Shockwave Therapy: A Game Changer!

It’s finally here! Our BTL Shockwave has arrived and we cannot wait to start using it! .

Never heard of shockwave? Let’s dive into the depths of this groundbreaking treatment and explore how shockwave may help you on your journey through recovery.

Shockwave’s Effect on Tissues

Shockwave therapy involves the application of acoustic waves to targeted areas of the body, creating a cascade of biological responses that stimulate healing. This non-invasive and high-intensity treatment has several benefits:

1. Enhanced Blood Flow
   The acoustic waves trigger increased blood circulation, promoting the delivery of oxygen and nutrients to the injured or affected area. Shockwave also causes release of specific growth factors leading to angiogenesis (aka blood vessel growth). This encourages more capillaries to grow in the targeted area.

2. Tissue Regeneration & Tendon Repair
   Shockwave therapy stimulates the production of collagen, a crucial protein for tissue repair. Evidence suggests shockwave stimulates proliferation of fibroblasts, the cells responsible for making collagen. This promotes the regeneration of damaged tissues, aiding in the restoration of normal function.

3. Pain Reduction
   By targeting pain receptors and interfering with the transmission of pain signals, shockwave therapy provides relief for individuals grappling with chronic pain conditions. It also decreases the amount of Substance P in the targeted tissues, a well known pain neurotransmitter. Shockwave is a welcome alternative for those seeking a non-pharmacological approach to pain management.

4. Reversal of Chronic Inflammation
   Chronic inflammation can be thought of an inflammatory reaction that gets stuck in a cycle of heightened inflammation. Shockwave therapy breaks this cycle by increasing the activity of mast cells, leading to a reboot of the inflammatory cycle and allowing tissues to return to a non-inflammatory state.

5. Muscle Relaxation
   If the thought of needles and IMS makes you feel queasy, shockwave is a great alternative. By targeting trigger points, shockwave can help decrease muscle stiffness and spasticity, leading to more flexible and relaxed muscles.

Conditions Treated with Shockwave Therapy

Shockwave therapy has been shown to have lasting effects across a variety of conditions, including:

• Tendinitis and Tendinopathies: Achilles tendinopathy, rotator cuff tendinitis, tennis elbow and other tendon-related issues.

• Plantar Fasciitis: A common cause of heel pain, often alleviated with shockwave therapy.

• Muscle Injuries & Tightness: Long-standing strains and tears, tight hamstrings and sore traps.

• Calcific Shoulder Tendinopathy: Helping to break down calcifications in the shoulder.

• Stubborn Hands & Wrists: Dequarvain’s and carpal tunnel syndrome respond well to shockwave therapy.

• Chronic Pain Conditions: Myofascial pain syndrome and chronic low back pain, to name a few.

Shockwave therapy is best for chronic conditions. If you are suffering an acute injury (for instance, a fresh ankle sprain that’s swollen and painful at rest, or a new whiplash), shockwave isn’t for you quite yet.

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If you’re ready to try shockwave, give us a call! To book an appointment, book online, email us at clinic@ladnervillagephysio.com or phone us at (778) 630-8800.

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Looking for some resources for the claims above? Here’s a great review article from Adam Tenforde & colleagues, published in 2022: Best practices for extracorporeal shockwave therapy in musculoskeletal medicine: Clinical application and training consideration.

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.

My Jaw Locks & Clicks! What's Going On?

One of the most common jaw complaints is clicking and locking, often associated with pain in the jaw, face, head and down the neck. This can often be caused by an anterior disc displacement, something we see frequently in the clinic.

But what is an anterior disc displacement and what can we do about it? Before we dive into that question, let’s back it up and talk about the anatomy of the temporo-mandibular joint.

The Anatomy of the TMJ

The temporo-mandibular joint (aka the TMJ) is what attaches the mandible (aka the jaw bone) to the skull. It is located just in front of the ear and, if you place your hands on either side of your face just in front of your ears, you can feel that jaw moving forward and back as you open and close your jaw.

The TMJ is a synovial joint between the temporal bone of the skull and the condyle of the mandible. Between the condyle and the temporal bone is a donut-shaped fibrous disc that is essential for proper opening and closing of the jaw. This disc is partially held in place by the retro-discal tissue, a network of loose connective tissue, blood vessels and nerves attaching the back of the disc to the bone behind it, just in front of the ear canal.

Anterior Disc Displacements

One of the most common causes of temporo-mandibular dysfunction (aka TMD) is when the disc becomes displaced, typically anterior in the joint and away from the ear canal. When this occurs, the retro-discal tissue in the back gets stretched and is unable to hold the disc back in its normal position.

Common symptoms of anterior disc displacements include:

• pain in the TMJ with chewing, yawning & talking

• pain in and around the ear

• headaches

• a reproducible click in the TMJ, with or without pain

• decreased range of motion with opening

When a disc moves anteriorly in the joint, it may click or block jaw movements but this isn’t guaranteed. Every person’s anatomy is different: jaw condyle shapes, depth of the socket, size of the disc, amount of retro-discal tissue and all the other factors that make a person unique can play into their TMD and experience of pain.

Treating a Disc Displacement

A few things to know first:

1. One third of asymptomatic people have at least one displaced TMJ disc. It’s really common to have a disc issue and not be bothered by it at all!

2. Discs will not (typically) relocate back to where they were. Instead, your body heals and creates a “pseudo-disc” from the now-stretched retro-discal tissue to act as the original disc.

3. When that disc moves forward, it can often block the opening of the TMJ. Over time, the disc remodels to be less donut-shaped and more wedge-shaped so the condyle of the jaw can easily slide over it.

Acute Disc Displacements

Remember how I said just up there that discs won’t relocate?

If the injury has occurred in the past 3 days, we can sometimes (and I stress SOMETIMES) get the disc to relocate. It has to be before the retro-discal tissue has stretched too much. Our therapists who treat TMD can attempt a specific maneuver to try and get that disc back to where it was.

Outside this 72 hour window, we are looking at healing and remodeling the disc.

Chronic Disc Displacements

We have a whole tool-box of therapy techniques to help with disc displacements in the TMJ. These include:

• Manual therapy of the TMJ - we use specific techniques to increase the range of motion of the jaw and help the disc remodel into the wedge shape we’re looking for.

• Soft tissue techniques (including IMS and massage) of the surrounding muscles - with a disc displacement, these muscles (for instance, the temporalis and masseter) are often clenching or working hard to compensate for the TMD, leading to increased pain and headaches.

• Neck assessment & treatment - when the TMJ is irritated, up to 70% of people also have neck pain. As a part of TMD treatment, the neck needs to be evaluated and treated accordingly.

• Exercises - the right exercise for you and your TMD is so important. The right exercise helps discs remodel, muscles relax and pain reduce. We spend a lot of time with you to make sure you are doing the correct exercise with the correct technique.

Top Five Tips in Dealing with a Disc Displacement

Finally, we live by these principles of managing disc displacements:

1. Don’t test it!! You will be tempted - does it still click? Is it still stuck? - but we beg you to resist this temptation. Let your disc heal. The more you poke it, the longer it’ll take to heal.

2. Avoid hard/crunchy/chewy foods for the first 6-8 weeks after a disc displacement. We promise you can eat your favourite food soon but avoid those types of foods initially.

3. Support your jaw when yawning. If you have the urge to yawn and really open your jaw, place a hand under your chin so you have something to push against and limit how much your jaw actually opens.

4. Sleep is so important for healing & pain control. We know that under 6.5 hours of sleep per night increases your experience of pain. We also know that you heal when you sleep. So make sure you’re getting enough sleep, with a good pillow supporting your head!

5. Posture also play a huge role. Make sure your computer is set up properly so you aren’t sitting in a head forward posture, putting more inappropriate muscular forces through your jaw. (Need some tips on computer set up? Read our blog!)

If you are dealing with a disc displacement, TMD or headaches, book with one of our TMJ therapists online, by email or calling us at (778) 630-8800.

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.

Meet Aman!

You may recognize Aman Bassi, Interim Physiotherapist, from his time with us in the spring. Aman has officially joined our team, bringing a wealth of knowledge from his Bachelor of Science in Cell Biology at SFU (just watch him and Devon get really excited about microtubules!) and his Master in Physical Therapy from UBC. He has a passion for science and evidence-based approaches and loves a good soccer game. Learn more about Aman below including why he will fight you for the remote on Sunday mornings…

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

Something totally random about me is that I have a collection of 4K-Blu Ray movies and am constantly adding to my ever growing collection of super high definition movies.

When did you decide you wanted to be a physiotherapist?

Studying cellular biology, I learned that life itself is an amazing phenomenon. Being in a profession where I can help people get back to their everyday lives, while also being in a field that relies on science to progress, gives me a reason to get up in the morning.

Which sports are you into?

Football (European and American) – Big Manchester United Fan who also will sit in front of the television all day for NFL Sunday.

Where did you grow up?

I grew up in Surrey!  

What is your favourite orthopaedic condition to treat?

Post Surgical Rotator Cuffs because it allows me to use a wide variety of exercises and manual therapy techniques to treat it.

What makes you happiest?

A cup of coffee in my hand in the morning watching Manchester United beat Liverpool.

LIGHTNING ROUND!!!!!

Cats or dogs? Dogs!

Favourite food? I am a very simple man, pizza and chicken wings.

Favourite dessert: strawberry cheesecake

Favourite Junk food: CHIPS (I consider myself a potato chip connoisseur)

Beach or mountains: Mountains

Favourite colour: A deep purple

Favourite music: Vivaldi’s Spring 1 recomposed by Max Richter

Favorite day of the week? Saturday

Nickname? My Last name Bassi would be the name my friends use

Would you rather be able to speak every language in the world or be able to talk to animals? Talk to animals because I can’t google translate a bark

Favorite holiday? Christmas!

How long does it take you to get ready? To put my clothes on? 47 seconds. To decide what to wear? 47 days.

Invisibility or super strength? Invisibility

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

Dawn or dusk? The quiet of dawn

Do you snore? Thankfully not

Place you most want to travel? Petra, Jordan (because they shot Indiana jones there). Also Hogwarts.

Last Halloween costume? It’s been a while. I think a clown?

Favorite number? #4

Have you ever worn socks with sandals? Yes but they have to be slides

Would you rather cuddle with a baby panda or a baby penguin? Penguin because I grew up with Pingu

Would you want to live forever? No, what makes moments great sometimes, is the fact that we never get them back again.

What's for dinner tonight? Chicken and Vegetables (like I said, I am a simple man)

My Feet Roll In - Do I Need Orthotics?

The term “rolling in” or overpronation refers to an alignment issue in the foot and ankle where the foot collapses towards the inside which tends to flatten the arch of the foot. Overpronation is a common issue in the general population but more prevalent in dancers by nature of the demand of the sport on the feet.

If left untreated, rolling in of the feet and ankle can cause secondary problems including:

• bunions (due to excessive pressure on the big toe)

• plantar fasciitis

• shin splints

• overuse injuries of muscles and tendons on the inside aspect of the foot and ankle

• pain on the inside aspect of the knee

An orthotic is a medical appliance that is inserted into the shoe and can help lift the inner aspect of the foot into proper alignment. Orthotics can be purchased over the counter or custom made by a pedorthist or podiatrist. Although a useful tool, they may not be necessary for all dancers experiencing rolling of the feet.

How do I know if I need orthotics or not?
My favourite answer… it depends.

For dancers, one of the biggest things to consider is whether the dancer’s foot rolls in when they are standing casually (or in parallel), or is it ONLY when they are standing in turnout. Let’s look at two different scenarios.

1. Rolling in ONLY when standing in turnout but NOT in parallel.

Rolling in at the feet ONLY when standing in a turned out position may be caused by excessive cranking at the knees and feet to achieve turnout. Dancers with poor strength and control of the turnout muscles in the hip will often overcompensate at the knee, ankle and foot, which puts a lot of pressure on the inner aspects of these joints. In this scenario, foot alignment can be corrected by training proper turnout at the hips. For these individuals, orthotics may not be necessary.

2. Rolling of the feet while standing in parallel AND in turnout.

Rolling of the feet with casual standing or standing in parallel may be indicative of other underlying issues such as weak intrinsic foot muscles, poor walking/running/jumping mechanics, ankle/foot instability, or other knee or hip issues causing compensation at the foot.

For these individuals, an orthotic in their everyday shoes may be needed to help realign the foot and provide symptom relief. However, orthotics must be accompanied with exercise to treat the underlying issue and strengthen muscles of the foot. The stronger the foot muscles are, the better the foot can support itself without the use of the orthotic.

NOTE: Currently, there are no over the counter orthotics that fit in dance shoes, which emphasizes the need to strengthen the muscles to support the foot while dancing.

In summary, rolling in or overpronation of the feet can often be corrected through appropriate strengthening and conditioning. Orthotics are a great tool for realigning the foot and providing symptoms relief but are not a replacement for exercise.

If you are a dancer experiencing rolling feet or want to learn more about addressing rolling in feet, book with Anh online or give us a call at (778) 630-8800. 

Meet Chan!

If you didn’t see Chantal Simak, Interim Physiotherapist, running around the clinic in the spring, you missed out! Chan joins our team next week, bringing their effervescent and enthusiastic energy to the clinic. Their passion for all things rehab is obvious to anyone watching and we are so excited to have them! Learn more about Chan below including why we all should be trying to get to their house for dinner…

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

I wouldn’t say this is totally random; however, being a part of the LGBTQIA2+ community is a very important aspect of my life. I deeply care about helping and learning how to encourage more conversations about ways to create a more inclusive healthcare environment. I aspire to build a community, collaborating with like-minded allied healthcare professionals who are ready to be active advocates for the LGBTQIA2+ community.

When did you decide you wanted to be a physiotherapist?

I had a mentor who was my soccer coach for the last 2 years of high school.  He was a brilliant Kinesiologist, who weaved his knowledge of exercise physiology and anatomy into the game of soccer. I not only became a better player and teammate because of these interconnections, but I also gained an appreciation for human anatomy and physiology. From then on, I shadowed some highly regarded physiotherapists in the area and quickly realized that physiotherapy is a profession where I can shine. I would have the opportunity to socialize all day, build meaningful relationships and cheer people on for every single accomplishment they make, just as my mentor did for me. I crossed the high school graduation stage with a clear picture of the career I was striving for, but little did I know that the announcer would slip up and say I aspire to be a “psychotherapist,” this had my family rolling with laughter in their seats. I was certain in that moment that nothing other than a physiotherapist was what I was to become!

It is a full circle moment, as it turns out I picked the perfect career. I have the flexibility to continue to explore the world, I get to learn every day and I have the most meaningful, heartfelt conversations with some truly amazing people. I am privileged to be able to serve the community and I hope to lead with inclusion as I actively support clients through every accomplishment and milestone, helping clients build both a strong body and mind. 

Which sports are you into?

My type of self-care often involves facing a fear and in doing so I am eager to continue backpacking, rock climbing, slacklining, road and mountain biking, surfing and backcountry split boarding.  

Where did you grow up?

I grew up in Vancouver until I was 10, then moved out to Langley, BC, back then, much of the city was farmland, a very fun environment to be in as a kid!

What is your favourite orthopaedic condition to treat?

I have many! I think shoulders are my favourite followed by knees, and ankles, all of which I, myself, have had problems with in the past.

What makes you happiest?

Surrounded by my nearest and dearest family and friends. My fondest memories are around a fire on the beach, catching a sunset at my favourite spot at Jericho Beach, stargazing in the mountains or simply relaxing in the backyard having a BBQ with some great tunes, company, and belly laughs.

LIGHTNING ROUND!!!!!

Cats or dogs? Dogs

Favourite food? Seafood

Favourite dessert: Salted caramel brownie with vanilla bean ice cream

Favourite Junk food: Anything 70% dark chocolate

Beach or mountains: Mountains

Favourite colour: Rainbow

Favourite music: Last year’s Spotify wrapped says Indie-Pop, but R&B too!

Favorite day of the week? Saturday

Nickname? Too many, here are the less embarrassing Chan, ChanChan, Chanana, Chanterelle

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

Favorite holiday? New Year’s Day

How long does it take you to get ready? 20 minutes tops

Invisibility or super strength? Super strength

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

Dawn or dusk? Dusk

Do you snore? Hah. Hah, ask my partner and her sleep headphones

Place you most want to travel? Peru, Japan, New Zealand, Thailand

Last Halloween costume? Finn from Adventure Time

Favorite number? 2

Have you ever worn socks with sandals? If it’s warm absolutely not; however, follow up question, who doesn’t wear socks with sandals when it is chilly out?

Would you rather cuddle with a baby panda or a baby penguin? Baby pandas don’t peck.

Would you want to live forever? If my partner gets to, too.

What's for dinner tonight? Barbequed maple syrup and garlic glazed salmon with lemon, sundried tomatoes, pan-fried onions, mushrooms, Bok choy and Jasmine rice. (Editor’s note - am I invited?)

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!

How Not To Injure Yourself During Your DIY Reno

If you have spoken to Nicole in the past year you have likely heard at least something about her recent bathroom renovation. Nicole is an experienced physiotherapist but she is brand new to the world of home renovations and it is safe to say there were some growing pains during the process (both mental and physical).

The renovation involved taking walls down, putting them back up, fixing a ceiling, waterproofing and then tiling a shower, installing a floor and much more. Through some trial and error, Nicole is here to share with you some of the techniques and insights she utilized along the way to decrease the strain on her body.

Nicole’s Top 11 Tips for Home Renovations

1. Share the load!

Whenever possible alternate which hand you are using for a task or use both hands at the same time. This is especially great for tasks that do not involve a lot of precision such as breaking old tile or taking down cabinets. 

2. Use the equipment!

Wear knee pads if you are kneeling. Prolonged pressure on your knees can cause bursitis and it is no fun. Also remember that having the correct tools can literally make your life easier. Don’t saw by hand if you have power tools available. Use extender poles to help you reach high places. You get the idea.

3. Repetition is not your friend.

Repetitive wrist extension is one of the leading causes for tennis elbow and other tendinopathies. Unfortunately, many construction tasks involve a lot of repetition. When you are able, try to use whole arm movements and drive the movement from the shoulder or elbow rather than using little wrist flicks. This can make drywall mudding and taping, hammering, and painting a lot easier on your body (fun sidenote: sometimes wearing a wrist brace will increase your awareness of your wrist motions and help you maintain a neutral position, this could potentially help you avoid these issues altogether). 

4. Avoid over-gripping equipment.

You don’t need a death grip on that paintbrush. Same goes for hand sanders, etc. Gripping too hard is another leading cause of tennis elbow and wrist/hand tendinopathies. 

5. Decrease the load.

Don’t carry around unnecessary tools, equipment, or materials. This can be applied on big and small scales. If you are drywalling, put less mud into your container at any one time to decrease the strain on your wrist. Why hold a 10lb weight if you can hold a 2lb weight and refill it more often? On a bigger scale, if you have to transport materials from one spot to another, it is easier on your body to make more trips while carrying less load rather than a few trips with huge loads. 

6. Be nice to your neck!

If working on a ceiling or something else overhead try not to look directly above yourself. Instead, look at the ceiling a few feet ahead of you and work in that spot (using your pole) to avoid straining your neck. Also make sure you don’t jut your chin out - the more you can keep your neck in a neutral position (no matter which direction you are looking) the better your neck will feel at the end of the day.

7. Beware of prolonged awkward positions.

Home improvements can have you twisting and turning into bizarre positions and sometimes you have to stay there for a long time. 

• Take breaks. It’s often tempting to “power through” but if you have been bending over for a long time stand up, arch your back backwards and give yourself a bit of a walk break. 

• If you have the ability to alternate between tasks that is also awesome as it challenges different muscle groups and gets you in different positions. You can hang a light fixture, which is tough on your neck and shoulders, but then to give that area a break maybe choose to install a door handle or take some time to tidy your work area before you hang the next light. The more you can distribute load between different body parts the better off you will be. 

8. Proper lifting techniques are a must. 

Follow these rules:

• Prepare for the lift.

•  Keep the load as close to you as possible. 

• When in doubt it’s always better to get a second person to help you. 

• Treat lifting materials like a workout. If you were at the gym exercising with a personal trainer, how would they have you pick up that bag of cement? How would you carry those 4x4’s? How would you manage the overfull garbage bag of debris?

•  Try using an in athletic “ready position” stance instead of hunching to help your back out when working. This especially applies to tasks like mixing mortar. It’s so tempting to hold the bucket between your feet and hunch while you mix the materials but it that is a difficult position for your back to hold for several minutes. A split stance mini squat gives your body more stability and less strain. 

9. Take the time to do it right.

Move your ladder more often to avoid overreaching which can strain your neck and shoulders, it could also help you prevent a fall. 

10. Some tools have more than one use.

We often think to use an extender pole when painting a ceiling. You can just as easily use one to reach low areas as well to prevent excessive bending/stopping/crouching (like staining a deck or a fence). 

11. Momentum can be your friend.

When you need to generate a lot of force to demolish something whenever possible use a “baseball swing” that uses your whole body. Your shoulders will thank you. 

This list is by no means complete but if it saves one person from an unnecessary sore neck or shoulder, it’s worth it. If you are an industry professional we would love to hear your favourite body-saving tips and tricks - comment below!

To book an appointment with one of our physios, book online, email us or call us at
(778) 630-8800.

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.

Top Five Fun Facts About The TMJ

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

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

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

Top Five Fun Facts About TMJ/D

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

Closed jaw

Open jaw

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

5. All those chewing habits can lead to TMD

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

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

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

Our Favourite Summer Activities

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

Devon (Physiotherapist/ clinic owner):

Favourite activity: Ultimate frisbee

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

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

Nicole (Physiotherapist/ clinic owner):

Favourite activity: Horseback riding

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

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

Sofy (Physiotherapist):

Favourite activity: Running

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

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

Stephanie (Physiotherapist):

Favourite activity: Climbing

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

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

Trevor (Physiotherapist):

Favourite activity: Golf

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

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

Anh (Physiotherapist):

Favourite activity: Tennis

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

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

Gabrielle (Register Massage Therapist):

Favourite activity: Swimming

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

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

Kheya (Registered Kinesiologist):

Favourite activity: Volleyball

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

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

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

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

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

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.

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.  

Meet Sofy!

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

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

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

When did you decide you wanted to be a physio? 

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

Which sports are you into? 

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

Where did you grow up?

Taiwan and Kimberley BC. 

What is your favourite orthopaedic condition to treat?

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

What makes you happiest? 

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

LIGHTNING ROUND!!!!!

Cats or dogs? Dogs

Favourite food? Thai food

Favourite dessert: Tiramisu 

Favourite Junk food: Instant noodles

Beach or mountains: Mountains

Favourite colour: Baby pink

Favourite music: Pop

Favorite day of the week? Sunday

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

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

Favorite holiday? Christmas

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

Invisibility or super strength? Invisibility

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

Dawn or dusk? Dusk

Do you snore? I “breathe loudly” 

Place you most want to travel? Nepal, South America

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

Favorite number? 3

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

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

Would you want to live forever? No

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

Yep, she painted that.

What is Kinesiology?

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

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

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

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

What kind of training does a kinesiologist have?

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

Is a kinesiologist like a personal trainer? 

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

What can a kinesiologist do for me?

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

• Create an exercise plan that is safe and realistic

• Identify muscle imbalances through assessment of your movement

• Help with maintaining fitness while you deal with an injury

• Develop an exercise rehab program to address an injury

• Ensure proper exercise technique to avoid unnecessary injury

• Provide motivation and accountability to stick with your exercise program

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

Is kinesiology covered by my extended health benefits?

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

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

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

• 12 visits with a kinesiologist

• 25 visits with a physiotherapist

• 12 visits with a registered massage therapist

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

Do I have coverage if I have a WorksafeBC claim?

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

What will my session look like?

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

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

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

• phone at 778-227-8030

• email at clinic@ladnervillagephysio.com

• book online

We look forward to meeting you!

Low Back Pain in Dancers and Gymnasts

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

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

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

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

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

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

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

What do spondylolysis and spondylolisthesis feel like?

Athletes will often complain of the following:

• Dull pain that can be sharp with movement

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

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

• Symptoms that are worse with activity and better with rest

How is it diagnosed?

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

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

How do we treat it?

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

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

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