Ask A Physio - What Happens To Balance As We Age?

As a vestibular physiotherapist, I talk a lot about the triangle of balance. There are three main inputs to our sense of balance:

1. Vestibular System - a complex network involving the inner ear, brain stem and cerebellum, the vestibular system is responsible for detecting head movements and the head’s position relative to gravity.

2. Visual System - another complex network, the visual system goes well beyond the eyes, involving several areas of the brain stem and cerebral cortex.

3. Touch & Proprioception - these are all the receptors in your muscles, joints and skin telling you what you are touching and where your limbs are in space. If you can touch your nose while your eyes are closed, congratulations! Your proprioception is working!

Vestibular deficits are one of the most common causes of imbalance. BPPV, vestibular neuritis & neuritis, vestibular migraine, and Meniere’s disease are all well-known vestibular causes of imbalance and are all very treatable.

But in reality, balance is a very complex interplay of not only those three things but also cognition, attention, emotion, perception, muscle strength, joint flexibility, pain, motor planning, general stress levels and so much more. Impairments in balance can come from anywhere and have a massive effect on people’s function, especially as we age. With 20-30% of seniors experiencing one or more falls each year and 1 in 5 of those resulting in serious injury, preventing and treating balance issues is imperative.

Other Factors Leading to Imbalance with Age

There are a myriad of factors that can add to imbalance as we age. Here are some of more common ones:

• Dehydration - as we age, the part of the brain responsible for telling us we are thirsty becomes less active, leading us to reach for the water bottle less and less. This dehydration can very quickly lead to light-headedness and imbalance.

• Medications - several medications list dizziness as a side effect. There’s also a host of medications listing vision changes, light-headedness and drowsiness as side effects, all of which can affect balance.

• Walking speed & instability - the slower someone walks, the higher their chance of falls. Combine that with a limp or unsteadiness and imbalance increases significantly.

• Foot problems - if people have impaired sensation in their feet, balance problems are likely to follow. Bunions, numbness, thick calluses and ulcerations can directly impact how people are feeling the ground.

• Heart issues - a common symptom of cardiovascular disease is dizziness and light headedness especially when untreated.

• Vision problems - aging often affects how our eyes adjust to light and distance, taking longer and longer to shift. It’s common for prescriptions to change as we age and people often struggle adjusting to bifocal or progressive lenses.

• Cognition changes - so many aspects of cognition affect balance. Multi-tasking takes a lot of brain power and often leads to impaired balance. Cognitive processing and reaction time are critical for maintaining balance. Memory problems are also linked to imbalance.

• Fear of falling - one of the leading predictors of imbalance and falls is a fear of falling. People with this fear often do not move nearly as much, leading to inactivity and muscle weakness.

Top Ten Things To Do For Balance (That Aren’t Balance Exercises)

1. Stay active - the old adage “use it or lose it” is very true, at least when it comes to muscles and the brain. The more active you are, the better. It really doesn’t matter what your passion is, just keep doing it at whatever level you can! Go to the gym or an exercise class to keep your muscles lean, mean and flexible.

2. Stay hydrated - brains are thirsty and, as we age, our brains forget to tell us. Pay attention to how much water you drink during the day and try to drink at least 8 glasses per day.

3. Learn something new - your brain never stops changing. It adds new connections and removes connections that aren’t being used. By trying something you’ve never tried before, you are inducing neuroplasticity in your brain. This helps your cognitive power and can help improve balance. The McKee House Seniors Society in Ladner has a whole range of things to try, from line dancing and yoga to water colour painting and ukulele.

4. Walk with friends - this one checks all the boxes: exercise? Check! Head turns and vision challenges while looking around and looking at your friend? Check! Carrying on a conversation while dodging obstacles? Check! Soul-filling and stress-relieving? Absolutely. Walking with friends should be a part of everyone’s weekly routine.

5. Cook complex meals or maintain a garden - these are just two examples but the idea is to do complex tasks that take longer than a day to plan for and complete, then require movement to do the task. Other examples are fixing cars, large art projects, being on an organizing committee - the options are endless!

6. Bring your stress down - stress has a massive effect on your brain. Cognition can become impaired through several mechanisms leading to reduced ability to multi-task, process information and react appropriately. There are several ways to de-stress: yoga, Tai Chi, meditation, boxing, knitting, reading or anything that feels relaxing.

7. Review your medications with a pharmacist - more than 4 medications is associated with an increased risk of imbalance. Pharmacists are experts in drugs and drug interactions and are the best source of this information.

8. Be proactive about mental health - anxiety and fear of falling are two of the biggest drivers of imbalance and falls in seniors, with one in five resulting in serious injury. Mental health experts such as clinical counsellors are wonderful resources to address these issues at the root cause.

9. Have a great relationship with your optometrist - eyes change as we age. Find yourself an optometrist and see them annually.

10. Treat what needs to be treated - if you’re diabetic, make sure your sugars are in check to avoid peripheral neuropathy. If you have cardiac issues, follow your cardiologist’s advice on medications and exercise. The better you are to your body, the better your balance.

For more on age-related imbalance, head to Balance and Dizziness Canada. You can also find a vestibular therapist in your corner of the world on their practitioner’s list.

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.

Ask A Physio: When Can I Go Back To Sport After An Ankle Sprain?

Ankle injuries are one of the most common acute injuries we see, especially amongst athletes. Pretty much everybody who has played a sport has sprained an ankle before, leading to a lot of people minimizing the injury and not taking it seriously.

There is often pressure from coaches (and ourselves!) to make a quick return to sport because “it’s just an ankle sprain.” Just because ankle sprains are common does not make them insignificant. We know that only about half of people who experience an ankle sprain seek help. We also know that up to ONE THIRD of individuals experience chronic ankle instability after an ankle sprain.

It is in your best interest to handle ankle sprains correctly. Otherwise, they come back to bite you again and again.

Below is a list of factors that physiotherapists consider while gradually returning you to your activity of choice. It’s not just about going back to practice and taking it easy for a day or two then going to play a game next week. In the clinic we test and re-test all of these aspects and gradually help people progress up to their top level of functioning.

If you want to manage your sprain yourself you absolutely can, especially it’s not your first time and you know what to expect. But please know that going back too soon is a really good way to get re-injured and everything that is listed below is relevant no matter who is doing your rehab.

(Looking for what to do immediately after an ankle sprain? Read our Top Ten Tips for Acutely Sprained Ankles in our blog!)

Factors to Consider in Ankle Sprain Rehab:

Pain:

• Do you have any pain?

• Does it hurt while exercising or afterwards?

• How intense is the pain and where is the location?

• How long after the pain starts will it subside and return to baseline?

Swelling:

• Is there swelling?

• Is it old or new swelling?

• How does the swelling fluctuate with activity?

Physical Aspects:  

• Does your ankle move in all directions as well as the other foot?

• Is the strength equal in all directions?

• How is the endurance?

• What about the power?

• How about your sensorimotor control - do you have complete proprioception back (a fancy word for knowing where your body is in space)?

• Is your balance as good on that side?

• How about your dynamic control - can you maintain stability and balance while moving and doing other things?

• Do you need a brace? Which kind of brace? When should you wear the brace? Can you wean off of the brace?

Mindset:

• How do you feel about your ankle?

• Are you confident that it will be fine?

• Do you feel that your ankle is stable?

• Are you psychologically ready to go back?

• In contact sports, does the thought of someone checking you from behind make you nervous?

Functional and sport performance:

• Can you hop? Jump? Change directions?

• Can you jog? Run? Sprint? Run a gentle curve? Cut to the side? Slam to a stop?

• What about things specific to your sport? For example if you are a soccer player can you pass? Receive a pass? Shoot? Tackle?

• Are you fast enough to react to another player?

• Can you do all the drills in practice? What about a scrimmage?

We want you to be able to do all of these things and do them well before you fully return to your sport. It’s a long list to consider and not always easy to answer every question, but it’s important to run through this list and make sure you are really ready to return to sport.

If you suffer with ankle sprains, get it checked out by a physiotherapist - we are the experts at this! We are always happy to see you and will do our best to get you back out there as soon and as safely as possible.

Need to book an appointment? Book online, send us an email or call us at (778) 630-8800. Happy healing!

Ask A Physio: If My Knee Hurts, Why Are You Looking At My Hip?

As physios, we see bodies differently than most people. This is a good thing - you want your body specialist to see beyond the obvious! But what is often obvious to us is a mystery to others.

You may have heard one of us talking about the “kinetic chain”, a concept borrowed from the engineering world and repackaged for health care. The basic idea is the movement in one joint will create and affect the movement of the next joint, and so on. If your pain is in your elbow, we would be doing you a disservice if we didn’t also look at your wrist, shoulder, neck and upper back as well.

The kinetic chain is a big reason why one-size-fits-all approaches don’t work.

We don’t tell you to simply Google your symptoms and treat yourself. One person’s treatment approach for sciatica will be completely different than the next. My grandma’s elbow pain often has a completely different cause than my daughter’s elbow pain, even if they are in the same spot. Looking at the body as a whole is imperative to proper treatment.

A Case Study in Kinetic Chains: Runner’s Knee

A great example of this is someone with runner’s knee, also known as patellofemoral syndrome (PFPS). To understand how PFPS develops, an understanding of knee biomechanics is crucial.

The patella (aka the kneecap) rides in a groove on the femur at the front of the knee and is critical for proper knee movement. The patella acts as the attachment point for ALL your quads - think of how much muscle that is! To stretch out your leg, your quads first contract and pull on the patella. The force is transmitted through the patellar tendon (or ligament, depending on who you read) and pulls on the tibia, the main bone of your lower leg. Without the patella, the amount of force required for the quads to unbend the knee is simply too great. The patella acts as a fulcrum, giving the quads a mechanical advantage.

Need a visual? Check out this fantastic video:

Muscle imbalance is one of the main causes of PFPS. The patella is held in its position by a fine balance of muscle and connective tissue. Muscles that attach to the patella directly - we’re talking about the quads here - are obviously a main focus. But there’s many more muscles to consider. Consider these two examples:

1. One cause of PFPS is tight calf muscles. The gastrocnemius, one of the calf muscles, attaches at the back of the leg above the knee and can have a great effect on knee function. When these muscles are too tight, people tend to walk more in a pronated foot position (see photo on the right), increasing the forces at the back of the knee and adding to the compression and irritation of tissues around the patella.

2. The IT band runs the length of the thigh on the outside of the leg and attaches to the outside of the patella. The gluteus maximus, the large muscle in your buttock that controls hip extension, attaches into the top of the IT band. If the glutes aren’t doing their job, you can experience knee pain even if it isn’t the source of the problem.

We don’t expect you to know the ins and outs of this - that’s our job! When you come in for a little rehab, don’t be surprised when we start checking out your other joints - you may be surprised by what we find.

If you need to see a physiotherapist, give us a call at (778) 630-8800, email us or book online. We would love to work with you!

Ask A Physio - Why Is My Joint Making That Noise?

Joints can make peculiar noises. They can snap, pop, crack, grind, grate, click and clunk. The proper name for these noises is crepitus. Many people become understandably nervous about this, especially if it is a “new noise.” Although crepitus is generally unwelcome, it is not as scary as you think.

When people come to physiotherapy for joint noises they generally have similar concerns. They want to know what is causing the noise and how to stop it.

The general perception people have is their joint must now be degenerated and “bone on bone.” People take this as a sign of aging and extreme arthritis and become scared for their joints. They do not want to unnecessarily wear the joints down.

So what do they do? They avoid the noise! They stop climbing stairs and getting down on the ground to play with their kids and grandkids. They tell me they have stopped doing the movement that initiates the noise in order to “preserve” the joint or avoid “making it worse.”

It seems logical right? If I rotate my neck to the right and it snaps or clicks I may feel unsettled by that and want to avoid that feeling. I hear constantly from my clients that they don’t swim anymore because their shoulder clicks when they bring their arm over their head, or they no longer squat because their knees click on the way down.

My response to these clients is always the same - I ask:

“Does it hurt when it clicks?” 

Because here is the thing. There are many causes for crepitus. And yes, some of them require treatment, but many do not! Before anything else, we need to figure out what is causing the clicking and decide if we have to be concerned about it or not.

Most snaps, crackles and pops are pain free and totally harmless.

If you do not experience pain when your joint makes a noise you don’t have to worry about it and can continue with business as usual. 

Common Causes of Crepitus

• The most common culprit is gas bubbles popping within the joint (think cracking knuckles). When the joint is stretched and released a gas bubble is formed and then pops, causing the noise.

• The crepitus could also be a tendon or ligament snapping over a bony structure. In this case there might be pain, but it has nothing to do with the joint and a whole lot more with the muscle. This would require an assessment, range of motion and strength exercises from a physiotherapist.  

• Arthritis. Yes, sometimes crepitus is because of arthritis.  But please know that the clicking or grinding does not mean you are doing “extra damage” to the joint. If you have arthritis a primary goal is to maintain range of motion. Working through your available range should be a priority rather than being avoided. If your knees are a little extra talkative but you have no pain and no decrease in function I would encourage you to continue with your activities. There are so many benefits to exercise (cardiovascular, mental, general strength, etc.) and it would be a shame to throw all of those away because of a misconception that you had about your click-y knee. 

Speaking of Knees…

Most noisy joints I see people for happen to be knees. If you’re wondering what that noise is and what’s causing it, here’s our top three noises people complain of and what they could mean (please be aware that this is a gross generalization but is meant to give you a decent idea):

1. Snapping, cracking or clicking “outside” of your knee: This is often due to the patellofemoral joint. The patella (aka kneecap) lives in a little groove that it is supposed to glide up and down in when your knee bends and straightens. If the patella is not properly aligned (maybe from an injury or muscle imbalance) it can make noise as you crouch, use the stairs, or just with bending and straightening your knee. If these noises are inconsistent, occasional, and pain-free I would not worry. If they are constant and painful then seeing a physiotherapist can be very helpful.

2. Snapping, cracking, or clicking “inside of your knee”: This is often your meniscus, which is the cartilage shock absorber within the joint. With injury or degeneration over time this structure can tear, rip or peel back. In some cases a flap of cartilage can get caught out of place and this will often cause the joint to “lock.” If you have a click within your knee that causes a sharp pain and sometimes causes the joint to lock it is likely a meniscus problem and you should visit a physiotherapist. 

3. Creaking or grinding: This is most often associated with arthritis. If it is early stages and you are noticing some pain it is definitely worth a trip to your neighbourhood physiotherapist as an arthritis management plan can significantly impact the maintenance of range of motion, strength and function in the joint. (Side note - since exercise is one of the best ways to manage osteoarthritis, we offer the GLA:D Program!)

Again, if you experience these noises and there is no pain then I would not be too worried about it. But if you have these noises and they are painful it is probably worth coming in to see a physiotherapist. We will assess your joint range of motion, muscle strength and balance, and see if we can identify the cause for the click so we can come up with a treatment plan that will work for you. 

If the noise bothers you enough that you cannot stop worrying about, come on in. If nothing else we can confirm to you that it is harmless and you can have peace of mind moving forward with your activities. We are always happy to help! 

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If you have any questions or would like to schedule an assessment please call Ladner Village Physiotherapy at 778-630-8800, email us or book online at ladnervillagephysio.com 

Ask A Physio: How Can I Get Rid Of My Sciatica?

We’ve all heard of sciatica - that awful, weird pain that runs down the back of your leg. It’s often fairly vague pain and hard to pinpoint but there’s no mistaking its presence.

Lately, we have seen a serious uptick in clients complaining of sciatica and its good friend, low back pain. So, what is sciatica and what exactly can we do about it?

What Is Sciatica?

Sciatica refers to in irritation of the sciatic nerve which runs down the back side of your leg and innervates the hamstrings and all the muscles below the knee. The sciatic nerve is HUGE - about the width of your thumb! It passes through, around and beside some major structures including the spine as well as the glutes and piriformis in the buttocks.

The classic profile of someone with sciatic-related pain can include:

• Pain in the low back that radiates down the back of the leg, described as anything from dull and achy to sharp, burning or electrical

• Tingling and/or numbness in the lower spine, buttock, back of thigh, calf and/or foot

• Increase in pain with certain postures - often sitting with the legs stretched out or driving a car is terrible, but standing, walking or lying down eases pain

• Electrical and/or shock-like pain down the back of the leg

• In extreme cases, weakness of the muscles in the lower leg and hamstrings

Usually, the pain is just on one side as it’s only one nerve that’s affected, not both at the same time.

How Do We Treat It?

At the root of it, sciatica is a symptom, not a diagnosis. When the sciatic nerve is pressed on or irritated by other structures, sciatic pain is the result.

Before addressing the sciatica itself, we need to figure out what’s causing the pressure on the sciatic nerve in the first place. The likely candidates include:

1. Herniated Disc - the nerve roots that exit the spinal cord to form the sciatic nerve can be compressed by a herniated disc, leading to sciatic pain. This is the most common cause of sciatica.

2. Spinal Stenosis - literally meaning “narrowing”, stenosis occurs when the tunnel of bone that allows the nerve roots to escape shrink, often by bone spurs or a loss of disc height.

3. Arthritis - When arthritis hits the spine, it usually leads to bone spurs around the exiting nerve roots, similar to stenosis.

4. Pelvic and/or SI Joint Hypermobilities - most of the muscles that lie over and around the sciatic nerve are attached to some point of the pelvis. When the pelvis is moving more than it should, these muscles often tighten down to try and stabilize the pelvis. When this occurs, an unintended consequence is pressure on the sciatic nerve. Pregnant women with sciatica: this is likely you!

5. Piriformis tightness - this deep muscle lies right over the sciatic nerve. If it’s too tight, it can squeeze the sciatic nerve.

The treatment approach is defined by the source of the sciatic nerve irritation. Is the problem at the spine? Is it a muscle imbalance or spasm causing the problem?

We see a lot of “one size fits all” fixes for sciatica online. These often don’t work because the root problem isn’t identified and addressed. If your sciatic pain isn’t going away, your best bet is to be assessed by your medical practitioner and figure out what’s driving your sciatica.

My Sciatica Is Gone! How Can I Prevent It From Coming Back?

There are loads of ways to keep sciatica at bay! The top tips:

• Stay active - Look at all those causes of sciatica listed above. All of them benefit from exercise - strengthening, stretching, MOVING. In fact, one of the biggest risk factors for sciatica is prolonged sitting. So if you don’t want sciatica, move more!

• Maintain a healthy weight - a normal weight keeps your spine healthier with less disc pressure and a lower chance of degenerative changes, both of which contribute to sciatic pain.

• Sit properly - I’m talking feet on the floor, bum at the back of your chair with a lumbar support properly. Not sure what that looks like? Check out our blog on proper ergonomics.

• Strengthen your core - A strong core means a supported spine and pelvis, preventing sciatic nerve compression.

• Use good body mechanics - Considering a disc injury is the leading cause of sciatica, protect those discs! Lift with your legs and try to not twist as you lift a heavy load. Hold those heavy loads close to your body and find a friend if it’s really heavy.

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If you’re dealing with low back or sciatic pain, give us a call at (778) 630-8800 or book online.

Ask A Physio: Anything You Can Do About Tennis Elbow?

Sometimes, it seems like we see injuries in spurts. I’ll have a day where I haven’t seen a sprained ankle in months and I’ll see 4 new ones that day. Lately, I’ve seen a lot of people with Tennis Elbow all asking the same question: is there anything you can do?

I’m sure you can guess the answer - YES! We have strategies for getting the pain to settle down, treatment techniques to help settle the tissue, and appropriate exercises to build it back up. But first -

What Is Tennis Elbow And Why Does It Happen?

Tennis Elbow (also known by it’s long name, lateral epicondylalgia or lateral epicondylitis) in an overuse injury of the muscles that attach to the outside part of the elbow. These muscles are responsible for pulling the hand backwards at the wrist, creating wrist extension.

People with Tennis Elbow complain of pain on the outside of their elbow, especially after using their wrists and hands a lot. Often, this pain is in a specific spot and when you hit it, it can be excruciating. People will often complain their grip strength has decreased especially when their arm is stretched out. (If you’ve heard of Golfer’s Elbow, it’s similar to Tennis Elbow but instead of the wrist extensors, it’s the wrist flexors that attach to the inside, or medial, part of the elbow that are the culprit. We can treat this, too!)

Tennis Elbow isn’t just for tennis players either! Anyone who does a lot of gripping or squeezing movements with their hands are at risk of developing Tennis Elbow - gardeners, plumbers, carpenters and painters are all great examples. We’ve also seen an uptick in people developing Tennis Elbow from increased typing and mouse work, both of which demand a lot of wrist action.

When it comes to rehab, physiotherapists are key to conquering this painful and annoying condition. Here are the top 5 most important things to remember in recovering from Tennis Elbow:

Top Five Tips for Tennis Elbow

1. Do not overuse an overuse injury! This is a common problem - your elbow hurts when you move your wrist, so you try to stretch it and work it out. A lot. This often just leads to more pain - instead of allowing the tissue to rest and heal, it just gets further irritated.

2. First, settle it down. We have a tonne of options for this - ultrasound, laser, soft tissue techniques, manual therapy, and gentle and appropriate exercises help to settle the tissue down and allow healing to begin.

3. A brace might help. Using a tennis elbow brace may be the break your muscle needs to start healing. These braces act like a fret on a guitar string - when you use your wrist, it stops the muscles from pulling on the irritated part, allowing it to heal.

4. Tape might help. Often, Tennis Elbow is accompanied by joints that aren’t working optimally. Tape can be used to adjust how the joints are moving, taking more pressure off the extensor muscles.

5. When it’s settled, start building it back up. For any overuse injury, the key is to slowly progress exercises appropriately while not letting it flare back up again. This can be tricky! Every body is different and needs to be treated as such - there is no cookie-cutter rehabilitation plan for Tennis Elbow. This is where your physiotherapist is your guide.

As for all overuse injuries, exercise is key to success BUT they need to be appropriate exercises. The goal is to challenge the elbow without aggravating the injury. Success depends on a slow, incremental approach that allows the muscles to gradually gain strength and to get rid of this annoying condition once and for all!

If you’d like to see one of our fabulous physiotherapists for your elbow pain (or any other pain!), book online or give us a call at (778) 630-8800.

Ask A Physio (COVID Edition): Why Is My Dizziness Worse?

The unexpected effects of COVID seem to be never ending. From toilet paper shortages to Clorox winning the stock market, we are living in a reality none of us could have predicted. It was impossible to buy yeast for months -that’s weird!

A big unexpected effect for me and my vestibular clients has been a sharp increase in dizziness. Almost daily, I'm seeing clients from months and years past saying the same thing:

My symptoms are coming back and I don’t know why.

Here’s my break down of why I think this is occurring and what you can do to combat it.

The success of vestibular rehabilitation relies on three key components:

1. Appropriate exercises that target the right problems - when working with someone with a vestibular disorder, it’s important to zero in on the cause of the problems and give the right exercises (learn more about that here).

2. Getting enough activity and stimulation to keep everything firing - it’s the classic 'Use It or Lose It’. For any brain to learn and retain anything, it needs to be used. This is one of the principles behind neuroplasticity (learn more about that here).

3. Managing stress and fatigue - these two things are the biggest inducers of vestibular symptoms. When stress or fatigue increase, symptoms typically aren’t far behind.

For most people, this pandemic has thrown two of the three components right in the trash. Stress is way up and activity levels are way down. Since the beginning of the year, there’s been a well documented rise in stress, anxiety and depression in the general population. This has spilled over into every area of our lives including the vestibular system. Combine that with less movement in our days - no exercise classes, working from home and staring at a screen for waaaaay longer than normal - and you have a recipe for a vestibular disaster.

So how do you combat this? How can you avoid this system crash?

1. Get outside. For your brain to be happy and stimulated, you need unpredictable stimuli. You need to see the birds swooping in the air and the cars driving by you. You need to navigate curbs, potholes and other people. You need to get outside the four walls of your home and let your brain experience something else.

2. Try something new. I know this is hard to do in a pandemic, but there are lots of pandemic-friendly activities that are also great for your vestibular system. Online exercise classes, diving headfirst into more complex recipes in the kitchen and dragging your bike out of the garage for a 10 km ride are all great ways to give your brain a real work out.

3. Go for a walk with a friend. This is very much a Dr. Bonnie Henry-approved activity and a great one for your vestibular system. Not only will it help you lower your stress levels but the activity of turning your head to talk to your friend as you walk is a great vestibular exercise!

4. Meditate. The research behind mindfulness practice and meditation is staggering in its breadth. It has been shown to decrease the symptoms of anxiety and depression, lower blood pressure, improve sleep, help control pain and improve quality of life. If you’re not sure how to get on the meditation train, guided meditations are a great starting point - you can find several on Youtube or through apps like Calm and Headspace.

5. Practice your vestibular exercises. If you’re a client of ours, you likely have a maintenance program you were given on your last day with the instructions to practice them three times per week. If you’ve fallen off the vestibular exercise wagon, it’s time to climb back on.

6. Get the right help. If your symptoms are skyrocketing, reach out! It may be that a vestibular therapist is the right person for you or it may be a counselor or psychologist is your best bet. A conversation with your family doctor is also a great place to start.

Whatever the reason for your symptom increase, know these two things: you are not alone and there are things that can help get your symptoms back under control. Reach out to us at (778) 630-8800 or by email. Through in person or virtual appointments, we are here to help!

Ask A Physio: Any Tips for Mouse Finger Pain?

So I don’t know about you, but COVID has certainly pushed me to using my computer a lot more. A. Lot. More. My body is feeling it, too - my neck is stiffer than it was, my hands are tired and my shoulders make a lot of noise after a long session on the computer.

We know that prolonged postures of any kind - standing in one spot, sitting still - aren’t great for anyone. Our bodies are for movement and all too often we get stuck in postures for hours at a time. When that prolonged posture is on the computer, that finger and wrist pain is often directly related to the position of the neck and shoulder as much as it is the wrist and hand.

So what should you do? The best thing you can do is set an alarm for 30 minutes and make a point of moving and stretching your body. If you have two minutes (or less!), this movement and stretching routine can help combat the stiffness and soreness associated with prolonged computer use.

Without further ado, presenting:

Top Ten Exercises for Computer-Related Pain

1. Shake it out! - I love a good shake - who doesn’t? Sit up straight, take your wrists and hands and give them a good shake, letting your fingers fly.

2. Chin to chest - Something we often forget is how much posture contributes to pain further down the chain. Sit up straight and tuck your chin into your chest, feeling a stretch down the back of your neck. Hold this for 10ish seconds.

3. Ear to shoulder, then a twist - Still sitting up straight, lean your ear to your shoulder and hold it for about 10 seconds. Then twist your head so your nose gets closer to your armpit; hold this for another 10 seconds. Repeat on the other side.

4. Shoulder rolls - Still sitting up straight (are you sensing a theme yet??), roll your shoulders up to your ears then squeezing them back and down, pushing your shoulder blades as far down your back as you can. Bring your shoulders forward then back up to your ears. Do this 5 times.

5. Wrist stretch - Stretch your right arm in front of you and bend your wrist and fingers back. Use your left hand to pull your right fingers further back, feeling a stretch in your forearm. Hold for 10ish seconds and repeat on the other side.

6. Prayer stretch - Place your hands together in a prayer position in front of your chin. Lower your hands down, keeping your palms together and feeling a stretch in your forearms. Hold for 10ish seconds.

7. Finger stretch - Place all your finger tips together - think Mr. Burns from the Simpsons - and push your fingers together. Keep your fingers together and pull your palms away from each other. Stretch your thumbs away from your other fingers. Feel a stretch for 10ish seconds.

8. Wrist circles - Draw circles with your wrists! 5 in one direction, 5 in the other.

9. Hand fist and open - Squeeze your hands into tight fists for a few seconds. Then stretch your hands out wide, reaching your fingers out as far as you can for a few seconds. Repeat 5 times.

10. Finish this off with a final shake!

Looking for a print out of this program? Here it is in PDF form, with pictures!

The better you support your body with proper ergonomics (see our previous two ergonomic blogs here and here) and frequent movement breaks, the less likely you’ll suffer from computer related pain. So set that alarm, stretch it out and stay pain free!

As always, if you would like to book an assessment with one of our fabulous physiotherapists or our amazing massage therapist, give us a call at (778) 630-8800 or email us at clinic@ladnervillagephysio.com.

Finally - do you have a burning question one of our physiotherapists can answer? If you’d like to #askaphysio, we would love to answer!