Top Five Fun Facts About The TMJ

That pesky jaw joint (better known as the temporomandibular joint or TMJ).

So many of us - 35%! - have issues with it yet only 5-10% of us actually seek treatment. Temporomandibular joint dysfunction (TMD for short) tends to hit in people ages 20-40, affecting women more than men.

Despite TMD being so common, not many people know what it is or what to do about it. Here are the top 5 things I want you to understand about the temporomandibular joint and dysfunction:

Top Five Fun Facts About TMJ/D

1. The TMJ moves out of its socket and has a disc

Closed jaw

Open jaw

The TMJ is not your average joint! When you open your mouth fully, the first half of that movement is the jaw rotating in the socket. In the second half, the jaw bone comes out of the joint and moves forward.

The disc is a little piece of tissue that sits on top of the condyle like a hat. It helps the jaw slide nicely out of the socket, holding the jaw in place when the mouth is fully open and returning it to its closed position. Thanks, little disc!

To feel the movement of your jaw, place your hands flat on your cheeks, just in front of your ears. Slowly open your jaw and feel the condyle pop forward into your hand about halfway through opening.

2. Discs can slip forward and that’s okay!

One of the most common causes of TMD is the disc can be displaced anteriorly - in other words, the disc can slip forward in the joint. This may result in clicking or locking of the jaw or it may not - in fact, 9-31% of people moving about their lives have an anteriorly displaced disc and absolutely no symptoms!

The biggest thing to remember with disc displacements is that discs remodel and heal. If you have a symptomatic disc issue, the name of the game is to lessen the irritation of the tissues for a little while to allow the disc to remodel and the TMJ to heal. We do that through manual therapy and specific exercises.

3. Sounds are totally fine, as long as they aren’t painful

Most jaw sounds are related to the discs and if it doesn’t hurt, don’t worry about it. Popping, clicking and snapping are all common sounds in people with no TMJ-related pain.

These sounds are also not predictive of more problems down the road, so ignore them as best you can. It’s hard - the jaw is right beside your ear and the noises can be LOUD! Be armed with the knowledge that these sounds typically decrease over time and everything will be just fine.

4. Your jaw has a resting position and you should be in it most of the time

Check in with your jaw right now - are your teeth together? Are your jaw muscles clenched, tensed or relaxed? Where is your tongue - is it flopped against your bottom teeth or resting on your palate?

Your jaw should be at rest most of the time. In fact, your teeth should only be in contact for 8-15 minutes per day!

Here’s what you need to look for in a resting jaw:

• Teeth slightly apart - your teeth shouldn’t be touching anywhere and be about 1mm apart

• Tongue against the roof of your mouth - your tongue should be resting comfortably against your palate. It should be a few millimetres away from your teeth at the front.

• Relaxed muscles - the chewing muscles in your cheek and on the sides of your skull should be nice and relaxed.

This resting posture is also heavily dependent on good posture throughout your whole body. For tips on this, visit our previous blog posts on posture Your Head Is A Bowling Ball & Ergonomics: The At Home Edition.

5. All those chewing habits can lead to TMD

We’re talking clenching, nail biting, cheek biting, lip pursing… all those mindless mouth habits so many of us are guilty of doing on a daily basis. All that added muscle activation can lead to overuse of the jaw muscles, causing anything from headaches, pain in and around the face and ear, tooth pain and tinnitus.

Since 45% of TMD is muscular in origin, it’s really important to identify and stop these habits. Changing these habits, like all habits, is really hard to do but it can mean the difference between pain and being pain-free.

If you are dealing with TMD, book with one of our therapists with advanced training in TMD. Book online, through email or call us at (778) 630-8800.

Questions I Get Asked the Most as an RMT (Registered Massage Therapist)

Our fabulous RMT Gabrielle De Winter joined us in January of this year. An instructor at the West Coast College of Massage Therapy, she has pursued further training in jaw pain, also known as temporomandibular joint dysfunction. In this short question and answer blog, Gabrielle answers the questions she most frequently gets as an RMT.

Gabrielle’s Most Frequently Asked Questions 

Do you get free massages? 

Only from my husband! Most RMTs are independent contractors that don’t have built in extended medical benefits through their union (in fact we don’t have a union) or through their workplace. Some RMTs will work out exchanges with other RMTs they know. Mostly, we will need to book in with a practitioner to get a massage, just like everyone else. 

Do your hands get sore? 

Sometimes! But if you’re in an appointment with me as your therapist, I’m more concerned about how your body is feeling and not thinking of my own. 

Can massage help migraines and headaches?

 Yes! Tension headaches are typically muscular in origin and respond well to massage. I have a particular interest in treating tension headaches with massage. I did a study in school where we found tension-like headaches can be reduced significantly with massage.

Migraine headaches are a little trickier - sometimes massage can help calm down the nervous system. Migraines are usually multi-faceted and if you haven’t tried massage, it may be worth a go.

If you come in for massage related to headaches, I’ll ask you a lot of questions around your activities, if you’ve seen your dentist or optometrist lately, if you have balance issues… From there, we will figure out the best course of action with massage therapy.

Is massage painful?

 It doesn’t have to be! I want to work within your comfort level and what’s safe and effective.

What if I fall asleep and snore?

If I notice that you’re falling asleep, I’ll ask if you’re okay with me working on you while you’re asleep. If that’s fine, great! If not, I’ll make sure you stay awake while I’m working on you.

But this happens all the time! We are engaging with the autonomic system and if the goal is relaxation, people definitely sometimes fall asleep.

Is it okay to ask for more or less pressure?

Absolutely! We will discuss this on our first visit - what kind of pressure you’re comfortable with. While we are in the treatment, if you decide the pressure level needs to change, we can adjust as we go.

Are my muscles tight? 

Muscles can be “tight” but we can use better words to help us better describe what is happening. What feels “tight” is often a muscle which has been shortened, lengthened, or aggravated. 

What most patients think of as “tight” is a shortened muscle. Muscles cross joint(s) that they act on which as a result can limit their range of motion if they are shorter than usual. In order for me to see if a muscle is short, I would perform a muscle length test, which involves bringing the insertions points of a muscle away from each other so I can see if a shortened muscle is decreasing a joint(s) range or movement. 

Muscles could also be felt as “tight” if they are in a lengthened position. Much like a rubber band stretched out. This happens often to desk workers who sit for long periods of times with their shoulders rotated forward. In order for their shoulders to be forward, the muscles that bring the shoulders back will lengthen to allow that opposite position of the shoulder blades to happen. Some of the muscles between the shoulder blades, namely the rhomboids and the middle fibres of trapezius in this desk worker scenario tend to become lengthened and weak overtime. 

Muscles can be aggravated or carry extra tone for a number of reasons. Common reasons are injury, overuse or poor posture. When a muscle gets aggravated, it may react by feeling tight, stiff, or sore. A few ways to avoid having constantly aggravated muscles include regular stretching, strength training, and of course a massage with your favourite RMT. 

Are you looking for a massage? You can book with Gabrielle online, by emailing us or giving us a call at (778) 630-8800.

Our Favourite Summer Activities

Here at Ladner Village Physiotherapy, we like to stay active. Let’s introduce you to our therapist’s favourite summer activities and why you might want to give them a try!

Devon (Physiotherapist/ clinic owner):

Favourite activity: Ultimate frisbee

Why you may want to try it: Ultimate frisbee is one of few sports where players often don’t begin to play until they are adults. This is great as it means everyone starts on an even playing field. The ultimate frisbee community is welcoming and encouraging. According to Devon, ultimate frisbee might be the activity for you to try if you enjoy hard work, games of strategy, sprinting, sarcastic banter and a few cold drinks after the game!

Where to try it: the Vancouver Ultimate League plays on fields all over Vancouver and they also have a Surrey league.

Nicole (Physiotherapist/ clinic owner):

Favourite activity: Horseback riding

Why you may want to try it: Horseback riding is an activity perfect for animal lovers. Nicole loves horseback riding because she loves spending time around horses, being outside, and working on her core strength and balance. Horseback riding might be the right activity for you if you are looking for a new and challenging activity to try which is fairly low impact and a lot of fun!

Where to try it: Delta has so many barns and stables for horseback riding, from beginner to advanced level! Crescent Stables offers lessons to all ability levels as does Five Star Farms and Top Form Equestrian.

Sofy (Physiotherapist):

Favourite activity: Running

Why you may want to try it: Running is one of the most accessible activities around! All you need is a pair of runners and you’re good to go. Sofy enjoys running as it is a great way to enjoy the outdoors, explore the city, and there are always new ways to challenge yourself. She recently completed her first marathon!

Where to try it: Out your front door! If you’re looking for a clinic or a group to run with, the Run Inn out of Tsawwassen is a great group to join (they can also get your feet set up for success with the right shoes for your body).

Stephanie (Physiotherapist):

Favourite activity: Climbing

Why you may want to try it: Climbing is a fantastic way to challenge yourself and try something you may not have tried before. Outdoor climbing is an amazing way to explore our beautiful backyard and (literally) bring your exploring game to new heights! Stephanie loves climbing as it is a social activity where you can enjoy time with her friends, and you are able to challenge yourself by setting goals (or projects as they are called in the climbing world) to complete.

Where to try it: The Hive is a great place to try bouldering, a type of climbing with shorter walls, no ropes and thick crash pads. If you’d prefer to be roped in, try Coastal Climbing in Surrey.

Trevor (Physiotherapist):

Favourite activity: Golf

Why you may want to try it: Golf is the perfect mix between a challenging competitive sport and a great relaxing activity. Whether you hit up the driving range, play 18 holes, or even just go to a pitch and putt, golf is a fun social activity that can be accomidated to your skill level. Trevor enjoys golf as he likes spending time with friends, a good competition, and taking a break from the craziness of life for a few hours.

Where to try it: Try one of South Delta’s fabulous golf courses! We have The Links at Hampton Cove, Kings Links by the Sea, Tsawwassen Springs & Beach Grove Golf Club.

Anh (Physiotherapist):

Favourite activity: Tennis

Why you may want to try it: Tennis is a perfect summer sport! It’s very accessible, affordable, and a lot of fun! Anh enjoys playing tennis as it’s a great way to work on her hand eye coordination (which we hear could use some work!). One reason we love tennis is that it’s an easy to learn sport for people of all ages! You can easily bring your kids out to play (or run around and chase balls for you, either way, we don’t judge)!

Where to try it: South Delta has tennis facilities at several major parks in Ladner and Tsawwassen. We also have two tennis clubs, the Ladner Tennis Club and Tsawwassen Tennis Club, both offering tennis lessons, lit courts at night and tournaments.

Gabrielle (Register Massage Therapist):

Favourite activity: Swimming

Why you may want to try it: Swimming is a fantastic low-impact activity. Since you can float in the water, swimming takes pressure off your joints and allows you to move them into different ranges of motion than you may be able to out of the water. Swimming not only helps stretch muscles by allowing them to move more freely, but it’s also a full body strengthening workout! Gabrielle loves swimming because you can stay cool, hang out with your family, and it’s great for stiff joints!

Where to try it: If lap swimming is your thing, your best local options this summer are Winskill Aquatic and Fitness Centre and the Ladner Outdoor Pool (the Ladner Leisure Centre will be closing at some point for several months, but we don’t know when that will happen as of yet). I’d also encourage you to get into nature and try swimming at Centennial Beach (warm and shallow for daaaaays).

Kheya (Registered Kinesiologist):

Favourite activity: Volleyball

Why you may want to try it: Volleyball is a fun, challenging, and quick moving team sport. Volleyball is a blast because you can play it indoors, outdoors, or even on the beach! Kheya loves volleyball as she loves the amount of teamwork involved, being outside, and the rush you get after getting a great hit or block in. Volleyball is great a great way to meet new people and be involved in the community as everyone all supportive, friendly, and welcoming.  

Where to try it: Volleyball BC offers several leagues for various ability levels all over Metro Vancouver. Urban Rec offers a beach volleyball league in Ladner.

We hope you enjoyed learning a little bit about our practitioner’s favourite summer activities and may even feel inspired to try a few of them for yourself!

If you have any aches or limitations preventing you from trying these activities, come visit one of our therapists to get the help you need to get back to it!

To book an appointment, call (778) 630-8800, email us or book online.

Neck & Back Pain - Part 2: Strengthening Exercises

She’s back! Registered kinesiologist Kheya McGill is here with part 2 of her two-part blog series on exercises for back and neck pain. In this final instalment, Kheya goes over her favourite strengthening exercises. Go back and read part 1 for a refresher on spinal anatomy and some great mobility and stretching exercises!

If you read our last blog, you know that you are not alone if you’re dealing with back and neck pain. In this blog, we will talk about the importance of adding strength exercises into your routine when dealing with your back and neck pain.

Strengthening is a very important part of this routine! When a person has back pain, we like to focus on strengthening the core and glutes (in addition to the muscles in the back and neck themselves). Increasing strength helps provide more support for the muscles that are tense and increases the ease with which we can complete our daily activities. Strengthening is also a very important tool for avoiding reinjury.

Why do we focus on strengthening the core and glutes when dealing with back pain?

The core helps support the spine. When an individual has a weak core, these muscles can’t do their job properly, putting more strain on the back. However, don’t be fooled by the myth that a strong core always means having rock hard abs!

In terms of postural support, one of the most important muscles to learn how to activate and strengthen is the transverse abdominus (your deepest core muscle). To activate the transverse abdominus, you want to tighten the muscles in the lower abdomen.

I like to think as if I am trying to gently pull my hip bones together but there are lots of different cues we can use, depending on what works for you. Notice in the photos below how I even have my fingers placed on my stomach (roughly 3cm in from my hip bones) so I can feel these muscles turning on beneath my fingers.

The glutes are another important muscle to strengthen when you have low back pain. The glutes include the largest muscle in the human body, the gluteus maximus, and play a very important role in supporting the lower back. When an individual has weak glutes, back muscles often take over the glutes’ job which can add tension and pressure in the low back. If you have a difficult time activating your glutes, the exercises outlined here should help! 

Kheya’s Top Five Strengthening Exercises

1) Toe taps 

Begin on your back. You will want to start this exercise by activating the core muscles as we talked about above. Next, you are going to lift your legs up so both your hips and your knees make a ~90 degree angle. From here, you are going to slowly lower one leg down at a time, trying to keep your knee bent at 90 degrees, and tap your toe to the floor. Try and keep your core engaged the entire time, and don’t let your lower back lift off the ground. Lastly, remember to breathe!

Complete 10 reps (5 toe taps per side) for 2-3 sets.

2) Bridges

Begin laying on your back with your knees bent. Engage your core and lift your bum off the floor, trying to create a straight line down your body and legs. Try and think about squeezing your bum at the top of the movement. If this is too easy, try adding a weight on top of your hips or a band just above your knees.

Complete 8-12 reps for 2-3 sets.

3) Bird dog

Begin on all fours with your hands below your shoulders. Engage your core and extend one arm and the opposite leg. When extending the leg, think about pushing your back heel through the wall behind you to extend as far as possible. If this is too difficult, try beginning by just lifting one arm at a time, keeping both legs on the floor. You can then progress to lifting one leg at a time keeping the arms on the floor, until you are able to lift opposite arms and legs at the same time.

Complete 10 reps (5 per side) for 2-3 sets.

4) Chin tucks 

Stand against a wall with your shoulders and the back of your head against the wall. If you need to, move your feet a step out from the wall so you can put your back flat against the wall. Push your chin so that your head goes straight back, lengthening through the back of your neck.

Hold the tuck for 3-5 seconds and repeat this 10 times.

5) Back rows

To do this exercise, you will need a band. Begin by looping the band at elbow height around something stable such as a banister or a doorknob. Hold one end of the band in each hand and bend your arms at the elbow to 90 degrees. Now, slowly pull your arms backwards, thinking about squeezing your shoulder blade together at the back.

Complete this 10-15 times for 2-3 sets.

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In addition to all these exercises, any type of general strength and exercise will be great for lower back pain, even exercises working the muscles not involved in your pain. (For more information on this, see our blog on general exercise for injury rehabilitation.)

If you are unsure of where to start, our registered kinesiologists would be happy to work with you to create an exercise program which matches your exercise goals and injury specific recovery needs.

Give us a call today give us a call at (778) 630-8800, email us or book online to seek treatment from a physiotherapist or to work with a registered kinesiologist.

Neck & Back Pain - Part 1: Mobility and Stretching Exercises

Our fabulous registered kinesiologist Kheya McGill is back! In part 1 of her two-part blog series, Kheya reviews her favourite mobility and stretching exercises to help you tackle your neck and back pain. For Kheya’s favourite strengthening exercises, visit Part 2.

Neck and back pain are very common conditions. Sinnott et al. found that, at any given time, 15-20% of us will report back pain and 10-20% of us will report neck pain. Those numbers are huge! Spending more time hunched over computers (like most of us have been over the past two years) hasn’t helped.

Taking movement breaks throughout the day can be incredibly helpful for keeping pain at bay. It really boils down to the saying “motion is lotion” - the more you move your body, the easier (and less painful) it is to move. If you’re able to, taking a quick break every hour can make all the difference.

In this blog I will outline a few of my favourite exercises to increase spinal mobility and stretch tight back muscles. Make sure to stay tuned for part 2 of my blog series on neck and back pain, which will focus on my favourite strengthening exercises.

But first, a review of spinal anatomy…

Our spine is organized into 5 main regions. From the head down, these regions are:

• cervical spine - 7 vertebrae that make up the neck

• thoracic spine - 12 vertebrae in the upper and mid-back, all of which attach to ribs

• lumbar spine - 5 vertebrae of the low back

• sacral spine - 5 vertebrae fused to form the sacrum, the triangular bone that helps make up the pelvis

• coccyx - also known as the tailbone, located at the very bottom of the spine

The spine has three main jobs:

1. Central supporting structure - the spine acts as a scaffold for your body. Muscles, ligaments and connective tissue attach to each vertebra of the spine and to the limbs. The rigidity of the spine also holds us up against gravity.

2. Protector of the spinal cord - millions of nerve cells travel up and down your spinal cord, sending signals up to the brain and out to the entire body. Without the bony protection of the vertebrae, the spinal cord would be much more vulnerable to trauma and injury.

3. Movement - the multiple joints of the spine allow a lot of movement to occur including sitting, standing, walking, bending forward and twisting around.

Keeping your spine healthy is critical to your overall health - the stronger and more mobile you are, the better!

Kheya’s Top Five Mobility and Stretching Exercises

The Mobility Exercises

What is it:

Mobility refers to the ability of a joint to move actively through a range of motion (see our previous post on flexibility vs. mobility for more on this). Improving mobility helps increase the range of motion available in the joints, leading to improved function and decreased pain.

1)      Thoracic spine openers

Begin by laying on your side with your legs slightly bent and stacked on top of each other. Stretch your arms out straight in front of you. Keeping your bottom arm on the floor, roll on your back and sweep your arm up and over to the other side, opening the chest. Keep your eyes on the top hand, rotating your neck as your arm rotates over your body. Once you have reached your end range, bring your arm back across your body.

Repeat 5-10 times per side.

2)      Lumbar rotation

Begin on your back with your knees bent, feet flat on the floor and your arms stretched out on either side of you like a “T”. Keeping your back flat on the ground, drop both legs out to one side. Hold this position for 5-10 seconds. Bring your knees back to the middle and then repeat the same movement on the opposite side.

Repeat this movement 10 times for 2-3 sets.

3)      Cat cow

Begin on all fours. With the hands underneath the shoulders, lift your head and chest while simultaneously letting your stomach sink and lower back arch. After this, switch and round the back and let the head and neck drop while rounding your back as much as possible.

Repeat these alternating movements 10 times and then repeat this for 2-3 sets.

The Stretches

Stretching is the ability to move muscles through a range of motion passively. In other words, pushing to get to the joints through the end range using assistance from your hands, the wall, a strap, or anything else (see our previous post on flexibility vs. mobility for more on this). Stretching is useful for back pain as it can help loosen sore and tight muscles.

1)      Childs pose

Begin on your hands and knees and drop your bum back onto your heels. Reach your hands forwards, dropping your head and shoulders down towards the floor.

Hold for 20-30s and repeat 2-3 times.

2)      Knee hugs

Begin laying on your back and hug one leg in towards your chest.

Hold this for 20-30s. Repeat on both sides and complete 2-3 sets.

Next up, the strengthening exercises! Head over to Part 2 for my favourite exercises to make your body stronger.

If you are unsure of where to start, our registered kinesiologists would be happy to work with you to create an exercise program which matches your exercise goals and injury specific recovery needs.

Give us a call today give us a call at (778) 630-8800, email us or book online to seek treatment from a physiotherapist or to work with a registered kinesiologist.

Ask A (Vestibular) Physio - Why Is My Vision Blurry?

Here’s a classic story from a new dizzy patient:

I spent a few days really dizzy, with the world seemingly spinning around me even though I was staying still. After those first few days, the spinning and moving stopped but my balance has been terrible since.

Not only that, but everything is blurry! When I try to read, I can’t keep the words in focus. I went to my eye doctor but they said my vision hasn’t changed, even though I can’t see anything!

What’s going on?!

This, dear reader, is a direct result of inner ear dysfunction! But wait, you may ask - how does the ear control the eyes!?

It’s time for a deep dive into the VOR.

What is the VOR?

The Vestibulo-Ocular Reflex, also known as the VOR, is the most adaptable (re: trainable) reflex in the human body. Here’s how it works:

• When your head turns to the left, the semi-circular canals in your ears sense the head rotation and send that signal to your brain.

• The brain then quickly (and I mean quickly - this happens in a few milliseconds!) sends a signal to your eye muscles to move your eyes the same amount to the right

This allows your eyes to keep things in focus even when your head is moving. (Want to know a secret? I love this reflex - I get rather excited talking about it! Can you tell?)

When does the brain use the VOR?

In short, all the time! When you walk, when you breathe and even when your heart beats, your head is moving. The VOR is critical to stabilizing vision so everything stays in focus when you are out and about in the world.

Without a fully functional VOR, things can quickly become blurry and out of focus. This occurs with vestibular neuritis and labyrinthitis.

How does the VOR actually work?

Who’s ready to get nerdy with me? It’s time for a deep dive into neurology!

Your inner ears send signals to your brain constantly. When your head is stationary, both ears send signals at about 100 beats per second to your brain. When you turn your head to the right, your right ear sends a faster rate of signals (for example, 120 beats per second) and your left ear sends a slower rate (say, 80 beats per second).

It’s this difference between the signals from your ears that triggers reflexive eye movement. Your eyes can stay focused on your target (whether that’s a book, the basketball hoop you’re shooting at or the person you’re in conversation with) without you even thinking about it.

Without this reflex, the world very quickly becomes blurry and out of focus. Any head movement can lead to blurry vision.

How does a problem with the VOR occur?

Anything that disturbs the function of the inner ear and the signals it sends can affect VOR. When your inner ear has a deficit, it sends signals to your brain at a lower rate.

For example if you have a right ear deficit, your right ear’s baseline rate of firing at rest may only be 80 beats per second. If your left ear is still sending signals to your brain at 100 beats per second, your brain perceives this difference and thinks you are rotating to the left.

Inner ear dysfunction such as labrynthitis and vestibular neuritis, concussions, vestibular migraines and other vestibular and neurological conditions can lead to VOR deficits.

Can we fix a broken VOR?

You bet we can! The VOR is the most adaptable and trainable reflex in the human body. Vestibular therapists give specific exercises with the primary purpose of training this reflex back to function.

If you’re looking for a vestibular therapist in Canada, visit Balance and Dizziness Canada for a list of certified vestibular therapists. We love what we do and would love to help you!

To book with one of our vestibular therapists, book online, send us an email or give us a call at (778) 630-8800.

Flexibility vs. Mobility - What’s The Difference?

People often use the terms “flexibility” and “mobility” interchangeably but there is a difference! In this blog, our dance physiotherapist Anh Duong explains the difference between the two as well as why one is more advantageous than the other.

As physiotherapists we throw around the terms “flexibility” and “mobility” a lot, but what do they actually mean?

Flexibility is the ability of muscles to move through range passively (in other words, pushing to the end of the joint’s range with assistance from your hands, the wall, a strap - you get the idea) where as mobility is the ability of a joint to move through range actively, using your muscle to do the movement without assistance.

Imagine a dancer who can do the full splits when she is stretching on the ground but cannot achieve the full splits when performing a grande jeté. This dancer would be demonstrating flexibility but lacking mobility.

Ultimately, dancers should be aiming for mobility over flexibility.

How do we improve mobility?

Strengthen while you lengthen! This is achieved by working the muscles while elongating them at the same time. Some ways you can do this include:

• opting for more dynamic stretches rather than static stretches

• using bands and weights for resistance

• performing resisted holds while in an elongated position

But doesn’t being flexible help my technique?

There is a misconception that hyperflexibility will improve dance technique when it can actually do the opposite.

Think of your muscles like hair elastics. If you use the same hair elastic and stretch it and stretch and stretch it, overtime it will become long and weak and no longer be able to hold up your hair. Similarly, an overstretched muscles becomes long and weak and loses its ability to produce force which is needed for all dance movements such as kicks and jumps.

But there’s more..

Overstretching is highly dangerous and
NOT recommended

In the short term, overstretching increases the dancer’s risk of muscles strains, muscle gripping due to weakness, and snapping/pinching hips.

In the long term, overstretching can lead to stretching of other tissues such as ligaments, cartilage and joint capsules which play an integral part in joint stability.

Micro-damage accumulates over time which may lead to long term problems such as early degeneration of the joint, and chronic instability and pain.

What does overstretching look like?

• “sitting” in extreme positions for long periods of time

• Having peers or teachers pushing limbs at end ranges

• using yoga blocks or furniture as a lever to get more range

• Stretching before warming up muscles

To recap:

Dancers should be aiming for mobility over flexibility which includes incorporating strengthening and avoid stretching joints into extremes.

In this day and age, with the influence of social media and growing popularity of incorporating gymnastics and acrobatics movements into dance technique, the demand on dancers’ bodies are higher than ever and it is important that we educate dancers, parents, teachers, about safe and effective training.

To book an appointment, call (778) 630-8800, email us or book online.

General Exercise for Injury Rehab

Most of us can relate to the experience of getting injured and wanting to lounge on the couch for days at a time, letting our bodies heal. However, that is not the best way to recover from an injury.

Most people understand there are many benefits to exercise, but did you know whole body exercise can be particularly useful when recovering from an injury? And no, I don’t just mean doing the exercises from your physiotherapist for your specific injured joint - I mean biking to help your shoulder pain, arm workouts to help your ankle injury, and cardiovascular exercise for… well, pretty much everything!

So why is exercise so good for you and what kind of benefits does it provide? Read on to find out!

Top 5 benefits of general exercise for injury rehabilitation:

1. Increased oxygen uptake

When you exercise, you are increasing blood flow around your body, increasing oxygen to your working cells. This increased oxygen to your cells not only allows your body to make better use of oxygen, but it can also lead to long-term changes by increasing the number of mitochondria in your cells (as you may remember from high school, mitochondria are “the powerhouse of the cell!”).

This means the more we work out, the more mitochondria we have that can turn the food we put into our body into energy. This improves your overall energy, allowing your body to put more energy towards healing and recovery.

2. New blood vessel growth

Aerobic exercises stimulates your body to grow new blood vessels (pretty cool, right!?). This leads to more oxygen and other nutrients that can be transported to the muscles, providing more energy to your body. When you think about this in terms of recovery from an injury, creating new blood vessels can help muscle tissue repair itself more quickly, as it is getting a better supply of nutrients from the rest of the body.

3. Release of endorphins

Endorphins have been called the “feel-good” chemical due to the feeling of euphoria they provide. They are released in abundance when you exercise and are responsible for the famous “runners high”, the boost of energy and “warm fuzzies” felt during a workout. Endorphins naturally help your body cope with pain and stress, meaning they can assist in injury recovery.

4. Improved brain function

When you exercise, your brain releases a chemical messenger called brain-derived neurotrophic factor (aka BDNF), which is thought to play a role in keeping our brains happy and healthy. Increasing BDNF through exercise can help improve cognitive function, mental well-being, and even improve brain recovery, all very important parts of overcoming an injury.

Most research points towards cardiovascular exercise being the best way to increase BDNF so hop on that bike, go for a run, or look into high intensity interval training for some amazing benefits!

5. Improved sleep

Regular exercise can also help improve sleep. Sleep has a huge impact on injury recovery - while you are sleeping, your body is busy repairing itself.

How does this work? When you sleep, your body releases hormones which aid in recovery from injuries. Your body then increases blood flow to muscles, providing them with the oxygen and nutrients they need to repair themselves. Lastly, while sleeping, the chemicals in charge of the stress response decrease. When you decrease stress, your body can put more energy towards recovering from your injury.

How much exercise do you need?

The Canadian government recommends at least 150 minutes of moderate to vigorous activity per week, regardless of injury status. This ideally should include a mix of resistance training and cardiovascular exercise.

However, if you’re not there yet, don’t worry! Here are some tips to getting started:

• Start with small activities that you enjoy and work your way up towards meeting these guidelines over time. If you prefer walking your dog, gardening, playing sports, or anything else that gets you moving, these are fantastic options to get you started and can provide numerous benefits as well.

• Set small goals such as 10-minute walks, taking the stairs instead of the elevator, or doing small exercises while doing your normal daily activities (think squats while you’re brushing your teeth or planks during a commercial break).

If you are unsure of where to start, one of our registered kinesiologists would be happy to work with you to create an exercise program which matches your exercise goals and injury specific recovery needs.

Give us a call today give us a call at (778) 630-800, email us or book online to seek treatment from a physiotherapist or to work with a registered kinesiologist.

Meet Kheya!

Kheya McGill, Registered Kinesiologist, joined our team in November of last year. She has a passion for neuroscience, spending three years doing research in the field while working closely with people with traumatic brain injuries. She volunteers with the Special Olympics as a coach and does respite work with children with developmental disabilities. Learn more about Kheya below!

What is something totally random that people won’t know about you?

When I was younger, I was obsessed with everything to do with the ocean (thanks to the little mermaid, obviously). Since then, I have been shark diving, and swam alongside sting rays, moray eels, lionfish, sea turtles, dolphins, and even barracudas. When snorkelling, I have had pictures taken of me by scuba divers as I like to free dive up to 30feet down!

When did you decide you wanted to be a Kinesiologist?

Towards the end of my university program in Kinesiology! I originally wanted to continue with more schooling immediately after I finished my degree, however, I loved my program so much I decided I wanted to work in the field for a few years before I go back to school.

Which sports are you into?

Soccer is my favourite sport, with volleyball as a close second!

Where did you grow up?

Tsawwassen.  

What is your favourite orthopaedic condition to treat?

Hard to say if I have a favourite yet! However, I do enjoy treating ankle injuries as there are so many ways you can incorporate new and fun exercises into an ankle rehabilitation program!

What makes you happiest?

Being around the people I love, working out, travelling, and being outside.  

LIGHTNING ROUND!!!!!

Cats or dogs? My cat but dogs in general

Favourite food? Maui ribs or my Papa’s stuffing

Favourite dessert: Cheesecake

Favourite Junk food: Chips!

Beach or mountains: Beach

Favourite colour: Blue

Favourite music: Impossible to narrow down- anything from alternative to rock, pop, rap, and even older hard rock pre-soccer game.  

Favorite day of the week? Saturday

Nickname? K, Kej, or KK

Would you rather be able to speak every language in the world or be able to talk to animals? Speak every language

Favorite holiday? Christmas

How long does it take you to get ready? 30 minutes from the time my alarm goes off to get out the door!

Invisibility or super strength? Invisibility

Is it wrong for a vegetarian to eat animal crackers? Absolutely not

Dawn or dusk? Dusk

Do you snore? No

Place you most want to travel? Bora Bora

Last Halloween costume? Not a big fan of Halloween… maybe a ninja?

Favorite number? 11

Have you ever worn socks with sandals? Definitely

Would you rather cuddle with a baby panda or a baby penguin? Panda

Would you want to live forever? No

What's for dinner tonight? Christmas eve feast! Roast and a ton of appetizers.

What is EMDR?

Have you ever wondered what EMDR is? Maybe you’ve heard of it or even tried it out yourself! Here, our resident Registered Clinical Counsellor Heather Doidge-Sidhu explains what it is and why she finds EMDR so useful in her clinical practice.

EMDR is the "gold standard" treatment modality for PTSD, and it is also extremely effective for mental health issues like anxiety, depression, phobias, pain, grief, and so many others. It stands for:

E - Eye
M - Movement
D - Desensitization (and)
R - Reprocessing

It's different from other types of therapy because its focus isn't on changing your thoughts, feelings, or behaviours that have resulted from a distressing event; it's about processing traumatic events in order to help your brain heal and communicate to its different parts in a more functional manner.

EMDR seeks to "file" all the pieces of a traumatic memory into its appropriate "folders". At its core, it's based on the belief that early traumatic events "prime" us to be more easily triggered to traumatic events as they happen throughout our lives.

Our brains are like computers. They like things to make sense, and things that are linked make sense. Thus, our brains link things that don't necessarily make logical sense to be linked.

As a really gentle example: have you ever smelled a certain smell and it triggered a memory completely unrelated to your present situation/environment? That's your brain making links. A lot of the time, this is totally harmless. But if there's a traumatic event, your brain starts making links that are repeatedly painful to experience. For example, a person shouting can put us into a state of fight or flight if we have experienced violence in our past.

So, what is processing?

Well, trauma stays in our mind "unprocessed", like a chunk. Rather than filing sound memories into the sound memory area, sight memories into the sight memory area, and so on and so forth, all the sensory, emotional, and physical aspects of a traumatic moment stay lumped together.

This likely had an evolutionary purpose in the past: if a sabre-toothed tiger chased you before and you got away, and you see another angry-looking sabre-toothed tiger, your "trauma chunk" will trigger you to run again. This saved lives! Unfortunately, this tendency to keep trauma this way in our minds is not as functional nowadays when most of our days are spent (hopefully) in non-life-threatening scenarios.

So, going back to the person with violence in their past: after EMDR, they will still remember the violence; EMDR does not take away experiences in our pasts. However, it will no longer feel distressing; it will simply be something unfortunate that happened.

EMDR takes the power away from traumatic events.

What should I expect when being treated using EMDR?

EMDR is an 8-step protocol, guided by your counsellor. It's typically faster than other types of counselling, but that is of course dependent on how much material needs to be processed. The start of EMDR Therapy resembles many other therapeutic modalities; it involves relationship building between the client and the therapist, history taking, and preparation for the processing. There is some assessment of present distress level, and some conversation about the client's goals regarding self-concept. Establishment of some baseline safety measures is key at this point as well, so the client has the tools to ground themselves if they're feeling triggered, and also "put away" difficult feelings if they arise either at inopportune times, or if they're feeling overwhelming.

The desensitization part of EMDR is the part people have likely heard about or seen videos of. It involves bilateral stimulation of some sort, usually eye movements, but also sometimes tapping, or sound-based, while focusing on parts of the traumatic event one at a time, until the client feels the entire thing is completely resolved.

EMDR is not finished at that point, though! The counsellor will then work with the client to solidify a more positive self-concept, in place of the negative one that existed previously. There are always some checks for residual tension indicating incomplete processing, and then there's closure and re-evaluation. Every session with an EMDR therapist should end with the client feeling better than how they felt at the start.

EMDR can be the only type of therapy you do with a counsellor, or it can be a piece of your therapeutic journey. It's up to you!

To learn more about EMDR, head to emdria.org.

Meet Heather!

Heather Doidge-Sidhu is a registered clinical counsellor and joins us from her home in Victoria! How, you may ask? Heather will be conducting sessions exclusively online while using a myriad of techniques including EMDR and clinical hypnosis.

Heather offers free 30-minute consultations to see if the two of you are a "good fit". Therapeutic alliance is one of the greatest predictors of success in a counselling relationship. During the consultation, you'll converse briefly and gently about what brings you to counselling, and you are welcome to ask Heather any questions you may have about her approach.

What is something totally random that people won’t know about you?

I’m a huge Buffy the Vampire Slayer fan.

When did you decide you wanted to be a counsellor?

I think I always knew, somewhere deep in my mind, that I was meant to be a counsellor. But it wasn't until 10 minutes into my first class in my Master’s in Counselling Psychology that I knew for sure it was the perfect fit for me.  I literally had the thought, “I’m home.” I haven't looked back since.

Which sports are you into? 

Basketball! I also love swimming, skiing, and soccer.

Where did you grow up?

A little town in the Interior called Williams Lake.

What is your favourite mental health issue to work with?

Prenatal and postpartum counselling, but honestly, I love it all. I'm so inspired by people who have the courage to make changes in their mental wellness.

What makes you happiest?

Spending time at the beach. 

LIGHTNING ROUND!!!!!

Cats or dogs? cats

Favourite food? butter chicken

Favourite dessert: anything chocolate

Favourite Junk food: peanut m&m’s in popcorn

Beach or mountains: beach

Favourite colour: green

Favourite music: 50’s and 60’s

Favorite day of the week? Saturday

Nickname? Heater, HBooyah

Would you rather be able to speak every language in the world or be able to talk to animals? Speak every language.  No, animals.  No, every language.  Including animal language?

Favorite holiday? Christmas

How long does it take you to get ready? Half an hour.

Invisibility or super strength? Why not flying???

Is it wrong for a vegetarian to eat animal crackers? Definitely not. I think it should be encouraged.

Dawn or dusk? Dusk.

Do you snore? It’s rumoured but I haven't seen proof. 

Place you most want to travel? Greece.

Last Halloween costume? Fairy Godmother (there was a whole Cinderella theme with my kids and husband).

Favorite number? 10

Have you ever worn socks with sandals? I’m not known for my fashion sense … so yes.

Would you rather cuddle with a baby panda or a baby penguin? Panda!

Would you want to live forever? Yup.

What's for dinner tonight? Is a question my husband and I ask each other every day.

Meet Gabrielle!

We are so happy to introduce one of our newest additions to the team, Gabrielle De Winter! Gabrielle (pronounced GABE-ree-ELLE) is a registered massage therapist, graduating valedictorian of her class from the West Coast College of Massage Therapy in 2017. Learn more about Gabrielle below!

What is something totally random that people won’t know about you? I LOVE panda bears!

When did you decide you wanted to be an RMT? Oh that’s a complicated one. I thought about it when I was 17 years old and visited the school. At the time I didn’t feel ready for all the touching of strangers! I knew that I wanted to eventually, though.

Which sports are you into? Basketball, martial arts, swimming, rock climbing and archery.

Where did you grow up? I grew up in Richmond, BC.  

What is your favourite orthopaedic condition to treat? Tension headaches!

What makes you happiest? Simple things like finishing a long hike, drinking a warm drink by the fire, or holding the hand of a loved one.  

LIGHTNING ROUND!!!!!

Cats or dogs? Dogs

Favourite food? Fresh steamed mussels in a white wine and cream sauce with a fresh baguette.

Favourite dessert: Pie, any and every type (except for cow pies)

Favourite Junk food: Green Tea Pocky or Cream Dill kettle chips (I can’t decide)

Beach or mountains: Beach

Favourite colour: Peach

Favourite music: Experimental Rock/ Rock Electronica (think Radiohead, Björk, Portishead)

Favorite day of the week? Thursday

Nickname? Gabe, Gabies, Panache, Gabriella poompe paya, Sweetie- kins and Sweetie- Pie. If you forget my name, just say , “chocolate” and I’ll turn around.

Would you rather be able to speak every language in the world or be able to talk to animals? Every language in the world.

Favorite holiday? Christmas

How long does it take you to get ready? 30 minutes

Invisibility or super strength? Super Strength

Is it wrong for a vegetarian to eat animal crackers? HAHA no

Dawn or dusk? DAWN

Do you snore? I think I do on the RARE occasion. I’m a light sleeper and I’ve woken myself up.  

Place you most want to travel? Belgium

Last Halloween costume? Tiger

Favorite number? 4

Have you ever worn socks with sandals? NEVER

Would you rather cuddle with a baby panda or a baby penguin? PANDA

Would you want to live forever?  Yes

What's for dinner tonight? A salad with all the nuts and bolts

Bladder Frequency and Urgency

Do you find yourself running to the bathroom more often than you think you should? Have you always been the person with the “small bladder” that goes to the bathroom three times at a restaurant when your friends don’t go at all? When you have to go pee, is it an urgent urge that makes you uncomfortable to wait?  Do you sometimes not make it to the bathroom on time?

If you experience some or all of these signs, you are not alone and can absolutely improve this. The best news is that the solution is pretty simple!

How is your bladder supposed to work?

Let’s pretend your bladder is your child, your brain is you (the parent) and your child wanting a snack is like your bladder wanting to pee.

We all know that some kids are very chill & relaxed while others can be quite high maintenance (but we still love them!). If your child (aka bladder) is calm and wants a snack (needs to go pee) they will ask “can I please have a snack?” and you (the brain) are able to respond appropriately.

Maybe the answer is “sure, it’s been a while since you have had a snack, absolutely you can have a snack.” Or maybe your answer is “you know what, we just ate lunch and I don’t think you need a snack right now.” If your child/bladder is calm they can usually accept the answer and go on their merry way for a while.

Eventually they’ll feel hungry (need to pee) again, and they will come back to you to ask for a snack again. And once again you can decide if it’s a good time for a snack. If you wait for longer periods the child might get more persistent or ask you more frequently but you are still very much in control of the situation. At the right time, the child gets their snack and everyone is happy.  

This goes very much to the heart of how things are supposed to work: your bladder sends signals to your brain as it’s filling up and it’s up to your brain to decide when is the right time to go pee.

What causes urinary frequency and urgency?

There are many reasons for urinary frequency and urgency. In my experience, the top two factors that we can influence and improve are:

1. Undesirable learned habits

2. Dietary factors

Undesirable Learned Habits

Let’s go back to that example and replace that lovely, polite child with a cranky one. Do cranky children ask for anything nicely or politely? I don’t know about you, but when my children are cranky they are definitely not polite. When cranky children think they need a snack they go “I WANT A SNACK RIGHT NOOOOOOOOOOOW” (even if you happen to be in the middle of the grocery store).

You are then in the precarious position of having to choose between:

1. giving into the tantrum and giving them a snack even though they don’t need a snack, or;

2. telling them “no, you cannot have a snack”.

If you give in, your child learns that tantrum equals guaranteed snack time, leading to more tantrums. If you hold your ground, you get to deal with the potential wrath of said cranky child (for most people, the wrath of a bladder can be in the form of a urine leak, fear of leaking, abdominal discomfort, etc).

This is where the habit starts to form. In general, if you give a kid a snack every single time they ask for a snack they are going to start asking for snacks more often (because snacks are delicious and they are clever little humans). The same applies to your bladder - if you go pee right at the moment you think you have to go and rush immediately to the bathroom, you are reinforcing a bad habit.

Your bladder has a bigger capacity than you think. You can go for hours upon hours at night without going pee. Why do you think you need to go pee before you leave the house when you literally just went pee 15 minutes ago? Did your kidneys magically turned superhuman and filled your bladder up to full capacity in 15 minutes? Probably not! You probably just have a habit of going pee before you leave the house. You might also have a habit of going pee as soon as you get home and maybe that has escalated into you needing to drop your groceries and sprint up the stairs to go pee as soon as you get home even though you didn’t need to pee while at the store.

They’re all learned habits. It’s important before you go pee to ask yourself:

Do I HAVE to go pee or do I just WANT to go pee?

The same way you would ask yourself “do I want a snack or do I need a snack?”. You should be in control of your bladder rather than your bladder controlling you.

I really think of the urge to pee kind of like a hunger cue. Most people do not drop everything they are doing and rush to the kitchen and stuff their faces with food at the first sign of hunger. So why are we sprinting to our bathrooms at the first realization that there is urine in our bladder?

It’s not an emergency, it’s just information. That bladder of yours is sending a friendly neighbourly signal up to your brain that says “FYI, getting kind of full, might want to think about that sometime soon.”

Dietary Factors

To make matters more complicated, you might be making your “child” crankier than it needs to be by eating certain foods and drinks. If your bladder is extra irritated, it’s going to make its presence known a lot louder and more often than you would like.

Foods that may irritate your bladder include:

• Coffee (decaf is better but still not perfect)

• Tea

• Alcohol

• Chocolate

• Carbonated beverages (yes, even plain soda water)

• Artificial sweeteners

• Citrus (oranges, lemons, etc).

• Tomatoes

What can I do about it?

There are several things you can do to take control of your bladder health. Some are fairly self-explanatory like decreasing or moderating your intake of the irritating foods listed above.

One of the main things you can do: drink more water. It’s counter-intuitive, but drinking more water more often than not helps you pee less frequently. I’ll say that one more time for the people in the back:

You can go pee less frequently if you drink more water.

Want to know why? If you are dehydrated, your urine will be very concentrated. Concentrated urine can really irritate the inner lining of the bladder and will want to get rid of that fluid ASAP. Your bladder is much happier to hold a larger amount of dilute fluid rather than a small amount of concentrated or irritating fluid.

There are also cognitive and physical techniques known as urge suppression techniques. They can help you deal with a strong urinary urge, avoid leaking and rushing to the bathroom, and normalize the number of trips you make to the bathroom. These should be taught to you on an individual basis by a doctor or pelvic floor physiotherapist that knows your individual situation and can determine which techniques are best for you.

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Your Takeaway Points!

If you suffer with urinary frequency and urgency, please remember these key points:

• Needing to go pee should not feel like an emergency

• Foods and drinks such as coffee, alcohol, and chocolate can irritate bladders

• A significant amount of urinary frequency and urgency is behavioral and can be modified

• Ask yourself if you have to go pee or you just want to go pee? Is the signal coming from your bladder or your brain?

• Drinking more water can decrease urinary frequency and urgency

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If you would like to know more about these or have an evaluation by one of our pelvic floor physiotherapists please feel free to contact the clinic at 778-630-8800 or clinic@ladnervillagephysio.com to book an appointment.

Overhead Shoulder Pain in Volleyball Players

Kheya McGill graduated from UBC with a Bachelors Degree in Kinesiology. A lifelong Tsawwassen resident, Kheya has recently joined Ladner Village Physiotherapy as a registered kinesiologist. In this article, she reviews the most common causes of shoulder pain in overhead movements common with volleyball players and five great exercises to help combat the pain.

Shoulder pain is common in volleyball players, particularly while arms are in the overhead position. The shoulder is one of the most mobile joints in our body, meaning it is also one of the most unstable joints. If you enjoy playing volleyball (or other overhand activities such as lacrosse, tennis or fly fishing), chances are you’ve experienced shoulder pain at some point whether that be soreness, stiffness or sharp pain.  

What causes overhead shoulder pain?

Common causes of overhead shoulder pain include:

• Shoulder impingement - A shoulder impingement occurs when tendons get “impinged” or compressed between the head of the humerus (aka the arm bone) and the bony architecture of the scapula (aka the shoulder blade). When you lift your arm overhead, the space between these bones in your shoulder decreases and increases pressure on the tendons. This can cause irritation, which can lead to an impingement. 

• Rotator cuff injury - The rotator cuff is a group of 4 muscles which surround your shoulder. These muscles help move the arm and scapula, while protecting the shoulder. Rotator cuff injuries are common and can occur for many reasons, including overuse, trauma, or degeneration. (Need more on this? Read our blog on the rotator cuff!)

• Osteoarthritis - A degenerative joint disease, osteoarthritis causes problems with the cartilage, synovial membrane, ligaments and bone in a joint. Osteoarthritis can cause tissue loss, remodeling, inflammation and lead to loss of normal joint function. A history of shoulder injuries leads to a higher risk of developing osteoarthritis here. Remember, arthritis isn’t just seen in “old” people!! (For more on osteoarthritis, read our blog!)

How can I improve my shoulder pain?

Although these injuries are all quite different, the good news is all of them can be improved with the right exercises! Here are a few of our favourite exercises and stretches to add to your routine: 

1. Internal and external rotation with band 

Using a band, secure one end of the band to a stable point (we suggest tying a large knot in one side and securing the band behind a door).

Internal rotation: 

• Grab the band with your hand so that the band is pulling your hand away from your body

• Bend your elbow and tuck it gently into your side

• Move your hand from the outside of your body towards the inside, bringing your hand closer to your belly
  

External rotation: 

• Turn your body around so the band is now going in front of your body and pulling your hand towards your body

• Bend your elbow and tuck it gently into your side

• Move your hand away from your belly while keeping your elbow tucked in
  

2. Shoulder flexion with resisted external rotation 

• Put a band around your forearms and bend your elbows at 90 degrees 

• With your arms shoulder width apart, place small amount of tension in the band, and lift your arms up from the shoulder
  

3. Thoracic spine openers

• Start laying on your side, with your hips and knees bent in front of you 

• Place both arms straight out in front of your chest 

• Keeping your bottom arm on the floor, reach your top arm across your body and towards the floor on the other side, opening the chest 

• Follow your top hand with your head and eyes, and then slowly return to starting position
  

  4. I, Y, T, W’s 

• Laying on your stomach, face down, with your arms overhead, thumbs pointing upwards (You may want to place a folded dish towel under your forehead - this helps you keep a neutral neck and breathe!)

• Pick a position (I, Y, T or W) and raise your arms, pulling your shoulder blades together

• Lower your arms back down to the ground, and repeat

• Try in each position to target different muscle groups
  

5. Pectoral stretches 

• Standing next to the corner of a wall, place your forearm against the wall, with your arm and shoulder at 90 degrees

• Lean your body forward until you feel a stretch across your chest

• Play around with the height of your arm to stretch different portions of your pectoral muscle
  

There you have it! Five simple exercises you can do at home or add to your daily workout routine to improve shoulder pain and scapular stability. 

If you’re suffering from shoulder pain, give us a call at (778) 630-800, email us or book online to seek treatment from a physiotherapist or to work with a registered kinesiologist.  

Five Simple Strategies for Symptom Management Post-Concussion

Stephanie Yip is one of our vestibular therapists here at Ladner Village Physiotherapy. Since her own concussion many years ago, she has been passionate about learning as much as she can about concussion rehabilitation. Here, Stephanie shares a few of her favourite strategies for symptom management post-concussion.

Have you (or a loved one) suffered a concussion? Are you finding yourself struggling with day-to-day tasks? Are you constantly overwhelmed by the onslaught of bright lights, noises, and people coming and going? Are you hiding in a dark room by late afternoon?

If you’ve answered yes to one or more of these questions, you are not alone. There are over 200,000 concussions diagnosed in Canada annually, and those are only the ones that are reported. When healing from a concussion, symptoms can be difficult to control.

Only about half of people know what to do when they or their loved ones suffer a concussion. For what to do in the first days and weeks after a concussion, check out Part 1 of our series So You’ve Had A Concussion and download Concussion Recovery 101.

Here are a few simple strategies that you can start implementing right away to start easing your symptoms when you’re having a bad day.

Full disclaimer: these are tools for symptom management, and can be used throughout the day to help you cope. These are not meant to replace concussion treatment/rehabilitation.

Five Strategies for Post-Concussion Symptom Management

1. Palming

This is my personal favourite strategy. Let’s say you’re at the grocery store because you desperately needed eggs but it’s a lot busier than you expected, and you are suddenly hit with a wave of dizziness as you scan the aisles. You want to run and hide in a dark room except there’s nowhere to go.

What do you do? Create your own “dark room”! Cover your eyes with your palm and bathe your eyes in darkness. Look forward into the black and count as you take 10 deep breaths. This works as a recovery tool and you can use it anytime you need a quick break from your surroundings.

2. Musician’s Earplugs

After a concussion, your brain becomes very inefficient at filtering out background noise. This is why you’ve probably noticed yourself yelling at the kids for playing their video games too loudly, or maybe you’ve suddenly developed a newfound loathing of the lawnmower. It can be tempting to start wearing earplugs or noise cancelling headphones to cope. The problem with this is if you start perpetually living in silence, you’ll never learn to tolerate noise again, which will stall your recovery.

Instead, give musician’s earplugs a try. These earplugs have varying levels of filter, so you can choose the least amount of reduction that you can tolerate. You’ll still be able to hear the lawnmower and hold a conversation with a friend, but you won’t want to rip your hair out.

3. F.lux

Do your eyes fatigue easily after using your computer or phone? I promise I’m not sponsored by F.lux but I do love their software.

F.lux is basically a fancier version of the “night mode” setting on your phone. F.lux makes your computer screen look like the “daylight” depending on the time of day, so it will be a warmer glow at night, and then brighter like sunlight during the day. You can adjust the settings to your bedtime so it gradually changes as your day progresses. You can also just keep it “warm” all the time if that’s what you’re able to tolerate that day. (But as your physio, you know I’ll be getting you to gradually increase the brightness over time...’cause that’s the only way we get better!)

4. Reading Tips

Reading is hard after a concussion! But that doesn’t mean you can’t still read and enjoy all the books you used to.

Try placing a piece of paper under each line as you’re reading. This reduces the amount of visual input that your eyes have to take in and filter and allows them to track the letters with less difficulty.

Large font books or enlarging the font on your kindle can be another lifesaver.

Audiobooks can also be a great option, and can even be used as a restful activity. I know they can seem daunting, but try starting out with some easy teen lit (think Harry Potter, Twilight or the Hunger Games) and make sure you like the voice of the reader! Before you know it, you’ll be listening to audiobooks every night.

5. Surface Orientation

Do you ever feel like you’re floating or walking on clouds? I’ve had clients also describe it as walking with pillows for feet. Or maybe you just get hit with waves of dizziness throughout the day. This one is for you.

You can do this sitting, standing, or lying down, depending on the situation you’re in. Whichever position you’re in, find something very firm and solid to stand, sit, or lie on. If you’re near a wall, press your full back against the wall. Focus on the feeling of your feet on the ground, your bum in the chair or the wall on your back. Really focus on each part of your skin that is touching the surface. Take a few deep breaths. Continue focusing on the firm surface you are supported against, and tell yourself that you are not moving. Imagine that gravity is gently pulling you straight down into the surface of the chair, wall, or floor. Check in with yourself. You should feel more grounded.

There you have it – five simple, easy strategies you can start implementing right away. And don’t forget the importance of sleep hygiene, exercise, and pacing!

Remember that concussion rehabilitation does not come with an instruction manual - there is no one-size-fits-all approach. A person dealing with persistent concussion symptoms needs a team experienced, knowledgeable and up-to-date with the latest evidence. Surround yourself with a good team to help navigate your way out.

If you have any questions about concussion rehabilitation, feel free to contact us through email or phone us at (778) 630-8800. If you would like to book an appointment, you can do so online.

Meet Sofy!

Our newest orthopaedic and pelvic floor physiotherapist, Sofy was born in Taiwan before moving to Kimberley, BC at a young age. She eventually ventured down to Vancouver to complete her degrees and now calls this beautiful city home. Growing up in the East Kootenays introduced Sofy to many sports and outdoor activities, where she spent most of her time in the mountains or at the golf courses. Besides being a physiotherapist, Sofy is also an artist. She loves oil painting and everything art! 

What is something totally random that people won’t know about you?

I moved to Kimberley because I had terrible eczema and allergies living in Taiwan and Kimberley was the only place that magically made my symptoms disappear (after exploring several countries and cities).

When did you decide you wanted to be a physio? 

I wanted to become a dentist since I was 8 years old. It wasn’t until 3rd year university when I realized that I couldn’t talk to people if I was working inside of their mouths. I love talking and getting to know people as well as learning about how the human body works. After exploring a few different professions, physiotherapy seemed to be the perfect fit!

Which sports are you into? 

Golf, golf, and golf! Tennis in the summer, squash in the winter. Rock climbing, spikeball, and volleyball are pretty fun too. 

Where did you grow up?

Taiwan and Kimberley BC. 

What is your favourite orthopaedic condition to treat?

I like them all! Each body part is fascinating in their own ways in my opinion, hard to pick a favourite. I took a special interest in hands and the upper extremities early on in my career, but now I like to treat everything. 

What makes you happiest? 

Camping on top of a mountain or painting away in my little studio. 

LIGHTNING ROUND!!!!!

Cats or dogs? Dogs

Favourite food? Thai food

Favourite dessert: Tiramisu 

Favourite Junk food: Instant noodles

Beach or mountains: Mountains

Favourite colour: Baby pink

Favourite music: Pop

Favorite day of the week? Sunday

Nickname? Sof, Meng (but I really don’t like it)

Would you rather be able to speak every language in the world or be able to talk to animals? Speak every language

Favorite holiday? Christmas

How long does it take you to get ready? 30 mins

Invisibility or super strength? Invisibility

Is it wrong for a vegetarian to eat animal crackers? No

Dawn or dusk? Dusk

Do you snore? I “breathe loudly” 

Place you most want to travel? Nepal, South America

Last Halloween costume? Cannot remember the last time I dressed up

Favorite number? 3

Have you ever worn socks with sandals? Whenever I’m too lazy to put on shoes

Would you rather cuddle with a baby panda or a baby penguin? Baby panda

Would you want to live forever? No

What's for dinner tonight? Turkey burger with yam fries

Yep, she painted that.

What is Kinesiology?

Kinesiology, also known as human kinetics, is the study of human movement, performance, and function. Kinesiologists work with people of all ages and physical abilities to help them achieve their health and wellness goals as well as improve their quality of life. 

A kinesiologist (kin for short) uses knowledge of anatomy, physiology, neurology and biomechanics to maximize the effectiveness of exercise rehabilitation. A kinesiologist can implement your exercise program, provide support in your rehab,  and help improve physical performance in sport, work or daily life.

In more simple terms, kinesiologists are exercise rehab rock stars!

Kins use exercise to get you back to the things you love. They will discuss your goals and current treatment plan with you and your physiotherapist (if you have a physio) and help develop an exercise program to meet your needs. They work with you for one-on-one exercise sessions to ensure your technique is perfect while they help progress you through your recovery process. Strength, endurance, balance, and general fitness goals will all be addressed - there will be no stone left unturned!

What kind of training does a kinesiologist have?

Kinesiologists have completed a 4 year bachelors degree from an accredited university. Both UBC and SFU have fabulous programs! Our kinesiologists are also active members of the British Columbia Association of Kinesiologists (BCAK).

Is a kinesiologist like a personal trainer? 

The primary difference between kinesiologists and personal trainers is education level. Kinesiology requires a four year university degree whereas personal training education is generally a few weekend courses. The increased scientific knowledge base and use of evidence-based research translates to a higher quality of care, a more comprehensive approach to your exercise, and more capability of helping you troubleshoot issues that may arise.

What can a kinesiologist do for me?

There are many reasons people can find kinesiologists valuable. Kins can:

• Create an exercise plan that is safe and realistic

• Identify muscle imbalances through assessment of your movement

• Help with maintaining fitness while you deal with an injury

• Develop an exercise rehab program to address an injury

• Ensure proper exercise technique to avoid unnecessary injury

• Provide motivation and accountability to stick with your exercise program

• Help you have fun while achieving the results you want!

Is kinesiology covered by my extended health benefits?

Usually yes! For most people kinesiology, active rehab, and physiotherapy assistant appointments (which are, for this purpose, mostly interchangeable terms) are included within your physiotherapy coverage. Some plans have separate categories for “Physiotherapy” and “Kinesiology”. It is always best to first check with your insurance provider to confirm your coverage.

Do I have coverage if I was in a car accident?

Yes! With ICBC coverage, within the first 12 weeks of a car accident you are automatically approved for:

• 12 visits with a kinesiologist

• 25 visits with a physiotherapist

• 12 visits with a registered massage therapist

If your accident was more than 12 weeks ago or you have had treatment for your accident at another clinic, please let our front desk know so we can help you sort out the logistics.

Do I have coverage if I have a WorksafeBC claim?

Yes! Our kinesiologists works closely with our physiotherapists to aid in the delivery of your recovery program.

What will my session look like?

Your first visit with your kinesiologist will be an hour long. Your kinesiologist will meet you and begin the session with a quick chat. They will ask you about your reasons for coming in, your goals and your current exercise program. They will then take some time to assess your movement, strength and capabilities before taking you through an appropriate exercise program.

The kinesiologist is in constant collaboration with your physiotherapist to ensure your exercise sessions are as effective and pleasant as possible. Follow up sessions can be 30 minutes, 45 minutes, or 60 minutes long. If you are a WSBC or ICBC client your appointments will always be 45 minutes.

If you want to learn more or you would like to book a session with a kinesiologist please contact the clinic via:

• phone at 778-227-8030

• email at clinic@ladnervillagephysio.com

• book online

We look forward to meeting you!

Meet Keltouma!

We are so lucky to have Keltouma Nouah join us at Ladner Village Physio for both orthopaedic and pelvic floor physiotherapy! This multitalented, multilingual woman recently moved with her family from Ottawa to the West Coast. Learn more about Keltouma and how you definitely want her on your side in a fistfight.

What is something totally random that people won’t know about you?

I speak 5 languages and hope to learn 2 more!

When did you decide you wanted to be a physio?

I decided to become a physiotherapist during my last year of my undergraduate studies. My dad had a severe low back injury and needed a driver to his physio session (that was me!). I took him to every session and learned so much about physiotherapy. I fell in love with the holistic approach to health.

Which sports are you into?

I love martial arts! I played competitive Tae-Kwon Do growing up, and now do kickboxing twice a week.

Where did you grow up?

This is a complicated question. I was born in Quebec City, and lived there for 5 years, then moved to Montreal and lived there for another 5 years. I then moved to Ottawa with my family and spent 20 years there. In 2020, I moved to my current home in Richmond, BC.

What is your favourite orthopaedic condition to treat?

Neck pain ! It's so common and such a pain to have! 

What makes you happiest?

Spending quality time with my family and friends!

LIGHTNING ROUND!!!!!

Cats or dogs? Cats

Favourite food? Chicken skewers

Favourite dessert? bingsoo or cheesecake

Favourite Junk food? fuzzy peach

Beach or mountains? beach

Favourite colour? blue

Favourite music? anything latin

Favorite day of the week? Friday

Nickname? too many to list

Would you rather be able to speak every language in the world or be able to talk to animals? Speak every language

Favorite holiday? Eid

How long does it take you to get ready? 5 minutes 

Invisibility or super strength? super strength

Is it wrong for a vegetarian to eat animal crackers? nope

Dawn or dusk? dawn

Do you snore? never

Place you most want to travel? Morocco

Last Halloween costume? cleopatra

Favorite number? don't have one

Have you ever worn socks with sandals? yes! What else do you wear at a cottage?

Would you rather cuddle with a baby panda or a baby penguin? baby panda

Would you want to live forever? no

What's for dinner tonight? lasagna

Low Back Pain in Dancers and Gymnasts

For dancers and gymnasts, low back pain can come in many forms and can involve the spine itself. Two of the most common spinal injuries are:

1. Spondylolysis - a stress fracture of the pars interarticularis, a thin area of the vertebra that is more vulnerable to injury.

2. Spondylolisthesis - occurs if stress fractures are on both sides of the vertabra and allow a slippage of one vertebrae over the other to occur.

Dancers and gymnasts are at a higher risk of developing these spinal injuries due to repetitive hyperextension-type movements such as back-bending. These movements put significant load on the pars interarticularis, a thin part of the vertabra that connects the main part of the vertebra at the front with the bony bits at the back.

When you combine hyperextension with forceful dismounts and landings (gymnasts, we’re talking to you), it increases the risk of both spondylolysis and spondylolisthesis significantly. As more and more dancers are combining gymnastic skills into their routines, I expect to see more dancers with these conditions as well.

A slippage of less than 50% (a Grade 1 or 2 spondylolisthesis) is often treated with physiotherapy including hands on treatment techniques and exercise. A slippage of greater than 50% (a Grade 3 or 4 spondylolisthesis) is considered more serious and usually involves the care of a specialist.

Both spondylolysis and spondylolisthesis can happen at any spinal level. It most commonly occurs in the L5 vertebra, with L5 slipping forward over S1 (see the photo above). The second most common site is L4. 

What do spondylolysis and spondylolisthesis feel like?

Athletes will often complain of the following:

• Dull pain that can be sharp with movement

• pain with extension type movements including arabesque, bridges, back walkovers, back hand springs etc.

• Focal pain in the low back but may radiate into the buttock or down the legs

• Symptoms that are worse with activity and better with rest

How is it diagnosed?

Diagnosis starts with a thorough subjective history. If a spondylolysis or a spondylolisthesis is suspected, imaging via X-ray, CT or MRI will be ordered to confirm a diagnosis.

It is important that athletes with suspected spondylitic conditions be medically cleared before beginning an exercise program. This is crucial for the health and well being of the athlete as the wrong exercises can aggravate and worsen the injury.

How do we treat it?

Spondylitic conditions can cause instability of the low back. Spinal stabilization through core stability training is a key component in prevention and rehabilitation in these young athletes. Often, athletes focus on the large muscles and neglect the little guys that are responsible for stabilization. Core stability training targets the little muscles that directly support the spine including the transversus abdominis, multifidi, paraspinal, and internal and external obliques.

Appropriate flexibility is also important after a spinal injury. Tightness of certain hip muscles can increase the extension of the low back which can exacerbate symptoms.

If you’re suffering from back pain, give us a call at (778) 630-800, email us or book online. 

Soft Tissue Injuries Just Need Some PEACE & LOVE

You may have heard the acronym RICE before (rest, ice, compression, elevation). This protocol was developed by Dr. Gabe Mirkin in 1978 and remained the primary recommendation for management of acute soft tissue injures (like ankle sprains).

In 1998, it was adjusted to PRICE (protection, rest, ice, compression, elevation). PRICE was en vogue from 1998 until 2012 when the research evolved yet again and we were given the newly named POLICE protocol (protection, optimal load, ice, compression, elevation).

POLICE had some positive changes, especially as it included active participation and appropriate loading rather than just several passive treatments.

But now there is a new kid on the block:

PEACE and LOVE 

The researchers behind PEACE and LOVE are Blaise Dubois and Jean-Francois Esculier. They identified how the previous RICE/PRICE/POLICE strategies ignored the subacute and ongoing stages of healing*. Because the subacute and ongoing stages compose the majority of the post-injury timeline, we welcome suggestions for this phase with open arms.

*We classify injuries as acute in days 0-4 after the injury, subacute from days 4-14, post-acute is after 14 days.

Without further ado, I present to you a protocol that emphasizes the PEACE-ful stages of immediate care, which emphasizes doing no harm, and the subsequent management that gives the soft tissues some LOVE.  

• P is for PROTECTION: Avoid activities that increase pain during the first few days after an injury.

• E is for ELEVATION: Elevate the injured limb higher than the heart as often as possible. 

• A is for AVOID ANTI-INFLAMMATORIES: These medications can reduce tissue healing. Avoid icing. 

• C is for COMPRESSION: Use elastic bandage or taping to reduce swelling. 

• E is for EDUCATION: Your body knows best. Avoid unnecessary passive treatments and medical investigations and let nature play its role. 

• L is for LOAD: Let pain guide your gradual return to normal activities. Your body will tell you when it’s safe to increase load. 

• O is for OPTIMISM: Condition your brain for optimal recovery by being confident and positive. 

• V is for VASCULARIZATION: Choose pain-free cardiovascular activities to increase blood flow to repairing tissue.

• E is for EXERCISE: Restore mobility, strength and proprioception by adopting an active approach to recovery. 

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Most of the above is self explanatory but there are a few points which are new or warrant some further explanation. Below are some key points for each factor. 

A for Avoid Anti-Inflammatories

• Inflammation is a natural and beneficial process to repair damaged soft tissues. 

• Using anti-inflammatory medications may negatively affect long-term tissue healing.

• Ice is analgesic but can interrupt regeneration and can lead to impaired tissue repair via disrupting angiogenesis, delaying macrophage and neutrophil infiltration and increasing immature myofibrils. 

E for Educate

• An active approach to recovery is better than a passive approach. 

• We want to avoid people feeling therapy-dependent or “needing to get fixed.” 

• Better education and correct load management can decrease the need for unnecessary injections or surgery.

• There is no “magic cure” and expectations should be realistic. 

O for Optimism

• Optimistic clients have better outcomes and prognosis. Beliefs and emotions are thought to explain more of the variation in symptoms following and ankle sprain than the degree of pathophysiology.  

• Catastrophisation, depression and fear can represent barriers to recovery.

V for Vascularisation

• Cardiovascular activity is important for the management of musculoskeletal injuries and should be completed in a pain-free way to boost motivation and increase blood flow to the affected area. 

• Early aerobic exercise and mobilisation improve physical function which can aid with successful return to work and decrease the need for pain medication. 

• Further research needs to be done for recommendations on dosage. 

E for Exercise

• Exercise can help restore mobility, strength and proprioception. It can also reduce prevalence of recurrent injuries such as ankle sprains. 

• Avoiding pain to ensure optimal repair during the subacute phase. Progress exercise as tolerated. 

For the full paper, download it here!