 2007). Fencers need to use strength and power training to increase their speed and efficiency supporting the short-burst, high-intensity energy required. Metabolic conditioning with a work-to-rest ratio of 1:3, rather than low-intensity, high-duration workouts will
be more productive (Turner et al. 2013). Fencing is a unilateral sport, which can lead to muscle imbalances, incorrect body alignment and poor coordination when executing fencing technique. Younger, skeletally immature athletes should use whole-body, bilateral strengthening programs to reduce muscle imbalances (Carter et al, 1993). Proficiency in taping to efficiently manage abrasions, blisters, lacerations and joint stabilization is a must, and protective equipment, including weapon blades, should be checked regularly for quality and wear.
Fencing is a dynamic sport enjoyed by men and women of all ages. Research shows the risk of injury to be low, and injury prevention strategies can be implemented to reduce the incidence of strains and sprains. Working together with coaches, medical personnel play an important role in the success of competitive fencing athletes.
En Garde!
Dinah Hampson is the Canadian National Fencing Team Physiotherapist and is a member of the Canadian Fencing Federation High Performance Committee. Dinah is the President and CEO of Pivot Sport Medicine in Toronto, ON.
14.5% of fencers identify tendonitis as their worst injury, both acutely and over the course of their
fencing career
Vincent Couturier, Men’s Sabre, competing at 2011 Pan American Games, Guadalajara, Mexico
www.manualconcepts.com
Here is your opportunity to learn highly effective and evidence based manual therapy and sports physiotherapy from leading professionals which will allow you to achieve immediate results.
to attend these clinically based, hands-on coursesInvitation Certifi cate in
Orthopaedic Manual TherapyCertifi cate in
Advanced Sports RehabilitationDESCRIPTION Intense 4-week fully comprehensive evidence based program
focused on the spine, shoulder girdle, sacroiliac joints, pelvis and lower limb. Participants may be eligible to undertake distance learning leading to higher qualifi cations at Curtin University including a Masters.
This 4-week course embraces a systematic approach to the challenges of management of the injured athlete from injury prevention, acute on-fi eld management, treatment in the clinic, and rehabilitation/return to sport for athletes at all levels of ability.
LOCATION & DATE
CURTIN UNIVERSIT Y Perth, Western Australia
Jun 2015, Nov 2015, Jun 2016
CURTIN UNIVERSITY Perth, Western Australia
Jan–Feb 2016
INSTRUCTORS Manual Concepts team including: Kim Robinson, A/Prof Toby Hall, Prof Michele Sterling, Prof Peter O’Sullivan, Steve Edmondston, Michael Monaghan, A/Prof Helen Slater, Mark Oliver, A/Prof Diana Hopper and Dr Dean Watson.
Manual Concepts Team including: Prof Jill Cook, Jenny McConnell, Lyn Watson, A/Prof Toby Hall, Kim Robinson, A/Prof Diana Hopper and Prof Peter O’Sullivan, and other leading specialist sports physiotherapists.
INVESTMENT AUD $6,450 AUD $6,450
Postgraduate educational programsdesigned to improve patient management
t
REGISTER NOW!
Courses fi ll early
Register online at www.manualconcepts.com or email [email protected] PO Box 1236, Booragoon, Western Australia 6954
MC-HPm-FirstHand-1213_2.indd 1 29/11/13 3:14 PM
Before After
No Long-Term ContractNo Up-Front Costs
145145
EMR + Management Software
Book your demo today: 877.510.7473
www.practiceperfectemr.com
Get your practice in shape.
Billing + Scheduling
Documentation/EMR
Business Growth Tools
HCAI/WSIB/Teleplan Ready
and look at me now!I’ve been using Practice Perfect EMR
for 6 months
Now
integrated
with FOTO!
MORE
Learn more at physiotherapy.ca/congress
P R E P A R A T I O N S
• A R E U N D E R W A Y •
...for the largest gathering of physiotherapists in Canada.Connect with your physiotherapy colleagues and participate in top-notch educational programming, discussions on scientific advances and professional issues, and dialogue with physiotherapists from across the country about challenges and achievements!
D O N ’ T B E A F R A I D
• W I T H S C O T T J O N E S •
After su�ering a hateful attack, which left him paralyzed from the waist down, Scott Jones turned his experience from hate to love. Join in Scott’s journey in creating an accepting and inclusive society through his talk on Friday June 19 at 8:00-9:00am.
Friday, June 19, 2015Start getting ready now to run a beautifully planned course and spend an active evening with colleagues and friends.
5 K R A C E
• F O R R E S E A R C H •
C H A L L E N G E
• DIVISIONS AND STUDENTS •
Division representatives participate annually in a challenge to raise funds for PFC. The Division collecting the highest numbers of pledges wins! The National Students’ Assembly has also joined PFC to raise funds for Canadian physiotherapy research and student members across Canada have mobilized to collect pledges. The university bringing the most PFC pledges to Halifax will receive a complimentary registration to Congress 2016 for one of its students.
B O A T C R U I S E
• & A U C T I O N •
Join us on this sailing and bidding adventure in support of physiotherapy research. For more details please visit our website.
F O R M O R E
• I N F O R M A T I O N •
...regarding these events please contact Rosalby Kelly at [email protected]
A N N C O L L I N S W H I T M O R E
• S T U D E N T C O M P E T I T I O N •
Each year, three student researchers are selected from Canadian physiotherapy university programs to present their work to a jury panel at Congress. Finalists receive a $1,500 travel stipend to attend. The winner will be determined immediately following the competition and will receive $1,000; the second place project will receive $500.
Halifax15_Spread.indd All Pages 2015-04-07 10:18 AM
Learn more at physiotherapy.ca/congress
P R E P A R A T I O N S
• A R E U N D E R W A Y •
...for the largest gathering of physiotherapists in Canada.Connect with your physiotherapy colleagues and participate in top-notch educational programming, discussions on scientific advances and professional issues, and dialogue with physiotherapists from across the country about challenges and achievements!
D O N ’ T B E A F R A I D
• W I T H S C O T T J O N E S •
After su�ering a hateful attack, which left him paralyzed from the waist down, Scott Jones turned his experience from hate to love. Join in Scott’s journey in creating an accepting and inclusive society through his talk on Friday June 19 at 8:00-9:00am.
Friday, June 19, 2015Start getting ready now to run a beautifully planned course and spend an active evening with colleagues and friends.
5 K R A C E
• F O R R E S E A R C H •
C H A L L E N G E
• DIVISIONS AND STUDENTS •
Division representatives participate annually in a challenge to raise funds for PFC. The Division collecting the highest numbers of pledges wins! The National Students’ Assembly has also joined PFC to raise funds for Canadian physiotherapy research and student members across Canada have mobilized to collect pledges. The university bringing the most PFC pledges to Halifax will receive a complimentary registration to Congress 2016 for one of its students.
B O A T C R U I S E
• & A U C T I O N •
Join us on this sailing and bidding adventure in support of physiotherapy research. For more details please visit our website.
F O R M O R E
• I N F O R M A T I O N •
...regarding these events please contact Rosalby Kelly at [email protected]
A N N C O L L I N S W H I T M O R E
• S T U D E N T C O M P E T I T I O N •
Each year, three student researchers are selected from Canadian physiotherapy university programs to present their work to a jury panel at Congress. Finalists receive a $1,500 travel stipend to attend. The winner will be determined immediately following the competition and will receive $1,000; the second place project will receive $500.
Halifax15_Spread.indd All Pages 2015-04-07 10:18 AM
18 PHYSIOTHERAPY PRACTICE | CONGRESS 2015
CrossFit™ Injuries and TrainingAn accurate look at CrossFit™ training: Injuries and training safelyYuri Feito, MPH, PhD, ACSM-RCEP, FACSM and Scotty Butcher, BScPT, PhD, ACSM-RCEP, CPA member since 1996
Pepe Niño at CrossFit BC in Vancouver
PHYSIOTHERAPY PRACTICE | CONGRESS 2015 19
Despite its criticism, the most recent data available suggest this training modality is no more dangerous than other more common athletic modalities, such as weightlifting, powerlifting, gymnastics or running
CROSSFIT™ IS A RELATIVELY NEW TRAINING MODALITY characterized by a training methodology consisting of “constantly varied, high intensity, functional movements.”1 CrossFit training has a reputation for being extremely effective in increasing multiple elements of cardiovascular and muscular fitness2); however, over the last several years, CrossFit has been highly criticized by the media and the healthcare community due to its reported high rates of injuries3-5 and its potential for overtraining and overuse-type injuries.6 Despite this criticism, the most recent data available7,8 suggest this training modality is no more dangerous than other more common athletic modalities, such as weightlifting, powerlifting,9,10 gymnastics,11 or running.12 Moreover, the reported injury rates associated with CrossFit are lower than those reported in competitive sports such as rugby13 or soccer.14 The purpose of this article is to correct some misconceptions about injuries due to CrossFit training and to provide the practitioner with some guidelines for working with CrossFit trainees.
Injuries due to training: When discussing injury, it is imperative to examine variables that can be easily compared between studies. Simply using proportions, such as the number of people participating in an activity divided by the number of people reporting an injury in that activity is inaccurate, can be misleading and will lead to erroneous interpretation of the available data (the reader is encouraged to read “Prevalence and Incidence Rates Are Not the Same” in Orthopaedic Journal of Sports Medicine15 for a more detailed discussion).
In epidemiology, prevalence and incidence are commonly used to depict the severity of a condition. Although they can be used to measure the same condition, they are calculated differently and cannot be interchanged. “Prevalence” is the total number of individuals in a group that displays an outcome of interest at a specific period of time.16 “Incidence,” unlike prevalence, is the number of new cases (i.e. injuries) that develop over a specified period of time.16 Therefore, in order to examine the safety of an activity we must first know the total number of
participants engaged in that activity, or a sample thereof, and the total time of exposure during the period of interest (i.e. one year). With this information we can calculate an injury rate (i.e. injuries per 1000 hours of exposure), which would allow us to compare activities and different studies.
In regards to injuries related to CrossFit, there have only been two studies that have accurately reported the number of injuries among CrossFit participants. In the study by Hak and colleagues,7 the incidence of injuries was reported as 73.5%, meaning almost three quarters of the sample (N=132), reported experiencing some type of injury over the previous 18 months. Even though this may seem significant, when investigators analyze the data more closely, and looked at the number of new injuries among the participants, adjusted by the amount of time exposed to the activity, they reported an injury rate that is similar to that of other sports (3.1 injuries per 1,000 hours of CrossFit training).
Similarly, Weisenthal, et al.8 reported on the incidence of injury among a group of 486 CrossFit participants. In their study, the proportion of total injuries was considerably lower than that reported by Hak et al., with only a total of 19% of individuals reporting some type of injury. Even though the authors did not originally report an incidence rate, those were later calculated and reported as 2.4 injuries per 1,000 hours of CrossFit participation.17 Considering the lack of data at the moment, it is not possible to make definitive conclusions regarding injuries in CrossFit; however, the preliminary research suggests that CrossFit is no more dangerous than many other popular methods of exercise. Also, as with any type of exercise training, safety is primarily determined by the ability of the trainer and trainee to appropriately monitor exercise technique, intensity, volume, and the tolerances of the trainee. CrossFit trainers (albeit, individual practices do vary) have been trained to monitor these factors and make adjustments for each individual.18
Guidelines for the practitioner and trainee: Taken in light of the above statement, it is important to note that not all “crossfit” is “CrossFit”. Some trainers
As with any type of exercise training, safety is primarily determined by the ability of the trainer and trainee to appropriately monitor exercise technique, intensity, volume, and the tolerances of the trainee.
Canadian Affiliate League competitorSherisse Santos-Nichol from CrossFit BC
will use methodology derived from CrossFit, but if they have not acquired the Level 1 Trainer certificate, they cannot use the term CrossFit to describe their practices. Many of the misconceptions regarding how CrossFit training is implemented are derived from improper coach training and use of the methodology. The following are a few training guidelines for practitioners who work with CrossFit trainees to ensure they are following the methodology appropriately. Please note that these guidelines are not different than what CrossFit Level 1 Trainers are taught,18 but are some of the key aspects that are not always followed:
1. Recognize the importance of an appropriate build up and progression. It is a mistake to engage in high-intensity work without mastering the basics of technique at a lower intensity first. Many of the perceived problems that can occur in newer CrossFit (or any other type of ) trainees results from doing too much, too fast.
2. Recognize that CrossFit is both a training method and a competitive sport. Many trainees develop a competition mentality for all of
their training sessions, even when not competing or preparing for a competition. Getting ‘one more rep’ or cutting a few seconds off of a workout time can be very motivating; however, caution should be heeded in training this way with every workout. Individuals should save most of their ‘all-out’ efforts for select benchmark/testing workouts and/or during competition. There is nothing wrong with “leaving a little left in the tank” for the next workout!
3. Prioritize and individualize technique development first. Despite what is commonly spread through social media, most CrossFit coaches and trainers emphasize technique over load and intensity. Ensuring good movement proficiency prior to loading and continued technical coaching while loading will help prevent technique breakdown. As part of this, each trainee should be assessed in their movement abilities and technique should be modified to fit the individuals’ anatomy and mobility. It may be a hard pill to swallow for some trainees, but not everyone is built to achieve the range of motion standards that are needed for CrossFit competition. During regular
training, assess movement patterns and mobility, and then encourage trainees to remove the ‘no rep’ mentality based on competition standards as needed.
4. Prioritize strength before heavy conditioning. It is very common for trainees to want to engage in a heavily loaded conditioning workout or attempting to go “Rx’d” (as prescribed) well before they have the strength capacity to do so. Doing repeated heavy lifts at a high percentage of a trainee’s 1RM (one repetition maximum) strength is a recipe for fatigue and technique breakdown. There are two aspects of this to the progress of a trainee that are important. First, training should emphasize development of maximal strength in the common lifts (squat, deadlift, press, clean, etc). As strength increases, the ability to tolerate submaximal load repetitions improves. Second, reduce the load of the conditioning workout (ie. scale the load) so that it is at a lower percentage of the lift’s 1RM than perhaps the individual would like. Encourage trainees to remove the ego with loading and avoid going “Rx’d” until strength improves significantly.
CROSSFIT
Conclusions CrossFit training is wildly popular and effective for developing all around fitness. Despite the recent criticisms related to the risks of injuries in CrossFit, it appears that this training methodology is no more dangerous than most other types of exercise/training, particularly when performed and programmed well. Trainees and coaches should follow these simple guidelines for assessing and progressing their training to insure both adequate and safe progress.
For a list of references, please visit www.physiotherapy.ca/Practice-Resources/Publications.
For more information, please contact:Scotty Butcher, PhD, BScPT, ACSM-RCEP Assistant Professor, School of Physical Therapy, University of Sas-katchewan [email protected] Feito, Ph.D, MPH, FACSMAssistant Professor of Exercise ScienceDept. Exercise Science & Sport Manage-ment Wellstar College of Health & Hu-man Services Kennesaw State University [email protected]
1 CrossFit® is a registered trademark of CrossFit, Inc
0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55%
Shoulder Back Hand Shin
Knee Wrist Neck
Ankle Elbow
Hip Foot
Quadriceps Hamstrings
Achilles Calf Eye
Incidence of Injury
Males Females Overall
0.3% 2.4% 2.9% 3.2% 4.0% 4.8% 5.9% 6.2% 7.5% 9.1%
13.9% 14.2% 14.7% 23.6% 38.9% 45.0%
20 PHYSIOTHERAPY PRACTICE | CONGRESS 2015
Male Female
Incidence of injury
Feito, Y; Paul, A. (2014) Injury Prevalence Among CrossFit Participants. Med Sci Sports Exerc. 46(5S); 759-769.
Ontario Women’s Directorate
RESPONDING TO PAST SEXUAL ASSAULT IN CLINICAL SETTINGS
To explore and learn, visit www.DVeducation.ca/sexualassault
This free and interactive online curriculum focuses on:
• the long-term physical, psychological and social impacts of sexual assault
• creating an environment that supports disclosures
• appropriately responding to a woman who has been sexually assaulted in the past
• fostering an interdisciplinary and collaborative approach within your practice setting
It’s been a year … She’s still in pain.
Funded by:
Reasons to GoodLife:
Energy
Happiness
55% off with your CPA membership -and free towel service!*
Access to any club in Canada.
Renew by June 15, 2015
New? Sign up by the 15th of the month to get started on the 1st!
www.Physiotherapy.ca/Membership
*Where available
Movement
I S P L E A S E D T O A N N O U N C E
C P A• T H E L A U N C H O F T H E •
LEARN MORE ABOUT HOW THE NEW CLINIC OWNERS PROGRAM WILL HELP YOUR PRACTICE: PHYSIOTHERAPY.CA/CLINICOWNERS
S U P P O R T A N D
R E S O U R C E S
T O H E L P
B U I L D
Y O U R
P R A C T I C E
PCOP Launch Ad.indd 1 2015-04-27 11:02 AM
Visit our Congress Exhibit Booth for give-aways and prize draws!
Attend our Friday nightDalhousie PT Alumni Reception
in the Delta Halifax Bluenose Ballroom!
(RSVP link on our website!)
Learn more about our Oct 2-5, 201550th Annniversary Weekend.
physiotherapy.dal.ca
2015 CONGReSS Welcome to Halifax!
Clinic for sale 3,500 square feet, friendly community
Forest Physiotherapy Claudette Liske 519-323-1175 Mount Forest, Ontario Priced to sell, includes building and 2 apartments
Untitled-2 1 2015-03-09 10:39 AM
STROKE PATIENTS RECOVER BEYOND THE REACH OF YOUR HEALING HANDSwhen referred to a physician with post-stroke expertise
There are many physicians across Canada who are post-stroke specialists, andthey can be located at www.beyondstroke.ca/Locator/. But patients won’t know thisunless you provide them with a referral request form to take to their family doctor.
To order referral request forms, call toll-free 1.866.683.9060, or download the form at www.beyondstroke.ca/HCPreferral/.
APC61PD14
Allergan_JournalAD_EN_Layout 1 15-02-23 10:10 AM Page 4
24 PHYSIOTHERAPY PRACTICE | CONGRESS 2015
An introduction to spasticity Spasticity is a manifestation of upper motor neuron syndrome, which is a group of symptoms caused by damage or injury to the central nervous system.1 It is characterized as a motor disorder leading to increased muscle tone, exaggerated tendon jerks and poor control of voluntary movement.2, 3 The major causes of spasticity include stroke, spinal cord injury, traumatic brain injury, multiple sclerosis, cerebral palsy and hereditary spastic paraparesis.4 Depending on the manifestation, the prevalence of spasticity is variably common. Upwards of 40% of stroke survivors may develop spasticity where an estimated 84% of patients with MS develop at least some spasticity over the course of their disease.5-8
Spasticity can be generalized, affecting widespread regions of the body, or focal, where one or more body parts is affected in isolation.9 Depending on the type and severity, the effects of spasticity are also variable and can be described at the level of both impairment and impact on active and/or passive function. Spasticity can cause stiffness, pain, spasms and involuntary movements, which can lead to poor positioning and difficulty sleeping. Skin breakdown and contractures can develop in more severe cases. Transfers and walking can also become challenging and may lead to falls. The ability to reach and grasp may also become compromised or the posturing of a limb may have a negative effect on body image.10, 11
Bathing, dressing, toileting can also become increasingly difficult which may increase the emotional and/or physical burden on the caregiver.12, 13 However, in some cases, spasticity may also be beneficial to a patient’s function. For example, spasticity may allow a patient with multiple sclerosis to maintain standing, transferring or even walking in the presence of progressive weakness.10 As a result, a thorough assessment is imperative to ensure spasticity management is necessary.
Assessing and treating spasticity A thorough assessment will include an accurate history, a physical exam and ideally, it should be done with the patient, caregiver and the interdisciplinary team rather than having a separate assessment with each professional.10 The history will help identify any symptoms and the impact of spasticity (negative and positive) on a patient’s function and well-being. It is important to identify any triggers to spasticity such as infections, pressure ulcers/
sores and ingrown toenails. Other relevant information will include previous or current treatment including: medications, formal PT/OT services, a home exercise program, splints/braces and the last formal seating review. The physical assessment will look at the level of resistance to passive movement, strength, sensation, upper extremity function, gait and general mobility as appropriate. This will help establish if weakness or spasticity is the main issue limiting function. Outcome measures are imperative at this stage to ensure progress of the patient can be regularly measured over the course of treatment.11, 14
The treatment plan is then developed based on goals relevant to patient and/or caregiver. These typically include managing symptoms, preventing or slowing down the progression of impairments, and improving passive or active function. The goal attainment scale has been shown to help focus and clarify the aims of treatment.14 Recent evidence also suggests spasticity treatment should be coordinated across many healthcare disciplines involving both pharmacologic and non-pharmacologic approaches as required.14 For example, a patient with global spasticity/spasms may be prescribed central acting muscle relaxants by a neurologist or physiatrist and then see an occupational therapist to optimize positioning in his/her wheelchair. Another patient with focal spasticity in a limb may receive botulinum toxin injections by a physiatrist and then see a physiotherapist for treatment and development of a comprehensive exercise program. An orthotist may also recommend a resting splint to provide a prolonged stretch.
In Canada, there are many clinics which employ an interdisciplinary approach to spasticity management. Providing patients with many treatment options under one roof in a collaborative manner is advantageous as it allows easy coordination across disciplines to develop aligned treatment goals and approaches that can be carried out at both the clinic and back in the patient’s community. The InterVal Rehabilitation Centre, located in Trois-Rivières, Quebec and G.F Strong Rehabilitation Centre, located in Vancouver, British Columbia, are both examples of interdisciplinary spasticity management clinics.
Interdisciplinary Spasticity Clinics (InterVal Rehabilitation Centre) The Spasticity Management Clinic at Interval Rehabilitation Centre has been in service for 14 years and has seen over 1000 spasticity patients to date. The care management team includes an occupational therapist, nurse, physiatrist, neurologist, orthotist, physical therapist and coordinator. Together, the team offers a wide range of short-term treatment including splinting, botulinum toxin injections, physiotherapy, occupational therapy, pharmacotherapy and referrals to other specialities.
Patients are referred to the clinic by their community healthcare provider which includes an initial assessment and can also include suggested treatment. Once the patient arrives, a comprehensive evaluation is carried out by the physiotherapist/occupational therapist who meets with the rest of the team, the patient and caregivers to determine the most realistic treatment goals and the most optimal treatment approach. The management team then communicates this plan to the community HCP to ensure patients are able to can continue their treatment plan when they are discharged from the clinic and return home.
GF Strong Rehabilitation Centre (GFS) The GFS Interdisciplinary Spasticity Manage-ment Clinic was founded in May 2010 and has seen approximately 450 patients to date. The core team includes four physiatrists (rotating), a nurse, physiotherapist, occupational therapist, and frequent consultations are sought from the on-site orthotist.
Like InterVal, patients require a referral from their family physician or nurse practi-tioner. The entire team takes part in the initial assessment and problem solves to establish a treatment plan based on specific goals, which are meaningful to the patient and caregivers.
Treatment depends on the pattern and severity of spasticity and typically focuses on: preventing or removing aggravating factors or triggers; providing recommendations regard-ing optimal positioning, seating, exercise, splinting/bracing; and providing recommenda-tions regarding oral medications and injections (botulinum toxin and phenol). Referrals can be made to the Intrathecal Baclofen Clinic (also housed at GFS) and combined clinics are held with a foot/ankle or upper extremity surgeon 3-4 times per year.
A Model Of Care For Interdisciplinary Spasticity Management
PHYSIOTHERAPY PRACTICE | CONGRESS 2015 25
Communication between the clinic and the patient’s community team (physician and/or therapist) is integral to the overall manage-ment of a patient’s spasticity.
Across the country, patients with spasticity
are being referred to clinics like InterVal and GFS for interdisciplinary care. With the many services available, patients get the coordinated treatment they need and the communica-tion required for continuing care back home.
To determine if your patients would benefit from interdisciplinary spasticity management, please refer to the literature references and a list of interdisciplinary spasticity clinics avail-able across Canada, on the CPA website.
PRESENTATION• Patient referred by her neurologist to the InterVal Spasticity Management Clinic • Presented with parasthesia of the right side of the body, with plantar flexed feet
(the right worse than the left)• Complained of falls and difficulties using the stairs• Had been receiving physiotherapy two times per week to manage gait problem
ASSESSMENT• Good ROM and strength LE, except 4 in dorsiflexion strength• Ashworth knee extensors; R= 2 with clonus and L = 1 with clonus• Ashworth ankle plantar flexors; R = 3 with clonus and L = 2 with clonus• Gait pattern shows loss of balance, Trendelenburg right hip, heel in a varus
position at heal strike (HS) and foot in an equinus position through swing phase and prior to HS (right heel remains 2 cm above ground)
• Walks unaided
GOALS• Improve and secure the gait pattern• Evaluate benefit of an assistive device to improve pattern and safety of gait• Orthotics to control equinovarus and thus reduce dragging of the toe• Request vehicle adaptation assessment
APPROACH• Neurologist conducts botulinum toxin injections under ultrasound guidance• Gastrocnemius (100u), soleus (100u) and tibialis posterior (100u)• Keep physiotherapy interventions externally.• Orthotic molding for right and left• Follow-up by team in 4 weeks
OUTCOME• Patient showed great benefit from the first botulinum toxin injection• Increased balance, decreased equinus and varus in neutral position• Ashworth measures of the plantar flexors reduced to R=1, L=0 • Safer (no falls) and less fatigue when walking, decreased clonus• At the third session, a lesser effect was observed so dilution was increased to 4
and the results were positive• To date, the patient has received six sessions involving the same chemical
denervation targets• Tibial orthoses are worn all day and the patient is safer with a more normalized
gait pattern and exerts less energy when walking
PRESENTATION• Patient referred to GFS by his family physician (at the request of his private PT)
with complaints of numbness and tightness in his right hand and trouble grasping/ releasing objects
• Was actively seeing a private PT and an outpatient OT at a local hospital; treatment included: cardiovascular exercise, UE/LE strengthening program, stretching and a night resting splint. Patient had tried FES, but he was unsure of the benefit.
• Private PT was recommending a trial of botulinum toxin injections in addition to his current program
ASSESSMENT• Generally good ROM and motor control at shoulder and elbow• Full ROM at wrist and fingers, but mild increase in tone at wrist, finger and thumb
flexors. Grip strength only 50% relative to contralateral side• Weakness in wrist/finger/thumb extensors and reduced selective control evident
when attempting to reach/grasp/release a specific object. Increased flexor tone noted in DIPs with effort of activity
• Writing legible but slow and dyscoordinated• Complaints of numbness and decreased sensation noted
GOALS• Improve selective finger/thumb extension without compensatory wrist flexion• Improve selective grasp/release
APPROACH• Physiatrist injects a conservative dose of botulinum toxin into FDP and FPL• Patient continues his rehabilitation routine with his community PT/OT• Recommendation for outpatient OT to trial a thumb splint• Recommendation for private PT to trial NMES/FES again • Physiatrist also prescribes oral medication and topical cream for new complaints
of neuropathic pain and refers patient for nerve conduction studies to rule out carpal tunnel syndrome
OUTCOME• Patient showed benefit from the first round of botulinum toxin injections;
improvement noted in extension of most digits, grasp and release and some functional tasks e.g. writing
• With repeated injections, functional improvement plateaued despite specifically targeting muscles at higher doses and additional muscles treated with botulinum toxin (FDS, FPB). Patient noted a loss of grip strength with increasing doses
• Lack of progress likely related to weakness and poor motor recovery and numbness despite a decrease in spasticity
• After 5 rounds of botulinum toxin over a course of 1.5 years, consensus was to stop injections and patient to continue with exercise program, NMES and night resting splint for ongoing spasticity management
Josée Matteau has been employed at the InterVal Rehabilitation Centre since her graduation from McGill University in 1992. She has been working as an occupational therapist at the Spasticity Management Clinic since its inception in 2001.
Felicia Wong currently works as a physiotherapist at G.F. Strong Rehabilitation Centre in the Interdisciplinary Spasticity Management Clinic and as part of the outpatient team of the Acquired Brain Injury Program.
Case StudiesCase 1:
45 year old female – diagnosedwith Multiple Sclerosis in 2012
Case 2:44 year old male – diagnosed
with left CVA in 2010
CANADIANS ARE FIERCELY COMPETITIVE WHEN IT COMES TO SPORTS PLAYED AND PERFORMED ON THE ICE. While most of us are already looking ahead to spring and summer sport activities, many winter athletes are reflecting on the completion of a competitive season. Figure skaters use the spring to recover from a busy schedule of on and off-ice training, competition and travel. National-level skaters usually take a break from training when the competitive season ends in April. Late spring is the time to prepare and lay down the foundation for a new season. During this preparatory phase, training volume is high, but training intensity is low-moderate. It is also the time to work with coaches and choreographers to develop two new skating programs for the next season, or to adapt one to cover two seasons. For physiotherapists, this preparatory period is a good time to address, review and correct any muscle imbalances or injuries.
Figure skating is a demanding sport because it combines all elements of athletic performance: energy system challenges, speed, strength, endurance, flexibility and skill, along with artistic expression. As such, both coaches and skaters are keen to push the limits with unique choreography and athletically-challenging skating components. The summer months of June, July and August are usually the most training-intensive, as both the volume and intensity of training are high in order to get the skaters competition ready.
The International Skating Union’s (ISU’s) competition circuit resumes in August for junior skaters and in September for senior skaters, continuing through the fall and into the winter months. Most skating nations hold their national championships in late December or January and world championships occur in March. During competition, skaters usually have less on-ice time and are in a maintenance phase of training. As such, training intensity is high, but the volume of work is lower.
Physiotherapists working with skaters need to have a good understanding of the different levels of skating participation and the physical demands of the sport (Table 1). Get to know your skater by asking meaningful questions during your physiotherapy assessment. For example, at what level of participation or competition is the skater training? In Canada, skaters are typically members of a local skating club where they receive professional training and coaching guidance. As skaters evolve in their discipline, they may move on to other clubs to learn from coaches who have expertise in certain areas such as pair skating or ice dance. Long-term athlete development involves progressing the skater through different levels of competition including juvenile, pre-novice, novice, junior and senior (Figure 1). These levels require certain skating components or element-specific milestones to be achieved. Critical to the physiotherapist’s understanding is that the skating competition levels are functionally performance-based and not necessarily athlete age-specific.
Empowering Canadian Figure Skaters to be Competition-Ready
While most of us are already looking ahead to spring and summer sport activities, many winter athletes are reflecting on the completion of a competitive season.
Agnes Makowski, MScPT, BScPT, Diploma Sport Physiotherapist, FCAMPT, Certified Gunn IMS CPA member since 1995
26 PHYSIOTHERAPY PRACTICE | CONGRESS 2015
2015 Senior World Pair Champions, Canadians Megan Duhamel and Eric Radford
PHYSIOTHERAPY PRACTICE | CONGRESS 2015 27
Physiotherapists should also consider the skater’s discipline (singles, pair, ice dance or synchronized skating) and current training volume. Most active skaters will have either one longer (e.g. 2-4 hour) on-ice training session per day, or two shorter on-ice sessions of 1.5-2 hours duration. Off-ice training may include dance training, strength and conditioning and/or yoga for recovery.
Singles skating involves challenging footwork elements and features a variety of powerful jumps that require quick muscle force production. New innovations in singles skating have included combinations of jumps in succession and, of course, the ever-demanding quad jump for men. Triple jumps are the most demanding for single women skaters and are often performed in combination with other jumps. Jumps challenge the alactic power energy system. Most competitive singles skaters will aim for shorter, 5 minute practice sessions, approximately 4 times per day. The nature of the jumps makes longer training sessions too demanding.
Pair skating involves a male and female team who demonstrate strong skating footwork skills, coordinated jumps and challenging lifts high into the air. Movements should be synchronized as much as possible. Both pair partners must also have power and speed in muscular force generation, as demanding jumps are also included in their required elements.
Ice dance is a growing figure skating discipline. Participation levels in Canada are on the rise, as developing skaters are inspired by the success of Olympic-medalist ice dancers, past and present. Ice dance features the use of a slightly shorter skate boot, with shorter blades to facilitate the challenging agility and footwork sequences, rotational twizzles and partner lifts that are unparalleled. Longer duration training sessions (i.e. >1 hour at one time) is unique to ice dance. Most competitive skaters will be on the ice 3-4 hours per day. How these training sessions are broken-up to focus on specific figure skating skills depends on each skating club and varies with each athlete.
Finally, synchronized skating is a team discipline that features both male and female skaters performing difficult skating edge-work, along with special formations on the ice. Synchro has also evolved to include lifts.
Each discipline is challenged with different energy systems, as competitive skaters must perform both a short program/dance (usually less than 2.5 minutes) as well as a free program/
Physiotherapists working with skaters need to have a good understanding of the different levels of skating participation and the physical demands of the sport.
� � � �
�
�
�
dance (usually less then 4.5 minutes). As a result, exercise prescription is an essential part of any skater’s rehab training program.
Physiotherapists should also be aware of common injuries that affect figure skaters (Figure 1). The two categories of skating-related injury are acute and over-use. Common skating injuries include strains of the shoulders and sprains (e.g. ankle, groin and wrist), contusions, lacerations and abrasions that are often caused by falls. Fractures of the wrist may occur from a fall on an out-stretched hand.
Table 1: Figure Skating Athletic Requirements S K AT I N G D I S C I P L I N E
Component Singles* Pairs* Dance Synchronized
Energy SystemShort Program (total duration <2.5 minutes)- anaerobic lactic capacity with aerobic power support- jumps require alactic power*
Free Program (total duration <4.5 minutes) - aerobic power with anaerobic lactic power components on
footwork sequences- jumps require alactic power*
Speed high high moderate moderate
Strength high high moderate moderate
Endurance moderate for short programs / high for free programs
Flexibility high high high moderate
Skill high high high high
28 PHYSIOTHERAPY PRACTICE | CONGRESS 2015
FIGURE SKATING
Figure 1: Levels of Skating Competition in Canada Figure 2: Areas of Injury Risk in Figure Skating
Due to the advanced technical innovation demands of jumping, some singles skaters may develop tibial stress irritation. Shin and back pain may also be attributed to skate boots that are too stiff (Table 2). Impact from jumping is absorbed best when sequential flexion occurs at the ankle, knee and hip joints. Therefore, learning proper jump and landing mechanics is essential for skaters who jump in their programming. It has been suggested that comfortable skate boots should allow for forward flexion of the ankle and knee, but be stiff enough to provide lateral ankle support and stability.
Asking your skater about past injuries is important. Research strongly supports the fact that such injuries as hamstrings strains and ankle sprains that are poorly rehabilitated have a high rate of reoccurrence. Sometimes injuries may be due to muscle imbalances or problematic equipment; however, the majority of skating injuries are related to training. As such, it is important to review the skater’s weekly training cycle. Each day should include a variety of training. It is essential to alternate hard and easier training days. When singles skaters are learning new jumps,
it is important to review jump and landing mechanics to address injury potential risk factors that have been identified for specific body areas, such as the knee. Plyometric training needs to be monitored, and is progressed more safely on alternate days to allow tissue adaptation and recovery. Weekly training also needs to include rest periods within each training session and throughout the week. Other methods of relative rest include such activities as yoga to incorporate flexibility and neuromuscular control.
Finally, take the time to review what is meaningful for the skater in terms of goals for the competitive season (often referred to as a macro-cycle or longer-term training period) vs. goals for a micro-cycle (such as a shorter-period of training for small, developmental events and competitions). Sometimes physiotherapists may advise about withdrawing a skater from a shorter-term event/competition during injury to allow for proper healing and rehabilitation when focusing on longer-range competition goals. An injury that is not well rehabilitated has high potential for re-injury. Therefore, it is important to communicate and
collaborate with a skater’s coach and support team to consider training and competition priorities for the short term, as well as the season’s long-term goals.
As one of Canada’s largest national sport organizations, Skate Canada’s vision is to “Inspire all Canadians to Embrace the Joy of Skating.” Approximately 750,000 Canadians have been reached by Skate Canada programming. With a firm commitment to promoting a healthy lifestyle that embraces the theme of “Skate for Life“, Skate Canada boasts a skating skill development system that meets every Canadian skater’s needs. Whether you are skating for fun or aiming for the podium, you can learn, progress and be challenged as an active skating participant. Most Canadians, including future hockey stars “Learn to Skate” through the CanSkate program. Skate Canada appreciates what it takes to develop high performance skaters and follows the Long-Term Athlete Development (LTAD) model. As a result, Skate Canada programming has evolved to include “Learn to Train,” “Learn to Compete” and “Skate to Win” streams.
Lumbar spine
Hip
Ankle
Shoulder
Hand/ wrist
Pelvis
Knee
1) Skate boots should be stiff enough so that the ankles are supported. TRUE: The stiffness of a skate boot needs to take into consideration the athlete’s level of skating development, body height and mass to enable safe and comfortable skating. Comfortable skate boots should permit forward flexion in order to allow for both ankle and knee bend, but remain stiff enough to inhibit lateral instability. If the ankle and knee cannot flex adequately, the impact forces of landing cannot be absorbed, and injuries to the knees, hips and back can develop.
2) Boots and blades are expensive; it is a good idea to buy boots that are bigger than the skater’s current size so that the developing skater can grow into them and have a longer use. FALSE: Skate boots that are larger than a half-size bigger will allow the foot to move in the boot, cause skin irritations, and limit force generation to the ice, thereby limiting effectiveness of movement. This may result in painful blisters that can limit skating comfort and enjoyment. Skates that are too large create a sloppy fit, referred to as negative space. The boot should be an extension of the body, fitting like a glove for the foot.
3) The skate brand and cost are more important than skate fit. FALSE: Skate fit is more important than brand. The best skate is the one that fits the foot well, regardless of brand. Consider trying at least three skate boot models before you make a final purchase if possible, as different skates fit different feet. A service-oriented store should allow skate exchange if the skate boot isn’t comfortable and doesn’t “break-in” within two to three training sessions. The skate should be comfortable “out of the box.” If it is not, it will not get better over time.
4) Skate boots may take a month to break-in. TRUE: The break-in period can vary across skaters depending upon the weight of the skater, strength of the skater, number of hours in the boot and stiffness of the boot itself. More importantly is recognizing the difference between breaking in versus the breaking down of a skate. Reasonable break-in time allows for both the skater’s body and skate boot material to adapt to the different kinds of training demands a skater is doing (e.g. footwork, jumps, spins and pattern dances). Break-down of the boot usually occurs when there is a noticeable decrease in lateral ankle support, particularly when landing jumps.
5) One type of skate boot is appropriate for all skaters. FALSE: Skaters’ feet come in different shapes and sizes, hence skate brand or type may be bested suited to one skater’s foot over another. Every athlete has individual needs. Factors to consider include the skater’s leg and foot structure, height and weight, as well as the intensity and duration of practices. Lighter and less-experienced skaters may choose a softer boot. Heavier skaters and those who jump may prefer slightly stiffer skate boots. The skate boot should be appropriate for the skater’s current ability, weight and training volume. Singles and pair skates are the same in structure, due to the common physical demands of footwork and jumps. Ice dance and synchronized skates have a lower boot and shorter blades to facilitate the unique agility, edges and footwork sequences required.
6) It is a good idea to change boot types often, throughout your skating career.THAT DEPENDS/BOTH TRUE AND FALSE!: Once you find a good skate that fits your foot well, most coaches and professional fitters recommend “sticking with it” throughout the skater’s career. However, skaters’ body proportions, weight, feet and skill levels do change over time. The boot type may need to change accordingly. If a skate boot change is recommended, it may be due to poor initial boot fitting or as a result of an athlete’s growth. Appropriate timing for skate boot changes should be discussed among the skater, coach, therapist, skate fitter and support team as appropriate. Making significant equipment changes right before competition is definitely not recommended.
7) Second-hand skates are a good option for younger skaters. TRUE: Often younger skaters out-grow their skates faster than they can break them in sufficiently. Correct skate boot fit and size are the most important factors. Gently-used skates are a cost-effective way to go for parents, as the developing skater will need to get new skates more often.
8) Poorly fitted skate boots can cause back, hip and knee pain. TRUE: Limited ankle and knee flexion have been shown to cause back, hip and knee pain as the altered mechanics of the restrained ankle affect the joints above the skate. Overly-stiff boots significantly affect the lower limb’s ability for proper mechanics and function. Flexion that occurs in the ankle, knee and hip in sequence has been shown to absorb impact the best. Minor skate adjustments may be needed to accommodate skaters returning to sport following injury such as post-fracture or to adapt the boots to any unique bony toe, foot or ankle contours.
9) Consulting with a knowledgeable skate fitter is a good investment in time and resources. TRUE: A professional skate fitter should have a variety of skate manufacturers available. Different skate boots fit different feet. Fitters are highly knowledgeable about skate fit and function and have a wealth of technical experience. Many fitters are former skaters and can help problem-solve regarding unique athlete fitting needs. For example, skaters with a narrow heel and wider forefoot can be more challenging to fit properly. Skates should not fit too big nor too wide. Skate stiffness changes depending on the skater’s height, weight and jumping ability. Boot adjustments may may include carving out some of the lining and heating the boot to adjust for foot and toe bony alterations that occur over time. A professional skate fitter is a great resource to consult with throughout the skater’s career.
10) Skate boots do not change much over the course of a training season. FALSE: As skaters grow and develop more difficult jumps and skating components, skates will adapt and conform quite a bit during a season. Skate boots, blades and laces should be checked at least once a month. Skate breakdown is most noticed if there is a lack of lateral support for landing jumps. Wear and tear can definitely occur. Boots that worked once will not work as well if broken down. Different boot materials, including leather and plastic, have a lifespan. Some competitive skaters now carry back-up boots to competitions in case there is a boot breakdown. These back-ups are already “broken in” and ready to compete in, if necessary.
1 In collaboration with Sport Science Committee for Skate Canada: Kelly Lockwood PhD, Agnes Makowski MScPT, Dr. Jane Moran, Sally Rehorick PhD, Dr. Marni Wesner
FIGURE SKATING
Table 2: Skate Boot Myths1
PHYSIOTHERAPY PRACTICE | CONGRESS 2015 29
CPA Practice – May 2015 Issue
1/2 page colour
$1,610 media
$90 production
$85 GST
$1,785 total
P r o d u c t i o n O n l y
Artist:
Date: Jan 21, 2008
Size: 3.37”
Docket:
Proof: 1
1 of 1
Publication(s):
CH
351770
VCH-FEB-007-15
February 19, 2015
6.75” x 4.5”
Proof: 1
1 of 1
CPA Practice – May 2015 Issue
Artist:
Date:
Size:
Publications(s):
Docket:
Cam
Phone: 604.675.2500Toll-Free in North America: 1.800.565.1727
“For me, I could perform my job duties in a wide variety of settings but it is my relationships with my coworkers that keep me where I am.”
Alicia O. at Richmond Oval
Join VCH now. We have a number of exciting Physiotherapist positions available. Find out more and apply at:
jobs.vch.ca
Come for the job. Stay for the team.Vancouver Coastal Health (VCH) is one of Canada’s largest health care service providers, delivering a full spectrum of care from acute to rehabilitation to residential and community care. No matter what your speciality in Physiotherapy, we have a place for you at VCH. You will be empowered to move and shape your career in a multitude of directions, and benefit from our unwavering commitment to education and training through courses and workshops and opportunities to pass on your knowledge to others. You will work with a family of like-minded professionals, in whatever setting you choose to live in. The opportunities are numerous, and the rewards are immense.
APS DRY NEEDLES Designed for Physiotherapists by Physiotherapists
Finally Canada has a Dry Needle
that was specifically designed for
multiple insertions.
APS gives you precision, performance
and patient comfort that cannot be
compared to by any other needle
on the market.
Order a mix of 10 today and receive 15% discount with one free box and no freight charges
www.remingtonmedical.com
T: 1-800-267-5822 F: 1-866-470-7787*Valid on first order only
NEW!
Use Promo Code 3100 when
ordering by fax, phone or online*
For more information and pricing, please contact Patterson Medical Canada at
1-800-665-9200 or www.pattersonmedical.ca
A Patterson Medical Exclusive
Congress 2015 Silver
SponSorVisit Patterson Medical’s Booth for a chance to Win a set of Smart Handles!
physiotherapy.ca/congress
A non-steroidal anti-inflammatory drug (NSAID in a gel format. For the over-the-counter relief
of aches and pain associated with recent (acute), localized muscle or joint injuries
such as sprains, strains or sports injuries (e.g. ankle sprain,
shoulder strain or back muscle pain).1‡
Recommend Voltaren Emulgel®.†
A topical gel that demonstrates proven pain relief and a
remarkable safety profile.1
Reach For The Most Recommended*
Topical Pain Relief
* FOR TOPICAL ANALGESICS
1. Voltaren Emulgel® product monograph. Novartis Consumer Health Canada Inc. September 7, 2012.
* The Medical Post & L’actualité médicale 2013 Survey on OTC Counselling & Recommendations.
† In consultation with a pharmacist or physician.
‡ This is typically as an adjunct to other measures such as rest for the relief of discomfort associated with such injuries. Local skin irritation (3.4%)
is the only common (>1%) adverse effect reported. Caution should be exercised for patients who have hypersensitivity to diclofenac,
acetylsalicylic acid or other non-steroidal anti-inflammatory drugs. Caution should be taken for patients with or without chronic asthma in
whom attacks of asthma, urticaria or acute rhinitis are precipitated by acetylsalicylic acid or other non-steroidal anti-inflammatory agents.
Voltaren Emulgel should be applied only to intact, non diseased skin and not to skin wounds or open injuries. It should not be used with occlusion.
It should not be allowed to come into contact with the eyes or mucous membranes, and should never be taken by mouth.
® TM/MC Novartis AG; used under license. © 2014 Novartis Consumer Health Canada Inc., Mississauga, ON, L5N 2X7.
www.voltaren.ca
