Top Ten Targets of Shockwave Therapy

Shockwave therapy has rapidly gained popularity in physiotherapy for its non-invasive and effective treatment of a whole host of conditions. By utilizing acoustic waves, shockwave therapy enhances tissue healing, reduces pain, and promotes recovery in many chronic conditions.

Wondering if shockwave is for you? Here are the top 10 conditions treated by shockwave therapy:

Top Ten Targets of Shockwave Therapy

1. Plantar Fasciitis

One of the most common causes of heel pain, plantar fasciitis occurs when the thick band of tissue connecting your heel to your toes becomes inflamed. Patients with plantar fasciitis often experience stabbing pain, particularly after periods of rest. Shockwave therapy is effective in breaking up the scar tissue and calcifications that may form in the plantar fascia, stimulating healing and reducing pain. It also promotes blood flow to the affected area, speeding up recovery and reducing inflammation.

2. Achilles Tendinopathy

Achilles tendinopathy (aka Achilles tendinitis) is typically caused by overuse or repetitive stress. Athletes, runners, and individuals with a high level of physical activity are particularly prone to this condition. Shockwave therapy helps by promoting the growth of new blood vessels (angiogenesis), increasing collagen production, and stimulating tissue regeneration. This allows for faster healing of the damaged tendon, while also reducing pain and inflammation.

3. Rotator Cuff Tendinitis

The rotator cuff is a group of muscles and tendons that surround the shoulder joint. Inflammation or degeneration of these tendons can lead to rotator cuff tendinitis, causing significant shoulder pain and restricted movement. Shockwave therapy has shown remarkable results in treating this condition by stimulating tendon repair, improving blood flow, and accelerating the regeneration of damaged tissue. It can also help break down calcific deposits in cases of calcific tendinitis.

4. Tennis Elbow (Lateral Epicondylitis)

Also known as lateral epicondylitis, tennis elbow is a painful condition that occurs when the tendons in the elbow are overloaded, often by repetitive motions. Shockwave therapy works by targeting the affected area, reducing inflammation, and promoting collagen production. This aids in the repair of damaged tissue, helping individuals return to their daily activities with reduced pain and improved functionality.

5. Golfer’s Elbow (Medial Epicondylitis)

Similar to tennis elbow but affecting the inner side of the elbow, golfer’s elbow (medial epicondylitis) causes pain and tenderness due to overuse of the forearm muscles. Shockwave therapy is effective in breaking down scar tissue, promoting tissue healing, and reducing inflammation. It helps patients regain strength and mobility, making it easier to perform both daily tasks and sports activities.

6. Patellar Tendinopathy (Jumper’s Knee)

Patellar tendinopathy, also known as jumper’s knee, is a condition commonly seen in athletes involved in jumping sports such as basketball and volleyball. It involves the degeneration of the patellar tendon, leading to pain and limited movement in the knee. Shockwave therapy stimulates collagen production and enhances blood flow, which helps to repair the damaged tendon and reduce pain.

7. Calcific Tendinopathy

Calcific tendinopathy occurs when calcium deposits form within a tendon, most commonly in the shoulder. This condition can cause significant pain and restrict movement. Shockwave therapy is particularly effective for calcific tendinopathy as it helps break down the calcifications, reducing pain and restoring mobility. It also stimulates the body's natural healing process, allowing for long-term relief from symptoms.

8. Myofascial Pain Syndrome

Myofascial pain syndrome is a chronic pain condition that affects the muscles and the fascia (connective tissue around the muscles). It is characterized by trigger points—tight, painful knots that form in muscles. Shockwave therapy helps to relax muscle tension and deactivate these trigger points, providing relief from pain and improving muscle function. This is especially helpful for individuals dealing with long-standing muscle stiffness and discomfort.

9. Chronic Low Back Pain

Chronic low back pain can result from a variety of conditions, including muscle strain, disc degeneration, or inflammation. Shockwave therapy can be used as part of a comprehensive treatment plan for chronic low back pain, helping to reduce pain by increasing blood flow to the affected area and promoting tissue regeneration. It also aids in breaking the cycle of chronic inflammation, allowing for long-term improvements in mobility and comfort.

10. De Quervain’s Tenosynovitis

De Quervain’s tenosynovitis is a painful condition affecting the tendons on the thumb side of the wrist. Repetitive motions such as gripping, grasping, or lifting can aggravate the condition. Shockwave therapy is effective in reducing inflammation, breaking down scar tissue, and stimulating the healing process in the affected tendons. It offers a non-invasive option for pain relief and improved wrist function, helping patients return to normal daily activities.

The Power of Shockwave Therapy

Shockwave therapy is particularly useful for chronic conditions, where traditional treatment methods may have failed or provided only temporary relief. By addressing the underlying causes of tissue damage, inflammation, and pain, shockwave therapy can provide long-lasting benefits, making it an attractive option for those seeking non-surgical interventions.

If you’re suffering from any of the conditions listed above, or if you’re curious whether shockwave therapy could be the solution for you, consider consulting with a physiotherapist trained in this advanced technique. The potential to relieve pain, improve function, and get you back to doing the things you love is just a shockwave away.

Ready to book? Book online, email us or give us a call at (778) 630-8800.

Pain: A Rant

If you haven’t heard, Nicole Coffey has been doing a deep dive into pain science with Neil Pearson, a physiotherapist who is an internationally recognized expert is pain science. And let me tell you: Nicole has thoughts about how we treat people in pain. Buckle up for this one!

I need to rant:  It should not be the responsibility for a person in pain to have to convince anybody that they are, indeed, in pain.

When did we stop believing people? When did someone saying “that hurts” not become enough for us? How do we expect people to prove that they are in pain? How miserable do they have to be before we believe them? Do we sympathize more if the pain is more intense? How intense is “intense enough” to warrant treatment? What if they pain lasts a long time? Do we feel more sorry for them or less? Where is the distinction between “poor you, it really sucks, that’s been bothering you for a while” versus “It’s been going on forever, surely you should be over it by now”?

I wanted to write about this because as a physiotherapist I run into this issue so often. I see people in pain who have to convince others about the legitimacy of their pain. Sometimes it’s a skeptical family member, sometimes it’s a health professional, and sometimes it’s insurance companies. Insurers do not love paying for “invisible conditions” and because pain is hard to measure, clients do not have a lot of traditional or mainstream quantitative data to demonstrate evidence of their illness. People in pain often cannot point to an MRI or blood test results for an explanation of why they are no longer able to fully function in their lives the way so many other people with chronic health conditions can.

Measuring Pain

Why is it hard to measure acute (short term) and chronic (long term) pain? One factor is because the experience of pain often depends a lot on context. Two people can be exposed to the same painful stimulus and still have two very different experiences.

Let’s use a simple example of trying to hold your hand in a bucket of ice water for as long as possible. If one person said the pain was 5/10 and one person said their pain was 7/10, would we ever say that one person is correct while the other is wrong?

Pain is a unique experience, and it is impacted by a multitude of factors including:

• previous experiences

• social and emotional factors

• sounds

• visual information

• and so much more

How much pain can be influenced by numerous factors is a huge topic which I will try to tackle another day, but for now can we suffice it to say that two different humans with different backgrounds, different beliefs, different amounts of stress, different amounts of anxiety, different physical abilities, different knowledge backgrounds (and so on and so forth) could very plausibly interpret any situation differently from each other.

Maybe one person takes ice baths every day and is used to extreme shocking cold, maybe one person has a history of severe frost bite and almost lost some fingers a few years ago so now they are extra cautious around cold. Maybe one person has calloused hands. Maybe one person had a huge fight with their spouse the night before and didn’t sleep well and is feeling irritable and upset. Maybe one person practices meditation and can separate out the emotions and panic that accompanies the feelings of cold more than the other participant.

Regardless of any of these things, would we ever say that their reported experience is wrong? Or could we maybe just trust the participant gave any honest answer about how much pain they experienced in that moment.

Maybe we could just believe them.

The Insurance Conundrum

Let me dive into the topic of insurance for a second. Because frequently when my clients are being told that they are lying, exaggerating, malingering, or whatever other term is thrown around, it’s often from the insurance adjustor who is giving justification for denying a claim or refusing to pay for treatment. I have witnessed too many times the panic and desperation people experience when dealing with insurance companies, especially when a claim is denied.

A claim being denied does several things:

• It invalidates the person’s experience and insinuates that they are catastrophizing

• it increases their mental load (they now have to appeal again and go see another doctor and another specialist hoping someone will believe them enough to fight for them)

• it strains them financially beyond belief.

Too many people attempt to go back to work earlier than they are able because they can no longer afford to stay at home and seek treatment. Would they love to try a knee brace? Of course, but they can’t afford it. Would they love to see if dry needling helps their neck? Of course, but they have run out of benefits and can’t take time off work to come to a physio appointment.

To take it further, people often underestimate the social impacts on those who experience chronic pain are swept up battling their insurance trying to justify coverage. Again and again, clients are forced to absorb the responsibility of self advocating to the detriment to other aspects of their lives in order to justify their coverage or else they quickly run out of options.

Story Time

I remember so clearly a client of mine in tears because she had to transport herself downtown to see yet another doctor (for the third time, only to be told once again that nothing could be done for her, but it had been 6 months since her last specialist visit so it was mandatory that she go otherwise her benefits would be cut off). She was in so much pain and so exhausted from that unnecessary outing that she no longer had the capacity to attend a very important family event that night.

She was absolutely shattered. She wasn’t even angry, she was just defeated. She told her family that she was fine but she wouldn’t be able to make it because she was tired. She told them not to worry and go on with the celebration without her. She told them maybe she will see them the next time they are in the country. This is what she told her family. She said she was fine.

She wasn’t fine.

She was suffering not only from her physical pain but also the mental/emotional aspect of feeling as if she had disappointed her family, while she herself was disappointed because she had been so excited to see her loved ones.

I’m not a mental health professional but I really feel that being with her family and helping them celebrate would have been so good for her mental health, but instead once again “like a wounded cat that just wants to hide”, she was left alone in her “black pit of pain” (client’s words). This upsetting experience could have been avoided completely had she not mandated to expend every ounce of her energy going to that unnecessary doctor’s appointment.

I know the next thought of many people is…. But what if they are faking it? What if they just want time off work? Maybe it’s not as bad as they say it is. They seemed okay when I saw them for a coffee date?

I would answer that most people want to feel good. Most people want to work and exercise and spend time with their families. Most people want to decrease their amount of suffering. They probably used every ounce of their energy to show up for that coffee date you had, and it would naïve of you to assume that how they present themselves in one hour of the day is representative for the other 23 hours of the day let alone the rest of the week. Also, I don’t think you get to decide how they feel.

A Thought Experiment

Do an exercise with me and think about a time that you were in extreme pain. For me this was childbirth and when my appendix was about to rupture. Even in those extreme situations I had the benefit of knowing that my pain was temporary and would come to an end. Many people do not have that luxury. Could I have lived with that pain 24/7? Was I able to hold a logical conversation during those times? What words would I use to describe that pain to a friend or a healthcare professional to paint an accurate picture of that situation? If I had been experiencing the same amount of pain but I did not know the reason I was in pain, how unsettling would it feel knowing that that overwhelming pain could return at any time and last for any duration without warning?

How invalidating would it be for a random man to say “Meh, I don’t think childbirth is that bad, I think you’re exaggerating”? I would be infuriated that someone who never in a million years could experience what I had experienced felt entitled to bestow judgment on my recollection of events.

Taking it further, what if that random person’s opinion affected the outcome of an insurance claim and I lost coverage because someone who works at a company has decided it’s probably “not that bad”? How much would I resent this as I had to cancel my children’s extra-curricular activities because I could now no longer afford them? What effect would that have on my mental health? On my marriage? I very quickly realized that if I had chronic pain I too would be automatically labeled a “catastrophizer.”

So the next time you have lunch with someone who suffers with chronic pain and you leave thinking “they seem fine they had a great time” remember that:

• you probably saw them on a good day

• they used every ounce of energy to try to show up and be with you (be honoured)

• if they do open up about some of their struggles and difficulties, please believe them that they are giving an accurate account of their lived experience.

Invalidating them does nothing helpful.

When in doubt be kind.

Rant over, thank you for listening.  

Low Back Pain in Dancers and Gymnasts

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

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

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

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

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

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

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

What do spondylolysis and spondylolisthesis feel like?

Athletes will often complain of the following:

• Dull pain that can be sharp with movement

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

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

• Symptoms that are worse with activity and better with rest

How is it diagnosed?

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

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

How do we treat it?

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

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

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

Top Ten: Backpack Tips

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

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

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

Top Ten Backpack Wearing Tips for Back To School:

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

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

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

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

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

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

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

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

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

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

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

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

Ask A Physio: When Can I Go Back To Sport After An Ankle Sprain?

Ankle injuries are one of the most common acute injuries we see, especially amongst athletes. Pretty much everybody who has played a sport has sprained an ankle before, leading to a lot of people minimizing the injury and not taking it seriously.

There is often pressure from coaches (and ourselves!) to make a quick return to sport because “it’s just an ankle sprain.” Just because ankle sprains are common does not make them insignificant. We know that only about half of people who experience an ankle sprain seek help. We also know that up to ONE THIRD of individuals experience chronic ankle instability after an ankle sprain.

It is in your best interest to handle ankle sprains correctly. Otherwise, they come back to bite you again and again.

Below is a list of factors that physiotherapists consider while gradually returning you to your activity of choice. It’s not just about going back to practice and taking it easy for a day or two then going to play a game next week. In the clinic we test and re-test all of these aspects and gradually help people progress up to their top level of functioning.

If you want to manage your sprain yourself you absolutely can, especially it’s not your first time and you know what to expect. But please know that going back too soon is a really good way to get re-injured and everything that is listed below is relevant no matter who is doing your rehab.

(Looking for what to do immediately after an ankle sprain? Read our Top Ten Tips for Acutely Sprained Ankles in our blog!)

Factors to Consider in Ankle Sprain Rehab:

Pain:

• Do you have any pain?

• Does it hurt while exercising or afterwards?

• How intense is the pain and where is the location?

• How long after the pain starts will it subside and return to baseline?

Swelling:

• Is there swelling?

• Is it old or new swelling?

• How does the swelling fluctuate with activity?

Physical Aspects:  

• Does your ankle move in all directions as well as the other foot?

• Is the strength equal in all directions?

• How is the endurance?

• What about the power?

• How about your sensorimotor control - do you have complete proprioception back (a fancy word for knowing where your body is in space)?

• Is your balance as good on that side?

• How about your dynamic control - can you maintain stability and balance while moving and doing other things?

• Do you need a brace? Which kind of brace? When should you wear the brace? Can you wean off of the brace?

Mindset:

• How do you feel about your ankle?

• Are you confident that it will be fine?

• Do you feel that your ankle is stable?

• Are you psychologically ready to go back?

• In contact sports, does the thought of someone checking you from behind make you nervous?

Functional and sport performance:

• Can you hop? Jump? Change directions?

• Can you jog? Run? Sprint? Run a gentle curve? Cut to the side? Slam to a stop?

• What about things specific to your sport? For example if you are a soccer player can you pass? Receive a pass? Shoot? Tackle?

• Are you fast enough to react to another player?

• Can you do all the drills in practice? What about a scrimmage?

We want you to be able to do all of these things and do them well before you fully return to your sport. It’s a long list to consider and not always easy to answer every question, but it’s important to run through this list and make sure you are really ready to return to sport.

If you suffer with ankle sprains, get it checked out by a physiotherapist - we are the experts at this! We are always happy to see you and will do our best to get you back out there as soon and as safely as possible.

Need to book an appointment? Book online, send us an email or call us at (778) 630-8800. Happy healing!

Ask A Physio: How Can I Get Rid Of My Sciatica?

We’ve all heard of sciatica - that awful, weird pain that runs down the back of your leg. It’s often fairly vague pain and hard to pinpoint but there’s no mistaking its presence.

Lately, we have seen a serious uptick in clients complaining of sciatica and its good friend, low back pain. So, what is sciatica and what exactly can we do about it?

What Is Sciatica?

Sciatica refers to in irritation of the sciatic nerve which runs down the back side of your leg and innervates the hamstrings and all the muscles below the knee. The sciatic nerve is HUGE - about the width of your thumb! It passes through, around and beside some major structures including the spine as well as the glutes and piriformis in the buttocks.

The classic profile of someone with sciatic-related pain can include:

• Pain in the low back that radiates down the back of the leg, described as anything from dull and achy to sharp, burning or electrical

• Tingling and/or numbness in the lower spine, buttock, back of thigh, calf and/or foot

• Increase in pain with certain postures - often sitting with the legs stretched out or driving a car is terrible, but standing, walking or lying down eases pain

• Electrical and/or shock-like pain down the back of the leg

• In extreme cases, weakness of the muscles in the lower leg and hamstrings

Usually, the pain is just on one side as it’s only one nerve that’s affected, not both at the same time.

How Do We Treat It?

At the root of it, sciatica is a symptom, not a diagnosis. When the sciatic nerve is pressed on or irritated by other structures, sciatic pain is the result.

Before addressing the sciatica itself, we need to figure out what’s causing the pressure on the sciatic nerve in the first place. The likely candidates include:

1. Herniated Disc - the nerve roots that exit the spinal cord to form the sciatic nerve can be compressed by a herniated disc, leading to sciatic pain. This is the most common cause of sciatica.

2. Spinal Stenosis - literally meaning “narrowing”, stenosis occurs when the tunnel of bone that allows the nerve roots to escape shrink, often by bone spurs or a loss of disc height.

3. Arthritis - When arthritis hits the spine, it usually leads to bone spurs around the exiting nerve roots, similar to stenosis.

4. Pelvic and/or SI Joint Hypermobilities - most of the muscles that lie over and around the sciatic nerve are attached to some point of the pelvis. When the pelvis is moving more than it should, these muscles often tighten down to try and stabilize the pelvis. When this occurs, an unintended consequence is pressure on the sciatic nerve. Pregnant women with sciatica: this is likely you!

5. Piriformis tightness - this deep muscle lies right over the sciatic nerve. If it’s too tight, it can squeeze the sciatic nerve.

The treatment approach is defined by the source of the sciatic nerve irritation. Is the problem at the spine? Is it a muscle imbalance or spasm causing the problem?

We see a lot of “one size fits all” fixes for sciatica online. These often don’t work because the root problem isn’t identified and addressed. If your sciatic pain isn’t going away, your best bet is to be assessed by your medical practitioner and figure out what’s driving your sciatica.

My Sciatica Is Gone! How Can I Prevent It From Coming Back?

There are loads of ways to keep sciatica at bay! The top tips:

• Stay active - Look at all those causes of sciatica listed above. All of them benefit from exercise - strengthening, stretching, MOVING. In fact, one of the biggest risk factors for sciatica is prolonged sitting. So if you don’t want sciatica, move more!

• Maintain a healthy weight - a normal weight keeps your spine healthier with less disc pressure and a lower chance of degenerative changes, both of which contribute to sciatic pain.

• Sit properly - I’m talking feet on the floor, bum at the back of your chair with a lumbar support properly. Not sure what that looks like? Check out our blog on proper ergonomics.

• Strengthen your core - A strong core means a supported spine and pelvis, preventing sciatic nerve compression.

• Use good body mechanics - Considering a disc injury is the leading cause of sciatica, protect those discs! Lift with your legs and try to not twist as you lift a heavy load. Hold those heavy loads close to your body and find a friend if it’s really heavy.

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If you’re dealing with low back or sciatic pain, give us a call at (778) 630-8800 or book online.

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.

Chronic Pain

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

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

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

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

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

There is no “set” pain response.

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

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

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

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

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

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

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

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

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

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

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

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

Chronic pain is not “all in your head”.

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

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

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

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

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

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

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

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

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