Shockwave Therapy: A Game Changer!

It’s finally here! Our BTL Shockwave has arrived and we cannot wait to start using it! .

Never heard of shockwave? Let’s dive into the depths of this groundbreaking treatment and explore how shockwave may help you on your journey through recovery.

Shockwave’s Effect on Tissues

Shockwave therapy involves the application of acoustic waves to targeted areas of the body, creating a cascade of biological responses that stimulate healing. This non-invasive and high-intensity treatment has several benefits:

1. Enhanced Blood Flow
   The acoustic waves trigger increased blood circulation, promoting the delivery of oxygen and nutrients to the injured or affected area. Shockwave also causes release of specific growth factors leading to angiogenesis (aka blood vessel growth). This encourages more capillaries to grow in the targeted area.

2. Tissue Regeneration & Tendon Repair
   Shockwave therapy stimulates the production of collagen, a crucial protein for tissue repair. Evidence suggests shockwave stimulates proliferation of fibroblasts, the cells responsible for making collagen. This promotes the regeneration of damaged tissues, aiding in the restoration of normal function.

3. Pain Reduction
   By targeting pain receptors and interfering with the transmission of pain signals, shockwave therapy provides relief for individuals grappling with chronic pain conditions. It also decreases the amount of Substance P in the targeted tissues, a well known pain neurotransmitter. Shockwave is a welcome alternative for those seeking a non-pharmacological approach to pain management.

4. Reversal of Chronic Inflammation
   Chronic inflammation can be thought of an inflammatory reaction that gets stuck in a cycle of heightened inflammation. Shockwave therapy breaks this cycle by increasing the activity of mast cells, leading to a reboot of the inflammatory cycle and allowing tissues to return to a non-inflammatory state.

5. Muscle Relaxation
   If the thought of needles and IMS makes you feel queasy, shockwave is a great alternative. By targeting trigger points, shockwave can help decrease muscle stiffness and spasticity, leading to more flexible and relaxed muscles.

Conditions Treated with Shockwave Therapy

Shockwave therapy has been shown to have lasting effects across a variety of conditions, including:

• Tendinitis and Tendinopathies: Achilles tendinopathy, rotator cuff tendinitis, tennis elbow and other tendon-related issues.

• Plantar Fasciitis: A common cause of heel pain, often alleviated with shockwave therapy.

• Muscle Injuries & Tightness: Long-standing strains and tears, tight hamstrings and sore traps.

• Calcific Shoulder Tendinopathy: Helping to break down calcifications in the shoulder.

• Stubborn Hands & Wrists: Dequarvain’s and carpal tunnel syndrome respond well to shockwave therapy.

• Chronic Pain Conditions: Myofascial pain syndrome and chronic low back pain, to name a few.

Shockwave therapy is best for chronic conditions. If you are suffering an acute injury (for instance, a fresh ankle sprain that’s swollen and painful at rest, or a new whiplash), shockwave isn’t for you quite yet.

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If you’re ready to try shockwave, give us a call! To book an appointment, book online, email us at clinic@ladnervillagephysio.com or phone us at (778) 630-8800.

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Looking for some resources for the claims above? Here’s a great review article from Adam Tenforde & colleagues, published in 2022: Best practices for extracorporeal shockwave therapy in musculoskeletal medicine: Clinical application and training consideration.

Meet Aman!

You may recognize Aman Bassi, Interim Physiotherapist, from his time with us in the spring. Aman has officially joined our team, bringing a wealth of knowledge from his Bachelor of Science in Cell Biology at SFU (just watch him and Devon get really excited about microtubules!) and his Master in Physical Therapy from UBC. He has a passion for science and evidence-based approaches and loves a good soccer game. Learn more about Aman below including why he will fight you for the remote on Sunday mornings…

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

Something totally random about me is that I have a collection of 4K-Blu Ray movies and am constantly adding to my ever growing collection of super high definition movies.

When did you decide you wanted to be a physiotherapist?

Studying cellular biology, I learned that life itself is an amazing phenomenon. Being in a profession where I can help people get back to their everyday lives, while also being in a field that relies on science to progress, gives me a reason to get up in the morning.

Which sports are you into?

Football (European and American) – Big Manchester United Fan who also will sit in front of the television all day for NFL Sunday.

Where did you grow up?

I grew up in Surrey!  

What is your favourite orthopaedic condition to treat?

Post Surgical Rotator Cuffs because it allows me to use a wide variety of exercises and manual therapy techniques to treat it.

What makes you happiest?

A cup of coffee in my hand in the morning watching Manchester United beat Liverpool.

LIGHTNING ROUND!!!!!

Cats or dogs? Dogs!

Favourite food? I am a very simple man, pizza and chicken wings.

Favourite dessert: strawberry cheesecake

Favourite Junk food: CHIPS (I consider myself a potato chip connoisseur)

Beach or mountains: Mountains

Favourite colour: A deep purple

Favourite music: Vivaldi’s Spring 1 recomposed by Max Richter

Favorite day of the week? Saturday

Nickname? My Last name Bassi would be the name my friends use

Would you rather be able to speak every language in the world or be able to talk to animals? Talk to animals because I can’t google translate a bark

Favorite holiday? Christmas!

How long does it take you to get ready? To put my clothes on? 47 seconds. To decide what to wear? 47 days.

Invisibility or super strength? Invisibility

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

Dawn or dusk? The quiet of dawn

Do you snore? Thankfully not

Place you most want to travel? Petra, Jordan (because they shot Indiana jones there). Also Hogwarts.

Last Halloween costume? It’s been a while. I think a clown?

Favorite number? #4

Have you ever worn socks with sandals? Yes but they have to be slides

Would you rather cuddle with a baby panda or a baby penguin? Penguin because I grew up with Pingu

Would you want to live forever? No, what makes moments great sometimes, is the fact that we never get them back again.

What's for dinner tonight? Chicken and Vegetables (like I said, I am a simple man)

Meet Chan!

If you didn’t see Chantal Simak, Interim Physiotherapist, running around the clinic in the spring, you missed out! Chan joins our team next week, bringing their effervescent and enthusiastic energy to the clinic. Their passion for all things rehab is obvious to anyone watching and we are so excited to have them! Learn more about Chan below including why we all should be trying to get to their house for dinner…

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

I wouldn’t say this is totally random; however, being a part of the LGBTQIA2+ community is a very important aspect of my life. I deeply care about helping and learning how to encourage more conversations about ways to create a more inclusive healthcare environment. I aspire to build a community, collaborating with like-minded allied healthcare professionals who are ready to be active advocates for the LGBTQIA2+ community.

When did you decide you wanted to be a physiotherapist?

I had a mentor who was my soccer coach for the last 2 years of high school.  He was a brilliant Kinesiologist, who weaved his knowledge of exercise physiology and anatomy into the game of soccer. I not only became a better player and teammate because of these interconnections, but I also gained an appreciation for human anatomy and physiology. From then on, I shadowed some highly regarded physiotherapists in the area and quickly realized that physiotherapy is a profession where I can shine. I would have the opportunity to socialize all day, build meaningful relationships and cheer people on for every single accomplishment they make, just as my mentor did for me. I crossed the high school graduation stage with a clear picture of the career I was striving for, but little did I know that the announcer would slip up and say I aspire to be a “psychotherapist,” this had my family rolling with laughter in their seats. I was certain in that moment that nothing other than a physiotherapist was what I was to become!

It is a full circle moment, as it turns out I picked the perfect career. I have the flexibility to continue to explore the world, I get to learn every day and I have the most meaningful, heartfelt conversations with some truly amazing people. I am privileged to be able to serve the community and I hope to lead with inclusion as I actively support clients through every accomplishment and milestone, helping clients build both a strong body and mind. 

Which sports are you into?

My type of self-care often involves facing a fear and in doing so I am eager to continue backpacking, rock climbing, slacklining, road and mountain biking, surfing and backcountry split boarding.  

Where did you grow up?

I grew up in Vancouver until I was 10, then moved out to Langley, BC, back then, much of the city was farmland, a very fun environment to be in as a kid!

What is your favourite orthopaedic condition to treat?

I have many! I think shoulders are my favourite followed by knees, and ankles, all of which I, myself, have had problems with in the past.

What makes you happiest?

Surrounded by my nearest and dearest family and friends. My fondest memories are around a fire on the beach, catching a sunset at my favourite spot at Jericho Beach, stargazing in the mountains or simply relaxing in the backyard having a BBQ with some great tunes, company, and belly laughs.

LIGHTNING ROUND!!!!!

Cats or dogs? Dogs

Favourite food? Seafood

Favourite dessert: Salted caramel brownie with vanilla bean ice cream

Favourite Junk food: Anything 70% dark chocolate

Beach or mountains: Mountains

Favourite colour: Rainbow

Favourite music: Last year’s Spotify wrapped says Indie-Pop, but R&B too!

Favorite day of the week? Saturday

Nickname? Too many, here are the less embarrassing Chan, ChanChan, Chanana, Chanterelle

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

Favorite holiday? New Year’s Day

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

Invisibility or super strength? Super strength

Is it wrong for a vegetarian to eat animal crackers? Absolutely not

Dawn or dusk? Dusk

Do you snore? Hah. Hah, ask my partner and her sleep headphones

Place you most want to travel? Peru, Japan, New Zealand, Thailand

Last Halloween costume? Finn from Adventure Time

Favorite number? 2

Have you ever worn socks with sandals? If it’s warm absolutely not; however, follow up question, who doesn’t wear socks with sandals when it is chilly out?

Would you rather cuddle with a baby panda or a baby penguin? Baby pandas don’t peck.

Would you want to live forever? If my partner gets to, too.

What's for dinner tonight? Barbequed maple syrup and garlic glazed salmon with lemon, sundried tomatoes, pan-fried onions, mushrooms, Bok choy and Jasmine rice. (Editor’s note - am I invited?)

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

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

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

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

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

A Case Study in Kinetic Chains: Runner’s Knee

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

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

Need a visual? Check out this fantastic video:

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

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

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

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

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

Improving Your Golf Game

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

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

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

The Golf Swing

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

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

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

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

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

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

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

The Exercises

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

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

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

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

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

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

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

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

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

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

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

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

Ask A Physio - Why Is My Joint Making That Noise?

Joints can make peculiar noises. They can snap, pop, crack, grind, grate, click and clunk. The proper name for these noises is crepitus. Many people become understandably nervous about this, especially if it is a “new noise.” Although crepitus is generally unwelcome, it is not as scary as you think.

When people come to physiotherapy for joint noises they generally have similar concerns. They want to know what is causing the noise and how to stop it.

The general perception people have is their joint must now be degenerated and “bone on bone.” People take this as a sign of aging and extreme arthritis and become scared for their joints. They do not want to unnecessarily wear the joints down.

So what do they do? They avoid the noise! They stop climbing stairs and getting down on the ground to play with their kids and grandkids. They tell me they have stopped doing the movement that initiates the noise in order to “preserve” the joint or avoid “making it worse.”

It seems logical right? If I rotate my neck to the right and it snaps or clicks I may feel unsettled by that and want to avoid that feeling. I hear constantly from my clients that they don’t swim anymore because their shoulder clicks when they bring their arm over their head, or they no longer squat because their knees click on the way down.

My response to these clients is always the same - I ask:

“Does it hurt when it clicks?” 

Because here is the thing. There are many causes for crepitus. And yes, some of them require treatment, but many do not! Before anything else, we need to figure out what is causing the clicking and decide if we have to be concerned about it or not.

Most snaps, crackles and pops are pain free and totally harmless.

If you do not experience pain when your joint makes a noise you don’t have to worry about it and can continue with business as usual. 

Common Causes of Crepitus

• The most common culprit is gas bubbles popping within the joint (think cracking knuckles). When the joint is stretched and released a gas bubble is formed and then pops, causing the noise.

• The crepitus could also be a tendon or ligament snapping over a bony structure. In this case there might be pain, but it has nothing to do with the joint and a whole lot more with the muscle. This would require an assessment, range of motion and strength exercises from a physiotherapist.  

• Arthritis. Yes, sometimes crepitus is because of arthritis.  But please know that the clicking or grinding does not mean you are doing “extra damage” to the joint. If you have arthritis a primary goal is to maintain range of motion. Working through your available range should be a priority rather than being avoided. If your knees are a little extra talkative but you have no pain and no decrease in function I would encourage you to continue with your activities. There are so many benefits to exercise (cardiovascular, mental, general strength, etc.) and it would be a shame to throw all of those away because of a misconception that you had about your click-y knee. 

Speaking of Knees…

Most noisy joints I see people for happen to be knees. If you’re wondering what that noise is and what’s causing it, here’s our top three noises people complain of and what they could mean (please be aware that this is a gross generalization but is meant to give you a decent idea):

1. Snapping, cracking or clicking “outside” of your knee: This is often due to the patellofemoral joint. The patella (aka kneecap) lives in a little groove that it is supposed to glide up and down in when your knee bends and straightens. If the patella is not properly aligned (maybe from an injury or muscle imbalance) it can make noise as you crouch, use the stairs, or just with bending and straightening your knee. If these noises are inconsistent, occasional, and pain-free I would not worry. If they are constant and painful then seeing a physiotherapist can be very helpful.

2. Snapping, cracking, or clicking “inside of your knee”: This is often your meniscus, which is the cartilage shock absorber within the joint. With injury or degeneration over time this structure can tear, rip or peel back. In some cases a flap of cartilage can get caught out of place and this will often cause the joint to “lock.” If you have a click within your knee that causes a sharp pain and sometimes causes the joint to lock it is likely a meniscus problem and you should visit a physiotherapist. 

3. Creaking or grinding: This is most often associated with arthritis. If it is early stages and you are noticing some pain it is definitely worth a trip to your neighbourhood physiotherapist as an arthritis management plan can significantly impact the maintenance of range of motion, strength and function in the joint. (Side note - since exercise is one of the best ways to manage osteoarthritis, we offer the GLA:D Program!)

Again, if you experience these noises and there is no pain then I would not be too worried about it. But if you have these noises and they are painful it is probably worth coming in to see a physiotherapist. We will assess your joint range of motion, muscle strength and balance, and see if we can identify the cause for the click so we can come up with a treatment plan that will work for you. 

If the noise bothers you enough that you cannot stop worrying about, come on in. If nothing else we can confirm to you that it is harmless and you can have peace of mind moving forward with your activities. We are always happy to help! 

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If you have any questions or would like to schedule an assessment please call Ladner Village Physiotherapy at 778-630-8800, email us or book online at ladnervillagephysio.com 

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.

Stephanie's Top Tips For Managing Your Sore Shoulder

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

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

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

EVERYDAY LIFE

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

Instead, follow these tips:

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

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

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

PAIN MANAGEMENT

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

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

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

POSTURE

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

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

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

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

SLEEP

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

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

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

• DO NOT TUCK the injured arm under your pillow

EXERCISE

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

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

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

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

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

Getting Rid of Plantar Fasciitis

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

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

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

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

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

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

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

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

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

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

Hallmarks of Plantar Fasciitis

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

• A gradual onset of pain

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

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

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

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

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

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

• Use of spiked athletic shoes or cleats

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

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

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

Getting Back to Function

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

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

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

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

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

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

What About Footwear and Orthotics?

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

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

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

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

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

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

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

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

Top Five Tips For Preventing Plantar Fasciitis

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

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

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

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

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

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

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!