Dr. Phil Shares: How Long Should Workouts Last?

How long should a workout last? It seems like a question that should have a straightforward answer, but the truth is, there isn’t one. You could spend as little as four minutes on a workout: “There is no minimum,” says Marie Urban, regional group training coordinator for Life Time. “You can get a great workout no matter how much time you have.” Or, you could grind away for hours.

How long you spend working up a sweat is entirely dependent on your goals, personal preferences and the time you have available.

How long you spend working up a sweat is entirely dependent on your goals, personal preferences and the time you have available. Even if you take your goals into consideration, it can be tricky to determine a set workout length, as there are benefits to exercising for any length of time.

SHORT DURATION, HIGH INTENSITY

For example, if you’re trying to build aerobic and anaerobic fitness, you can accomplish that in only four short-but-intense minutes of work. How? Through a popular form of high-intensity interval training (HIIT) known as Tabata training.

Tabata training involves performing a cardio-focused exercise (e.g., sprints or burpees) as many times as you can for 20 seconds before stopping for a 10-second rest, and repeating for a total of eight rounds.

In 1996, researchers found performing a Tabata workout five days per week was more effective for building aerobic and anaerobic fitness than steady-state cardio.

Even traditional strength training offers benefits in the briefest of sessions. A recent study published in Medicine and Science in Sports and Exercise reveals young men who lifted weights for only 13 minutes per session three days per week made similar strength gains in eight weeks as men who spent 68 minutes in the gym three days per week. The only catch: Subjects performed all sets to failure, or the point at which they couldn’t do another rep with good form. So, there was no slacking here.

It’s worth noting this study included only 34 subjects, and the men had previous experience with strength training; whether the results would apply to new lifters, women or older adults remains to be seen.

GO LONGER FOR MORE RESULTS

In addition, the shorter training sessions weren’t as effective for increasing muscle size (also known as hypertrophy) as the longer sessions. As researchers note, higher training volumes are key for achieving muscle hypertrophy, and higher training volumes require a greater time commitment.

Still, the group that did 13-minute sessions gained some muscle, suggesting you may be able to get away with a quick workout from time to time. However, you would have to continue adding sets, reps and/or exercises if you wanted to continue seeing progress. According to the findings of a 2017 meta-analysis, adding one set each week was associated with an increase in the percentage of muscle gain by 0.37%. As you continue adding sets, reps and/or exercises, your training sessions inevitably take longer to complete.

If you’re training for a specific event (e.g., marathon, bodybuilding competition), your training sessions will likely vary in length as you near your event date, and may include sessions that err on the longer side (60 minutes or more). In these instances, it’s a good idea to work with a fitness professional and/or follow a quality training program, as opposed to trying to come up with your own workouts.

DAILY ACTIVITY MATTERS

By the way, your daily activity level is perhaps more important to your overall health than working out for a set period of time. Research even shows being sedentary can limit the positive effects of exercise. According to the U.S. Department of Health and Human Services, there’s a strong relationship between sedentary behavior and risk of death from any cause, as well as death from heart disease.

Urban recommends squeezing activity into your day wherever you can: Park far away from the store, take the stairs instead of the elevator, do pushups while you microwave food and crank out some situps during commercial breaks. “Having an active lifestyle is more important than working out for an hour every day,” she says.

by Lauren Bedosky

Shared by Dr. Phil; McAllister @ Forward Health Guelph

Dr. Kyle: High Intensity Interval Training!

I’m sure you’ve heard the hype about high intensity interval training (HIIT) – bursts of exertion separated by short periods of recovery – sound tough, right? That’s because it is. The attention around HIIT has provoked researchers to further investigate it’s physiological benefits, which have been promising.

The problem with most workout programs is lack of intensity. People putt around the gym for about an hour, jump from one machine to the next without breaking a sweat. What’s the problem? Nothing, if your goal is to build strength. But from a physical fitness and weight loss perspective, you are overlooking HIIT’s cardiovascular and fat-incinerating benefits.

HIIT is a time-efficient strategy to increase muscle and accelerate fat loss. Intervals of activity and rest can vary between 30 seconds to a few minutes. The duration and intervals can be modified depending on the individual and goal in mind. The objective is to create a fast-paced and physically demanding workout that challenges our threshold of exercise intensity.

So why HIIT vs. cardio?

HIIT is most commonly compared to moderate intensity continuous training (MICT). MICT, also known as steady state cardio, consists of long periods of activity at constant intensity. For example, 45 minutes of jogging at 5km/h is considered MICT. Although it provides significant cardiovascular improvements and may be a favourite for endurance training, HIIT can offer more!! Remember, you can’t go wrong with increasing the intensity of exercise. Let’s compare!

With regards to that pesky body fat, HIIT significantly reduces abdominal and visceral fat in both men and women (1). High intensity training, above 90% peak heart rate, was more effective at reducing whole-body adipose tissue. Many studies show HIIT is superior to MICT in improving aerobic fitness (2). Cardiovascular measures (VO2 max, contractile function, ejection fraction, respiratory fitness and endothelial function) significantly improved with 7-12-week HIIT programs. This holds true for people who have previously suffered from a cardiac incident. Implementing HIIT under supervision during cardiac rehabilitation can improve quality of life by enhancing their cardiorespiratory fitness. No deaths or cardiac events occurred during HIIT programs across all recent studies. What doesn’t kill you makes you stronger, right?

Additionally, studies have demonstrated greater improvements in insulin sensitivity, glucose regulation, HDL cholesterol, and blood pressure with HIIT compared to MICT (2,3). Improved insulin sensitivity allows the body to utilize glucose more efficiently as energy, instead of being stored as fat! By implementing HIIT with intermittent fasting, the body utilizes fat stores for energy, increasing fat oxidation and mobilization (4). HIIT is also more effective than MICT at reducing oxidative stress and inflammation (5). These benefits are observed in subjects across all age categories. HIIT doesn’t discriminate; all can experience the health advantages of HIIT.

HIIT is extremely efficient because we experience what’s known as “excess post-exercise oxygen consumption,” or EPOC – meaning we reap the calorie-burning effects hours after our workout.

During intensive exercise, energy stores are quickly depleted. Our carbohydrate stores, oxygen and other essential compounds are exhausted, resulting in an energy deficit. After HIIT, we eventually reach our normal resting level of metabolic function. Carb stores are replaced (with an appropriate diet), oxygen levels will increase, and body temperature will return to normal (6). These processes require energy, explaining why we continue to burn calories after exercise. Even though HIIT and MICT both induce EPOC, HITT increases lipid metabolism to a greater extent AND is extremely time efficient (6).

So whether you want to call it HIIT, interval training, circuit training, etc., say hello to the most time efficient and beneficial exercise available. Combining HIIT with intermittent fasting and a wholesome diet, expect accelerated fat loss and physical fitness improvements. So what are you waiting for? Let’s turn up the intensity to 11!

References:

1. Maillard F, Pereira B, Boisseau N. Effect of high-intensity interval training on total, abdominal and visceral fat mass: a meta-analysis. Sports Medicine. 2018 Feb 1;48(2):269-88.

2. Hannan AL, Hing W, Simas V, Climstein M, Coombes JS, Jayasinghe R, Byrnes J, Furness J. High-intensity interval training versus moderate-intensity continuous training within cardiac rehabilitation: a systematic review and meta-analysis. Open access journal of sports medicine. 2018;9:1.

3. Costa EC, Hay JL, Kehler DS, Boreskie KF, Arora RC, Umpierre D, Szwajcer A, Duhamel TA. Effects of high-intensity interval training versus moderate-intensity continuous training on blood pressure in adults with pre-to established hypertension: A systematic review and meta-analysis of randomized trials. Sports Medicine. 2018 Sep 1;48(9):2127-42.

4. Wilson RA, Deasy W, Stathis C, Hayes A, Cooke M. Combining intermittent fasting with high intensity interval training reduces fat mass by increasing fat oxidation and mobilization. InAustralia and New Zealand Obesity Society and Breakthrough Discoveries 2018 Joint Conference, Melbourne, Australia, 16-18 October 2018. 2018

5. Ramos, Joyce S., et al. “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 (2015): 679-692.

6. Ahlert M, Matzenbacher F, Albarello JC, Halmenschlager GH. Comparison of epoc and recovery energy expenditure between hiit and continuous aerobic exercise training. Revista Brasileira de Medicina do Esporte. 2019 Feb;25(1):20-3.

Dr. Phil Shares: Does Your Water Need A Boost?

Does Your Water Need a Boost?

Since the body is 60% water, drinking H20 is “crucial for so many of the most basic biologic functions. Cells need to be hydrated with water or they literally shrivel up and can’t do their job as efficiently,” says Robin Foroutan, MS, RD, a spokesperson for the Academy of Nutrition and Dietetics. That includes an impaired ability to expel environmental waste and detox; if you’re dehydrated you may feel cloudy-headed, have headaches or feel constipated, among other ills.

Plain water should always reign as your drink of choice. “It has a better capacity to usher out metabolic toxins from the body compared to liquid that already has something dissolved in it, like coffee or tea,” says Foroutan. However, there are certain additions that can make the once-plain sip seem more interesting and deliver health benefits, too.

Here, alternative hydration boosters to try (and which ones to skip):

Not only does a slice of lemon provide a refreshing taste, but “it’s alkaline-forming, meaning it helps balance out things that are naturally acidic in the body,” says Foroutan. This can have an added post-workout benefit “it can reduce lactic acid, an end product of exercising muscles,” she says.

This amino acid supplement is in a powder form, so it dissolves nicely in water and has a lemon-like taste, says Foroutan. “Acetyl L-Carnitine is a mitochondrial booster. Your mitochondria, the powerhouses of the cells that make cellular energy, help the body use fat for fuel more efficiently,” she says.

Vitamin B12 is crucial for overall health and plays a key role in keeping the brain and nervous system working. “It’s mainly found in animal products, meaning many vegetarians and vegans need to supplement with it, but even some meat eaters have trouble absorbing it,” says Foroutan. “You can have the best kind of diet and even feel OK but have a B12 level that’s less than optimal. When we bring those levels up, people tend to feel more energetic and their mood is better,” she says. Try adding a dropper-full of B12 to your glass of water once a day, suggests Foroutan.

Many grocery stores now stock bottled hydrogen water, but a less expensive solution is purchasing molecular hydrogen tablets to add to your drink. “These can be used to help balance inflammation in the body,” says Foroutan. While inflammation is a normal body process — it happens during exercise, too — low-grade chronic inflammation is damaging. One review in the International Journal of Sports Medicine concluded hydrogen may also boost exercise performance, though researchers are still examining potential mechanisms.

If you have trouble getting enough water because you don’t like the taste, then a bubbly drink (one that contains zero artificial or real sweeteners) can be a healthy way to motivate yourself to drink more. Research in the American Journal of Clinical Nutrition found sparkling water was just as hydrating as regular water. Still, there’s some concern these drinks may wear away at tooth enamel, (although the American Dental Association says they’re far better than soda), so consume carbonated water in moderation.

If you’re active, you lose electrolytes in sweat and it’s important to replace them, but in a smart way, says Foroutan. Many bottled electrolyte waters contain just a trace amount and are often loaded with added sugars, notes Foroutan, so it’s important to read the labels carefully. You can also skip the sugary drinks altogether by buying electrolyte tablets and dissolving them in water. What’s more, “you can get electrolytes from leafy greens (Think: a handful of spinach in your smoothie or a chicken-topped salad),” says Foroutan.

Alkaline water has a higher pH than regular water, but alkalized bottled water is expensive, and there just isn’t enough research to support making the investment, according to the Mayo Clinic and Cleveland Clinic. Foroutan agrees there’s no reason to buy it bottled, but if you really want to try it “you can add a pinch of baking soda to water to create alkaline water.”

Shared by Dr. Phil McAllister @ Forward Health Guelph

Dr. Phil Shares: Should You Get an Extra Hour of Sleep or a Workout?

Should You Get an Extra Hour of Sleep or a Workout?

You’re lying in bed, trying to decide what time to set your alarm for tomorrow. You could get a full seven hours of sleep if you wake up at your normal time, or you could wake up an hour and a half earlier to make that morning spin class. Which should you choose?

This seemingly simple riddle is one we’ve all faced at some point. The decision seems impossible. Sleep is essential for a healthy immune system and injury-prevention, but exercise can contribute to better, sounder sleep.

PRIORITIZE SLEEP

“Sleep and exercise are both incredibly important for your body, but if you have to choose one it has to be sleep,” says Amy Leigh Mercree, a wellness coach. “Adequate amounts of sleep gets your body the time it needs to replenish and refresh your cellular functioning. If you do not get to do that, your health will suffer greatly.”

Most experts agree that when forced to choose, they’d almost always choose sleep. Adults need 7–9 hours of sleep, according to the National Sleep Foundation, for optimal performance, memory retention and good health. But achieving a sound night’s sleep is largely dependent on your commitment to your body’s circadian rhythm, which is when we normally go to bed and wake up. A Northwestern study showed our muscles also follow that circadian cycle, meaning if you’re working out during the time when you’re normally asleep, your muscle repair will be less efficient.

EXERCISE IS IMPORTANT, TOO

But just because sleep is usually the answer doesn’t mean you should discount the need for exercise for your overall health if you’re always crunched for time. “Exercise changes the brain and is critical for brain health. What’s good for your body is good for your brain, too,” said John Assaraf, brain researcher and CEO of NeuroGym. “Through exercise, you are feeding your brain by increasing blood and oxygen flow.”

When you have to choose, remember a short workout is better than no workout at all. If you have only 10 minutes, do a quick workout at home with simple exercises like squats, jumping jacks and planks. There are also lots of apps that can give you a quick workout for a specific time frame using only your bodyweight.

BE HONEST WITH YOURSELF

If you find yourself constantly short on time, it might also be good to see where that time is actually going. Try tracking your days meticulously for a week to see where you might be wasting time. Almost everyone is guilty of too much time on social media or watching TV, so see if you could substitute that time for working out. This will help you get a proper night’s sleep and a workout.

by Tessa McLean

Shared by Dr. Phil McAllister @ Forward Health Guelph

Dr. Laura: Opioids have lasting affect on the microbiome

Pain medications that include opioids have a lasting negative affect on the gut microbiome. Have you ever taken a Tylenol #3 with codeine? Had an operation and needed pain killers like meperidine (Demerol) or morphine? Or a prescription for oxycodone (OxyContin®) or hydrocodone (Vicodin®) to help relieve intense pain? Opioids are a class of drugs that also include the illegal drug heroin, synthetic opioids such as fentanyl.

Consequences of opioid use are well known. If overdosed, it suppresses breathing function. Also commonly experienced at prescribed levels are: constipation, nausea, vomiting, bloating and “leaky gut” (gut barrier dysfunction). There is an evident change in bacterial colonies and bile acid production is also affected. Bile acids are used to break down fats and digest food. Gut barrier dysfunction can lead to multiple food sensitivities and chronic inflammatory patterns like headaches, joint pain and brain fog. All of this disruption can increase risk of infectious disease.

Support of the microbiome with probiotics is key to health maintenance. Research continues on which would be most beneficial during opioid therapy. Critical is the restoration of a healthy microbiome post surgery, opioid pain medications or even addiction.

Naturopathic doctors excel in identifying food sensitvities, removing unwanted microbes, repairing and restoring gut function.

Dr. Laura M. Brown, ND is a registered naturopathic doctor with a Functional Medicine approach.  She has advanced training in pharmaceuticals, is a certified HeartMath Practitioner and a Certified Gluten Practitioner  and holds the designation of ADAPT Trained Practitioner from Kresser Institute, the only Functional Medicine and ancestral health training company.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5827657/

https://www.ncbi.nlm.nih.gov/pubmed/26906406

https://www.ncbi.nlm.nih.gov/pubmed/27895265

Dr. Kyle: Posture Perfect

You can prevent slips and falls. You can reduce your risk of a motor vehicle accident. You can limit contact sports. One thing that you cannot avoid however, is gravity. If your body and spine are not aligned, the force of gravity will start to wreak havoc on your musculoskeletal system. Making sure we maintain proper posture throughout our work day is critical for longevity in our career. So how do we protect ourselves?

The secret to good posture is maintaining the spines natural curves. When standing, your head, shoulders, hips and ankles should all line up. When sitting, your ears, shoulders and hips should be in line and your buttocks should be at the back of the chair. Sit tall with your chest and head up.

Some tips for creating an ideal posture include:

• Stand tall with shoulders back
• Tuck your chin
• Brace the abdomen
• Squeeze your glutes
• Keep your knees slightly bent

Due to modern day technology, one of the most common signs of poor posture is anterior head carriage. This mean that the head is resting too far forward away from the body. We are not always cognisant of our head posture as we check our smart phones and work on our laptops. The farther our head protrudes forward, the greater the force on our neck. This can lead to chronic neck and upper back pain and lasting postural alterations.

One exercise I recommend to patients to reduce anterior head carriage are chin tucks. These can be done up against a wall or lying flat on your back. You simply bring your chin directly in towards the spine and hold. You can press gently into the wall or pillow to enhance the muscle contraction of your deep neck extensors. Now your spine will naturally carry the weight of your head and allow your neck and upper back muscles to relax. So keep your chin up and your pain levels down!

For more tips and tricks to enhance your posture, visit my Instagram page @drkylearam of email me at drkyle@forwardhealth.ca.

Dr. Kyle: Tips For Sleeping Better

1. Make your bedroom your oasis. If you are going to invest in something, why not invest in a good mattress and pillow that you will spend almost a 1/3 of your life on. Complete your bed with comfy blankets and sheets.

2. Keep it dark. Shut off all alarm clocks, TV’s, phones etc. Make sure no LED light is being emitted. This may require you to unplug some electronics around your room. Black-out curtains are a must.

3. Control room temperature. Make sure you are not too hot or too cold. There is nothing worse than sweating all night under the covers while your body struggles to maintain optimal body temperature.

4. Stop consuming caffeine after 2pm. This ensures that the effects of caffeine will be long gone before your head hits the pillow. Try a decaf coffee in the afternoon to fight off cravings.

5. Don’t work out within 2 hours before bed. This will disrupt hormone rhythms and deprive your body of energy stores needed to repair your body as you sleep.

6. Meditate. A simple 5-10 minutes mediation or deep breathing routine will calm the nervous system and transition you from our fight-or-flight response to your rest-and-digest state.

7. Reduce exposure to blue light after the sun goes down. Change display settings on your phone or use computer programs to block out blue light at night.

8. Have a chamomile tea or small snack with raw-honey to maintain your blood sugar levels throughout the night.

Sweet Dreams!

Dr. Laura: Is Your Thyroid Tired ?

Perhaps your thyroid needs a check-up? It does if you feel sluggish, tired, constipated, have difficult concentration, and are a wee bit depressed.

Subclinical hypothyroidism is when a patient with sluggish digestion, cognition, fatigue and weight issues has a high TSH but normal T4. It is important to look at the reasons for the symptoms, which could have multiple causes, before reaching for the thyroid hormone replacement drug.

Don’t let the sunset on your thyroid…

What nutrients help the thyroid?

Nutrition is a factor. Consider levels of zinc, iodine, selenium and iron as they all play a role in thyroid function. B12 is also an important one to look at and easy to run the labs to determine its status.  Also the health of the gut microbiome and liver needs to be healthy as a large amount of the inactive T4 converts to the active T3 thyroid hormone in the liver and the gut. So many people have issues with the balance in their microbiome.  

Does stress play a role?

Another area of thyroid health to consider is the stress axis. This involves the hypothalamus, pituitary and adrenal, or HPA. Chronic long term stress can make it difficult for optimal thyroid function. In addition to mineral level attention, it is highly important to support the adrenals and provide opportunities for stress management.  

Are there natural thyroid medications?

Finally, there are other options to synthetic thyroid. Natural desiccated thyroid (NDT) may be something to consider if diet and lifestyle changes don’t break through the fog. NDT provides both T4 and T3, which is good if there is an issue with conversion.

How can a naturopathic doctor help?

Naturopathic doctors are medical trained and naturally focussed. They can run labs for the nutrient levels, thyroid stimulating hormone (TSH), T4, T3, and any antibodies to help rule out autoimmune thyroid disease. This helps determine what nutrients might be missing and what foods or nutraceutical dose to suggest and for how long. Naturopathic doctors with education in pharmaceuticals are able to prescribe natural desiccated thyroid. They are also very good at stress management and adrenal (HPA-axis) support with both nutrition, lifestyle and stress management programs.

Dr. Laura M. Brown, ND is a board certified naturopathic doctor with advanced training in pharmaceuticals, functional medicine and stress management. She is a Heart Math Certified Practitioner, a graduate of the Kresser Institute’s Adapt Level 1 functional medicine training and is a Certified Gluten Practitioner.

Dr. Laura: Signs of Blood Clot

Swelling, tenderness, redness in the legs, shortness of breath and or chest pain are all signs of a blood clot. This is an emergent condition and needs to be addressed immediately. To prevent a blood clot, there are plenty of natural remedies that will help.

C-L-OT-S Awareness Campaign

Spread the word on the CLOTS awareness campaign. A clot in blood is the underlying cause of the top three cardiovascular killers: heart attack, stroke and venous thromboembolism (VTE). If symptoms of chest pain, lightheadedness, shortness of breath, leg tenderness and or leg swelling emerge, a visit to the emergency room is best to rule out anything serious.

C – Chest Pain

L– Lightheadedness

O– Out of breath

T- Leg Tenderness

S– Leg Swelling

Natural ways to help thin the blood

Did you know there are a number of natural health products that help thin the blood? Things taken regularly in substantial enough quantities or in combinations like fish oil, curcumin, Dong quai, dan shen, onion, reishi, papain, devil’s claw, garlic, ginkgo, feverfew, ginger, clove oil, horse chestnut, bilberry, kava kava, evening primrose oil, borage, black current, dandelion root, cayenne fruit, green tea, and vitamin  E all inhibit platelet aggregation (thin the blood). These natural remedies also have other actions on the body so you must seek professional advice for what products are right for you. Taking natural remedies to help thin the blood may help reduce the risk of cardiovascular events, and reduce the need or amount of prescription medication.

Naturopathic doctors are trained are medically trained and naturally focussed. Need relief from swelling, pain or fatigue? Call 519 826.7973 or book your appointment online

Dr. Laura M. Brown, ND is a Naturopathic Doctor, a Certified Gluten Practitioner, a HeartMathCertified Practitioner and is a graduate of Adapt Level 1 at KresserInstitute of Functional Medicine. Essentially, Dr. Brownhelps people better digest their food and the word around them.

Dr. Kyle: Torn ligament? Maybe not.

Knee pain can come in a variety of presentations. Whether from a sports injury, slip and fall, or out of the blue, no two knee injuries are completely alike. The extent to which tissues are damaged is specific to the patient’s genetics, lifestyle, trauma, and fitness level. A well-trained athlete may be quite high functioning even with a serious tear, while a mild injury may keep a very sedentary person out of commission for several months.

Often times I will hear “hey doc, I think I might have heard a pop and the inside of my knee really hurts!”. My first reaction is to suspect a ligament tear. Once examining the patient further however, orthopedic testing shows stable knee ligament testing, no swelling or redness, and no severe joint line tenderness. So what’s the deal?

Like most soft tissue injuries, ligaments can be damaged to varying degrees. In the clinical world, there are 3 grades of ligament tears. Grade 1 is mild ligament damage, grade 2 is moderate, and grade 3 is severe/ruptured ligament tear. Common symptoms of a complete tear include sudden onset of pain and severe swelling, joint instability, and impaired function. The truth is, disruption of tendon fibers can happen to varying degrees. Think of muscle strains and ligament sprains on a spectrum of structural damage from 0 to 100%. The higher percentage of damage, the longer time it will take to establish preinjury performance levels.

Fortunately, if ligament stability is determined to be adequate by a healthcare professional, a conservative trial of care will often resolve symptoms. Ligaments in the body have the natural ability to heal on their own. Healing consists of 3 distinct phases including the inflammatory phase, the reparative phase, and the remodelling phase. Simply put, fibrotic scaffolding will be laid down so newly formed collagen can connect the severed ends of the tear. It is important to seek proper medical attention so that rehabilitation can begin as soon as possible.

For injuries of this nature, treatment will often begin with controlled range of motion exercises. Other modalities such a laser and acupuncture are helpful for enhancing healing at this stage. As tensile strength of the ligament improves, the joint will be able to tolerate more load. Eventually strengthening exercises will be included into the plan of management and progressed with increasing difficulty.

So if you or someone you know is worried that their knee pain may need surgical intervention, make sure you get it assessed by a medical professional who specializes in musculoskeletal injuries. It may be quite reassuring to know that with the right tools and knowledge the body will be able to heal and adapt on its own.

For more information, please contact drkyle@forwardhealth.ca or visit my professional Instagram page @drkylearam.

References:
Woo SL, Abramowitch SD, Kilger R, Liang R. Biomechanics of knee ligaments: injury, healing, and repair. Journal of biomechanics. 2006 Jan 1;39(1):1-20.