How to Create a Basic Exercise Program
Regular exercise is an essential component of maintaining good health. It is common knowledge that exercise can improve the function of our heart and skeletal muscles, but there are so many other reasons to get up and move, such as improving sleep and cognitive functions, helping to manage stress and anxiety, and reducing the risk of many chronic diseases. While most forms of physical activity are great, we should all be following a regular workout program that is a little more comprehensive than going for a quick walk around the block.
Why Follow an Exercise Program?
With a structured program we can set goals, increase our efficiency, evaluate our progress, and keep ourselves more accountable. Furthermore, if the program is well-designed, there is a much lower chance of creating (or furthering) muscle imbalances (eg. strong chest muscles with relatively weak upper back muscles), or neglecting things that are important, such as our core.
Basic Exercise Program Template
The following is a very basic exercise program template; it will not be very useful to high-performance athletes, or even to individuals who have a moderate amount of experience with proper training. However, it is a well-balanced plan that will work well for casual or beginner gym-goers. The plan is as follows:
- Warm-up: 5-10 minutes of light activity that will elevate heart rate and prepare the muscles for the rest of the workout
- “Cardio” machines, such as the treadmill, stationary bike, elliptical, or stair-climber
- Dynamic stretching exercises, such as leg swing, squat to stand, knee to chest, thread the needle, open book/turn the page
- Core: 2 exercises that target the core muscles (generally speaking, the core includes the abdomen and lower back, or the area between the thorax and the pelvis)
- Beginner: leg slide, prone hip extension, knee side plank, knee plank
- Intermediate: plank, side plank, Pallof press, dead bug
- Advanced: plank with leg and/or arm lift, side plank and cable row, cable chop, cable lift
- Push: 1 exercise that targets the muscles that help with pushing movements (typically the pectorals, triceps, deltoids, etc.)
- Beginner: wall or knee push-up, standing cable chest press, standing cable fly
- Advanced: push-up, standing military press, bench press
- Pull: 1 exercise that targets the muscles that help with pulling movements (typically the biceps, latissimus dorsi, trapezius, etc.)
- Beginner: seated row, prone trapezius squeeze
- Advanced: kneeling lat pull-down, three-point or two-point row
- Hinge: 1 exercise that targets the muscles that help with movements primarily requiring bending at the hips (typically the hamstrings, gluteals, erector spinae, etc.)
- Beginner: bridge, hip thrust
- Advanced: Romanian deadlift, single-leg bridge, weighted hip thrust
- Squat: 1 exercise that targets the muscles that help with squatting or lunging movements (similar to hinge exercises, but with much greater emphasis on the quadriceps)
- Beginner: body squat, supported split squat
- Advanced: goblet squat, Bulgarian split squat, dumbbell forward and/or backward lunge, front squat
- Cool-down: 5-10 minutes of light exercises that will help with recovery and allow the heart rate to come back down
- Static stretching exercises, in which one or muscles are held in a lengthened position for a period of time, such as a prone quadriceps stretch or certain yoga poses
- Self-myofascial release, such as foam rolling or muscle release balls
How Frequently Should I Perform the Workout?
Once you have used the template to create a program for your current fitness level, you should ideally be going through it at least twice, but preferably three times per week. As a new or relatively casual user of the gym, you might find that performing the workout more frequently than three times per week can be overly fatiguing. Any less than twice per week is not enough to see any significant results in a reasonable amount of time.
One way to structure the program would be to attend on Mondays, Wednesdays, and Fridays only. This gives you a day of rest between workouts, and the entire weekend to yourself.
When Should I Change the Exercises?
Once you feel that any of the exercises are becoming too easy, or that you are losing interest in them, it is likely time to exchange them for something different and more challenging. This will depend on many factors that are specific to each individual, and so there is no magic time frame for when you should be moving on to something new.
Important: If you experience pain while working out, the exercise(s) you are performing are likely too challenging and/or you are not performing them correctly. This is a good sign that you should stop and re-evaluate whether or not you need to regress to an easier exercise, or if you need to ask a professional to help you improve your form.
Comparing Physiotherapists and Kinesiologists
If you have ever wondered what the difference between a kinesiologist and a physiotherapist is, or you have no idea what a kinesiologist is to begin with, you have come to the right place. The information that follows will give you a better idea of what each profession is, and when you might want to consider seeing one and/or the other.
Keep in mind that this information is about kinesiologists and physiotherapists in British Columbia, and may not be completely accurate when applied to other countries, or even to other provinces or territories within Canada.
First off, it is important to understand the educational differences of the two professions:
- Kinesiologist: Before practicing as a kinesiologist, individuals are required to first obtain a bachelor’s degree in kinesiology (or equivalent, such as human kinetics) at an accredited post-secondary institution. This is four years worth of studying and practical experience.
- Physiotherapist: To become a physiotherapist, a master’s degree must be earned following a bachelor’s degree. Most individuals will acquire a bachelor’s degree in kinesiology first before going on to receive their master’s in physiotherapy. Combined this is six to seven years worth of studying and practical experience.
As you can see, physiotherapy requires a greater level of education than a career as a kinesiologist. This gives physiotherapists an even deeper understanding of human anatomy and musculoskeletal injuries, and expands their potential scope of practice (eg. ability to learn and apply more invasive techniques, such as dry needling).
However, it is important to note that there are many options of continuing education for individuals in either profession once they have begun working. In other words, a kinesiologist specialized in gait analysis of marathon runners is likely more knowledgeable in this area than a physiotherapist specialized in rehabilitating individuals who were in car accidents, and vice versa. Furthermore, while it is not required at any point, both kinesiologists and physiotherapists can progress further academically if they so choose.
Methods of Treatment
Given the significant amount of overlap in the education that both professionals have, you might be wondering why these are distinct professions. While both are heavily educated in human anatomy and biomechanics, and both can prescribe a rehabilitative exercise program, the primary methods of treatment are what largely separates kinesiologists from physiotherapists.
- Kinesiologist: Most kinesiologists are primarily active therapists – they use demonstrations and educate others on how to improve themselves physically. For example, they can teach clients how to correctly perform strengthening and stretching exercises that are relevant to their needs. They can also assess and give advice on how to improve posture, gait, and other biomechanics. Kinesiologists can apply these techniques in a fitness context with athletes, or a rehabilitation context with injured individuals.
- Physiotherapist: Most physiotherapists are primarily passive therapists – they perform various techniques that require minimal effort from the client. Dry needling/intramuscular stimulation (IMS), cupping, manual stretch, massage, transcutaneous electrical nerve stimulation (TENS), laser, taping, shockwave, and extracorporeal shockwave therapy (EWST) are several examples of different passive therapeutic modalities that a physiotherapist may use. They work almost exclusively in a rehabilitation context.
As with the section on education, it is important to understand that these are not strict rules that the two professionals must follow. Kinesiologists can learn how to apply many of the same passive modalities as physiotherapists, just as physiotherapists can choose to provide more active rehabilitation. Typically it comes down to a combination of the needs of the client and the preferences and expertise of the professional.
How Do I Know Which Professional to Choose?
In many cases physiotherapists and kinesiologists go hand-in-hand. For example, if you have recently been in a car accident and you are still experiencing a lot of pain and decreased mobility, it is probably better to see a physiotherapist. The various passive techniques can help manage pain, increase mobility, and will typically be a lot less demanding on your body than engaging in active stretching and strengthening.
At some point you should transition to seeing a kinesiologist, as they can further your strength and mobility with an exercise program that you can perform on your own, even once you are no longer seeing the kinesiologist. This will likely come at the recommendation of the physiotherapist or your physician.
There are some situations where you may only want to see one professional or the other:
- Kinesiologist: If you are not suffering from a major trauma like a car accident or a severe sports injury, but rather just some overall stiffness and difficulty doing certain physical tasks, you may be able to just skip right to seeing a kinesiologist. The same might be said if you are looking for a strength and conditioning program specific to your athletic goals and needs.
- Physiotherapist: Many extended health plans cover physiotherapy but not kinesiology. For this reason, physiotherapy alone might be a better option financially if you do not think you need extensive rehabilitation. You may also choose physiotherapy if you believe you are in good shape, but you are just having a bout of pain or stiffness that passive treatment might help manage.
Maintaining a Fitness Routine While on Holidays
No One Said It Would Be Easy…
While a handful of individuals may find it easy to squeeze in a few workouts while they are on holidays, for the rest of us it can be a rather challenging task. This is because exercise can feel a lot like work, and the last thing we want to do while taking time off from the weekly grind is more work. However, it is important that we don’t completely neglect our physical health in this setting, especially during extended holidays or if you are currently undergoing rehabilitation. Fortunately, I have some suggestions from personal experience that may help you prepare for your trip and find some success while you are away; I will break these into four points:
1) What Is the Nature of Your Holiday?
The first step in maintaining a fitness routine on holidays is establishing what type of holiday you are taking. This will give us a better idea of what type of fitness equipment you we readily have at your disposal, and what you may need to bring. We can separate holidays up into three different types:
- Staycation: If you are having a “staycation,” where you are taking time off work to relax in the comfort of your home, then this part will be easy! You can simply head to the nearest gym or use whatever equipment you already have at home. All you need now is to find the motivation to exercise!
- Vacation: I’ll define a vacation as a relaxing getaway; you are leaving the comfort of your own home to escape to the comfort of another place. For example, this could be the home of a family member or close friend, or even a resort in Mexico. In these situations, you may have access to a gym or someone else’s fitness equipment, but you will also likely need to bring a couple things of your own. It will probably be harder than a staycation to find the motivation to deliberately exercise, but it shouldn’t be too much harder to find the time.
- Travelling: I’ll define travelling as an adventurous holiday; you are going somewhere to explore and will be on the move more than you will be relaxing. Examples of this include the following: backpacking through several countries in Europe, biking around Iceland, or hitchhiking and couchsurfing around South America. This is the most difficult type of holiday to find time to go through an exercise routine (though you are likely getting some exercise in from the nature of the trip itself). You will have to find alternative ways to perform exercises, as you won’t have access to much workout equipment.
2) What Fitness Equipment Should You Bring?
Obviously this won’t apply to staycations, but for the other two types of holidays there is only so much fitness equipment you can fit into your luggage.
One of the lightest and most versatile items is a resistance band (or a series of them with varying levels of resistance). Resistance bands are essentially weightless and take up negligible amounts of space in your luggage, and they provide an endless amount of ways to challenge your body. This is an absolute must-carry for your holidays!
It’s also useful to carry something that you can use for self-myofascial release (i.e. self-massage). A foam roller would be far too large, but a small ball (tennis, lacrosse, RAD, etc.) and/or a hand-held massage stick are relatively compact options. However, if you had to choose between resistance bands or a self-massage option, the bands are far more valuable.
Last on the list is a fitness program – you need to have an idea of what exercises you are going to be doing before you leave for your trip. If you are currently undergoing rehabilitation or personal training you should request a routine that you can easily complete while you are away. A fitness program that utilizes bodyweight, cardiovascular training, and resistance bands would be a good start! However, if you are on your own and have no fitness professional to seek advice from, you could always search up some exercises and stretches online, or purchase a reliable fitness training book to take with you!
3) Finding the Time and Motivation to Exercise While on Holidays
The final step is actually setting time aside and motivating yourself to complete the exercises.
Finding time is the easier part – no matter how busy and intense your trip is, you will have at least a few minutes to spare to exercise. I would recommend doing them either first thing in the morning, or at the end of the day before you “unwind.” Of course, if you have a day where there is a big gap of nothing at some point, you could easily complete them then instead!
Finding motivation is the harder part – just remember that you got where you are now by putting in time and effort. There’s no sense taking two steps forward and one step backwards by completely abandoning your fitness program now. Enjoy your vacation, and even decrease the frequency and intensity of exercise, but work enough to maintain the progress that you have already built for yourself!
What is a Sit-Stand Desk?
A sit-stand desk refers to a desk or desktop workstation that can be height-adjusted to allow the user to switch between standing or sitting positions at their will. These two formats are as follows:
- The full-sized sit-stand desk typically has the traditional rectangle-shaped desktop, which can be height-adjusted manually or electronically if it is motorized.
- A desktop workstation is an accessory that is placed on top of a regular desk and can be height-adjusted to lay flat on the desk allowing for seated use, or be raised to a point that allows the user to stand at the desk. These also come as either manual or motorized.
Why Switch to a Sit-Stand Desk?
The purpose of a sit-stand desk is to allow a more ergonomic approach to desk use, especially in a work environment where the user may be restricted to one for hours on end. Two significant changes a sit-stand desk may provide include the following:
- The simple freedom to quickly change between seated and standing postures can give the user a way to resist overusing certain muscles and underusing others. For example, in individuals who spend too much time sitting, the hamstrings and hip flexors are often tight, while the quadriceps and gluteals are often weak. The opposite tends to occur in those who spend too much time standing. Also, there is the notable tendency to start to round inward at the shoulders and hunch forward at the spine when seated at a computer for a long time.
- More calories are burned while standing than while sitting, as a standing posture requires more musculature to be used and is thus more metabolically demanding. In other words, it is a more “active” position.
Furthermore, there are many research studies that show positive correlations between stand-sit desks and improved health. This, along with the abundance of research that outlines the potentially negative implications of sedentary lifestyles (a prime example being one that includes a seated desk job), creates a very positive image of stand-sit desks! Much of this can likely be attributed to the two facts just listed above. The following is a list of the findings from some of these studies:
- Using a standing desk may result in lower blood sugar levels
- Sitting is associated with obesity and metabolic disease
- Standing desks and sit-stand desks seem to help reduce pain in the neck, shoulders, and back
- Sedentary lifestyles are associated with obesity, cancer, heart disease, stroke, diabetes, and neck pain, among other negative health issues
How Much is a Sit-Stand Desk?
The desktop workstations are generally cheaper than the full sit-stand desks, and typically range between $100-$300. For the full sit-stand desk, the adjustable frame alone can range between $250-$800, with even greater costs for those that include the desktop attachment.
It is important to mention that transitioning to a stand-sit desk may not feel great at first, especially if you have been used to sitting at a desk for years. This is where you need to take advantage of the adjustable height; gradually increase your tolerance for standing until the body can adapt to the more physically demanding position.
As mentioned previously, an always-standing position is not necessarily the goal – it is good to vary the amount of time you spend in each position just like it is important to vary your diet, hobbies, and so on. This occasional change of position, as well as periodically taking microbreaks to do some quick stretches or exercises, may help to take the sedentary aspect out of a desk job to make it easier on your body and keep you healthier.
What is Progressive Overload?
Progressive overload is the gradual increase in stress placed upon the body in the context of fitness training and physical rehabilitation. As the demands on the body are continuously advanced, it will adapt, quite specifically, to handle the increased load by becoming faster, stronger, more efficient, and so on.
Why is Progressive Overload Important?
The concept of progressive overload is important in avoiding a “plateau” in physical adaptations. A plateau occurs when the exercise stresses being placed on the body are not increased after several training sessions, and so the body no longer needs to adapt.
For example, if you were to perform ten repetitions (reps) of push-ups a day for three days per week, eventually they would become so easy that the muscles involved in the movement would stop increasing in size, strength and coordination, as they simply would not need to. In other words, the demand for adaptation is no longer present from the current stimulus, and so although your body will maintain the current level of fitness required for the exercise, it will not increase in strength, size, power, or endurance.
For those who are happy with their current level of fitness, progressive overload is less important. For everyone else, especially those who are undergoing active rehabilitation, it is a crucial component in reaching your goals.
How is Progressive Overload Applied?
To progressively overload an exercise, it needs to place a greater demand on the body in some way. The following is a list of many different methods that can be used to achieve this:
- Increase the number of sets
- Decrease the rest duration between sets
- Increase the amount of resistance
- Eg. performing a bicep curl with 20lbs is more demanding than curling 15lbs
- Biases increased muscular strength (the maximum force your muscles can produce) over other muscular adaptations
- Increase the duration (if one is present)
- Eg. performing a plank for 60 seconds is more demanding than planking for 30 seconds
- Eg. running for 30 minutes is more demanding than running for 20 minutes
- Biases increased muscular endurance (the ability of your muscles to resist fatigue) over other muscular adaptations
- Increase the speed at which you complete the exercise
- Eg. if you perform 10 repetitions of a squat in 15 seconds, it will be more demanding than if you completed the 10 repetitions in 30 seconds
- Biases increased muscular power (the ability of your muscles to exert maximal force in the shortest possible amount of time) over other muscular adaptations
- Advance the exercise to a more difficult variation, using one of more of the following:
- Add a dynamic component
- Combine with another exercise
- Reduce the size of the base of support
- Reduce the stability of the base of support
- Increase the range of motion/change the angle of the body parts involved
- Increase the frequency of training
- Increase the number of exercises per training session
Depending on your fitness goals, you may also want to adjust the number of repetitions you are performing each set. Research on the optimal number of reps for a given muscular adaptation often varies. However, suggestions tend to fluctuate closely around the following ranges:
- ≤ 6 reps biases muscular strength
- 6-12 reps biases muscular hypertrophy (the size of your muscles)
- >12 reps biases muscular endurance
This is not an exhaustive list of ways that you can progressively overload your workouts. However, it includes some important concepts that you should familiarize yourself with if you are to achieve the results you want, in terms of fitness training and physical rehabilitation.
Am I Exercising at the Correct Intensity?
Once an exercise is no longer providing a physical challenge to your body, it is probably time to progress it. However, this progression should be gradual and consistent – focus on improving by small amounts at a time and choose progressions that make sense. It would be unwise sense to suddenly jump to hammer curling 40lb dumbbells once 15lb dumbbells have become too easy; advance in smaller increments, such as increasing from 15lbs to 20lbs, or increasing the number of sets from 2 to 3.
Inability to maintain proper form can be a key indicator that you have chosen an exercise or progression that is too intense, and you should take a step back. Learning and maintaining ideal form is one of the most important concepts of exercising. It doesn’t matter if you are lifting weights at the gym for fitness, aesthetics, or physical rehabilitation, or if you are playing tennis, or even going for a jog outside – the importance of excellent form holds true in all these situations. So, if you find your body perturbating uncontrollably while trying to perform a core exercise, or you are activating additional muscle groups to compensate for a level of intensity that is far too high for you to perform correctly, it is time to tone it down a notch.
Pain is another indicator that you have attempted an exercise or progression that is not at your current level. This is especially important when undergoing active rehabilitation as it interferes with your ability to exercise effectively, in turn delaying progress in the program. Additionally, it can cause further aggravation to the injuries that you are attempting to recover from, leaving you feeling worse off than if you hadn’t chosen to exercise at all.
Examples of Progressive Overload
Level 1 – Wall push-up
Level 2 – Incline push-up
Progression: Changed angle
Level 3 – Traditional push-up
Progression: Changed angle
Level 4 – Elevated push-up
Progression: Changed angle
Level 5A – Elevated push-up with leg lift
Progression: Decreased size of base of support
Level 5B – Elevated push-up with unstable support
Progression: Decreased stability in base of support
Other ways to progressively overload these six exercises:
- Increase number of reps
- Increase number of sets
- Increase speed of each rep
- Decrease rest duration between sets
- Increase the range of motion/add a dynamic component (eg. “T push-up”)
- Combine with another exercise (eg. add a jump squat to make it a “burpee”)
Muscle Imbalances (And How They Can Create Pain/Dysfunction)
What is Muscle Imbalance?
Muscle imbalance can be described as an inequality in the distribution of forces between the agonist and antagonist muscles of a joint. In other words, muscles acting in one direction on a joint are pulling harder than muscles acting on the joint in the opposite direction. This can negatively affect how the joint functions.
How Does a Muscle Imbalance Occur?
There are several ways in which the force ratios between agonist and antagonist muscles can be disrupted and result in a muscle imbalance, including the following:
- Poor posture
- Eg. prolonged periods of being hunched over a computer
- Improper training
- Eg. too much emphasis on training agonist muscles over antagonist muscles
- Eg. tennis elbow, muscle sprains, multiple sclerosis, stroke
Forward head posture and forward rounded shoulders are very common examples of poor postural habits. These can largely be attributed to increasingly sedentary lifestyles that many people are adopting in our society. It comes down to the simple fact that many of us will spend hours each day in front of a computer, TV, textbook, cellphone, tablet, steering wheel, and many other objects and tasks in which we often can find ourselves slumping into very forward rounded positions.
Eventually, poor postural habits like this can lead to a muscle imbalance because the agonist muscles that are consistently being shortened will begin to maladapt to the position by tightening, whereas the antagonist muscles will begin to weaken from frequently being underused and in a lengthened state. These negative muscular changes brought on by poor postural habits then result in a forward rounded position that is maintained even when not engaging in these activities that reinforce it. The following are some of the muscles and muscle groups that would be affected in this example:
- Eg. tightening of pectoralis major and minor, upper trapezius, levator scapula
- Eg. weakening of middle and lower trapezius, rhomboids, deep cervical flexors
How Does a Muscle Imbalance Cause Pain and Dysfunction?
Whether it was poor posture that led to the muscle imbalance or not, it will likely become the result if the issue is not addressed (again, due to the gradually worsening pull of the joint in one direction). A progressive decrease in mobility and flexibility can eventually take form, as some movements will be limited by muscle weakness, while others will be limited by muscle tightness.
To give a more detailed example: in our case of forward head posture, one major issue is that every inch that the head sits forward from its normal, neutral position, it feels ten pounds heavier. Of course, this means that there is a significant amount of extra work being put on the structures of the neck that support the head. Not only can this result in irritation for the neck muscles and other structures that are working excessively hard, but it also greatly increases the risk for more serious issues in the future, such as degenerative disc disease.
How Do You Fix a Muscle Imbalance?
Assuming your muscle imbalance has arisen from poor postural habits, improper training, or an injury that has since been resolved, the fix involves reversing the problems that have led to it. Muscles that have tightened up need to be stretched, and muscles that have weakened need to be strengthened. At the same time, good postural habits need to be re-established. If the imbalance is a result of improper training at the gym, an additional recommendation would be to develop a new routine that includes a good distribution of exercises across all muscle groups once the imbalance has been resolved.
Of course, some of these suggestions might be easier said than done, especially if a lack of mobility or an excess of pain is inhibiting you from performing certain exercises or stretches that you think might help. Fortunately, there are many professionals that can assist with restoring mobility, managing pain, developing workout programs, and providing education on posture and exercise. Don’t be afraid to seek assistance from a physician, kinesiologist, physiotherapist, chiropractor, or any of several other kinesiology and health professionals.
Finally, consider visiting some of our other blogs for more information on related topics that may be helpful in fixing (or preventing) a muscle imbalance:
- Neutral Spine – https://www.novaactiverehab.com/neutral-spine/
- Posture – https://www.novaactiverehab.com/posture-and-postural-cues/
- Pain Cycle – https://www.novaactiverehab.com/pain-cycle/
Note: if your imbalance is the result of a serious disease or a more severe, on-going injury, the fix may not be as simple. Seek advice from a physician and see if the prior suggestions can benefit you.
Stages of Healing of a Soft Tissue Injury
What is Soft Tissue?
Soft tissues are any of a variety of tissues that support, connect, or surround other structures in the human body, and that are not rigid like bone. There are many types of soft tissues, such as fat, muscle, fibrous tissue (tendons, ligaments, fascia), synovial tissue (found at joints and other structures), blood vessels, lymph vessels, and peripheral nerves (nerves outside of the brain and spinal cord).
What is a Soft Tissue Injury?
A soft tissue injury is the damage that can occur at a localized area of soft tissue as the result of some sort of physical trauma or repetitive abuse. Soft tissue injuries can be classified into two categories:
- Occur when there is a sudden, abnormal stress placed on the tissues, such as a physical blow or a rapid movement that the body is unprepared for. Some examples of acute soft tissues injuries include muscle or tendon strains, contusions, and ligament sprains.
- Occur over an extended period of repetitive stress that is placed on the tissues, such as overtraining or monotonous hobbies and/or jobs. Some examples of overuse soft tissue injuries include tendonitis and bursitis.
There are countless scenarios in which an individual might receive a soft tissue injury. Perhaps you ‘rolled’ your foot while hiking or stepping off a curb, which resulted in the spraining of a ligament in your ankle (an acute soft tissue injury). Or, maybe you have been going for a long run every morning on hard, flat pavement for the past several weeks. However, if you have poor footwear, or you simply don’t give your body enough time to recover, eventually you may find yourself suffering from medial tibial stress syndrome (‘shin splints’), patellofemoral pain syndrome (‘runner’s knee’), or Achilles tendinitis. All three of these are examples of overuse soft tissue injuries.
Nova Active Rehab specializes in recovery from injuries sustained in car accidents – acute soft tissue injuries (which often become chronic if not dealt with). This will be the focus for the remainder of this post.
The Stages of Healing of a Soft Tissue Injury
Once a soft tissue injury has occurred, the body will respond by initiating the healing process. There are three stages (or phases) of healing, which occur in the following order:
- Inflammatory stage
- Repair (proliferation) stage
- Remodeling (maturation) stage
The Inflammatory Stage
In the first stage of healing, the inflammatory stage, the body is responding rapidly to the onset of a soft tissue injury. Typical signs of inflammation include warmth, redness, pain and swelling, the latter two of which will serve to limit the function of the damaged tissues. This limitation is a protective mechanism, as it will help reduce the chance of further injury to the site.
Your body will also release a number of chemicals during this phase, which will cause a cascade of events that lead into the next stage of healing – the repair stage. The inflammatory stage is brief, lasting up to about five days. This phase of healing ends with the clotting of blood vessels, the mechanical protection against the entry of foreign bodies (if our internal system was exposed to the external environment, such as with a cut or scrape; scab formation), and the subsiding of the inflammatory response.
Following a car accident, here are some suggestions for recovery during this stage:
- Visit your family doctor as soon as possible (or the hospital if your injuries are severe enough)
- Focus on letting your body rest and heal (avoid any intense physical activity or movements that result in pain)
- If cleared by a physician, undergo some gentle, pain-free range of motion activities
- If cleared by a physician, utilize PRICE (protection, rest, ice, compression, elevation) to the injured site
The Repair Stage
The purpose of the repair stage of healing is to remove the dead tissue and debris from the site of the injury, and to replace it with new tissue. However, when the new tissue is formed, the structure of it is much less organized. This is largely because the new fibres are being deposited in random directions (as opposed to being neatly lined up, as in healthy tissue), resulting in a less functional tissue. This is referred to as scar tissue.
This phase begins shortly after the initial injury and can last several weeks (or longer) depending on the extent of the injury and the response from the individual’s body. As the inflammatory phase ends and the new tissues begins to form, there should be a gradual increase in function (strength, mobility, etc.). However, as mentioned prior, this scar tissue is still not as functional as the healthy tissue that existed prior to the injury, and so you should not expect to regain all your strength and mobility during this phase of healing.
Following a car accident, here are some suggestions for recovery during this stage:
- If cleared by a physician, undergo some passive and active range of motion activities that are within a reasonable pain tolerance (to avoid joint contractures, scar adhesions, and other issues that can limit your recovery)
- Consider seeking out some or all of the following professionals at this point: physiotherapists, chiropractors, massage therapists, occupational therapists
- Eventually this could be advanced into some progressive resisted exercises, as well as neuromuscular and proprioception retraining
The Remodeling Stage
The final stage of the healing process, the remodeling stage, begins once there is a sufficient amount of scar tissue in place. The purpose of this phase is to remodel the scar tissue over time into a more healthy, functional tissue. In order to ensure this occurs properly, the individual will have to introduce appropriate stimuli for the injured soft tissue, including a variety of movements or exercises that are gradually progressed in intensity.
From the onset of the remodeling stage at about a few weeks post-injury, this stage should last anywhere between about one to eighteen months. This is a massive range of time, which again will depend on a number of factors, such as the extent of the injury, the intervention of any professionals working with the individual, and the motivation and body responses of the individual during this phase. The goal at the end of this phase, and thus the end of the healing process, is to once again have a healthy, functional soft tissue at the site of the once-injured soft tissue. However, if the remodeling stage is not concluded successfully, then the individual may be bothered by pain, reduced mobility, and an overall limitation in function in the tissue long after the healing process has concluded.
Following a car accident, here are some suggestions for recovery during this stage:
- If cleared by a physician, begin a progressive return to all pre-injury activities by gradually restoring normal mobility, strength, conditioning, and proprioception through active rehabilitation
- This can be done with assistance by the previously mentioned professionals (physiotherapists, massage therapists, etc.) as well as kinesiologists, who are specialized in creating a structured, progressive, active rehabilitation program
Soft Tissue Injury and Healing Stages – https://www.doctorsconvey.com/physical-therapy/soft-tissue-injury-healing-stages
Functional Assessment of the Spine and Extremities (FASE) Manual (2009 Edition)
Moderation and How It Relates to a Healthy Lifestyle
What is Moderation?
Moderation can be defined as the avoidance of excess or extremes. There can be a lot of value in this single word when used in the context of health and well-being. This post will seek to explore various domains of health and how we might better ourselves by applying some degree of moderation to these areas of our lives.
Think about everything that you consumed or did yesterday. Did you eat a lot of high-fat foods, or was your diet mostly balanced? Did you spend hours in front of an electronic screen, or did you decide to do something active? Have you been drinking enough water? What about in the last week? Before reading further, I challenge you to pick apart the last week (or longer) and identify the most prominent things in your life that are going unchecked – that are not being moderated at all, but that you recognize maybe should be.
Moderating Nutrient Consumption
Understanding and “watching” what we eat is an important part of maintaining our health, and is critical in choosing what we should focus on moderating in our diet. While many of us know that over-eating foods loaded with fat, sugar, salt, and various artificial ingredients is not good for us, it is harder to put an actual number to how much we should allow in our diet.
The nutrition fact labels that are available on most packaged items in Canada are a good place to start in forming an understanding of the amounts of different nutrients we should be getting in our diet. For example, if an item says that it has 15 grams of fat per serving, it should say that it contains 23% of our “% daily value” on the label. In other words, if you consume a single serving of that food item, you have consumed 15 grams of the 65 grams for that day that are recommended for you to maintain a healthy diet. I encourage you to read the labels frequently before you buy and consume various items, so you can start to build an idea of what your diet is lacking in, and what is being consumed in excess that should be moderated.
Although the nutrition fact labels can be extremely useful, there are a few things to keep in mind with respect to them:
- Pay attention to what is considered a serving size on the nutrition fact labels rather than making assumptions; some companies might list fives pieces or half of a single food item as a serving size, when a full package contains far more than this.
- The percent daily values are created based on the recommended daily caloric intake of an average-sized individual; people who have much smaller or larger dimensions than average or who engage in lifestyles that may demand more of certain nutrients (eg. a woman who is 5’1” and who runs marathons, a man who is 6’5” and is a muscular body-builder) may need to adjust their daily caloric intake accordingly.
- Some values on the nutrition fact labels are not a recommended daily intake, but rather a safety limit to avoid adverse health conditions. Sodium and cholesterol are two important examples of this. In other words, you should not be trying to meet the percent daily values for these items, as your body is able to thrive on far less.
- Many foods and beverages do not contain nutrient fact labels, such as fresh produce and beverages containing greater than 0.5% alcohol content. Fresh produce is typically composed of mostly carbohydrates, with highly varying amounts of different vitamins and micronutrients. Alcohol is typically just “empty” calories, adding large amounts of calories to your diet but with negligible nutritional value. You will have to do some of your own research on other items.
Once you have created a habit of keeping track of what you are putting into your body, it becomes easier to moderate your diet. For example, if you find that you are consuming 150% of the daily recommended value of carbohydrates in packaged foods alone, and you haven’t even factored in the fresh produce you are consuming, maybe you are lacking in proteins and fats. In another scenario, maybe you are gaining weight steadily, but believe you are eating very healthy foods. After calculating your daily consumption, you find that your intake of carbohydrates and fats are both at 100% of the recommended values, but your intake of protein is at 150%. In this case, you are just over-eating protein-rich foods, and need to lower your total consumption of protein.
If you absolutely cannot be bothered by reading labels, at least remember to always include a variety of foods from all the different food groups in your diet, and change what you eat and drink from day-to-day.
This section is dedicated to those who consider themselves or someone they know a “work-a-holic.” While it is certainly a good thing to have a solid work ethic, and to work a lot so we can pay our bills and save money, it is equally as important to have down time.
It is difficult to put a number on what is an excessive amount of work, especially since some people can handle a greater workload better than others, and every occupation varies in how cognitively and/or physically demanding it is. However, if you find that you rarely or never have the time to prepare proper meals, visit with friends and family, engage in some sort of leisurely activity, or even sleep a proper number of hours each night, it is possible that your workload is excessive. If you find yourself in this situation, attempt to moderate your work-life to make some room for other activities, as every person has a point in which they will eventually burn out, whether it be physically, mentally, or both. At the very least, take a vacation to somewhere relaxing once in a while!
This leads us into another important area of health, which involves what we choose to do in our spare time, or our leisure time. Although it is okay to sit and enjoy television, play video games, and other sedentary activities at times, it is good to also have hobbies that are more active. This is especially true if you have a very sedentary occupation, such as an accountant or any other job that demands a lot of desk work. Now, you don’t have to think of active hobbies as being restricted to running or lifting weights. While some people enjoy these, activities such as hiking, skiing, tennis, or even maintaining a garden might be more appealing to others. The benefits of exercise are too valuable to not engage in any exercise in our leisure time.
The opposite may hold true for those who have a very high energy lifestyle. I can give a personal example of this: I know someone who works as a labourer six days per work, typically about ten hours each day, performing very intense physical work. On top of this, he goes to the gym twice every day of the week; on days where he is working, he will go for about two hours before work, and for about two hours after work. While he is a very strong, muscular individual, I can almost guarantee this will eventually lead to massive burn-out, similar to what I mentioned earlier when discussing work-a-holics. This is a less common case, in which I would consider recommending that this individual actually take some rest days here and there, where he can focus on a more sedentary hobby and allow his body to rest and recover.
How Does Moderation Relate to Injury Recovery and Rehabilitation?
As alluded to in the previous section, our body needs some down-time in order to adequately recover from trauma. Whether that is by lifting weights at the gym and causing small, deliberate tears to our muscles, or through an actual injury incurred from an accident while driving or playing sports, rest is mandatory for the body to make repairs.
Let’s use a practical example to make this clearer: imagine you have just been in a car accident, in which you were rear-ended hard enough to cause some notable damage to your body. Specifically, you have incurred soft tissue injuries to your neck and lower back. As you wait for your body to heal from these initial injuries, the pain cycle is already looping continuously and further exacerbating your pain, restricted range of motion, loss of function, and so on.
At this point, many people simply want their pain and injuries to be resolved, and so “more is better” might seem like a viable option when starting an active rehabilitation program. However, choosing to add more weight, perform more exercises, or work out more frequently than your body is ready for might actually do more harm than good. If you are increasing your pain and symptoms significantly due to active rehabilitation, there is a good chance you are overdoing it in some way. Leave yourself rest days in between workouts, and avoid exercises that cause an increase in your symptoms (sometimes this means just doing an easier variation or using less weight). In other words, listen to your body and consider moderating your program.
Moderation is Not a Rule
Although this can be a useful concept, it should be taken with a grain of salt at times rather than as some sacred, golden rule. For example, if you only drink water (and the rare glass of milk for vitamin D and calcium), this doesn’t mean that you should moderate your water consumption but starting to drink soft drinks and slurpees. Also, many of us might not have the option of moderating how much we work. Use it more as a loose guideline to help you make better choices at times, or to consider making some healthier modifications to your lifestyle. Think back to the activity from the beginning of the post, and see if you can use moderation to balance those things in your life that have gone without limitation in the past.
Definition – http://www.dictionary.com/browse/moderation
The Pain Cycle (and How to Break It)
What is the Pain Cycle?
The pain cycle is a continuous loop of negative issues that can develop when we sustain an injury. There is a positive feedback effect that occurs throughout this loop, in the sense that increasing the amount of one factor leads to an increase in subsequent factors of the loop. The following diagram may help demonstrate the important components of the pain cycle and how the positive feedback effect works:
There is a lot of information packed into this diagram, but it will make more sense when each component is broken down:
- Pain: When a physical trauma occurs, such as a neck injury in a car accident, you are likely going to be confronted with pain before anything else. In this sense, you can think of pain as the catalyst in initiating the pain cycle.
- Muscle Guarding: Pain, aside from being an unpleasant sensation, acts as a signal for the body that an injury is present. Our body typically responds to this signal through the use of muscle guarding, a protective mechanism in which muscles around the site of the injury will spasm (contract involuntarily) to restrict movement. The goal of this is to prevent further injury, similar to how we might use a cast or splint in the case of a sprain or fracture.
- Restricted Range of Motion: While the purpose of muscle guarding is to minimize movement around an injured area, this can eventually become detrimental. This is because the restricted range of motion can persist after the damaged tissues have been repaired. Why this occurs is largely due to the fact that our body has already long since adapted to not using the injured area and surrounding musculature. At this point, muscle guarding is no longer serving a positive role in our body.
- For example, if your neck has been injured and has stiffened up significantly due to pain and the subsequent muscle guarding, your body will typically react to this lost range of motion by “borrowing” it from other joints in the body, also known as compensating. Instead of extending at the neck to look up, you might extend from lower in the spine. Similarly, rather than primarily rotating your neck to perform a shoulder check, you rotate more from below the neck.
- Muscle Weakness and Atrophy: Following long periods of muscle guarding and restricted movement is muscle weakness and atrophy. Our body is extremely efficient with managing its resources, and will avoid investing energy into things that are not currently serving a purpose. As such, an area that has been injured, guarded, and movement-restricted will gradually begin to weaken and suffer muscular atrophy (loss of muscle mass) over time – it simply is not being used enough to maintain a sufficient input of energy from the body.
- This is no different than why we begin to lose muscle mass if we stop working out, or why it becomes difficult to remember things if we don’t recall them for a long time. It would be wasteful for our body to continuously invest in those specific muscles or brain cell pathways if they are not something we will need in the near future.
- Decreased Function: The next stage in the pain cycle is decreased function. In reality, this has been occurring throughout the entire cycle. However, once it reaches this point, the ideal response from the body would be to start restoring function as the injured area is healed, preventing a cycle from ever being established. Of course, this is not always the case, otherwise the concept of the pain cycle would not exist.
- Psychological Stress: Various forms of psychological stress can ensue, such as: frustration, anger, depression, helplessness, and so on. Although this is not a very productive response, it is hard to blame someone for being frustrated, given the cascade of negative events that have built up to this point. Unfortunately, these various forms of stress can increase tension in our body and decrease our motivation, which eventually will lead to more pain as we continue to neglect the physical issues, such as guarding, decreased range of motion, atrophy, and loss of function.
As we can see, each component of the pain cycle feeds into the next until it meets back up with where it began, demonstrating the positive feedback effect that was mentioned earlier.
How is the Pain Cycle Broken?
In order to break the pain cycle, we need to target the factor that is fueling it the most: pain. However, there is a difference between the pain from the initial injury, and the residual pain that continues to feed into the cycle. Once the injury to the tissues (eg. contusion, fracture, sprain, strain) has healed to a functional level, the residual pain we continue to experience is actually a result of the events that took place during the dysfunctional period (refer back to the pain cycle). Thus, we should seek to rehabilitate the site as soon it is functional again.
We can employ a number of methods to deal with the residual pain. First of all are passive techniques, which can be very useful, especially in the early attempts at managing the pain cycle. The following are some examples:
- Applying heat or ice (heat is generally better for tightness/stiffness, as it promotes increased blood flow to the area, whereas ice is typically better to use on swelling/inflammation, as it will reduce the amount of blood flow to the area)
- Relaxation strategies (deep breathing, positive mental attitude, meditation, experiencing nature, and anything else that you find will help you reduce mental stress and the accompanying physical tension)
- Passive therapy (passive stretch, shockwave, massage, acupuncture, laser, percussion, and many other services that trained professionals such as physiotherapists, chiropractors, and massage therapists can provide for you)
While passive techniques can have tremendous benefits, they can also be limited in their ability to completely break the pain cycle. This is because a lot of these techniques only cause temporary relief to the problem. However, this opens the opportunity to incorporate the second major key to breaking the pain cycle: active techniques. Active techniques should be gradually incorporated once an adequate amount of function has been restored through passive rehabilitation, so the pain cycle can be broken for good.
I will define active techniques as anything in which you are physically engaging the musculature in and around the site of the injury. In other words, increasing your level of movement. This can include anything from going for a walk or run, lifting weights, performing stretches, or finding an active hobby (tennis, hiking, etc.). Kinesiologists can be very beneficial at developing a structured active rehabilitation program for you, as well as demonstrating the exercises and progressing the plan at a proper pace.
By performing both active and passive strategies at the same time, you will eventually see an opposite effect in the pain cycle – it will become more of a relief cycle. As pain is manage our muscles will guard less, which can help free up range of motion, allowing us to move more freely and build up our strength again, and so on. Eventually the passive rehabilitation will no longer be necessary, and we will instead remain active with the goal of maintaining our health, rather than rehabilitating our body. However, it takes a conscious effort from us to make these changes. The longer we sit around and hope for the best, the more we are fueling the pain cycle to make things worse.
Proper Posture and Postural Cues
What is Good Posture?
Posture can be defined as the position or alignment of body parts. Good posture is when our body is positioned in a way that places the least amount of strain on our ligaments, bones, joints, and muscles. Click to read about neutral spine. It should be relatively easy to maintain such a position for extended periods of time.
What is Meant by Center of Mass and Base of Support, and How Are They Related to Posture?
Describing what good posture looks like is more complicated than you might think. To start, it is important to understand the concept of center of mass. Center of mass can be thought of as the single point where all the mass of an object is evenly distributed around. For example, in a uniformly-shaped object, such as a perfect cube or sphere, the center of mass would be in the exact center. In a human with a healthy weight, average dimensions and who is in a standing position with excellent posture, the center of mass would be located inside the body, behind the navel (belly button) and near the bodies of the lower lumbar vertebrae.
A second important concept is base of support, or the area beneath an object that is bounded by the points of contact that the object has with the supporting surface. Again, this is explained better through an example; if we think about our ideal human in their perfect standing posture, the base of support would look something like a trapezoid. Furthermore, when standing with good posture our center of mass should be situated over the base of support that is created by our feet. Ideally, it would be directly between our feet so that there is even distribution on both sides of our body. The following picture will help demonstrate this:
Notice the trapezoid-like “base of support” (marked in green) that is created by the contact of our feet with the supporting surface. The red dot labeled “center of mass” is where the center of mass of our body should be located in our base of support (when we are in good standing posture) if we were to draw a straight line from it down to the ground.
What Does Good Posture Look Like?
Now that we understand how posture works, we can establish what this looks like in the human body. The following pictures will show some of the many reference points you can use to help you find a good posture:
What Are Postural “Cues”?
Postural cues are simple ways of reminding ourselves to adjust our posture into a better position. Of course, there are an infinite number of cues you could develop for yourself, so long as they adhere to the information about good posture provided thus far. The following are a few memorable ones that I have picked up over time:
- Drool Test (Head/Neck) – If you were to let yourself drool to the point where the saliva ran from your mouth and down your chin, then when it drips it should land at the top of your sternum. If the drool lands in your sternal notch (concavity at the base of the neck behind the sternum), your head is too far back. If the drool lands past the top of the sternum, then your head is too far forward. You could also place a ruler against your chin and down to the top of the sternum. If you reach a point where you as feel as though you are restricting your airway, even if it is before the ideal position of the drool test, stop the movement before that point.
- Shoulders Back/Chest Puff (Shoulders/Chest) – It is becoming more common to find individuals with shoulders that are rounded forward, and a chest that is rounded inward. If your shoulders are too far forward (refer to pictures of good posture) then you simply need to remind yourself to pull them back slightly. At the same time, puff your chest out minimally. It is important to realize that these are small, subtle movements; if you pull your shoulders too far back you are asking for backward rounded shoulders, and if you puff your chest out too far you are going to hyperextend your lumbar spine.
- Spread the Ground (Hips) – In an ideal standing posture, our feet should be pointed just slightly out from perfectly straight forward. Feet that are pointed inward or markedly outward are less optimal. This postural cue will help with feet that are pointed too far out (more common than inward-facing). Essentially, you want to push outward from your heels, as though you are trying to spread the ground apart that is directly beneath you. You should feel work from the muscles around your hips.
- Soft Knees (Knees) – From your neutral standing posture, if you were to suddenly extend your legs at the knees, your knees should move backward slightly before “locking”. If no movement occurs at the knees when you perform this action, it means that your knees are already locked in your neutral position. For this postural cue, remind yourself to unlock your knees ever so slightly when standing. It will likely feel very odd for the first few days, but your body will eventually adjust.
- Arches Up (Feet) – If the arches on the inside of your feet are absent (flat arches), it can strain and alter the posture of other parts of the body, such as the knees. For this postural cue, activate the muscles in your lower legs that pull the feet upward at the arch, but maintain contact with the floor at the balls of your feet and your heels. Avoid curling the toes while performing this.
Does Posture Only Refer to When We Are Standing?
Although it has been the focus of this post, it should be noted that posture doesn’t exclusively refer to when we are in a neutral standing position. In reality, it includes any position that we place our body in, whether it be static (such as sitting or standing), or dynamic (such as running, jumping, squatting), though dynamic positions are often referred to as our “form.”
The concepts of center of mass and base of support still hold true in most of these situations. For example, you may have heard that you should bend at the knees while lifting an object off the floor, and to lift it close to your body. This is because if you bend entirely at the lower back and lift the object far from your body, your center of mass moves forward and well outside of your base of support. To maintain your balance (prevent you from falling forward), the muscles of your lower back would have to work astronomically harder, which can result in an injury.
Can I Achieve Perfect Posture?
In reality, there is no such thing as a perfect posture. We all have individual differences in our anatomy and biomechanics, whether it be the result of genetics, individual factors (eg. poor postural habits, age), or environmental factors (eg. poorly designed work environment, disease), that bar us from developing and maintaining a perfect posture.
However, although we may never be able to perfect the posture of our body, we are all capable of making improvements to our posture over time in one way or another. Just remember that these changes should be done very gradually. In other words, don’t hold a postural cue through an entire day when you are first performing it, otherwise you are going to fatigue your body and create new aches and pains. Short holds of 15-30 seconds at a time for a few times each day is a good start, and then you can slowly increase duration and frequency every few days until it becomes habitual.
Justin, B. (2016). Postural and Palpation Assessment.