Movement For Low Back Pain
Dr. Steven Scappaticci, B.Sc. (Hons.), CSCS, DC, FRCms
The year is 1950 and you have low back pain. You go to the local doctor (or perhaps he makes a house call) and while smoking he tells you to lie in bed for a week to rest your back muscles. Fast forward to 2019 and your millennial grandchild has some low back pain. They go to the nearby chiropractor and after receiving some manual treatment and rehab exercises they are told to keep moving with relative rest as needed throughout the day. Two similar scenarios with different endings and differing subsequent outcomes. Why is this?
Well just like many aspects of health care, things change over time. New research and methods emerge and either dispels old ways of thinking or builds current models to strengthen them. Whether it is the medical practice of bloodletting that has been replaced with pharmacotherapy or the change in the management of low back pain or many of the other examples that exist in manual therapy & medicine, times change!
Low back pain can be tough! Not just for the patient experiencing the pain but also for the health professional managing the case. I’ve written a previous blog titled “Psych-aticia! How Low Back Pain Can Fool You!” which outlined nearly all the possible causes for “sciatic-like” symptoms and how they are all interrelated. Sometimes when a patient is in acute pain, it is difficult to truly find the source of pain when everything hurts! This is where the full clinical picture comes into play. That being said, sometimes the pain moves. It may start on one side and then be on both sides, you may see them on Day 1 of injury and then by the next time you see them things have worsened considerably just due to the pattern of their low back pain.
Pain aside, there are a number of ways to “categorize” back pain (and to some degree all joint pain). The classic way that is taught is flexion- vs. extension intolerant, meaning do they have pain when they bend forward or arch backwards? Similarly, the folks at Functional Range Systems (FRS) talk about opening angle vs. closing angle joint pain. It should be noted that depending on the nature of the pain/injury, one could experience pain in both directions as multiple tissues could be affected.
Assuming no red flags or need for outside management, a patient with low back pain can be treated with conservative care. The specific type of care is not necessarily what is important for this article but they may experience treatments including: myofascial release, spinal manipulative therapy, the use of a modality, rehabilitation, and/or even acupuncture. That being said, rehab is a huge component of a patient’s recovery and is the focus for this blog.
Every patient is different as is his or her presentation and pain. It only makes sense for their treatment to be unique and tailored to them. With that in mind, many principles of rehab can be applied to multiple patients. One example is if someone has back pain felt predominantly with extension (or even extension & rotation, such as a the lumbar Kemp’s Test). In this case, it would be beneficial for the patient to focus on exercises that promote controlled spinal flexion and depending on the assessment findings, some pelvic tilting exercises as well. A great exercise for this is the segmental cat-camel exercise, nicely highlighted by the group at FRS. The flexion-based exercises will help relieve the patients extension based pain. The flexion movement will help to gap the facet joints along the spine. Providing relief from over compression and irritation of the joints.
The same principle can be implemented with those suffering from flexion-based pain. If someone has “sciatica” or even a flexion induced muscle strain, performing multiple repetitions of extension-based exercises would be beneficial. Exercises such as the cobra/sphinx pose, McKenzie exercises, and even the segmental cat-camel stretch again this time focusing on the extended position. Of course, even with the exercises listed here there are ones to start with and ones to progress to.
One thing to remember is that once pain has decreased and functionality has increased, one should focus on improving all the ranges that were injured and the surrounding area.
So although the examples given may be a little more textbook and black & white than true clinical practice, as patients improve to transition to an active care model, exercises such as these can help their low back pain tremendously!
If you are in the Niagara Region and looking for evidence-based, effective care I can help. At the same time, if you aren’t from the Niagara Region, the Distance Rehab Program is available to you. You’ll have a personalized rehab program designed just for you, which you can perform in the comfort of your own home! Just email firstname.lastname@example.org for more.
Olivia Di Bacco, B. Kin. (Hons.), RMT, FST Level 1
My first interaction with Fascial Stretch Therapy was at the 2015 Olympic wrestling trials. I was about to compete at the biggest tournament of my life, and was unable to get into a full squat - a vital part of wrestling. To say I was freaking out would be an understatement. One of the therapists available was a fascial stretch therapist. She got me on her table, told me to breathe, and worked some magic. Thirty minutes later, I got off the table, and was able to do a full squat with no pain. I went on to win my next match and ultimately finished third, one spot away from qualifying as the Olympic alternate. My interest in Fascial Stretch Therapy was piqued, and I continued to implement it into my personal treatment plan. Fast forward a few years, and I became a registered massage therapist. Following my certification as an RMT, the first supplementary education I wanted was Fascial Stretch (FST). I am very proud to be able to offer this service to my clients. My hope is that whatever your movement or fitness goals are, FST will help you to reach them!
Who benefits from Fascial Stretch Therapy?
- Do you ever stand up after sitting for an extended period of time and feel as if your lower back is “tight”?
- Do you struggle to get into a good squat?
- Are you unable to put both of your arms straight overhead?
- Is relaxing and decompressing after a long day a struggle for you?
- Do you reach the end of a busy week of training or physical activity and feel sore all over?
- Fascial Stretch Therapy (FST) is a hands on therapy that can help you take your movement to a new level. If you want to move safely and efficiently through whatever tasks your daily life brings, FST could be part of an effective overall treatment plan for you!
What is “FASCIA”?
Connective tissue runs throughout your entire body, and is the most prevalent form of tissue in your body.
- Fascia = another word for that connective tissue
- Fascia = a full body communication and force transmission network
- Fascia = connected to, and influencing every body system
What does a Fascial Stretch Therapy session look like?
FST, while based on physiological principles, more closely resembles a dance than a strict therapeutic modality. No two treatments are alike, as FST therapists interact with your current levels of body tension, stress and individual needs.
As a registered massage therapist in addition to FST practitioner, I enjoy incorporating soft tissue work alongside fascial stretch techniques to provide a comprehensive treatment!
- You, the client, can expect:
- Continuous communication about your level of comfort, your breathing patterns and any changes taking place in your body tissues
- NO PAIN
- Passive (I move you) movements of your joints, limbs and body parts
- Active (We move together) movements of your joints, limbs, and body parts
- Work in multiple planes of movement: up, down, side to side, diagonal, spiral...
- Full body work
What will I feel like after a Fascial Stretch Therapy session?
Like an itch that is hard to scratch on your own, the goal following an FST session is for you to feel a sense of “ahhh...that’s better.” Ideally, a sensation of “openness” or “clearing out” of areas in your body where dysfunction in the form of fascial restrictions have been residing will follow you off the table. As a full body treatment technique, it is not uncommon to have an overall increased sense of relaxation, both physically and mentally.
Why use Fascial Stretch Therapy?
FST is a treatment format that focuses not on individual muscles or areas of the body. Instead, it employs a full body method by dealing with what Thomas Myers refers to as “Anatomy Trains.” Anatomy trains, or fascia mobility nets as Chris and Ann Frederick call them, are a visual representation of our fascial anatomy. Using fascial nets allows us to assess and treat with the chain, or ripple effect that may be happening, in mind.
As we move about our day completing various tasks, these nets will work together, with different contributions depending on what those specific tasks are. Often, as we interact with a particular net, you may experience a sensation in a different area of your body than the one being touched. For example, many athletes have fascial restrictions in their lateral line/net. This can present itself while the therapist is moving the foot/ankle as a sensation in their hip, or around their rib cage.
Using these fascial nets also helps the therapist be more efficient in providing treatment. Instead of worrying about whether they are treating the cause or effect of a problem the client is experiencing, this global approach will ideally address both.
Finally, FST works well with a variety of other treatment forms. It can enhance the effectiveness of soft tissue techniques and manual adjustments.
Why do you use straps?
Fascial Stretch therapy involves the use of straps on the table to enhance the experience for the client, and make the treatment easier for the therapist. By putting one leg at a time under the straps, the client feels more secure on the table, enabling them to relax. This also limits unwanted movement, and helps the therapist manipulate the joints, limbs and tissues more effectively.
What are you waiting for?
Whether you are a desk worker tired of having a sore back, an athlete looking to push the needle on your recovery process, or an individual with high levels of life stress, FST could be a useful component of your treatment plan. With physical, mental and emotional benefits to be gained, the time to see if Fascial Stretch Therapy is right for you is NOW!
*With thanks to:
Thomas Meyers, author of “Anatomy Trains: Myofascial Meridians for Manual and Movement.”
Chris and Ann Frederick, authors of “Fascial Stretch Therapy” and “Stretch to Win”
Dr. Steven Scappaticci, B.Sc. (Hons.), CSCS, DC, FRCms
Numbness or tingling of the hand is a common symptom. Anecdotally, many seem to attribute this more often than not to Carpal Tunnel Syndrome. In reality, there are many potential causes for someone to experience numbness in their hand. Some of these reasons are innocent and fixable; some are manageable, while some others are life-threatening. Lets remember which conditions are more common & use a full clinical picture to identify other possible causes for numbness.
A few important points to remember is that anytime there is sensation changes, such as numbness there will be involvement of one or multiple nerves. This may be a direct or indirect piece of the puzzle as to what is truly causing the problem. It means something very different if the numbness is constant versus intermittent as well as if it is in one hand compared to being experienced in both hands.
The nerves in our arms and hands actually originate in the neck. They leave the neck by exiting between the vertebra, through the neck muscles, and course down the arm going over, under, and even through some muscles. As they travel, they split and divide many times until they reach the fingertips! You can see that there are many potential sites where something can become compromised.
So what’s on this long list of possible reasons for hand numbness? We can systematically break this down into musculoskeletal(MSK) causes and systemiccauses for simplicity. All the causes are bolded below.
Under the MSK category we’ll start at the neck with cervical spondylosis, simply recognized as degeneration. Now this is often painless but if severe enough, it can lead to stenosis– a narrowing of the space housed by the spinal cord and the exiting nerve roots that can lead to numbness. A similar mechanism is if those exiting nerve roots become significantly irritated, one may experience a cervical radiculopathy. There are many causes of cervical radiculopathy but one that stands out is a cervical disc herniation. This presentation can vary from sharper pains to weakness but can also include numbness in the arm/hand.
Continuing along, Thoracic Outlet Syndromecan be the culprit of arm/hand numbness. A much more involved condition, compression/irritation of the affected nerve (95% of the time as there is a small percentage that is of a vascular cause) that can occur in a few different places in and around the neck and chest/upper arm. Whether it’s tight musculature in the neck/arm or the presence of a cervical rib, the compression can cause hand numbness. A related diagnosis that can cause hand numbness is that of Double-Crush Syndrome. It is here that the nerve or nerves are compressed at two sites along its path. Muscles, bones, or even cysts, such a Ganglion Cyst, can irritate nerves in the arm/hand. These Ganglion cysts exist in the wrist and although usually asymptomatic can cause issues and create sensory changes in the affected hand.
Further down the arm we can have what we’ll refer to as “Tunnel Syndromes”. As mentioned earlier, nerves can run between muscles in “tunnels”. Specific nerves take residence in specific tunnels. For example, the median nerve courses through the carpal tunnel. The ulnar nerve passes along the cubital tunnel at the elbow. There are numerous “tunnels” (i.e. radial tunnel, Guyon’s Canal) within the body, both in the upper and lower limb and these can often be superficial and prone to irritation. When irritated, guess what can occur…numbness!
Lastly, numbness symptoms can be due to posturaltractioning of nerves as well as positional/occupationalfactors. There are some nerves that we mention actually pass through muscles. If the muscles are overused or injured it can compromise the nerve that pierces it as well (i.e. Pronator Teres Syndrome).
We’ve spent a considerable amount of time speaking about MSK causes of hand numbness. There are also many non-MSK causes for hand numbness. We’ll refer to this category as systemic reasons. These causes may start insidiously with no known cause or warning. Some here may also be present on both sides of the body.
People commonly know that a heart attackcan present with pain down the left arm. Lets first clear up the fact that it does not have to be the left arm. It can be the jaw, neck, and even the right arm that presents with pain. Also, women’s signs/symptoms of a heart attack can be quite atypical. However aside from pain, numbness may be felt/perceived in the arm. It’s best not use this symptom alone to dictate further management, use the full clinical picture!
Sticking with the cardiovascular system, a strokemay also cause numbness. Once again, the hallmark sign may be weakness of the face and/or arm, but numbness is a cardinal sign as well.
Diabetic neuropathiescause numbness. They may commonly start in the feet first but can spread to the hands in the classic “glove & stocking distribution” to give about numbness. There are other medical conditions such as Multiple Sclerosis, Guillain-Barre Syndrome, & even Raynaud’s Syndromethat can cause hand numbness. These are examples of some of the neurologic & autoimmune conditions that create numbness but are not the entire list. Lastly, there are some lifestyle factors that can cause numbness. One in particular is excessive alcohol use, or Alcoholic Neuropathy.
Now that you know what can cause numbness in the hand, you may be asking yourself what can you do to prevent it from happening? First off, some of these you can’t prevent but for the ones that you can, there are a few things to help lower the risk of occurrence. Be sure to live a healthy lifestyle. A life that includes a healthy diet with moderate indulgence, and being active! Do not let things build up. Go for your routine exams. Seek manual therapy from a qualified professional when you have lingering aches and pains! Be proactive with your health!
Note that the systemic causes listed above are not in the realm of chiropractic treatment. For diagnosis & management of such systemic conditions, please seek care from a medical doctor.
Dr. Steven Scappaticci, B.Sc. (Hons.), CSCS, DC, FRCms
With April shower’s comes those May flowers! It’s also the time of year to till gardens, lay sod, pick weeds, aerate the lawn…the list of gardening tasks almost never ends. And before you know it its time to rake leaves again! But lets not get too ahead of ourselves here.
Gardening is a tricky task. It requires us to repetitively bend, crouch, squat, lift, twist and hold certain positions for a while. The issue is that when we get back into the gardening routine, we’re often getting out of our winter routine – a routine that may have left us a little more sedentary than we’d like!
Gardening isn’t the high profile sport you often watch on TV but it does come with many physical demands just like sports do! Strength, flexibility, and mobility are all required for even the simplest of tasks. What compounds things even more is the presence of certain medical conditions that may make it difficult to garden. This should not scare anyone away from gardening; rather it should just make them take more precaution.
So what are some tips for gardening safely you may be asking? Well for starters (and in no particular order of importance):
1. CHANGE POSITIONS OFTEN
There may be no perfect posture or position for gardening so why not change things up? Changing your positioning often can really help to give some relief to certain areas of your body. Whether it’s seated, standing, crouching, kneeling…etc. be sure to change up your positioning every 15 min at least!
2. RAISED GARDENS/PLANTERS
This is becoming a popular approach to gardening. Smaller, contained, and raised gardens/planters are a great way to prevent aches and pains! Having the garden off the ground and closer to you can help from bending over to reach the ground and putting your back at risk for injury. For those with a smaller yard or the interest in only maintaining a small garden, this tip is for you!
3. LIFT WITH YOUR LEGS
Who hasn’t heard this one before? Save your back and lift with your legs! A tip for more than just gardening but a key tip when it comes time to haul bags of dirt across the yard.
4. USE WHEELS
These things are made for a reason! Wheels on trolleys/carts, & wheelbarrows make life so much easier! Why physically carry dirt, pots, or even tools from the front to the backyard when you can use a wheelbarrow? Just be careful how heavy you load them. Always best to keep them light! Similarly, you can consider lighter tools, perhaps something with a plastic handle versus a heavy wood or metal one.
5. GARDEN WITH OTHERS
Two’s company & three may be a crowd but not when it comes to gardening. Garden with others to share the workload! Whether it be your spouse/partner or even your kids, allow others to help & lift the heavy objects for you!
Perhaps more important than any aforementioned tips is to be active all year round. This may sound super obvious but to many its not. Someone may cycle in the spring, summer, and fall but do nothing in the winter. Why not pick up a recreational activity in the “off-season” to make it not so hard on our bodies when we get back into an old routine.
Do you have any questions? Contact me and let’s chat. Happy Gardening!
Why You Can’t Touch Your Toes
Dr. Steven Scappaticci, B.Sc. (Hons.), CSCS, DC, FRCms
We’ve all been asked to touch our toes at some point in our lives. Whether it was our doctor assessing us, a yoga instructor leading us into a pose, or during a fitness test from high school gym class, we’ve all been there.
At the same time, we probably all know someone who cannot touch their toes. Perhaps they’re always stiff because they’re inactive and sit a lot. If we sit in a position that keeps muscles or joints in certain positions, it’s tough to expect that the tissues will be ready and available to perform on cue when asked. But what about those people who are always active but still cannot touch their toes?
According to a quick Google search, depending on the source, approximately 38-53% of adults cannot touch their toes.
If you ask those people why they cannot touch their toes, you’ll often hear the rationales “my hamstrings are tight”, “I have short arms”, “ it’s genetic”, “it’s my age”, “that’s just the way I’m built”, the list goes on and on.
But seriously, what do all of these people have in common that prevents them from touching their toes? You’d be surprised to find that there is NO ONE FACTOR that exists that prevents all these people from touching their toes. But there may be a collection of reasons that can partially or fully contribute to not being able to touch your toes.
The key concept when it comes to movement capabilities comes from Dr. Andreo Spina and the team at Functional Range Systems. What are the joint prerequisites for a specific movement? And does the individual have these prerequisites?
So for someone to bend forward and touch their toes, what are the joint prerequisites? Well starting “at the top”, the individual will require to flex their spine, which we observe when their mid- and low-back start to round. Similarly, they’ll require adequate hip flexion. The knees should be kept straight in this model and there will be very little movement at the ankles as well. Of course this blog will assume that there are no issues with the upper limbs i.e. the shoulder flexion that is required.
So from a joint perspective, we can see that here that there are many sources of potential limitation(s). Someone may lack the ability to flex the lumbar spine. Is this due to surgical hardware in their back? Are they hyperlordotic? What is causing this? Do they lack the inability to flex their spine due to a medical condition (i.e. Anklyosing Spondylitis)? Or do they simply lack the ability to segmentally flex their lumbar spine, another key concept from Functional Range Systems.
Of course since we mentioned that the ability to flex at the hip is essential, is something preventing that from happening? Osseous blocking? Pinching in the anterior hip crease? Tight posterior hip elements? There can be many scenarios occurring in and around the spine and hips that can contribute to limitations.
Now we’ve just talked about the ‘joint prerequisites’ required but let’s not forget about the ‘tissue requirements’ as well. Since we fold forward when we touch our toes, it creates a pull or a stretch on the posterior elements involved. The tensile ability of these tissues is a huge contributor to achieving the desired toe-touch. People are familiar with the need for pliable hamstrings but there are many other tissues that are often neglected when it comes to this conversation. Aside from hamstrings, there needs to be a lengthening of the spinal erectors, psoas, glutes, and even the calves!
When there is muscle tension that prevents muscle lengthening it can create undesirable tension on surrounding nerves as well! This is actually the cause for the pulling sensation behind the knee that people experience when folding forward. It’s in your best interest to avoid this sensation and scenario!
Now if you can’t touch your toes perhaps this blog gives you some insight into where to start in your search for the key piece. If you have any pain, I encourage you to seek out a qualified health care practitioner who will work with you to achieve your goals!
By: Justin Parro, M.Sc. Kin, R.Kin
Whether you are an elite athlete training for sport and competition or a recreational exerciser because you know the benefits of a healthy active lifestyle, the vast majority of people in the training world are working through pre-existing injuries and/or restrictive conditions. There are no definitive statistics for this comment since the use of the term “restrictive conditions” can be as broad as to consider someone who cannot achieve full range of motion somewhere throughout their body. This doesn’t necessarily mean that pain is present but it is certainly a common result. Some things to consider:
These are just few questions that many of you reading this will be able to relate to and if you can, you likely fall in the category of pre-existing injury or restrictive conditions. If this is the case then you are in a state that requires repair to your previous healthy condition. This is not to say that you are not a healthy person, but in an ideal training environment the goal should be to perform full range of motion exercises without risking re-injury or even worse, compounding a current injury. This leads us to the very important question: How can we achieve a healthy training state with recovery and injury prevention as the priority?
The first step is to be self-aware and recognize what’s going on physically with your body. For some this is easy. For example you grew up playing hockey and the repetitive strain on your hips from skating has caused you to have tightness and reduced range of motion or perhaps even pain. Maybe this affects your low back, which in turn hinders your ability to pick things up without experiencing discomfort. This again is an example of someone who would find it easy to identify the problem. A less obvious example might come from someone who has worked a desk job for the last 10 years and overall you feel “fine”. In reality you cannot achieve full range of motion in the squat. Since you don’t experience pain you think that’s just normal for you. The truth is that for this particular example you should consider yourself to be in a state of rehab to restore your previous full range of motion, even if you haven’t seen this range of motion since you were a teenager.
To provide a point of reference, US statistics have shown upwards of 7 million sports and recreation related injuries on an annual basis (Conn et al., 2003). If we look at ergonomic and workplace related injuries, according to Statistics Canada there are easily more then half a million workplace injuries reported annually. This doesn’t include the issues that people experience from sitting at a desk all day and other repetitive strain injuries that are not recognized because employees are not taking time away from work due to these injuries.
If you are experiencing pain on a daily basis or during specific activities consult with a health care practitioner (chiropractor, physiotherapist, massage therapist, etc.). They will identify the problem and provide treatment to reduce and eliminate pain. Often they will provide rehabilitative exercises which can be done at home or outside of the clinic. From this point the onus falls on the individual to stay motivated and carry out these exercises. It is far too common for people to think that pain is the norm for you based your your history. Don’t let that be you!
Let’s say you are overall healthy with no history of injury. One of the best things you can do is find an exercise professional who can provide you with a full body movement assessment and identify any deficiencies. If done properly this will lead to an effective plan to rehab to your previous healthy state.
Let’s shift gears to being pain free. This could be post-treatment or this could be someone who never experienced pain but does have restrictions in range of motion. Where should you go from here? The most common thing we see in training is that people go from rehab straight to performance. In this case we’ll consider performance to be your regular training routine. This is when re-injury or restriction become far too common. Often, we see or better yet, we hear people training with restriction and saying something like “I can’t do that and I’ll never be able to again because ‘X’ body part is too tight or gets sore when I move that way”. It’s time to change your mindset! The correct answer is to address the hole in our approach to rehab and training. We need to bridge the gap!
What does it mean to bridge the gap?
If you find yourself in the category above, training is okay but be aware of the changes that need to be made to your programming in the interim. There is no set timeline on this and there’s a strong possibility that you might float in and out of this stage for various reasons. When building your training program, consider these three steps:
There are several critical factors to bridging the gap: keep movements pain free, work to increase functional range, build structural integrity through strength and stability, and create symmetry. This is where an exercise professional with knowledge of human anatomy, biomechanics, and physiology should guide you through this process.
Any movement that you choose to do in training should be pain free. You will find yourself testing the waters at times to know how far along you are from rehab to performance. In order to do this you are working near your threshold and your body is going to give you feedback, so you need to listen. It is not okay to train through pain.
Spend time using the various tools that exist to increase your range of motion and your functionality for training and every day life. Examples include mobility programming that promotes active range control, flexibility programming to help increase your passive range, and soft tissue release. The latter can come from manual therapy or it can be self-guided using tools like bands, lacrosse balls, and other equipment at your gym. Each element has its place. The time you spend on increasing range of motion will partially depend on your restrictions, however it is important not to consume all of your exercise time with this. An effective program addresses your needs in a reasonable amount of time and creates balance among programming elements. This is relevant for the recreational exerciser who likely doesn’t want to spend hours every day on these things and the elite athlete who needs to focus on sport specific training.
Your training should consist of exercises that address your weaknesses (i.e. push/pull, squat/deadlift, etc.), work core strength and build to extremities, and create balance from side to side. Here are some great ways to address the core strength and balance:
This list is not exhaustive and can serve as a starting point for strength and stability. What’s great about these exercises if programmed properly they can be used to increase strength on your compound lifts even if you’re not specifically training those lifts. So, focus on these movements and slowly implement the compound movements like squatting, deadlifting and pressing when your body is ready (no pain, proper range of motion, and unilateral joint stability). If correctly programmed and implemented with intent, the above information will serve as a framework for the bridge from rehab to performance. This is the basic formula to successful training with injury prevention at the forefront.
Dr. Steven Scappaticci, B.Sc. (Hons.), CSCS, DC, FRCms
If you’re unfamiliar with ‘Intermittent Fasting’, there’s no clear definition but simply put it’s a term for cycling your diet between periods of fasting and non-fasting. The key is that this is all occurring withoutmalnutrition. This may sound similar to how you normally eat; however you’ll see how it may differ from what you do on a daily basis.
As with many aspects of nutrition, there are many debates, myths, and controversies. Intermittent fasting is not immune to these! But for the purpose of this article, we’ll just focus on the basic overview of intermittent fasting.
With intermittent fasting there is a designated period where you can eat and the rest of the time in the day is reserved for fasting. Within a 24-hour period, you are in one phase or the other; you do not continuously go back-and-forth between the two. There are many forms of intermittent fasting.
A common form is fasting for 15-16 hours straight and then allowing yourself an 8-9 hour window to eat all the days’ meals. This is a nice amount of time to get you in a true fasted state however, short enough to avoid putting your body into the proposed “starvation mode”. If this sounds difficult, a common tip is using your sleeping hours (i.e. 8 hours) to contribute to this fasting window.
This may not be where a beginner would start though; perhaps a smaller fasting window is the place to start. For some, they will take it further by altering their “windows” to allow for greater time in the fasted state (e,g, Warrior Diet – 20 hour fast, 4 hour fed). Some fast every day, some do ‘alternate day modified fasts’ and some even do the occasional ‘whole day fast’, there are many variations. Remember, its fasting WITHOUT malnutrition!
You may be asking yourself, ‘why would anyone want to fast?’ Believe it or not there are a number of reasons. Decades ago fasting was used as a primary treatment option for obesity, however today you may find people fasting for religious reasons, non-obesity related fat loss, a hunger strike, and famine just to name a few .
When one stops eating the body will begin to digest the contents found within the digestive tract followed by the remaining glycogen stores in the liver . If you were to venture on that 16-hour fasting journey, the fasted state truly doesn’t begin until around hour 12! In the fasted state, insulin levels are low since the glucose in the body has been utilized as fuel already and the body then switches to utilizing fat as its fuel .
This is the major proponent of intermittent fasting; the body spends enough time fasting to truly get to a state where fat is utilized. Given the typical North American lifestyle, one could see how people have trouble getting to this phase.
The benefits of intermittent fasting have been noted, but at the same time are still considered to be in the preliminary research phase. There appear to be many cardiovascular benefits such as: increased HDL (the good cholesterol), decreased LDL & triacylglycerol, and improvements in blood pressure, just to name a few. Similarly, it can improve insulin concentrations & sensitivity, which is important for controlling diabetes risk .
It should be noted, many of the immediate benefits, specifically weight loss, have been seen in both intermittent fasting as well as the more traditional methods of calorie restriction . This is simply due to both of these methods having the ability to put an individual in a caloric deficit, allowing them to lose weight. But does intermittent fasting provide some benefit that regular caloric restriction doesn’t?
With regards to the long-term beneficial effects of fasting, it seems to be difficult to conclude due to the lack of long-term human studies. On the one hand, The National Institute on Aging released, just last fall, a report highlighting that mice who increased their time between meals were healthier and lived longer than mice who ate more frequently . But let’s not jump to conclusions as this happened in mice, not humans; but the results are still interesting nonetheless.
Given the hypotheses surrounding the mechanisms of intermittent fasting, one may think that the reduction in free radical production that comes with food restriction may result in less cellular oxidative damage. Oxidative stress comes on through many processes and eating is one of them. Some argue that the reduced oxidative damage may prevent telomere shortening and that’s the effect fasting has on aging. Does this have a link to longevity? Maybe but it may be too soon to conclude in humans .
One last interesting piece regarding intermittent fasting and ones longevity is the beneficial effects of autophagy. Autophagy is a process our body uses to breakdown and recycle damaged cells. It is a protective mechanism in many areas of the body with some studies claiming that abrogation of autophagy, specifically in neurons can lead to disease . Although we know the body will resort to “eating itself” in the fasted state, there is still research needed to strengthen the ties between autophagy and the protective effects against certain systemic diseases.
Intermittent fasting is not for everyone, as there are relative contraindications. If you have a poor diet, poor sleep habits, excessive stress, issues with fasting and your training times, or hormonal issues/other medical conditions (e.g. cancer), intermittent fasting may not be for you at the moment . Please contact a regulated health professional with regards to if intermittent fasting is right for you!
This article is solely meant to be “food for thought” and in no way attempts to skew you to one side or the other. If you’re familiar with intermittent fasting hopefully you’ll find this article to be a good overview. If this is a new concept, I encourage you to delve further if you’re interested. For any other questions or comments, feel free to contact me directly!
 Davis, C S; Clarke, R E; Coulter, S N; Rounsefell, K N; Walker, R E; Rauch, C E; Huggins, C E; Ryan, L (25 November 2015). "Intermittent energy restriction and weight loss: a systematic review". European Journal of Clinical Nutrition. 70(3): 292–299. doi:10.1038/ejcn.2015.195
 Johnstone, A. (2015). Fasting for weight loss: an effective strategy or latest dieting trend? International Journal of Obesity. 39, 727-733.
 Intermittent Fasting (Time-Restricted Eating)
 Rose, Chip. (06 September, 2018). Longer daily fasting times improve health and longevity in mice. National Institute on Aging – U.S. Department of Health & Human Services.
 Himbert, Caroline, Thompson, Henry, Ulrich, Cornelia M. (2018). Effects of Intentional Weight Loss on Markers of Oxidative Stress , DNA Repair and Telomere Length –a Systematic Review. The European Journal of Obesity. 10(6): 648-665.
 Alirezaei, Mehrdad, Kemball, Christopher C., Flynn, Claudia T., Wood, Malcolm R., Whitton, J. Lindsay, Kiosses, William B. (2010). Short-term fasting induces profound neuronal autophagy. Autophagy. 6(6): 702-710.
Dr. Steven Scappaticci, B.Sc. (Hons.), CSCS, DC, FRCms
I’m the last person who truly makes New Years resolutions. But I am one of the ones who no matter the time of year, will try and implement things into my life or change things for the better. Same, same but different.
Taking a look back to New Years resolutions, why do they always seem to fall to the wayside? People are usually enthusiastic about them at the end of December but often let them go in late January. So hopefully as you’re reading this, you’ll either be encouraged to continue with the work you’ve put in so far, or perhaps make a small but significant change for the better!
But why do resolutions fail? Much like a number of other questions in life, it depends on so many factors. Some we can control and some we cannot. I’ll highlight a few reasons as to why these attempted changes may not make it to spring!
To start, we can get so excited about our new goals that we make them UNREALISTIC. It’s one thing to say you want to get in better shape (a common but vague goal) but it’s another thing to say you want a six-pack by Valentines Day. I applaud the enthusiasm but we need to recognize that there’s “ideal” expectations and then there are “real” expectations. Often times we shoot for “ideal” and decide to call it quits before getting to the “real” expectations.
Next is TIME. Simply put, we either do not give ourselves enough time or just don’t want to put the time in to do the necessary work. In today’s society we want things and we want them fast! Three hours each week on meal prepping? No thanks; I’ve got things to do. A month until I start to notice a real change in my waistline? Thanks but I’ll take the cake instead.
The last reason I’ll mention is we OVERLOAD ourselves with these resolutions. It often starts with one change we want to make but then snowballs into adding a few others. This may work if we are dealing with resolutions that are related, for example “go to the gym 3x/week and pack healthy snacks with lunch”. Complementary goals, great! But what happens when we overload things? How about creating diet/exercise goals and wanting to read more each night, make more money, and travel more? Can we see how this second example may be a bit much?
If you’re going to make a change at all, I applaud that. I hope you’ll walk away from this article knowing to make realistic changes, give yourself time, and start small and go from there!
Dr. Steven Scappaticci, B.Sc. (Hons.), CSCS, DC, FRCms
Many times people from afar will see smoke billowing up from the trees in the distance. It doesn’t take a genius to know that there’s a strong probability that beneath that smoke, is a fire.
If someone were to only clear the smoke, they’ll eventually realize that the problem still remains and that the smoke will return. What does any of this have to do with musculoskeletal health? Well often times when it comes to muscle and joint aches/pains the metaphor of the smoke and fire applies.
Let’s take for example that a patient presents with right shoulder pain. The patient tells you that they have trouble lifting their arm and they keep pointing to the side of their shoulder (think middle deltoid) where they usually feel the pain (the smoke). After asking some questions to rule out any major conditions, you move onto the physical exam and find that there is no pain with actual palpation of the area where they feel the pain. You have just read a fantastic article about not looking for the smoke; rather you decide to look for the fire. This leads you to move away from where they feel the pain and check out a few muscles higher up and find that the source of their pain is coming from their supraspinatus – a muscle that often refers pain to the spot they’re complaining about.
Great! You think you’ve found the source but you check a few other things and find the true source. They have trouble moving their shoulder blade on the same side that they feel the pain. This is causing the shoulder to have less room to move and is the true source of their pain (the fire!). You then work with them to control for their pain and improve their movement capabilities.
Another classic example is someone presenting with pain on the inside of his or her knee. They say they haven’t injured it in any way but the pain has progressively come about more recently in the last few weeks. Your physical exam is pretty unremarkable with regards to their knee with the exception of some direct tenderness on the inside of their knee. No foot or ankle issues are found so you decide to check out the function of their hip. You find a key piece of the puzzle, as their gluteus medius is considerably weaker on the same side. They are surprised by this but you explain to them in your report of findings that the hip muscle in question has a large role in hip stabilization, particularly not allowing the lower limb to move too far inward (aka abduction). You then work with them to control for their pain and improve their movement capabilities.
There’s a fantastic quote by Ida Rolf, “Where you think it is, it ain’t!” Hopefully these examples have shown that where the pain is most evident is not actually the true source of the pain.
Do you have pain similar to these examples? Perhaps you’re looking for a second opinion! If I can help in any way, I’m just one click away!
Written By: Dan DeBruyne, Msc PT, BA Kin
Time - it is the one thing that we all have the same amount of. Everyone gets 24 hours, 1440 minutes, 86400 seconds per day. It is also one of the most common barriers that people cite when asked what stops them from exercising (Sallis and Hovell, 1990; Sallis et al., 1992). This is consistent across all demographics worldwide . We all want to be as efficient as possible with our time, especially when it comes to fitness. For many of us the idea of going to the gym for a couple hours sounds time-consuming, boring and downright impossible to fit into our schedule.
You are not alone in this line of thinking, in fact, people have been looking for ways to maximize the their workouts benefits while minimize their time for years. One of the techniques created for this purpose is high intensity interval training. High intensity interval training or HIIT is roughly defined as a short amount of near maximal effort exercise - followed by a moderate or low effort exercise recovery time - repeated for multiple bouts.
High intensity interval training is found in exercise regimens like Tabata, Crossfit, Fartlek, and the Peter Coe Method among others. Since its inception in the 1970’s this exercise method has morphed many times but at its core follows the same principles of high-speed/high effort, followed by low to moderate speed/effort to recover.
The science behind the method is that by working at your body’s maximal cardiovascular capacity you improve the metabolism of your muscles. This improves their efficiency at accepting oxygen from the bloodstream and clearing out various waste products that build up during exercise. These metabolic adaptations can then improve your ability to perform at lower thresholds (ie: a light jog). Think of it like working out any other muscle group in the body - if you’ve worked up to squatting 200 lbs - then moving 20lbs should be a piece of cake. Except instead of massive thighs you end up with a totally ripped cardiovascular system (not as easy to appreciate in the mirror, but impressive nonetheless). The difference between conventional weight training and HIIT is that the cardiovascular system adapts much quicker to stimulus then skeletal muscle. This means that positive changes from HIIT training can show up in as little as 2 weeks of regular high-intensity interval training while changes in muscle size won’t show up until 6 weeks of conventional weight training.
A 2015 meta-analysis (that is a study that combines multiple studies to create a summary of the research) found that persons aged 18-45 cardiovascular fitness and cycling endurance increased with both low intensity steady training and high-intensity interval training. The major difference between the two was that the VO2 Max scores were higher in the HIIT groups. Without getting too technical, your VO2 max is an indicator of how well your body can take in oxygen and remove waste products from your muscles during cardiovascular exercise (Ramos et al. 2015).
Numerous studies have documented adaptations similar to that of endurance training including increased resting glycogen content (how much energy is being stored in your muscles), reduced rate of glycogen utilization and lactate production (improved muscle efficiency), increased muscle lipid oxidation (fat burning), improved vascularization (bloodflow) to extremities, improved insulin sensitivity (important for prevention of type 2 diabetes), as well as subjects’ improved exercise performance. (Burgomaster et al. 2005, 2008; Gibala et al. 2006; Rakobowchuk et al. 2008).
Other research has also indicated that patient enjoyment and involvement is increased in comparison to moderate intensity or low intensity exercise (Bartlett et al. 2011). Which makes sense when we consider it takes less time, requires more focus and requires us to truly work hard.
So I know the question on the tip of your tongue… how little can I get away with?
Well, to improve cardiovascular fitness, insulin sensitivity, and exercise capacity most research had individuals performing 2-3 sessions a week with 4-6 sprints lasting 30 seconds at 90-100% of the persons maximal capacity, interspersed with 4 minutes of low-to-moderate (~60%) cycling. For a total of 14 minutes per session or 28 minutes per week. But this type of training doesn’t just have to be sprints or cycling - there are many ways to incorporate this into your training sessions and or core workouts - such as sled pulls/pushes, kettlebell swings, press-ups, jump squats, body weight squats, rowing ergometers, speed walking, skipping, assault bikes etc. Anything that gets you breathing hard and can be sustained for ~30 seconds at a maximal effort.
**Caveat - if you have any cardiovascular issues, blood pressure concerns, breathing issues, recent surgery or any other major health concerns - it is advised that you see a healthcare professional prior to starting a HIIT program. **
As always if you are unsure, injured or just want more information before beginning your own high-intensity training, get connected with your local professional and go from there.
Ramos, J. S., Dalleck, L. C., Tjonna, A. E., Beetham, K. S., & Coombes, J. S. (2015). The impact of high-intensity interval training versus moderate-intensity continuous training on vascular function: a systematic review and meta-analysis. Sports Medicine, 45(5), 679-692.
Bartlett JD, Close GL, MacLaren DP, Gregson W, Drust B & Morton JP (2011). High‐intensity interval running is perceived to be more enjoyable than moderate‐intensity continuous exercise: implications for exercise adherence. J Sports Sci 29, 547–553.
Burgomaster KA, Howarth KR, Phillips SM, Rakobowchuk M, Macdonald MJ, McGee SL & Gibala MJ (2008). Similar metabolic adaptations during exercise after low volume sprint interval and traditional endurance training in humans. J Physiol 586, 151–160.
Burgomaster KA, Hughes SC, Heigenhauser GJ, Bradwell SN & Gibala MJ (2005). Six sessions of sprint interval training increases muscle oxidative potential and cycle endurance capacity in humans. J Appl Physiol 98, 1985–1990.
Egan B, Carson BP, Garcia‐Roves PM, Chibalin AV, Sarsfield FM, Barron N, McCaffrey N, Moyna NM, Zierath JR & O’Gorman DJ (2010). Exercise intensity‐dependent regulation of PGC‐1α mRNA abundance is associated with differential activation of upstream signalling kinases in human skeletal muscle. J Physiol 588, 1779–1790.
Gibala MJ & McGee SL (2008). Metabolic adaptations to short‐term high‐intensity interval training: a little pain for a lot of gain? Exerc Sport Sci Rev 36, 58–63.
Gibala MJ, Little JP, van Essen M, Wilkin GP, Burgomaster KA, Safdar A, Raha S & Tarnopolsky MA (2006). Short‐term sprint interval versus traditional endurance training: similar initial adaptations in human skeletal muscle and exercise performance. J Physiol 575, 901–911.
Jelleyman, C. , Yates, T. , O'Donovan, G. , Gray, L. J., King, J. A., Khunti, K. and Davies, M. J. (2015), The effects of HIIT on metabolic health. Obes Rev, 16: 942-961. doi:10.1111/obr.12317
Content in the “Personal Barriers” section was taken from Promoting Physical Activity: A Guide for Community Action (USDHHS, 1999).