Cognition and Vestibular Disorders - So Much Brain Fog!

Anyone who’s had any kind of vestibular dysfunction knows this simple fact: your brain leaves you. It’s like someone has taken out the best parts of your brain and replaced it with air. You cannot pay attention or multi-task, things are more confusing and memory has taken a vacation. Yet somehow it feels like your brain is working overtime.

As someone who has experienced this, I can tell you first hand it is one of the most frustrating parts of vestibular dysfunction - the feeling of stupid. There’s no other way to describe it.

You just feel dumb.

Luckily, we finally have that research that shows what vertigo sufferers have known for years - it DOES affect our cognition! It DOES affect more than just our sense of balance! Vestibular dysfunction affects so many different parts of the brain involved in cognition.

When we talk about the vestibular system, we usually just think of the snail-looking thing in the inner ear - the semicircular canals and vestibule that make up the vestibular end organ. What we don’t usually discuss is where this information goes - and let me tell you, it goes far and wide. The brain lights up like a Christmas tree on an MRI when stimulated with vestibular input. There are projections to the hippocampus, thalamus, parietal cortex, the cerebellum, the midbrain… I could go on!

When you boil it all down, the vestibular system is directly involved in four main cognitive processes:

1. Memory - short term memory is especially impaired with vestibular dysfunction.

2. Attention - those with vestibular dysfunction show difficulty both with staying on task as well as accuracy with the task at hand.

3. Executive Function - the planning, organizing and prioritizing part of your brain is heavily influenced by the vestibular system. This is why those with vestibular dysfunction have so much difficulty multi-tasking!

4. Spatial Navigation - this is the brain’s ability to digest and manipulate information in 2D and 3D. You use this skill when reading a map or manipulating shapes to go into a puzzle.

These four areas are crucial to functioning in our world. It’s so difficult to get the kids to school, get yourself to work, figure out what’s for dinner and remember that dentist appointment when your vestibular system is throwing wrenches into the system. While your brain recovers, it’s important to use some strategies (and not beat yourself up about temporarily needing them!):

• Write It Down - Whatever it is, get it in writing. Put it in a calendar, jot down a list or put that post-it somewhere easy to see. If you don’t have a system, now is the time to create one! If you’re not one for technology, get an old-fashioned agenda and take that thing with your everywhere. If you’re like me and attached to your phone, use it to your advantage by using the reminder and alarm functions.

• Take Brain Breaks - A great way to encourage attention is to give yourself scheduled breaks, preferably with some physical activity involved. Set an alarm for a period time - when that alarm goes off, get up and away from the task at hand. Do a quick set of yoga, dance in the kitchen or go for a brisk walk. Whatever it is, move your body!

• Remove Visual Distractions - Not only does a busy environment have a negative effect on focus, symptoms of vestibular dysfunction are often triggered by busy visual fields. Do yourself a favour and create a calm, relaxing space free of clutter.

Vestibular dysfunction doesn’t just affect your ears and vestibular rehabilitation doesn’t just help your balance. The right approach to rehabilitation will challenge your entire brain (aka neuroplasticity - never heard of it? Check out our blog on neuroplasticity). The challenge should always be hard for you - not impossible but outside your comfort zone. Symptoms should be triggered and then brought back down.

If you have any questions about vestibular rehabilitation, feel free to contact us through email or phone us at (778) 630-8800. If you would like to book an appointment, you can do so online.

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.

Ask A Physio (COVID Edition): Why Is My Dizziness Worse?

The unexpected effects of COVID seem to be never ending. From toilet paper shortages to Clorox winning the stock market, we are living in a reality none of us could have predicted. It was impossible to buy yeast for months -that’s weird!

A big unexpected effect for me and my vestibular clients has been a sharp increase in dizziness. Almost daily, I'm seeing clients from months and years past saying the same thing:

My symptoms are coming back and I don’t know why.

Here’s my break down of why I think this is occurring and what you can do to combat it.

The success of vestibular rehabilitation relies on three key components:

1. Appropriate exercises that target the right problems - when working with someone with a vestibular disorder, it’s important to zero in on the cause of the problems and give the right exercises (learn more about that here).

2. Getting enough activity and stimulation to keep everything firing - it’s the classic 'Use It or Lose It’. For any brain to learn and retain anything, it needs to be used. This is one of the principles behind neuroplasticity (learn more about that here).

3. Managing stress and fatigue - these two things are the biggest inducers of vestibular symptoms. When stress or fatigue increase, symptoms typically aren’t far behind.

For most people, this pandemic has thrown two of the three components right in the trash. Stress is way up and activity levels are way down. Since the beginning of the year, there’s been a well documented rise in stress, anxiety and depression in the general population. This has spilled over into every area of our lives including the vestibular system. Combine that with less movement in our days - no exercise classes, working from home and staring at a screen for waaaaay longer than normal - and you have a recipe for a vestibular disaster.

So how do you combat this? How can you avoid this system crash?

1. Get outside. For your brain to be happy and stimulated, you need unpredictable stimuli. You need to see the birds swooping in the air and the cars driving by you. You need to navigate curbs, potholes and other people. You need to get outside the four walls of your home and let your brain experience something else.

2. Try something new. I know this is hard to do in a pandemic, but there are lots of pandemic-friendly activities that are also great for your vestibular system. Online exercise classes, diving headfirst into more complex recipes in the kitchen and dragging your bike out of the garage for a 10 km ride are all great ways to give your brain a real work out.

3. Go for a walk with a friend. This is very much a Dr. Bonnie Henry-approved activity and a great one for your vestibular system. Not only will it help you lower your stress levels but the activity of turning your head to talk to your friend as you walk is a great vestibular exercise!

4. Meditate. The research behind mindfulness practice and meditation is staggering in its breadth. It has been shown to decrease the symptoms of anxiety and depression, lower blood pressure, improve sleep, help control pain and improve quality of life. If you’re not sure how to get on the meditation train, guided meditations are a great starting point - you can find several on Youtube or through apps like Calm and Headspace.

5. Practice your vestibular exercises. If you’re a client of ours, you likely have a maintenance program you were given on your last day with the instructions to practice them three times per week. If you’ve fallen off the vestibular exercise wagon, it’s time to climb back on.

6. Get the right help. If your symptoms are skyrocketing, reach out! It may be that a vestibular therapist is the right person for you or it may be a counselor or psychologist is your best bet. A conversation with your family doctor is also a great place to start.

Whatever the reason for your symptom increase, know these two things: you are not alone and there are things that can help get your symptoms back under control. Reach out to us at (778) 630-8800 or by email. Through in person or virtual appointments, we are here to help!

Meet Trevor!

Trevor Reid is our latest addition to the clinic and we are thrilled to have him! Originally from Langley, Trevor’s passion for physiotherapy may only be rivaled with his love of all things aviation. Learn more about Trevor below!

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

I’m an aviation and space fanatic, I spend countless hours reading about aviation and space in my spare time. I plan on obtaining my pilot’s licence within a few years!

When did you decide you wanted to be a physio?

I decided to pursue physio in high school as my favourite classes were always PE and biology. Therefore, physio was the perfect career for me as it allowed me to work in a field that combined my interest in physical activity and science. Additionally, I have spent many hours attending physiotherapy from various injuries throughout my life. These experiences motivated me to pursue such a rewarding career.

Which sports are you into?

I enjoy weightlifting, soccer, and hockey, but football is my favourite to watch!

Where did you grow up?

I grew up in Langley and only just recently moved to Vancouver.  

What is your favourite orthopaedic condition to treat?

My favourite orthopedic condition to treat is shoulder pain. Specifically, I enjoy treating impingement syndrome. The shoulder is an amazing region of the body and it typically responds very well to physiotherapy intervention!

What makes you happiest?

Travelling! I think my next trip will be somewhere in Europe! 

LIGHTNING ROUND!!!!!

Cats or dogs? Dogs

Favourite food? Salmon Sushi

Favourite dessert: Tuxedo cake

Favourite Junk food: Ben and Jerry’s half-baked ice cream

Beach or mountains: Mountains

Favourite colour: Red

Favourite music: Country music

Favorite day of the week? Saturday

Nickname? Trev

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

Favorite holiday? Christmas

How long does it take you to get ready? 15 minutes

Invisibility or super strength? Invisibility

Is it wrong for a vegetarian to eat animal crackers? Frowned upon

Dawn or dusk? Dawn, I wake up at 6:30-7am every morning

Do you snore? No

Place you most want to travel? Normandy beaches in France

Last Halloween costume? Bottle of ketchup 

Favorite number? 16

Have you ever worn socks with sandals? Noooo

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

Would you want to live forever? No, 115 years seems long enough for me

What's for dinner tonight? Steak, rice and veggies

Meet Hamraj!

Some of you will recognize Hamraj Sidhu from his time with us as a physiotherapy student. We are so excited he has decided to join our little clinic! Read more about Hamraj below including why physiotherapy was his calling and how he may be able to get you an “in” with the British Royal Family.

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

In 2011, I sat with The Duke & Duchess of Cambridge, Prince William and Kate (as well as Prime Minister Steven Harper, the Governor General and more) during the opening ceremony of the Calgary Stampede.

When did you decide you wanted to be a physio?

I always knew I wanted to be in health care but did not know exactly what field. It wasn’t until the end of my second year of university when I began to work at a physiotherapy clinic as a Kinesiology co-op student that I really developed a passion for the profession. After this experience, I spent the remaining two years of my undergraduate degree taking additional courses such as advanced Human Anatomy and Physiology, Sports Injuries and Prevention, and more to help further my interest and knowledge.

Which sports are you into?

Basketball and rugby. I developed a passion for basketball at a young age and was involved in multiple clubs and organizations that travelled to compete. Rugby was a second sport that I enjoyed a lot! I developed a lot of friendships and life skills through sport.

Where did you grow up?

I grew up in a small town of 5,000-6,000 people called Mackenzie in Northern BC. Snow would last up to 8 months there!

What is your favourite orthopaedic condition to treat?

Anything to do with the shoulder! I just find the shoulder complex extremely fascinating with all the different joints involved and areas to look at that can contribute to someone’s symptoms.

What makes you happiest?

Being with family and friends! I also really enjoy my fitness routine at the gym because that it my 1-2 hours where I can completely turn off my brain from everything.

LIGHTNING ROUND!!!!!

Cats or dogs? Dogs

Favourite food? Pizza

Favourite dessert: Chocolate cake

Favourite Junk food: Chips

Beach or mountains: Mountains

Favourite colour: Blue

Favourite music: R&B + Hip hop (and a mix of other genre)

Favourite day of the week? Saturday

Nickname? Hamu

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

Favourite holiday? Christmas

How long does it take you to get ready? 15-20 minutes

Invisibility or super strength? Invisibility

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

Dawn or dusk? Dusk

Do you snore? Apparently I do sometimes?

Place you most want to travel? Greece

Last Halloween costume? Solar system

Favourite number? 23

Have you ever worn socks with sandals? Yes, definitely

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

Would you want to live forever? Vancouver, we have everything here!

What's for dinner tonight? Fettuccine Alfredo

Meet Anh!

Hailing from the Northern coast of British Columbia, Anh Duong brings a wealth of dance expertise to our clinic. Learn all about what makes Anh tick and why we are so excited for her to join us!

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

I did not learn how to ride a bike until I was 23 years old. Our family was never the outdoorsy type and my parents just never saw the need for me to learn. Luckily I have awesome, and very patient friends.  

When did you decide you wanted to be a physio?

Growing up as a dancer I’ve always had an interest in how the body moves. I also grew up in a family that values health and wellness. During my first year at university, I took an anatomy course and fell in love. I thought to myself, “how do I combine my values around health and well-being, my passion for dance, and my newfound love for anatomy all into one?” and physiotherapy was the answer. 

Which sports are you into?

Dance! I’ve trained in ballet, jazz, tap, contemporary, modern, hip hop, and acrobatics. I also recently started playing tennis but I’m just happy if I can get the ball over the net.

Where did you grow up?

Prince Rupert BC, the rainiest city in Canada.

What is your favourite orthopaedic condition to treat?

Hips, ankles and feet, all of which I, myself, have had problems with in the past.

What makes you happiest?

I am happiest in the dance studio. But may also be caught smiling when eating delicious food with family and friends.

LIGHTNING ROUND!!!!!

Cats or dogs? Dogs

Favourite food? Sushi

Favourite dessert: Crumbled apple pie, the crumble is a must!

Favourite Junk food: Nachos

Beach or mountains: Beach

Favourite colour: Rose gold

Favourite music: R&B

Favorite day of the week? Saturday

Nickname? Just Anh

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

Favorite holiday? Lunar New Year

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

Invisibility or super strength? Invisibility

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

Dawn or dusk? Dawn

Do you snore? Don’t think so

Place you most want to travel? Japan, South America, Rome   

Last Halloween costume? A basketball player.

Favorite number? 9

Have you ever worn socks with sandals? This should be a crime

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

Would you want to live forever? Nope

What's for dinner tonight? Butter Chicken

What Is A Pessary?

Nicole Coffey is our resident pelvic health guru and expert on all things related. Read as Nicole answers a Q& A about what exactly a pessary is and who could benefit from one.

What is a pessary? I get this question a lot.

A pessary is an internal vaginal support device typically made of medical grade silicone. They are generally used by women who experience bothersome symptoms from prolapse (when one or more of the abdominal organs including the bladder, uterus or rectum descend and decrease the space within the vaginal canal - find more information in my earlier blogs Part 1: What is Prolapse? and Part 2: I Have A Prolapse! Now What?). This can lead to symptoms such as vaginal heaviness, pressure, a sensation that something is “up there”, or noticing tissue protruding from your body. There might also be bladder and bowel symptoms such as incomplete emptying. Pessaries can also be used to treat urinary stress incontinence, which is accidental urine leakage with activities such as coughing, sneezing, jumping, running, and so on. The pessary acts like an internal shelf to hold the organs up, keeping them away from the entrance of the vagina.

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Typical Pelvic Floor Anatomy

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Uterine Prolapse

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Inserted Pessary

For some people, surgery is an option. For people who do not want to have surgery or who are not surgical candidates, a pessary can be a fantastic option for treatment. (For the record, pelvic floor exercises are also awesome and can help as well, but we are talking about pessaries today).  

So what holds people back? Pessaries can be intimidating. But have no fear, I am here to show you that they aren’t so bad after all!

Take a look at the most common questions I get about pessaries:

1.       Do they hurt?

No! The best thing about a pessary is when it is inserted you can’t feel the pessary and you can’t feel your prolapse! This is why they are so magical. Some women who have a history of vaginal pain (such as pain with intercourse and tampon use) might have discomfort while inserting and removing the pessary. Other women report an initial discomfort when inserting and removing the pessary until they get the hang of it but the majority of users report no pain.  If you do feel pain when inserting and removing the pessary and you are post-menopausal you might benefit from vaginal estrogen cream (this is an excellent conversation to have with your doctor).

2.       Are they hard to get in and out?

Not really. Some styles are trickier than others and require a little bit of skill, but with a little bit of practice you will be a pro at managing your pessary.

3.       When do I wear it?

This is mostly up to you. Some women only wear their pessaries during high intensity exercise. Some women insert it every morning and remove it every night. Others wear theirs for 3-5 days at a time. If a gynaecologist fits you with a pessary there is an option to wear it for longer periods (up to 3 months at a time), but this again is a conversation to have with your specialist.

4.       Can I have intercourse when I am wearing my pessary?

Usually no. There are some types (ring pessaries) that would allow for penetrative vaginal intercourse, but the majority of pessaries need to be removed for intercourse.

5.       How soon after having my baby can I be fit with a pessary?

I personally do not fit people with pessaries before 12 weeks post-partum because your body is still healing and changing. I also do not fit people who are currently pregnant. Again, if you see a gynaecologist they will be able to work with you in these situations as needed.

6.       I don’t have prolapse but I leak urine, can I still use a pessary?

If you leak urine due to stress incontinence (coughing, running, jumping, etc.), a pessary absolutely can help. It will probably just be a slightly different type and you likely will only have to wear it at times that you leak such as while at the gym. A pessary will not help with urge incontinence (leaking due to a very sudden and strong urge to pee).

7.       How do I know what size and type I need?

This one is unfortunately a little tricky. Fitting a pessary is a combination of experience, art, and some trial and error. During your appointment I discuss with you which type of pessary I think would be best for you to try first and why. Then we proceed to try a few different sizes and shapes as needed until the perfect one is found. Sometimes this happens right away and sometimes it takes a few tries. It might take more than one appointment but it is worth it in the end to have a pessary that fits properly.

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If you have any further questions about pessaries or would like to book a pessary fitting, book online, send us an email at clinic@ladnervillagephysio.com or give us a call at (778) 630-8800.

Motion Sensitivity - Part 2: Top Ten Exercises!

Stephanie Yip is one of our vestibular therapists here at Ladner Village Physiotherapy. In Part 2 of her two part series on motion sensitivity, Stephanie gives some great exercise options for motion desensitization.

If you read my last blog post on what motion sensitivity is, and have now realized that this is what has been plaguing your existence, do not fret! Like I emphasized in my last post, this does not have to be your reality! I am here to share with you 10 easy exercises that you can start doing today to finally get over your motion sensitivity! 

Before we start, here are some disclaimers:

1. As mentioned, motion sensitivity rehabilitation DOES require triggering those icky symptoms. I know, so not fun. However, we only want to trigger mild symptoms that resolve within 3-5 minutes. Therefore, it’s really important that for all of these exercises, you start at a small enough dose that you aren’t making yourself sick for the next several hours. This may mean just trying the exercise for 15 seconds to start, and then gradually increasing the amount of time you expose yourself to the stimulus.

2. Motion sensitivity exercises work best when individualized to the person. You’ve probably already realized that the way you experience motion sickness is very different from your friends. Some people get really sick riding elevators/escalators but have no issues in the car. Others can’t stand being a passenger in a car, but have never had any issues with those spinny rides at amusement parks. In order for your motion sensitivity rehab to be optimal, the exercises you do should be as similar to your personal triggers as possible. Since this is just a generalized list of exercises, you may find that some of them do nothing for you, while others may make you feel awful.

With this in mind, here are some great ideas of motion sensitivity exercises that are easy to fit in to your day-to-day life!

My Top 10 Motion Sensitivity Exercises

1) Look out the side window of your car next time you’re the passenger

If you are one of my fellow car sick sufferers, you have probably noticed that you feel a lot better if you sit in the front seat and look straight ahead. This is because when you are looking straight ahead, your visual and vestibular systems are in agreement and saying the same thing. On the flip side, if you look out the side window, your visual system is seeing all sorts of quickly moving trees and street poles making you feel like you’re moving while your vestibular system is telling the brain you’re just sitting in your car; a mismatch that creates the icky feeling you get. It may not feel great, but if you start with just 15-30 seconds of looking out the side window, then resume looking straight ahead, settle your symptoms, and repeat – you’ll gradually increase your tolerance until sitting in the backseat will no longer be impossible. All your tall friends will love you for it!   

2) Play on the swing set

Next time your kids beg you to push them on the swings, see if you can take a turn on the swings instead! The world around you will blur as you swing through, really messing with your visual system, and really helping you with your rehab!

3) Go on the see saw

Since you’re already at the playground, having a blast on the swings, why not take a whirl at the see saw? This exercise is particularly helpful for those of you who get a horrible lurch in the stomach every time you take the elevator, aka those who can’t stand vertical motion.

4) Play some Mario-Kart or any other video game with a lot of looking around

Ever tried playing a first-person shooter game, tried to look around while walking forward and just felt queasy? If yes, and you need an excuse to play some video games guilt-free, you can now tell the world that you’re actually training your vestibular system and being very productive.

5) Watch the clouds while you walk

Do this one responsibly and do check that your coast is clear first! As you walk, your vestibular system will be telling your brain that you are moving forward, but the clouds floating about will be telling your visual system something totally different. Use this mismatch to your advantage and get training.

6) Log roll down a hill

This one is pretty self-explanatory and is definitely for those looking for an advanced level exercise. Be warned – go slow with this one and build up gradually.

7) Read while walking, as a passenger in the car, in a hammock or while sitting in a rocking chair

If you’re focused on non-moving words on a page, your visual system won’t be able to correlate with the vestibular system which is telling your brain you’re moving. You can adjust how much you move to make this one easier or harder.

8) Play some focused catch

If you watch a ball being thrown very closely, keeping the ball in focus the whole time, the background behind the ball will be both blurry and moving. This can confuse your brain and bring on those feelings of motion sickness.

9) Do some eyes closed yoga or t’ai chi

You wouldn’t expect something as simple as yoga or t’ai chi to really amp up your motion sickness. If you’re a regular yogi or t’ai chi practitioner, this is often a really nice way to slowly start tackling those gross feelings. When you take away your vision and add some movement, your brain really has to work overtime to figure out where you are!

10) Do some chair spins

That office chair you spend most of your day in? Give it a good twirl every once in awhile! Not only can this one be done quickly, you likely can do it a LOT throughout the day without too much effort.

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What are your favourite exercises to combat motion sickness? Add some ideas in the comments below!

If you’re suffering from motion sickness, we can help - book online, send us an email or give us a call at (778) 630-8800.

Knee Arthritis 101: The Basics

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

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

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

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

Today we will be discussing osteoarthritis of the knee.

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

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

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

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

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

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

Let me say this loud and clear:

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

Let’s look at a classic scenario.

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

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

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

What happens next? 

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

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

It also doesn’t have to be this way. 

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

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

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

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

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

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

What causes the pain in knee arthritis?

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

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

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

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

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

Remember:

• Not everyone with OA has these issues.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ask A Physio: Any Tips for Mouse Finger Pain?

So I don’t know about you, but COVID has certainly pushed me to using my computer a lot more. A. Lot. More. My body is feeling it, too - my neck is stiffer than it was, my hands are tired and my shoulders make a lot of noise after a long session on the computer.

We know that prolonged postures of any kind - standing in one spot, sitting still - aren’t great for anyone. Our bodies are for movement and all too often we get stuck in postures for hours at a time. When that prolonged posture is on the computer, that finger and wrist pain is often directly related to the position of the neck and shoulder as much as it is the wrist and hand.

So what should you do? The best thing you can do is set an alarm for 30 minutes and make a point of moving and stretching your body. If you have two minutes (or less!), this movement and stretching routine can help combat the stiffness and soreness associated with prolonged computer use.

Without further ado, presenting:

Top Ten Exercises for Computer-Related Pain

1. Shake it out! - I love a good shake - who doesn’t? Sit up straight, take your wrists and hands and give them a good shake, letting your fingers fly.

2. Chin to chest - Something we often forget is how much posture contributes to pain further down the chain. Sit up straight and tuck your chin into your chest, feeling a stretch down the back of your neck. Hold this for 10ish seconds.

3. Ear to shoulder, then a twist - Still sitting up straight, lean your ear to your shoulder and hold it for about 10 seconds. Then twist your head so your nose gets closer to your armpit; hold this for another 10 seconds. Repeat on the other side.

4. Shoulder rolls - Still sitting up straight (are you sensing a theme yet??), roll your shoulders up to your ears then squeezing them back and down, pushing your shoulder blades as far down your back as you can. Bring your shoulders forward then back up to your ears. Do this 5 times.

5. Wrist stretch - Stretch your right arm in front of you and bend your wrist and fingers back. Use your left hand to pull your right fingers further back, feeling a stretch in your forearm. Hold for 10ish seconds and repeat on the other side.

6. Prayer stretch - Place your hands together in a prayer position in front of your chin. Lower your hands down, keeping your palms together and feeling a stretch in your forearms. Hold for 10ish seconds.

7. Finger stretch - Place all your finger tips together - think Mr. Burns from the Simpsons - and push your fingers together. Keep your fingers together and pull your palms away from each other. Stretch your thumbs away from your other fingers. Feel a stretch for 10ish seconds.

8. Wrist circles - Draw circles with your wrists! 5 in one direction, 5 in the other.

9. Hand fist and open - Squeeze your hands into tight fists for a few seconds. Then stretch your hands out wide, reaching your fingers out as far as you can for a few seconds. Repeat 5 times.

10. Finish this off with a final shake!

Looking for a print out of this program? Here it is in PDF form, with pictures!

The better you support your body with proper ergonomics (see our previous two ergonomic blogs here and here) and frequent movement breaks, the less likely you’ll suffer from computer related pain. So set that alarm, stretch it out and stay pain free!

As always, if you would like to book an assessment with one of our fabulous physiotherapists or our amazing massage therapist, give us a call at (778) 630-8800 or email us at clinic@ladnervillagephysio.com.

Finally - do you have a burning question one of our physiotherapists can answer? If you’d like to #askaphysio, we would love to answer!

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.

The Rotator Cuff

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

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

What is the rotator cuff?

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

What does the rotator cuff do?

The rotator cuff has 4 main jobs:

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

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

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

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

How do you injure your rotator cuff?

There are two main ways people injure their rotator cuffs:

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

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

Once it’s injured, how do you fix it?

There are two main keys to shoulder rehabilitation:

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

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

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

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

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

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!

How Do We Learn? Neuroplasticity, Of Course!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Happy learning!

Have An Empty Wine Bottle Lying Around?

So I know we’re all in the same boat here. We’ve been staying home for over a month, which has probably included a lot of vegging out, binge-watching old movies, and baking more cookies than we could ever eat. We think about working out but gyms are closed, and it’s just so hard to get motivated for a home workout. Then you check your phone and see Nicole’s blog telling you it’s time to start strength training. What to do??

Don’t worry, I am here to help! All you need is one wine bottle (and don’t tell me you haven’t consumed at least ONE bottle of wine!). Fun fact: an average empty wine bottle weighs about 2.5lbs – personally my preferred dumbbell! Got your wine bottle? Let’s get started!

Here are 5 exercises that YOU can do AT HOME with just one empty WINE BOTTLE! This is a full body workout and has both easier and harder variations so no matter where you’re at in your fitness journey, this workout is for you!

Exercise #1: Triceps Curls in a Bridge

Lie on your back with your knees bent. Lift your hips up into a bridge position. Bring your arms up so that they are directly over your shoulders with the wine bottle held horizontally between both hands. Bend your elbows so that the wine bottle goes towards your head – but don’t let it hit your head!

Easier variation: Take out the bridge and just do the triceps curls!

Harder variation: Make it a single leg bridge!

Exercise #2: Biceps Curls in a Wall Sit

Position yourself with your back to the wall like you are sitting in a chair, knees bent to around 90 degrees. Grab the wine bottle with both hands and bend and straighten your arms while keeping the elbows tucked at your side.

Easier variation: Take out the wall sit and just do the biceps curls! Or drop that wine bottle! (gently)

Harder variation: Extend out one leg at a time!

Exercise #3: Side Plank Star

Get into a side plank, on your forearms or on your hands, you pick…just make sure you’re engaging all of those lovely shoulder muscles so your shoulder is not collapsing down! Grab that wine bottle and hold it up in the air.

Easier variation: Plank on your knees, drop that wine bottle and put your hand on your waist!

Harder variation: Wrap the wine bottle under your body and back up into the air (just like the picture on the right)!

Exercise #4: Wine Weighted Lunges

Grab that wine bottle with both hands and lunge one foot forward, dropping the back leg down so that your knee is bent to around 90 degrees. Step back and do the other side.

Easier variation: Drop the wine bottle. You can even use your free hands to now hold on to a chair for support!

Harder variation: Add a rotation with the wine bottle towards the side of the lunging foot with each lunge. Pulse it out at the bottom of the lunge. Do some walking lunges. So many options!

Exercise #5: Wine Weighted Side Stepping Squats

Grab the wine bottle and get into your best squat – you got it, able to see and wiggle your toes! Now step to the side while staying in your squat. Don’t forget to change directions!

Easier variation: Just squat, forget about the side steps. Do mini squats if you don’t want to get down low.

Harder variation: Add in some overhead presses with the wine bottle as you side step!

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Want to make this a full blown, 30-minute total body workout? Just do each of the above exercises for 1 minute and take a 1 minute break after exercise #5…Then repeat 5 times!

For those of you looking for a bonus challenge…Do this workout with a FULL wine bottle, and then pour some out to celebrate when your 30 minutes is over.

As always, to book an (online!) appointment, give us a call at (778) 630-8800, email us or visit us at ladnervillagephysio.com.

I don’t know what you’re waiting for – happy workout! 

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

Ergonomics: The At Home Edition

So you’ve found yourself working from home all of a sudden. Kids are underfoot, you don’t have a proper office or even a desk to claim for yourself and the online video meetings seem to be endless. Chances are, you’ve had to improvise. Maybe you’ve been waking up, staying in your PJs, and curling up in bed with your laptop. Or maybe you find yourself sitting cross legged on the couch, laptop down on the coffee table.

I saw an article recently compiling “unglamourous” photos of people’s at home workstations. There were photos of people balancing their laptops on recycling bins, using ironing boards in their bathrooms – there are definitely some very creative people out there. This may have all been fine for the first couple of days, but now that it’s been a few weeks, I’m guessing you’ve probably started noticing some new aches and pains that only seem to appear after a day working from home. Is your neck starting to throb? Low back feeling angry?

The good news is, that doesn’t have to be your new reality! And no, you don’t need to order the fanciest ergonomic chair, or that automatic sit-stand desk! The great news is that even if you don’t have access to a desk at all, there are simple ways that you can make your own ergonomic work station at home, using things you probably already own!

Why Is An Ergonomic Set Up So Important?

Let’s start by quickly reviewing why an ergonomic set up is important at all. You’ve probably already noticed that your body doesn’t react well to sitting cross legged with your body hunched over, neck curled down while you work on your laptop for 5 hours. But why is that?

First of all, our bodies were not designed to be in any one static posture for hours on end, so even if you are in a so-called “perfect ergonomic set up” it is still very important that you change your position and take moving breaks regularly. But when we are in a prolonged poor posture, the effects are worsened as some muscles remain in a shortened position while others are overly stretched. Therefore, we want to remain in a relatively neutral position. (For more information, check out our previous blog on the physics behind ergonomics.)

How do you do that? Focus on these three things:

1. Screen Height: The top line of your screen should be just around eye level or slightly below and within arm’s reach so that your neck can remain in a neutral position rather than constantly looking down or craning forward. If you don’t have an external monitor you can adjust, you can stack books under your laptop or monitor until you attain the correct height. Don’t have a ton of books? You could use an upside down laundry hamper, tupperware, shoe boxes, old boardgames - the options are endless!

2. Keyboard and Mouse: If you are using a laptop, the keyboard height may now be too high for your wrists/arms. This is where getting an external keyboard and mouse can be so pivotal. While external monitors are often quite pricey, an affordable keyboard and mouse are much easier to find. You can now set up the keyboard and mouse in a way that your wrists are not curled up or down, with your elbow bent at around 90-100 degrees by your side, and arms supported. The position of your keyboard/mouse should also be close enough to you that you are not having to reach to use them.

3. Chair Set Up: If you’re going to be sitting, you want your hips and knees to be bent to around 100-120 degrees, with your feet supported – no dangling feet! Find a box, books, anything that can support your feet while maintaining a height that will allow the above set up to happen. You can also use a rolled up towel or small cushion to support your lower back, and maintain your natural lumbar curve.

Change Your Position Frequently

So now that you know the basics of how to set up your work station ergonomically, you can change it up, while maintaining the essentials. This is important as the best posture is a changing posture. This means you can stand or walk on the spot while working, while maintaining all of the above elements. And if you don’t want to have to keep adjusting your work station, take short but frequent stretch breaks (every 30 minutes or so). Get up and do a quick lap of your room, move your neck, do a few lunges.

Some Big No-Nos

• Clutter: If there’s a lot of clutter under your work area, there won’t be any space for your legs and feet to sit comfortably. If there’s a lot of clutter around your work area, you’ll be constantly reaching over things to get to what you need, resulting in unnecessary repetitive strain. Place what you need close by, and remove what you don’t need.

• Poor Lighting: Glare, or light reflected off of your work surfaces into your eyes, can be not only irritating, but can also result in more aches and pains if you end up in a poor posture trying to avoid the glare, or leaning to see your work better. To avoid this, position yourself so that you are either sitting beside or parallel to the window, and between lights in your room. If you have overhead lighting, make sure your screen is at a right angle to the work surface.

And there you have it - easy and simple ways you can make working from home way easier on your body. And most importantly...don’t forget to keep moving! Check out our blog on fun ways you can keep moving while in quarantine.

Looking for some individualized tips to tweak your own at home workstation? We are here for you! Book online, email us at clinic@ladnervillagephysio.com or call us at (778) 630-8800.

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RESOURCE LINKS:

1. WorkSafeBC [Internet]. Worksafebc.com. 2018 [cited 7 April 2020]. Available from: https://www.worksafebc.com/en/resources/health-safety/books-guides/how-to-make-your-computer-workstation-fit-you?lang=en&origin=s&returnurl=https%3A%2F%2Fwww.worksafebc.com%2Fen%2Fforms-resources%23q%3Dcomputer%2520workstation%26sort%3Drelevancy

2. Office Ergonomics: Practical solutions for a safer workplace [Internet]. Lni.wa.gov. 1995 [cited 7 April 2020]. Available from: https://www.lni.wa.gov/IPUB/417-133-000.pdf

Stretching!

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

Touché dear client, touché.

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

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

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

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

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

When Is Stretching Is Not Helpful?

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

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

When Is Stretching Great?

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

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

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

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

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

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

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

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

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

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

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

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

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

Happy stretching!

Quarantined? Keep Moving!

If you’re anything like me, the world is an anxiety-producing place right now. Every company I have ever given my email to is sending me their COVID-19 updates. I understand why but it’s not helping my mind calm down.

There is a huge body of research showing how exercise helps with a whole assortment of mental health conditions. As gyms, pools and public spaces shut down, several companies are stepping up and offering their services online, often for free.

Down Dog owns a series of online apps, all of which they are providing for free during the COVID-19 outbreak, helping people to stay as healthy as they can in their own homes. You can find their apps on iOS or Android. Here’s what they do:

• Down Dog Yoga - yoga from home! You can chose your practice type (restorative, flow, hatha, gentle, etc), your level (Beginner 1 on up) and how long you want your practice to be.

• Yoga For Beginners - completely useless at yoga? Try this one!

• HIIT Workouts - for something more intense, try this one. Again, you can choose your level of difficulty, your focus (total body? arm workout or glutes?) and how long you want to go for. The best part? NO EQUIPMENT REQUIRED. Just turn it on and GO.

• 7 Minute Workout - same idea as HIIT with a little bit less intensity. And hey, who can’t give 7 minutes a day for a little sweat?

• Barre Workouts - are you caught up in the barre obsession? This is a great way to get at home! I’ll probably break this one out with my kids too - they’ll love practicing their ballerina moves. Once again, it’s the same idea - pick your focus and your time, then go for it!

The Washingtonian, an online publication out of the states, published a list of fitness studios offering their classes (some for free!) by online stream. Take a look and see what strikes your fancy. They’ll also be updating their list as the days go on.

One of my favourite meditation apps is Headspace, available on iOS and Android. In response to the outbreak, they have created a “Weathering the Storm” category with free meditations, sleep stories and more! If meditation is something you’ve been meaning to get into, now is definitely the time and Headspace is a great way to get started.

Finally, one of my favourite home exercises is an oldie but a goodie: Twister with my kids. The pretzels I twist myself into are certainly a good workout!

As of March 16, 2020, the biggest rule is social distancing. That leaves all kinds of things available for us - a lovely bike ride on the dyke! Walking among the tidal flats at Centennial Beach! Going for a jog in the gorgeous sunshine! Get outside for now and stay moving for the long haul.

Do you have a favourite website, app or idea for this outbreak? Let us know and we will add it to the list!

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As always, if you’d like to book in with a physiotherapist, give us a shout at (778) 630-8800 or clinic@ladnervillagephysio.com. We are also now offering Telehealth services for those unable to come in person.