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.

Top Five Tips for the Fair-Weather Runner

If you’ve ever been a runner, you probably know this feeling: the weather is getting nicer, sun is coming out again, so you decide to pull out the running shoes and head out for a run.

If you’re anything like me, you probably think, “how bad can it be? I’ll just run the same distance as I used to, aim for the same pace, and everything will be fine!”. Unfortunately, this isn’t always how it works.

Jumping right back into running can often lead to injuries, including a bruised ego when you realize how hard it is to run at your old pace (trust me, I’ve learned this the hard way). In this blog, we are going to talk about a few tips on how to get back into running in a safe and productive manner.

Kheya’s Top Five Tips To Getting Back to Running

1.      Make A Plan and Start Slow

The first tip to getting back into running is to make a plan. How often are you going to run? For how long? Do you have an end goal in mind for how long you would like to be able to run? When making your pain, consider the following:

• Frequency - aim for 3 times per week max. This will allow you to have at least one rest day between each of your runs to give your body the appropriate amount of time to recover, as well as time to add in some strength training.

• Pace - start slow! I often recommend to my clients to start with a walk/jog mix, then slowly decreasing your walking time and increasing your running time. For example, this might look like walking for 2 minutes, then running for 1 minute the first week, and then increasing to 1 minute and 30s walk and 1 minute and 30s run the next week, 1 minute walk, 2 minutes run the following week, and so forth. Continue this until you can keep up a slow running pace for your whole run!

• Time/ distance - start small and add a little bit of time each week. This is going to be very dependent on your current fitness but beginning with 10-20 minutes and slowly working your way up is a great place to start. Once you get comfortable with this time, you can start adding 5 minutes to your run each week. You can also track this with distance (for example, starting with 1-3km run and adding 0.5km each week).

• Setting a goal: having a goal distance in mind is a great way to keep yourself motivated when getting back into running. Goals should be SMART (specific, measurable, achievable, relevant, and time-bound). This means you should set a clear distance you would like to run in a clear within a reasonable time frame. A great example would be “I am going to run 3 x per week, beginning with a 2km run and increasing by 0.5km each week, with a goal of being able to run 5km in 6 weeks”.

2.      Train Smarter, Not Harder

Up until this point, we’ve only been talking about your basic steady run. However, just doing a simple base pace run isn’t always the most effective way to improve your running. When setting up a running schedule, it is great to break up your runs into different types. For example, you could split up your week into doing one long run, one run with sprint intervals, and one recovery run. You could even investigate different types of runs such as hill runs, Fartlek running, or tempo runs.

Here’s an example:

• Monday: 25 minutes of sprint intervals, 20s sprint, 2 minutes of walking/jogging

• Wednesday: Recovery run (3km at a slower pace than typical)

• Saturday: Long run (8km at your base pace)

3.      Have A Proper Warm Up and Cool Down Routine

A warm up that focuses on mobility and activating the muscles you are going to be using during a run is important. I would then start your run with a fast walk or very slow job for 5-10 minutes, before transitioning into your faster running pace. For a cool down, I would recommend doing a light walk at the end of your run, to help transition your body as your heart rate slows down, followed by some light stretching. Remember, a proper routine also includes proper nutrition and rehydrating!

4.      Keep Up With Your Strength Training

Strength training is very important for preventing injuries as well as increasing your running speed and efficiency. If you decide to totally transition into running without keeping up with your other workouts, you are going to be missing out big time! Aim for 2-3 days a week of strength training.  

5.      Invest In The Proper Shoes

Fun fact: did you know runners should be replaced every ~800 kilometers? Running shoes are the foundation of your performance and having improper shoes can impact your running gait, posture, and cause a whole array of problems. I would strongly recommend going to a proper running store like the Run Inn and have someone assess your foot and gait and recommend proper shoes for you. I promise, paying the price to have proper shoes is well worth it in the long run!

I hope you enjoyed these tips on getting back into running! If you have any questions, give us a call at (778) 630-8800, email us or book online to seek advice/treatment from a physiotherapist or to work with a registered kinesiologist.

Strength Training vs. Cardio - Which Is Better?

First off, let me start by saying that the title of this blog is a total hook. Cardiovascular exercise and weightlifting/strength training are both fantastic and one is not better than the other. The truth is that it is important to include both in your routine and have several benefits on their own.

Cardiovascular Training

Cardiovascular or aerobic training refers to exercise which increases heart rate and respiration. Examples include running, walking, cycling, swimming, or skiing.

Regular aerobic exercise (also known as cardio) has many incredible benefits:

• Reduce risk of cardiovascular disease and chronic health conditions

• Improve heart and lung health

• Positive benefits on mental health

• Improve endurance

• Improve immune system function

Overall, cardiovascular training can help you stay healthy and live longer!

Strength Training

Strength training refers to any training using weights or against resistance. This may include body weight, dumbbells, barbells, kettlebells, or a resistance band.

Strength training has many fantastic benefits, many of which overlap with aerobic training. These include:

• Maintain and improve bone strength

• Increase muscle mass

• Reduce risk of heart and lung disease

• Improve metabolism by helping your body burn more calories

• Decrease risk of certain diseases including heart disease, diabetes and arthritis

• Decrease risk of injury

Strength training is very important to keep up with as you age, as it will allow you to keep up the strength to do the things you love and even just your activities of daily living (i.e., cooking, cleaning, grocery shopping) without assistance.

Both cardiovascular exercise and strength training have a plethora of benefits, many of which I didn’t even mention! A successful exercise routine should include a mix of resistance training and cardiovascular training.

And Now, Some Myth-Busting…

Now that we’ve had a little introduction, I need to bust a myth I hear a lot in clinic: That cardio is the best and only method to use for weight loss.

Keep in mind, the literature on this topic is constantly changing, so this is where the research is at the moment. While weight loss shouldn’t be your only reason for exercising, I understand it is a motivator for many people to start. However, the myth that cardio is going to be better than strength training for weight loss is not actually as true as we used to believe.

Cardio can certainly assist with weight loss as it will increase the number of calories you burn; however, strength training is an excellent weight loss tool as it increases muscle mass. When you increase the amount of muscle in your body, these muscles continue to burn more calories, even when you are resting. Think of it like this: muscles help to burn more calories at rest than other types of body mass such as fat- the more muscle you have from strength training, the more calories you are going to burn day to day. While cardiovascular exercise can burn calories and can help you enter the calorie deficit which is necessary for weight loss, it doesn’t have the added benefit of increasing muscle mass. This means you will not continue to burn as many calories you would at rest compared to when you are strength training. 

 So How Much Of Each Type Of Exercise Should I Do?

Current exercise guidelines suggest that adults should get 150 minutes of moderate intensity or 75 minutes of vigorous intensity cardiovascular exercise per week and at least two strength days of strength training in a week.

If you’re not here yet, don’t fret! Start small and slowly increase as you feel comfortable and get into a routine. The most important thing is just that you are moving your body, no matter what that looks like! Ideally you still need at least 2 days of resistance training per week but outside of that stick with what you enjoy! If the gym and running or biking isn’t your thing, try joining a sports team, going on walks with friends, or anything else that gets your heart rate up.

 Decreasing Sedentary Time

Another important tool for staying healthy is decreasing sedentary time - this means time sitting or laying down not doing anything. There are lots of things you can do to break up your sedentary time:

• Get up for small breaks during long periods of sitting at work

• Use a standing desk

• Do some stretches while you watch tv

• Do squats while you brush your teeth

Anything you can do move your body will contribute!

I hope you learned something about the differences between strength training and cardio in today’s blog! The main takeaway should be that both resistance training and cardio should be incorporated into a strong exercise regimen. If you have questions or need help figuring out to incorporate different types of exercises to meet your goals, be sure to book in with our registered kinesiologist for support.

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.

Isometric, Isotonic, Concentric, Eccentric... What Does It Even Mean!?

If you’ve been around rehab or gym people, you’ve likely heard terms like isometric, isotonic, concentric and eccentric thrown around. But what do they even mean??

When we talk about exercises, we generally break them down into two types: isometric and isotonic. Isotonic exercises can be further broken down into concentric and eccentric parts of the exercise. All have an important role in exercise and rehab.

The language can be confusing so let us be your guide - we promise, it’ll make sense by then end!

Isometric Exercises

Isometric exercise refers to an exercise where you hold one position, meaning the muscle stays still and does not move through a range of motion. Some great examples of isotonic exercises include wall squats and planks. Isometric exercises may be held from anywhere from a couple of seconds to over a minute.

Isometric exercises are fantastic for improving stability of a joint. They are often used in rehab as they can be lower impact that other types of exercise.

We often use isometric exercises when moving through a full range of motion is painful. While isometric exercises can help you build strength, they will likely not be as beneficial for improving power output or speed in the long term. Recent research has shown the benefit of using isometric exercises for strengthening tendinopathies, so we often do these types of exercises for injuries like patellar tendinopathies, Achilles tendinopathies and tennis elbow.

Isotonic Exercises

Isotonic exercise refers to an exercise where a joint is moving through a range of motion. Examples of an isotonic exercise would be a bicep curl, squat or a push-up. In each of these exercises you move a weight (whether that be body weight or additional weight, like a dumbbell) through a range of motion.

Isotonic exercises are fantastic for gaining strength and can be adapted to focus on different goals such as power, speed or increasing range of motion.

Isotonic exercises can be broken into two main types:

1. Concentric - the portion of an exercise where a muscle is shortening.
   
   With an concentric movement, tension in the muscle increases to meet the resistance of the weight, moving the weight in space. An easy example of a concentric contraction would be the part of a bicep curl where you are lifting the weight up towards your shoulder by bending your elbow.
   

2. Eccentric - the portion of an exercise where a muscle is lengthening.
   
   With an eccentric movement, tension increases are you lengthen the muscle and control the weight as it goes down with gravity. An easy example of an eccentric contraction would be the part of a bicep curl where you are lowering the weight back towards the ground.

While isotonic exercises contain both a concentric component and an eccentric component, you can alter exercises to put more emphasis on one part of the exercise to reach certain goals. Both eccentric and concentric exercises are shown to increase muscle strength, muscle mass and power output.

While the research is not conclusive, some research has shown that focusing on the eccentric portion of an exercise may help to increase muscle strength and growth more than the concentric portion. One way to achieve this is to slow down the portion of an exercise where you are lengthening the muscle (e.g., slowly lowering the dumbbell in a bicep curl, slowly lowering the bar on a chest press, or slowing down how quickly you drop towards the ground in a squat).   

If you have questions or need help figuring out to use these exercises to meet your goals, be sure to book in with our registered kinesiologist for support.

 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.

Busting Common Exercise Myths: Part 3 - Stretching Tight Muscles

Kheya McGill , Registered Kinesiologist, is back with another myth-busting blog! In part 3, Kheya reviews why stretching may not be the thing you need to get rid of tight muscles.

Most of the time when people are feeling stiff, tight or sore, their go-to response is to stretch. Now don’t get me wrong, stretching can be fantastic, but I’m here to explain to you why it may not be the answer to all your problems.

When we feel a muscle is “tight”, this could mean the muscle is shortened, lengthened or aggravated. Muscles can feel this way for a variety of reasons and may be related to an injury, overuse, posture or muscle weakness.

When a muscle is weak, it takes a lot more effort for the muscle to perform the job it is meant to do. This can end up with the muscle being habitually turned on and activated, leading to stiffness and pain. To put it simply, the muscle ends up being overworked as it is not strong enough to meet the demands of what you are asking it to do in your daily life. This can cause irritation to that muscle or put strain on the muscles around it which are having to work hard to compensate for that weak muscle.

When we stretch a muscle in this state, you may notice it feels better temporarily and you may even gain some range of motion. The problem is stretching is unlikely to get to the root cause of your problem.

Instead, that muscle may need to be strengthened.

When a muscle is stronger, it is easier for that muscle to move through a range of motion and control movements. You won’t need to rely on the supporting muscles as much and it won’t end up being activated all the time.

A good way to think about this is thinking about an orchestra. If you have a whole orchestra but you’re only relying on the 2 clarinet players to carry all the sound, these clarinet players are going to end up becoming extremely fatigued.

On the other hand, if you help all the other members of the orchestra practice their instrument so they can all contribute equally to the music being produced, the clarinet players are going to have some pressure taken off them and be able to relax more. This is the same thing that happens if you are relying too much on one muscle group and another group is not strong enough to support it. The muscle groups around will end up becoming exhausted which can lead to a feeling of tightness or soreness.

A Case Study - The Hip Flexor

A good example of a muscle this commonly happens to is the hip flexors. The hip flexors sit at the front of your hip and assist you in lifting your leg up towards your body (think about marching, or even just lifting your leg to take a step). When you sit down, your hip flexors are in a relaxed position. Over time they can become weak and learn to stay contracted in a shortened state, leading to the stiff or tight feeling.

If you are having a hard time picturing this, think about holding an elastic band stretched vertically in front of your hip, from below your belly button to the front of your thigh. When you stand up the band is stretched out and when you sit down the band has some slack. When we stretch our hip flexors it is likely to provide some temporary relief as you are pulling them out of that shortened state however it is likely they will return to this state shortly after.

In this scenario, I would suggest you work on strengthening the hip flexors, working them through their full range of motion. Helping this muscle become strong through the full range of motion typically leads to less feelings of tightness in your daily life.

So When Should I Stretch?

Well, this is a great question! Unfortunately, there is no clear answer - the opinions in the literature right now are still vast and strong. Stretching is a very controversial topic and there doesn’t seem to be a right answer. Personally, I like to start my workout with a dynamic warm up and some mobility exercises, and I save the last 5-10 minutes of my work out for cooling down with some stretches. If this works for you, then fantastic, but if you have a routine that seems to work well for you then continue with that!

In this blog, I hope you learned why sometimes “tight” feeling muscles may actually be weak and need strengthening, not stretching! If you have been stretching for a period of time and have not seen the results you are hoping for, give strengthening a try instead!

If you have questions or need help figuring out how to strengthen the muscles that are bugging you, be sure to book in with our registered kinesiologist for support.

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.

Busting Common Exercise Myths: Part 2 - The Perfect Squat

Is there a perfect squat form for everyone?

If you’ve been around a gym or done much exercise in your life, it is likely you have tried to adjust your squat form at one point or another. Maybe you have seen videos of fitness influencers on social media and tried to copy what their squat looks like.

In our heads, the ideal squatter often has their toes facing forward, feet shoulder width apart, knees stay behind their toes, chest up, back straight, and no “buttwink” (curving of the low back as it drops at the end of a squat).

Unfortunately, this isn’t the perfect form for everyone, and there isn’t a one size fits all perfect squat form. This is due to the differences in our anatomical build. We all have different anatomy in our spine, hips, knees, pelvis, and ankles, and everyone has different levels of function and mobility at each of these joints.

One of the easiest examples of differing anatomy is the angle at which our legs naturally sit. When in a natural position (I.e., laying flat on your back with your legs down and relaxed), some people’s feet will naturally face straight up and forward while some will naturally sit with their toes pointing outside away from their bodies. By forcing everyone to put their toes forward, we may be putting them in a position which is less natural for their specific body anatomy. Individuals whose feet naturally fall towards the outside when in this position may feel more comfortable with their toes pointed away from their bodies when squatting, rather than having their toes facing forwards.

Another good example of this is ankle mobility. Individuals with tight ankles may have a difficult time going into a deep squat as the don’t have a large enough range of motion through the ankle joint to allow their knees to move forward. There are a couple of ways to adjust this. Firstly, these individuals should be working to improve their ankle mobility. However, some people may not be able to improve their ankle mobility a whole lot, and that is okay! People with tight ankles may benefit from raising their heels when they squat. This may mean using a small wedge or small plate under the heels- this will allow them to squat much deeper as their ankles are less limited.

The last example we will talk about is the length of your femur (aka your thigh bone). Online, we often see individuals being praised for how deep they can go in a squat- but this is not something everyone will be able to do safely or comfortably. Individuals with longer femurs will naturally have to lean forward more in their squat to stay balanced and offset the weight or their body. Individuals with longer femurs also may not be able to squat down quite as deep, as they will be unable to stay upright due to the weight of their body or barbell pulling them backwards.

The important thing to remember here is there are anatomical features that CAN NOT BE CHANGED and that is not a bad thing!

This means no squat form is better than another. The best squat form is the one that is safe and feels right for your body.

We don’t expect you to know the length of your femur, hip angle or ankle mobility. If things aren’t feeling right in your squat, play around until they feel better. Here are some things you can try:

• Depth - short calf muscles and femur length will affect how deep you can go in your squat, so adjust to find the right depth for you

• Foot angle - pointed straight ahead or pointed outside? This will often be based on your hip anatomy and the amount of torsion on your shin bone

• Foot width - femur length and the width of your pelvis play in here as well, so feel this one out. A wider stance is more stable and requires less distance to travel.

• Type of squat - different types of squats (front squat, barbell back squat, goblet squat, box squat, sumo squat, etc.) demand different body positions, depending what muscle group you want to target

• Ankle position - tight calves or limited ankle mobility may require doing things a bit differently, such as a heel elevated squat

While there is no perfect squat form that works for everyone, there is absolutely a perfect squat form for your body! If you are unsure of where to start or how to perfect your squat form, 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 at (778) 630-8800, email us or book online to seek treatment from a physiotherapist or to work with a registered kinesiologist.

Happy squatting!

Busting Common Exercise Myths: Part 1

There are a lot of myths out there surrounding exercise. While online and social media resources can be great for providing exercise ideas, inspiration and routines, not all the information we see online is reliable. Today we are going to chat about some common myths we hear in clinic about exercising and get to the truth behind them.

Myth 1: You can spot reduce fat 

Truth: It is a common misconception on the internet that you can use certain exercises to reduce fat in one part of the body- for example, doing sit ups or crunches to reduce stomach fat. Unfortunately, you cannot spot reduce fat.

Think of it like driving a car- you can’t only use gas from the right side of your tank! When we drive the whole tank empties, and when we work out, we burn calories from all over the body. This may result in a loss of fat from some area quicker than others- for example, the abdominal area is one of the first areas to decrease fat for many people.

However, don’t let his confuse you- you can still target muscle growth in certain body parts, but this is a completely different process! Fat cells do not magically transform into muscle cells or vice versa. By working out we burn calories from all over our body, which can help reduce fat, and by strength training we can increase muscle definition in certain areas.

Myth 2: Lifting will make you bulky

Truth: Lifting heavy weights will not make you bulky!

Lifting weights is actually a great way to lose weight if that is your goal. When we lift the appropriate weights, our body will begin to build muscle. Muscle has a higher metabolic rate than fat, meaning when we lift weights our body will naturally burn more calories, even at rest.

At the end of the day, bulkiness or weight gain comes down to calories in versus calories out. If you are putting more calories into your body then you are burning, then you are will likely gain weight. If you are burning more calories than you are eating, you will lose or maintain your weight. To gain a lot of muscle bulk, you would need to greatly increase your caloric intake as you increase your strength training. 

Myth 3: No pain, no gain 

Truth: This is a tough saying that we hear a lot in clinic. However, it is important to differentiate between types of pain and understand that this is not always true! While it is okay to work through some types of pain, it is important to learn to differentiate between different types of pain such as delayed onset muscle soreness, muscle fatigue, and pain related to an injury. 

Firstly, it is totally possible to have an excellent workout without being sore afterwards. Other indicators of a good workout to look for may be how difficult the workout feels, whether you are able to lift heavier weights than you previously could, or if you can do more reps than you previously could.

Delayed-onset muscle soreness (DOMS) tend to be muscle soreness which occurs between 24-48 hours after a workout and dissipates within 2-5 days. DOMS are normal and a type of pain we are okay with! However, we don’t want severe pain which lasts outside this time frame, pain which comes with excessive swelling, or pain that continues to worsen for days after a workout.

And again, remember you can still have a good workout without having bad DOMS!

In clinic, we normally try and avoid any sharp, pinching, or tingling type pains. A general rule of thumb to keep in mind is to not let your pain increase above 2 on a pain scale while completing an exercise. For example, if you come in with baseline shoulder pain of 2/10, we typically wouldn’t want to push this pain past a 4/10 with any of the exercises we complete. However, this may vary between injuries and exercises, so always listen to your practitioner’s advice first and foremost! 

Need some help with your exercise routine? Book with our kinesiologist online, by email or at (778) 630-8800.

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.

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.

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.