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    Every active person from daily walker to weekend warrior to high performance athlete enters the world of physical activity with a goal. Goals may include: pleasure or recreation; maintaining physical abilities; losing weight; improving health, vitality and longevity; managing diseases such as diabetes, heart disease or depression; or performance goals from finishing your first race to competing in the Olympics.

    In the effective pursuit of these goals, many obstacles such as illness, fatigue, or injury will slow down and frustrate these achievements. These injuries may be from acute traumas, repetitive strain, chronic continuous muscle contractions, or any combination of these. There are many risk factors that may contribute to any of these injuries and all must be addressed for the full resolution of the problem.

    The Holistic Clinic has gathered together a team of active health care professionals that can address all of the relevant issues involved in injury management and prevention, healthy nutritional management of many health conditions, weight management, and many other health issues.

    For training programs, guidance, and skill development, our web site links to most of the important Ottawa area resources that can help you achieve whatever goal you wish to pursue.

    Injuries to the musculoskeletal system can be caused by three different mechanisms: Acute injury, repetitive strain, or chronic prolonged muscular contraction.

    Acute injury

    Most people are familiar with acute injuries that are due to a sudden overload on a tissue. These injuries include sprains and strains, sudden blows or hits, and are very recognizable because of the redness swelling, pain, and heat from the damaged tissue. The best management of these injuries includes Rest, Ice (ideally for 10 minutes every hour), Compression (usually with a tensor bandage) and Elevation (above the heart). The best success for a speedy recovery is if the injury is properly diagnosed and treated with additional therapeutic modalities such as ultrasound or low power laser.

    Repetitive strain injuries (RSI)

    RSI’s occur due to small, but additive tissue damage sustained through performance of repetitive tasks. They often develop in the absence of acute injury and results in chronic localized pain and dysfunction with or without objective physical changes (such as swelling). Whenever there is tissue damage, your body will mount an inflammatory response, or a response that leads to the breakdown and repair of the damaged tissue. The end result of this process is the deposit of fibrous connective tissue (scar tissue) at the site of injury. With repeated minor tissue damage, this scar tissue builds up until it begins to restrict motion, entrap nerves, tighten muscles and lead to pain.

    Chronic prolonged muscular contractions

    In a relaxed state, muscles do not require much blood, and the supply of blood matches the muscle’s demands. When the muscles are involved in rhythmic contractions, such as during walking, running or cycling, the blood circulation to the muscles increases and matches the increased demands of the muscles (unless the activity is very intense). When a muscle is contracted for a prolonged duration, the blood supply to the muscle is restricted due to continuous compression of the blood vessels by the muscle. At the same time, the muscle’s requirement for oxygen has increased due to the contraction, so the blood supply to the muscles is not matching the muscles demands.

    When this chronic, static muscle contraction occurs, your body responds by sending cells to the area that will lay down fibrous connective tissue within the muscle to help re-enforce and support the muscle. Over a long period of time, the muscle slowly becomes weaker, more “leathery”, and painful knots or trigger points will develop in the muscle.

    The most common cause of static muscle contraction is poor posture. Poor posture can occur while standing, sitting, sleeping, playing sports, working, or doing hobbies. The most effective approach is prevention, which can be addressed by the individual or the activity

    Prevention and management of musculoskeletal pain

    Musculoskeletal injuries can be prevented through intervention directed to both the individual and the activity.

    Individual interventions may include education on:

    • Postural education for sitting, standing and sleeping
    • Advice on technique and biomechanics of the activity.
    • Exercise including cardiovascular, strengthening and stretching
    • Proper training programs
    • Nutritional advice
    • Stress management and visualization training

    Activity interventions may include:

    • Biomechanical evaluations to improve equipment or technique

    If the musculoskeletal pain already exists and all attempts to self manage the condition fail to relieve the pain or stiffness, it is time to get help in managing the problem. Assuming that all of the self-management biomechanical approaches are being addressed, the clinical management of musculoskeletal pain may involve any of the following and usually in this order:

    • Restore the muscles to their normal state:This may involve Active Release Technique and massage therapy to eliminate any scar tissue, physical modalities such as ultrasound or electrical modalities, mobilization and assisted stretching techniques, joint manipulation, nutrition, or acupuncture.
    • Eliminate any compensation patterns: Your body will adapt to the way you use it. If chronic postures have been adopted for a period of time, or if pain has been present for a prolonged period, the body has created compensation patterns to the conditions. When the pain or posture has been corrected, your body may still be using these compensation patterns. They may include asymmetrical movement patterns such as limping, or postural habits such as slouching. Before any stabilization or strengthening can begin, these patterns must be eliminated or they will be perpetuated and lead to future problems.
    • Stabilize the affected areas: The fine-tuning of motion in most joints of the body is controlled by smaller “stabilizing” muscles. If these muscles are injured or dysfunctional, then the joint will not move properly when the larger “force generating” muscles contract. If this occurs, then the joint and other tissues (tendons and ligaments) are stressed. This can lead to chronic dysfunction and repeated injury. Once the tissues have been returned to a normal state, then these small stabilizing muscles must be retrained to function properly. Exercises that train these muscles include stability exercises such as those performed on an exercise ball, wobble board, or any other device that challenges balance. The joint stabilizing muscles must be retrained before any strength exercises are performed to ensure that the joints are stable and will not be re-injured.
    • Strengthen the affected areas: The final stage of rehabilitation is strengthening the larger “force generating” muscles through resistance training programs. These programs may take advantage of weights, elastic tubing, lifting body weight, or any other program that will fit into the individuals goals, lifestyle and resources.

    Nutrition for Endurance, Strength, and Recreational Athletes

    There is widespread belief among athletes that special nutritional practices, which include food, vitamin, mineral, and herb supplements, will enhance their achievements in competition. However, if one’s goals are to improve performance, improve energy, decrease recovery time, reduce susceptibility to pain and inflammation, and experience superior health, then there are basic nutritional principles that require attention first.

    These principles when applied daily over the long term will have a much greater influence on the above objectives than any one particular supplement. Many of the basic principles referred to are reviewed in the article 13 Steps to Better Health that can be accessed from the home page. Additional important information is also presented here.

    1) Remove simple, refined sugar:

    To help in improving performance and health remove most of the sugar and refined carbohydrates from your diet. This includes most “white” foods from sugar to white flour products. The average North American consumes close to 60 kg of sugar per year. Estimates suggest that North Americans consume 15-25% of their daily calories as fructose sweeteners found predominantly in candy, cereal, and off the shelf snack food. Research strongly links fructose sweeteners to insulin resistance that is linked to obesity, inflammation, cardiovascular risk factors, and many other health issues. Fructose, as compared to glucose, is preferentially metabolized to fat in the liver, can induce an inflammatory response, and a functional deficiency of essential fatty acids and selected vitamins and minerals. Researchers are increasingly linking the use of fructose sweeteners to the current epidemics of obesity and diabetes (Type 2).

    Sugar and other refined carbohydrates place significant stress on the body’s blood sugar regulatory system. This often leads to a roller-coaster ride of energy ups and downs that can lead to increased fatigue and body fat in many individuals. Limiting simple refined carbohydrates in the diet while ingesting complex slow-release carbohydrates over the long term leads to increased energy and the ability to train and perform at a higher level. Examples of complex slow-release carbohydrates include beans, peas, lentils, brown rice, millet, buckwheat, oatmeal, whole wheat, etc.

    Consuming complex slow release carbohydrates on a day-to-day basis while training serves to load up muscle sugar (glycogen) stores. Consuming a meal of complex slow release carbohydrates the night before and 3-4 hours prior to an exercise event aids in loading liver sugar (glycogen) levels for the day of the event. Bonking occurs during a race event when liver sugar (glycogen) stores are depleted. The risk of this happening increases the longer the duration of the race exercise event.

    Small amounts of cane sugar can help to restore liver and muscle glycogen (carbohydrate) levels both during and after an exercise event. This helps to prevent bonking. Many studies report that ingesting drinks less than or equal to 8-10% carbohydrate are absorbed into the body at similar rates as water and have a beneficial effect on performance during the exercise event. The role of sport gels is to provide carbohydrate to prevent bonking during prolonged (usually greater than 90 minutes) exerciserace events.

    2) Consume high quality lean protein with meals:

    Protein meals help to maintain consistent blood sugar levels by limiting insulin and allowing easy access to body fat stores. Include one serving (about the size of the palm of your hand) of a protein rich food at most meals. Examples include free-range or organic meats, chicken, turkey, eggs, fish, nutsseeds, tofu, yogurt, and lower fat cheeses. Consume seeds and nuts in their raw, preferably fresh form. Vegetable oil contains trans fats for preservative purposes, so avoid nuts and seeds that contain added vegetable oil.

    The amount of protein required by the average mostly sedentary person is approximately 0.8 grams per kilogram of body weight. Therefore, a 70kg (150lb) person requires approximately 56 grams of protein per day. Endurance athletes (marathoners, adventure racers, etc.,) can require 1.7 grams per kilogram of body weight. This translates to 119 grams of protein per day in a 70kg individual. Elite body builders require approximately 1.12 grams of protein per kilogram of body weight. The 70kg athlete requires 78.5 grams of protein per day. A can of tuna contains approximately 30 grams of protein. The reason endurance athletes require more protein is that endurance training triggers much more protein breakdown that needs to be replaced.

    Many individuals are interested in supplementing their diet with high quality sources of protein that contain little to no saturated fat. Whey protein from the whey fraction of dairy is an excellent source of high quality protein for both athletes and non-athletes. Whey protein concentrates and isolates have had milk sugars and fats removed by ultrafiltration. Whey protein provides a balanced source of essential amino acids that are easily digested, absorbed, and taken up by muscle tissue. When combined with juice, water, and fruit it makes for an excellent post-exercise nutrition beverage that can replace muscle sugar stores and replenish amino acids required for muscle repair. The routine use of a post-workout shake might be the most important nutritional supplementation habit for enhancing body composition Whey protein is also a very good source of branched chain amino acids that are involved in antioxidant status, immunity, and detoxification. Whey proteins also promote the feeling of fullness and satiety, support gastrointestinal health, enhance the growth of gut microflora, support better muscle tissue integrity in circumstances characterized by muscle wasting, and enhances body composition. While whey protein supplements are highly useful, they do not replace protein obtained from a balanced diet.

    3) Eat a variety of foods from all food groups

    This helps to ensure optimum nutrition as well as decrease the risk of developing food allergysensitivity. Most people are very monotonous with respect to their food choices eating the same foods over and over again. Food sensitivities can contribute to poor performance, fatigue, stomach and bowel problems, blood sugar imbalance, joint pain, menstrualhormonal imbalance, bladder problems, breathing problems, and just about any other symptomillness that you can think of. It is our experience that tailored broad dietary programs minimizing the common food allergens improves performance and overall health.

    Other guidelines to consider when eating for optimal health and performance include eating a nourishing breakfast, timing your meals consistently, consuming high quality oils, avoiding trans fats and other manufactured oils, consuming a variety of fruit and vegetables, minimizing caffeinated beverages, drinking pure water, and getting more sleep. Please see the article “13 Steps to Better Health” that can be accessed from the home page for more discussion of these principles.

    Eating a high quality diet to is essential to optimal health, performance, and disease prevention as outlined above and in the article “13 Steps to Better Health” located on the home page. When a high quality diet is being consumed, then supplementing with minerals, nutrients, and herbs safely and efficaciously can significantly and exponentially benefit health.

    4) Supplement:

    It is well understood by leading nutritional researchers and experts to day that the right supplement program can improve natural immunity and resistance to disease, ability to cope with stress, energy and stamina, joint health, mood, and athletic performance. Some of the important points to know when considering supplementing are:

    • Each of us has unique biochemical needs and requires special considerations when supplementing to optimize health and performance.
    • Nutrients have different effects on our metabolism at different doses.
    • Factors that influence appropriate doses of nutrients include age, gender, geography, dietary habits, lifestyle habits, medical conditions, familial predispositions, work, sleep, stress factors, and medications.
    • Some commonly used doses far exceed levels that have been proven safe and effective.
    • Over-dosing of some nutrients (beta-carotene, vitamin E, B vitamins, etc.) has become as commonplace as under-nutrition (with other nutrients such as vitamin D, EPADHA from fish oil, magnesium, selenium, chromium, etc.).
    • Nutrients have different effects on our metabolism when given at different times of the day.
    • Nutrients have different effects on our metabolism when given in different combinations.
    • Nutritional supplements interact with over the counter and prescription medications.
    • Some drug-nutrient interactions are synergistic and beneficial, while others have serious adverse effects.
    • There are now far too many important variables, and information and understanding is evolving far too quickly for individuals to properly tailor supplement programs for themselves while ensuring the safety and effectiveness of their programs.

    The Holistic Clinic has incorporated, as part of our nutritional assessment, an evidence-based software engine with thousands of evidence-based nutritional rules to help ensure access to properly personalized nutrient recommendations. These nutritional rules are all based on the latest available research. Once completed, the practitioner can further tailor the assessment based on history, examination and test results. These web-enabled rules are updated weekly to ensure safety and optimize effectiveness. Each of the factors in the above list are incorporated into the programs recommendations, safeguarding against under and over-nutrition, drug-nutrient interactions and much more. The rules engine has been incorporated into a system known as Nutriscan, which takes the tailored nutrient recommendations complete with practitioner input and uses automated nutrient packaging technology to create one-of-a-kind personal nutritional packets. These packets are printed with the individual’s name and the best time of day that each packet is best taken to optimize results. There are thousands of nutrient combinations and variations available to meet precise individual needs. The Nutriscan questionnaire can be completed in the comfort and privacy of home, workplace or doctor’s office. Top-level security systems ensure the highest medical privacy standards are upheld.