How Not To Injure Yourself During Your DIY Reno

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

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

Nicole’s Top 11 Tips for Home Renovations

1. Share the load!

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

2. Use the equipment!

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

3. Repetition is not your friend.

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

4. Avoid over-gripping equipment.

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

5. Decrease the load.

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

6. Be nice to your neck!

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

7. Beware of prolonged awkward positions.

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

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

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

8. Proper lifting techniques are a must. 

Follow these rules:

• Prepare for the lift.

•  Keep the load as close to you as possible. 

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

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

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

9. Take the time to do it right.

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

10. Some tools have more than one use.

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

11. Momentum can be your friend.

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

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

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

General Exercise for Injury Rehab

Most of us can relate to the experience of getting injured and wanting to lounge on the couch for days at a time, letting our bodies heal. However, that is not the best way to recover from an injury.

Most people understand there are many benefits to exercise, but did you know whole body exercise can be particularly useful when recovering from an injury? And no, I don’t just mean doing the exercises from your physiotherapist for your specific injured joint - I mean biking to help your shoulder pain, arm workouts to help your ankle injury, and cardiovascular exercise for… well, pretty much everything!

So why is exercise so good for you and what kind of benefits does it provide? Read on to find out!

Top 5 benefits of general exercise for injury rehabilitation:

1. Increased oxygen uptake

When you exercise, you are increasing blood flow around your body, increasing oxygen to your working cells. This increased oxygen to your cells not only allows your body to make better use of oxygen, but it can also lead to long-term changes by increasing the number of mitochondria in your cells (as you may remember from high school, mitochondria are “the powerhouse of the cell!”).

This means the more we work out, the more mitochondria we have that can turn the food we put into our body into energy. This improves your overall energy, allowing your body to put more energy towards healing and recovery.

2. New blood vessel growth

Aerobic exercises stimulates your body to grow new blood vessels (pretty cool, right!?). This leads to more oxygen and other nutrients that can be transported to the muscles, providing more energy to your body. When you think about this in terms of recovery from an injury, creating new blood vessels can help muscle tissue repair itself more quickly, as it is getting a better supply of nutrients from the rest of the body.

3. Release of endorphins

Endorphins have been called the “feel-good” chemical due to the feeling of euphoria they provide. They are released in abundance when you exercise and are responsible for the famous “runners high”, the boost of energy and “warm fuzzies” felt during a workout. Endorphins naturally help your body cope with pain and stress, meaning they can assist in injury recovery.

4. Improved brain function

When you exercise, your brain releases a chemical messenger called brain-derived neurotrophic factor (aka BDNF), which is thought to play a role in keeping our brains happy and healthy. Increasing BDNF through exercise can help improve cognitive function, mental well-being, and even improve brain recovery, all very important parts of overcoming an injury.

Most research points towards cardiovascular exercise being the best way to increase BDNF so hop on that bike, go for a run, or look into high intensity interval training for some amazing benefits!

5. Improved sleep

Regular exercise can also help improve sleep. Sleep has a huge impact on injury recovery - while you are sleeping, your body is busy repairing itself.

How does this work? When you sleep, your body releases hormones which aid in recovery from injuries. Your body then increases blood flow to muscles, providing them with the oxygen and nutrients they need to repair themselves. Lastly, while sleeping, the chemicals in charge of the stress response decrease. When you decrease stress, your body can put more energy towards recovering from your injury.

How much exercise do you need?

The Canadian government recommends at least 150 minutes of moderate to vigorous activity per week, regardless of injury status. This ideally should include a mix of resistance training and cardiovascular exercise.

However, if you’re not there yet, don’t worry! Here are some tips to getting started:

• Start with small activities that you enjoy and work your way up towards meeting these guidelines over time. If you prefer walking your dog, gardening, playing sports, or anything else that gets you moving, these are fantastic options to get you started and can provide numerous benefits as well.

• Set small goals such as 10-minute walks, taking the stairs instead of the elevator, or doing small exercises while doing your normal daily activities (think squats while you’re brushing your teeth or planks during a commercial break).

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

Give us a call today give us a call at (778) 630-800, email us or book online to seek treatment from a physiotherapist or to work with a registered kinesiologist.

What is Kinesiology?

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

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

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

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

What kind of training does a kinesiologist have?

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

Is a kinesiologist like a personal trainer? 

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

What can a kinesiologist do for me?

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

• Create an exercise plan that is safe and realistic

• Identify muscle imbalances through assessment of your movement

• Help with maintaining fitness while you deal with an injury

• Develop an exercise rehab program to address an injury

• Ensure proper exercise technique to avoid unnecessary injury

• Provide motivation and accountability to stick with your exercise program

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

Is kinesiology covered by my extended health benefits?

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

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

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

• 12 visits with a kinesiologist

• 25 visits with a physiotherapist

• 12 visits with a registered massage therapist

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

Do I have coverage if I have a WorksafeBC claim?

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

What will my session look like?

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

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

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

• phone at 778-227-8030

• email at clinic@ladnervillagephysio.com

• book online

We look forward to meeting you!

Top Ten: Backpack Tips

If you’ve seen me around town, I’m usually carrying my bright blue backpack on my shoulders and either zipping around on my bougie cruiser bike (and my new wicker basket!) or walking while zoning out to a podcast. Backpacks are my favourite way to carry my essentials while keeping the weight happily distributed and my hands free.

Like most people I know, I have fallen victim to poor backpack habits in the past. I have definitely been that person in class treating my pack like a clown car, pulling out item after item and desperately trying to find the thing I need. At the end of those days, it was all I could do to pop an Advil and get in the bath - not exactly the smartest thing to do.

So, dear reader, it’s a great time to learn from my mistakes! Let’s go over the essentials of backpack wearing - how much weight is appropriate, how to pack your backpack and what red flags you should pay attention to.

Top Ten Backpack Wearing Tips for Back To School:

1. Ensure your pack weighs no more than 10% of your body weight. We commonly hear that 15% is the upper limit, but current research questions this number. Another journal article identifies “significant biomechanical, physiological and discomfort impacts on the wearer, especially with loads above 10% of the student’s body weight”. The take home? Keep it under 10%.

2. Buying a new pack? Go for wide straps and a padded backing. The cushion will help distribute the weight and make it much more comfortable especially on long days.

3. While you’re at it, make sure the pack actually fits your back. Try it on (preferably with some weight) - the bottom of the back should be right around hip height and not hitting your bum.

4. Use both straps. Please, for the love of everything holy, distribute that load across both your shoulders.

5. If your pack is particularly heavy one day, use the waist strap. It will help keep the load closer to your centre of gravity and distribute some of the weight from your shoulders to your pelvis.

6. Place heavy things close to your body at the back of the pack. There’s a reason the laptop pouch is at the back of the bag (beyond the whole projecting the valuable thing part) - it keeps the weight close to your body’s centre of gravity and places less stress on your muscles and joints.

7. Use those multiple compartments. They keep your load spread out and in place, reducing the chance of injury from load shifting.

8. Putting your backpack on and off should be easy. If you’re struggling, it means your pack is too heavy.

9. If you’re leaning forward to carry your pack, it’s too heavy. Your backpack shouldn’t be pulling you backwards. If it is, back pain won’t be far behind.

10. Other signs of too much weight in your pack: neck pain, tingling and/or numbness in your shoulders, arms or hands, and visible strap marks show up on your shoulders. If you start experiencing any of these signs, it’s time to re-evaluate your pack situation ASAP.

We see a lot of poor backpack practices lead to postural changes and pain. Develop good habits early and avoid the problems down the road - you’ll be happy you did!

If you’re suffering with backpack-related pain, give us a shout at (778) 630-8800, email us or book online.

Are Your Nerves Limiting Your Mobility?

Our dance physiotherapist Anh is back! Here, she discusses neural mobility and tension - what it is, why it occurs and why dancers especially should know about its wide-ranging effects.

Hey dancers! Are you or do you know someone who stretches for hours a day, every day of the week and still can’t get into their splits? As dancers we often think about stretching our muscles to improve mobility. But what if it isn’t your muscles that are preventing you from touching your toes or achieving the splits? What if the problem is your nerves?

Your nerves are meant to move freely throughout your body. They connect our brains to our big toes and everything in between.

Neural tension occurs when a nerve’s ability to move has been impeded.

You can think of your nervous system as a tangle of ropes, extending from your brain to all areas of your body. Imagine one of these thick ropes starting at the top of your head, running down your spine, behind your glutes, down the back of your leg and all the way into the bottom of your foot and toes (this would be your sciatic nerve). If there is a restriction anywhere along the line of this rope, you won’t be able to move your leg the way you should.

Like rope, nerves do not like to be stretched or squeezed - both affect the ability of the nerve to do its job. In order to achieve full range of motion, nerves need to glide back and forth in the body. If a restriction is present and not removed, further stretching can cause irritation of the nerve over time.

So how do I know if it's neural tension that's preventing my mobility and not muscle?

1. If you are experiencing burning, tingling, numbness, or shooting pain that radiates past the muscle that is being stretched

2. If the sensation of stretching changes with different head and neck positioning

3. If the sensation of stretching changes with a change in position of a joint unrelated to the muscle being stretched (ie. stretching your hamstring feels better when your feet are pointed vs when your feet are flexed)

How do I get rid of neural tension?

First things first - if there’s neural tension, there’s a reason for it. As physiotherapists, we assess and identify the source of the tension. Is there something squeezing the nerve in the back? What about in the glutes or behind the knee? Finding the source of the problem is always the first step.

We then use a combination of techniques including manual therapy, soft tissue massage and specific exercises designed to help settle the tissue down and not reaggravate it.

Without a doubt, nerve flossing comes into play. Nerve flossing is a dynamic stretching technique that mobilizes the nerve. Think of a piece of dental floss: when you are flossing your teeth, you pull on one side of the floss and allow the other side to slacken, then reverse directions. Nerve flossing is the exact same idea - it is performed by tensioning one end of the nerve while slacking the other end.

Nerves control your muscles. If a nerve feels unsafe (like when going from sedentary to being over stretched) it will send signals to the muscle to contract and stiffen. This puts the dancer at risk of muscle strain. It is important to incorporate nerve flossing techniques and movements into your warm and stretch routine. 

For more information on neural tension and its effect on mobility, book online or give us a call at (778) 630-8800.

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

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

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

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

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

A Case Study in Kinetic Chains: Runner’s Knee

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

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

Need a visual? Check out this fantastic video:

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

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

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

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

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

Getting Rid of Plantar Fasciitis

It’s coming up to that season - heel pain season! When we all go from wearing our supportive boots and shoes throughout fall and winter to popping on those flip flops as soon as it hits 15 degrees. Every summer we see an uptick in people complaining of heel pain: a stabbing pain smack in the heel first thing in the morning that sometimes lessens with walking, sometimes not. And when we touch that point on your foot that hurts? You go through the roof.

Read all about plantar fasciitis - the hallmarks of the condition, how we treat it and our top five tips on how to prevent it from coming back.

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Plantar fasciitis is the most common cause of heel or “rearfoot” pain. It is most commonly the result of overuse of the plantar fascia (aka plantar aponeurosis), a thick band of connective tissue that runs from the heel to the toes on the bottom of the foot. The plantar fascia has a lot of important jobs in the foot:

1. Protection of blood vessels and nerves - like any part of your body, the network of vessels and nerves is dense and required to keep your tissues healthy. The plantar fascia lines of the bottom of the foot and acts as a suit of armour for anything you may step on.

2. Site of muscle attachment - a bunch of the little muscles that control the toes attach directly onto the plantar fascia.

3. Helps to maintain your arch - take off your shoe and admire the curves of your foot. Some of those curves are brought to you by the plantar fascia!

4. Shock absorption and distribution of forces when standing and walking - arguably the most important role of the plantar fascia, it is integral to a healthy foot when walking and running.

Think of the plantar fascia as the string on a bow - the tension on that string maintains the integrity of the whole bow and provides explosive force for the arrow.

With every step you take, that downward force is absorbed by your plantar fascia. When you roll over your foot and propel off your big toe, your plantar fascia recoils and transfers some of that absorbed energy into forward momentum. Your foot is then returned to its curvy shape, ready to absorb the next step.

But if your bow is only as good as your bowstring, what happens when it starts to fray?

Hallmarks of Plantar Fasciitis

The person with plantar fasciitis will generally complain of the following:

• A gradual onset of pain

• Pain in a specific spot on the heel that is tender when palpated

• Worse in the morning, especially when getting out of bed for the first few steps

• Pain typically decreases with activity unless it’s been going on for awhile, in which case it just hurts all the time

There have been several risk factors associated with developing plantar fasciitis. These include:

• Increased training volume and/or number of practice days per week - this is the big one. Overuse injuries happen when the tissue is stressed too much and isn’t allowed to rest and regenerate.

• Anatomical variations - Varus knees (aka bow-legged) and high-arched feet both lead to a higher incidence of plantar fasciitis.

• Use of spiked athletic shoes or cleats

• Standing work - those who stand at work all day are a bit more likely to develop plantar fasciitis.

• Lack of flexibility and strength in the lower extremities - Tight calves? Weak toe muscles? What about your hamstrings and glutes? All these contribute to how to walk and how those forces go through and are absorbed by your feet.

One area of debate in the risk factor world is the link between BMI and plantar fasciitis. While it has been suggested in several studies that those with a higher BMI are more likely to develop plantar fasciitis, additional studies of athletes with a range of BMIs have not found a significant difference in likelihood of developing plantar fasciitis. A sedentary lifestyle is associated with a higher BMI and therefore weaker muscles so it may be that instead of weight being a risk factor for plantar fasciitis, it’s the lack of strength and flexibility that’s the issue at play.

Getting Back to Function

Plantar fasciitis is something we see in the clinic every day. Typically, rehab goes a little something like this:

1. Settle the tissue down - like every overuse injury, we have to settle it down before we build it back up. This may mean LASER or ultrasound. This may mean massaging the tissue, either with a frozen golf ball or with our hands. This may mean supporting the foot with a gel heel pad or heel lift to temporarily provide some of that cushioning. There are lots of options to settle it down, we just have to figure out the combination that works for you.

2. Tape it - supporting the foot through tape, especially when its aggravated, can be really helpful. There are a variety of tape jobs that are used depending on your specific issues.

3. Ice it - I’m a fan of frozen golf balls. You can pop them on the ground and roll the bottom of your foot out on them, giving yourself a soothing ice massage.

4. Stretch the tight things - without a doubt, this means calves. If you come in for physiotherapy for a plantar fasciitis, expect this from day one. The plantar fascia can be thought of as a continuation of the Achilles tendon, which connects the bulky calf muscles (the soleus and gastrocnemius) to the heel. Stretching and maintaining the length of the calf muscles helps cut down on the stress through the plantar fascia - loosening the bowstring, in a way. There may be more things tight as well, from your quads and hamstrings to other muscles up the chain.

5. Strengthen the weak things - again, we need to look at the whole chain. How are your quads? What about your glutes? Is your core working the way it should? We also need to look at those little muscles in your foot that support your arch and attach into the plantar fascia as they likely need some attention of their own.

What About Footwear and Orthotics?

Proper footwear is incredibly important in the prevention and management of plantar fasciitis. With summer coming, we reached out to our friends at the Run Inn for their recommendations on plantar fascia-friendly sandals for the summer:

• Oofos Sandals and Sliders - these provide great arch support with a lovely cushion. They were recently recommended by the American Podiatrist Association specifically to support those with plantar fasciitis.

• Hoka Slides - another great option for warmer weather, Hokas are nicely cushioned with great support for those with plantar fasciitis.

Once the pain settles down, getting appropriate footwear for your feet will help keep plantar fasciitis and other foot problems at bay. There are several factors that go into finding the right shoe for you - the last, the toe box, the rise… I could go on.

As with anything shoe-related, do not buy them online without being fitted first! Go to a local store that knows their stuff - for us, that’s definitely the Run Inn - and get fitted properly. Different bodies and different feet demand different support! They also have a range of over the counter orthotics that may help as well.

For some, custom orthotics is the way to go. Finding a local pedorthist - someone who is an expert in the foot and all things foot orthotics - is key. We are lucky enough to have a great group in Ladner, West Coast Pedorthics. They are fantastic, informative and thorough - we highly recommend them!

It’s Gone! How Do I Stop It From Coming Back?

Plantar fasciitis can take months to finally go along its merry way. Once it’s gone, these habits will help keep it that way:

Top Five Tips For Preventing Plantar Fasciitis

1. Wear good shoes all year round - make sure the sandals you choose to wear in the summer are just as supportive as the shoes you wear the rest of the year. Cheap flip flops are not your friend! Remember that all feet are different and demand different supports - get your feet fitted properly by shoe experts.

2. Keep your calves long and supple - a tight calf is plantar fasciitis’s best friend. Download this PDF for instructions on how to stretch both your gastrocs and soleus.

3. Untuck your bed sheets at night - when the sheets of your bed are tucked at the bottom, it forces your feet to be more pointed and shortens your calves. Sleeping with loose bed sheets allow your ankles and feet more freedom of movement.

4. Plan and pace your running and walking - Nicole did a great three part series on injury prevention in running, all of which can equally be applied to walking. Follow her tips on adjusting your running and walking volume, foot strike and strength training.

5. Maintain a healthy weight and exercise routine - it is clear that a healthy BMI combined with a regular exercise program helps keep the plantar fascia healthy.

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Are you experiencing foot pain? Book an appointment online, through email or by calling (778) 630-8800 - we will help you figure out what’s going on and how to get it under control.

Runner's Knee

Patellofemoral Syndrome is a classic injury that causes pain around your kneecap. It is also something that I myself am dealing with right now. Also known as “Runner’s Knee,” it’s usually a dull achy pain that is worse with going up and down stairs, running, jumping and squatting. It can also get cranky when you sit with your knees bent for a prolonged period of time such as watching a movie. It is very common and the cause can be multifactorial, so I am hoping that this post will give you a basic understanding of what may be going on with your knee.

Inside The Knee

First, let’s go over the anatomy of your knee shall we? Your knee is actually more than one joint! There is the big joint between your femur (thigh bone) and your tibia (shin bone), but there is also a joint between your femur and your patella (kneecap). In fact, your patella sits in a little groove at the base of the femur and when you bend or straighten your knee the patella glides up and down it’s little groove.

This is all fun and games until it starts to hurt. There are generally a few contributing factors for patellofemoral pain, I have listed a few of the more common culprits below:

• Overuse: Activities that require high levels of repetitive stress on your joints are more likely to cause Patellofemoral Syndrome. All of that running and jumping can cause irritation underneath the kneecap as it rubs up and down over the femur.

• Alignment Issues between your hips, knees and ankles: If your hip muscles are weak then your form can suffer. Have you ever done a squat and noticed that your knee kind of collapsed into the midline rather than staying aligned and straight? That is hard on your knee. People with that technique error have a higher incidence of Patellofemoral Syndrome. If you can’t control your knee when you are standing still you are most likely not in control when you are running or jumping or stepping off of a curb either. If you do something incorrectly for about 30-60 minutes straight & 3-5 times per week, that can result in a LOT of misdirected force.

• Women are more prone than men to patellofemoral injury: It is speculated that this is because of wider hips (so the knees more naturally bias inwards). Strengthening your outer hip muscles (such as the gluteus medius) can help prevent or correct the inward collapse of your knee.

• Muscle imbalances: There are four separate parts to your quadriceps (the big muscles on the front of your thigh). If the outer muscle is stronger than the inner muscle (which is often is) then the patella gets tugged toward the strong side. This also can cause it to track improperly in its little groove.

• Inappropriate footwear:  If you overpronate or have flat feet you could likely benefit from a shoe that has cushion and support rather than a minimalist shoe.

• Being overweight: When you are going down stairs your knee experiences three times your body weight in forces and pressure. If you weigh 200lbs then each knee is taking 600lbs. The forces are even higher (4-5 times your body weight) when you squat to tie a shoelace or pick something up off of the floor.

• An injury: Falling on your knee or dislocating a kneecap can increase chances of patellofemoral pain.

What Can I Do About It?

Because patellofemoral pain is multifactorial, there is generally not one simple answer that will give you a quick fix (bummer, I know). For this reason, I strongly suggest making an appointment with a physiotherapist so they can properly assess your personal situation. Treatment will involve the following:

• Addressing your risk factors and will likely include strengthening your quads and your hips

• Suggestions for altering your current training program will also be made

• Tape may also be helpful to alleviate painful symptoms temporarily

FAQ: Is biking instead of running a good option?

The is by far the most common question I get from runners with knee pain who are looking to maintain their cardio and activity levels while they rehab their knees.

My answer? Maybe, but not necessarily.

I know that is an extremely vague answer but here is why. Although biking has less overall force going through your knees compared to running, it is still a repetitive activity that involves a lot of knee bending and straightening. If your seat is too low or too far forward this can make your knee bend too much with each revolution, putting unnecessary excess force through the knee. Also, having the gear of your bike too high can cause increased force through the knee. For some people it is a viable alternative to running while others find that biking is still too aggravating. It really needs to be assessed on a case-by-case basis.

For those who are curious this is how I ended up with my sore knees…

I popped both of my children (40lbs each) into a bike trailer and proceeded to ride for 20+km while hauling them behind me. It was my first time riding my bike in several months, my seat was too low, the load was too high, and the volume was too much. Should I have known better? Probably. Was it a fun day? Absolutely. Will I rehab my knees back up to running the distances I want and get back to squats with resistance? Of course! Will it take some time and patience……. Also yes.

Good luck running out there everybody!

As always, if you find yourself battling a running injury of any kind please call us at 778-630-8800 to make an appointment with one of our skilled physiotherapists so we can get you back on track as soon as possible.

Nice To Meet You Again!

If someone on the street asked me about our clinic I would probably say something like “Ladner Village Physiotherapy has three physiotherapists and a massage therapist. We take pride in offering specialized services such as pelvic floor physiotherapy and vestibular rehab.”

But there is more to us than just that. So as we prepare to re-open the clinic after being away for two months I would like to give you the inside scoop and re-introduce the real us. The “us” you might not know about at first glance. What random experiences have we had that could help us treat you better? One physio might be a better fit for you than others (for example if you horseback ride see Nicole, if you rock climb see Stephanie, and so on). Of course if you are ever wondering who to see our lovely front desk staff will be able to point you in the right direction. But, here is some insight into what we have to offer.

So who are we?

Devon

Devon is one of the owners of Ladner Village Physiotherapy. She has two young girls and is a lover of board games, skiing and ultimate frisbee. She would cut off her right arm to travel around the world and is usually planning her next adventure. Devon is our resident vestibular rehabilitation guru and is always up to date on current events.

Who should see Devon?

• Concussion clients - Devon can help with many aspects of concussion and runs a concussion circuit every Friday morning. It’s filled with all kinds of fun things - obstable courses, puzzles, balance exercises and things that involve a lot of post its and lasers. She’s always having fun with them!

• Vestibular clients - Do you spin when you wake up in the morning or lie down at night? Does the world move a little more than it should? Diagnosed with BPPV, Menieres or labrynthitis? Feeling off balance? Devon will pick you up and plunk you back on solid ground. She educates you extensively (be careful about asking her questions, she gets very excited and will start talking about neurotransmitters) about what is going on and what you can do about it. You can be confident that Devon is providing you with excellent care.

• Ankles - Devon has more experience than most when it comes to ankle injuries and she will gladly help you on the road to recovery with your own injury.

• Gardeners - Gardening is hard! There is bending and lifting and twisting and reaching. Devon is here to make sure you don’t hurt yourself while you enjoy your yard.

Stephanie

Stephanie is cheery and lovely and has the cutest little pup you ever did see. But what you might not know is that she is also probably the most hardcore out of the group (competitive rock climber!!), does yoga and paddle boarding and is a published author! She an an incredible thirst for knowledge and is constantly learning more about her craft.

Who would be great to see Stephanie?

• Rotator cuff issues - Stephanie is the one for you. She will get that rotator cuff behaving like no other. Just imagine being able to lie on your side again or put a jacket on without worrying which hand you put in first! Heaven.

• Rock Climbers - Stephanie is small and mighty and an excellent rock climber. She is there to make sure your body is ready to handle that dyno you’ve been dying to try.

• Skaters – fun fact, Stephanie used to teach skating lessons, which is more than Devon and Nicole can say (Nicole still stops by running into the boards, Devon usually just falls). So, hockey players and ice dancers alike, if you need some help with your skating mechanics, she is the physio for you!

• Dizziness and imbalance - As a sufferer herself, Stephanie has an intimate understanding of how vestibular issues can affect your life. She is here to help you with your symptoms and help you get your life back!

Nicole

Nicole is also an owner at Ladner Village Physiotherapy. She grew up in Ladner and still lives here with her family. She loves any activity that involves fresh air (picnics included) and wants to know all about you, your favourite hiking spots and your best chocolate cake recipes. In her “previous pre-child life” Nicole also played soccer and did some horseback riding! Please tell her stories about your horses so she can live vicariously through you.

Who should see Nicole?

• “Mom stuff” - Nicole is the resident pelvic floor therapist. This means you can talk to her about absolutely anything including, but not limited to: posture when breastfeeding, how to carry your baby in an ergo without hurting your back, exercise during pregnancy, exercise after baby, accidental urine leakage, prolapse, painful intercourse and everything in-between. If it’s pregnancy or baby-related she has got your back and will not rest until you are feeling AWESOME.

• Runners - Although Nicole refers to herself as a “jogger” rather than runner, she has a few half marathons under her belt and can help you with your training, your gait, and treat your overuse injuries to get you back on the road.

• Baseball/softball players - Nicole played competitive softball for MANY years (as a catcher). She understands throwing and batting mechanics, plus she wants to hear all about the epic double play from last game.

• Pelvic Floor Dysfunction - Pelvic pain? Accidental leakage of urine or feces? Prolapse? Nicole is there for you. She can help. The biggest thing she hears is “why didn’t I know about this sooner.”

What do we love about our clinic?

• Sessions are one on one. They always have been, they always will be. You will never be “juggled.” We know your time is important and you don’t want an appointment to take up a huge chunk of your day. Your time slot is yours and we are dedicated to you completely during that time.

• The physical space. We spent a long time designing the space to be exactly what we needed. Private treatment rooms, a super long hallway, you name it we planned it that way and we are so thrilled with it.

• Our clients. This is our community. We live here, we work here, some of us grew up here. We could not be more thankful for our fantastic clients who make coming to work such a pleasure.

• Technology is our friend. All of our equipment is up to date and we are constantly buying new equipment to keep up our learning and training (coming soon- a virtual reality system for Devon’s vestibular clients).

• We are constantly learning. The best part about our field of health care is that it is constantly evolving. We get very excited about the courses we take to further our education within our chosen niche and we take the time to train each other and practice our techniques. We strive to be our best so we can be confident that you have received the best care that is highly skilled and evidence based.

For our returning clients, we cannot wait to see you again! If you’ve never been here before, we’d love to meet you! Give us a call at (778) 630-8800 or email us at clinic@ladnervillagephysio.com to book your next appointment.

See you soon!

Injury Prevention in Running - Part 3: Strength Training

Nicole Coffey, one of the owners of Ladner Village Physiotherapy, is a life long runner with several half marathons under her belt. This blog is the final instalment in a three part series on common running injuries and how to prevent them. Enjoy!

The sun is shining, the grass is green, and it’s a great day for a run!

The gyms are closed and options for exercise are more limited these days. As a result, more and more people have been lacing up and pounding the pavement, which is awesome if you ask me. But (and there is always a but) the cold hard truth is that running comes with a 50% injury rate. My last few blogs (Part 1 and Part 2) have covered some common misconceptions people have about preventing running injuries as well as some of the most common training errors I see in my clients who are injured (see below for a quick review). Let’s now focus on what you CAN do to prevent running injuries.

Do you remember being in high school and the teacher would say “this will be on the test- if you only remember one thing, remember this.” Well, dear reader, this is the take home message. There IS something you can do. It’s not a nutritional supplement that magically makes you bigger/faster/stronger (but if you ever find one of those let me know okay?). It’s not stretching for 20 minutes per day (even though you’ll be extra flexible), and it’s not buying a fancy new treadmill or a new running outfit (although those do sound snazzy).

The answer is strength training!

Many runners I know avoid the gym at all costs. They worry they’ll get too bulky and heavy and it will slow them down, or they think if they go into the gym they will hurt themselves and it will negatively impact their running. But this is not what the research shows. The research shows that strength training is one of the best things you can do to increase running performance and decrease running injuries. For maximum benefit and impact on running strength training should account for 20% of your training.  

Strength training has several benefits for runners:

1. Increased running economy

2. Increased running power output

3. Prolonged point of exhaustion

4. Reduced risk of overuse injuries

What kind of strengthening should you be doing?

• Lift heavy weights. That means doing exercises such as squats, calf raises, farmer’s carry and deadlifts at 60-80% of your maximum effort will give you more benefit than doing more reps at lower weights.

• Plyometrics and other explosive exercises such as lunges, jumping and hopping.

How often should you strength train?

One or twice per week is good. Because the strength training is done at such high load and intensity you only need to do it twice per week during your “off season” or “training season.” When in “race season” strength can be well maintained with only one session per week as long as the intensity is correct (in addition to your running of course).

What else do I need to know?

• Don’t go nuts. Technique here is still critically important. If you have never done weighted resistance exercise before you need to learn proper technique before you start loading up the barbells. If you don’t know how to do these exercises get someone who is qualified to teach you. Youtube is not your friend here.

• Be ready. This is also assuming you don’t already have a pre-existing injury. If you do, get help with it and rehab correctly before implementing new aspects to your training program.

Lifting heavy loads and doing explosive exercises can help increase muscular strength, making you a stronger and more efficient runner with less chance of overuse injury.

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“Uhhhhh You’re forgetting something Nicole, I can’t go to the gym right now because of a little thing called COVID-19.”

I know that right now you don’t have access to a full gym and weight rack right now, BUT exercises like:

• single leg jumping

• hopping

• lunges

require no extra equipment and can definitely be incorporated into your routine at home right now. Once restrictions have been lifted we can all get back to the gym.

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Looking for the other instalments? Check out Part 1 - Running Volume and Part 2 - Footstrike! Here’s what we have learned so far:

Common Mistakes:

1. Increasing volume too quickly, resulting in overuse injury

2. Putting too much emphasis on stretching, which does not reduce overuse injury rates

3. Trying to make yourself a “mid-foot striker” when you are naturally a “heel-striker”

What Can You Do To Decrease Injury:

1. Increase volume by no more than 10% per week (includes distance AND intensity)

2. Increase cadence by no more than 10% (aim for 160-180 steps per minute)

3. Re-allocate some of the time you spend stretching and focus on strengthening instead.

Happy running everybody - enjoy the sunshine! 

As always, if you have an injury that you would like assessed or if you need assistance with technique please call our clinic at (778) 630-8800 and we will be happy to help! 

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References:

1. Beattie, K., Kenny, I. C., Lyons, M., & Carson, B. P. (2014). The effect of strength training on performance in endurance athletes. Sports Medicine, 44(6), 845-865

2. Berryman, N., Mujika, I. Strength Training for Middle – and Long-distance Performance: A Meta-Analysis in International Journal of Sports Physiologiy and Performance. 2017:13: 57-64

3. Blagrove RC, Howatson G, Hayes PR Effects of Strength Training on the Physiological Determinants of Middle- and Long-Distance Running Performance: A Systematic Review. Sports Med. 2018 May;48(5):1117-1149. doi: 10.1007/s40279-017-0835-7.

4. Lauersen J, Bertelsen DM, Andersen LB (2014) The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials British Journal of Sports Medicine 2014;48:871-877

5. Mikkola J, Vesterinen V, Taipale R, Capostagno B, Häkkinen K, Nummela A (2011) Effect of resistance training regimens on treadmill running and neuromuscular performance in recreational endurance runners, Journal of Sports Sciences, 29:13, 1359-1371

Injury Prevention in Running - Part 2: Foot Strike

Nicole Coffey, one of the owners of Ladner Village Physiotherapy, is a life long runner with several half marathons under her belt. This blog is the second instalment in a three part series on common running injuries and how to prevent them. Enjoy!

In a continuation from my last blog, here are a few more commonly misunderstood running topics. Hopefully they save you some time and some pain. As always, if you have any questions about your specific running style or gait please feel free to contact the clinic for an assessment with one of our physiotherapists!

Heel Strike vs Midfoot or Forefoot Strike

This debate came to the forefront quite some time ago when the minimalist shoe fad hit town. And yes, it’s true that people with a heel strike have a higher chance of knee pain (1). BUT: those who have a mid-foot strike have an equal and proportionate risk of Achilles and calf injuries (2), so it’s one or the other, one is not superior.

The “evil heel-strike theory” was based on the concept that landing on your heel meant you were increasing your “braking force” as the ground reaction force pushed back at you (in the opposite direction that you were travelling) and therefore you would have to work harder to overcome that. Turns out that isn’t true!

There is no difference in the efficiency of running for a heel strike vs. a midfoot strike.

Also worth noting, if you happen to be a rear-foot striker and you try to change yourself to a mid-foot striker you increase your chance of injury to your calf and Achilles pain (3) So, run the way you run. The majority of people prefer a heel strike. A heel strike is not the devil it was once made out to be, and if you try to change your gait pattern you are probably doing yourself more of a disservice. Time to focus your energy on more helpful techniques.

Cadence 

This is one topic people don’t often think to ask me, but I feel like it’s worth noting. Should you pay attention to your cadence? My answer to this one is “yes, it couldn’t hurt.”

Cadence is the number of steps you take in one minute. An elite runner will run about 180 steps per minute, efficient recreational runners should aim for 160-170 steps per minute. Increasing cadence can indeed decrease some risk of knee pain.  This is because a slower cadence means you are taking longer steps, which means you are spending more time in the air and actually travel a little higher, which means you are landing harder and from a higher height.  This heavier landing puts extra strain and impact on your joints.  “Subtle increases in step rate can substantially reduce the loading to the hip and knee joints during running and may prove beneficial in the prevention and treatment of common running-related injuries.” (3).  

Also note that taking faster steps does not mean you have to run faster. You can still run a 6 minute mile or a 10 minute mile, the difference is if you are taking big huge long slow strides vs tiny quick little steps.

“Calm brain fast feet” - I’m not sure where that saying is from but I really like it.

Once again, remember that any change must be implemented gradually. If you increase your cadence by more than 10% you decrease running efficiency, which means you are going to work harder and get tired more quickly, which is not the point.

Happy running everybody! Next up we will talk about the role of stretching and foam rolling for runners!

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Looking for the other instalments? Check out Part 1 - Running Volume and Part 3 - Strength Training!

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References:

1. Heiderscheit, B. C., Chumanov, E. S., Michalski, M. P., Wille, C. M., & Ryan, M. B. (2011). Effects of step rate manipulation on joint mechanics during running. Medicine and science in sports and exercise, 43(2), 296–302. doi:10.1249/MSS.0b013e3181ebedf4 

2. Kulmala, et. Al (2013). Forefoot Strikers Exhibit Lower Running-Induced Knee Loading than Rearfoot Strikers. Medicine and science in sports and exercise. N=19

3.  Lyte et al. (2016). Effects of Foot Strike an Step Frequency on Achilles Tendon Stress During Running. Journal of Applied Biomechanics 32:4