Waterloo Chiropractor, Waterloo Physiotherapist, and Massage Therapist (RMT)

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The quest to give a more complete view of strength training and endurance sports continues!

In my first two articles in this series, I discussed the impact of strength training on your ability to consume oxygen (no major impact) and the impact on running economy.

In the article on strength training and running economy, I explained how 8-12 weeks of 2-3 sessions/week is required to see any change.  Heavy weight, low rep exercises seem to trump plyometrics and high rep exercises.   On top of this, masters and female runners are more likely to be responders.  I also discussed how simply running more, if you are a low volume runner, should be the first step in trying to get faster (of course there are other benefits to strength training if you are thinking beyond speed). 

Now, since there are so many multisport athletes who read this column, I thought I would address how strength training impacts cycling economy specifically.   Surprisingly, the relationship isn’t quite as clear!

Intuitively, you’d think it would almost be the opposite in the minds of most- that strength training would be more helpful to cycling than to running.  It kind of makes sense to speculate that cycling requires more powerful, larger muscles to smash big gears, while running requires light legs and next-level cardio.  Therefore, lifting weights should help cyclists more, right?  Wrong!

When we look at studies like THIS ONE, we see that cycling economy isn’t something that’s nearly as difficult to develop as running economy.  As studies like this one show, runners with no cycling training tend to have pretty good cycling economy, while cyclists have horrible running economy.  Cycling economy isn’t hard to train, but running economy is!

That’s also why we see that V02max is a great predictor of longer cycling event performance, while V02max does not do a great job of predicting running performance.  

So when we look at the studies on strength work and cycling economy, we get mixed answers. 

Click HERE to read the rest on the Run Waterloo magazine.

Wanted: Physiotherapist Associate 

We are looking for the right physiotherapist to fill a 1-year maternity leave starting in September 2021 with the opportunity to join the clinic long term. 

Hours: 15-20 hours/week or more if desired.  Flexible in terms of days and times. 

We are hoping to find an evidence-based therapist with strong work ethic, who works well independently, is motivated, possesses good people skills, and has a keen interest in the science of injury management with a focus on active care.  Acupuncture is an asset. 

We are also hoping to find somebody who values patient care above all else, and is easy to get along with and contributes to our positive work environment.  We want a great teammate! 

Learn more about our clinic and club we are associated with: www.drdelanghe.com www.health-performance.ca

Included:

  • Jane practice software
  • Full time reception during regular office hours
  • Access to office after hours 
  • Your own treatment room 
  • Access to gym space for 1-on-1 sessions 
  • TENs and acupuncture needles 
  • Payment: Percentage split with ceiling 

Send Resumes to: info@drdelanghe.com

Dear Patients,

It’s time for an update.  As many of you already know, our staff is contributing to Canada’s dwindling population growth!

We’re excited to let you know that Dr. Sean and his wife are expecting their first child in early August, while physio Sayaka and her husband are expecting their first in September.

That being said, we want to make sure you all are taken care of during this busy time. 

What this means for office hours:
(1) Dr. Sean along with reception will take the first week of August off with reduced hours in August.  

  • If the baby comes as expected, no changes will be made.  
  • If the baby comes at a different time your appointment will have to be moved accordingly- we apologize for any inconvenience this may cause! 
  • During the time Dr. Sean is off, physio and RMT will still be available at the clinic if you are in pain and cannot wait.
  • We will also have an emergency chiro available- details TBA. 

(2) Physio Sayaka will be taking about a year off closer to September.

  • We have high standards! If the right person comes along to cover her mat leave, we will bring them on board.
  • Otherwise, full time hours with Dr. Sean, RMT and occasional hours with physio Kayla will be available to keep you in one piece in the meantime. 


As always, you can book online, call (519) 885-4930 or reply to this e-mail if you you need to reach us. 


Yours in good health,


Dr. Sean Delanghe 


By: Waterloo Physiotherapist Sayaka Tiessen

No, I’m not talking about this season’s hottest Balenciagas, and I’m not even going to get into the carbon plated shoe thing. (Side note: a lot of interesting studies about their efficiency have come out, as have some important discussions about equity in sport.)

We are going to just have a straight talk about your running shoes – what to look for when buying, how to screen for lemons, and injury considerations. Get ready to nerd out!

What to look for when buying

  1. What is the purpose of the shoe you are looking for?
    • A trail shoe for grip and stability? A plush road runner for pounding the pavement? A racing flat or track spike to break the speed of sound? Know what you are looking for to help narrow your search.
    • Stability shoe or neutral? Or dare I say, minimal? This is a complicated question and one where I would look at your previous shoe history and maybe stay within it, unless a change is recommended by your health professional. For example, I know people with pancake flat feet who were put into a stability shoe and it caused more problems for them, so having flat feet DOES NOT mean you need a “motion control” shoe. If you have orthotics, you should go with a neutral shoe 100% of the time so that it can function the way it should. Perhaps get your feet checked out by your health provider if you are in doubt.
  2. Shop when your feet are the largest, and bring anything you typically would have on your feet when you run
    • Your feet tend to get a smidge larger as the day goes on, so plan your trip to your local running shop for the afternoon or later in the day if you can.
    • BYOS – bring your own socks, specifically the types of socks you would wear while running. This will give you a much more accurate feel for the shoe and fit. If you wear orthotics, an ankle brace, or special heel lift in your runners, bring them!
  3. Brand loyalty is ok to a point, but keep an open mind (unless you are sponsored, which I am not).
    • Most companies will tweak their models with each new iteration – new foam! a different upper! a whole new last! There is no guarantee that a shoe will be the same from year to year, meaning it might not provide the same type of ride.
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4. COMFORT IS KING- No matter how much you try to convince yourself, the shoe will not become more comfortable over time. Don’t ignore hot spots, rubbing, and sliding. These will become your nemesis. See how your foot sits on the insert. This is a fun trick I learned from listening to Chris Johnson, a PT legend in the running field. Just take the insert out and place your foot on it. What do you see? If your foot oozes way beyond the borders of the insert, it might be too narrow. In this photo, you can see that my foot is a bit wide relative to the insert, meaning my toes are going to scrunched together once in the confines of the shoe. I have wide feet and finding a shoe that fits is a tough quest, but some brands do fit wider than others (Altra, New Balance to name two).

How to screen for lemons

Sometimes life gives you lemons, and that’s ok if you know how to screen for them to avoid being saddled with a pair of defective shoes. You might get some odd looks if you try these in the store, so bring the shoes home, and in a reasonable, non-Hulk manner, put them through their paces.

The video posted below is a sequence of tests developed by physiotherapist Bruce Wilk. Some of my favorites are:

  1. The Break Test: This is to see if the shoe breaks at the level of the toes and not in a weird place like the mid foot. It shouldn’t be overly stiff either. This does not apply to minimalist shoes as they will fold up like a piece of origami.
  2. The Twist Test: Mostly looking for symmetry here
  3. The Rock Test: This is to see if the shoe is sitting evenly on the surface. Press straight down and apply a bit of a rock left and right. Does one shoe start tilting a lot?

WATCH MORE HERE.

What if I’m injured?

There are some footwear considerations when it comes to dealing with injury. I will mostly be talking about drop, which is the height difference between the heel and the toes. Most shoes will describe the drop in mm. Below are a few considerations about heel-toe drop and how it might play into injuries. These are generalizations, so take it with a grain of salt!

Zero Drop (aka a flat bottom, not necessarily no cushioning. Remember, we are talking about the difference in height between the heel and toes)

  • Places more stress on feet, ankles, and the Achilles, so if you have any issues in these areas, it might be best to avoid this type of shoe.
  • Good if you are dealing with knee issues, or have a stiff first toe because the shoe won’t bias you into slight extension.
  • If you are new to zero drop shoes, it is important to gradually introduce them into the shoe rotation because you will probably get tight calves when you start using them.

Regular Runner with a Drop (the vast majority of shoes)

  • Places more stress at the knee, so if you have cranky knees, consider avoiding this type of shoe.
  • Good if you are dealing with an Achilles injury, or plantar fascia pain because it will put your posterior chain on some slack.

Cushioning or Barefoot/Minimal?

  • Cushioning is best if you are: recovering from an injury (notably any bone stress injury, plantar foot pain), have osteopenia or osteoporosis, are new to running, or are planning on doing the vast majority of your runs on pavement*.
  • Barefoot is something you can work towards if that is what you are interested in. I know people that love the tactile sensation that going more minimal gives them. *you can run in barefoot/minimalist shoes on pavement, but you must give your body time to adapt to the stress.

THE TAKEAWAY?

The most recent studies suggest the best shoe for you if the shoe that FITS, meaning you won’t subconsciously change your gait to avoid that nasty blister on your toe. I know you love that hot new colourway from (insert whatever brand here), but if it has a weird break pattern, or it feels uncomfortable in the shop, it is highly unlikely to EVER be comfortable. Take it from me – I have made that mistake a few times in my career.

Give this post a share with anyone you know who is eyeing up a new pair of kicks. Live in the Kitchener-Waterloo area, dealing with a running injury and want to get a plan in place? Book your appointment here.

Welcome back to my series on strength training for endurance athletes.  Last article took a look at the role (or lack there of) of strength training and our ability to consume oxygen.    

That being said, we still know that strength training does have a positive impact on performance in endurance athletes.  The caveat: it has to be the right type of athlete, with the right type of deficiency conducting it at the right time in training.

So how do we decide how and when to implement strength training?  Learning the science of how it impacts us helps to guide these decisions in the best possible way.  This series most definitely is not a clear-cut, quick-fix answer, nor is it remotely all inclusive.  The more you learn, the more you will realize there is to learn!  Heck, I went to school for 8 years after high school in human-physiology related fields followed by 10 years in working and coaching in the field- and I definitely still feel like the more I learn, the more confusing it can become at times!  

That being said, the more information you arm yourself with, the more you will be able to start to tell the difference between pseudoscientific advice and real, efficient and effective performance-boosting advice.  Our next step toward this direction: How it impacts our exercise economy…  

CLICK HERE to read the rest on the Run Waterloo blog.

By: Sayaka Tiessen, Hons. BKin, MSc (PT)

It’s been a while! Life has been insanely busy the past couple months. You might have noticed on my social media feeds that I have moved my physiotherapy practice to join forces with Delanghe Chiropractic & Health/Health & Performance. Pumped for what this opportunity will bring!

So what’s on the agenda today? In honour of a few patients I have seen recently for a variety of running related injuries, we will be addressing the question: do injured runners run differently?

I will be drawing from an article by Christopher Bramah published in 2018 that looks at this very issue. He compared healthy runners (no reported injury in over 18 months) to injured runners to see if there were any run gait characteristics that were predictive of current injury. He specifically looked at the four most commonly cited soft tissue injuries in the running population: Patellofemoral Pain Syndrome, Iliotibial Band Syndrome, Medial Tibial Stress Syndrome, Achilles Tendinitis.

(Let’s just acknowledge the fact that I haven’t used Microsoft Paint in possibly a decade. How is it still a thing?)
(Let’s just acknowledge the fact that I haven’t used Microsoft Paint in possibly a decade. How is it still a thing?)

You might not have heard of these conditions before, but you have probably experienced them. Here is a quick breakdown of what each of these injuries involve in the simplest of terms:

Patellofemoral Pain Syndrome (PFPS): pain around the patella, aka the knee cap at the front of the knee

Iliotibial Band Syndrome (ITBS): pain at the outside of the knee

Medial Tibial Stress Syndrome (MTSS): AKA Shin Splints (the bane of my existence for many years), pain around the inner part of the bottom 1/3 of the shin.

Achilles Tendinitis (AT): pain at the Achilles tendon.

I have to say, it’s always pretty neat when the findings of a study are similar to what you experience clinically. After analyzing the running biomechanics of the injured and non-injured study participants, Bramah’s team found that the injured runners presented with:

overstride.jpg
A straighter knee and ankle dorsiflexion (toes pulled up to the shin) when landing. This is essentially what we would call overstriding/overreaching while running – your foot is way out in front of your center of mass when you first hit the ground.
forward lean.jpg
Increased forward trunk lean. This can be caused by low back and gluteus maximus weakness/fatigue. We need to strike a balance of leaning forward too much and sitting back like you’re in a La-Z-Boy. Photo is from the Bramah et al. 2018 article.
trendelenburg.jpg
A significant drop in the opposite hip to the one they are standing on, also known as a Trendelenburg. This can be a sign of weakness of the hip stabilizing muscles on the leg they are standing on because they cannot keep the pelvis level. Note that the hip drop was found to be the most accurate at predicting if the runner was injured.

These are pretty important to note because they can actually exacerbate your injury by adding stress to the already injured tissues. Talk about adding insult to injury!

I do have to acknowledge that not every runner is the same. There are some runners that are FAST, have a wicked hip drop, and are totally functional. But as a physiotherapist, it is good for me to keep in mind that these running traits are often present with an injured runner.

What are the implications?

If you are a runner dealing with any type of injury, come in and get assessed. The weather is warming up and nothing is more of a bummer than not being able to get out there and enjoy it.

I do not believe that all runners should run the same way. However, I am not opposed to tweaking your run form to help iron out some of these movements patterns. Gait assessments are a great way to get a second set of eyes on your run form and see if there is anything we can adjust with cueing.

On top of running tips, I always give some homework to help you move better. I typically assign a short list of exercises that are targeted to your concerns – all business, no filler.

Don’t let nagging injuries keep you on the couch! Let’s work together to get you back out there! Click here to book now

By: SAYAKA TIESSEN, HONS. BKIN, MSCPT

In both kinesiology and physiotherapy school, we were taught anatomy. The sheer volume of knowledge was overwhelming. Where does each muscle attach? What nerve controls which muscle? It felt like we were learning everything there was to know about the body. That was incredibly naive of me, as research has plowed on and has shown just how complex our movement systems are.

This post will take a closer look at the infraspinatus, one of your four rotator cuff (RC) muscles. Located just under the boney ridge of your shoulder blade, it is commonly injured, especially in overhead athletes (throwers, climbers, etc).

When I learned about the infraspinatus, we were told that it was a muscle that externally rotates, or turns your arm outward (see below for a picture showing that position) and that it is controlled by your suprascapular nerve. But within the last 20 years or so, researchers have found that the infraspinatus has three distinct regions, each innervated by its own mini branch of the suprascapular nerve; the superior, middle, and inferior infraspinatus subregions.

Why does this matter? Well, turns out that the subdivisions serve slightly different purposes, kind of like how your municipality functions within the province. The province of Ontario has an overarching goals, but Waterloo Region will function in a different way than say the GTA. They also will take on more or less burden depending on the task at hand (regional containment of COVID19 being a prime and timely example). This goes for the subregions too – some sections might turn on more or less depending on the degree of arm elevation, your plane of movement, and resistance.


If that’s the case, then is there a way to make rehab more specific by targeting movements that bias one subregion over another?

I was hoping the answer would be yes, but the research isn’t there yet. It seems as though there are still some discrepancies in the research about which subregion does what. Furthermore, the role of the inferior infraspinatus has yet to be determined.

I have summed up 4 key takeaways below in terms of the roles of the subregions:

  1. All three subregions of infraspinatus are more active the higher your arm is in front of you (eg: they will work harder if you are reaching into a high cupboard, and will work less if reaching for something at waist height).
  2. The superior infraspinatus has a shared insertion on the top of the arm bone with your supraspinatus (another RC muscle that will have its own blog post next). It is thought that both muscles contribute to shoulder stabilization, and that redundancy allows for people to have tears and still be strong.
  3. The middle infraspinatus is more of a pure external rotator.
  4. There is minimal evidence for the role of the inferior infraspinatus.

What does this mean for rehab?

  • When you are dealing with a fresh injury, start with exercises where your arm is low and closer to your body, like farmer’s carries. Any load on your arms will turn on your rotator cuff, and this is the least provoking position to be in.
  • You can start with isometrics (exercises where you are not moving your arm through range) if you cannot even move the shoulder without pain.
  • You don’t have to rotate your shoulder to get your infraspinatus. You can just do an arm raise and it will work all three subregions. The higher your arm, the more the infraspinatus will be working.
  • Generally, strengthening external rotation follows the same principle. The movement of rotating your arm outward will be more challenging the further away your upper arm is from your body (overhead vs tucked into your side).

Check out the video below for 4 different exercises that target the infraspinatus, ranging from lower muscle activation to the most, using the principles I outlined above. Some of these exercises are based on articles published by researchers at the Digital Industrial Ergonomics and Shoulder Evaluation Laboratory at the University of Waterloo (local shout out!).

The next write up will target the supraspinatus – yet another notorious RC muscle that also has 2 subregions despite being super slender. As I eluded to above, superior infraspinatus shares an insertion with supraspinatus, and we will talk about why that is so important for shoulder stability and how you could approach rehabilitation for a torn supraspinatus. Stay tuned!

Sayaka is an evidence based physiotherapist in Waterloo. Click here

to learn more about her!

How long until we officially race again?  I would say probably at least a few weeks, wouldn’t you?  While I’m sure many of you miss toeing the line, there are some positives.  For instance, one of the best ways to take advantage of this extended offseason is to work on weaknesses that are normally tough to address.

Constantly acting in A-race mode, followed by tapering, followed by recovering can definitely result in short term spikes in performance. But often the long term, gradual development is sacrificed.

A great way to take a swing at improving your baseline ability to perform is a full strength program. However, it is not as logical to include when in close proximity to an A-race.  If you’re anything like me, you’ve thought of introducing more strength work throughout the pandemic.  If you’re not like me, you’ve actually done it- good for you, you jerk!

The questions that I get from the team on this topic are endless.  I have written about the topic in short before such as here.  However, I thought it was finally time to take a deep dive into strength training for endurance athletes.

CLICK HERE to read the rest in the Run Waterloo Magazine. 

So, apparently masks are a thing this year!  Despite how much good they can do, there still is some push-back out there.

However, when you look at the evidence, when you’re around other people, if everybody is wearing a mask, the odds of infecting each other goes down.  If you personally are unsure, take a look here, here, here, here, here, here, here, here, here, here, here, here, here, here, here, here, here, here, here, here, here…..

However, a legitimate question that I get asked is how does wearing a mask impact performance when we’re exercising?

CLICK HERE to read the rest in the Run Waterloo Magazine. 

We all get injured.  Muscle strains. Tendonitis. Stress fractures. The list goes on for runners! Not to mention we also have to deal with all the regular life injuries that others have to cope with like headaches, lower back pain and shoulder issues.

Yet, doesn’t it seem that certain people recover faster from injury than others?  Even if two people have exactly the same injury, and do exactly the same things to manage it, the healing time can still be drastically different.

So what separates us?  There is no doubting that physical characteristics, such as age and level of fitness, can impact recovery time.  However, if all things physical are held equal, healing times for the same injury can STILL differ drastically.

Why is this? One possible explanation: the influence of the mind.

CLICK HERE to read the rest in the Run Waterloo Magazine. 

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