Dr. Kyle: Diet Do’s and Don’ts for 2019

 

Looking to start a new diet in 2019? Here are a few tips on what to avoid and what to incorporate into your nutritional regime this year.

FATS ARE GOOD

The human body is designed to process and burn fats as one of its primary energy sources. Fat enhances food digestion and nutrient absorption. Accompany sides of vegetables with a fat source to increase nutrient bioavailability.

Try cooking with animal fats, organic grass-fed butter and coconut oil. Avoid trans fats and poly-unsaturated vegetable oils like canola oil.

Add some wild-caught salmon into your diet to balance out the ratio of omega-3’s to omega-6’s. The typical western diet has an abundance of omega-6’s so eating salmon 1-2 per week will boost your levels of anti-inflammatory omega-3’s.

DON’T SHY AWAY FROM CHOLESTEROL

Cholesterol is vital for the synthesis of hormones and vitamin D. It also helps form cell membranes and other structural components.

Eat whole foods and at least 1 yolk with your egg whites. This will give you a better nutrient profile and a healthy dose of cholesterol.

RED MEATS

Red meats have almost everything you need to not only survive but thrive. They are one of the most micronutrient dense fuel sources on the planet. Red meats are high in b-vitamins, iron, zinc, magnesium, and creatine.

Red meat also includes Lamb! It is an excellent source of heme-iron as well.

GET YOUR PROTEIN

It is most commonly recommended that daily intake should be 1g of protein per pound. Older athletes will need more due to less efficient protein absorption.

Keep in mind that dietary needs will fluctuate based on physical demands and training goals. Athletes trying to put on mass should eat 40g before bed to maintain protein synthesis throughout the night.

20g per meal will provide 90% of muscle protein synthesis. 40g will provide 100%.

Carbohydrates

Some carbs are better then other! So, we want to pick the right ones.

Avoid refined sugars (obviously). Include variation and eat 2 forms of carbs at a time for faster absorption. I recommend sweet potatoes, spinach, red peppers and carrots. These foods have plenty of micronutrients and produce low levels of gas.

Add a side of white rice to your meat and vegetable dish. White rice is easy to digest, and can help supplement your macronutrient intake. Oats on the other hand can be hard to digest – soak them in warm water overnight or add yogurt.

Remember, carbohydrates are used to fuel workouts! Getting adequate carbs to sustain your athletic performance will protect against muscle tissue breakdown.

As always, ask a healthcare professional for dietary recommendations that best suit you. Some foods that work well for others may not sit well for you. Listen to your body.

Stay healthy and good luck achieving all your health and wellness goals for 2019!

Dr. Kyle: Debunking the Salt Myth

Do you pay attention to how much sodium you take in?

Maybe you should!

It turns out that sodium may not be as bad as we previously thought. In fact, sodium is essential for many metabolic processes. Sodium is responsible for regulating blood pressure, maintaining blood volume and is required for neuron function and signal transduction.

Many believe that high (or adequate) salt intake will lead to high blood pressure. Most cases of hypertension are actually a result of genetics or stress. A small percentage of the people who are sodium sensitive may experience an increase in blood pressure, but an overwhelming benefit for the rest of the population cannot be ignored.

Sodium has several benefits including:

• Increased performance
• Increased stamina / endurance
• Increased blood volume
• Increased recovery

During high intensity exercise, the body actually responds better to a higher blood volume. This improves delivery of oxygen and nutrients to the working cells of the body. High blood volumes are also optimal for kidney filtration and removal of toxins and metabolic waste products.

Low dietary sodium and elimination diets can have detrimental effects for high performance athletes. Low salt intake will decrease overall blood volume, making the blood thicker. This can cause muscle weakness, cramps and lethargy.

What Type of Salt?

I recommend iodized salt. Iodine helps with thyroid function and regulates metabolism. Unbleached, pure Himalayan salt is also a good option.

So if you are hitting a wall during your workout it may be due to sodium depletion. Bottom line, make sure you are drinking plenty of water, eating sufficient carbs for your training needs, getting a balance of micronutrients from a variety of whole foods, and don’t be afraid to sprinkle a little salt on your meals every once in a while!

Dr. Kyle: Sport Injury Rehabilitation

 

There are many factors to consider before clearing an athlete to return to sport. Time since injury, improvements in range of motion and increases in joint stability are all good metrics to evaluate before giving an athlete the green light.

Many rehabilitation programs focus primarily on enhancing maximal muscle strength. Current research suggests that Rate of Force Development (RFD) may actually be a better predictive factor in determining whether an athlete is ready for sport.

Common athletic maneuvers such as pivoting, jumping and stop-and-starts require rapid stabilization of the joints in the lower limb. This requires almost instantaneous muscle activation to prevent joint displacement and avoid re-injury. Factors such as neural activation, fiber composition and muscle contractile properties influence RFD and the body’s ability to absorb load on the joint. Therefore, it may not matter how strong the muscle is, but rather how fast the muscle can fire.

So how might this change rehabilitation programs?

Most physical rehabilitation protocols help build strength but fail to include an explosive component. Because athletic demands are often variable and unpredictable, it is important for the muscles to be able to react to any situation. Incorporating explosive plyometric exercises and a variation of sport specific drills will improve RFD and prevent future injury.

Take home points for sport-injury rehab:

• Allow sufficient time to for healing process to occur
• Recover full range of motion and flexibility
• Progressively overload the muscle to build strength
• Explosive training to enhance ability of muscle to generate force rapidly.
• Incorporate plyometric and sport specific drills to complement athletic demands.

As always, the best way to stay in the game is to avoid injury in the first place. So don’t wait for the pain to start before implementing an effective strength AND conditioning program.

If you or someone you know is suffering from a sport injury, call and book an appointment today for a complete musculoskeletal assessment!

 

Reference:
Buckthorpe, M., & Roi, G. S. (2018). The time has come to incorporate a greater focus on rate of force development training in the sports injury rehabilitation process. Muscles, ligaments and tendons journal, 7(3), 435-441. doi:10.11138/mltj/2017.7.3.435

Dr. Kyle: Can Changes in Weather Predict Pain?

 

 

I always thought my grandma was crazy when she’d say I can “feel” a storm coming as she’d rub her knees. To my surprise, her knees were often better at predicting the weather than our local news. How come?

It’s believed that changes in barometric pressure can lead to increases in musculoskeletal pain. In particular, for individuals suffering from osteoarthritis. But what’s surprising is most of the research is either inconclusive or there’s little evidence to support these claims.

After hearing a number of my patients describe similar changes in pain levels due to the changes in weather, I thought I’d take a further look at these claims.

In one survey by Von Mackensen et al., one to two thirds of patients with rheumatoid arthritis believed their symptoms were weather-sensitive (1).

Other studies found an increase in barometric pressure or a drop in ambient temperature are both associated with an increase in pain (2).

At first glance it appears there may in fact be some credible evidence to support this strange phenomenon, but why?

Joint Pain in Scuba Divers

Have you ever swam to the very bottom of a pool in the deep end and felt your ears pop? This sudden change in pressure is similar to what scuba divers experience but on a smaller scale.

Sudden changes in tissue gas tension surrounding the joints can cause fluid shifts and interference of joint lubrication. When divers go deep, their joints may hurt as there’s not as much fluid surrounding their joints. This becomes worse if severe osteoarthritis exists (3).

Why Your Joints Hurt More on Colder Days

Colder temperature and its association with increased pain is much easier to explain. We know that cold temperature reduces inflammatory markers, changes the viscosity of the fluid in our joints, and can decrease the strength and support of our muscles around joints (4). Patients tend to experience more severe joint pain during the cold winter months.

Show Me Your Search History and I’ll Diagnose Your Pain

I still recommend an in-person consultation but we’re close to this becoming a reality. A recent study found an association with local weather and rates of online searches for musculoskeletal pain symptoms.

Searches for arthritic related symptoms are significantly more common in climates closer to -5 degrees Celsius than 30 degrees Celsius. Although this doesn’t explain WHY osteoarthritic patients suffer more pain, it gives us a better idea of WHEN they experience worse symptoms and under WHAT conditions (5).

Well there you have it folks. There are still many uncertainties and unknowns on why joint pain increases when the temperature drops or pressure rises. But if you can sense the next snow storm or torrential downpour from your knees and not the news, you may be experiencing some underlying osteoarthritis.

1. Von Mackensen S, Hoeppe P, Maarouf A, Tourigny P, Nowak D.
Prevalence of weather sensitivity in Germany and Canada. Int J
Biometeorol. 2005;49(3):156-166.

2. McAlindon T, Formica M, LaValley M, Lehmer M, Kabbara K.
Effectiveness of glucosamine for symptoms of knee osteoarthritis:
results from an internet-based randomized double-blind controlled
trial. Am J Med. 2004;117(9):643-649.

3. Compression pains. In: US Navy Diving Manual. Revision 4 ed. Naval
Sea Systems Command; U.S. Government Printing. 1999:3-45.

4. Golde B. New clues into the etiology of osteoporosis: the effects of
prostaglandins (E2 and F2 alpha) on bone. Med Hypotheses. 1992;
38(2):125-131.

5. McAlindon T, Formica M, Schmid CH, Fletcher J. Changes in barometric pressure and ambient temperature influence osteoarthritis pain. The American journal of medicine. 2007 May 1;120(5):429-34.

Tips for Snow Shovelling

 

Don’t Let the Snow Get You Down

Winter weather can pack a punch and, with the season’s heavy snowfalls, injuries often result. Improper snow shovelling is often to blame.

But shovelling out after a storm doesn’t have to leave you stiff and sore. With a little know-how, you can clear your driveway without the all-too-common back, neck and shoulder pain cramping your style. Here’s how:

Before You Start:

  • Drink plenty of water. Dehydration is just as big an issue in the winter months as it is in the summer.
  • Dress in several layers so you can remove a layer as you get warm.
  • Wear proper footwear. Shoes and boots with solid treads on the soles can help to minimize the risk of slips and falls.
  • Pick the right shovel. Use a lightweight, non-stick, push-style shovel. A smaller blade will require you to lift less snow, putting less strain on your body. An ergonomically correct model (curved handle) will help prevent injury and fatigue. Also, if you spray the blade with a silicone-based lubricant, the snow will slide off more easily.
  • Before beginning any snow removal, warm up for five to 10 minutes to get your joints moving and increase blood circulation. A brisk walk will do it.

All Set to Go

PUSH, DON’T THROW.

Push the snow to one side and avoid throwing it. If you must throw it, avoid twisting and turning — position yourself to throw straight at the snow pile.

BEND YOUR KNEES.

Use your knees, leg and arm muscles to do the pushing and lifting while keeping your back straight.

WATCH FOR ICE.

Be careful on icy walkways and slippery surfaces. Intermittent thaws and subsequent freezing can lead to ice building up underfoot, resulting in nasty slips and falls. Throw down some salt or sand to ensure you have a good footing.
Once you’ve mastered safe snow shovelling techniques, you’ll be free to have fun and stay fit all winter.

 

Call and book an initial assessment with Dr. Kyle Aram today!

 

The Back Squat: Tips from Dr. Kyle

Advanced Squatting Technique

 

 

The back squat is one of the most popular and important exercises in the development of lower body strength. Maximal back squat performance shows strong correlations with improved athletic ability.

Although this is one of the most common exercises in strength and conditioning programs there is still variation in coaching styles for the classic back squat. Over the last decade there has been an ongoing debate over what techniques produce the best back squat.

So what does the evidence show?

First I must point out that techniques that work for some people may not work for everyone. Each individual has slight variations in the structure of their hips. Some people are born with more shallow hip joints while others present with a much deeper ball and socket structure.

Contrary to popular belief, the back squat does not produce excessive strain on the ACL. As squat depth and knee flexion increases, the force through the ACL increases as well. However, there is significantly less shearing force on the ACL during the squat as compared to open chain exercises such as knee extensions.

What about depth?

As knee flexion increases, so do the forces on the patella-femoral joint and tibio-femoral joint. Training in a progressive-overload fashion and allowing proper time for recovery will help avoid injury to the quadriceps tendon.

Deeper squats have been reported to result in greater jump performance in controlled trials. A combination of both deep and shallow squats (of greater intensity) demonstrated the greatest improvement in 1 rep max strength in a recent study.

Should the knees go beyond the toes?

Current research shows that when the knees pass beyond the toes while squatting there is an increase in anterior displacement of the tibia in relation to the femur. This may lead to a greater risk of sprain or strain in the knee. Research also showed that when the squat was restricted (knees did not pass beyond the toes) there was a noticeable increase in the shearing forces in the low back. Therefore it is not recommended to restrict the knees from going beyond the toes in and effort to reduce knee strain, as this will disproportionately increase the shearing forces in the lumbar spine.

What is the ideal trunk position?

Positioning of the trunk is directly related to the range of dorsiflexion in the ankle. When the range of motion in the ankle is restricted, the body tends to lean forward during the descent phase of the squat. When full range of motion is achieved in the ankles, the knees can shift forward and the torso remains more upright. Stretching and soft tissue therapy of the posterior calf muscles prior to squat training will therefore improve ankle mobility and prevent excessive forward lean.

Where should I be looking?

Downward gaze while squatting is associated with a greater forward lean. Maintaining a more upward gaze will keep the torso upright and prevent excessive shearing forces in the low back.

Last but not least: Foot position

Foot position will be slightly different for each lifter. A “natural” foot placement is recommended. This means roughly shoulder width apart with the toes pointing slightly outward. As mentioned before, everyone has different anatomical structure of the hips, ankles and knees. Foot placement will therefore be dependent on the natural rotation of the hips.

So what is the optimal back squat technique?

• Heels remain in contact with the floor
• Gaze forwards and upwards
• Natural stance width and foot positioning
• Full depth (115-125 degrees)
• Knees tracking over toes
• Chest up, relatively upright posture, neutral spine

As always, these are just recommendations and each individual should use precaution when beginning a new exercise. Please refer to a qualified strength and conditioning coach or a licensed health care professional for a complete movement assessment. Call 519-826-7973 or visit www.forwardhealth.ca to set up an appointment with Dr. Kyle today!

Visit https://www.facebook.com/drkylearam/ for video demonstrations and more!

Concussion Management: What you need to know.

What is a concussion?

A concussion is a traumatic brain injury that causes a temporary disturbance in brain cells. A concussion is sustained when there is a sudden acceleration or deceleration of the brain inside the skull. The most common cause of a concussion is a direct impact to the head. A significant hit elsewhere in the body can transmit force to the head and neck and creates a whiplash effect. This type of impact can also result in a concussion.

Signs and Symptoms

• Nausea/Vomiting
• Headaches
• Dizziness
• Loss of Consciousness
• Sensitivity to light/noise
• Visual disturbance
• Neck pain
• Irritability/Mood changes
• And many more!

How are they treated?

When a concussion is suspected, the individual should be removed from play or activity. An immediate referral to a licensed health care professional with training in concussion management is crucial for early diagnosis and treatment. Once an assessment has been completed there are certain protocols that should be followed to ensure proper recovery. These concussion treatment guidelines may include:

• Relative cognitive and physical rest for first 24-48 hours
• Gradual return to normal daily activities
• Progressive exercise therapy
• Manual therapy of the neck
• Diet and nutritional recommendations
• Vestibular rehabilitation

Recovery

Roughly two weeks after a concussion is sustained, the brains energy levels return to normal. In this time span it is important to rest and prevent a second impact from occurring. This is especially important in younger athletes who may be eager to return to play. Signs and symptoms should continue to be monitored by a licensed health care practitioner.

 

For more information or questions about concussion management please contact drkyle@forwardhealth.ca.

 

Tips to Improve Your Running

Do you want to run farther? Run faster? Or simply run with greater ease? These tips are for you!

 

 

Cadence

• Try to run at a rate of 180steps/min. This will help decrease the force per stride on your knees, reduce risk of injury and minimize wear-and-tear on the joints.

Mid-foot Strike

• Leading foot should land under your center of mass. When you heel strike ahead of your center of mass it creates a backwards “braking force” that makes each stride less efficient and will slow you down.

Hip Stability

• The pelvis needs to be stable and hips should remain at the same level. If the hips are moving up and down with each stride, this may be an indication of glute weakness and poor muscular control.

Rotation

• Core should be stable and prevent rotation through the torso. Arms should swing straight back and forward and not side-to-side across the body.
TIP: your feet will follow the direction you swing your arms.

Bounce

• The force you generate should be propelling you forward and not upward. Reducing vertical oscillation will limit wasted energy.
TIP: less ground contact is optimal.

Hip Extension:

• Hips must be mobile enough to extend the leg back past your body. Proper glute activation will help extend the hip back and save the stress on your low back.

Try to incorporate one tip at a time into your daily or weekly run. If you have any questions on proper running technique feel free to email me at drkyle@forwardhealth.ca!