REP 13: NORDIC POLE WALKING – MADE FOR PHYSIOTHERAPISTS?
When I was first introduced to Nordic Pole Walking (NPW) 6 years ago, the common comment as you walked by someone was “where’s the snow”. Today, I have to carry business cards with me because I am constantly asked “what are you doing and how can I learn more?”
If you’ve ever tried NPW, you would agree that it is easy to become passionate about it. It’s a fun activity that can help you optimize your treatment and get patients moving, no matter your area of practice.
The big idea
As physical therapists, we are masters of movement, from the micro- level of a shoulder joint, to cardiorespiratory dysfunction, to the entire integrated person. As a physiotherapist, I have become passionate about the need to keep people moving and help them realize that how we treat our bodies today will impact their quality of life 10-15 years from now.
Mounting research is showing the positive impact of regularly scheduled, moderate activity on decreasing pain and improving overall fitness. Dr. Michael Evans from Toronto, summarized some of this research in a brief, entertaining, and now famous YouTube video, 23 ½ hours.
If patients are being encouraged to find only 30 minutes, 4-5 times a week, to incorporate activity into their day, physiotherapists need to find and prescribe activity options that are not only beneficial, but provide the biggest bang for patients limited time investment.
My take on things…..
“Movement is Life and Life is Movement”
As orthopaedic physiotherapists, we rarely treat acute ankle sprains. More often than not, we see the recurrent ankle sprain that happened 20 years ago which now presents with ankle OA, compensations at the knee joint, and chronic instability. Our patients come to us with an orthopaedic problem whose ability to rehab will be adversely influenced by the fact they have diabetes or cardiovascular disease. How can we address all these components effectively? What can we prescribe a person who has just been diagnosed with Parkinson’s Disease (PD) to empower them in their independent rehabilitation efforts?
Patients need activity solutions that are fun, inexpensive, easy to learn, and easy to pick up again after “falling off the wagon”. Therapists need activity solutions that are backed by solid clinical evidence. NPW is an activity that patients truly enjoy doing once they have tried it. As a therapist, what I love is that it effectively helps patients carry over the benefits of my treatment, and it is also a preventative activity that works on many levels, including fitness, flexibility, strength, and stability.
The clinical evidence for NPW
In Europe, NPW has always been considered a sport. It originated in Finland as summer cross-training for their Olympic cross-country ski team, and soon became popular with skiers and track and field athletes in Germany. Exercise physiologists have been studying NPW for years, and scientific evidence has demonstrated that NPW:
- Burns 25 – 46% more calories than regular walking
- Incorporates 90% of the muscles of the body
- Reduces stress by up to 30% on hip and knee Joints
- Improves posture and balance
- Provides benefits for those with diabetes and cardiorespiratory conditions
- Aids in falls prevention
- Improves ambulation for patients with PD and Multiple Sclerosis (MS)
I call NPW “Pilates taken to movement”. Since the rate of perceived exertion only increases by 1-3 points, it is ideal for your deconditioned patient. One could easily incorporate a NPW to work or during their lunch hour. A study published in 2013 in the Journal of Sports Science and Medicine compared the effects of Nordic Pole walking versus regular walking and resistance exercise in older adults. It found that NPW provided the additional benefits in improving muscular strength on all variables of fitness compared to conventional walking.
Which populations can use NPW?
I have incorporated NPW with many populations.
In my experience, it has been an excellent cross-trainer for my triathalon athletes, who describe really feeling their core engage while swimming and running afterwards.
At the clinic, we have noticed NPW to be increasingly popular with Zoomers and people aged 45 and up. I will also encourage it with my 50+ tennis players. The longer stride length, elongation and increased mobility through the trunk seems to improve the flexibility of their hips and reduce their back pain.
I had a patient who presented with a highly irritable flare of her knee OA. She ‘lived to walk’ and was concerned about having a TKA because she had recently had heart by-pass surgery. What stood out with her presentation was her marked scoliosis. I introduced her to poling immediately, and we adjusted the poles to compensate for the scoliosis. She was so excited to feel that she could walk again. In the clinic, we managed her knee OA symptoms and did strengthening. She NPW’ed 3 times a week, 30- 45 minutes each time. She came to see me a year later and I could not believe the change in her spine. She reported having minimal knee pain, and that her family doctor was amazed that her height measurement had increased. She said that her cardiologist confirmed “every variable of her fitness level measured had improved.” People age, but ‘all is not lost’ for them. As a therapist, it is rewarding that something so simple can be so effective.
Our neuro-rehabilitative physiotherapists have used strapped and unstrapped Nordic Poles in treating patients with MS, PD and post- stroke on a regular basis. I was asked to speak on physiotherapy and aging at a community event last summer. There were a few people with PD in attendance, so I was asked to restrict the ‘active’ component of my presentation. I had brought poles. When the attendees with PD strapped into the poles and started to walk, the cadence came more naturally for them. The two men were off to the races, walking up and down the parking lot. One man’s wife was brought to tears when she saw him walk “almost normally”.
I have trained physiotherapist instructors who are using poles in their falls preventionprograms, cardiorespiratory rehab, post breast cancer rehab, osteoporosis, and diabetestreatment. We have found that MVA treatment plans will often accept them.
Getting over the stigma
North Americans tend to associate the poles with a need for walking with assistance, rather than as a strengthening and flexibility tool. There is a perception that it is an activity only for the elderly or deconditioned. Yet, it is very popular in Scandinavian countries as both a sport and as recreation. They even have designated NPW trails!
The mindset in Canada is changing though. Global TV did a great segment on the increasing popularity of NPW, and it is now a category in all the major walk/runs. We have entered NPW teams into the Toronto 10km, Toronto Waterfront 5km/ ½ marathon.
Like with any activity, NPW is perhaps not for everyone. We have found that for patients who are skeptical, introducing NPW during a treatment has helped them to see it as a positive activity. Providing free info sessions in the clinic has also been invaluable for helping people see its potential.
As a clinic, running classes can be time consuming and may not generate much income. So, we host a free information session once a month and offer one class weekly. Our physiotherapists are trained in NPW and will often teach it one-on-one during treatment sessions and then encourage a 1-3 class follow-up.
We also encourage patients to look for classes in their community. Many poling companies offerlists of NPW instructors in cities across the country.
Technique is Important
For patients to gain full benefit of participating in NPW, it must be done correctly. It is important that physiotherapists learn the technique and are able to teach it effectively. The bulk of the research has been based on poles with wrist-straps, which is the technique most commonly used world-wide. A strapless technique can be easily adapted from the traditional 6 step strapped technique. Different poling companies also offer instructor training programs.
I cannot describe the personal satisfaction that I received when our first team of NPW crossed the Scotiabank 5km finish line. We were all ages and abilities but shared a common sense of camaraderie, excitement and achievement. Many had never thought they would participate in such events and it was their physiotherapy team that got them there. I am addicted and can’t wait to get out with my poles now that spring has sprung!
To anyone who is concerned about the stigma, I reply: there is a reason why people walk into their nineties in Finland.
If this topic sparked your interest, consider checking out these additional resources I’ve pulled together:
The Ultimate Nordic Pole Walking Book is a useful learning and teaching resource. The six steps to NPW are clearly laid out in this book, as well as an excellent summary of relevant research. Available on Amazon.
I have contributed to the rehabilitative component of the major poling companies in Canada and have developed a course for rehabilitation professionals which addresses the spectrum of poling.
Additional research papers you may be interested in checking out:
- van Eijkeren, FJ, Reijmers, RS, Kleinveld, MJ, Minten, A, Bruggen, JPT, Bloem, BR. Nordic walking improves mobility in Parkinson’s disease. Movement Disorders 23.15 (2008): 2239-2243. (Not open access)
- Duncan, M., Lyons, M. The effect of hiking poles on oxygen uptake, perceived exertion and mood state during a one hour uphill walk. Journal of Exercise Physiology 11.3 (2008): 20-25.
- Willson, J, et al. Effects of walking poles on lower extremity gait mechanics. Medicine and Science in Sports and Exercise (January, 2001). 33(1): 142147
- Keast, ML. Nordic walking: introducing a new low-impact exercise system for cardiac rehabilitation patients. Minto prevention and rehabilitation center, University of Ottawa Heart Institute (2009): 13–14.
What have been your experiences with NPW and clients? What populations do you find most effective?
There are many areas of physiotherapy that have begun research using poles. Are you involved in any that you would like to share?
Let’s chat using the comments box below or via the CPA Facebook page or Twitter (hashtag#30Reps)
About Jennifer Howey
Jennifer Howey has a clinical practice and is the owner of InsideOut Physiotherapy & Wellness Group Inc. in downtown Toronto. An avid believer in physiotherapy promotion and education, Jennifer has been featured on CBC, Global National, the Globe & Mail and is a clinical lecturer within the Physical Therapy Program at the University of Toronto. Jennifer was involved with developing the rehabilitation component for Nordic Pole Walking in Canada and is currently a Master Trainer. She is also a national instructor for BSN Leukotape – K taping.