Chiropractic + Naturopathic Doctor • July/August 2018 • News And Events

A man known for skiing on the edge of danger feels Canadian sport is a safer place.

Former national-team racer and Crazy Canuck Steve Podborski, now CEO and president of Parachute Canada, said the majority of national sport organizations have adopted the Canadian Guideline on Concussion in Sport.

The federal government committed $1.4 million and tasked Parachute Canada, whose mission statement is injury prevention and saving lives, with developing harmonized concussion protocols that can fit all sports.

The objective was to have 20 sport organizations sign on within a year of publication, but the uptake has been faster than that.

“What we have done in Canada in a period of nine months is gone from a group of disparate, out-of-date, unsubstantiated and poorly- understood approaches to dealing with concussion in sport, and we’ve harmonized it with 42 of the 56 national sport organizations in Canada,’’ Podborski says.

“You take the word ‘sport’ out, you have the world’s best concussion management protocol. We’re working to get it into our emergency rooms right across Canada.”

Winter and summer sport organizations funded by Sport Canada are either on board with the concussion guideline or working to get there, Parachute Canada said in a statement.

The guideline includes pre-season education, head-injury recognition, onsite medical assessment, concussion management, intensive treatment and return- to-school, return-tosport checklists.

While the guideline will help athletes, coaches and administrators assess and contain brain injuries, Podborski feels parents will benefit the most from having a tool that takes fear and confusion out of managing symptoms in their children.

Recent research indicates concussion recovery no longer requires spending weeks in a dark, silent room, Podborski said, and if assessed and treated correctly, returning to school, work and sport can happen sooner.

“Figure skating is quite different from hockey, yet they both have adopted it in their context.”

Thirty per cent of traumatic brain injuries are sustained by children and youth, many of them occurring while participating in sports and recreational activities, according to Parachute.

While it behooves sport organizations that receive federal government funding to adopt the guideline, Ontario has put concussion safety into law.

The province passed legislation called Rowan’s Law last month. Named after 17-year-old rugby player Rowan Stringer, who died after multiple concussions, the legislation makes concussion education, prevention and management practices mandatory.

The World Federation of Chiropractic (WFC) is amongst 14 international organizations that have come together to found the new Global Rehabilitation Alliance (GRA), with chiropractor and epidemiologist Professor Pierre Côté being elected to the Board.

The GRA is an initiative of the World Health Organization (WHO) and arose out of a high-level meeting, “Rehabilitation 2030: A Call To Action” that took place in February 2017. WFC Disability and Rehabilitation Committee Chair, Professor Pierre Côté and Secretary- General Dr. Richard Brown were in attendance at this meeting and contributed in drafting a formal statement of support for the WHO on behalf of the global health professions.

Following a number of meetings and the drafting of a White Paper setting out the aims and objectives of the new alliance, the formal launch of the GRA took place at the International Committee of the Red Cross Headquarters in Geneva during the week of the World Health Assembly.

At its inaugural meeting, Professor Côté was elected to the Board. As well as holding the federally- funded Canada Research Chair in Disability Prevention and Rehabilitation, Professor Côté holds positions at the University of Ontario Institute of Technology (UOIT) and at the Canadian Memorial Chiropractic College (CMCC), where he heads the UOITCMCC Centre for Disability Prevention and Rehabilitation.

The aims of the GRA are to advocate for rehabilitation services around the world and to strengthen the role of rehabilitation in health and social systems around the world. The GRA will aim to further the efforts of existing rehabilitation organizations by building and strengthening networks and partnerships. It will work with WHO as a strategic partner to advocate for quality, co-ordinated and accessible rehabilitation services.

According to WHO, only 10 people per million population in the world currently has access to skilled rehabilitation services. It is also known that 74 per cent of the total years lived with disability in the world are living with conditions for which rehabilitation is beneficial. With a 23 per cent increase in prevalence of health conditions with severe disability, there is a large unmet need in lowand middle-income countries, and the need for a dedicated focus on rehabilitation workers is critical.

A study published in the journal Menopause has identified several key factors in postmenopausal women that are associated with height loss, a common occurrence in this age group that is known to increase the risk for death and disease.

“Having done strenuous exercise regularly, at least three times a week in their teens was protective for later life height loss in our study,” says professor Jean Wactawski-Wende, the study’s senior author and dean of the University at Buffalo School of Public Health and Health Professions.

Three other factors were associated with height loss of 1-inch or more: older age, heavier weight and use of corticosteroids, the latter of which is known to reduce bone density.

“Although this study was done on postmenopausal women, there is a key message for younger women: strenuous exercise in teenage years has lasting effects on your bones later in life,” Wactawski- Wende says.

That’s likely because physical activity helps to build bone. Strenuous workouts – any activity long enough to work up a sweat and increase heart rate – would likely also result in helping increase peak bone mass in participants when they were young women.

The average height loss among the more than 1,000 women studied was fourth-tenths of an inch during an average five-year follow up. In general, though, Wactawski- Wende adds that postmenopausal women should have their height checked regularly to monitor for height loss.

Fibromyalgia and resistance exercise have often been considered an impossible combination. But with proper support and individually adjusted exercises, female patients achieved considerable health improvements, according to research from Sahlgrenska Academy.

“If the goal for these women is to improve their strength, then they shouldn’t be afraid to exercise, but they need to exercise the right way. It has long been said that they will only experience more pain as a result of resistance exercise, that it doesn’t work. But in fact, it does,” says Anette Larsson, whose dissertation was in physical therapy and who is an active physical therapist at Närhälsan in Herrljunga.

As part of her dissertation, she studied 130 women aged between 20-65 years with fibromyalgia, a disease in which nine of ten cases are women. It is characterized by widespread muscle pain and increased pain sensitivity, often combined with fatigue, reduced physical capacity and limitation of activities in daily life.

About half of the women in the study (67) were selected at random to undergo a program of person-centered, progressive resistance exercise led by a physical therapist. The other 63 women comprised the control group and underwent a more traditional therapy program with relaxation exercises. The training and exercises lasted for fifteen weeks and were held twice a week.

“The women who did resistance exercise began at very light weights, which were determined individually for each participant because they have varying levels of strength. We began at 40 per cent of the max and then remained that level for three to four weeks before increasing to 60 per cent,” Larsson says.

More than six of 10 women were able to reach a level of exercise at 80 per cent of their maximum strength. One of the 10 was at 60 per cent; the others were below that figure. Five individuals chose to stop the training due to increased pain.

“On a group level ... the women felt better, gained muscle strength, had less pain, better pain tolerance, better health-related quality of life and less limitation of activities. Some of the women did not manage the exercise and became worse, which is also an important,” Larsson says.

In the control group, the improvements were not as significant, but even there, hand and arm strength improved. The findings for the women in the resistance exercise group are affected by several factors, including the degree of pain and fear of movement before and during the exercise period.