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!