Skier's Thumb

A lot of us are eagerly looking outside the window every morning as of mid-November just hoping for that first dusting of snow that signals skiing season is finally close. But as you're packing up your poles and heading off to the slopes, it pays to keep in mind that a great skiing season is one without injury.

While we may hear more about lower body injuries when it comes to skiing, injuries to the thumb are approximated to make up 5 -10% of the total (Foye, 2010), and if not properly managed can have devastating consequences. Skier's thumb occurs when the thumb is forced backwards away from the hand, causing damage to the ulnar collateral ligament that connects the bones at the base of the thumb. The ligament can be fully or partially torn, and sometimes may pull a piece of bone off resulting in a small break known as an avulsion fracture. Simply falling on an outstretched hand can cause this type of injury, but it is much more likely to occur from a fall with a ski pole in the hand, which is why it is strongly correlated with skiing.

Skier's thumb typically presents with pain at the base of the thumb which worsens with any movement, swelling and possibly bruising in the area, difficulty using the thumb to grasp and soreness if you touch along the inner side of the thumb. If you incur some of these symptoms, skip the wait at the doctor's office and book an emergency appointment with a physiotherapist. By asking you specific questions about what happened at the time of injury and by observing the area and performing specific tests, your physio can confirm a diagnosis and help you make a plan for treatment.

If there is any possibility of a break, you will be sent to have X-rays taken. If the physiotherapist suspects that the ligament is fully torn

then you will be advised to see an orthopedic doctor to send you for more testing in the form of an MRI or ultrasound to get an exact picture of the damage. In cases where there is a complicated break or the ligament is fully torn, surgery is essential to repair the lesion. If the ligament is damaged but still attached (a partial rupture), or if there is a small piece of broken bone that has not moved out of place, it can be treated conservatively, that is, without surgery. In these cases you will be immobilized in a brace for around 4 weeks. Your physio will provide treatment to speed up the healing, decrease the pain, help you with your mobility and strength, and finally make sure you are fully recovered before returning to skiing to prevent the injury from recurring. Don't be fooled; the thumb may be a small area but it is essential to have it in top shape for many of your activities, not limited to skiing. Studies have shown that injuries requiring surgery that do not get it may result in permanent disability of the joint (Heim, 1999), so don't risk ignoring your symptoms.

It is great to know what to do in case of an injury, but knowing how to prevent it can save you a lot of trouble. Skiers should be trained to drop their poles before they land from a fall. This simple act will significantly decrease your chance of suffering from skier's thumb. Furthermore, you are safest using poles with finger grooves, without any restraining devices such as a wrist strap.

Finally, if you are returning to sport after a thumb injury, a taping of the joint or a protective brace could mean the difference between hitting the slopes all season long…or being stuck waiting until next year.

Best of luck this season!

Heather Little, physiotherapist, Action Sport Physio West Island

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Sources
Foye, P. Skier's Thumb. eMedicine [online]. Revised Aug 31, 2010. (Cited Dec 8, 2010).

Heim, D. The skier's thumb. Acta Orthopaedica Belgica. Dec 1999; 65(4):440-6.

Fall Prevention 101

As we get older, the chances of suffering from a fall increase. The severity of a fall can range widely. Some falls can cause minor disability, while others can have more serious consequences. Chances are that someone you know may be at risk for a fall.

It is estimated that 1 in 3 seniors above age 65, and nearly 1 in 2 seniors over age 80, will fall at least once a year, leading to disability. This is not something that should be taken lightly.

Here's the good news. Once you identify your (or your loved one's) risk of falls, there are steps you can take to prevent falls.
Here are a few tips to help you identify whether you or your loved one is at risk for a serious fall.

1. Are you taking multiple medications? Some medications, when mixed, can have side effects like nausea that could increase your risk of falling. If you’re not sure, talk to your doctor.

2. Do you have trouble walking? If you regularly experience dizziness, shortness of breath, joint pain, or any other difficulties when you walk, talk to your doctor.

3. Are you exercising regularly? Regular exercise can help strengthen your muscles and improve your balance and coordination so you won’t feel as unsteady on your feet. If you’re afraid of falling while you exercise, your doctor can refer you to one of our physical therapists, who can supervise your exercises.

4. Are you wearing the right shoes? Walking in shoes that don’t fit properly can increase your risk of falling. Avoiding shoes in favor of stockings is dangerous, too, so try to wear proper-fitting shoes with non-skid soles as much as possible.

5. Is your home full of fall hazards?

• Area rugs might add color to your home and uneven carpets may seem inconspicuous, but they can be a hazard. Make sure they have some sort of slip-resistant backing to them, even if you just use double-sided tape to secure them to the floor.
• Remove clutter from walkways.
• Tape down electrical and phone cards so you don’t trip over them.
• Use non-slip mats in your bath and/or shower.
  

Shed Some Light

It’s easy to trip over objects that you can’t see, so make sure that your home is well-lit.

• Use 100-watt bulbs whenever possible (make sure that you don’t exceed the wattage rating on your lamps and other lighting fixtures to avoid a fire hazard).
• Place a lamp next to your bed that you can switch on if you need to wake up at night.
• Install night-lights in your bathroom and hallways.
• Make sure your stairways are lit as well, and turn on the lights before going up or down stairs.
• Keep flashlights in easily accessible places in case you lose power.

Balance Exercises Help Decrease Risk

Your physical therapist can teach you the appropriate balance exercises, which can help prevent falls by increasing your stability. Here are a few you may want to try. For best results, please consult your doctor and physical therapist before your start any exercise routine.

• Standing on one leg:

• Stand next to a chair or desk and hold onto it with both hands
• Maintain your balance on one leg for 5-10 seconds
• Rest and repeat 5 times 
• Perform with opposite leg

• Walking heel-to-toe:

• Stand by a wall or in a hallway
• Position your heel just in front of the toes of the opposite foot each time you take a step
• Your heel and toes should touch or almost touch with each step
• Walk 10 feet with as little support from the wall as possible

A WORD OF CAUTION:

If you (or a loved one) feel unsteady on your feet, see one of our skilled physical therapists for reducing your (or your loved one's) risk of falls. Our therapists can also recommend balance exercises that are just right for you, based on your current physical condition. Call us today to learn what we can do for you. Our therapists are standing by to assist you.

Call today to see how we can help you be more mobile and be more independent with your daily activities.

10 Golden Rules to Avoid Running Injuries

1. Keep it simple

Be careful not to over treat and complexity of an injury. Avoid repetitive treatments that offer no progress. Avoid surgery. Orthotics should not be your primary option. Be sure to use simple, flat running shoes.

2. The body adapts!

The body adapts as long as the given stress is no greater that its capacity to adapt. The majority of overuse injuries come from a surcharge on the anatomical structures (bones, cartilage, tendon, muscle...). Therefore, every new stimulus must be integrated progressively (volume, intensity, difference in height, surface, new shoes).

3. Efficiency is in the rhythm!

It is preferable to increase the number of steps to over 170 steps/min in order to minimize impact, loss of energy and the risk of injury while maximizing stride efficiency. Quality training (intervals, threshold, etc...) should be located anywhere between 180 and 185 steps/min.

4. The Kenyan surface

Flat surfaces (road, track, treadmill) cause regularity of movement in every stride, which means a repetition of biomechanical weaknesses. Cross-country is the best surface because it is a firm and irregular surface offering a wide variety of movements in the lower limbs.

5. Warming up: The secret of the pros

In order to prepare for training, you must: increase the temperature with progressive jogging for 15 to 20 minutes and progressive ballistic stretching (educational and progressive tempos).

6. Stretching: yes and no!

Pre-training static stretching should only be practiced IF muscular restrictions affect the biomechanics enough to create pathology or a deterioration of mechanical efficiency.

7. Naturally strong

Barefoot running or walking as often as possible is a good way to solidify the support structures responsible for natural absorption... and prevent a number of injuries. The body can also be solidified with a stabilisation, strengthening and proprioception program.

8. Variety of activities, variety of movements, variety of stress...

Complete rest is rarely the best treatment when injured. A change in activity is recommended as soon as possible, i.e. painless cardio.

9. We are what we eat / a healthy spirit in a healthy body

The foods we eat are the constituents of our bodies. Quality, variety and balance are the key words when talking about an athlete’s nutrition. Pleasure, positive attitude and good living habits have a direct influence on the body and its injuries, through complex physiological systems (hormones, nervous system, etc.).

10. Keep yourself well surrounded

Whether you are an elite athlete or an occasional jogger, your medical well-being must be assured by a competent, specialized and understanding health professional. For these precise reasons, a runner must never accept final recommendations from health professionals (Physio, Chiro, MD) who are not runners themselves.


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Adapted by Éric Boucher, these tips are derived from the Prevention of Running Injuries seminar by Blaise Dubois, consulting physiotherapist with Track and Field Canada.

Back Pain

Did you know that we bend and twist our spinal column 1500 to 2000 times per day and that 35% of the positions we use are hurting us? It’s not a surprise that this delicate area composed of 33 vertebras is susceptible to so many injuries. Back pain is the most common health problem in our society. Nearly 80 % of the population will suffer from severe back pain and for 10 %, it will become a chronic problem.

Several factors are at the origin of back pain: micro traumas generated by bad repetitive movements, stress that creates muscular tensions and contractions, extra weight which compresses the vertebras and tires the spinal column, bad posture, etc. Back pain can also be caused by various pathologies (scoliosis, osteoarthritis, herniated disc, osteoporosis, etc). The majority of back pain is attributed to misuse and bad life habits.

Being sedentary brings about bad muscular tonus, poor posture and does not promote fl exibility. Your back needs to move and to be in motion to maintain its strength and its mobility. To maintain your back in good condition it is essential to exercise. Activities that are most recommended: walking, swimming, biking (in sitting position with a straight back),yoga, pilates, stretching and muscular reinforcement adapted at a moderate intensity. At work, take a few minutes to get up, walk around and stretch. By strengthening muscles (abdominals, lumbar, buttocks muscles), you increase your endurance and your muscular control, which decreases the risk of potentially hurting your back.

These recommendations apply to occasional back pain episodes and chronic pain episodes. However, it is always better to consult a health care professional in order to avoid aggravating your symptoms or condition. In the case of acute pain due to trauma or a bad movement, lots of rest and control of the symptoms is recommended (ice, medication, analgesics, etc.). Once the crisis has passed, it is imperative to be guided back to your daily activities to avoid a relapse or recurrences. Contact a physiotherapist who will be able to evaluate your condition and to recommend a plan of treatment and exercises that will correspond to your personal needs.

Written by Rémi Bergeron, physiotherapist at the Downtown Montreal Action Sport Physio clinic.

June is Athletic Therapy Month

What is a certified athletic therapist and what can he/she do for me?

In Canada, a Certified Athletic Therapist - CAT(C) is a health care practitioner devoted to the prevention, identification, intervention, management and treatment of emergency, acute and chronic musculoskeletal conditions and injuries to the physically active sustained either at work or through involvement in recreational or sporting activities.

An Athletic Therapist (AT) optimizes the ability of professional, amateur and recreational athletes to perform at their best through sport specific training, injury prevention and rehabilitation for rapid return to work or play. An Athletic Therapist also works in occupational and industrial settings to enhance the health and performance of individuals in the work force.