The weather this summer has been quite phenomenal. We have been getting nice hot sunny days on the west coast; we sure are a lucky bunch. Sure it rains sometimes but I'd rather have the odd rain here and there than the threat of West Nile mosquitoes and the high humidity of our poor fellow canucks in Toronto. They might even have Krispy Kremes out there, but I'd rather have the fresh chocolate croissants of Granville Island. Living in BC gives us the unique opportunity to choose to play in the mountains, in the water or on land all year round. Now how can you beat that? Still, the ability to be active year round, and especially in the summer months also means more sport related injuries. Women tend to suffer from injuries due joint instability from less muscle protection around the joint. Knees are the most common. Men tend to suffer from injuries due to shortened and tight muscles due in part to inflexibility and not stretching enough. In my experience, these are the common gender specific type of complaints that I have seen at the clinic.

Women that are active in sports like basketball and volleyball will usually encounter knee injuries if they do not work on stabilizing those joints. Paying particular attention to joint strengthening exercises or pre-game joint taping/braces can help prevent the potential of a major joint injury. The most common would be the tearing of the Anterior Cruciate Ligament (ACL). ACL injuries will set you back from your sport for months to allow for proper healing and rehabilitation. Learn more about the mechanics of ACL injuries in women in this month's "Research News".

I was lucky enough to go see the Cirque Du Soleil show, "Allegria", that is currently playing in Vancouver till August 10. The performers are not only amazing athletes in all respects but also have to perform daily without incurring serious injuries to themselves. The power and strength of the performers is incredible in itself, but much more amazing is the flexibility coupled with that power. Here is a prime reason for all of us to adhere to a proper stretching program daily to avoid injuries. Flexible muscles will prevent severe strains and chronic and painful injuries. To learn more about the "Myths and Truths of Stretching", check out the "Research News" section. You will learn why it is so important to stretch and how to do it properly. This will be a two part series as the study is a long one.

Are you actually eating what you are reading? Dietician, Ali Chernoff has contributed an article on "READING BETWEEN THE LINES" this month. She asks the question "How do you know if what you read or hear has any truth to it? Follow her discussion under the "Professional Advisor" section to learn more.

Katrina Lewis, our physical fitness and lifestyle consultant is having a health coaching seminar this month on practical weight loss techniques that you can use at home, work and play. Bayside patients get a small discount to attend.

Congratulations to Diana Carlsen who is our contest winner for the exercise ball draw we had last month! Using the ball properly for your stretches and workouts will bring superior results to your workouts. Ask me how if you have any questions.

We are still having another exercise ball contest this month. As before, to enter, all you have to do is click onto the link below and email your name and telephone#. The winner will be picked at random on July 31st. Only one entry per email address. Good luck!

Click Here to Enter The Contest!

Smile of the month:

This car comes screaming up to the front of a veterinarian hospital. A man jumps out with a limp cat in his hand, runs in and says, "I've got to see the Vet".

They let him in the back. He puts the cat on the examining table. The doctor comes in and puts his stethoscope on the cat and says: "I'm sorry sir, the cat is dead."

The man says: "It can't be. It's my best friend. I want a second opinion". The doctor complies and opens the door and calls out a name. In comes a Labrador Retriever. The Lab goes over, sniffs the cat and shakes its head and leaves.

The vet says: "Sir, the cat is dead."

"It can't be!" says the man.

"Ok, one more opinion". Says the Vet. He goes to another door and calls out a name. A cat comes in, jumps on the table, shakes it's head and leaves.

The vet now says again: "Sir, the cat is dead."

The man apologizes and says, "I'm sorry I got so emotional, but you know, it was my friend and I really had to know for sure. How much do I owe you?"

The vet says: "That will be $645." The man complains: "What! To tell me that my cat is dead?"

The Vet says: "No sir, it was $45 but the lab report was $100 and the CAT scan was $500.

To your health!

Dr. Andrew Chin.

Women active in sports that involve jumping and pivoting (e.g., volleyball or basketball) are up to eight times more likely to rupture their anterior cruciate ligament (or ACL - a primary knee ligament) than men participating in the same sports. Ligaments are the durable tissues that hold our bones together; the ACL and its counterpart, the posterior cruciate ligament (PCL), provide stability in the knee joints, and injuries to them can be painful and debilitating.

Researchers evaluated why female athletes are prone to knee ligament injuries in a recent study published in The Journal of Bone and Joint Surgery. Higher muscle stiffness helps brace the knee joint and reduces strain on the knee ligaments; therefore, the researchers examined muscle stiffness of the knee joint during muscle activation in 12 female and 12 male athletes competing for the National Collegiate Athletic Association (NCAA) in basketball, volleyball or soccer, and compared these athletes to 28 collegiate athletes involved in endurance sports, including bicycling and running, which are low-risk for cruciate ligament injury. Women and their male athlete counterparts were matched for size, weight and activity level.

Rotations of the leg were greater in female than in male athletes when participating in sports and when passively rotated at rest. In addition, measurements indicated that women demonstrated significantly lower knee muscle stiffness under rotational stress than their male counterparts. During jumping and pivoting maneuvers, which are the most likely time for a cruciate ligament injury, the difference in protective muscle stiffness around the knee was the most pronounced between the men and women.

Women are more prone to serious injuries of the knee ligaments than men, possibly due to less muscle protection. If you are a female athlete, talk to your doctor of chiropractic about methods for strengthening the stabilizing muscles around your knees. Also, adhere to proper techniques and form when performing your sport to minimize the risk for injury.

References
Wojtys EM, Huston LJ, et al. Gender differences in muscular protection of the knee in torsion in size-matched athletes. The Journal of Bone and Joint Surgery 2003:85(5), pp. 782-789

Pictures from: www.emedx.com

Myths and Truths of Stretching - Individualized Recommendations for Healthy Muscles

Ian Shrier, MD, PhD; Kav Gossal, MD
THE PHYSICIAN AND SPORTSMEDICINE - VOL 28 - NO. 8 - AUGUST 2000

In Brief: Stretching recommendations are clouded by misconceptions and conflicting research reports. This review of the current literature on stretching and range-of-motion increases finds that one static stretch of 15 to 30 seconds per day is sufficient for most patients, but some require longer durations. Heat and ice improve the effectiveness of static stretching only if applied during the stretch. Physicians should know the demands of different stretching techniques on muscles when making recommendations to patients. An individualized approach may be most effective based on intersubject variation and differences between healthy and injured tissues.

Despite limited evidence, stretching has been promoted for years as an integral part of fitness programs to decrease the risk of injury (1-6), relieve pain associated with "stiffness" (5), and improve sport performance (4-6). Many different stretching recommendations have come out of the medical literature, and new research has challenged some long-held concepts about common stretching practices. As a result, misconceptions and misinterpretations are common--not just among patients, but among healthcare professionals, as well. Thus, many clinicians are at a difficult crossroads when making sound recommendations to patients.

Proposed Stretching Benefits
Proposed mechanisms are thought to be either (1) a direct decrease in muscle stiffness (defined as the force required to produce a given change in length) via passive viscoelastic changes or (2) an indirect decrease due to reflex inhibition and consequent viscoelasticity changes from decreased actin-myosin cross-bridging. Decreased muscle stiffness would then allow for increased joint range of motion.

New evidence suggests that stretching immediately before exercise does not prevent overuse or acute injuries (7,8). However, results from animal studies suggest that continuous stretching (ie, 24 hours per day) over days, compared with intermittent stretching of only minutes per day, outside of exercise periods may produce muscle hypertrophy (9-11), which could theoretically reduce the risk of injury (9,12). However, clinical research on stretching minutes per day is still inconclusive (13,14), and more research is needed before definitive conclusions can be made. With respect to alleviating the pain associated with stiffness, the weight of the evidence suggests that the decrease in stiffness is not as important as the increase in "stretch tolerance" (15-17). Briefly, an increase in stretch tolerance means that patients feel less pain for the same force applied to the muscle. The result is increased range of motion, even though true stiffness does not change.

A Search for Answers
Despite the controversies mentioned previously, stretching still decreases pain and may provide substantial benefits if used under appropriate conditions. However, the problem remains on how to choose an appropriate stretching protocol. Most authors now believe ballistic stretching (ie, bouncing) is dangerous (4-6,18). Time recommendations for holding a stretch vary between 10 and 60 seconds (5,19-24). Clinicians are also faced with choosing a method that may improve the effectiveness of stretching: superficial heat, superficial ice, deep heat, and warm-up (25-30).

Duration and Frequency
Before discussing the evidence on how long to hold a stretch, it is necessary to explain the concept of viscoelasticity. Stretches must be held to obtain maximum range of motion because muscles are not purely elastic, but rather viscoelastic. An elastic substance such as a rubber band lengthens for a given force and returns to its original length immediately upon release. The effect is not dependent on time. On the other hand, the flow and movement of a viscous substance such as molasses depends on time (33). A viscoelastic substance exhibits both properties. Therefore, muscle length increases over time if a constant force is applied (creep, figure 1A: not shown), or the force decreases over time if the muscle is stretched to a constant length and held (stress-relaxation, figure 1B: not shown). When the force is removed, the substance slowly returns to its original length. This is different from plastic deformation, in which a material such as a plastic bag remains permanently elongated even after the force is removed (33). Note that though stretches also affect tendons and other connective tissue, within the context of normal stretching, the stiffness of the overall motion is mostly related to the least stiff section (ie, resting muscle) and is minimally affected by the stiffness of tendons. Patients are given many common protocols on stretch duration. In summary, for both the immediate (within 60 minutes) and long-term (over weeks) range-of-motion increases, research shows that one 15- to 30-second stretch per muscle group is sufficient for most people, but some people or muscle groups require longer duration or more repetitions. For immediate effects, stretching increases range of motion through both a decrease in viscoelasticity and an increase in stretch tolerance (ie, the analgesic effect previously discussed). With long-term stretching, viscoelasticity remains constant and the increased range of motion occurs only because more force can be applied to the muscle before the subject feels pain (ie, increased stretch tolerance).

Immediate effects.
The immediate effects of stretching on range of motion have been studied in animals and humans. These results are consistent with those of human hamstring muscles that showed decreased stiffness with five repeated stretches (35).

In support of this theory, Henricson et al (27) found that muscles differed in their response to heat plus stretching. If true, the optimal duration and frequency for stretching may also vary by muscle group. Alternatively, range of motion in humans might be primarily limited by pain (15-17). If this theory is true, any smaller benefits obtained from decreased viscoelasticity with longer-duration stretches would be overshadowed by the large changes in range of motion from stretch-induced analgesia (stretch tolerance).

Long-term Effects.
The long-term effects of stretching on range of motion have been studied in humans only. After 6 weeks, individuals randomized to stretch for 30 seconds per muscle each day increased their range of motion much more than those who stretched 15 seconds per muscle each day. (A small increase in range of motion in the 15-second group was not statistically significant.) No further increase was seen in the group that stretched for 60 seconds (19). Therefore, 30-second stretches are likely to achieve the maximum benefit quicker (within 6 to 7 weeks) than 10-second stretches, but the two programs eventually achieve similar results by 10 weeks.

Rationale for Individualized Programs
The above studies support the use of 30-second stretches as part of a general fitness program. This may be appropriate for group exercise classes in which one would want to use a duration that would benefit most individuals--similar to the recommended dietary allowance for vitamins and minerals. However, physicians and physical therapists usually treat individuals rather than groups.

Consequently, some muscles must have achieved maximum benefit after two to three stretches, whereas others required five to six stretches. In human long-term studies, some individuals gained much range of motion with only 15 seconds of stretching, while others gained very little with 45 seconds (24).

Rather than give everyone the same stretching recipe, we prefer to individualize our prescription to account for intersubject variation and differences between healthy and injured tissues. We advise patients to stretch until they feel a certain amount of tension or slight pulling associated with this length, but no pain. As the stretch is held, stress-relaxation occurs, and the force on the muscle decreases. When patients feels less tension because of changes in viscoelasticity and an analgesic effect, they can then simply increase the muscle length again until they feel the original tension. The second part of the stretch is held until patients feel no further increase. If patients return for follow-up and have not gained any range of motion, and they are not overstretching (forcing a stretch, causing muscle spasm or pain), intersubject variability cited above may be the reason, and the clinician should consider recommending that the stretch be held longer.

Part 2 of this article to continue in next month's issue.

"READING BETWEEN THE LINES"

There is too much misleading nutritional information out there! Are you confused as what to believe or not to believe because it all sounds so conflicting? It is not only frustrating to me as a Registered Dietitian, but it must be doubly so, to you, the consumer.

Newspapers, magazines, radio and TV news, and books can all make a presentation sound convincing to the lay person. As a result, we often jump to conclusions without realizing that the information provided by these various sources, if professionally evaluated, is unsupported by scientific data.

How do you know if what you read or hear has any truth to it?

In order to draw informed conclusions one must validate the sources. Ask yourself the following questions:

Is their any scientific basis to this article or program?
Is it biased?
Are their credentials and/or institution reliable and accredited?
Do they have the educational background to make such claims?
Are the results quoted anecdotal or factual?

For example, a study that states calcium is best absorbed by only consuming milk. If the Dairy bureau sponsored this study, they would not consider soymilk or broccoli, which can both be sources of calcium.

Sometimes when you read a diet book, and then peruse a few articles that seem to back up the book, you may discover that the editor of the articles also sponsored the publication of the book. Look for warning signs such as "it is well known that…" and "hundreds of people state…" Never jump to conclusions. There is no such thing as a single miracle food. Too much of something is not a good thing.

Believing research based on a single study is not a valid conclusion.

Studies that promise a quick fix, such as a major weight loss in a very short period of time, are often untrue. Be especially wary when they show before and after pictures, or include great testimonials.

The bottom line is, if it sounds too good to be true, chances are that it probably is not true. One must realize that not all medical studies quoted by the media are truthful as they can be funded by interested sponsors and therefore slanted in the interests of continuing the monetary sponsorship for research.

Remember that headlines in newspapers are usually taken out of context and designed to grab your attention. Many studies discussed in the media sound interesting but in retrospect are often too small in sample size, too short in duration, or too narrow in focus to be legitimate. For example, the concept that gingko can cure memory loss if one suffers from Alzheimer's, is quite a reach. There is no actual treatment when the wording describing the medication use indicates it is just a recommendation.

In conclusion, recognize that there is very little valid nutrition information out there. Everyone is out to make a buck on the uninformed public. Things that sound good are best sellers. Nutritional advice should be individualized.

Fad Diets do not work, the first 3 letters of diet is die.

Your best choice is to book an appointment with a Registered Dietitian who can give you sound nutritional advice that suits your personal lifestyle.

Ali J. Chernoff can be reached at 604-676-0200 or via email, ali@nutritionatitsbest.com. More information is also available on her Web site, http://www.nutritionatitsbest.com/