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.

Vestibular Exercises for Tired Caregivers of Little Ones

Does this story sound familiar? You go see your favourite physiotherapist who gives you a bunch of great, well-intentioned exercises perfectly targeted for you and your body. By the time you get home, life hits - the laundry needs attention, someone needs to make dinner and someone is crying. How are you supposed to get it all done?!

For caregivers of littles, this often presents a huge challenge - how do you get your exercises in while still managing everything you have going on at home?

When it comes to vestibular exercises, I have come up with a great list that you can try at home. As always, check in with your vestibular therapist to make sure these exercises are appropriate for you.

Devon’s Top Ten Exercises for Vestibular Stimulation With Babies & Toddlers

1. Create an obstacle course with tape

Grab some masking or painter’s tape and start taping lines on the ground. Tape a long, straight piece down and walk heel to toe on it; tape a zig-zag on the ground to walk along; tape some shapes to jump into - you are only limited by your creativity!

Bonus points if you use different colours of tape and assign different rules to different tape colours. For instance, move slowly on the yellow tape, fast on the green tape and backwards on the blue tape.

2. Play Floor is Lava

Grab all the pillows you can find and scatter them around the room. Go from one pillow to the next, making up rules as you go. Let your little one pick a pillow to “sink into the lava” or decide that all the blue pillows sunk.

3. Peak-A-Boo with movement

For the super-littles, a game of peak-a-boo is a great place to get some vestibular input. When you close or cover your eyes, move either forward/backward or up/down - that movement with eyes closed will give your vestibular system a nice kick. Remember to do this one in sitting if you’re quite off-balance with eyes closed in standing!

4. Ring Around the Exersaucer

If you have a little sitting in an exersaucer, jolly jumper or even on a blanket on the ground, walk around them in some kind of silly walk while making eye contact and having your head turned toward them. You could be a penguin, a hopping bunny, a gorilla - whatever you’d like! The bigger and more exaggerated the movement, the better!

5. The Hokey-Pokey

If you want to get your body moving, do the Hokey Pokey! You can move as much as you want and even close your eyes for parts of it to give you a real challenge. Putting your head in? Drop that head as far down as you can!

6. Toy handoff

A common vestibular exercise I prescribe is looking at something in your hand while moving your head. This is easy to do here - when you grab a toy to hand your kid, look at the toy as you turn and move towards your kid without allowing your eyes to come off of the toy.

7. Yoga

You may be thinking, how am I supposed to do yoga with little kids around? My kids and I started down Cosmic Kids Yoga together during the pandemic and they loved it. Give it a try! It even became a regular thing in our home before lunch.

8. Silly walks

Create your own silly walks with your littles! High kicks, wobbly knees, spins… take turns creating a silly walk and having everyone else copy it. If you have one walking little and one non-walking little, holding the baby while doing your silly walk gets your bonus points!

9. Tickle fights

Honestly, the vestibular system and spontaneous movement are made for each other. Tickle fights are such a great way to engage in unpredictable movement patterns and react to their movements. Add some rolling around and you’ve got the whole package!

10. Patty Cake

When playing patty cake, keep your eyes switching back and forth between your hands - this gives your vestibular system some great stimulation.

Remember - make sure you’re safe to do any and all of these exercises, especially ones in which you are closing your eyes and moving through space. The last thing you need is a fall! If in doubt, check in with a vestibular therapist about which exercises are appropriate for you.

If you need the help of a vestibular therapist, call us at (778) 630-8800, book online or email us.

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

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

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

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

Isometric Exercises

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

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

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

Isotonic Exercises

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

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

Isotonic exercises can be broken into two main types:

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

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

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

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

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

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

Busting Common Exercise Myths: Part 3 - Stretching Tight Muscles

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

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

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

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

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

Instead, that muscle may need to be strengthened.

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

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

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

A Case Study - The Hip Flexor

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

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

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

So When Should I Stretch?

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

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

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

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

Busting Common Exercise Myths: Part 2 - The Perfect Squat

Is there a perfect squat form for everyone?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

While there is no perfect squat form that works for everyone, there is absolutely a perfect squat form for your body! If you are unsure of where to start or how to perfect your squat form, our registered kinesiologists would be happy to work with you to create an exercise program which matches your exercise goals and injury specific recovery needs.

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

Happy squatting!

Busting Common Exercise Myths: Part 1

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

Myth 1: You can spot reduce fat 

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

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

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

Myth 2: Lifting will make you bulky

Truth: Lifting heavy weights will not make you bulky!

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

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

Myth 3: No pain, no gain 

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

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

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

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

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

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

Neck & Back Pain - Part 2: Strengthening Exercises

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

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

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

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

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

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

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

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

Kheya’s Top Five Strengthening Exercises

1) Toe taps 

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

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

2) Bridges

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

Complete 8-12 reps for 2-3 sets.

3) Bird dog

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

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

4) Chin tucks 

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

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

5) Back rows

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

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

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

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

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

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

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

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

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

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

But first, a review of spinal anatomy…

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

• cervical spine - 7 vertebrae that make up the neck

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

• lumbar spine - 5 vertebrae of the low back

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

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

The spine has three main jobs:

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

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

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

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

Kheya’s Top Five Mobility and Stretching Exercises

The Mobility Exercises

What is it:

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

1)      Thoracic spine openers

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

Repeat 5-10 times per side.

2)      Lumbar rotation

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

Repeat this movement 10 times for 2-3 sets.

3)      Cat cow

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

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

The Stretches

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

1)      Childs pose

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

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

2)      Knee hugs

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

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

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

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

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

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.  

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!

Soft Tissue Injuries Just Need Some PEACE & LOVE

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

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

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

But now there is a new kid on the block:

PEACE and LOVE 

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

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

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

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

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

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

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

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

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

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

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

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

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

A for Avoid Anti-Inflammatories

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

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

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

E for Educate

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

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

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

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

O for Optimism

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

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

V for Vascularisation

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

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

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

E for Exercise

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

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

For the full paper, download it here!

Improving Your Golf Game

Trevor Reid, one of our physiotherapists at Ladner Village Physiotherapy, is a former athletic therapist with some of Fraser Valley University’s varsity teams. An avid golfer, Trevor has given his tips on how to improve your golf game.

Want to know more about Trevor? Read all about him here!

Golf is a fun sport played by many in our community. We are lucky to have an abundance of courses including Beach Grove, Tsawwassen Springs, The Links at Hampton Cove, Kings Links and Delta Golf Course. I’m still working my way through all of them!

The Golf Swing

As you could imagine there are many different forces and mechanical components involved in a golf swing. As complex as a golf swing may be, Newton’s Third Law of Physics still applies:

When two objects interact, they apply forces to each other of equal magnitude and opposite direction.

In other words, when a club hits the golf ball it causes the ball to go flying in the opposite direction. We can use this simple concept to our advantage in two main ways: generating more force and moving through a bigger range of motion:

1. Producing more force - Any exercise that strengthens an individual’s muscles involved with a golf swing will allow them to produce more force which can then be applied to the golf ball.

2. Increasing available range of motion - Any mobility exercise that can gain range of motion related to a golf swing can allow for force to be generated over a longer period of time.

When performing a specific strength and mobility regime you will be able to hit the ball further and improve your game!

A good golf swing involves your entire body. Your feet need to be planted and well engaged. The power behind your swing is driven from your legs and core and transferred to your arms in one seamless motion. Making the most of your swing requires strong muscles and mobile joints from head to toe.

The Exercises

Looking for some starters? Here are some of my favourite golf strengthening and mobility exercises you can do at home 2-3 times per week. The first four exercises can be performed for 10 repetitions (both sides) for 2-3 sets, then finish off with the stretch at the end.

1. Dead bug: A good exercise to strengthen the core muscles.

Lay flat on the ground, raise your arms and legs in the air and keep the knees bent at 90 degrees. You will then straighten/lower one arm and the opposite leg at a time while the opposite limbs stay in the starting position. You will then return to the starting position and repeat the same movement on the opposite side. Be mindful to keep your core engaged - no back arching!

2. Resistance band trunk rotation: Helpful on strengthening the rotational muscles.

Tie a band around a stationary structure (like a door knob) then stand 3 to 4 feet away from the band. Straighten both arms fully and hold the band between your interlocked hands. From this position, you will rotate away from the band and then return to the starting position, perform this movement on both sides.

3. Knee swings: Effective at keeping the hip muscles and lumbar spine mobile.

Lay on your back, bend both knees and then swing them side-to-side.

4. Seated thoracic spine rotation: Good for improving the mobility of your thoracic spine.

Sit in a normal chair, cross your arms across your chest and then slowly rotate left and then the right.

5. Quadratus lumborum stretch: A muscle commonly tight in golfers.

Start on your hands and knees and place your hands slightly off to the side. Lean back while keeping your hands in the same place, go until you feel a stretch on the opposite side of your lower back. Hold for 30 seconds on both sides.

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Does your golf swing need a bit more oompf? Book with us online, by email or phoning (778) 630-8800. Until then, see you on the course!

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. 

Stephanie's Top Tips For Managing Your Sore Shoulder

Stephanie Yip is one of our physiotherapists here at Ladner Village Physiotherapy with a passion for treating shoulder injuries. In her latest blog post, Stephanie shares her top tips for acute shoulder management.

The shoulder joint is the most mobile joint in our body, but that also makes it the most unstable joint and prone to injury. Chances are you’ve experienced an achy shoulder at some point in your life. With rock climbing and paddle boarding being my two favourite activities, I have definitely had my share of annoying shoulder pain. I get it - you can’t sleep, easy tasks feel impossible, and you just want to get back to life.

To learn more about shoulder anatomy and the muscle of the rotator cuff, check out this blog post. Today, I am here to share some practical, easy-to-implement, everyday tips for managing your sore shoulder in the early days of your rehab journey.

EVERYDAY LIFE

If your shoulder is in pain, you will automatically want to hold your arm to your side and not use it as much. This will only increase the stiffness and tension in the surrounding muscles, and add to your discomfort.

Instead, follow these tips:

• Continue to use your arm in pain-free ways throughout the day - The best way is to use it for easy tasks like turning a page in your book, picking up your keys, or taking out your credit card.

• Keep tasks within an easy arm’s reach - Avoid long levers. Carry loads close to your body. Avoid reaching far away for items by moving your body closer to what you need.

• Avoid repetitive overhead motions - The most unstable and (muscle-speaking) demanding position for your shoulder is overhead. When your shoulder is healing, avoid being up here as much as you can.

PAIN MANAGEMENT

So your shoulder is sore and bugs you all the time – now what?

• Avoid compensating movements - The most common one is hiking your shoulder up to reach items overhead. This will create more tension and discomfort in the muscles around your shoulder.

• Try heat or cold to ease the pain - This is 100% your choice; pick the one that feels better for you.

POSTURE

Your posture plays a huge role in where your shoulder is positioned and as a result, how much pain you experience while at rest.

• Don’t let your shoulder poke forward - This means no slouching!

• Support your arm when resting - If you’re chilling on the couch or at your desk for a while, support your arm with a cushion/pillow/armrest so that it’s in a neutral, stable position

• Use the “fish hook” rule - Imagine there’s a fish hook pulling you up by your sternum. This will help set your back in a better position.

SLEEP

It is normal to feel more pain or discomfort at night while trying to fall asleep. When sleeping, you aren’t aware of where your arm is in space and are much more likely to put it in a position that can get quite painful.

• If you’re a back sleeper - Place a rolled up tea towel under your elbow. This will help keep your shoulder in a more neutral position.

• If you’re a side sleeper - Sleep on your unaffected side and hug a pillow with your injured arm so that it is comfortably supported.

• DO NOT TUCK the injured arm under your pillow

EXERCISE

You get some shoulder rehab exercises, and you’re super excited to get started. Remember these key points:

• Do your exercises in small, but frequent bouts - Your shoulder is like a young puppy: it wants to get exercised regularly but gets tired quickly.This means it’s better to do your exercises 3 times per day for 5-10 minutes, rather than doing just one session for 30 minutes.

• Use pain as a general guide - It’s okay to feel mild discomfort while performing your exercises (think 3-4/10 on an imaginary pain scale) but it shouldn’t feel excruciating. It’s normal to feel a bit of soreness afterwards for a couple of hours but it shouldn’t leave you in agony for days.

If you need this as a printable tip sheet, download it here - Shoulder Management 101

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Are you experiencing shoulder pain? Book an appointment online, through email or by calling (778) 630-8800 - we will help get you started on your own rehab journey to getting back to what you love to do most!

Diastasis Rectus Abdominis 101: All About The "Mummy Tummy"

Abdominal diastasis, diastasis rectus abdominis, diastasis recti, abdominal separation, ab gap, “mummy tummy” ….. it has a lot of names. But whatever you call it, I want you to know a little bit more about it so you can be better equipped to manage it.

What is it an abdominal diastasis?

Diastasis Rectus Abdominis (also known as DRA) is a common occurrence where the linea alba (the line of connective tissue between your six-pack muscles) gets stretched. Note that I said stretched, not torn. Think of pizza dough - stretching the pizza dough is a diastasis, but there are no holes or tears in the pizza dough (which would be a hernia).

DRA most commonly occurs during pregnancy but can also occur in people who have never been pregnant, such as people who lift really heavy weights with poor abdominal engagement and technique.

DRA is considered a normal change in pregnancy!

Your body stretches to accommodate the growing baby and honestly, stretching is kind of the name of the game when it comes to pregnancy. Did you know that uterine capacity increases from 4ml to 4000ml at term and abdominal length increases by an average of 115% at 38 weeks gestation? Can you imagine how uncomfortable pregnancy would be if your stomach didn’t stretch? I can only imagine the heartburn.

So I hope we can all agree that the stretch is a good thing and we are on team stretch - yay for stretch! But unfortunately, as with other body parts faced with a sudden increase and then decrease in size (RIP pre-baby boobs), it is also quite common for that stretch to remain after pregnancy.

How common is DRA?

Way more common than you think! Here’s the research from Mota et al and Sperstad et al showing how common DRA is in pregnancy:

• 33.1% of women at 21 weeks pregnant

• 100% of women at 35 weeks pregnant

• 60% of women at 6 weeks post-partum

• 32% of women at 12 months post-partum

How do I know if I have a diastasis?

There are a few ways to tell! The most obvious sign that people notice is the presence of an abdominal “dome”, “cone” or “triangling” of their stomach when they exercise or during daily activities (like getting up from the couch or straining on the toilet). This is a protrusion or bulge down the center line of your stomach when you attempt to use your muscles without correctly preparing or stabilizing first.

Some common movements which can cause doming are crunches, “V” sits, Russian twists, pull ups and getting up from bed or a reclined position.  This picture is someone with a diastasis doing a double leg lift without any preparation for the movement. Can you see the peak down the middle of her tummy? This is what we are talking about when we say “the dome.”

Avoiding the dome is one of the biggest considerations for proper DRA management.

If you haven’t noticed a dome you may also be able to feel the increased space between your abdominals.

To test yourself for DRA:

• Lie flat on your back and press your fingers into your midline right underneath your sternum.

• Press again a few inches down and keep going all the way down to your pubic bone.

• When you press you might feel that some places feel firm and springy while in other places your fingers might sink in deeper. This could indicate an area that has stretched.

• You can confirm this with a head lift test: with your fingers in the soft spot do a mini crunch and lift your head and shoulders off the ground, does the soft spot narrow? If it does that is another indication that you likely have a diastasis (the narrowing is a good thing, don’t let it freak you out!).

Need a visual? Check out this youtube video for a guide to assessing your own DRA.

Still not sure if you have a DRA? A pelvic floor physio, midwife or OB could also tell you right away if you have a diastasis and give you further direction.

Is it my fault?

This is a question I hear a lot and the answer is usually a resounding NO. Women often say to me “maybe if I didn’t gain so much weight” or “maybe if I was younger then my gap wouldn’t be so big” but according to the research this simply isn’t true.

According to a wide body of research, here is a list of things that are NOT risk factors for DRA:

• Age 

• Ethnicity

• Height 

• Pre-pregnancy weight

• Duration of labour  

• Method of delivery

• Weight gain during pregnancy 

• Baby weight at birth

• Gestational age 

• Exercise training before, during and after pregnancy

• BMI before pregnancy or at 6 months postpartum

Some things that we think might contribute to a diastasis are:

• Having multiple pregnancies close together

• Being pregnant with multiples

• Heavy lifting using a Valsalva technique

• Genetics

Will it go away?

While some natural recovery can occur in the first 8 weeks postpartum a large number of women will still have a DRA and need to learn how to properly manage it going forwards.

How do I manage my DRA?

Management will include learning proper movement and abdominal techniques so you can exercise without worsening your diastasis. You will need to avoid the dome. I know I mentioned that earlier but it needs to be repeated.

Exercises and movements which cause a dome will need to be modified until you are strong enough to maintain control throughout the entire movement.

Take a look at the pictures on the right hand side. You can see the doming in the DRA in the top picture. Through proper technique, this doming can be controlled - this is demonstrated in the bottom picture. This person has properly activated the rest of her abdomen and is in control of the movement. Can you see how her stomach remains flat even when she lifts her legs?

(For what its worth, this lady deserves a lot of credit because that move is really hard to do properly and I’m sure it took some time and practice to get to this level!)  

The most important thing to remember:

AVOID THE DOME. Say no to the dome. You are now a dome-free zone.

A pelvic floor physiotherapist will be able to assess your abdominal diastasis, teach you correct abdominal control techniques, give you exercises to increase your abdominal strength and endurance, and help you transition back to your preferred type of exercise.

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If you suspect you have an abdominal diastasis and want to investigate further, please feel free to book with Nicole at Ladner Village Physiotherapy by booking online or calling us at (778) 630-8800. She will be happy to help!

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

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

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

What Is Tennis Elbow And Why Does It Happen?

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

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

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

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

Top Five Tips for Tennis Elbow

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

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

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

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

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

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

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

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!