My Feet Roll In - Do I Need Orthotics?

The term “rolling in” or overpronation refers to an alignment issue in the foot and ankle where the foot collapses towards the inside which tends to flatten the arch of the foot. Overpronation is a common issue in the general population but more prevalent in dancers by nature of the demand of the sport on the feet.

If left untreated, rolling in of the feet and ankle can cause secondary problems including:

• bunions (due to excessive pressure on the big toe)

• plantar fasciitis

• shin splints

• overuse injuries of muscles and tendons on the inside aspect of the foot and ankle

• pain on the inside aspect of the knee

An orthotic is a medical appliance that is inserted into the shoe and can help lift the inner aspect of the foot into proper alignment. Orthotics can be purchased over the counter or custom made by a pedorthist or podiatrist. Although a useful tool, they may not be necessary for all dancers experiencing rolling of the feet.

How do I know if I need orthotics or not?
My favourite answer… it depends.

For dancers, one of the biggest things to consider is whether the dancer’s foot rolls in when they are standing casually (or in parallel), or is it ONLY when they are standing in turnout. Let’s look at two different scenarios.

1. Rolling in ONLY when standing in turnout but NOT in parallel.

Rolling in at the feet ONLY when standing in a turned out position may be caused by excessive cranking at the knees and feet to achieve turnout. Dancers with poor strength and control of the turnout muscles in the hip will often overcompensate at the knee, ankle and foot, which puts a lot of pressure on the inner aspects of these joints. In this scenario, foot alignment can be corrected by training proper turnout at the hips. For these individuals, orthotics may not be necessary.

2. Rolling of the feet while standing in parallel AND in turnout.

Rolling of the feet with casual standing or standing in parallel may be indicative of other underlying issues such as weak intrinsic foot muscles, poor walking/running/jumping mechanics, ankle/foot instability, or other knee or hip issues causing compensation at the foot.

For these individuals, an orthotic in their everyday shoes may be needed to help realign the foot and provide symptom relief. However, orthotics must be accompanied with exercise to treat the underlying issue and strengthen muscles of the foot. The stronger the foot muscles are, the better the foot can support itself without the use of the orthotic.

NOTE: Currently, there are no over the counter orthotics that fit in dance shoes, which emphasizes the need to strengthen the muscles to support the foot while dancing.

In summary, rolling in or overpronation of the feet can often be corrected through appropriate strengthening and conditioning. Orthotics are a great tool for realigning the foot and providing symptoms relief but are not a replacement for exercise.

If you are a dancer experiencing rolling feet or want to learn more about addressing rolling in feet, book with Anh online or give us a call at (778) 630-8800. 

Neck & Back Pain - Part 2: Strengthening Exercises

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

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

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

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

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

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

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

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

Kheya’s Top Five Strengthening Exercises

1) Toe taps 

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

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

2) Bridges

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

Complete 8-12 reps for 2-3 sets.

3) Bird dog

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

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

4) Chin tucks 

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

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

5) Back rows

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

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

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

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

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

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

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

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

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

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

But first, a review of spinal anatomy…

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

• cervical spine - 7 vertebrae that make up the neck

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

• lumbar spine - 5 vertebrae of the low back

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

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

The spine has three main jobs:

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

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

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

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

Kheya’s Top Five Mobility and Stretching Exercises

The Mobility Exercises

What is it:

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

1)      Thoracic spine openers

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

Repeat 5-10 times per side.

2)      Lumbar rotation

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

Repeat this movement 10 times for 2-3 sets.

3)      Cat cow

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

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

The Stretches

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

1)      Childs pose

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

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

2)      Knee hugs

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

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

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

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

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

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. 

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.