General Advice (tips)

When the weather strikes sports…

Lightning kills more people directly than any other weather phenomenon. In the United States, it kills 100 people and injures hundreds more each year.

Lightning is an enormous danger to physically active people, due in part to the prevalence of thunderstorms in late afternoons and early evenings which coincide with a busy time for outdoor activities in our society.

The activities the most at risk are: hiking, boating, golfing, cycling, horseback riding, tennis, baseball and soccer.

As with any injury, prevention is the key. Try to get the weather forecast in advance and schedule your activities accordingly.

If caught in a thunderstorm and feel lightning is about to hit you, crouch on the ground, with your feet together, hands around knees, and bend forward. Don’t lie flat.

Stay away from tall objects (trees, telephone poles…) and from objects that conduct electricity (golf clubs, medal fences, bicycles, fishing rods…) If you are in a group, keep distance between each other.

Most importantly, always remember the 30-30 rule:

  • When you count 30 seconds or less between lightning and thunder, head for a shelter…

  • Remain in the shelter for 30 minutes after the last clap of thunder.

Play safe, stay healthy!

Too much exercise… So little time!?

The last recommendations for exercise prescription is that everybody should do between 30 to 60 minutes of aerobic exercise of low to moderate intensity on MOST of the days plus three sessions of strengthening exercise weekly.

For many of you it sounds like Mission Impossible! I hear you saying: “I don’t have the time”, “I’m too tired when I get back from work to go exercise”, “I need to spend time with my kids or my spouse”, etc… But daily exercise should be part of your life just like sleeping, eating, taking a shower… Do you ask yourself if you have time to shower? No… You just TAKE the time to do it. Exercise should be the same. You have to prioritize. Put it in your schedule and stick to it just like if it was an appointment.

The minimum of 30 minutes doesn’t have to be done all at once. If you have a busy schedule, you can do 2 bouts of 15 minutes or 3 bouts of 10 (ex: get up 15 minutes earlier in the morning and go for a walk, than do another 15 minutes walk during your lunchtime)

You feel too tired? Exercise will give you energy to finish your day. If you exercise right after work, you will unwind and be fresh and energized for the rest of the day.

You need more time with your kids or spouse? Exercise with them. Meet your friend for a coffee and go for a walk.

You find exercise boring… do something you like at the same time: read a magazine, watch your favorite TV show.

The key is to plan your exercise daily, add variety and stick to it, no matter how busy or tired you are.

Eventually, you will get the benefits of exercise, it will become a second nature and it will part of your life just like brushing your teeth!

Growing pains?

Is children leg pain really coming from growing?
Since every child grows and not necessarily have pain and since their arms are growing… pain free, it makes wonder if the growth is the real cause of pain.

Most of the time, the pain is felt in the legs or knees and is worse in the evening or night after a lot of running and jumping during the day.

Very often there is a cause to the pain and if we correct it, the pain goes away.

It could be misalignment of the feet (for example, overpronation), leg length difference, muscle imbalance or lack of flexibility.

Since the bones are growing faster than the muscles and tendons, this period is a time of increased tightness and if the child has tight muscles already, it’s going to be worse. We see that more with boys than girls because they generally tend to be less flexible.

On the other hand, during their growth, the girls’ pelvis get wider and this puts a lot of pressure on their knees especially if their hip rotators are weak so they need to increase their core and hip strength to avoid knee and leg pain.

Rare other causes are bone tumors (benign or not) and referred pain from hips or back.

In conclusion, if your child complains constantly of pain after activity, have him or her seen by a sports medicine doctor to rule out any disease and get proper advice for possible orthotics and exercises.

Tight hamstrings?

You can’t touch the floor when you bend forward? You have chronic low back pain? You are a runner or your physical activities involve a lot of running?

If so, then you might have tight hamstrings. Hamstrings are the muscles in the back of your thighs, responsible for bending your knees and extending your hips. They insert on the ischial tuberosity (sitting bones). They are big and strong muscles that tighten easily. That’s why it’s so important to stretch them regularly.

A common mistake when stretching the hamstrings is to bend the lower back and reach for the feet (see fig. 2 and 3).

Figure 2 and 3

This can put your back at risk for injury and it does not maximize the stretch in the hamstrings.

The best way to stretch your hamstrings is to isolate them while having the low back in a neutral position (fig.1)


I refer you to the March ‘06 tip of the month for the generalities on stretching if you want more information. Make sure you incorporate this proper hamstrings stretching exercise in your routine.

Hamstrings stretch:

  • Lie down on your back
  • Bend both knees
  • Keep a slight arch in your low back all the time (“sway”)
  • Bring your thigh at 90° and hold it there (A)
  • Flex your foot (extend your ankle) (B)
  • Hold the back of your thigh with both hands and extend your knee slowly until you feel the stretch in the back of your thigh (C)
  • Hold for 30 sec.
  • Repeat three times on each side.

A stitch in the abdomen

You made a resolution for the New Year and decided to start jogging to be more fit, to lose some weight and to get healthier. But every time you run, after few minutes, you get a stitch in your abdomen and it forces you to stop…

Most often, for beginning joggers, the stitch is secondary to a diaphragm spasm. The diaphragm is a big membrane splitting your thorax from your abdomen and this is in fact a muscle! Its role is crucial for breathing and as with any muscle, you need to train it and to get it adapted when you start exercising.

The most common mistake is to start too soon, too fast. So when a stitch happens, the best thing to do is to slow your pace, and to massage the area with your fingers. Usually, the pain will go away and you will be able to resume your activity. If the pain doesn’t subside, it might be a symptom of thoracic spine dysfunction, poor core strength or pelvic obliquity. Sometimes, a leg length discrepancy is the cause of the symptoms.

Other rare causes are kidney stones (dehydration during activity can increase the pain) or mesenteric ischemia (lack of blood flow in the bowels).

Be patient, massage your abdomen, increase your speed progressively and if the stitch doesn’t go away, consult with your sports medicine doctor to rule out any misalignment, spine or pelvis dysfunctions and any unusual cause of abdominal pain during exercise.

Exercise Prescription During Menopause:

Lately, women have been worried about the risks of taking Hormone Replacement Therapy (HRT) to help relieve symptoms of menopause. Since the WHI (Women’s Health Initiative) studies published in 2002, women have been told that HRT is not for everyone and should only be taken for a short period of time. Women wonder what other options are available to relieve acute symptoms of menopause (hot flashes, vaginal atrophy, mood disturbances, insomnia) and also how to prevent the long-term risks of osteoporosis and cardiovascular diseases (CVD) in a way that will not be harmful.

There is a very natural way to achieve relief, with no side effects. It is called EXERCISE. Exercise plays a crucial role in treating menopausal symptoms and prevention of major health events (cancer, CVD). No other medication, supplement or food has such a wide range of influence during menopause.

It is already known that being sedentary is a risk factor for CVD. The regular practice of exercise has a DIRECT prevention effect, and also an INDIRECT positive effect by decreasing the other risk factors for CVD (HBP, diabetes, hyperlipemia, obesity). It has been proven that regular exercise reduces the risk of breast cancer, colon cancer, and other cancers related to obesity (uterine, gallbladder), as well as the risk of getting gallbladder stones and osteoarthritis. Weight-bearing activities (walking, dancing, running) and resistance activities (weightlifting) prevent osteoarthritis by increasing bone density.

As for taking care of acute menopausal symptoms, exercise has positive effects on almost every one: reduction of vasomotor symptoms (night sweats, hot flashes), reduction of weight gain frequently seen during menopause, reduction of irritability, anxiety and depression, reduction of fatigue, increased libido and added concentration.

Urinary incontinence can be treated with KEGEL exercises (pelvic floor strengthening exercises), if done on a regular basis.

The exercise prescription for menopausal women is 30 minutes of moderately intense aerobic exercise, meaning an activity done at a mildly difficult perceived effort (55-65% of maximum cardiac pulse), ideally each day of the week. This is the same prescription recommended to the general population by the Centers for Disease Control (CDC) and the American College of Sports Medicine (ACSM). Those 30 minutes can be split during the day (ex: 3 x 10 minutes) providing the same benefits. The best aerobic activities are those involving large muscle groups: cycling, walking, jogging, dancing). Swimming and aqua fit classes are good for fitness, relaxation and for obese people, but should not be the only exercise, since they are not helping to prevent osteoporosis.

Strengthening exercises are also part of the prescription: 2 to 3 sessions each week involving 6 to 8 targeted muscle groups (upper body, lower body, core), 1 to 3 sets of 8 to 10 repetitions for each group. Recommendations for stretching are 2 to 3 sessions per week, 3 to 4 repetitions of 30 seconds per exercise.

Yoga is a helpful form of exercise during menopause. It increases flexibility, balance and strength and also has some psychological benefits, such as reduction of stress.

A recent study showed that to obtain the best benefit of sleep for menopausal women, exercise should be moderate in intensity, more than 30 minutes in duration and ideally performed in the morning.

The frequent weight gain seen during menopause is related to lack of estrogen, combined with change of habits (more sedentary). We know that for each day or 2 of inactivity per month, weight gain is as high as 3 pounds per year. Because the weight gain localizes mainly at the waist, it is more than an aesthetic concern to avoid this gain. It has been shown that the amount of fat in the abdomen is directly related to CVD and hormone-dependent cancers.

The best way to lose weight on a long-term basis is the association of diet and exercise, mainly because exercise increases and protects the fat-free mass to maintain the basal metabolism. Even if there is no weight loss, with the regular practice of exercise, it helps protect against the complications of obesity and particularly against the risks of breast, uterine and colon cancers. A study published in 2003 showed that women walking between 1.25 and 2.5 hours a week, were reducing their risk of breast cancer by 18%. The benefit was even greater for women who walked more often, or if their body mass index (BMI) was lower than 25.

FIT AND FAT is healthier than THIN AND INACTIVE. This is truer than ever during menopause!

Wrap Up


30 minutes, ideally every day

At least one weight-bearing activity (ex: walking)


3 sessions per week

1-3 sets of 8-10 repetitions per exercise (6-8 groups, including the core muscles)


3 sessions per week

3 to 4 – 30 second repetitions per exercise

OPTIONAL (but recommended)

Pelvic floor exercises (KEGEL)

Yoga or other stress-relieving activity (meditation, deep breathing techniques)

Calf strain (tennis leg)

You feel a snap in your calf after a sudden move in basketball, soccer, ultimate Frisbee… (It doesn’t have to be tennis!) You can’t walk any more and wonder what’s going on…

You probably got a strain of your medial gastrocnemius (the muscle belly in the inside of your leg), which is the most frequent cause of calf sudden pain during activity.

First thing to do is RICE: Rest, Ice, Compression and Elevation. If you have a bruise and still have difficulty walking on the next day, the strain can be more severe and you could have a tear (either in the muscle belly or at the musculotendinous junction). It could also be an Achilles tendon tear or a Plantaris Brevis muscle rupture (Plantaris Brevis is an accessory muscle located deep in the calf, is not present in every body and its tear could be quite debilitating for a few weeks). In presence of those symptoms, it’s highly recommended to consult with your sports medicine doctor to assess the extent of the damage and undergo an MRI or ultrasound if necessary.

If the strain is mild, gentle stretching and gradual return to sports is recommended. If the strain is moderate to severe, or if there is a muscle tear, rest is mandatory. Compressive taping, modalities and rehabilitation will be prescribed before returning to play.

By all means, it is important to AVOID heat, deep massage and a rapid return to activity which can cause more damage (tearing) and/or calcification of the muscle (a complication called ossificans myositis).

If you are prone to calf strain, it might be important to assess your legs and pelvis alignment, your flexibility and also rule out there is not another issue (ex: lumbar disc problem) causing chronic spasm in your calves and putting you at risk for the strains.

If the pain didn’t start with activity, or if you don’t recall a traumatic event, your doctor might order a Doppler to rule out a DVT (Deep Vein Thrombosis).

Finally, if you want to prevent this injury, correct any misalignment, warm up properly, stay well hydrated and make sure you stretch your calves regularly.

Let’s Talk about Your Breasts & Exercise:

The main component of the breast is fat. The volume of the glandular tissue by itself is the same for every woman. Generally speaking, active women have a lower percentage of fat and therefore smaller breasts but this can vary due to genetic tendencies. This being said, it is usually impossible to predict the size of the breast according to a particular percentage of fat.

At the superior aspect of the breast, there are Cooper’s ligaments which are an extension of the deep muscular fascia of the thorax. These are not “real” ligaments but they exist to hold the breast over the ribs. Since there is no muscular support to the breast, it is affected by gravity. This is the main reason you should support your breasts during exercise. Studies of motion were done during walking, running and jumping. During walking, women with A or B cup breasts had almost no vertical motion of their breasts and did not need much, if any support. Women with a size C cup or larger needed a bra to limit this vertical motion. This motion is greatest with jumping and running. All women should wear a sports bra for all sports involving these activities.

Twenty years ago, the “Sport Bra” didn’t exist. It was invented in 1977 by using two jock straps. Today, the choices are unlimited. Here are some suggestions on how to find a good sports bra.

  • Support limiting motion in all directions to a maximum of one inch
  • Wide bra straps for stability
  • All metal should be covered to protect the skin from abrasion
  • No seams at the level of the nipples
  • Breathable fabric with minimal elasticity
  • Possibility to insert a shield protector for contact sports

The other reason to wear a sports bra during exercise is to protect from trauma. Seventy-two percent of female athletes were complaining of breast pain after exercise. The two main causes are lack of support and minor trauma (mainly contusions).

Contusions generally appear more severe than they are, due to the extent of bleeding that causes swelling and bruises. The usual treatment is ice application for ten to twenty minutes, every two hours. A hematoma will need to be drained only if the swelling or the pain keeps increasing, or if there is a sign of infection (possibly an abscess). To be noted, breast contusion doesn’t increase the risk of breast cancer.

The other cause of breast trauma is the “runner nipple”. This is generally seen more in men than in women. The irritation usually shows during a prolonged exercise program when the shirt or seam causes the nipple to bleed. Men can prevent this by putting a band-aid over the nipples or using“Vaseline” like ointment. Women get it less often when they use a well-fitted sports bra.

Cold can also cause injury to the nipples and it is important to wear a windbreaker when the weather cools down.

In conclusion, women should always wear a sports bra when they exercise. The exception is for women with A & B size cups whose exercise consists of walking only. A good sports bra provides good support and breast protection and minimizes the risk of injuries.

Pre-Participation Physical Exam:

It’s time to go back to school and time for the pre-participation exam. For most students and their parents, they need to decide whether it’s in their best interest to make an appointment. It is a good occasion to find undiagnosed medical problems and to get advice for the prevention and treatment of sports injuries. The sports medicine physician will look for all types of different problem areas, such as a possible cardiac murmur; exercise induced asthma, anorexia nervosa, and Marfan syndrome (a genetic condition with a possible fatal outcome of sudden death during activity). The physician will also review any predisposing factors to musculoskeletal injuries such as misalignment, poor flexibility, muscle imbalance and weakness. The doctor will look for any deficit retained from previous injuries, and assess any new injuries. It is also a great time to get baseline data for the following months which could include joint range of motion, blood pressure, weight and height measurements, etc.

The exam will give the physician an opportunity to counsel the patient regarding proper warm up exercises, stretching, nutrition, and early prevention of overtraining syndrome and eating disorders.

Components of the Pre-Participation Exam:

A. History

History is the most important part of the exam. It should include a general medical history (family and personal history, habits, drug, medication & vitamin use, allergies, vaccination status). Additionally a sports history will get details of what sport is being played, the level that the patient is at, and the equipment used. A nutrition history will review eating and hydration patterns; weight fluctuation and screen for the risk of eating disorders. Finally a review of the systems is used to rule out cardiac issues, EIA, GI symptom, anemia or iron deficiency, lingering damage by concussions, musculoskeletal problems, etc…

B. Examination

A general systematic examination should be done including vitals, height and weight measurements, ENT, cardiovascular, respiratory and gastro intestinal systems, completed with a brief neurological exam and visual acuity. In the case of a positive family or personal history answer, the examination would be more in depth in relation to that particular system.

The musculoskeletal examination is done with particular attention to the joints (ROM and stability) and muscles (strength and flexibility). The practitioner would focus on the areas at risk for the sport involved and the previously injured body parts. Patients involved in swimming, throwing sports and racket sports should get a thorough exam of the shoulder and elbow. Sports that affect the hyperextension of the spine (gymnastics for example) should get a complete exam of the spine. Running activities will need to have special attention paid to the spine, knees and ankles. Finally, body alignment and equipment need to be evaluated.

C. Additional Testing

Additional testing will be done depending on the findings, the sport, and the level of participation. For instance, athletes involved in endurance sports might be screened for iron deficiency or anemia.

Body fat assessment is important for many sports and could provide a baseline data for comparison during the season. It has to be used very carefully because it could put some more sensitive athletes at risk for eating disorders.

Peak flow is a test that could be done during an office visit to screen for exercise induced asthma. If needed, it could be completed by more extensive pulmonary function testing.

Visual analysis (i.e. treadmill running) is also a good tool to detect muscle imbalance and misalignment.

In contact sports that have an increased risk of getting a concussion, a baseline neuropsychological testing is recommended before the season to compare with in case of an injury.


A pre-participation exam is very important to all potential and existing athletes. It can rule out any medical and musculoskeletal conditions that could put the athlete at risk for injuries, diseases and even death (in rare circumstances). It is a good occasion for the sports medicine physician to educate the athlete, prevent injuries, and optimize their performance.

After all, the number one piece of equipment for activity is your body. The healthier it is; the better off you’ll be in the long run.

Nutrition for Activities:

Do you ever wonder what to eat and drink before, during and after exercise?

Here are a few tips:


The main goal before exercise is to get optimal hydration and optimal reserve of glycogen (the “sugar fuel” in your muscles and liver).

For the meal before exercise, you should look for food with high carbohydrate content (i.e. bread, pasta, rice, cereal, potatoes, yogurt, crackers and fruit). Try to limit food with high protein content (it can dehydrate) and food with a high fat content (it will slow your digestion). You should also avoid pure sugar content in the hour before exercise since it can give you a hypoglycemic reaction at the beginning of exercise (it increases insulin production). Although you don’t want to take pure sugar in the hour before, it can be taken immediately before the exercise. You shouldn’t drink any alcoholic beverages before exercise since it can impair your coordination, dehydrate, and put you at risk for HEAT/COLD related injuries.

Everyone has a different tolerance and sensitivity to foods rich in fiber (cabbage, broccoli, onion, cauliflower, garlic, cucumber, corn, beans…), or to spicy foods, so adjust your intake of those accordingly. Be careful with caffeine (coffee, tea, coca cola and chocolate) because of its diuretic effect (can result in dehydration). As far as hydration before exercise, water is the best, especially if your work out is lasting less than an hour. You should drink between 10-16 ounces the hour before you begin exercise.


During exercise, the goal is to stay hydrated. Even a small level of dehydration will affect your performance. The best way to do this is to drink small quantities on a regular basis (4-6 ounces every 20-30 minutes).

If the activity lasts less than an hour, water is fine. If it lasts longer than an hour, you need to add sugar and salt to your water. The ideal beverage would have 4-8% of glucose, maltodextrin, or glucose polymers and ¼ teaspoon of salt per 32 ounces. Most of the sports drinks on the market have this content.

If you like, you can make your own drink consisting of the following:

  • 16oz of Water
  • 16oz of Orange Juice
  • 1-3 Teaspoons of sugar
  • ¼ teaspoon of salt

If you want to take sportsgels or other sweets, make sure you drink plenty of water to dilute the sugar and favor its absorption.


After exercise, the goal is to re-hydrate, replenish glycogen (for the liver and muscles), replenish electrolytes and repair damaged muscle fibers. Once again, if the exercise lasted less that one hour, water is fine as long as you didn’t perspire too much. If you exercised for more than one hour, you will need to add more salt to your next meal. To replenish the glycogen, you need to get something as soon as possible after you finish your exercise; ideally within thirty minutes.

Since most of the time people are not hungry after exercise, replenishment is easier with a beverage since they’re not as heavy, and liquid is absorbed faster into the body. The best combination for this post-exercise beverage is 1.5g of carbs/kg (~0.7g/lb) plus 7g of proteins (i.e. if you weight 150 lbs, then you’ll need 11g of carbs and 7g of proteins). A good beverage with this combination could be chocolate milk or a yogurt smoothie.

The first meal after exercise should be taken ideally within two hours and include high glycemic index food, a good source of proteins, salt or salty food (i.e. tomato juice, crackers, nuts, cheese, ham, salsa, ketchup, soy sauce) and a good source of potassium (i.e. milk, yogurt, cheese, oranges, bananas, strawberries, beans, nuts, potatoes).

Last but not least, make sure you drink enough water to keep your urine clear for the remainder of the day and you’ll be ready for your next workout!

Exercise and post-partum: facts and fiction

There are many benefits of returning to an active life after pregnancy. They include: weight loss, higher self esteem, and lower risk of post-partum depression. Many women think they won’t have the time to exercise because their newborn baby will be so demanding. To that I say, “If you can find the time to sleep, eat and take a shower, you can certainly find the time to exercise”. You can go for a walk with the stroller; use a stationary bicycle; a VCR/DVD exercise program… all while your child is sleeping.

If you think you won’t have enough energy to exercise with the sleep deprivation and the added stress of taking care of a newborn baby, you are wrong! Exercise in moderation raises your energy level. Your sleep quality will improve due to more time in a deep phase of sleep and you will feel better!

You may have some concern about when you can start to exercise, or if exercise will interfere with your breastfeeding. Let’s review a few facts and fictions regarding that:

I have to wait 2 months after delivery before going back to my aerobic class. TRUE OR FALSE?

FALSE. You can resume your exercise program as soon as you want after a vaginal delivery. If you have a C-section, you will have to wait three weeks for collagen synthesis before doing any strong abdominal effort. A good rule of thumb is that exercise should not cause or increase pain. For aquatics, you should wait until your vaginal bleeding has ended after a vaginal delivery; when the cervix has closed. Don’t worry about running or jumping; the exercise won’t cause a prolapse of the uterus or the bladder. If you already have a prolapse, you can empty your bladder before exercising to avoid loss of urine during impact sport activities.

If I am breastfeeding and I start running, my milk production can decrease. TRUE OR FALSE?

FALSE. Although exercise is consuming energy, it won’t affect your milk production, unless your caloric intake goes below 1500 calories per day (which is certainly not recommended for breastfeeding women!). Studies have even proven that the milk production is slightly increased with exercise. This is related to the friction of clothing on the nipples that increases the level of PROLACTINE (the hormone which controls lactation). For better comfort, breastfeed or extract your milk before exercising and wear two bras (this is very effective!). This way your breasts won’t be too heavy and you will avoid the grimace of some fussy babies who don’t like the taste of the milk after exercise (high intensity activity produces lactates that can be tasted in the milk).

If I exercise, I will lose weight more rapidly than if I diet only. TRUE OR FALSE?

TRUE. It is well known that exercise, combined with caloric restriction, is the best way to lose weight. It maintains your lean mass and basal metabolism while gradually losing fat. Don’t expect to have the same waistline right away; your abdominal muscles need to be toned and it takes six weeks for the uterus to go back to its normal size. The best exercise regimen will combine aerobic activities (walking, swimming, cycling, etc.) and weight training (core strengthening: back, abdominal and perineum exercises).

Exercise on a regular basis and have fun! You will soon see the results and your baby will have a happy mother!

Shin Splints

Most people refer to pain in their lower legs as “shin splints”.

The term shin splints is a catch-all for many diagnosis’s; but most of the time it is related to pain along the medial aspect (inside) of the tibia shaft. This pain is actually an inflammation of the bone envelope (the periostum) and should be called a periostitis. The most frequent cause of periostitis is repetitive running and/or jumping activities. Too much training done too quickly can result in periostitis. It is almost always associated with improper footing, especially in the presence of overpronated feet.

If caught early on; rest, ice and correction of alignment (either with orthotics or appropriate shoes) will help cure the problem. In addition to the above, you need to make sure that the ankle mobility is normal and that the calves’ muscles are not too tight before you begin your workout program again.

If the problem is not treated early, there can be a continuation of the injury and eventually it can become a stress fracture of the tibia. A stress fracture is a non-traumatic fracture due to microtraumatisms. If the fracture occurs (due to the bone not having enough time to recover and rebuild after a work out), rest would be mandatory and more prolonged than if you treat the problem early on. Again the alignment correction is crucial to avoid the recurrence of the injury. There are some conditions to rule out in the presence of a stress fracture. One of these conditions is if the bone can’t get the supply it needs to rebuild. This can come from a lack of calcium in the diet or estrogen insufficiency that is seen in amenorrheic female athletes.

Other causes of leg pain include stress fracture of the fibula (most common with supinated feet or feet with high arches), and chronic exertional compartmental syndrome. The latter is discussed in another section of the site, but be aware that there are four leg compartments and if the condition is affecting the deep posterior compartment it can be mistaken for a periostitis.

Less common causes of leg pain are a nerve entrapment (e.g. the superficial peroneal nerve) or a blood flow disease (e.g. vein insufficiency, or a deep vein thrombosis – DVT). These are serious conditions that require immediate medical attention.

Any leg pain could be a referred pain (e.g. a pain from a lumbar disk or a sacro-illiac joint dysfunction). It’s important to evaluate the lower back, pelvis, hips, as well as the lower leg alignment when assessing leg pain.

In closing, if you suffer from so-called “shin splints”, locate exactly where on your leg your symptoms are, and the exact cause will be easier to diagnose and treat.

Does exercise in the cold make you sick?

My mom used to tell me “En avril, ne te decouvre pas d’un fil.”

This is French, obviously, and means: If you take off your layers too soon, after the winter, you’ll get sick.

Was she right?

What we know is that exercise in the cold weather per se doesn’t give you the cold or the flu. You have to be exposed to the virus first in order to get it.

We know that intense exercise can decrease your IgA antibodies for about 2 hrs after the work out. Exposure to cold, does decrease those antibodies further. So, if you have been exposed to a virus, then work out intensively in the cold with improper clothing (it’s your own body temperature drop that counts, not the reading of the thermometer), you might end up with a runny nose…

On the other hand, it has been shown that moderate intensity exercise increases immunity and might be protective for upper respiratory tract infections.

Bottom line, make sure you have appropriate clothing, take off layers when your body temperature is raising and put them back as soon as you slow down. If you are exercising intensively in the Cold, avoid contact with sick people and get proper rest, food, hydration, and warm up during the first 2 hours after you’re finished with your training session. Exercise at moderate intensity is good for your immunity and may protect you from upper respiratory tract infections during the cold season.

Now that I am a mom, I prefer to say to my kids: “Spring showers bring May flowers,“ which is more likely true and helps to endure the rainy days of April !!!!

To Stretch Or Not To Stretch?

Stretching helps to increase flexibility, one of the components of fitness.

Everyone can improve his or her flexibility with stretching: those who are stiff and those who are already flexible will see improvement with regular practice.

Although it had been done for years as part of the WARM UP, late studies show that stretching a cold muscle can cause damage and won’t increase performance.

It is best done after activity (not necessarily immediately after…as long as the muscles are warm). It could be done after a bath or shower at night and then has an extra benefit: relaxation before going to sleep.

There are different ways to stretch:

  • Active: you take a stretched position and hold it for a minimum of 30 seconds (so that the myotatic reflex fades).
  • Assisted, active: someone else brings your limb into a stretched position and you hold it for 30 seconds.
  • Passive: someone else brings you into the stretched position and holds it for 30 seconds.(More risk of injuries)
  • PNF (proprio-neuro facilitation, the most effective): You take the stretched position, then someone else apply a resistance to the antagonist muscles( opposite action) for 5-10 sec then you reach the new position and repeat for 3 times.

Whatever method you choose, avoid bouncing, make sure you have a proper alignment and protect your back (don’t overreach, keep a slight arch in your lumbar spine and bend your knees if needed). It should never be painful. You should feel a pleasant sensation of pulling.

Finally, adapt your stretching to your sports and make sure you stretch the muscles you are using. A good reference on this subject is Bob Anderson’s book: “STRETCHING”

Which exercises will help me to get rid of my belly?

Abdomen protrusion can have many causes:

  • Accumulation of intra-abdominal fat (most common in men)
  • Accumulation of sub-cutaneous fat (most common in women)
  • Lack of abdominal muscles tonus (mainly the transverse abdominal, the deepest of them)
  • Bad posture (hyperlordosis of the low back…think of the toddlers)
  • Intestinal bloating

Physical activity helps to correct most of them. In the case of fat accumulation, you need to do activities that will burns more calories and monitor your diet so that your energy intake is less then your energy expenditure. Aerobic activities are the best. Think of doing an activity that lasts for a minimum of 30 minutes at moderate intensity: walking, jogging, swimming, riding a bike, cross country skiing… Try to do it daily. After a few weeks you should notice a decrease in your waist line. The results are easier to achieve with intra-abdominal fat and it’s a good thing since this fat is putting you more at risk for cardio-vascular diseases.

To increase the tonus of your muscles, you need to get more than a “6 packs”. You need to train the transverse abdominal muscle, the one closer to your organs. It supports the abdominal content and is part of the muscle group who stabilize the CORE. Training the other CORE muscles (multifidus in the back, pelvic floor and gluts) will also improve your posture and your spine alignment. To train the CORE muscles, the best activities are Yoga, Pilates and Floor exercises with a Swiss Ball.

Finally, any regular physical activity helps to increase the transit of the bowels, decreasing gas, constipation and bloating. If it persists you might want to try enzymes (like “BEENO”) when you eat culprit vegetables (cabbage family, onions…), decrease your pop consumption and eventually rule out lactose intolerance or gluten intolerance with your physician.

In conclusion , these exercises will not only help to improve your body image but even more importantly, will decrease your risk of cardio-vascular disease, colon cancer and prevent low back pain.

Heat or Ice?

A good rule of thumb for acute sports injuries
is the Acronym RICE:

R for rest
I for Ice
C for compression
E for Elevation

Ice is better for the acute phase because it helps to decrease swelling, limits inflammation and is a good pain killer. Do local application for 10 to 20 minutes every 2 hours. Protect the skin from frostbite by using a towel.

Heat is a good modality for chronic muscle spasm (ex: chronic low back pain). Try to avoid it with any inflammation, muscle tear, wound or possible skin infection.