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.

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

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

Gabrielle’s Most Frequently Asked Questions 

Do you get free massages? 

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

Do your hands get sore? 

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

Can massage help migraines and headaches?

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

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

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

Is massage painful?

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

What if I fall asleep and snore?

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

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

Is it okay to ask for more or less pressure?

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

Are my muscles tight? 

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

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

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

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

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

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.

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!

Summertime in Delta

That big shiny thing in the sky… I’m told that’s the sun. According to the weather man “June-uary” is over and the heat has finally arrived. How exciting!

Before we all just rush outdoors to soak it all in I wanted to point out that we Vancouverites are not so great at dealing with warm days (kind of in the same way we aren’t great with snow. How can you be expected to be good at something if you never get to experience it am I right?). Let’s take this opportunity to remind ourselves of some important factors to consider before heading out into the sun to exercise.

Nicole’s Top Tips for Summer Exercise

1. Stay hydrated! Your body will sweat extra when it is hot out. Keep yourself cool and help prevent heat injury (such as heat stoke) by keeping the H2O handy!

2. Be aware of your fitness level. Unless you are acclimated to the heat your exercise tolerance will go down when it is hot out. Take it easy and listen to your body. Go at an intensity that feels good for you. You probably won’t be able to run as far or as fast when it’s 28 degrees out as you did a few weeks go when it was 10 degrees and cloudy. And that’s okay.

3. Timing is everything. Take advantage of the long days! Early mornings and late evenings are significantly cooler and more pleasant for exercise (or just to exist in generally speaking, just ask my golden retriever).  

4. Wear sunscreen. Just do it.

5. Wear appropriate clothes. Loose fitting thin clothes in a light colour will help you stay cool.

6. Location location location! Is there a shady spot that you could go for your run instead of the track? Could you bike along the water where there is a breeze? It’s worth checking out!

Some of our favourite outdoor summer exercise opportunities in Delta include:

• Swimming - Whether it’s at Centennial Beach, the outdoor pools in Ladner and North Delta, or your own backyard, swimming has many benefits. It’s great exercise, it’s fun and it keeps you cool. What’s not to love?

• Hiking or nature walks - If climbing mountains isn’t your thing than A) you chose the right place to live because Ladner is as flat as a pancake, and B) Delta has some lovely little forest walks including Deas Island, Watershed Park and Burns Bog. If mountains are your thing then that’s great too. Be safe and take pictures for us!  

• Walking - Walking as exercise is underrated. It gives you cardiovascular benefits and is well tolerated when it’s hot out (need more details? Check out our earlier blog on the health benefits of walking as well as our favourite walks in our neighborhood). You can make a walk more challenging by changing the terrain (walking on sand is more difficult that concrete) or by increasing distance. Remember that walking doesn’t have to be fancy - I love my evening neighbourhood walks with my dog.

• Water sports - Paddle boarding and kayaking are great options in South Delta. They work your core and upper body while you get to stay cool out on the water. Just remember your hat and sunscreen!

Remember to go indoors if needed - not everyone likes the heat and that’s okay too. You could do yoga inside your own home, or workout at the gym (woo hoo for air conditioning).

Whatever you decide, I hope you have a great time and stay safe. It’s been a doozy of a year and I’m glad that we can all take an opportunity to enjoy some of this lovely weather. 

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

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

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

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

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

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

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

“Does it hurt when it clicks?” 

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

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

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

Common Causes of Crepitus

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

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

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

Speaking of Knees…

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

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

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

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

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

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

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

Exercise and Arthritis - The GLA:D Way

Arthritis can be a life-changing disease. I have arthritis myself - I feel your pain!

As physiotherapists, we treat a lot of arthritis and hear a lot of misconceptions - “I shouldn’t squat down, that’s bad for my knees” or “I’m supposed to rest when my hip hurts”. But what if we told you this way of thinking is wrong? What if we told you that you could gain some control over your pain simply by changing the way you move?

The research has come a long way. Want the up-to-date info? Keep reading!

Top Ten Facts About Osteoarthritis (aka OA)

1. It is not “something that just happens” as we age! It is a disease that develops slowly over years and years, often not being diagnosed until quite late in the process.

2. Over 20% of people in Canada have arthritis, most of that being OA. I don’t know about you, but that number blows my mind.

3. OA affects young people as well. I was diagnosed with arthritis in my mid-thirties after years of chronic ankle sprains (prior joint injury - a big risk factor!) and I’m not alone. 60% of people with OA are younger than 65 when they are diagnosed and that’s usually after several years of going undiagnosed. We exist!

4. Meniscal tears and muscle weakness are early signs of OA. Research has also shown the faster we treat these with appropriate exercises, the more you can delay the onset of OA symptoms.

5. You do not need an X-ray for an OA diagnosis. In fact, X-rays are only 30-40% accurate in detecting OA. X-rays usually only pick up OA in the later stages. In other words…

6. Ignore the X-ray. Did your X-ray come back negative? Or maybe it shows “bone-on-bone”? Great news - it doesn’t matter! X-ray findings do not predict or define your symptoms or how you function. It doesn’t matter if you have the tiniest bit of OA or the worst case ever - what matters is how it feels, how strong you are and what you can do with it.

7. Physiotherapists can diagnose OA. We do this by listening to your symptoms, testing out your joint and taking a close look at your risk factors.

8. Losing 5% of your body weight can really help reduce your joint pain for those who are overweight. The force that goes your through your knees with each step is equivalent to four times your body weight. If you take 10 lbs off the scale, 40 lbs of stress are removed from your knees when walking.

9. Motion is lotion - your body is meant to move, even when OA is an uninvited guest. Physical activity helps lubricate the joint and maintains the health of the cartilage, even if there’s not much left.

10. Only 2% of people with hip and knee arthritis will go on to get a replacement. The decision to get a joint replacement is often a difficult one and based on many factors. That leaves a whole lot of people in need of management strategies.

The Best Thing We Can Do For OA?
EXERCISE

Research has shown again and again and again that exercise:

• has better long term pain control than drugs

• improves the health of cartilage

• helps delay (or even completely avoid!) surgery and all the possible complications that comes along with it

So what kind of exercises should you be doing? Well we are GLAD (Ha! Get it? No? You’ll get it in a second…) you asked!

Introducing The GLA:D (TM) Program

The Good Life with Osteoarthritis in Denmark (also known, thankfully, as GLA:D) (TM) program was developed by researchers in, you guessed it, Denmark!

GLA:D (TM) is a group exercise class for those suffering with hip and knee OA. This six week program’s goal is to teach participants about OA and give them the best we have at combating it: appropriate exercises done properly.

The research behind GLA:D (TM) has some incredible findings:

• 30% reduction in pain levels at both 3 and 12 months after the program

• More than 50% reduction in use of painkillers

• Half the anxiety around fear of movement and damaging joints with activity

• Less than a third of sick time from work

• Significant improvement in quality of life

GLA:D (TM) has four components:

1. Initial assessment - Before you even get started in the program, a physiotherapist will do a one hour 1:1 appointment with you to make sure you’re appropriate for the GLA:D program, test out your hip or knee and go over all the exercises with you.

2. Education sessions - Over 2 or 3 classes, participants learn about osteoarthritis and its risk factors, symptoms, coping strategies and self help tools. They will also learn about the science behind pain and how they can use this to help control their own pain.

3. Exercise sessions -12 sessions of physiotherapist-led group classes lasting an hour each. These sessions focus on neuromuscular exercise - strengthening muscles with a huge focus on control throughout the whole movement.

4. Outcome measures - At the beginning of the program and then again at 3 months and 12 months afterwards, participants will be contacted by researchers about their adherence to the exercise program, their pain levels and how they are functioning. This data is used for public health funding and future research.

Starting in January 2021, Ladner Village Physiotherapy will offer the GLA:D (TM) Program online!

For details on registration, head on over to our GLA:D Program page.

Ready to go? Register at (778) 630-8800 or by email - we are so excited to meet you!

Knee Arthritis 101: The Basics

Arthritis is a big topic and there is no way I could cover it all so today I am just going to cover some of the basics to help you understand what is going on with your body.

First of all, it’s important to note that there are many types of arthritis. The two most common types are:

1. Degenerative arthritis, also known as osteoarthritis (OA for short)

2. Inflammatory arthritis such as rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis

Today we will be discussing osteoarthritis of the knee.

Here are the top five things you absolutely need to know about arthritis:

1. Arthritis is not a catastrophic diagnosis. You can continue to thrive and lead an active lifestyle with an arthritic knee and it’s not the end of the world. 

2. Exercise is your best friend. Say this with me, three more times!

3. X-Ray findings are not proportionate to functionality or pain levels. Someone who describes “occasional stiffness” in their knee might have a “severe” x-ray, while a “mild” x-ray might belong to someone who describes unbearable pain that keeps them awake at night. X-rays do not give the whole picture!

4. Most knee pain from arthritis is from structures around the joint, and that pain can settle. It’s not the cartilage nor is it the outer compact bone causing the pain in your knee. 

5. There are things you can do to slow the progression and maximize your function.

Let me say this loud and clear:

Maintaining an active lifestyle is one of the best things you can do if you have arthritis!

Let’s look at a classic scenario.

Meet Stacy. She’s 62 and tweaks her knee while out for a run. That weekend she goes away for a vacation with her family. They play golf, tennis, and even go kayaking! Now her knee is quite sore and even swollen. Stacy decides to rest for a few weeks figuring she just over-did it while away. But it’s still swollen two weeks later.

She goes to her doctor, who orders an x-ray. The x-ray uses technical terms like “osteophytes” and “joint space narrowing”. She is told she has arthritis in her knee. That night Stacy has company for dinner and a friend, let’s call him Gary, said he has the same thing! Gary says his knee is “bone on bone” (and demonstrates grinding with his knuckles together while making an awful scraping noise) because all his cartilage has “worn away” and that his friend Steve had to have a knee replacement and limped for months.

Now Stacy is devastated. She doesn’t want arthritis and she certainly doesn’t want a knee replacement. She feels doomed. 

What happens next? 

Option A: Stacy is scared and wants to protect her knee. So Stacy stops playing tennis and stops golfing, she hires someone to do her gardening and doesn’t even really walk the dog anymore because if running hurts than walking probably isn’t great either right? (I want you to know it hurts me deep down inside to type that). But when Stacy suddenly stops exercise and spends many hours per day sitting her knee gets stiffer and her muscles get weaker.

In her mind this has confirmed her worst fears that her knee is in awful shape (look how quickly it’s deteriorating!) and tries to protect it further by resting even more. This cycle of inactivity can is bad news bears. 

It also doesn’t have to be this way. 

Option B: Stacy doesn’t worry about Gary or his friend Steve because she knows nothing about their situations and her doctor didn’t mention surgery at all. Stacy’s knee is still a bit stiff and sore so she modifies her activities for a few weeks. Runs on the dyke become walks with the dog and she tries pickleball with a few friends instead of tennis. To her delight the knee pain improves! Her muscles have stayed strong from her modified activities and she still enjoyed her time out and about. Now Stacy is in a position to gradually rebuild and reintroduce activities she enjoys as she is able. (This scenario is a lot better if you ask me). 

I will say it again: exercise is your best friend.

You are not wearing out the joint further by exercising. It is the most effective treatment for early and moderate knee OA (not to mention other health benefits). Exercise helps you maintain range of motion and strength. It is a lot easier to maintain strength and range than build it back up again after it has been lost.

Also, do not underestimate the benefits of exercise for the rest of your body. Many people who get an arthritis diagnosis self-impose activity restrictions and become more sedentary. This can have detrimental health benefits including increased risk of high cholesterol, heart disease and diabetes. Further, muscle weakness and joint stiffness can be contributing risk factors to falls. People with osteoarthritis experience 30% more falls than those without.

There is no use going too hard all day every day and being in extreme pain just for the sake of it but don’t stop all activity completely. You have to find a middle ground between activities that are challenging vs. aggravating (which is easier said than done). A physiotherapist can give you recommendations on which activities can be modified and help you figure out strength and range of motion exercises that are appropriate for you specifically. 

Ok, so I hope you get it by now. If you have arthritis you should exercise. But let’s keep going, shall we? Let’s discuss why this diagnosis doesn’t have to be all doom and gloom.

What causes the pain in knee arthritis?

The cartilage that degenerates has no nerve endings nor does the hard compact bone beneath it. So they cannot be the source of the pain. So which structure is actually responsible? 

The three main causes of knee pain associated with arthritis are:

1. Periosteum - the thin lining of tissue around the bone, it has nerve endings and supplies blood to the bone. If it tears it will hurt. 

2. Synovitis - Synovium is the connective tissue lining of the joint itself. It can become inflamed and very painful. Synovitis can feel like joint tenderness or pain, swelling, and nodules (hard lumps). 

3. Bone edema - This is more common in women who have underlying osteopenia or osteoporosis since the bones are already weaker. When stress on the bone increases, as is the case with arthritis, the deeper central layer of the bone can become swollen, which feels like a deep and intense ache. 

Remember:

• Not everyone with OA has these issues.

• If you do experience pain from these structures it will likely settle down over a few weeks or months and your knee pain and function will return back to baseline. It’s not forever.

• Like I mentioned above, the severity of an x-ray does not correlate with pain or disability.

• Treatment should not be based off of the x-ray.

• Do not let a bad x-ray be the reason you stop your favourite activity.

• Do not let a bad x-ray make you afraid of feel doomed.

• Please please please do not get surgery just because the x-ray is bad especially if everything else is great! (Disclaimer: obviously I am a physiotherapist and not your surgeon, so I’m not the one making calls on surgery. But if a surgeon is pushing for you to get surgery and you feel completely fine I would be asking why they feel it is necessary. They might have an excellent reason - that’s cool, making calls in grey areas is what they do all day every day so their opinion should be considered - I just don’t want you getting surgery because a friend of a friend had their knee done so you figure you might as well join the club). 

The Arthritis Foundation provides a very general list of things you can do to slow down the arthritis progression and keep you are healthy and active as possible. These include:

• Maintain a Healthy Weight: Excess weight worsens OA. Combine healthy eating with regular exercise to maintain a healthy weight.

• Control Blood Sugar: Many people have diabetes and OA. Having high glucose levels can make cartilage stiffer and more likely to break down. Having diabetes causes inflammation, which also weakens cartilage.

• Maintain Range of Motion: Movement is medicine for joints. Make a habit of putting your joints through their full range of motion, but only up to the point where it doesn’t cause more pain. Gentle stretching, raising and lowering legs from a standing or seated position, daily walks and hobbies such as gardening can help.  Listen to your body and never push too hard.

• Protect Joints: Make sure to warm up and cool down when doing exercise. If you play sports, protects joints with the right gear. Use your largest, strongest joints for lifting, pushing, pulling and carrying. Watch your step to prevent falls. Balance rest and activity throughout the day.  

• Relax: Find ways to reduce or avoid stress through meditation, listening to music, connecting with friends and family, doing fun activities, and finding ways to relax and recharge.

• Choose a healthy lifestyle: Eating healthy food, not smoking, drinking in moderation and getting good sleep will help you to feel your best.

I really hope you feel slightly better about an arthritis diagnosis. This is something that can be managed.

If you have any questions about your arthritis or are looking for some specific suggestions to help your daily life please contact the clinic via email or phone us at ( 778) 630-8800. We look forward to meeting you!

The Rotator Cuff

A few years ago, I took my then three year old daughter skiing for the first time. It was exhilarating! I held her between my legs as we swooshed down the hill, both of us giggling the whole way down. On the second run she wanted to try by herself, so I went a bit ahead to catch her. Down she comes and I grab her with my left arm, feeling a crunch and a bit of a snap in my shoulder as I did. Uh oh, I thought - did I just feel that? My shoulder was sore but we skied another run, had some celebratory hot chocolate and went home.

The next morning, I couldn’t lift my arm without intense pain. Washing my hair was next to impossible. It was agony. I knew I had damaged my rotator cuff and it was time to get to work.

What is the rotator cuff?

The rotator cuff is a group of 4 muscles - the supraspinatus, infraspinatus, Teres minor and subscapularis (not pictured - lives on the underside of the shoulder blade) - that attach the humerus (aka the upper arm bone) to the scapula (aka the shoulder blade). These muscles aren’t big - the supraspinatus is roughly as thick as my thumb! For the amount of work these muscles do, they certainly aren’t as beefy as you would think.

What does the rotator cuff do?

The rotator cuff has 4 main jobs:

1. Supports the shoulder capsule - have you ever eaten chicken wings and noticed the white little nubbin that connects the bones? That, dear reader, is a capsule! A capsule surrounds every movable joint in your body, protecting it and making sure the synovial fluid (aka the lubricating fluid) greases those hinges, so to speak. The rotator cuff surrounds and helps support the shoulder capsule, giving it more structural integrity as the shoulder moves through its incredible range of movement.

2. Keeps the shoulder in its socket - if you look at the bones of the shoulder and strip away everything else, it looks like a really big golf ball on a golf tee. The rotator cuff acts like bungee cords attaching that golf ball down to the tee - a few springs to help guide the shoulder to where it should be.

3. Moves the shoulder - this is where the “rotator cuff” gets its name from: it rotates the shoulder! These four muscles are key to lifting your arm up to your side and getting your hand to reach up behind your head and your back. If you’ve ever had issues with your rotator cuff, you’ll know things like putting on deodorant, putting on a jacket or reaching for your seat belt in the car are particularly problematic.

4. Fine tunes the shoulder movements - not only do these muscles move the shoulder but they also act to smooth and fine tune movements. Think of when you’re reaching for that glass of wine - you want your movements to be as smooth and accurate as possible. Your rotator cuff is one reason for your successful wine grab!

How do you injure your rotator cuff?

There are two main ways people injure their rotator cuffs:

1. Overuse and repetitive strain - anyone who uses their shoulders a lot, especially with overhead movements, are susceptible to rotator cuff strains. Baseball players, electricians, carpenters and hair stylists are perfect examples of people who often have their arms up and aggravate their shoulders over time.

2. Acute strain - this is just like my story above. It may be your dog pulling unexpectedly on their leash or your toddler jumping into your arms when you weren’t quite expecting them to jump.

Once it’s injured, how do you fix it?

There are two main keys to shoulder rehabilitation:

1. Posture - posture is key to shoulder health. Remember that the rotator cuff muscles attach the shoulder blade to the humerus. When someone sits with rounded shoulders, their shoulder blades sit further away from their spine and at more of an angle. This means the humerus sits more forward in the socket and puts the rotator cuff muscles in a disadvantageous position - they have to work a lot harder to function. Over time, this leads to degradation of the rotator cuff. When you have proper posture, your shoulder blades are much more likely to sit back where they should, allowing your rotator cuff to work properly.

2. Strength - this is key to everything, isn’t it? For your rotator cuff to be working, it needs to be strong. But it’s just not the rotator cuff, it’s everything else that interacts with the shoulder - rhomboids, traps, lats, biceps, triceps, I could go on! - as well as everything that’s involved with posture. That. Is. A. Lot. And while it can seem overwhelming, that’s where we as physiotherapists come in. This is where we guide you on what to do and when, with how much weight and when you can move on to harder things.

For more information on rotator cuff rehabilitation, check out Physio-Pedia’s page on the rotator cuff.

Shoulders are dynamic - they have a huge range of movement and we use them all day. When pain sets in, it can often feel like they will never get better. But with a proper assessment, we can figure out why your shoulder is hurting, get to the source of the problem and do something about it.

If you would like to have one of our therapists look at your shoulder - or anything else! - give us a call at (778) 630-8800 or email us at clinic@ladnervillagephysio.com.

How Do We Learn? Neuroplasticity, Of Course!

One of the biggest myths about physiotherapy is we only work on bodies. It’s true, we do that a lot! We use manual therapy, soft tissue massage, modalities like LASER, ultrasound and dry needling (aka IMS - intramuscular stimulation) - all to help your body heal and perform at its best. However, the most important thing we do is prescribe exercises. Why?

The number one thing we are trying to change is your brain.

Whenever we learn a new skill, be it playing a guitar or performing the perfect squat, we need to start with activating the right muscles in the right sequence to get the right outcome. And that, dear reader, doesn’t happen at the muscle level - that all starts from the brain.

So what is this brain change we speak of? How does it work? More importantly, how do we make it work for us?

Neuroplasticity is the brain’s ability to change. This change can be harnessed for good (that guitar chord progression is amazing!) or evil (stop leaning over to pick up that box - squat it out!!).

As a physiotherapist, we harness the power of the brain’s ability to change itself through specific exercises. If I want you to improve the range of motion of your shoulder, I’m going to give you exercises that force your brain to engage a specific muscle and build on top of that. Those silly movements we ask you to do? There’s a method to the madness, we swear!

So what makes for good neuroplastic change? Kleim and Jones wrote THE paper on neuroplasticity back in 2008. This became the guidebook with how we influence neuroplasticity for the forces of good. Here are their ten principles and how we relate this to our exercises:

1. Use It or Lose It - want to still be able to squat in 20 years? Squat now. Your brain is very good at eliminating circuits that aren’t being used. If you want to keep a skill at a certain level, you need to practice it regularly.

2. Use It and Improve It - when you practice a task, your brain becomes more efficient at that specific task. It strengthens the neurons and their synapses, prunes off the inefficient pathways and creates a faster circuit.

3. Specificity - if the goal is to improve your golf swing, working on your tennis form isn’t the best way to do it. Sure, some of the muscles used are the same and you’ll see a cross training effect. But to get the best results for your golf game, we need to focus on your golf swing - break down those movements, improve them and put it all back together.

4. Repetition Matters - how many times does an baby fall before they master the art of walking? Almost 14,000 times! (Thanks, Dr. Lara Boyd, for that nugget - I’ve been keeping that number in my head for 10 years!) Keep this is mind if you’re getting frustrated - “brains are stubborn, but so am I”.

5. Intensity Matters - when you’re working out or practicing a new skill, work hard and make it count. Sweat! Fail! Make it hard! The more you push it - either physically or mentally - the faster you’ll see change.

6. Time Matters - we know we get faster neuroplastic change if we start rehabilitation shortly after an injury. The sooner we start, the better.

7. Salience Matters - you need to care about what you’re doing to get change! You know that adage, “You can’t make a person change”? It’s true for the brain, too! If the person doesn’t care, they will not see neuroplastic change. This is why we ask you what you love to do - we need to make sure the exercises we are prescribing relate to something that matters to you and helps you get to your end goal. Otherwise, what’s the point?

8. Age Matters - younger brains are better at neuroplastic change. We used to think younger brains were the ONLY brains that could change, but research has blown that out of the water. Older brains change, too - here is no age limit to neuroplasticity!

9. Transference - this is the cross training effect. Let’s go back to the golf/tennis example. Both games demand good shoulder control, a strong core and good hand/eye coordination. If we focus only on your golf game, your tennis game will improve a bit as well.

10. Interference - I’ll use a personal example with this one. I have spent so much time playing ultimate frisbee that I cannot play tennis without flicking the tennis racket. I can’t do it! My wrist just flicks every time I hit the ball. The neuroplastic change I have developed to throw a frisbee has interfered with my ability to hit a tennis ball properly. I could put in the effort to induce enough neuroplastic change and separate these circuits if I wanted to, but it’s not salient for me (see what I did there?).

Want to have more neuroplasticity in your life? There are two things you can do to make your brain more efficient at neuroplasticity: aerobic and mental exercise. Both have shown to increase the brain’s ability to adapt and change. All the more reason to get out for that bike ride and rock that crossword puzzle!

As always, if you’d like to see one of our physiotherapists, give us a call at (778) 630-8800, email us at clinic@ladnervillagephysio.com or book online.

Happy learning!

Stretching!

Ahhhhhh stretching. I’m not going to lie, it’s not my favourite thing. I used to brush off my lack of flexibility with a light-hearted “sorry, I don’t bend that way” until one day a client totally called me on it! We were talking about yoga and I was saying that I preferred running and the gym because “I don’t bend that way.” And she said “saying you’re too inflexible for yoga is like saying you are too dirty for a bath. The worse you are the more you need it!” And…. I think she was absolutely right. I actually might have given her a high five.

Touché dear client, touché.

Since then I have definitely incorporated more stretching into my fitness routine. But here is the thing, it’s important to know why you are stretching. What is the goal? Are you aiming for more range? Trying to avoid injury? Trying to warm up or cool down?

A lot of people view stretching as the magical answer to preventing and healing all injuries but this simply isn’t true.

There are a lot of different categories of stretching including static, dynamic, and pre-contraction stretching (more commonly known as PNF). What I have written below applies to good old-fashioned active static stretching (meaning you are doing the stretching to yourself, not someone doing it for you).

Stretching increases blood flow to muscles, can be psychologically relaxing and increases flexibility.  That new-found flexibility has it’s own set of benefits including improved performance in physical activities and decreased risk of injury for certain activities.

Should everyone just start stretching everything right now???? Not necessarily. Again, you have to remember the goal. Below I have given a few examples to outline situations when stretching is great vs some times when it is not-so-great. These obviously are not extensive lists but I just wanted to give you an idea about some things that we as physiotherapists are thinking about before we give you a stretch.

When Is Stretching Is Not Helpful?

• If someone is hypermobile (eg. they have too much “wiggle room” in their joints) then stretching can be detrimental because they are adding even more range of motion to a joint that already moves too much! This will increase risk of injury. (A super quick screening test to tell if someone is hypermobile is to look at the Beighton Score.)

• Stretching won’t prevent an overuse injury. This is a common misconception and not supported in the research.

When Is Stretching Great?

• People who sit at a desk all day often experience muscle shortening (hamstrings, hip flexors and pectorals are major culprits). Then when these people try to be active, they have increased risk of injury because their muscles are too tight to allow full range of motion. In this instance stretching muscles can help maintain their natural length, avoid shortening, and possibly avoid an injury.

• For jumpers. Volleyball, basketball, soccer and ultimate players - we’re looking to you! During a jump the tendon and muscle are stretched as they land to absorb energy. That energy is then needed as they recoil to rebound and jump back into the air (think of a giant elastic being stretched then snapping back). If their tendon is lacking length that jumper is at higher risk of hurting themselves as they land and take off repeatedly.

• In general, most stretching is safe as long as it is done with proper form and technique.

If you are going to stretch, here are some things to consider:

• Don’t stretch cold muscles. Doing an intense stretch on cold muscles can increase your risk of injury. A brisk 5-10 minute walk could be your warm up, or something similar to the dynamic warm up (see below). Or you can do your stretches after your workout when your muscles are already nice and warm!

• Hold it, don’t bounce. You should focus on a gentle, slow, sustained stretch of at least 30 seconds. Bouncing can harm your muscles.

• Be gentle. I used to think that a stretch was only effective is my muscles felt like they were about to snap in half. But you catch more flies with honey and muscles are no exception. You should keep the intensity of your stretch at a 3/10, which is enough to feel some tension it but not enough for it to hurt. On this note, remember to breathe!

• Use caution. If you have a pre-existing injury or a chronic ongoing issue, stretching might not be the answer. Maybe you need strength instead. Maybe you need to adjust your technique with the situation that is causing the injury. We can help you figure this part out!

• Be consistent. Stretching is also similar to other types of exercise in the fact that consistency is key. Stretching two days per month will not affect your flexibility in the same way that running two days per month won’t help you with your cardio.

• Stretching does not count as a warm up. A sustained static stretch (where you hold a certain position for >20 seconds) completed before a high-power activity such as sprinting decreases power output and increases injury risk. 

Instead of starting your workout with stretching, you should be doing a dynamic warm-up: swing your legs, do some squats, jog on the spot… move the limbs and joints you are about to move gently through their range of motion before beginning the more intense part of your exercise. Spending 5-10 minutes at the beginning of your workout warming up will help lower your risk of injury.

Looking for some guidance on your stretching routine with your aches and pains? We are here for you!

Book on online appointment - call us at (778) 630-8800, email us at clinic@ladnervillagephysio.com or book online.

Happy stretching!

Snow!

Snow!!! Maybe I’m alone in this but I really like snow - IF it is on a mountain and IF (and this is a big “if”) I have nowhere to go. Otherwise it’s a fairly large pain. And down here in South Delta I generally am pretty happy! We have plenty of snow up in the mountains that we can access any time we like for fun things like skiing or snowshoeing or what have you, but generally do not have to deal with the white stuff on a day to day basis down here the way the rest of Canada does (which involves shovelling and driving in the snow and is decidedly less fun). That being said, once in a while winter decides that even sunny South Delta gets some snow, and if the weather network is correct (another big “if”) then we have some snow coming our way in the next week.

But here is the thing - snow is not only a figurative pain, it can literally cause you pain or injury. Did you know that every year the average number of emergency room visits due to snow shovelling related injuries in the US is around 11,500!? Shovelling snow can cause back pain, shoulder pain, neck pain or even a heart attack. Not to mention a slip on the ice can result in anything from a bruised tailbone to a broken hip.  As a physiotherapist I would like to take it upon myself to hopefully prevent a few snow related injuries this week.

So without further ado I present to you:

Nicole’s Tips and Tricks for Dealing with Snow-Mageddon 2020 (South Delta Edition)

Shovelling Snow:

• Pace yourself! It is significantly easier to shovel 2 inches of fluffy snow than 8 inches of hard packed snow. If it is going to be snowing all day do yourself a favour and get out there a few times. Not only does it spread the work out over time with rest breaks, but each session will involve less load and strain.

• Push the snow!!! Don’t twist and lift, don’t throw it over your shoulder, just put your shovel on the ground, and walk forwards. When you get to the end of the line squat and use your legs instead of your back to lift the snow and place it in the pile. Your back will thank you for it.

• Use a good shovel. If it is too short you will have to bend more. If it’s too heavy you’re increasing your workload. A shovel that is mid-chest height is a good bet.

• Treat it like a workout. You’re going to be working hard in cold weather. A good warm up and cool down can help decrease chance of injury and post-workout muscle soreness. It doesn’t have to be fancy, a few arm swings, some marching on the spot, and off you go!

• Ask for help if you need it. If you experience any pain or shortness of breath discontinue and seek medical help if needed. If you have concerns about your cardiac health consult with your doctor before shovelling or get someone else to do it for you. We live in a lovely neighbourhood and the guy next door is not going to mind helping you out.

 Walking on Snow and Ice:

View fullsize

Courtesy of Alberta Health Services

I have already made a short post on this elsewhere but it is worth repeating. A normal upright walking pattern can put you at higher risk of your feet shooting out from underneath you when you are walking on a slippery surface. To decrease the chances of a nasty fall all you have to do is walk like a penguin! That means:

• Lean slightly forward

• Angle your feet slightly outwards

• Take small almost shuffling steps

• Keep your arms out at your sides (not in pockets)

• Wear proper footwear (okay, penguins don’t wear shoes but you should)

Courtesy of ABC News

So good luck everyone and stay safe out there! If you do happen to end up with an injury or two and would like a physiotherapy assessment please feel free to contact the clinic at (778) 630-8800 or through our website at https://ladnervillagephysio.com/

Chronic Pain

Want to know what truly fascinates me? Chronic pain. There are lots of definitions for chronic pain, but most sources agree on this one:

Pain that is persistent and lasts longer than 12 weeks can be classified as chronic pain. 

With most injuries (let’s say a sprained ankle) you injure yourself (tissue damage). There is an inflammatory reaction (your foot becomes swollen and looks like a balloon with toes sticking out) and you probably feel some pain with certain movements (if you try to run or jump). But body is on the ball and starts working to heal the tissue injury (building scar tissue). You find that slowly but surely your range of motion and activity tolerance improve, the pain and swelling dissipate and you’re back to playing soccer in 6-8 weeks. Yay!

But what if the pain doesn’t go away? What if the tissue is healed but you still feel pain? What if the pain you feel is way out of proportion to the severity of the injury? What if the pain is still there six months later? What if you still can’t put weight on that foot, it hurts to touch it gently and you can’t stand putting a shoe on because it feels like too much pressure?

This is the realm of chronic pain and it can have major implications on physical and mental well being. People start to get told “it’s in your head” and “suck it up” and “it should be better by now”. The reality is that we are only just starting to understand the complexity of chronic pain.

There is no “set” pain response.

A certain injury does not cause a pre-calculated level of pain. Everyone’s experience of pain, even with similar injuries, vary greatly.

How we act and react can depend on many factors such as stress and the “threat level” of the injury.

We have lots of receptors throughout our body (in our skin, joints, etc) that recognize lots of different things such as sharp vs dull, hot vs cold, light vs firm pressure, etc. When that input is noxious (irritating or damaging) those signals are sent by nociceptors. When enough of these signals get sent to the brain all at once the brain interprets them and decides how to act.

Some different scenarios for you: maybe your brain feels like something tickles and so it sends a signal to you that you should squirm, maybe you are getting a massage and it “hurts so good” but you decide to keep still even though it’s not comfortable, or maybe you stepped on a a nail and your brain decides that the situation is dangerous and immediately moves your foot away from the nail. In each instance, your brain got a nociceptive input but decided to react in different ways depending on the situation. That interpretation of danger and threat level is important and helps determine how you feel about the input you are experiencing.

How you perceive your injury and how it impacts your life has a huge role in how you feel pain.

A classic example is a paper cut. It is small, it is mighty, and it is a total pain (pun intended) for everyone. But who do you think will feel more threatened from that paper cut - a violinist who has a concert tonight or to a soccer player who has a game next weekend? If I was a betting woman (I’m not but let’s pretend) I would guess the violinist will panic - “oh my gosh can I play? Will I have to miss the concert? Is everything ruined?” - and that paper cut will probably throb all day long. Switch to the soccer player who probably thinks “Yup, that sucks, but as long as I’m careful reaching into my soccer bag I’ll probably be fine” and then goes on with his day and forgets about the paper cut. Those two people had very different reactions to the same injury.

The amount of tissue damage cannot predict the amount of pain experienced.

I know this seems strange. If you have pain you assume it’s because something is injured right this very moment, but in chronic pain this is not always the case.

Let’s start with amputees who have phantom limb pain. If someone’s foot is gone it’s impractical to think that they can have an itch on their big toe or an ache in their ankle because there is literally no remaining tissue, so how could it be damaged and send signals to the brain if there is nothing there to be damaged? And yet there are many reports of amputees feeling pain in their lost limb.  On the other extreme, some people have severe life threatening injuries and feel no pain at all. Soldiers with gunshot wounds will sometimes report not realizing they were hit until after the situation calmed down. Their body was so busy in survival mode that it didn’t have time to stop and worry about a major wound.

This also happens with knee arthritis. Some people have “brutal” X-rays that show severe knee degeneration but report only minor stiffness in the morning and no impact on their daily function. These folks can still walk, garden, etc. Other people report debilitating pain that stops them from doing simple daily tasks such as standing and walking for more than a few minutes at a time but their x-rays show only mild degeneration. We cannot rely on X-rays or MRI’s as a way to determine how much pain someone is in. The longer you have pain the weaker the correlation between pain and tissue integrity.

The longer you have pain, the more efficient your body’s pain warning system becomes.

It’s like it has practiced and practiced and practiced sending those signals up your spinal cord to your brain and it becomes really good at it. This starts to get more complicated but to oversimplify we start to call this system “sensitized.” It’s like your body has turned up the volume button on the radio - a simple input on one end (light touch) is over-represented and feels overwhelming and loud at the other (which gets interpreted as extreme pain). The brain is being told there is more danger at the tissue than there actually is. This often leads to pain avoidance behaviours (it hurts when I move so I’m going to move less) even though the joint and muscle are completely physically capable of moving. 

Chronic pain is not “all in your head”.

There are legitimate physiological processes that lead to chronic pain. The good news? Your body did this as part of a protective response for you. There was a real or perceived threat and your body said “Not on my watch! I’ve got your back.” Your body is not silly - it wants to keep you safe.

The other good news? If your body wound up this much in response to a need it can also down-regulate when that need is no longer present. That means going back down to pre-pain levels! It means feeling like you are in control of your pain instead of it controlling you.

You just need the tools so it can get the message “thank you for your help but your services are no longer required. Chill out.”

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If you would like to do some more learning here are some awesome resources:

• TedTalk by Lorimer Moseley, who is absolutely brilliant and it really explains a lot of how interpretation of stimulus can influence pain. Honestly it’s one of my favourite videos.

• Here is another good intro that I like - “Tame the Beast”

• If you prefer to do some reading anything by David Butler or Lorimer Moseley is great. They have a book called “Explain Pain” which is a great read.

• Neil Pearson is a local (B.C.) man who has done a ton of work with chronic pain. His resources are also quite good.

Okay friends, I’m outta here for now. Happy reading!

A Local Gem for Seniors: The McKee Seniors Recreation Centre

Last week, Nicole and I spent two days at the McKee Seniors Recreation Centre for their open house week. To be honest, the most I knew was they did a cute trick or treating event for the kids during Fright Nights at Hallowe’en. Past that, I knew very little about what went on inside those walls.

On Monday we set up our little table in the hall and talked to everyone who came by, answering any physiotherapy related questions people had for us. We were sitting opposite a bulletin board advertising the latest offerings in McKee House - a photography class, Osteofit, all different kinds of yoga, a men’s only strength class… Quite frankly we were blown away by the variety of options they had.

After getting a facility tour from Ben, the president of the McKee House Seniors Society, here’s a bit of what we learned:

• Membership to the McKee House is $30 for the year (that’s such a deal!!) and you need to be 50 years of age to join

• There are a crazy number of classes they offer - some for an extra fee, some included in your membership. Some of my favourites include:

  • Core, Balance and Strength (specifically targeted at decreasing the risk of falls through balance exercises and floor work)

  • Workout Warriors for Men (a strengthening class specifically for men with a mix of weights, cardio and flexibility)

  • Gentle Yoga (aimed at those with arthritis and limited mobility with an instructor that can modify poses as needed)

  • Muscle Max (an energetic class for making you sweat, using different equipment including weights and bands)

  • Osteofit (a class originally developed by the BC Women’s Hospital aimed at fall prevention for both men and women, especially for those with osteoporosis)

  • Introduction to Argentine Tango (because why not?)

• They have drop-in everything you can think of - knitting, cribbage, conversational Spanish, snooker, poker, trivia….

• The space is lovely with large windows, comfy chairs, a great cafe and a large auditorium for movie nights and concerts

You can find all their current programs listed in their current program guide.

The McKee House is a wonderful part of the Ladner community. We all know how important it is to stay social and active as we age. The exercise classes offer a means to strengthen, improve mobility and improve energy levels, all huge factors in reducing the risk of falls. Both brain and body health stand to get a boost through the offerings at the McKee House.

Have you been thinking about checking them out but nervous about going? I’m not sure you could meet a friendlier bunch of people with just enough sarcasm thrown in for a good laugh (you can see why it left such an impression on me)! Do yourself a favour and head on over - you’ll be happy you did.

If you’re wondering which class is for you and you would like some guidance, give us a call at (778) 630-8800 to make an appointment with one of our physiotherapists.

How to Avoid Common Gardening Injuries

Gardening season is here! And if you’re like me you have launched yourself outside with enthusiasm and gusto. There is so much to love about gardening. The fresh air, it’s relaxing (sometimes), and can be a very rewarding activity. But gardening can also be very physically demanding work and if you aren’t careful you might end up with an injury that could have been prevented.

Below are some tips to help you avoid the most common gardening-related aches and pains that we see!

1. PACING: If your normal activity level is walking the dog for 20 minutes around the block would you suddenly wake up one day and decide to run a marathon? Probably not. If you did you would probably survive the ordeal but your body certainly would not be happy with you. The same goes for gardening. If you are generally sedentary and don’t do a lot of full body exercise, then keeping your arms overhead for four hours while you trim the hedge all in one day because “you just want to get it over with” is probably not the best idea for your shoulders. Instead try to do the more intense activities for shorter periods of time and try to spread them out throughout the day or over a few different days with easier activities interspersed.

2. YOUR LOW BACK: Repetitive bending and twisting is tough on any back, but if you have a history of back problems (especially disc problems) then you really may trigger some pain. Be careful with your lifting posture and use proper techniques (wide stance, back in neutral, lift with your legs, you know the drill). For lifting and carrying keep the load as close to the center of your body as possible.  Maybe try sitting on a low stool when working in a garden bed instead of being on your hands and knees. If your back starts to feel sore take a break. Better yet, if you notice you have been hunched for a while get up, walk around and maybe give your back a chance to arch a bit before the ache even sets in. 

3. YOUR SHOULDERS: The reaching, the grabbing, the digging, the pulling, the pruning, the supporting of body weight while on hands and knees…. it’s almost a perfect storm. Once again, unless this is something you do regularly, shoulders can struggle with a sudden increase in heavy activity. Specifically, shoulders tend to dislike overhead activities, reaching, and twisting. The more repetitively you do these things or the more prolonged the activity, the more likely you could end up with rotator cuff impingement (pinching) or tendinopathy (overuse injury). Again, pacing and rest breaks are your friends. Also, if you must prune the hedge get on a ladder so there is less overhead work, and move that ladder frequently to avoid unnecessary reaching. 

Please note that a little bit of muscle stiffness the day after gardening is completely normal and can be a good thing. It means you worked your muscles hard enough that they will become stronger. If you experience this soreness it is probably a good idea to take a rest day in order to give yourself some recovery time. Pushing through sharp pain is not recommended.

We hope these tips have been helpful for you. If you have any questions or would like to book an assessment  you can give us a call at the clinic 778-630-8800 or access us online at ladnervillagephysio.com.

Happy gardening!