The Dangers of High Heels

Summer is here and with the warmer weather, out come shorts, t-shirts and of course open-toed shoes. It’s a great feeling to have our toes out after months of having feet wrapped up in thick socks and boots. However, if you are one of the millions of women who love wearing high heels, your favourite pair of shoes might be doing more harm than you realise.

Every woman who has spent time in high heels can relate to the pain of sore feet and that enormous relief of taking your shoes off at the end of a long day but after years of wearing them your  whole foot’s anatomy changes. Read on to find out why this is a problem and how you can prevent it.

Although millions of women around the world wear high heels daily, there has been very little research done on the impact of these shoes on biomechanics and injury risk.

Recently, Dr Neil J. Cronin and his colleagues at the Musculoskeletal Research Program at Griffith University in Queensland, Australia wanted to address what happens to the muscles and tendons of women who habitually wear high heels. The results of their study were published in the Journal of Applied Physiology.

In one of the first studies of its kind, the Australian scientists recruited nine young women who had worn high heels for at least 40 hours a week for a minimum of two years. The scientists also recruited 10 young women who rarely, if ever, wore heels to serve as controls. The women were in their late teens, 20s or early 30s. The scientists asked the heel-wearing women to bring their favourite pair of high-heeled shoes to the lab. There, both groups of women were equipped with electrodes to track leg-muscle activity, as well as motion-capture reflective markers. Ultrasound probes measured the length of muscle fibers in their legs. All of the women walked multiple times along a 26-foot-long walkway that contained a plate to gauge the forces generated as they walked. The control group covered the walkway 10 times while barefoot. The other women walked barefoot 10 times and in their chosen heels 10 times.

As expected, the women used to wearing high heels walked differently from those who usually wore flats, even when the heel wearers went barefoot. They found that the heel wearers moved with shorter, more forceful strides with their feet in a flexed, toes-pointed position. This movement pattern continued even when the women kicked off their heels and walked barefoot. As a result, the fibres in their calf muscles had shortened and they put much greater mechanical strain on their calf muscles than the non heel-wearing group did.

Dr Cronin explains that by stretching and straining their already shortened calf muscles, the heel wearers walk less efficiently with or without heels and require more energy to cover the same amount of ground as people in flats and probably causing muscle fatigue.

The constant muscle strain that occurs when walking in heels may ultimately increase the likelihood of strain injuries.  The risks extend to exercise workouts, when heel wearers abruptly switch to running shoes or other flat shoes. “In a person who wears heels most of her working week,” Dr. Cronin says, the foot and leg positioning in heels “becomes the new default position for the joints and the structures within. Any change to this default setting,” (like putting on flat shoes) constitutes “a novel environment, which could increase injury risk.”

It should be noted, he adds, that in his study, the volunteers “were quite young, average age 25, suggesting that it is not necessary to wear heels for a long time, meaning decades, before adaptations start to occur.”

So what do you do if you love wearing high heels but are concerned about the risk of injury? Many women feel their most beautiful in a gorgeous pair of heels and, as long as you don’t have a pre-existing back or foot injury, it doesn’t mean you need to get rid of all your high heeled shoes.

However, it is important to try and limit the amount of time spent in them. If possible, try alternating high heels with flat shoes and try to remove them whenever possible, e.g. when you are sitting at your desk. When you get home or on weekends, switch to flat shoes. Although you may not feel as pretty in flats, your feet will thank you for it!

What is that tape athletes were wearing at the Olympics?

A few weeks ago, millions of people around the world were glued to their TV screens watching the 2012 Olympic Games. It is incredible to watch the planet’s top athletes doing what they do best.

During and after the games, there were many questions asked. One of the most popular questions was “What is that tape the athletes are wearing?”  In fact, a popular website listed it as number 1 on their list of “Top 5 Odd Olympic questions”.

So what is this brightly coloured tape which was so popular among this year’s Olympians? Is it a fashion statement, a passing trend or is it really beneficial?

This tape is called Kinesiotape and can be used to treat various conditions, not only sports injuries. It can be safely used on children, adults, pregnant women and animals.

What is surprising to many people is that Kinesiotape is not new at all. It was invented by a Japanese chiropractor, Dr Kenzo Kase, in the 1970s and became really popular after rolls of tape were donated to various countries at the 2008 Olympic Games in Beijing.  Fans of Kinesiotape include Serena Williams, Novak Djokavic, Mario Balotelli and Lance Armstrong. In his book, “Every Second Counts”, Armstrong writes  “something that was better than any laser, wrap, or electric massager. He had The Tape. It was a special hot-pink athletic tape that came from Japan and seemed to have special powers.”

In 2009, I qualified as a certified Kinesiotaping practitioner with the KTAI (Kinesiotaping Association International) and use this tape on a regular basis with many different patients. it has been used to successfully treat many conditions including whiplash, lower back pain, plantar fasciitis, tendinopathies and TMJ Dysfunction. Its varied uses have made it an incredibly beneficial treatment tool for physiotherapists worldwide. 

Kinesiotape is 100% cotton, waterproof and can be worn for 3-5 days making it possible for athletes to use while competing in various sports.

It is designed to facilitate the body’s natural healing process while providing support and stability to muscles and joints without restricting the patient’s ability to move.

The key to the tape’s success lies in its ability to microscopically lift the skin. This creates ridges in the skin which allow for better flow of blood and lymphatic fluid, resulting in decreased swelling and bruising. It also has the ability to re-educate the neuromuscular system,  reduce pain and inflammation, enhance performance, prevent injury and promote good circulation and healing.

Due to its popularity and success, many companies have tried to copy Kinesiotape and assorted rolls of coloured “sports tape” can be bought at shops everywhere. Understanding how and where to use the tape requires a detailed knowledge of anatomy and biomechanics. To achieve the desired results, Kinesiotape should only be used under supervision of a certified Kinesiotape practitioner. It’s important to be aware that effective and successful results are dependent on applying the correct taping applications for a specific condition.

If you have any questions or think that Kinesiotape may be able to help your condition, please contact me.

Is your iPad a pain in the neck?

More and more people around the world are using tablet computers like the Apple iPad. It is estimated that by 2015, there may be as many as 80 million tablet users in the United States alone.

The simplicity of these hand-held devices can make life easier but for some they may literally be a pain in the neck.

Recently, researchers at the Harvard School of Public Health  (HSPH) begun quantifying the ways in which a person’s posture, and also the design of the tablet and its case, affect comfort—evidence that will help companies develop new ergonomic guidelines as tablets become more common in the workplace. “The beauty of tablets and other mobile devices is their flexibility,” said lead author Jack Dennerlein, director of the Occupational Biomechanics and Ergonomics Laboratory at HSPH. “You can use them almost anywhere and in different ways. You can hold them in your lap; you can hold them in your hand. The problem is that some of the postures people are in when using a tablet can be awkward and lead to discomfort with prolonged use.”

In this study, Dennerlein and his colleagues studied 15 experienced tablet users in 4 different postures. While users browsed the Internet, responded to email, played games, and watched a movie, their head and neck posture and gaze angle were measured using an infrared three-dimensional motion analysis system.

The researchers found that placing a tablet on the lap created the greatest strain because it forces the user to look down at a steep angle, causing head and neck flexion. Working for long periods of time with the head slumped forward and the neck flexed can result in neck pain.  Users held their heads in the most neutral positions when sitting in the Table-Movie configuration (tablet placed on table in case at its higher angle setting—73 degrees for the iPad). 

Tablets are changing the way we work and their popularity is continually increasing so how do you ensure that your tablet doesn’t cause you pain?

-       Vary your posture every 15 minutes

-       Use a case that doubles as a stand – these reduce the need to grip the device and allow it be propped up at an angle which minimizes neck strain

-       Switch between using your tablet and your desktop computer. If you are going to be doing a lot of typing, rather use your desktop computer

-       Take regular breaks from looking at your screen and stretch your neck everyday

Are we born to run?

With all the hype and excitement around Comrades, I wanted to share an article I recently read which was published in the New York Times. In this article, Tara Parker-Pope discusses a question which I am often asked in my practice. Is running bad for us? Are  humans designed to run long-distances?   

The Human Body Is Built for Distance

By TARA PARKER-POPE

“ Does running a marathon push the body further than it is meant to go?

The conventional wisdom is that distance running leads to debilitating wear and tear, especially on the joints. But that hasn’t stopped runners from flocking to starting lines in record numbers.

But now a best-selling book has reframed the debate about the wisdom of distance running. In “Born to Run” (Knopf), Christopher McDougall, an avid runner who had been vexed by injuries, explores the world of the Tarahumara Indians of Mexico, a tribe known for running extraordinary distances in nothing but thin-soled sandals.

Mr. McDougall makes the case that running isn’t inherently risky. Instead, he argues that the commercialization of urban marathons encourages overzealous training, while the promotion of high-tech shoes has led to poor running form and a rash of injuries.

“The sense of distance running being crazy is something new to late-20th-century America,” Mr. McDougall told me. “It’s only recently that running has become associated with pain and injury.”

The scientific evidence supports the notion that humans evolved to be runners. In a 2007 paper in the journal Sports Medicine, Daniel E. Lieberman, a Harvard evolutionary biologist, and Dennis M. Bramble, a biologist at the University of Utah, wrote that several characteristics unique to humans suggested endurance running played an important role in our evolution.

Most mammals can sprint faster than humans — having four legs gives them the advantage. But when it comes to long distances, humans can outrun almost any animal. Because we cool by sweating rather than panting, we can stay cool at speeds and distances that would overheat other animals. On a hot day, the two scientists wrote, a human could even outrun a horse in a 26.2-mile marathon.

Other research suggests that before the development of slingshots or bows, early hunters engaged in persistence hunting, chasing an animal for hours until it overheated, making it easy to kill at close range. A 2006 report in the journal Current Anthropology documents persistence hunting among modern hunter-gatherers, including the Bushmen in Africa.

“Ancient humans exploited the fact that humans are good runners in the heat,” Dr. Bramble said. “We have such a great cooling system” — many sweat glands, little body hair.

Spring-like ligaments and tendons in the feet and legs are crucial for running. (Our close relatives the chimpanzee and the ape don’t have them.) A narrow waist and a midsection that can turn allow us to swing our arms and prevent us from zigzagging on the trail. Humans also have a far more developed sense of balance, an advantage that keeps the head stable as we run. And most humans can store about 20 miles’ worth of glycogen in their muscles.

And the gluteus maximus, the largest muscle in the human body, is primarily engaged only during running. “Your butt is a running muscle; you barely use it when you walk,” Dr. Lieberman said. “There are so many features in our bodies from our heads to our toes that make us good at running.”

So if we’re born to run, why are runners so often injured? A combination of factors is likely to play a role, experts say. Exercise early in life can affect the development of tendons and muscles, but many people don’t start running until adulthood, so their bodies may not be as well developed for distance. Running on only artificial surfaces and in high-tech shoes can change the biomechanics of running, increasing the risks of injury.

What’s the solution? Slower, easier training over a long period would most likely help; so would brief walk breaks, which mimic the behavior of the persistence hunter. And running on a variety of surfaces and in simpler shoes with less cushioning can restore natural running form.

Mr. McDougall says that while researching his book, he corrected his form and stopped using thickly cushioned shoes. He has run without injury for three years.”

Back Care Tips for Moms and Dads

I was recently invited to speak to a group of moms on how to protect their backs during daily activities with their children.

New mothers face many challenges adjusting to this new stage of their lives. One problem that is commonly experienced, but often ignored, by new mothers is back pain. It is estimated that 80% of new mothers will experience back pain at some point during the first year of their baby’s life. This is due to many factors, including changes that occurred during pregnancy, hormonal changes, weight changes and most importantly carrying your new baby.

As the baby grows and increases in weight, the stress placed on a mother’s back and neck will increase and may contribute to further back pain.

Below are some tips and advice to prevent back pain during everyday activities with your children.

·   Feeding -  Sit comfortably with feet flat on floor and adequate back support. Ensure that you are comfortable and not leaning forward while you are feeding.

When breast-feeding, support the baby with pillows under your arm. Bring baby to you, not the other way around

Always remove the high chair tray before putting baby in/taking baby out. This seems insignificant but will prevent the stress placed on your back caused by holding the child away from your body.

·   Changing

Changing table should be at chest height. Have everything close to you at arm’s reach so that you don’t need to twist your body.

·      Carrying

Hold baby close to your body and try to swop sides so that you are not always carrying your baby on the same arm.

When lifting the child (or toys) off the floor, bend your knees and not your hips. Always keep your back straight.        

·       General

Stretch daily and try to do some form of exercise every day, even just a short walk.

Try to maintain a healthy weight

Use heat to ease back pain

Listen to your body and don’t ignore pain

If you would like any more information or advice on your specific pain, please contact me.

Hot or Cold?

One of the most common questions physiotherapists get asked is whether to apply heat or cold to treat an injury.

If used correctly after an injury or following a rehabilitation program, heat or cold can help to reduce pain, assist with tissue healing, control swelling, and increase flexibility.
If used incorrectly, though, it can worsen an injury and cause even more damage. It is therefore always advisable to consult your physiotherapist before you start treatment.

In this month’s newsletter, we will look at some basic guidelines of when to use heat or cold.

Cold therapy

Cold is typically applied within the first 24-48 hours of the acute stage of an injury, to prevent tissue damage or after the first 48 hours if inflammation persists. It may also be used after an exercise program to prevent or reduce pain and swelling or to ease muscle spasms. 
How to use cold therapy

Cold therapy can be used throughout the day for approximately 10 to 15 minutes at a time. It is important to use a damp towel between the ice pack and the skin to increase effectiveness and decrease the risk of nerve or skin damage, which could lead to frostbite. Visually check the area of the body being treated with ice packs or other cooling agents every 5 minutes – while there may be discomfort and redness initially, treatment should be discontinued if these symptoms persist. While cold therapy is a good treatment option for many, it is not recommended for people with some medical conditions. Always check with your physiotherapist first.

Hot therapy

Heat sources such as hot packs dilate blood vessels and increase blood flow, delivering needed nutrients and oxygen to cells in the area being heated, aiding the removal of cell waste and promoting healing.
Therapeutic heat is often used in the chronic phase of an injury. It may also be used prior to physiotherapy or exercise to decrease muscle tension and increase flexibility and range of motion. It also plays a role in pain management and reduction of muscle spasms, muscle tension and joint stiffness.

Heat therapy should be avoided in the acute phase of an injury when swelling is present and the skin is hot to touch.
Hot packs should be applied for 15 to 20 minutes. Visually check the skin every 5 minutes and discontinue treatment if there are abnormal changes in skin colour or you experience increased discomfort.
Do not lie on a hot pack or apply heat when going to sleep since it increases the likelihood of burns resulting from close or prolonged contact with the heat source.
While heat therapy is a good treatment option for many it is not recommended for people with some medical conditions. Always check with your physiotherapist first.
Acute and chronic injuries

Cold therapy with ice is the best immediate treatment for acute injuries, while heat is generally used for chronic injuries or injuries that have no inflammation or swelling. What is the difference between acute and chronic injuries? 

Acute injuries are injuries that happen suddenly and can cause severe pain. The injury often results from impact or trauma, such as a fall, sprain, or collision. The cause of chronic injuries is less obvious and can be subtle and slow to develop. Acute injuries may cause dull pain or soreness and are often the result of overuse. 

Cold therapy with ice is the best immediate treatment for acute injuries because it reduces swelling and pain. Cold therapy is also helpful in treating some overuse injuries or chronic pain in athletes. 

Heat is generally used for chronic injuries or injuries that have no inflammation or swelling. Sore, stiff, nagging muscle or joint pain is ideal for the use of heat therapy. Athletes with chronic pain or injuries may use heat therapy before exercise to increase the elasticity of joint connective tissues and to stimulate blood flow. Heat can also help relax tight muscles or muscle spasms. Don't apply heat after exercise. After a workout, ice is the better choice on a chronic injury. 

I hope this information has helped clarify this issue. If you have any doubts or questions about the best way to deal with an injury, please feel free to contact me.

New Year, New You

Every New Year people all over the world make New Year’s Resolutions and by the end of January, many of these have already been broken. According to the Wall Street Journal, the most popular resolutions are to lose weight, be healthier and exercise more. If your resolution was to exercise more and you are struggling to stick to it, read on for some interesting news about how exercise affects our fat cells.

Earlier this month, researchers from the Dana-Farber Cancer Institute and Harvard Medical School examined the effect of exercise on a cellular level. The researchers discovered a new hormone produced in response to exercise which turns white fat into brown fat, also known as the “good fat”. Brown fat cells burn calories by using energy, while white fat cells are inactive storage areas for fat.

This hormone is called PGC1-alpha and is produced in muscles during and after exercise and decreases a person’s susceptibility to obesity, diabetes and other related health problems.

This is just one of the numerous benefits to exercising, however there are some important things to consider before starting a new exercise program.

The key to a successful and injury-free exercise program is to match your current fitness level and gradually increase the program length and difficulty.

By following the fitness tips below you can greatly reduce your risk for injury.

• Consult with a health care professional such as your physiotherapist before embarking on an exercise program.
• Start slowly if you've been sedentary or if you are trying something new.
• Be realistic when setting your goals.
• Choose an exercise activity that you enjoy. The one you like doing is the one you'll stick with.
• Exercise does not have to be done at the gym. It can be a "lifestyle" activity such as a brisk walk or hike, gardening, or using the stairs.
• If you are overweight, consider beginning with low-impact activities such as swimming, cycling, or walking. These activities put less strain on joints.
• If you are in an exercise program and not losing weight, don’t get discouraged. There are other health-related benefits associated with physical activity even when weight loss does not occur.

Wishing you a happy and healthy 2012!

The Benefits of Chocolate Milk

After a workout there is a critical window, usually between 45 minutes to an hour, for refueling muscles.  During this time, it is important to replenish spent glycogen stores and maintain blood sugar levels.

 New research suggests that chocolate milk provides the optimal level of carbohydrates to protein ratio to refuel tired muscles and replace fluids lost as sweat during the workout. 

"Serious and amateur athletes alike enjoyed physical recovery benefits when they drank low-fat chocolate milk after a vigorous workout," said Dr. John Ivy, lead researcher on the studies and chair of The University of Texas at Austin College of Education’s Department of Kinesiology and Health Education.

Dr Ivy and his team compared the recovery benefits of drinking low-fat chocolate milk after exercise to the effects of a carbohydrate beverage with the same ingredients and calories as typical sports drinks as well as to a calorie-free beverage. They asked 10 trained cyclists to ride a bike for 90 minutes at moderate intensity, then for 10 minutes of high intensity intervals.

The scientists found the athletes had significantly more power and rode faster (reduced their ride time by an average of six minutes) when they consumed low-fat chocolate milk rather than a carbohydrate sports drink or calorie-free beverage.

Compared to the other recovery drinks, chocolate milk drinkers had twice the improvement in maximal oxygen uptake after four and a half weeks of cycling, which included intense exercise five days a week, with each exercise session followed by one of the three recovery beverages. Maximal oxygen uptake is one indicator of an athlete's aerobic endurance and ability to perform sustained exercise. The study included 32 healthy, amateur male and female cyclists.

Dr Ivy's research also revealed that low-fat chocolate milk drinkers built more muscle and lost more fat during training, compared to study participants who consumed a carbohydrate drink. This study also included 32 healthy, amateur male and female cyclists who rode for one hour, five days a week, and drank one of the three recovery beverages immediately following and one hour after the bout of exercise.

"We don’t yet understand exactly what mechanism is causing low-fat chocolate milk to give athletes these advantages — that will take more research," said Ivy, "but there's something in the naturally-occurring protein and carbohydrate mix that offers significant benefits."

Ivy notes that a 30-minute recovery window after exercise, for people of all fitness levels, is as important as the nutrition supplement that's consumed.

So after your next workout, try some chocolate milk! It tastes better and may have some surprising results.

Is sitting lethal?

For most of us, the average day consists of 8-10 hours of sitting at a desk followed by extended periods  in traffic and then ends off with a few more hours sitting in front of the TV. Its no secret that sitting for long periods can lead to back pain, stiff and painful joints and weight gain. Is sitting really that bad for us?



Have you ever wondered why some people who consume the same amount of food as others gain more weight?

James Levin, an inactivity researcher at the Mayo Clinic in Minnesota was puzzled by this same question. In 2005 he conducted a study which aimed to answer this. Participants in the study consumed the identical amount of calories and were not allowed to exercise at all. Some of the subjects packed on the kilos but other subjects gained little or no weight at all.

In addition to monitoring their diet and weight, subjects were also given motion-tracking underwear to wear. The subjects who gained the least weight were, not surprisingly, the subjects who moved the most. You may be wondering how they did so because they were banned from exercise. They simply performed more movements during the day e.g. walking around the office, taking the stairs, performing housework or gardening. On average, participants who gained more weight sat for two hours more per day than those who didn’t put on weight.

The conventional wisdom is that if you watch your diet and exercise at least a few times a week, you’ll effectively offset your sedentary time i.e. the time spent being inactive.  

However, Marc Hamilton, an inactivity researcher at the Pennington Biomedical Research Center says that “Exercise is not a perfect antidote to sitting.” He believes that this idea is as illogical as believing that a person can counter smoking a pack of cigarettes everyday by jogging. 

When we are inactive, the electrical activity of our muscles drops, our calorie-burn rate drops, insulin effectiveness decreases and the enzymes responsible for breaking down fat decrease. These negative effects can be seen after only 24 hours of inactivity.

In a study by the American Cancer Society, men who spent six hours or more per day of their leisure time sitting had an overall death rate that was nearly 20 percent higher than those who sat for three hours or less (during their leisure time). The death rate for women who sat for more than six hours a day was about 40 percent higher. 

The good news is that it is relatively easy to overcome the effects of inactivity. The answer lies in a simple concept with a complicated name: Non-Exercise Activity Thermogenesis (NEAT). It refers to the energy expended for everything we do that is not sleeping, eating or sports-like exercise. NEAT is a method of reaping major benefits from thousands of minor movements performed throughout the day. 

In Dr Levine’s study using the motion-detecting underwear, obese subjects averaged only 1500 movements per day and 600 minutes of sitting. In comparison, farm workers averaged 5000 daily movements and only 300 minutes of sitting.

Even trivial physical activities increase a person’s metabolic rate substantially and it is the cumulative impact of many small activites that contribute to a person’s daily NEAT.

Tips to increase your daily NEAT:
* Use the stairs instead of the lift
* Don’t go for the closest parking, rather choose one further away and walk more
* Instead of sending an email to a colleague who works near to you, get up and walk
* Do your own housework
* Go for a short walk during your lunch break

Get moving to stay healthy!

The Power of Posture

Physiotherapists often stress the importance of improving one’s posture. Maintaining good posture is important to prevent neck and back pain, improve respiratory and digestive function and prevent injuries. New research suggests that your posture may affect the way you see yourself and also the way others see you.

In the animal kingdom, size matters.Big is dominant and postures that make the animal appear larger cause others to treat that animal as if he were more powerful. This is true for many species, including humans.

Two researchers at Northwestern University in Illinois, Li Huang and Adam Galinsky have conducted three 

separate experiments to test this theory. Their results, published in Psychological Science, reveal that posture has a strong effect in making a person think and act in a more powerful way.

In one of these experiments, participants were randomly appointed as managers or sub-ordinates while adopting expansive (i.e. open) or constricted (i.e. closed) body postures. They were instructed to sit in this position for an extended period of time. 

Participants were then asked to perform a word-completion task. They were instructed to complete a number of fragments, e.g. “l_ad”, with the first word that came to mind. Seven of the fragments could be interpreted as words related to power (“power”, “direct”, “lead”, “authority”, “control”, “command” and “rich”). For each of these that was filled out as a power word (“lead”, say, instead of “load”) the participant was secretly given a score of one point.

Although previous studies suggested a mere title is enough to produce a detectable increase in an individual’s sense of power, Dr Huang and Dr Galinsky found no difference in the word-completion scores of those told they would be managers and those told they would be subordinates.

The posture experiment, however, did make a difference. Those who had sat in an expansive pose, regardless of whether they thought of themselves as managers or subordinates, scored an average of 3.44. Those who sat in constricted postures scored an average of 2.78.

Proof that by simply changing your posture you can improve your self-esteem and feel more powerful.