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Is Nordic Walking a Superior Approach for Hip and Knee OA Rehabilitation? – February 16, 2022

February 16, 2022


Mandy ShintaniMandy Shintani, OT (BC) & Gerontologist
Urban Poling

Mandy Shintani has been an occupational therapist for 35 years and is a gerontologist. She is an international conference speaker on walking poles for rehabilitation. 8,000+ therapists and wellness professionals worldwide have completed the courses she developed. Sixteen years ago, with her skills as an OT, she developed the evidence-based, FDA registered Activator Poles (patented) and technique specifically for rehabilitation, which are the focus of 18 current independent studies. She has been featured numerous times in media and was a finalist in the prestigious YWCA Women of Distinction Award for Innovation & Entrepreneurship.


Lunch & Learn Recording & Transcript


The content displayed in this transcript is the intellectual property of Mandy Shintani & Urban Poling. You may not reuse, republish, or reprint such content without written consent. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by OA Action Alliance or CDC/HHS. This transcript was automatically generated in Zoom, and edited for clarity; however, the OAAA cannot guarantee there are no mistakes or errors.

February 16, 2022

Title: Is Nordic Walking a Superior Approach for Hip and Knee OA Rehabilitation?

Presenter: Mandy Shintani, OT (BC) & Gerontologist

Organization: Urban Poling


(Katie Huffman) Hello, and welcome to the Osteoarthritis Action Alliance Lunch and Learn webinar for February 16, 2022. Our presenter today is Mandy Shintani who has been an occupational therapist for 35 years and is a gerontologist. She is an international conference speaker on walking poles for rehabilitation, and there are over 8000 therapists and wellness professionals worldwide that have completed the courses she developed. 16 years ago, with her skills as an occupational therapist she developed the evidence-based FDA registered activator tools and techniques, specifically for rehabilitation. These are the focus of 18 current independent studies, she has been featured numerous times and media, and was a finalist in the prestigious YWCA women of distinction Award for innovation and entrepreneurship. Her talk today is titled: Is Nordic Walking a Superior Approach for Hip and Knee OA Rehabilitation.


(Mandy Shintani) Thank you so much Katie! As an occupational therapist and gerontologist, I am passionate about teaching innovative strategies to improve functional ability independence and for being active. My hope is that you’re going to walk away from this webinar, whether you are a healthcare professional or someone with a on a new rehab and wellness tool, with the ability to increase your positive outcomes for your client’s balance confidence and walking ability. First of all, I just want to thank you so much to Katie and overall, to the OAAA for inviting me to speak today it’s a real honor.

So, the whole concept of Nordic walking was introduced to me by my Swedish neighbor. I think we can all agree that the Scandinavians represent one of the healthiest groups on the planet, particularly their older adults, and I wanted to find out what they were doing. Evidently, my neighbors stayed healthy simply just by walking, which I found really fascinating when you think about all the things that we do to stay healthy. And also, she said, everyone there uses walking Poles, a fitness activity called Nordic walking that are used by preschoolers, working moms, the Swedish Olympic cross-country team for their summer training programs, and of course older adults. Now I had never heard of this concept before, I mean, using walking poles everywhere. And when I looked at the research what I was amazed at is that there are 360 independent peer reviewed studies on PubMed. And what I found is that poling really targets our main goals for rehab. This was 2006, so we have been doing it in Canada, for a long time, it is considered best practice for orthopedic we have here. I know it is a new concept to United States, so I am very happy for a lot of you here to introduce it now, as some of you already are familiar with, so if you have used it before, please let me know through the chat button where they use it, personally or professionally.

So, what are some of those key goals that I mentioned? Okay well, as you can see with this fellow here when you’re actually applying weight on to the poles, we actually have a ledge on ours, you’re actually taking what the research shows anywhere between 11-34% of painful hip and knee joint pressure. Now, when you’re pressing down as well, you’re offloading some of your weight, and that improves your balance because you have got four points of contact. When you push on that ledge, again, it forces you into an upright posture and helps to normalize your gate or walking pattern.

And, of course, what the research shows is that the more normal you’re walking pattern is, of course, the less pain is released. You are also at less risk of falling, as it strengthens the core. And it’s a great tool, if you’re a healthcare professional, that you explain to your client how to use. And they can continue to use it within their community as a lifelong tool.

Now I’m also going to talk to you about how those same benefits can apply for standing exercises. So, if you’re at home, right now, if you want to just stand up and begin weight shifting as this fellow is doing here. You can use the back of the Chair, I know you guys don’t have poles, but you can imagine that using the poles really allows you to. Again, this will help to improve your posture, you’ve got the four points of contact for balance and that’s going to improve your confidence, and it’s going to take some weight off. And it’s also going to allow you, because you’ve got the constant balance, to actually make your movement much bigger.

So, in the agenda today I’m briefly going to go through some of the benefits that research points out as Nordic walking pertains to OA. I’m going to talk to you about a different technique, then the fitness activity of Nordic walking. So just to clarify, that Nordic walking is a fitness activity but I’m going to talk to you about a different type of technique that’s called the activator technique that is really more for balance offloading. You would use this anytime you want to take a significant amount of load off hip and knee joint which is particularly helpful for pre and post replacement surgery. And of course, this is something you would want to run by your surgeon and physical therapist.

I’m going to show you some standing exercises and then going to talk to you about how you might obtain the activated post in the course and then we’ll open up for Q and A. So, let’s just go back to the basics. What is Nordic Walking? We’ve coined it here in Canada as urban poling, and well, basically it’s your upper body doing a technique somewhat similar to cross country skiing.

And that’s why there’s so many health benefits associated with it, and I ‘m not sure if you’re familiar with cross country skiing, but it does have one of the highest cardiovascular workouts of any activity. And in cross country skiing, your lower body is just walking so we combine those together very simply it’s simply just walking with specialized walking poles. But what’s neat about it is you are getting that benefit of that increase aerobics workout hence why I talked about the weight management earlier. I’m going to explain to you a little bit more about how it is effective for strength, training, and as I mentioned earlier getting that balance and posture.

So, this is a video that was developed with the Canadian Arthritis Society because they recognize that it is an effective activity to be used with people with OA.

(VIDEO) Staying active is a vital part of living well. For many people with arthritis, Nordic walking can be a safe and fun way to get fit, stay active, and retain your mobility. Nordic poles engage your back and arms, turning walking into an all-body workout that’s also safer and more stable. Nordic walking can help just about anyone, especially people with issues such as spinal stenosis, osteoarthritis of the knee’s hips or ankles, or people preparing for a recovering from joint replacement surgery.

(Mindy Shintani) Hopefully you got an idea of what the activity looks like, and as you can see it’s a lot of fun and you can even do it in the wintertime. I’m coming to you from North Vancouver Canada, of course, so I had to show you one scene and the snow. And you can really vary it, so you can really bring up the intensity if you want to. I’m going to show you later on how you can do it more for those clients where it’s really just about general walking.

So, let’s talk at look at walking and let’s compare the use of poles of walking alone, you can see here that when you’re walking, you’re primarily using your lower extremity muscles. However, when you use poles, you were actually now engaging anywhere from 75 to 90% of your muscles so you’re really taking you’re walking and you’re turning it into a low impact full body workout. And for that reason, what they found in this study is you’re actually going to burn on average about 20% more calories with some subjects as high as 46%. And of course, I think you’re already aware that when you do reduce your weight that does help significantly with the loading on your hip and knee joint. So, a lot of people understand you know how there’s an increase of aerobic workout balance posture, but I find a lot of people have a more challenging way of accepting what does it help out with core strengthening. So, I’m going to get you to do a little demonstration, along with me, so I can explain how using the poles is really effective for core strengthening, and of course core strengthening is key for your ability to transfer, such as sit to stand, as well as your ability to walk.

So, if you could stand up right now and what I want you to do is pretend you’re going to give me a handshake. Because the handshake position is actually what you would use for the fitness activity of Nordic walking. And I want you to, when you give me that handshake, then land your hand or rest your hand on top of the table, or the back of the Chair. And then I want you to put one hand on your abdominal muscles and I want you to push down put a downward force on that table back the Chair is if you’re pressing down on the ledge of this Core grip handle and hopefully what you’re finding is that when you push down you’re going to feel contraction that’s happening in your core muscles. So, for example, if you were walking with the poles and you walk one mile, that’s equivalent to 1800 steps. And that means that you’re actually going to engage your abdominal muscles 1800 times, so what a simple, easy convenient way for you to improve your core strengthening. Simply by walking one mile and then you could also, if you wanted to keep pressing down, you can feel it in your lats your side muscles your pecs your arms and you’re back muscles.

One of the reasons why we do use it in Canada here as well, for people who do have back pain as well, so, while I know it is new in the United States, I just wanted to show you some international recognition for this activity, it is recognized by the world confederation for physical therapy, you can see here for both strength and for balance exercises. It’s also recognized by a number of different associations both in Canada and the US. So, I show you the video from the Arthritis Society, but it’s also recognized by the Arthritis Foundation. And it’s also used because of that weight management piece, it is also recognized by a lot of groups such as diabetes Canada, as cardiac rehab, as well as in the obesity foundation as well. Here it is used as an effective alternative to canes and to reduce or delay the use of walkers.

Let’s just quickly look at some of the challenges associated with using some of these other devices. For example, when you are using the walker, you are leaning forward in what we would call a stooped posture…there is zero arm swing that is required. Arm swing is really beneficial in terms of maintaining your balance while you’re walking and if I had you stand up again and lean on your desk as if you’re leaning on the walker, I think what you would notice that you’re actually relaxing your core muscles, which really goes against some of the goals we’re trying to achieve within rehabilitation or wellness programs. Whereas, as I mentioned earlier when you’re using the poles, you are standing up right, and there is a tremendous amount of arm swing, that hopefully you saw in that video as well as legs drive-which I’ll be showing you later on in some videos as well. So, let’s just take a look at some of those videos, so I think most people are prescribed the cane. But you are leaning to one side, with a cane your wrist is now in a hyper extended position places the greatest amount of stress and it does change your walking pattern so let’s just take a look at this video.

(Video of person walking with cane vs. walking with walking poles plays.)

Hopefully, what you can see there’s just her tremendous sense of confidence with using the poles she’s actually mimicking a more normal walking pattern which is opposite arm and leg with that regular arm swing and then you could just see how unsteady she felt when she wasn’t using any device. Now this is Susan she’s actually based in Alberta, and what she found is that you initially were provided with the crutches a post hip surgery. And she said that she felt quite unsteady with the crutches she found that they were awkward because they’re at that 45-degree angle, she felt that she was that they might slip. Let’s just look at her walking pattern.

(Video of Susan walking with crutches vs. walking poles plays.)

And, and then this is just a quote from Dr jack Taunton, he’s actually our chief medical officer for the 2010 and 2016 Olympics who was a professional marathon runner. He also under underwent 7 spinal surgeries and basically, he talks about the fact that if he was using a walker he’d be leaning forward, but also for Dr Tom and he’s really an icon here around Vancouver, and what he says as well is that you know he still walks. That’s his main form of exercise now, and he doesn’t want to be seeing around town, using a cane or a Walker he just he likes the whole concept of the poles representing him still being an athlete. He calls it power walking when he uses the poles. So just a difference in terms of people’s self-image. Sometimes I find when we give a walker or a cane to a client, they feel like that really represents a decline, or the start of a decline in their overall function, and we really want to motivate our clients to understand that really exercise and walking is more important.

Okay, so let’s quickly go through the research, there are 360, as I mentioned, studies on the benefits of using Nordic walking. And we’ve got 18 current studies on our activator poles. One of them is actually used to do with Hip OA, and that is being done University of Saskatchewan. And so, in terms of the hip OA, this is the most common study that I often talk about, it was done in Denmark and what they found in this one is that generally improvements in function performance were greater after Nordic walking compared with home based exercises and strength training at all follow up measures. And here’s a study that was done in Israel and what they found is that 91% of the subjects, 100 subjects, actually found a marked reduction in pain on walking and essential increase in distance walked. It does improve your mood overall; this is studies done in comparison to walking alone.

And I’m just going to show you a Gait Assessment study done on Barbara and if you can believe that she has had two shoulder two hip, two knee replacements and a neck fusion. She had a lot of issues with their balance as well.
(Video of Barbara walking without any tools.)

So, this is Barbara not using the poles, you can see very wide gait pattern she’s walking flat footed slow gait pattern…and a lot of gait dysfunction.

(Video of Barbara walking with walking poles.)

And here she is using the poles, you can see right away, she increased her stride, she’s using her arms more normally, she’s actually the lifting up her feet-that’s really key lifting at your feet-because in terms of fall prevention you’re not going to hit cracks in the sidewalk which is a very common reason why people fall, she’s increased her speed, etc.

(Video of two above videos playing side by side.)

There it is side by side, and if we looked at the overall results, Barbara walked 37% faster, she increased her stride length by 47% and overall, significantly reduced her gait dysfunction. So now I’m just going to show you quickly the activator technique which was studied by University of Western Ontario. In studying what also is referred to as the Japanese Nordic walking style they found that compared to doing the fitness activity style it may reduce the compensation or a pelvic rotation in patients with hip OA. So, it may be a better option for joint protection and prevention of secondary disorders of the hip in a patient. So basically, in the activator technique, you really want to keep the pole vertical, and your elbow should be bent at 90 degrees. So, it’s still opposite arm and leg, but you want to keep that pole vertical versus the diagonal that you find in the Nordic walking technique. In terms of the difference in the developing of our poles, we did develop it to be ergonomic, it was recognized or certified by the Ease of Use Program with the Arthritis Foundation, and we did make it strapless because the most common reason why people have an injury when they use poles is related to the strap itself so it’s if the pole gets caught or people stumble this will attach the Pole and it’s this gear thumb injury that you see right here.

So, I’m just going to finish off with just showing you that you can use the poles for exercises as I mentioned earlier, for confidence, for balance, for posture, or for offloading. It does seem to motivate people to do their exercises and it also allows you to do the exercises in lots of different places like your home environment. I often say do by the kitchen sink, but you can do it while you’re watching TV, too. You can have a wall behind you and also allow for a variety of more types of exercises that you can do. So, if you’re interested, we do have a four-hour activator course that is recognized by the United States’ Physical Therapy American College of Sports Medicine and many associations within Canada as well. So, if you want to find activator poles, you can obtain them through Amazon or through our website.

A lot of information I talked about during this webinar was about how to adjust the poles, how to do the technique, but the activator and the urban poling or fitness or Nordic walking fitness technique is also on our website. And if you are someone who is a therapist or fitness instructor and you want to start up a class, you can email Diane or Dianna at urban for our US distributors and so thank you so much to everyone, and I just want to leave five minutes for questions now.


Great! Thank you so much for the presentation. we do have time for some questions. So as a reminder, you can type any questions into the chat, and I will read them aloud.

QUESTION: And we do have a question here, someone asked, I already have hiking poles that I use when taking rugged or steep trails, but would they work for Nordic walking, or do you need a special type?

ANSWER: Mandy Shintani: yeah, I mean, I think, just like I guess if you’re thinking of you know tennis versus racquetball you know if you use the proper equipment, you’re going to get optimal benefits of the activity. A couple things I would say to that too, if you’re actually going to do the Nordic walking technique you do need a boot shaped tip for that to enable you as I showed you in that first video to do the technique properly, so I would encourage you to get the proper ones. We get some benefit out of hiking pools, you know absolutely I think it’s still giving you know some of the balance, you know some of the offloading, so I do leave that up to each person, but you know optimal benefits, I think, to the research is better in terms of having the proper equipment. The one thing I would say is just make sure you’re using good equipment, particularly if you are using it to offload. I always cringe when I hear people say that they’re just going to get cheap poles from Walmart or Costco and those could have very low weight bearing capacities to them. So just make sure that again if you’re offloading you do want a good quality pole, to ensure that doesn’t slip and it’s safe to use talk it over with your physical therapist or your surgeon, maybe get their opinion regarding it as well.       

QUESTION: I see there’s a question about where someone can get information on the four-hour course and then a second question on the cost of Poles all of that, I believe is on the Urban Poling website.

ANSWER: Mandy Shintani: Yeah absolutely. So, if you go to our website on the course if you look under education, you should see our online courses where we do live virtual classes, or you can email us. We also do customized groups as well. And then the cost of the poles as well, is on there as well, but they run at around 114 dollars.

QUESTION: There’s a question here about whether urban poles are effective and successful with individuals with spinal stenosis.

ANSWER: Mandy Shintani: With spinal stenosis, yeah, actually one of the first places to actually use our poles in 2006 was the Baker general hospital with Dr Charles Fisher. He actually was the President of the spinal society; he actually changed their protocols to the activator poles for spinal stenosis post-surgery. And that’s the whole reason, when you had surgery for spinal stenosis you really want to maintain that upright posture, and so the activator technique absolutely has a place with spinal stenosis post-surgery.

QUESTION: And then I think you might have touched on this, but I’ll just make sure so that this person’s question is answered, are these poles primarily for therapeutics or can they be simply use for Nordic walking?

ANSWER: Okay well great question. So, all that research I mentioned earlier, the 360 studies, just so you know that is actually done on the fitness activity of Nordic walking. So here in Canada, even though my intention was to bring it in as a rehab tool, what we found is that it was way more popular through the fitness industry. In fact, I found often the rehab professionals I talked to actually wanted to use it for themselves as a fitness activity, so there are so many benefits for it as a fitness activity. There’s lots of benefits for doing it as a fitness activity and you may find that you do get enough offloading when you use it as a fitness activity.

QUESTION: That was great, thank you and one more question for someone, maybe, who has not done poling before. Is there a recommendation on how far someone should go for the first time or any advice you have for people who haven’t tried it before?

ANSWER: Yes, I mean if you already are seeing a rehab professional or you know you, work with a fitness instructor, I would determine that with them, of course, because they can do the assessment. They know you best so that would be your first line. But if not, I always suggest, as a general rule, go 30% of your maximum walking because what people don’t realize, is that you are using a lot of muscles, you’re also learning new activities which takes a lot of cognitive concentration as well.

So, this is what I find…is people get the poles and get super excited, I mean it’s a new tool it’s lots of fun! But the most common question I get is people will come back and they’ll say I was exhausted, you know, or you know you can overstress your joint so I’m always about slow and steady wins the race. I start off 30% is going to be enjoyable, you’re going to achieve what you want to achieve and then move gradually up to your maximum walking tolerance. And I think you’re going to find that you’re going to be able to see that eventually, because of that off-loading, and you’re going to increase your walking speed eventually. But yes, start off slow and I think you’re going to get much greater success, you also remember, using a lot of joints you don’t normally use in your upper extremities. So, you do need to work those slowly up to full capacity so that you are not over working those muscles as well.


(Katie Huffman) That’s great. Thank you so much for that information and we do have a couple of other questions, I think that can be answered on the website that I believe will be provided in follow up email that I sent out later this week, once the recording is ready. And you can reach out to Mandy directly. Mandy did you have anything you wanted to add before we close today’s presentation?

(Mandy Shintani) Oh, no, I just wanted to say that if people do have specific questions that you think aren’t answered I’m just going to put my email in here under the chat button. I’m happy to take specific questions, through my email and just want to say thank you so much, everyone I hope everyone stays safe out there. You know this is a great activity right now with walking you know, being one of the recommended safe activities to give a try. I think most people find that until they actually try it out, they don’t really understand you know what the benefits would be like, and I think you’ll kind of get your ‘Aha’ moment. So, thanks so much Katie, I really appreciate it, and again thank you so much, everyone for your time.

(Katie Huffman) Thank you Mandy for your presentation and thanks to all of you for joining us today. We hope that you’ll be able to join us next month for our March 16th Lunch and Learn featuring an overview of the OA Action Alliance’s newly updated resources in the OACareTools: Resources for Healthcare Providers, Employers, and Adults with OA. Thank you and take care.