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Acclaimed pastry chef/restaurateur Gale Gand and her partners have a joke about where to locate new restaurants each time they’ve launched one: “Build them within walking distance of an emergency room,” she says. She points out that famed Chicago restaurant Tru, where she serves as executive pastry chef and partner, is less than a block from an ER in downtown Chicago.

“You have the normal cuts, stitches, and burns,” says the busy mother of three, though the risks of being a chef include a lot more than sharp knives and fire. “It’s a super-physical job,” explains Gand, whose been known to wrap ice packs around her knees while whipping up desserts in the kitchen.

“It’s going up and down stairs carrying things, loading boxes onto dollies, unloading cases of bananas, lots of bending and lifting,” she explains. It’s not uncommon for chefs to slip and fall while carrying heavy bags of flour or large cans down stairs – which Gand has done.

Add to that long periods of standing and countertops that are too low or high to be ergonomically correct, and the result is frequent lower back pain, achy knees and feet that always hurt.

“We have the most expensive rubber (anti-fatigue) mats around but they only do so much,” says Gand. “I change shoes a few times a day, from clogs, to Vans to Skechers, which have thick soles.” Back and knee surgery is typical for chefs, she says. “I’ve had knee surgery and I’ve had cortisone injections in my back because of pain. The last time was just before my wedding because I wanted to be comfortable.”

Still, for those who love to prepare food, the show must go on, and Gand, who travels the world demonstrating her pastry prowess and promoting her books, has a few suggestions to help prevent or alleviate pain in the kitchen:

• Good shoes are a must
• Strengthen your abs and back (core) so you can hold yourself up comfortably
• Massage, whirlpool, and hot tub soaks are great for aching muscles
• Gand is a big fan of ice and Aleve for everything from burns to sprains to sore muscles
• Back braces, such as those worn by truckers and others who load heavy goods, can be helpful
• Support inserts in shoes can also help

Chef Michel Roux, who runs London restaurant Le Gavroche and is author of “The Marathon Chef: Food for Getting Fit”, agrees that physical fitness is essential to being a healthy and productive chef. “Life in the kitchen is hard going, so it’s hugely important to keep yourself in shape,” says Roux, who has run 17 marathons. While it may be tough to work out regularly, it’s a big help in the kitchen, physically and mentally. Roux runs in-between lunch and dinner service and says he often bumps into fellow runner/chef Gordon Ramsay.

Other tips:

• Invest in a good, anti-fatigue mat to stand on, or try a rug in the kitchen for comfy padding
• Counters should be at the right height, so you’re not bending over or reaching up excessively
• Be aware of proper posture; don’t hunch your neck, back, or shoulders
• Occasionally rest one foot on a low stool or shelf to give your back a break
• Change tasks frequently to avoid repetitive stress

Bryan Christie

Injury Tip Sheet: Stress Fractures

Learn what you need to know to help treat and prevent this common injury

Kathy Weber, M.D., M.S.
Daphne R. Scott, PT, Dsc
Chicago, IL

Fast facts

• Occur most often in the leg and foot    
• Occur more often in women than in men
• Majority heal without surgery or complications

What you need to know

What is a stress fracture?

• Stress fractures are tiny (micro) breaks that occur in bones
• Bones, like muscles, need time to recover.  If you demand too much of the bone it weakens and can develop small breaks or fractures
• Stress fractures are generally the result of overuse; when muscles become weakened or fatigued by overuse they cannot properly absorb repeated shock or impact and the impact gets transferred to the surrounding bone

Signs & symptoms

• Pain at the site of the fracture; symptoms for stress fractures in the lower leg can be similar to symptoms for shin splints
• Localized pain at the site of the stress fracture
• There may be mild swelling 
• Initially the individual may experiences localized pain at the site during exercise and typically decreases after exercise or with rest
• Pain initially will resolve with rest but overtime if the stress fracture is not treated pain will be noted during rest

When should I see a doctor or other professional?

• You should see a doctor if the pain does not decrease with rest or the pain persists
• You develop a rash or redness and bruising at the injury site
• If pain does not subside with time, see your doctor
• Your physician will perform a physical exam and typically radiographs of the area will be obtained.  If the radiographs are inconclusive, your physician will determine if further imaging is necessary to determine the exact location and severity of the fracture
• Many times the clinical history and the exam is sufficient to diagnose a stress fracture

Causes

• Repetitive pressure or use of force on a bone, such as with running or jumping
• Increasing the intensity of training without proper conditioning
• Sudden trauma to the bone such as landing improperly after a long jump or a direct blow to a bone can result in a stress fracture 

Risk factors

• Individuals who have weakened bones from conditions such as osteoporosis
• Athletes who play on hardened surfaces or who use worn out shoes or orthotics
• People who have flat feet or high arches
• Increasing activity to much, to soon, without adequate recover

What you can do

Prevention

• Never increase the intensity of your workouts by more than 10% each week
• Ensure that you properly stretch prior to and after all workouts
• Make sure you rest between workouts to allow your body time to recover
• Cross training and maintaining a healthy diet to improve bone strength can help improve bone health

Recommendations for treatment and rehab

• Treatment is specific to the type and location of the stress fracture.  Some stress fractures require strict immobilization and non-weight bearing status while others may be treated with relative rest and others with surgery.  Your physician will tailor the treatment to the specific stress fracture.
• Elevate the limb, if possible, and ice the site of the fracture to reduce swelling
• You should work with you physician to develop a return to activity guideline.  Remember if you return to your regular activity too soon, recovery time lengthens and the fracture could have difficulty healing

What can I do to stay active?

• Participation in any weight bearing activities if the stress fracture is in the leg will be at the discretion of a doctor and should only be participated in after consulting with a health care professional
• Low impact activities such as swimming can typically be performed but should be approved by your treating physician prior to participation in said activities

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Bryan Christie

Injury Tip Sheet: Shin Splints

Learn what you need to know to help treat and prevent this common leg injury

Kathy Weber, M.D., M.S.
Daphne R. Scott, PT, Dsc
Chicago, IL

Fast facts

• Occurs in athletes of all ages
• The majority of shin splints are caused by improper training
• The shinbone (tibia) supports more than 80% of the body’s weight
• Cause over 10% of all running injuries

What you need to know

What are shin splints?

• Pain and soreness along the shinbone (tibia) due to stress caused from excessive running or overtraining.
• Shin splints are considered an ‘overuse injury’ and result from inflammation in the tendons adjacent to the tibia

Signs & symptoms

• Tenderness, soreness, or pain in the lower leg, typically on the outside aspect of the shin bone  at the onset of exercise, which can reduce as the workout wears on
• Mild swelling along the tibia

When should I see a doctor or other professional?

• If you have localized pain, pain that is initially relieved with rest but now persisting with rest, pain with activities of daily living (walking), night pain you may have a stress fracture and not shin splints. Stress fractures are small hairline breaks in the bone and will not heal with simple icing and/or anti-inflammatory treatments
• If you continue to exercise with a stress fracture eventually the stress fracture will go onto fracture requiring surgery

Causes

• Shin splints are caused by an overload of stress on the shinbone itself and the connective tissues surrounding the bone.  This overload can be caused by specific activities such as running downhill or running in shoes with inadequate support
• Shin splints often occur due to overtraining, or a sudden increase in the intensity of a workout
• Shin splints can also be caused by overpronation, causing additional stress on the tendons in your foot and calf

Risk factors

• Shin splints are most common among runners, especially those just beginning running or an extensive training program, such as for a marathon.
• Running in worn out shoes will cause additional stress on your arches, which can contribute to shin splints
• Inadequate stretching will put additional strain and demand on the muscles

What you can do

Prevention

• Adequate stretching prior to and after workouts, especially long training runs, are an important part of preventing shin splints
• Additionally, make sure that you do not increase your mileage too quickly and ensure that your footwear has appropriate arch support
• Athletes should incorporate lower extremity strengthening such as hip, gluteus, and calf raises to help stabilize their lower leg muscles

Recommendations for treatment and rehab

• At the onset of shin splints it is important to ensure you have appropriate foot support and incorporate stretching into your training
• In order to reduce the swelling that is sometimes associated with shin splints, you can ice the area after workouts.  A combination of icing every twenty minutes and, if appropriate, taking an anti-inflammatory medication will help relieve the inflammation and pain associated with shin splints
• Active rest is an important part of any overuse injury
• Your doctor may also refer you to a Physical Therapist to address biomechanical deficits contributing to your shin splints

What can I do to stay active?

• Many runners use this rest time to cross train, incorporating swimming or cycling and avoiding weight bearing exercises
• Minimizing any exercise that increases or reproduces your pain will allow for a more expedient recovery




Bryan Christie

Injury Tip Sheet: Calf Strain

Learn what you need to know to help treat and prevent this common leg injury.

Kathy Weber, M.D., M.S.
Daphne R. Scott, PT, Dsc
Chicago, IL

Fast facts

• Strains and sprains are the most common causes of low back pain
• Sprains and strains are the most common workplace injury in the United States
• Symptoms and treatment for both strains and sprains are often the same

What you need to know

What is a calf strain?

• The calf muscles form the Achilles tendon and attach to the heel and   help propel us forward with walking and running.  When standing still, the calf muscle allows us to rise up on to our toes. This muscle is particularly important during running and jumping activities.
• The calf muscles are made of two major muscles, the gastrocnemius and the soleus.  A calf strain is when one of these muscles is stretched beyond its capacity or is partially torn.

Signs & symptoms

• Pain or tightness in the calf muscle
• Mild swelling, tenderness, and tightness in the calf
• Pain that decreases with rest and increases with activity, especially when pushing off from the toes
• In severe tears you may be able to hear a popping or tear

When should I see a doctor or other professional?

• You should see a doctor when there is persist swelling, pain, dysfunction, or if a rash or fever develops
• If the strain does not improve after a couple of weeks of self-treatment
• Your physician may recommend immobilization for a short time period
• Severe strains may require physical therapy and in very rare cases surgery

Causes

• Overuse of the calf muscle without proper conditioning or recovery time
• Sudden, explosive demands on the calf that may strain or tear the muscle such as when a sprinter leaves the starting block
• In rare cases, strains can be caused by direct blows or trauma to the calf

Risk factors

• Running on uneven ground or hills
• Athletes who depend on large, explosive leg action such as hurdlers
• Working out with inadequate cushioning and foot and arch support
• People with any muscle imbalances or who have improper running mechanics

What you can do

Prevention

• Stretch and warm up prior to exercising to loosen muscles
• Returning to your sport after an injury: proper warm-up and cool-down including stretching and ice after workouts to help boost recovery
• For women who often wear high heels, stretching is particularly important
• Increase your workout intensity slowly and allow proper recovery time
• Wear footwear that is appropriate   for the activity that you are participating in

Recommendations for treatment and rehab

• Treatment for muscle strain includes RICE treatment (rest, ice, compression, elevation)
• If appropriate, an over-the-counter anti-inflammatory medication maybe helpful  to help reduce swelling and manage the pain
• After the initial injury, typically a few days, the use of heat will help improve blood flow and relax the muscles.  Heat is not recommended immediately following a calf strain or tear
• You can also wrap the calf in an ACE bandage for additional support but should not be wrapped too tightly to prevent blood flow or increase the risk of a blood clot.
• Pain-free stretching the calf muscles regularly maintains muscle flexibility

What can I do to stay active?

• Work with your physician on what activities you can and can not do during the healing process
• Typically participate in activities that do not increase or reproduce the calf pain
• Use of the stationary bike and swimming, only if pain-free, are all lower impact activities that can allow for exercise without aggravating the injury.
• Higher impact activities such as running will need to be avoided until the calf injury has healed.  Returning to activity to soon increases risk for re-injury or worsening the injury (i.e. strain develops into a tear)

Bryan Christie

Injury Tip Sheet: Hamstring Strain

Learn what you need to know to help treat and prevent this common leg injury

Kathy Weber, M.D., M.S.
Daphne R. Scott, PT, Dsc
Chicago, IL

Fast facts

• The hamstring is actually a group of three different muscles
• Hamstring and back strains are the two most common types of strains
• Most hamstring strains occur at the thick part of the muscle where it joins the tendon

What you need to know

What is a hamstring strain?

• The hamstring muscles are the muscles that are on the back of the thigh.  The muscles begin at the ischial tuberosity (part of the pelvis bone) and continue down the back of your thigh to their attachments below the knee.  They help provide stability and motion control when you bend your leg
• A strain occurs when muscle fibers are stretched beyond their capacity
• A hamstring strain is when one or more of the three muscles that make up the hamstring become overstretched or, if the strain is severe, torn

Signs & symptoms

• The most common symptom is sharp pain in the back of the thigh
• Cramping and spasms in the muscle
• With severe strains it is possible to hear or feel a popping
• Typically if a tear occurs there is noticeable bruising in the back of the thigh
• Tenderness in the back of the thigh when walking or bending the leg
• May have difficulty sitting pain free especially if the injury is closer to its origin near the pelvis

When should I see a doctor or other professional?

• You should see a doctor if the pain keeps you from your normal routine
• If pain does not improve after two or three weeks of self-treatment

Causes

• Hamstring strains often occur during exercises that involve running or jumping
• In severe cases it is possible to hear a pop or snap when the muscle tears
• Hamstring strains may occur when the muscles have not been properly stretched

Risk factors

• Sports that require explosive leg action, like track and field or soccer, place additional stress on the hamstring
• Athletes whose hamstrings are significantly weaker than their quadriceps are more prone to hamstring injuries
• Older athletes or people with a previous history of hamstring injuries
• Teenagers going through sudden growth spurts are also prone to mild hamstring strains

What you can do

Prevention

• The key to preventing a hamstring injury is flexibility—stretch often
• Incorporate strength training designed to balance the muscles on the back and the front of your leg
• Do not increase your workout intensity by more than 10% a week

Recommendations for treatment and rehab

• Treatment for a hamstring strain involves an icing and anti-inflammatory regimen to reduce swelling within the first 3 days of the injury.  Icing after activity once the individual has returned to activity is important
• Rest is important to allow the micro tears in the muscle fibers time to heal, otherwise they can easily be reinjured
• Elevate the leg when possible to improve blood flow and circulation
• Icing is recommended during the acute injury time period (typically 3-5 days) then heat may be incorporated to improve circulation and facilitate healing of the injured area.  Icing should still be used especially after any activity to help reduce any inflammation that may occur with the activity

What can I do to stay active?

• Participate in activities that do not reproduce or increase pain
• It is important to allow the hamstring to heal prior to returning to activities that require hamstring activation
• Gentle pain-free stretching
• Activities such as swimming with a buoy between the legs (initially) and circuit weight training without involvement of the lower extremities can be an option to remaining active while recovering
• Typically activities such as running, elliptical trainer, and stair stepper typically are too taxing on the hamstring during the healing process