Top 5 Ski & Snowboard Injuries and What to Do About Them

ski and snowboard injuriesWhiplash. Catch an edge on your snowboard or hit an unexpected cat track? Signs are a sore, aching, or stiff neck by the end of that day or the next.  Whiplash is a strain of the neck muscles and possibly a sprain of the ligaments.  When minor, your neck will benefit from letting it rest and heal (and not crashing again). If you have to hold your head with your arms to get out of bed, that’s often a sign of ligamentous instability or fracture.  Go see a doctor. Static x-rays will help visualize fractures. Flexion and extension x-rays will show ligamentous instability (You should have seen Dr. Laura’s after her accident😮). Even if you don’t hit your head, whiplash can cause concussion/TBI, either in the brainstem or because momentum causes the brain to hit the skull. More on this below.

Ache behind your knee. We see this a lot in the winter, both in skiers and snowboarders.  The hamstring and gastrocnemius tendons cross behind the knee and this area often becomes inflamed and sore.  Foam rolling your hamstrings and calves regularly can help prevent this.  Getting Active Release Techniques here helps relieve the area when it is already inflamed so that you can get back on the mountain.

ACL tear. You hear that pop in your knee, and it starts to feel unstable, and then swell.  Well, you may not have heard a pop, but you may still have strained the anterior cruciate ligament (ACL) of the knee and possibly the lateral collateral ligament (LCL). Once you’re safely off the mountain, get some ice on there and elevate your leg to decrease swelling.  We screen for ACL tears in our office with the same orthopedic tests that the orthos and PTs do, so we are happy to take a look at it when it’s is not so swollen that it’s immobile.  If you’re pretty sure you tore it, you are headed for an MRI, and they will also need to have the swelling down beforehand.  From there, if you are surgery bound, know that doing PT before surgery gives you a better outcome and PT after surgery is essential to get full range of motion and function without compensatory patterns.  In our office, we often see issues in the hamstring and popliteus (the muscle that crosses behind the knee) months or years after surgery, and we would love to help you fix those. To minimize your chances of an ACL tear: train to improve the muscle balance in the legs, especially strengthening the hamstrings, as well as the core and hip muscles.

Concussion/TBI. Never fall and don’t hit trees. Also wear a helmet in case you do (Scientific Review).  Helmets with MIPS (Multi-Directional Impact Protection System) technology are designed to reduce rotational forces caused by the angled impacts to the head.  Symptoms of a concussion include: headaches, issues with concentration or memory, balance and coordination dysfunction, dizziness or “seeing stars”, ringing in the ears, nausea, vomiting, issues with fluent speech, generalized fatigue, difficulty sleeping, etc.  If you or your child exhibits any of these symptoms after a hit to the head or neck, get it checked.

Shoulder injury. Dislocation, labral tear, rotator cuff injury, AC separation, SLAP tear. To minimize your risk: strength train, avoid the FOOSH- the Fall On Outstretched Hand (it’s safer to fall on your shoulder with your arm tucked by your side), and get ski poles that have a wrist-release.  Get medical attention if you have dislocated your shoulder, have any paralysis in your arm or experience extensive weakness or numbness. If something doesn’t feel right and you can move your shoulder, we will check it out for you.  If your shoulder hurts so much you can’t move it, we’re going to recommend diagnostic imaging.

Far Infrared Sauna Benefits to Health & Wellness

The Infrared Sauna is here.  Try it out after your next chiropractic treatment or massage session and discover the benefits.

Infrared Sauna at JH Backcountry Health

 

Benefits of Infrared Sauna Use

  • Improved Circulation
  • Muscle Pain Relief
  • Workout Recovery
  • Detoxification of Heavy Metals and Chemicals
  • Cardiovascular Health
  • Immune System Support & Reduction in Systemic Inflammation
  • Rejuvenation of Skin
  • Weight Loss? – Maybe

Come in for 30 minutes of warmth and getting your sweat on!

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Improved Circulation of Blood

Infrared heat warms muscles and increases your blood flow to a level similar to exercise.  Also, as your body temperature increases, you work to produce sweat to cool yourself and the heart pumps faster, increasing your circulation.

Muscle Pain Relief

As your blood circulation increases with the infrared heat, this helps clear metabolic waste and delivers oxygen-rich blood to depleted muscles, enabling them to recover more quickly.  Muscles also relax and are more supple when the tissue is warm, allowing for greater flexibility and increased range of motion.  The infrared heat dilates the blood vessels to the muscles, allowing them to deliver more blood to stimulate healing in the muscles and other soft tissues.

Recovery from Workout

Improved circulation helps clear metabolic waste products such as lactic acid that is produced in the muscles during the workout and increases the blood flow to the muscle tissue for healing.  A Finnish study published in 2015 also shows decreased cortisol and increase growth hormone with post-workout sauna use and shares this conclusion: “Deep penetration of infrared heat (approximately 3-4 cm into fat tissue and neuromuscular system) with mild temperature (35-50°C), and light humidity (25-35%) during FIRS (Far InfraRed Sauna) bathing appears favorable for the neuromuscular system to recover from maximal endurance performance.” 

Detoxification

We can sweat out heavy metals – and this infrared sauna will make you sweat!  Check out this article Arsenic, Cadmium, Lead, and Mercury in Sweat: A Systematic Review 

“In individuals with higher exposure or body burden, sweat generally exceeded plasma or urine concentrations, and dermal could match or surpass urinary daily excretion. Arsenic dermal excretion was several-fold higher in arsenic-exposed individuals than in unexposed controls. Cadmium was more concentrated in sweat than in blood plasma. Sweat lead was associated with high-molecular-weight molecules, and in an interventional study, levels were higher with endurance compared with intensive exercise. Mercury levels normalized with repeated saunas in a case report.”

Blood, urine, and sweat (BUS) study: monitoring and elimination of bioaccumulated toxic elements.

“Many toxic elements appeared to be preferentially excreted through sweat. Presumably stored in tissues, some toxic elements readily identified in the perspiration of some participants were not found in their serum. Induced sweating appears to be a potential method for elimination of many toxic elements from the human body.”

Cardiovascular Benefits

Clinical implications of thermal therapy in lifestyle-related diseases.

“Vascular endothelial function is impaired in subjects with lifestyle-related diseases, such as hypertension, hyperlipidemia, diabetes mellitus, obesity, and smoking. Sauna therapy also improved endothelial dysfunction in these subjects, suggesting a preventive role for atherosclerosis.”

Sauna exposure leads to improved arterial compliance: Findings from a non-randomised experimental study by the European Journal of Preventive Cardiology

“Pulse wave velocity, systolic blood pressure, diastolic blood pressure, mean arterial pressure, left ventricular ejection time and diastolic time decreased immediately after a 30-minute sauna session. Decreases in systolic blood pressure and left ventricular ejection time were sustained during the 30-minute recovery phase.”

Clinical Effects of Regular Dry Sauna Bathing: A Systematic Review 

“Intense short-term heat exposure elevates skin temperature and core body temperature and activates thermoregulatory pathways via the hypothalamus [] and CNS (central nervous system) leading to activation of the autonomic nervous system. The activation of the sympathetic nervous system, hypothalamus-pituitary-adrenal hormonal axis, and the renin-angiotensin-aldosterone system leads to well-documented cardiovascular effects with increased heart rate, skin blood flow, cardiac output, and sweating [].”

Immune System Support and Reduced Inflammation

In one study, regular sauna use decreased the incidence of common colds: Regular sauna bathing and the incidence of common colds.  I am still searching for more research to support this claim for immune system support seen on many sauna retailers’ pages. 

Sauna bathing and systemic inflammation. “There was a significant inverse association between the frequency of sauna bathing and the level of C-reactive protein”

Rejuvenation of Skin

In the journal Dermatology “Heart beat rate and ionic concentration in sweat as well as epidermal blood perfusion showed a training effect under regular sauna. A decrease in casual skin sebum content on the skin surface of the forehead was observed in these volunteers. The present data suggest a protective effect of regular sauna on skin physiology, especially surface pH and stratum corneum water-holding capacity.”

Weight Loss?

Well this one is more controversial.  We know that the sauna warms you up and makes you sweat.  Sweating to cool your body is an active process. As the Journal of the American Medical Association put it: “Sweating is a part of the complex thermoregulatory process of the body involving substantial increases in heart rate, cardiac output, and metabolic rate, and consumes considerable energy.” A small study at Binghamtom University found that participants had up to 4% body fat loss with regular sauna use for 8 weeks to 4 months. There are a few theories on how sauna use could lead to weight loss. The increased heart rate and work to cool the body may burn some extra calories. It could be the decreased cortisol seen after sauna use. Cortisol is the stress hormone that is associated with weight gain and difficulty losing weight. Another possibility is the increased human growth hormone increases metabolism and muscle development.  Or maybe your muscles aren’t as sore and your joints don’t hurt as much, so you end up being more active throughout the day.  Studies are not conclusive here.  The water weight you lose from sweating, that’s not really healthy weight loss.  Please hydrate before and after your sauna session!

Other interesting studies to date

Sauna bathing is inversely associated with dementia and Alzheimer’s disease in middle-aged Finnish men. 

Seminal and molecular evidence that sauna exposure affects human spermatogenesis.- Showing detrimental but reversible effects on male fertility in terms of sperm quality and quantity and no effects on male sex hormones. 

The effect of sauna bathing on lipid profile in young, physically active, male subjects. 

“Ten complete sauna bathing sessions in a Finnish sauna caused a reduction in total cholesterol and LDL cholesterol fraction levels during the sessions and a gradual return of these levels to the initial level during the 1st and the 2nd week after the experiment. A small, statistically insignificant increase in HDL-C level and a transient decline in triacylglycerols were observed after those sauna sessions. The positive effect of sauna on lipid profile is similar to the effect that can be obtained through a moderate-intensity physical exercise.”

Cardiovascular and Other Health Benefits of Sauna Bathing: A Review of the Evidence put together by Mayo Clinic.

“Sauna bathing has been linked to an improvement in pain and symptoms associated with musculoskeletal disorders such as osteoarthritis, rheumatoid arthritis, and fibromyalgia. Having sauna baths also improves headache disorders. In an RCT by Kanji et al, people with chronic tension-type headache were randomized to regular sauna bathing or advice and education for a period of 8 weeks, and sauna therapy was found to substantially improve headache intensity.”

Clinical Effects of Regular Dry Sauna Bathing: A Systematic Review

“This suggests that heat stress, whether induced by infrared or Finnish-style sauna, causes significant sweating that is likely to lead to hormetic adaptation and beneficial cardiovascular and metabolic effects. This is further supported by the two large observational studies that found striking risk reductions for sudden cardiac death (63%) and all-cause mortality (40%) as well as for dementia (66%) and Alzheimer’s disease (65%), in men who used a sauna 4−7 times per week compared to only once per week []. While these large cohort studies are based on calculated hazard ratios with adjustments for common cardiac risk factors, it has been pointed out that the association between sauna activity and health outcomes may be noncausal and that sauna use is merely an indicator of “healthy lifestyle” and other socioeconomic confounding factors []. Nevertheless, these findings point to the need for further study and serious consideration given to sauna bathing to address the ever-increasing individual, societal, and financial burdens of cardiovascular disease as well as dementia-related conditions in aging populations.”

This page is in progress right now.  We will keep adding more as we find the research.  

Is it Healthy to Exercise in Wildfire Smoke?

Living in this area, we already have a strong tendency to overdo exercise. As health care practitioners, we see overuse injuries all the time. And you know you don’t always give your body time to rest and recover after a big event or to heal after an injury. How likely are we to temper our exercise enthusiasm during wildfire smoke, and how necessary is it really?

Is exercising outdoors when it is smoky doing us more harm than good?

Good question. And a bit of a complicated one.

What is in wildfire smoke that is dangerous?

First, lets talk about the type of particles released from wildfires. Most specifically the particle called PM2.5 — fine particulate matter smaller than 2.5 micrometers in diameter.
The scary thing about PM2.5 particles is that they are easily breathed in, and once they hit our lungs they cause irritation and inflammation with sometimes serious repercussions.

Image Credit: Jen Burgess/IsolineStudios for BC Centre for Disease Control.

For most of us, we have mild symptoms such as:
• Itchy or watery eyes
• Sore throat
• Runny nose
• Mild cough
• Phlegm & mucus production
• Wheezing
• Headache

More serious symptoms can result such as:
• Shortness of breath
• Severe cough
• Dizziness
• Chest pain
• Heart palpitations

If you are experiencing these, get out of the smoke and please get medical attention if symptoms persists.

Children, the elderly and those with lung conditions are more affected by air quality and should be more careful to avoid exposure.

Children’s airways are still developing and they breathe more air per pound of body weight than adults. Source

How to Check Air Quality

Look at both the Air Quality Index (AQI) and specifically the PM2.5 measurement for your area. I use AirNow

Well, the Air Quality Index is not looking great, but I want to exercise. Consider these options:

Exercise indoors in a place with a good air filtration system, specifically with a HEPA filter.

Monitor the Air Quality and choose your time of day for exercise based on that.

Anecdotally, I notice less smoke here in the morning and like to get out then.

Do lower intensity exercise.

While doing strenuous exercise you breathe 10 times more air than while resting, thus increasing your exposure to these particles by 10 times. Less gasping for air equals less exposure. Source

Change your elevation.

Sometimes you can get above the smoke. Try a hike at the top of Teton Pass, off the Tram or your own high elevation favorite.  Keep in mind, it’s not always comforting to look down at the smoke below you.

Drink water and eat a diet that will help you combat the inflammation caused by the smoke.

Consider a respirator/ N95 mask.

If you work outside or for low intensity exercise, wear a respirator/ N95 mask. A well-fitted N95 can reduce PM2.5 exposure by 95% Personally, I can’t handle wearing one while running or biking, but despite the annoyance I can walk with one on. You can find them at the hardware store.

Dr Laura with N95 Respirator on a smoky day
Dr Laura sporting the N95 respirator on a smoky day

More harm than good exercising outside in wildfire smoke? Not necessarily.

Although this study was done in an urban area, measuring urban pollutants, the PM2.5 levels were considered, low intensity exercise, eg. commuting by bike or walking, seems to convey health benefits that outweigh the harm for healthy adults when the PM2.5 levels are under 95 μg/m3 and for lower concentrations, less than or equal to 22 μg/m3 the outlook is better.

“PM2.5 concentration (22 μg/m3) benefits of physical activity by far outweigh risks from air pollution even under the most extreme levels of active travel. In areas with PM2.5 concentrations of 100 μg/m3, harms would exceed benefits after 1 h 30 min of cycling per day or more than 10 h of walking per day.  For half an hour of cycling every day, the background PM2.5 concentration would need to be 95 μg/m3 to reach the tipping point.” Read the study

Bear in mind this study was done in urban areas with more pollution than wildfire smoke causing the increased PM2.5 and that they were commuting by bike, not charging up Ferrin’s or Putt-Putt.

The truth is we need more data to determine the risks vs benefits.

Want to be a citizen scientist and help contribute data to support research on the health impacts of wildfire smoke? Download the EPA’s Smoke Sense app. You can view air quality, see where fires are burning and report your smoke observations and health symptoms.

Thank you for reading. Play it safe out there!

Mountain Bike Injuries & How We Can Help

Mountain biking is a way of life for many in the Jackson Hole area.  It invokes a sense of adventure and sparks the adrenaline rush that we junkies all seek.  For many of us, this includes pushing our body and comfort level to the max, exposing us to the risk of injury. 

Let’s take a look at the common injuries associated with this great summertime sport.

1. Skin and soft tissue injuries are very common.  This includes everything from lacerations to sunburn.  Wearing the proper gear and a high SPF sunscreen does well to prevent exposure.

2. Traumatic injuries are also a risk.  Upper extremities injuries are more common; however, serious traumatic injuries can also involve the head, neck and spine.  Please get yourself checked out at the ER or by a trauma specialist if needed!  If you’ve been checked out at and cleared at the ER and still have lasting pain,  or maybe you didn’t bother at the time but might need some attention now, we can check for post-concussion symptoms and physical injuries.   As primary sports physicians, we can treat and refer as necessary to help you recover from injuries including concussions and whiplash.  

3. Chronic/Overuse injuries happen frequently when we are addicted to a sport.  On average, a mountain biker on an moderate trail will rotate the pedal around 5,000 times per hour!  Pedaling is almost exclusively a sagittal plane motion (forwards and backwards) .  Any kind of motion dysfunction in the lower extremity leading to motion in another plane (eg. lateral motion)  will increase susceptibility to chronic/overuse injury.  This could be a muscular imbalance, motion dysfunction or postural issue leading to knee pain, tendinopathies, foot pain, neck and shoulders issues, peripheral neuropathies and low back pain.

The doctors at JH Backcountry Health excel in identifying and correcting these dysfunctions.  We use functional motion analysis techniques to identify aberrant patterns and then correct using active release techniques, stretches, chiropractic adjustments and exercise prescriptions.  

As it reads on our home page, our mission is to provide the citizens of Jackson, WY and visitors to the area a means of maintaining their incredible active lifestyle. The proverbial “Go Big” no longer has to be followed by “or Go Home”.  Schedule an appointment today.  Let us help you continue to enjoy your adrenaline addiction!

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