Slope Safety!

Common Ski/Snowboarding Injuries & Tips to Avoid Them

Garrett Fischer DPT, Cert. DN

Skiing and Snowboarding is a popular winter pastime for many of us who live in North Idaho. As with most sports, they both come with the potential for injury. Following some simple guidelines can decrease your chance for injury, leading to a much more enjoyable and safe winter ski season!

If you sustain an injury while skiing and snowboarding, there is a high likelihood that it involves your knee. Knee injuries are the most common, and make up 30% of all skiing/snowboarding injuries. They are closely followed by shoulder, wrist, and closed head injuries (i.e. concussions). Knee injuries are also more common among beginning and intermediate skiers than advanced and elite level skiers.

Although the majority of skiers and snowboards try to stay safe, unexpected injuries still occur with improper preparation, varied snow conditions or poor judgment. There are some practical steps you can take to decrease your risk of getting hurt this season: 

1. Get In-Shape: Pre-season training should focus on overall body fitness, balance, coordination and agility, combined with a careful warm-up before venturing back on the slopes. A good program should include both cardiovascular and strength training. Many of these injuries can be avoided with the proper strengthening in key muscle groups of your legs, hips, and core.

2. Select quality equipment:  Improperly fitted or misadjusted gear can cause injury.  Seek out expert advice when purchasing and fitting boots, bindings and skis. Dress in layers and make sure outerwear is functional ie;  made of fabric that is not only water repellent, but slide-resistant. Wearing a helmet significantly reduces your risk of head injury. 

3. Improve your technique: Learning proper technique whether skiing or snowboarding will improve your body mechanics and lead to less injury risk. Injuries are most common in beginner and intermediate level skiers/snowboarders. Taking ski/snowboard lessons will help speed up that process. 

4. Warm-Up: Research studies have shown that cold muscles are more prone to injury. Warm up with jumping jacks, running or walking in place for 3 to 5 minutes. Take a couple of slow and easy runs to complete your warm up.

5. Hydrate/Rest:  Even mild levels of dehydration can affect physical ability and endurance. Drink plenty of water before, during, and after skiing. We also tend to make mistakes and use improper form when fatigued, so make sure to take rest breaks throughout the day. Take time to acclimate to changes in altitude if you are travelling from a different area. 

6. Know your Safety Rules: Understand and abide by all rules of the ski resort. Know general safety rules of skiing, such as how to safely stop, merge, and yield to other skiers/snowboarders. Stay on marked trails and avoid potential avalanche areas.

7. Be Aware: Watch out for rocks and patches of ice on ski trails. Make adjustments for icy conditions, deep snow, powder, and wet snow. Pay attention to warnings about upcoming storms and severe drops in temperature. Make good decisions about the areas you intend to ride based on your ability level and the snow conditions that day. 

This article was intended to provide general information only and are not a substitute for your own good judgement or consultation with a physical therapist.

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The Fascinating Importance Of Good Posture

What is Good Posture?

Posture is basically the position in which we keep our body standing, sitting and even lying. A good posture ensures that our whole body is symmetrical in alignment and that the muscular tension is correct. And maintaining good posture should be quite easy.

Furthermore, posture refers to the alignment and positioning of the body with respect to the ever-present force of gravity. Whether we are standing, sitting or lying down, gravity exerts a force on our joints, ligaments, and muscles. Good posture involves spreading the force of gravity within our body so that there is no overstress on any structure.

Your posture affects the way you walk, run, jump, lift weights and perform other skills. Due to the importance of good posture such as ease of movement, a good balance between muscle strength and flexibility, good spine positioning and proper functioning of internal organs, you will feel good.

In addition, good posture means maintaining the two natural curves on the back.  The first curve is the concave curve from the base of the head to the shoulders. The second curve is the concave curve from the top of the back to the base of the spine. It’s like the 2 C shape in the back.

When you are in the correct posture, it should feel almost effortless to maintain the position. When you stand up, the weight of your body should be distributed evenly over the soles of the feet (not on the heels or in the front).

What Constitutes A Good Posture?

Because of the importance of good posture, maintaining it should not be seen as a massive mental task or a constant nuisance. In fact, the design of the body is to unconsciously maintain a normal posture through certain muscles. Although you should be aware of your posture to some extent, here are some tips to help you.

Sitting properly: Make sure your feet are on the floor or on a footrest instead of hanging in the air. Keep your knees at or below your hips. Also, keep your shoulders relaxed with your forearms in a parallel position to the ground and your backrest should support your entire back.

Stand up correctly: Make sure your weight is supported by the soles of the feet, with the feet 4 to 5 inches apart. Tuck in your stomach and keep your hands hanging naturally from the sides of the body. Maintain a straight and tall structure.

Preferable lying position: An important secret to sleeping well is to have a good comfortable mattress. If you prefer a hard one, it is good enough. Also, if you feel comfortable with a softer one, then it is fine too. Continuously support your head with a pillow that is raised in relation to the rest of your body to facilitate blood circulation. Also, avoid lying on your stomach.

Importance of Good Posture

1. Improves circulation and digestion

When you are standing or sitting with your body in proper alignment, all your organs can function properly. This includes your stomach, therefore, one importance of good posture is it can improve digestion. With respect to the digestive system, good posture allows the internal organs of the abdomen to assume their natural position without excessive compression. Excessive compression can interfere with the normal flow and functioning of the gastrointestinal tract. Inadequate posture has been postulated as a contributing factor to various digestive problems such as acid reflux to constipation and even hernias.

2. Help your muscles and joints

Good posture helps us keep bones and joints in proper alignment so that our muscles are used properly. This decreases abnormal wear on joint surfaces, which could lead to degenerative arthritis and joint pain. It also reduces stress on the ligaments that hold the vertebral joints together, thus minimizing the likelihood of injury. Good posture allows muscles to work more efficiently, which allows the body to use less energy and, therefore, prevents muscle fatigue. It also helps prevent muscle fatigue, excessive use disorders and even back and muscle pain.

3. Eliminates back and neck pain

When you have good posture, your bones and spine can balance and support your body weight easily and effectively. When you have poor posture, your muscles, tendons, and ligaments must constantly work overtime to support this same weight. This additional and ineffective effort can cause back and neck pain. It can also cause tension headaches. Focusing on improving your posture can be a great help in addressing these problems.

4. Improves breathing

Another importance of good posture is that it improves breathing. To function effectively, your lungs need space to expand in your chest. Whenever you slump over, your rib cage collapses a bit, leaving less room for your lungs to open, resulting in ineffective breathing.

5. It improves memory and learning

Recent research has shown that there may be a link between good posture and memory retention when learning new things. It is theorized that good posture improves your breathing. Thus it allows you to take more oxygen, and when you take more oxygen, your cognition improves.

6. It gives you a taller and slimmer look

Certain positions of bad posture bring out your belly, giving you a “beer belly” profile. And the sag makes you look smaller than you actually are. Standing straight will correct these problems and improve your appearance.

7. It makes you look confident and powerful

Research shows that tall and fit men are not only considered more attractive by the opposite sex but also earn more during their lives than smaller and overweight men. While there isn’t much you can do about the height God has given you, you can make the most of what you have by standing with the right posture.

Lastly, an open and straight position is simply perceived as more authoritative and dominant.

You see this even with animals. When chimpanzees or dogs are subdued, they bow their heads and become small. Dominant animals, on the other hand, stand upright and take up more space. An upright posture is a “power pose” that transmits trust and status to other humans.

8. It makes you feel confident and powerful

Apart from the fact that good posture makes you look confident, its other importance is that it actually makes you feel confident. This is one reason why the military has focused for more than a century on posture training for its soldiers. They saw that staying upright improves the morale of the troops. Now modern researchers have begun to demonstrate this intuitive observation.

Studies have emerged that highlight the power of the mind/body connection and, in particular, how physical posture and body language affect how we feel mentally and emotionally. What researchers are discovering is that not only will good posture make you look powerful to others but it also makes you feel powerful to yourself.

The reason is simply the presence of testosterone. In her book, Presence, social psychologist Amy Cuddy highlights studies that show how “power postures,” including standing with a good upright posture, increase testosterone and decrease cortisol in the body. On average, assuming a power pose causes a 16% increase in testosterone and an 11% decrease in cortisol in minutes. This will make people feel less anxious and safer. She and her research team discovered that after assuming a powerful pose or simply standing with a good upright posture, individuals were better able to assert themselves, be proactive and comfortable taking risks.

If you suffer from passivity and lack of motivation, start focusing on your posture. It is not a quick fix, of course, and it will not immediately make you a confident and assertive. But it can help, and it is so easy to do that there is no reason not to try.

9. Improves concentration and mental performance

A Colorado College study found that male students with the best sitting posture scored significantly higher on the test than students who slouch.

The increase in concentration and mental performance is probably caused by the increase in testosterone and the decrease in cortisol levels we have just mentioned. As Dr. Tomi Ann Roberts, lead author of the study, concluded: “An upright posture makes people feel dominant and successful, which improves their ability to relax and focus on problems.”

Therefore, one importance of having a good posture is that it can help improve your concentration levels.

10. It improves the mood

Yet another importance of good posture is that it improves one’s mood. Standing and sitting with good posture can not only make you feel more confident and more powerful, but it can also increase your happiness. One study found that when people take up slumpy and slouchy postures while being asked to remember memories, they were more likely to remember sad and depressing episodes. People in an upright position, on the other hand, were more likely to remember happy and positive memories.

11. Healthy spine

One other importance of good posture is that it helps you have a healthy spine. Correct posture is very important to keep the many complex structures of the back and spine healthy. Support is especially important for people who spend many hours sitting in an office chair or standing throughout the day.

If good posture and adequate back support are not maintained, tension can be added to the muscles and pressure on the spine. Over time, the stress of poor posture can change the anatomical characteristics of the spine. This will lead to the possibility of narrowing of the blood vessels and nerves.

Having proper postural alignment will allow you to work more efficiently. There will be less fatigue and tension in the ligaments and muscles of your body. Being aware of good posture is the first step in breaking old habits of bad posture and reducing stress and pressure in the spine.

How to Achieve Good Posture

Having read the importance of good posture, it is necessary to know how to achieve it. Your overall goal with posture is to have a neutral spine. I will show you what to focus on to get that neutral spine when you are standing or sitting.

To achieve correct posture while standing, the ears, shoulders, hips, knees, and ankles should line up in one straight line.  A big problem that people have with achieving a neutral spine is getting the shoulders to line up where they should be.

It is of great importance to achieve good posture while standing. Here are some tips:

Weight should be distributed evenly on both feet while standing. If someone can push you down and easily make you lose your balance, then your body weight is not evenly distributed between your feet.

Viewing from the side, your ear, shoulder tip, hips, and ankles should line up vertically with each other.

The chin should be parallel to the floor.

When viewing yourself from the front, your left and right shoulders should also be aligned, just like your left and right hips.

Sitting incorrectly is the most damaging to your posture. Instead of using your skeleton to support your weight, you let your chairs do all the work. Unfortunately, this tends to make you slump and slouch. Combining this with the way you hunch over your computer to get closer to the screen, and you will have a very bad posture.

Therefore, it is of great importance to maintain good posture while sitting. Although this is more difficult than standing. The first thing you can do to reduce the time you sit. Take a break every 30 to 45 minutes to get up and move your body. Go for a walk and do some stretching or even jockey training in the office. If your office allows it, use a standing desk, keeping in mind that standing all day is probably as bad as sitting all day.

To achieve good posture while sitting, you must make sure that:

The ears are above the tips of the shoulders.

The shoulders are back. Do not slump forward. They should be nice and relaxed.

Flat feet on the floor with knees, hips, and elbows bent 90 degrees.

Take frequent breaks to get up and move.

Conclusion

Having a good posture is of great importance. It improves your concentration levels, gives you a look and feel of confidence, helps in keeping your spine healthy among other things.

This Fabulous article was by Chibueze Okwuonu found at thebodyposture.com

Shoulder Pain

In this segment of physical therapy content I would like to discuss shoulder pain including screening, evaluation, diagnosis, and treatment. Shoulder pain can occur for many different reasons. It can be caused by trauma from an impact, including sports collisions, falls, motor vehicle accidents, etc. It can also be caused by lifting and movement injuries that cause immediate trauma to the soft tissues (muscle, tendon, ligament). Chronic conditions that cause shoulder pain can be associated with overuse injuries, poor posture, “wear and tear” related to past injuries and the resultant gradual breakdown of joint structures, or some combination of these 3 situations.

The type of injury that has led to your shoulder pain will have an impact on the type and progression of treatment that is provided during your rehabilitation. An acute trauma may require an x-ray or other form of imaging in order to rule out a fracture or other major injury that will need to be immobilized to allow healing prior to any rehabilitation exercises being performed. Once any fractures or soft tissue injuries have healed adequately, then the introduction of gentle stretching and strengthening exercises can begin and progressed as appropriate, as well as functional activities (those activities that mimic the movements that you perform during your typical day at work or home).

A soft tissue injury from lifting, reaching, or other movement may also require full or relative immobilization initially in order to allow healing to take place prior to rehab exercises. In many cases, soft tissue injuries are able to be managed with the application of the PRICE (Protection, Rest, Ice, Compression, Elevation) protocol initially during the acute stage (0-4 days but could be longer if signs/symptoms of inflammation persist), followed by a gradual re-introduction and progression of rehabilitation exercises.

Shoulder pain from a more chronic (long-term) condition will also likely require relative rest and the PRICE protocol in order for any pain and inflammation to decrease, along with a progression from light stretching and strengthening exercises to more intense exercises and the performance of functional activities.

Regardless of the type of injury or the cause, your body will respond to an APPROPRIATE rehabilitation program by increasing ROM, strength, and function of the involved regions. If strength, ROM, or function digresses as a result of overwork or progressing too quickly through a rehab program, then the program should return to the previous stage of the rehab protocol until the next phase of the protocol can be performed without a significant increase in pain or inflammation, or a decrease in strength, ROM, or function. This is the way to ensure that the rehabilitation protocol will progress without re-injury.

Muscular injuries (like rotator cuff or biceps tears/strains) are more likely when performing a motion yourself is painful, however when someone else moves your arm for you while you are relaxed it does not hurt. This is because the pain is only present when the muscle is contracting and is pulling on the injured muscle tissue.

Injury to the labrum (the cartilaginous ring surrounding your shoulder socket to make it deeper) is more likely to result in popping or clicking with arm movement and is usually painful whether or not your arm is moving actively (using your shoulder muscles) or passively (shoulder muscles are relaxed).

An injury to the AC joint can also result in pain and popping/clicking, especially with overhead motions like a military press.

Shoulder pain can also be a result of impingement of the soft tissue structures of the shoulder, including the rotator cuff complex (the rotator cuff is actually a group of 4 muscles in the shoulder responsible for static and dynamic stability), one of the 2 biceps tendons (the long head and the short head), and others. Impingement injuries are commonly a result of poor posture and scapular positioning which results in friction on the soft tissues with movement that breaks them down. This can be resolved with postural training and and exercise program that promotes ideal joint positioning and biomechanics.

Many cases of shoulder pain and dysfunction can also be related to arthritis and other degenerative process that occurs gradually as we age. Some people develop this faster than others as a result of genetic, dietary, and lifestyle factors. Regardless of the reason for its development, arthritis and degeneration of the shoulder complex can permanently alter the bony and soft tissue structures. In many cases strength, ROM, and functional exercises are beneficial, and will improve a person’s ability to use the affected extremity.

I hope you have enjoyed this general overview of types of shoulder injuries and their signs and symptoms. If you have a new or chronic shoulder injury, I suggest the help of an orthopedic physical therapist as they will likely be able to help you return to the activities you enjoy!

Low Back Pain

Low back pain is the most common reason people come to physical therapy clinics for treatment. There are many reasons for it, including falls, sports injuries, motor vehicle accidents, or just bending forward to pick something up or to tie your shoes. Sometimes low back pain is just there when you wake up one day without any obvious reason. Low back pain can frustrate both patients and health care providers, however there are things you can do to help to decrease your pain and resume your normal activities.

Some of the things to consider when choosing treatments for low back pain include what caused the pain, what is the quality of the pain (is it aching, sharp, burning, etc), how is it progressing (is it getting better or worse?), if there is also leg pain (nerve impingement), which positions and activities make the pain better or worse, and what the goals of treatment are.

What Caused The Pain?

If the pain is traumatic in nature, like in a fall or motor vehicle accident, it may be beneficial to undergo an x-ray to determine if there has been a fracture. If a fracture was sustained then the necessary healing needs to take place prior to any exercises being performed. It is possible for a fracture to also be sustained when lifting, especially when performed by older individuals. Traumatic injuries can result in other low back injuries as well; such as muscle strains, ligament sprains, intervertebral disc injuries, nerve impingements, spinal cord injuries, and body alignment issues.

If the pain started due to lifting, especially when performed from a low position and combined with twisting and without bending the knees, this can lead to muscle strains, ligamentous sprains, intervertebral disc injuries, and nerve impingements.

What is the Quality of the Pain?

If the pain is more of a dull aching then it is more likely that gentle stretches and other exercises may be tolerated. However if the pain is sharp in nature then more healing may need to take place prior to the initiation of stretching and other exercises. If this is the case, then the RICE approach (Rest, Ice, Compression, Elevation) may be beneficial to facilitate the healing process.

Is it Getting Better or Worse?

If the pain is getting better since the initial injury, then this is a good sign that your body is doing a relatively good job of recovering already and this will likely improve your prognosis (your ability to recover). A focused examination and plan of care will help to pinpoint the treatments and exercises that will help you to recover more quickly and to a greater extent, so that you can return to your normal activities.

Are You Also Experiencing Leg Pain?

If you are also experiencing leg pain with your low back pain, then this may be evidence of a nerve impingement in your low back. Nerve impingements can cause pain, numbness, tingling, sensations of hot and cold, weakness, and paralysis in the areas of the leg that the specific nerve is responsible for. Impingement can occur at any location along the nerve pathway, but some common areas of impingement are in the low back, the sacroiliiac (SI) joint, and the hip joint. Weakness and paralysis are the most severe forms of impingement and require immediate attention so permanent damage is not sustained.

What Positions and Activities Make The Pain Better or Worse? How does this affect treatment?

If your low back pain is worse with sitting and forward bending, then it may be associated with a disc issue, and movements that may help to decrease your pain may include backward bending in standing and laying in prone. These exercises are performed to see what the effect is on your pain. If the exercises decrease your low back pain, or decrease and “centralize” your leg pain (move your leg pain up your leg, bringing it closer to your spine), then is is likely these exercises will help you and are added to your plan of care. If the exercises improve the range-of-motion of your low back or improve the strength of any weak lower extremity muscles after performing them, then this is also evidence that may be beneficial. Other core and lower extremity strengthening and stretching exercises are gradually added to the plan of care when appropriate.

If your low back pain is worse with standing and backward bending, then it may be associated with a bony vertebral issue, and movements and exercises that “round” the low back to open up the space between the vertebrae may be beneficial. These exercises include lying on your back and pulling your knees to your chest or sitting in a chair and forward bending. If these exercises help to decrease your low back and/or leg pain or symptoms (numbness, tingling, etc), and/or improve low back range-of-motion or leg strength after performing 10 to 20 repetitions, then they can be added to your plan of care. Core and lower extremity strengthening and stretching, as well as sport specific or functional activities are included in the plan of care when appropriate.

Note: If these exercises make your low back or leg pain worse, then DO NOT CONTINUE TO PERFORM THEM! This is likely not the appropriate movement pattern for you.

What Are Your Goals?

After determining which movements help with your pain and symptoms, more general strengthening, stretching, and functional exercises should be added to the plan-of-care depending on what level of function you need to return to. Do you only need to return to a desk job and have a more sedentary lifestyle? Then basic core and lower extremity strengthening and stretching may be sufficient. Do you need to return to a construction job requiring heavy levels of activity and lifting? Then you’ll likely require more intense core and lower extremity strengthening, ergonomic lifting technique training, and other job-specific training to ensure a safe and effective return to work. If you need to return to a specific sport, then your rehabilitation will include the appropriate sport-specific training and activities to ensure a timely and effective rehabilitation.

I hope this article was informative. Do you have questions or comments? Please add them below.

Lower Crossed syndrome

Lower crossed syndrome is a postural condition in which the hip flexors are tight and pull the pelvis and lower trunk forward, while the abdominal muscles are weak and lengthened, further allowing the lower trunk to move forward.  In addition to this, there is tightness of the low back extensor muscles, which act in bending the trunk backward.  The last element of lower cross syndrome is weak gluteal muscles, which further allow the pelvis to rotate in a forward direction.  This syndrome results in increased compression of the lumbar spine and can cause back and lower extremity pain, and even upper extremity pain as postural and alignment issues can easily affect other areas of the body.  

To improve posture and rid yourself of lower crossed syndrome, stretching of the hip flexors and low back extensors, coupled with strengthening of the abdominals (especially the deep abdominals) and the gluteal musculature would be a good start.  For more specific instructions on how to improve your specific type of lower crossed syndrome, see a physical therapist for individualized care.

Upper Cross Syndrome

Upper Cross Syndrome is a postural condition in which both the head and shoulder blades move in a forward position, with excessive curvature of the upper back between the shoulder blades.   This lengthens the muscles of the upper back and the front of the neck, while shortening the muscles of the chest and back of the neck.  This position also takes space away from the rotator cuff and biceps tendons, and can place pressure on these structures, with the potential to cause pain and even damage resulting in rotator cuff inflammation, scar tissue development, and even tears!   Upper Cross syndrome can also cause impingement of the soft tissues and nerves in the neck, potentially resulting in pain, numbness, or tingling in the arms and other areas of the body.  It can also contribute to headaches associated with impingement and tight neck musculature.  Sitting for long periods of time in a slumped posture during the day, such as with jobs that require sitting at a desk or driving, contribute to this syndrome.  After the body is in this position for long periods of time, the tissues adapt to the positioning of the bones, making it more difficult to correct.  However, there are some simple exercises that can help to return to head, shoulder blades, and upper back into the ideal position.  These include doorway stretches to stretch out the chest musculature, cervical retractions to bring the skull back into the correct position over the neck and shoulders, and strengthening of specific muscles attached to the shoulder blades that bring them toward the spine and down ward (middle traps, rhomboids, lower traps), as well as postural training in both sitting and standing.