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.

The Autonomic Nervous System - What It Is and How We Can Train It

The nervous system is incredibly complex. Everything we do, think and feel involves the nervous system at multiple levels. In this blog, we are going to focus on one specific area - the autonomic nervous system: what it is, why it’s important and how we can train it.

What is the autonomic nervous system?

The autonomic nervous system (ANS) plays a pivotal role in regulating vital functions, doing so unconsciously. It serves as the body's autopilot system, controlling involuntary actions such as heart rate, digestion, respiratory rate, and glandular secretion.

It consists of two main branches: the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS), which work together to maintain your body in homeostasis (in other words, to keep everything in balance, from body temperature and heart rate to the amount of oxygen and carbon dioxide in your blood).

1. Sympathetic Nervous System (SNS):

• Often referred to as the "fight or flight" system, the SNS mobilizes the body's resources during times of stress or danger.

• Functions include increasing heart rate, dilating airways, and redirecting blood flow to vital organs, preparing the body for action.

• In rehabilitation, an overactive SNS may contribute to conditions like high blood pressure, anxiety, and muscle tension, requiring interventions to promote relaxation and stress management techniques.

2. Parasympathetic Nervous System (PNS):

• Known as the "rest and digest" system, the PNS promotes relaxation, digestion, and energy conservation.

• Functions include slowing heart rate, constricting airways, and stimulating digestion, facilitating restorative processes.

• In rehabilitation, enhancing PNS activity can aid in promoting recovery, reducing stress, and improving sleep quality, through techniques such as deep breathing exercises, meditation, and progressive muscle relaxation.

(Note - for those of you with an in-depth knowledge of the nervous system, you understand that this is an incredibly simplistic way of talking about the ANS and misses a lot of things, like how poly-vagal theory challenges this framework and the concept of the freeze response. But hey, we all have to start somewhere, right?)

Like anything else in the human body, the ANS can become dysfunctional, leading to wide-ranging effects. Autonomic dysfunction, or dysautonomia, is well documented in spinal cord injuries, Parkinson’s disease, traumatic brain injury and long COVID. There is more and more research looking into stress-induced dysautonomia as a cause for heart disease. Dysautonomia has also been suggested as one of the mechanisms underlying chronic fatigue syndrome and complex regional pain syndrome.

When ANS dysfunction occurs, a multitude of symptoms may result including:

• Balance problems

• Nausea & vomiting

• Brain fog, forgetfulness or trouble focusing

• Fatigue

• Fast or slow heart rate

• Feeling like you cannot regulate your temperature

• Sweating more or less than usual

• Fainting or passing out

• Shortness of breath

• Dizziness or lightheadedness

• Heart palpitations

• Headaches

• Exercise intolerance

• Mood swings or anxiety

• Vision issues

What can I do to help my autonomic nervous system?

While we cannot consciously control much of the ANS, certain practices and interventions can influence its function. Here are some techniques for training the ANS:

1. Breathing Exercises:

• Deep breathing exercises, such as diaphragmatic breathing or box breathing, can stimulate the PNS, leading to a relaxation response.

• Techniques like coherent breathing, where inhalation and exhalation are paced evenly, can improve heart rate variability and promote ANS balance.

2. Mindfulness Meditation:

• Mindfulness practices involve non-judgmental awareness of the present moment, which can help regulate ANS activity by reducing stress and promoting relaxation.

• Regular mindfulness meditation has been shown to increase PNS activity, decrease SNS arousal, and enhance overall well-being.

• New to mindfulness practice? Try an app like Calm, Headspace or Insight Timer to get started!

3. Physical Activity and Exercise:

• Aerobic exercise and physical activity can have profound effects on ANS function, promoting cardiovascular health and improving autonomic balance.

• Moderate-intensity exercise, such as walking, swimming, or cycling, can enhance PNS activity while reducing sympathetic arousal.

4. Relaxation Techniques:

• Progressive muscle relaxation and guided imagery are relaxation techniques that can help reduce ANS activation and promote relaxation.

• These techniques involve systematically tensing and relaxing muscle groups, visualizing calming scenes, or inducing sensations of warmth and heaviness in the body.

5. Yoga and Tai Chi:

• Mind-body practices like yoga and tai chi combine physical postures, breathwork, and mindfulness, promoting ANS balance and stress reduction.

• These practices have been shown to increase heart rate variability, improve baroreflex sensitivity, and enhance overall resilience to stress.

If you’re looking to add some ANS training into your day, try one! These simple options can help improve sleep, reduce stress and help heal and recover from injury.

Looking for help with your autonomic nervous system, or anything else rehab-related? Book online with us - physiotherapy, massage therapy or kinesiology!

Ask A Physio - What Happens To Balance As We Age?

As a vestibular physiotherapist, I talk a lot about the triangle of balance. There are three main inputs to our sense of balance:

1. Vestibular System - a complex network involving the inner ear, brain stem and cerebellum, the vestibular system is responsible for detecting head movements and the head’s position relative to gravity.

2. Visual System - another complex network, the visual system goes well beyond the eyes, involving several areas of the brain stem and cerebral cortex.

3. Touch & Proprioception - these are all the receptors in your muscles, joints and skin telling you what you are touching and where your limbs are in space. If you can touch your nose while your eyes are closed, congratulations! Your proprioception is working!

Vestibular deficits are one of the most common causes of imbalance. BPPV, vestibular neuritis & neuritis, vestibular migraine, and Meniere’s disease are all well-known vestibular causes of imbalance and are all very treatable.

But in reality, balance is a very complex interplay of not only those three things but also cognition, attention, emotion, perception, muscle strength, joint flexibility, pain, motor planning, general stress levels and so much more. Impairments in balance can come from anywhere and have a massive effect on people’s function, especially as we age. With 20-30% of seniors experiencing one or more falls each year and 1 in 5 of those resulting in serious injury, preventing and treating balance issues is imperative.

Other Factors Leading to Imbalance with Age

There are a myriad of factors that can add to imbalance as we age. Here are some of more common ones:

• Dehydration - as we age, the part of the brain responsible for telling us we are thirsty becomes less active, leading us to reach for the water bottle less and less. This dehydration can very quickly lead to light-headedness and imbalance.

• Medications - several medications list dizziness as a side effect. There’s also a host of medications listing vision changes, light-headedness and drowsiness as side effects, all of which can affect balance.

• Walking speed & instability - the slower someone walks, the higher their chance of falls. Combine that with a limp or unsteadiness and imbalance increases significantly.

• Foot problems - if people have impaired sensation in their feet, balance problems are likely to follow. Bunions, numbness, thick calluses and ulcerations can directly impact how people are feeling the ground.

• Heart issues - a common symptom of cardiovascular disease is dizziness and light headedness especially when untreated.

• Vision problems - aging often affects how our eyes adjust to light and distance, taking longer and longer to shift. It’s common for prescriptions to change as we age and people often struggle adjusting to bifocal or progressive lenses.

• Cognition changes - so many aspects of cognition affect balance. Multi-tasking takes a lot of brain power and often leads to impaired balance. Cognitive processing and reaction time are critical for maintaining balance. Memory problems are also linked to imbalance.

• Fear of falling - one of the leading predictors of imbalance and falls is a fear of falling. People with this fear often do not move nearly as much, leading to inactivity and muscle weakness.

Top Ten Things To Do For Balance (That Aren’t Balance Exercises)

1. Stay active - the old adage “use it or lose it” is very true, at least when it comes to muscles and the brain. The more active you are, the better. It really doesn’t matter what your passion is, just keep doing it at whatever level you can! Go to the gym or an exercise class to keep your muscles lean, mean and flexible.

2. Stay hydrated - brains are thirsty and, as we age, our brains forget to tell us. Pay attention to how much water you drink during the day and try to drink at least 8 glasses per day.

3. Learn something new - your brain never stops changing. It adds new connections and removes connections that aren’t being used. By trying something you’ve never tried before, you are inducing neuroplasticity in your brain. This helps your cognitive power and can help improve balance. The McKee House Seniors Society in Ladner has a whole range of things to try, from line dancing and yoga to water colour painting and ukulele.

4. Walk with friends - this one checks all the boxes: exercise? Check! Head turns and vision challenges while looking around and looking at your friend? Check! Carrying on a conversation while dodging obstacles? Check! Soul-filling and stress-relieving? Absolutely. Walking with friends should be a part of everyone’s weekly routine.

5. Cook complex meals or maintain a garden - these are just two examples but the idea is to do complex tasks that take longer than a day to plan for and complete, then require movement to do the task. Other examples are fixing cars, large art projects, being on an organizing committee - the options are endless!

6. Bring your stress down - stress has a massive effect on your brain. Cognition can become impaired through several mechanisms leading to reduced ability to multi-task, process information and react appropriately. There are several ways to de-stress: yoga, Tai Chi, meditation, boxing, knitting, reading or anything that feels relaxing.

7. Review your medications with a pharmacist - more than 4 medications is associated with an increased risk of imbalance. Pharmacists are experts in drugs and drug interactions and are the best source of this information.

8. Be proactive about mental health - anxiety and fear of falling are two of the biggest drivers of imbalance and falls in seniors, with one in five resulting in serious injury. Mental health experts such as clinical counsellors are wonderful resources to address these issues at the root cause.

9. Have a great relationship with your optometrist - eyes change as we age. Find yourself an optometrist and see them annually.

10. Treat what needs to be treated - if you’re diabetic, make sure your sugars are in check to avoid peripheral neuropathy. If you have cardiac issues, follow your cardiologist’s advice on medications and exercise. The better you are to your body, the better your balance.

For more on age-related imbalance, head to Balance and Dizziness Canada. You can also find a vestibular therapist in your corner of the world on their practitioner’s list.

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.

Don't Call It A Mild Concussion

Devon Konrad, MPT, is one of our physiotherapists at Ladner Village Physiotherapy. She has a special interest in vestibular rehabilitation and concussion management. She also has some opinions, if you couldn’t tell. Read about what’s annoying her in the field of concussion rehabilitation below!

The concussion world moves fast. It wasn’t long ago the first line treatment for someone with a concussion was to sit in a quiet, dark room until symptoms had completely abated. Only then was the sufferer allowed to crawl out of their hiding hole and into the world, often to be bombarded with a complete assault on their senses: everything was BRIGHT, everything was LOUD, and it was all TOO MUCH.

While many advancements have been made in the world of concussion rehab, there are so many myths and old school ways of thinking that still persist. In the past few months, I have heard people say you need to lose consciousness to have a concussion (you don’t), helmets prevent concussions (they don’t) and if the CT or MRI is normal, it’s not a concussion (imaging can’t see a concussion. Yet.).

While these myths annoy me, most health care practitioners now understand they are, in fact, myths. However, I still see too many people that have been given out-of-date and just plain wrong information from health care practitioners.

There Is No Mild Concussion Anymore

Just yesterday, I ran into a very common one: the concept of a graded concussion, either mild, moderate or severe. We used to grade concussions based on a few factors: if someone lost consciousness and for how long; if they had any amnesia; and the presence of certain symptoms that supposedly indicated if the concussion was more or less severe.

In the last few years, this concept has been thrown out the window.

We no longer discuss the grade of the concussion. Instead, we discuss the domains affected by the concussion. The research world still hasn’t figured out exactly how to break this down and different models exist. In general, researchers (see links below) consider these 8 areas to be ones of importance in concussion rehabilitation:

• Ocular / visual - how your brain is taking in and processing visual information as well as how your eyes are moving. Problems with your visual system may result in blurry vision, difficulty reading or missing objects when you try to grab them.

• Vestibular - how your brain senses your body’s movement and its relation to gravity. Problems with your vestibular system tend to be dizziness, vertigo or imbalance.

• Cardiovascular / autonomic - your brain is implicitly involved in heart rate and blood pressure and how these respond to changes in posture and demand. Problems here may show as an elevated or blunted resting heart rate, inability to tolerate exercise or lightheadedness when standing up.

• Anxiety / mood - emotional lability, irritability and anxiety are very frequently seen after a concussion. Often these symptoms dissipate as brains heal but it’s common for people to see a psychotherapist trained in brain injuries to help treat this domain.

• Cognitive / fatigue - difficulty thinking, multi-tasking, remembering items and words, and navigating spaces are all common complaints after a concussion. This can be secondary to other domains (for instance, if you are having trouble with your vision, it’s going to be much more difficult to focus on reading a book and thinking about what you’re reading) but it may also be a problem all on its own.

• Headache / migraine - one of the most common symptoms after a concussion, this is typically caused by any of the other domains or it could be a domain of it’s own.

• Cervical - also known as the neck, people typically get some type of neck injury after a concussion. If necks aren’t treated properly, they can exacerbate the symptoms from all the other domains.

• Sleep - this can often be thrown for a loop after a concussion, either with too much sleep, too little, or both at the same time. Sleep hygiene is imperative for a healing brain and, just like the neck, impaired sleep can exacerabte all the other domains.

At this point in concussion rehabilitation, health care practitioners who claim to treat concussions should be very well versed in this concept. They should be doing multi-domain assessments and referring to appropriate health care practitioners because one practitioner cannot possibly treat all these domains. Concussion rehab is a multi-discilpinary field and all practitioners involved in concussion care should understand this implicitly.

Get Out Of The Dark Room

I heard this one a few weeks ago - someone came in with a concussion and one of their health care providers told them to stay in a quiet, dark room until their symptoms went away.

The research on this one is super clear. No one should be living in a dark room for days or weeks on end.

Rest is great for the first 24-48 hours, but that’s it. In this time, people with concussions are allowed to sleep as much as they want and be relatively subdued. Even in these first two days, however, they need to be exposed to some level of stimulation. It is often as simple as a walk around the block with sunglasses and a hat, and that’s ok! But staying full time in a dark room for days and days is simply not allowed anymore.

After those first 2 days, exercise needs to start. However, when I say exercise, I don’t mean go for a 10km run. Here are the parameters I use in returning to exercise after a concussion:

• Before exercising, take note of your symptom level out of 10.

• Aim for 20 minutes of movement. Breaks are fine, especially initially!

• During and after exercise, it is normal and safe for your symptoms to be slightly exacerbated. We want to keep those symptoms within 1-2 points of your baseline.

• Once you have finished exercising, your symptoms should return to their pre-exercise level within one hour.

If you find that your symptoms went higher or lasted longer than they should have, that’s ok! Use this as a guide for next time and try your best to stay within this range.

Typically, people start exercising with walking around their neighborhood. It’s a great way to keep control of symptoms as well as get some visual and auditory stimluation. As brains heal, people find they can gradually increase their pace, intensity or how long they’re exercising. As long as symptoms aren’t peaking too high and coming down within an hour, then it’s all good!

The Resources Are Piling Up

There are lots of up-to-date concussion resources out there for practitioners, parents and people who have suffered concussions. Here’s my curated and definitely not complete list:

For People With Concussions & Their Loved Ones:

VCH My Guide: Concussion - a wonderful, up-to-date resource that everyone with a concussion should visit.

VCH My Guide: Teen Concussion - the same as above, but focused on adolescents with concussions.

Concussion Online Training Tool - a wonderful tool for athletes, coaches, parents, teachers, medical professionals and anyone who may come into contact with someone who has had a concussion. This one is much more focused on recognizing an acute concussion and what to do immediately after it happens. I recommend everyone take this training.

For Health Care Practitioners Wanting To Get Deeper Into Concussions:

There are so many weekend courses focussed on concussion management as well as units on concussion as part of another specialty (for instance, the CCVR course through 360NeuroHealth has a large unit on concussion from a vestibular perpsective). If concussion rehab is where you want to be, check out these:

Consensus Statement on Concussion in Sport - published in 2023, this is our guiding document in how we currently treat concussions.

University of Calgary Online Concussion Course - run by the world renowned Kathryn Schneider, a free online course that takes a deep dive into concussion pathophysiology and introduces rehabilitation strategies.

Concussion Nerds - a massive course designed to go as deep as possible into concussion rehabilitation as we know it. Facilitated by the amazing physiotherapist Natasha Wilch.

Canadian Concussion Network - for those wanting to stay up to date with concussion research, I implore you to join the CCN. The leading brains in Canada run this organization!

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Looking for those research articles? Here they are!

Kontos AP, Sufrinko A, Sandel N, Emami K, Collins MW. Sport-related Concussion Clinical Profiles: Clinical Characteristics, Targeted Treatments, and Preliminary Evidence. Curr Sports Med Rep. 2019 Mar;18(3):82-92. doi: 10.1249/JSR.0000000000000573. PMID: 30855306.

Lumba-Brown A, Teramoto M, Bloom OJ, Brody D, Chesnutt J, Clugston JR, Collins M, Gioia G, Kontos A, Lal A, Sills A, Ghajar J. Concussion Guidelines Step 2: Evidence for Subtype Classification. Neurosurgery. 2020 Jan 1;86(1):2-13. doi: 10.1093/neuros/nyz332. PMID: 31432081; PMCID: PMC6911735.

Craton N, Ali H, Lenoski S. COACH CV: The Seven Clinical Phenotypes of Concussion. Brain Sci. 2017 Sep 16;7(9):119. doi: 10.3390/brainsci7090119. PMID: 28926944; PMCID: PMC5615260.

Neuro Physio - What Does It Look Like?

Neurological physiotherapy plays a crucial role in enhancing the quality of life for individuals living with neurological conditions, including stroke, spinal cord injury, Parkinson’s disease and multiple sclerosis.

One effective approach is the Bobath Concept, which focuses on task-specific and goal-oriented treatments. Our physiotherapist Rebecca Harper treats people with neurological conditions and has advanced training in the Bobath Concept. In this blog, we'll delve into what assessment and treatment look like as well as explore the principles behind the Bobath treatment approach.

A Neurological Physiotherapy Assessment

Like any physiotherapy assessment, a neuro physio assessment has four key components:

1. Subjective History: The assessment process begins with an in-depth discussion between you and your physiotherapist. Key points covered include your medical history, current diagnosis, home environment, daily activity levels and individual goals. This initial exchange of information lays the foundation for your personalized treatment plan.

2. Physical Assessment: The physical assessment involves evaluating various aspects of your physical capabilities. This includes assessing muscle strength, range of motion and sensation. The physiotherapist observes how you perform specific movements such as sitting to standing, transfers, reaching and walking. These observations provide valuable insights into your movement patterns and limitations.

3. Movement Analysis: Delving deeper, the physiotherapist breaks down the movements observed in the previous step. This is often accomplished through hands-on assessment, where the therapist uses manual techniques to both analyze movement patterns and facilitate improved mobility. Tasks like standing from a chair and reaching for an object are broken down into components, allowing for precise muscle activation and movement pattern improvement.

4. Developing a Treatment Plan: Based on the assessment findings, the physiotherapist collaborates with you to create a tailored treatment plan. This plan outlines the frequency of appointments and incorporates home exercise programs. The goal is to integrate the newfound movement patterns into the patient's daily activities, fostering sustainable progress.

Going Forward with Treatment

As you embark on your neurological physiotherapy journey, subsequent sessions become pivotal in achieving sustained progress and functional improvement. Building upon the foundation laid during the initial assessment, these sessions are tailored to address your specific needs and goals.

• Progressive Muscle Activation and Movement Refinement: Subsequent treatments aim to build on the initial assessment's insights and progress made. Your physiotherapist will continue to refine muscle activation patterns and movement techniques. Through a combination of hands-on manual therapy and targeted exercises, you'll work together to enhance your muscle control and coordination. These sessions play a crucial role in solidifying the improved movement patterns identified earlier.

• Task Integration and Functional Practice: One of the hallmarks of the Bobath Concept is its focus on real-world functionality. In subsequent sessions, you'll have the opportunity to integrate the improved movement patterns into tasks that mirror your daily activities. This step bridges the gap between rehabilitation exercises and practical application, ensuring that the progress you make directly translates to your daily life.

• Goal Reassessment and Setting: As you progress through your treatment plan, goals achieved will be celebrated and new ones will be set. Neurological rehabilitation is a dynamic process and your goals may evolve as you regain more functionality. Your physiotherapist will work closely with you to set realistic and motivating goals, keeping you engaged and motivated throughout your journey.

• Feedback and Collaboration: Subsequent sessions are also a platform for you to provide feedback on your progress and experiences. Your input is invaluable in tailoring the treatment plan to your evolving needs. Collaborative discussions with your physiotherapist ensure that the treatment remains aligned with your aspirations, making the process more personalized and effective.

• Home Exercise Program Enhancement: In addition to your in-clinic sessions, your physiotherapist will continue to refine your home exercise program. These exercises are designed to complement the progress you're making during your sessions and contribute to the overall success of your rehabilitation. They empower you to actively participate in your recovery journey even outside the clinic.

• Adaptation and Long-Term Planning: Neurological conditions often involve long-term management. Subsequent sessions serve as checkpoints for evaluating your progress over time. Your physiotherapist will help you adapt your treatment plan as needed, ensuring that you're consistently working towards your goals and addressing any new challenges that may arise.

The Bobath Concept

The Bobath Concept is a leading approach within neurological physiotherapy, emphasizing task-specific and goal-oriented treatments. This method revolves around utilizing specific muscle activation patterns and sensory input to enable successful task completion across various contexts and environments. Everyday tasks such as dressing, walking, and reaching become the focus of treatment, promoting functional independence.

The heart of the Bobath Concept lies in its use of manual handling techniques to activate muscles and facilitate movement. This initial facilitation sets the stage for active participation, practice opportunities, and meaningful goal achievement.

If you have any questions, please contact us at (778) 630-8800 or clinic@ladnervillagephysio.com. To book an assessment, contact us or book online.

Top Five Tips for the Fair-Weather Runner

If you’ve ever been a runner, you probably know this feeling: the weather is getting nicer, sun is coming out again, so you decide to pull out the running shoes and head out for a run.

If you’re anything like me, you probably think, “how bad can it be? I’ll just run the same distance as I used to, aim for the same pace, and everything will be fine!”. Unfortunately, this isn’t always how it works.

Jumping right back into running can often lead to injuries, including a bruised ego when you realize how hard it is to run at your old pace (trust me, I’ve learned this the hard way). In this blog, we are going to talk about a few tips on how to get back into running in a safe and productive manner.

Kheya’s Top Five Tips To Getting Back to Running

1.      Make A Plan and Start Slow

The first tip to getting back into running is to make a plan. How often are you going to run? For how long? Do you have an end goal in mind for how long you would like to be able to run? When making your pain, consider the following:

• Frequency - aim for 3 times per week max. This will allow you to have at least one rest day between each of your runs to give your body the appropriate amount of time to recover, as well as time to add in some strength training.

• Pace - start slow! I often recommend to my clients to start with a walk/jog mix, then slowly decreasing your walking time and increasing your running time. For example, this might look like walking for 2 minutes, then running for 1 minute the first week, and then increasing to 1 minute and 30s walk and 1 minute and 30s run the next week, 1 minute walk, 2 minutes run the following week, and so forth. Continue this until you can keep up a slow running pace for your whole run!

• Time/ distance - start small and add a little bit of time each week. This is going to be very dependent on your current fitness but beginning with 10-20 minutes and slowly working your way up is a great place to start. Once you get comfortable with this time, you can start adding 5 minutes to your run each week. You can also track this with distance (for example, starting with 1-3km run and adding 0.5km each week).

• Setting a goal: having a goal distance in mind is a great way to keep yourself motivated when getting back into running. Goals should be SMART (specific, measurable, achievable, relevant, and time-bound). This means you should set a clear distance you would like to run in a clear within a reasonable time frame. A great example would be “I am going to run 3 x per week, beginning with a 2km run and increasing by 0.5km each week, with a goal of being able to run 5km in 6 weeks”.

2.      Train Smarter, Not Harder

Up until this point, we’ve only been talking about your basic steady run. However, just doing a simple base pace run isn’t always the most effective way to improve your running. When setting up a running schedule, it is great to break up your runs into different types. For example, you could split up your week into doing one long run, one run with sprint intervals, and one recovery run. You could even investigate different types of runs such as hill runs, Fartlek running, or tempo runs.

Here’s an example:

• Monday: 25 minutes of sprint intervals, 20s sprint, 2 minutes of walking/jogging

• Wednesday: Recovery run (3km at a slower pace than typical)

• Saturday: Long run (8km at your base pace)

3.      Have A Proper Warm Up and Cool Down Routine

A warm up that focuses on mobility and activating the muscles you are going to be using during a run is important. I would then start your run with a fast walk or very slow job for 5-10 minutes, before transitioning into your faster running pace. For a cool down, I would recommend doing a light walk at the end of your run, to help transition your body as your heart rate slows down, followed by some light stretching. Remember, a proper routine also includes proper nutrition and rehydrating!

4.      Keep Up With Your Strength Training

Strength training is very important for preventing injuries as well as increasing your running speed and efficiency. If you decide to totally transition into running without keeping up with your other workouts, you are going to be missing out big time! Aim for 2-3 days a week of strength training.  

5.      Invest In The Proper Shoes

Fun fact: did you know runners should be replaced every ~800 kilometers? Running shoes are the foundation of your performance and having improper shoes can impact your running gait, posture, and cause a whole array of problems. I would strongly recommend going to a proper running store like the Run Inn and have someone assess your foot and gait and recommend proper shoes for you. I promise, paying the price to have proper shoes is well worth it in the long run!

I hope you enjoyed these tips on getting back into running! If you have any questions, give us a call at (778) 630-8800, email us or book online to seek advice/treatment from a physiotherapist or to work with a registered kinesiologist.

My Jaw Locks & Clicks! What's Going On?

One of the most common jaw complaints is clicking and locking, often associated with pain in the jaw, face, head and down the neck. This can often be caused by an anterior disc displacement, something we see frequently in the clinic.

But what is an anterior disc displacement and what can we do about it? Before we dive into that question, let’s back it up and talk about the anatomy of the temporo-mandibular joint.

The Anatomy of the TMJ

The temporo-mandibular joint (aka the TMJ) is what attaches the mandible (aka the jaw bone) to the skull. It is located just in front of the ear and, if you place your hands on either side of your face just in front of your ears, you can feel that jaw moving forward and back as you open and close your jaw.

The TMJ is a synovial joint between the temporal bone of the skull and the condyle of the mandible. Between the condyle and the temporal bone is a donut-shaped fibrous disc that is essential for proper opening and closing of the jaw. This disc is partially held in place by the retro-discal tissue, a network of loose connective tissue, blood vessels and nerves attaching the back of the disc to the bone behind it, just in front of the ear canal.

Anterior Disc Displacements

One of the most common causes of temporo-mandibular dysfunction (aka TMD) is when the disc becomes displaced, typically anterior in the joint and away from the ear canal. When this occurs, the retro-discal tissue in the back gets stretched and is unable to hold the disc back in its normal position.

Common symptoms of anterior disc displacements include:

• pain in the TMJ with chewing, yawning & talking

• pain in and around the ear

• headaches

• a reproducible click in the TMJ, with or without pain

• decreased range of motion with opening

When a disc moves anteriorly in the joint, it may click or block jaw movements but this isn’t guaranteed. Every person’s anatomy is different: jaw condyle shapes, depth of the socket, size of the disc, amount of retro-discal tissue and all the other factors that make a person unique can play into their TMD and experience of pain.

Treating a Disc Displacement

A few things to know first:

1. One third of asymptomatic people have at least one displaced TMJ disc. It’s really common to have a disc issue and not be bothered by it at all!

2. Discs will not (typically) relocate back to where they were. Instead, your body heals and creates a “pseudo-disc” from the now-stretched retro-discal tissue to act as the original disc.

3. When that disc moves forward, it can often block the opening of the TMJ. Over time, the disc remodels to be less donut-shaped and more wedge-shaped so the condyle of the jaw can easily slide over it.

Acute Disc Displacements

Remember how I said just up there that discs won’t relocate?

If the injury has occurred in the past 3 days, we can sometimes (and I stress SOMETIMES) get the disc to relocate. It has to be before the retro-discal tissue has stretched too much. Our therapists who treat TMD can attempt a specific maneuver to try and get that disc back to where it was.

Outside this 72 hour window, we are looking at healing and remodeling the disc.

Chronic Disc Displacements

We have a whole tool-box of therapy techniques to help with disc displacements in the TMJ. These include:

• Manual therapy of the TMJ - we use specific techniques to increase the range of motion of the jaw and help the disc remodel into the wedge shape we’re looking for.

• Soft tissue techniques (including IMS and massage) of the surrounding muscles - with a disc displacement, these muscles (for instance, the temporalis and masseter) are often clenching or working hard to compensate for the TMD, leading to increased pain and headaches.

• Neck assessment & treatment - when the TMJ is irritated, up to 70% of people also have neck pain. As a part of TMD treatment, the neck needs to be evaluated and treated accordingly.

• Exercises - the right exercise for you and your TMD is so important. The right exercise helps discs remodel, muscles relax and pain reduce. We spend a lot of time with you to make sure you are doing the correct exercise with the correct technique.

Top Five Tips in Dealing with a Disc Displacement

Finally, we live by these principles of managing disc displacements:

1. Don’t test it!! You will be tempted - does it still click? Is it still stuck? - but we beg you to resist this temptation. Let your disc heal. The more you poke it, the longer it’ll take to heal.

2. Avoid hard/crunchy/chewy foods for the first 6-8 weeks after a disc displacement. We promise you can eat your favourite food soon but avoid those types of foods initially.

3. Support your jaw when yawning. If you have the urge to yawn and really open your jaw, place a hand under your chin so you have something to push against and limit how much your jaw actually opens.

4. Sleep is so important for healing & pain control. We know that under 6.5 hours of sleep per night increases your experience of pain. We also know that you heal when you sleep. So make sure you’re getting enough sleep, with a good pillow supporting your head!

5. Posture also play a huge role. Make sure your computer is set up properly so you aren’t sitting in a head forward posture, putting more inappropriate muscular forces through your jaw. (Need some tips on computer set up? Read our blog!)

If you are dealing with a disc displacement, TMD or headaches, book with one of our TMJ therapists online, by email or calling us at (778) 630-8800.

Isometric, Isotonic, Concentric, Eccentric... What Does It Even Mean!?

If you’ve been around rehab or gym people, you’ve likely heard terms like isometric, isotonic, concentric and eccentric thrown around. But what do they even mean??

When we talk about exercises, we generally break them down into two types: isometric and isotonic. Isotonic exercises can be further broken down into concentric and eccentric parts of the exercise. All have an important role in exercise and rehab.

The language can be confusing so let us be your guide - we promise, it’ll make sense by then end!

Isometric Exercises

Isometric exercise refers to an exercise where you hold one position, meaning the muscle stays still and does not move through a range of motion. Some great examples of isotonic exercises include wall squats and planks. Isometric exercises may be held from anywhere from a couple of seconds to over a minute.

Isometric exercises are fantastic for improving stability of a joint. They are often used in rehab as they can be lower impact that other types of exercise.

We often use isometric exercises when moving through a full range of motion is painful. While isometric exercises can help you build strength, they will likely not be as beneficial for improving power output or speed in the long term. Recent research has shown the benefit of using isometric exercises for strengthening tendinopathies, so we often do these types of exercises for injuries like patellar tendinopathies, Achilles tendinopathies and tennis elbow.

Isotonic Exercises

Isotonic exercise refers to an exercise where a joint is moving through a range of motion. Examples of an isotonic exercise would be a bicep curl, squat or a push-up. In each of these exercises you move a weight (whether that be body weight or additional weight, like a dumbbell) through a range of motion.

Isotonic exercises are fantastic for gaining strength and can be adapted to focus on different goals such as power, speed or increasing range of motion.

Isotonic exercises can be broken into two main types:

1. Concentric - the portion of an exercise where a muscle is shortening.
   
   With an concentric movement, tension in the muscle increases to meet the resistance of the weight, moving the weight in space. An easy example of a concentric contraction would be the part of a bicep curl where you are lifting the weight up towards your shoulder by bending your elbow.
   

2. Eccentric - the portion of an exercise where a muscle is lengthening.
   
   With an eccentric movement, tension increases are you lengthen the muscle and control the weight as it goes down with gravity. An easy example of an eccentric contraction would be the part of a bicep curl where you are lowering the weight back towards the ground.

While isotonic exercises contain both a concentric component and an eccentric component, you can alter exercises to put more emphasis on one part of the exercise to reach certain goals. Both eccentric and concentric exercises are shown to increase muscle strength, muscle mass and power output.

While the research is not conclusive, some research has shown that focusing on the eccentric portion of an exercise may help to increase muscle strength and growth more than the concentric portion. One way to achieve this is to slow down the portion of an exercise where you are lengthening the muscle (e.g., slowly lowering the dumbbell in a bicep curl, slowly lowering the bar on a chest press, or slowing down how quickly you drop towards the ground in a squat).   

If you have questions or need help figuring out to use these exercises to meet your goals, be sure to book in with our registered kinesiologist for support.

 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.

Busting Common Exercise Myths: Part 3 - Stretching Tight Muscles

Kheya McGill , Registered Kinesiologist, is back with another myth-busting blog! In part 3, Kheya reviews why stretching may not be the thing you need to get rid of tight muscles.

Most of the time when people are feeling stiff, tight or sore, their go-to response is to stretch. Now don’t get me wrong, stretching can be fantastic, but I’m here to explain to you why it may not be the answer to all your problems.

When we feel a muscle is “tight”, this could mean the muscle is shortened, lengthened or aggravated. Muscles can feel this way for a variety of reasons and may be related to an injury, overuse, posture or muscle weakness.

When a muscle is weak, it takes a lot more effort for the muscle to perform the job it is meant to do. This can end up with the muscle being habitually turned on and activated, leading to stiffness and pain. To put it simply, the muscle ends up being overworked as it is not strong enough to meet the demands of what you are asking it to do in your daily life. This can cause irritation to that muscle or put strain on the muscles around it which are having to work hard to compensate for that weak muscle.

When we stretch a muscle in this state, you may notice it feels better temporarily and you may even gain some range of motion. The problem is stretching is unlikely to get to the root cause of your problem.

Instead, that muscle may need to be strengthened.

When a muscle is stronger, it is easier for that muscle to move through a range of motion and control movements. You won’t need to rely on the supporting muscles as much and it won’t end up being activated all the time.

A good way to think about this is thinking about an orchestra. If you have a whole orchestra but you’re only relying on the 2 clarinet players to carry all the sound, these clarinet players are going to end up becoming extremely fatigued.

On the other hand, if you help all the other members of the orchestra practice their instrument so they can all contribute equally to the music being produced, the clarinet players are going to have some pressure taken off them and be able to relax more. This is the same thing that happens if you are relying too much on one muscle group and another group is not strong enough to support it. The muscle groups around will end up becoming exhausted which can lead to a feeling of tightness or soreness.

A Case Study - The Hip Flexor

A good example of a muscle this commonly happens to is the hip flexors. The hip flexors sit at the front of your hip and assist you in lifting your leg up towards your body (think about marching, or even just lifting your leg to take a step). When you sit down, your hip flexors are in a relaxed position. Over time they can become weak and learn to stay contracted in a shortened state, leading to the stiff or tight feeling.

If you are having a hard time picturing this, think about holding an elastic band stretched vertically in front of your hip, from below your belly button to the front of your thigh. When you stand up the band is stretched out and when you sit down the band has some slack. When we stretch our hip flexors it is likely to provide some temporary relief as you are pulling them out of that shortened state however it is likely they will return to this state shortly after.

In this scenario, I would suggest you work on strengthening the hip flexors, working them through their full range of motion. Helping this muscle become strong through the full range of motion typically leads to less feelings of tightness in your daily life.

So When Should I Stretch?

Well, this is a great question! Unfortunately, there is no clear answer - the opinions in the literature right now are still vast and strong. Stretching is a very controversial topic and there doesn’t seem to be a right answer. Personally, I like to start my workout with a dynamic warm up and some mobility exercises, and I save the last 5-10 minutes of my work out for cooling down with some stretches. If this works for you, then fantastic, but if you have a routine that seems to work well for you then continue with that!

In this blog, I hope you learned why sometimes “tight” feeling muscles may actually be weak and need strengthening, not stretching! If you have been stretching for a period of time and have not seen the results you are hoping for, give strengthening a try instead!

If you have questions or need help figuring out how to strengthen the muscles that are bugging you, be sure to book in with our registered kinesiologist for support.

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.

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?)

Busting Common Exercise Myths: Part 2 - The Perfect Squat

Is there a perfect squat form for everyone?

If you’ve been around a gym or done much exercise in your life, it is likely you have tried to adjust your squat form at one point or another. Maybe you have seen videos of fitness influencers on social media and tried to copy what their squat looks like.

In our heads, the ideal squatter often has their toes facing forward, feet shoulder width apart, knees stay behind their toes, chest up, back straight, and no “buttwink” (curving of the low back as it drops at the end of a squat).

Unfortunately, this isn’t the perfect form for everyone, and there isn’t a one size fits all perfect squat form. This is due to the differences in our anatomical build. We all have different anatomy in our spine, hips, knees, pelvis, and ankles, and everyone has different levels of function and mobility at each of these joints.

One of the easiest examples of differing anatomy is the angle at which our legs naturally sit. When in a natural position (I.e., laying flat on your back with your legs down and relaxed), some people’s feet will naturally face straight up and forward while some will naturally sit with their toes pointing outside away from their bodies. By forcing everyone to put their toes forward, we may be putting them in a position which is less natural for their specific body anatomy. Individuals whose feet naturally fall towards the outside when in this position may feel more comfortable with their toes pointed away from their bodies when squatting, rather than having their toes facing forwards.

Another good example of this is ankle mobility. Individuals with tight ankles may have a difficult time going into a deep squat as the don’t have a large enough range of motion through the ankle joint to allow their knees to move forward. There are a couple of ways to adjust this. Firstly, these individuals should be working to improve their ankle mobility. However, some people may not be able to improve their ankle mobility a whole lot, and that is okay! People with tight ankles may benefit from raising their heels when they squat. This may mean using a small wedge or small plate under the heels- this will allow them to squat much deeper as their ankles are less limited.

The last example we will talk about is the length of your femur (aka your thigh bone). Online, we often see individuals being praised for how deep they can go in a squat- but this is not something everyone will be able to do safely or comfortably. Individuals with longer femurs will naturally have to lean forward more in their squat to stay balanced and offset the weight or their body. Individuals with longer femurs also may not be able to squat down quite as deep, as they will be unable to stay upright due to the weight of their body or barbell pulling them backwards.

The important thing to remember here is there are anatomical features that CAN NOT BE CHANGED and that is not a bad thing!

This means no squat form is better than another. The best squat form is the one that is safe and feels right for your body.

We don’t expect you to know the length of your femur, hip angle or ankle mobility. If things aren’t feeling right in your squat, play around until they feel better. Here are some things you can try:

• Depth - short calf muscles and femur length will affect how deep you can go in your squat, so adjust to find the right depth for you

• Foot angle - pointed straight ahead or pointed outside? This will often be based on your hip anatomy and the amount of torsion on your shin bone

• Foot width - femur length and the width of your pelvis play in here as well, so feel this one out. A wider stance is more stable and requires less distance to travel.

• Type of squat - different types of squats (front squat, barbell back squat, goblet squat, box squat, sumo squat, etc.) demand different body positions, depending what muscle group you want to target

• Ankle position - tight calves or limited ankle mobility may require doing things a bit differently, such as a heel elevated squat

While there is no perfect squat form that works for everyone, there is absolutely a perfect squat form for your body! If you are unsure of where to start or how to perfect your squat form, 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 at (778) 630-8800, email us or book online to seek treatment from a physiotherapist or to work with a registered kinesiologist.

Happy squatting!

Top Five Fun Facts About The TMJ

That pesky jaw joint (better known as the temporomandibular joint or TMJ).

So many of us - 35%! - have issues with it yet only 5-10% of us actually seek treatment. Temporomandibular joint dysfunction (TMD for short) tends to hit in people ages 20-40, affecting women more than men.

Despite TMD being so common, not many people know what it is or what to do about it. Here are the top 5 things I want you to understand about the temporomandibular joint and dysfunction:

Top Five Fun Facts About TMJ/D

1. The TMJ moves out of its socket and has a disc

Closed jaw

Open jaw

The TMJ is not your average joint! When you open your mouth fully, the first half of that movement is the jaw rotating in the socket. In the second half, the jaw bone comes out of the joint and moves forward.

The disc is a little piece of tissue that sits on top of the condyle like a hat. It helps the jaw slide nicely out of the socket, holding the jaw in place when the mouth is fully open and returning it to its closed position. Thanks, little disc!

To feel the movement of your jaw, place your hands flat on your cheeks, just in front of your ears. Slowly open your jaw and feel the condyle pop forward into your hand about halfway through opening.

2. Discs can slip forward and that’s okay!

One of the most common causes of TMD is the disc can be displaced anteriorly - in other words, the disc can slip forward in the joint. This may result in clicking or locking of the jaw or it may not - in fact, 9-31% of people moving about their lives have an anteriorly displaced disc and absolutely no symptoms!

The biggest thing to remember with disc displacements is that discs remodel and heal. If you have a symptomatic disc issue, the name of the game is to lessen the irritation of the tissues for a little while to allow the disc to remodel and the TMJ to heal. We do that through manual therapy and specific exercises.

3. Sounds are totally fine, as long as they aren’t painful

Most jaw sounds are related to the discs and if it doesn’t hurt, don’t worry about it. Popping, clicking and snapping are all common sounds in people with no TMJ-related pain.

These sounds are also not predictive of more problems down the road, so ignore them as best you can. It’s hard - the jaw is right beside your ear and the noises can be LOUD! Be armed with the knowledge that these sounds typically decrease over time and everything will be just fine.

4. Your jaw has a resting position and you should be in it most of the time

Check in with your jaw right now - are your teeth together? Are your jaw muscles clenched, tensed or relaxed? Where is your tongue - is it flopped against your bottom teeth or resting on your palate?

Your jaw should be at rest most of the time. In fact, your teeth should only be in contact for 8-15 minutes per day!

Here’s what you need to look for in a resting jaw:

• Teeth slightly apart - your teeth shouldn’t be touching anywhere and be about 1mm apart

• Tongue against the roof of your mouth - your tongue should be resting comfortably against your palate. It should be a few millimetres away from your teeth at the front.

• Relaxed muscles - the chewing muscles in your cheek and on the sides of your skull should be nice and relaxed.

This resting posture is also heavily dependent on good posture throughout your whole body. For tips on this, visit our previous blog posts on posture Your Head Is A Bowling Ball & Ergonomics: The At Home Edition.

5. All those chewing habits can lead to TMD

We’re talking clenching, nail biting, cheek biting, lip pursing… all those mindless mouth habits so many of us are guilty of doing on a daily basis. All that added muscle activation can lead to overuse of the jaw muscles, causing anything from headaches, pain in and around the face and ear, tooth pain and tinnitus.

Since 45% of TMD is muscular in origin, it’s really important to identify and stop these habits. Changing these habits, like all habits, is really hard to do but it can mean the difference between pain and being pain-free.

If you are dealing with TMD, book with one of our therapists with advanced training in TMD. Book online, through email or call us at (778) 630-8800.

Flexibility vs. Mobility - What’s The Difference?

People often use the terms “flexibility” and “mobility” interchangeably but there is a difference! In this blog, our dance physiotherapist Anh Duong explains the difference between the two as well as why one is more advantageous than the other.

As physiotherapists we throw around the terms “flexibility” and “mobility” a lot, but what do they actually mean?

Flexibility is the ability of muscles to move through range passively (in other words, pushing to the end of the joint’s range with assistance from your hands, the wall, a strap - you get the idea) where as mobility is the ability of a joint to move through range actively, using your muscle to do the movement without assistance.

Imagine a dancer who can do the full splits when she is stretching on the ground but cannot achieve the full splits when performing a grande jeté. This dancer would be demonstrating flexibility but lacking mobility.

Ultimately, dancers should be aiming for mobility over flexibility.

How do we improve mobility?

Strengthen while you lengthen! This is achieved by working the muscles while elongating them at the same time. Some ways you can do this include:

• opting for more dynamic stretches rather than static stretches

• using bands and weights for resistance

• performing resisted holds while in an elongated position

But doesn’t being flexible help my technique?

There is a misconception that hyperflexibility will improve dance technique when it can actually do the opposite.

Think of your muscles like hair elastics. If you use the same hair elastic and stretch it and stretch and stretch it, overtime it will become long and weak and no longer be able to hold up your hair. Similarly, an overstretched muscles becomes long and weak and loses its ability to produce force which is needed for all dance movements such as kicks and jumps.

But there’s more..

Overstretching is highly dangerous and
NOT recommended

In the short term, overstretching increases the dancer’s risk of muscles strains, muscle gripping due to weakness, and snapping/pinching hips.

In the long term, overstretching can lead to stretching of other tissues such as ligaments, cartilage and joint capsules which play an integral part in joint stability.

Micro-damage accumulates over time which may lead to long term problems such as early degeneration of the joint, and chronic instability and pain.

What does overstretching look like?

• “sitting” in extreme positions for long periods of time

• Having peers or teachers pushing limbs at end ranges

• using yoga blocks or furniture as a lever to get more range

• Stretching before warming up muscles

To recap:

Dancers should be aiming for mobility over flexibility which includes incorporating strengthening and avoid stretching joints into extremes.

In this day and age, with the influence of social media and growing popularity of incorporating gymnastics and acrobatics movements into dance technique, the demand on dancers’ bodies are higher than ever and it is important that we educate dancers, parents, teachers, about safe and effective training.

To book an appointment, call (778) 630-8800, email us or book online.

Bladder Frequency and Urgency

Do you find yourself running to the bathroom more often than you think you should? Have you always been the person with the “small bladder” that goes to the bathroom three times at a restaurant when your friends don’t go at all? When you have to go pee, is it an urgent urge that makes you uncomfortable to wait?  Do you sometimes not make it to the bathroom on time?

If you experience some or all of these signs, you are not alone and can absolutely improve this. The best news is that the solution is pretty simple!

How is your bladder supposed to work?

Let’s pretend your bladder is your child, your brain is you (the parent) and your child wanting a snack is like your bladder wanting to pee.

We all know that some kids are very chill & relaxed while others can be quite high maintenance (but we still love them!). If your child (aka bladder) is calm and wants a snack (needs to go pee) they will ask “can I please have a snack?” and you (the brain) are able to respond appropriately.

Maybe the answer is “sure, it’s been a while since you have had a snack, absolutely you can have a snack.” Or maybe your answer is “you know what, we just ate lunch and I don’t think you need a snack right now.” If your child/bladder is calm they can usually accept the answer and go on their merry way for a while.

Eventually they’ll feel hungry (need to pee) again, and they will come back to you to ask for a snack again. And once again you can decide if it’s a good time for a snack. If you wait for longer periods the child might get more persistent or ask you more frequently but you are still very much in control of the situation. At the right time, the child gets their snack and everyone is happy.  

This goes very much to the heart of how things are supposed to work: your bladder sends signals to your brain as it’s filling up and it’s up to your brain to decide when is the right time to go pee.

What causes urinary frequency and urgency?

There are many reasons for urinary frequency and urgency. In my experience, the top two factors that we can influence and improve are:

1. Undesirable learned habits

2. Dietary factors

Undesirable Learned Habits

Let’s go back to that example and replace that lovely, polite child with a cranky one. Do cranky children ask for anything nicely or politely? I don’t know about you, but when my children are cranky they are definitely not polite. When cranky children think they need a snack they go “I WANT A SNACK RIGHT NOOOOOOOOOOOW” (even if you happen to be in the middle of the grocery store).

You are then in the precarious position of having to choose between:

1. giving into the tantrum and giving them a snack even though they don’t need a snack, or;

2. telling them “no, you cannot have a snack”.

If you give in, your child learns that tantrum equals guaranteed snack time, leading to more tantrums. If you hold your ground, you get to deal with the potential wrath of said cranky child (for most people, the wrath of a bladder can be in the form of a urine leak, fear of leaking, abdominal discomfort, etc).

This is where the habit starts to form. In general, if you give a kid a snack every single time they ask for a snack they are going to start asking for snacks more often (because snacks are delicious and they are clever little humans). The same applies to your bladder - if you go pee right at the moment you think you have to go and rush immediately to the bathroom, you are reinforcing a bad habit.

Your bladder has a bigger capacity than you think. You can go for hours upon hours at night without going pee. Why do you think you need to go pee before you leave the house when you literally just went pee 15 minutes ago? Did your kidneys magically turned superhuman and filled your bladder up to full capacity in 15 minutes? Probably not! You probably just have a habit of going pee before you leave the house. You might also have a habit of going pee as soon as you get home and maybe that has escalated into you needing to drop your groceries and sprint up the stairs to go pee as soon as you get home even though you didn’t need to pee while at the store.

They’re all learned habits. It’s important before you go pee to ask yourself:

Do I HAVE to go pee or do I just WANT to go pee?

The same way you would ask yourself “do I want a snack or do I need a snack?”. You should be in control of your bladder rather than your bladder controlling you.

I really think of the urge to pee kind of like a hunger cue. Most people do not drop everything they are doing and rush to the kitchen and stuff their faces with food at the first sign of hunger. So why are we sprinting to our bathrooms at the first realization that there is urine in our bladder?

It’s not an emergency, it’s just information. That bladder of yours is sending a friendly neighbourly signal up to your brain that says “FYI, getting kind of full, might want to think about that sometime soon.”

Dietary Factors

To make matters more complicated, you might be making your “child” crankier than it needs to be by eating certain foods and drinks. If your bladder is extra irritated, it’s going to make its presence known a lot louder and more often than you would like.

Foods that may irritate your bladder include:

• Coffee (decaf is better but still not perfect)

• Tea

• Alcohol

• Chocolate

• Carbonated beverages (yes, even plain soda water)

• Artificial sweeteners

• Citrus (oranges, lemons, etc).

• Tomatoes

What can I do about it?

There are several things you can do to take control of your bladder health. Some are fairly self-explanatory like decreasing or moderating your intake of the irritating foods listed above.

One of the main things you can do: drink more water. It’s counter-intuitive, but drinking more water more often than not helps you pee less frequently. I’ll say that one more time for the people in the back:

You can go pee less frequently if you drink more water.

Want to know why? If you are dehydrated, your urine will be very concentrated. Concentrated urine can really irritate the inner lining of the bladder and will want to get rid of that fluid ASAP. Your bladder is much happier to hold a larger amount of dilute fluid rather than a small amount of concentrated or irritating fluid.

There are also cognitive and physical techniques known as urge suppression techniques. They can help you deal with a strong urinary urge, avoid leaking and rushing to the bathroom, and normalize the number of trips you make to the bathroom. These should be taught to you on an individual basis by a doctor or pelvic floor physiotherapist that knows your individual situation and can determine which techniques are best for you.

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Your Takeaway Points!

If you suffer with urinary frequency and urgency, please remember these key points:

• Needing to go pee should not feel like an emergency

• Foods and drinks such as coffee, alcohol, and chocolate can irritate bladders

• A significant amount of urinary frequency and urgency is behavioral and can be modified

• Ask yourself if you have to go pee or you just want to go pee? Is the signal coming from your bladder or your brain?

• Drinking more water can decrease urinary frequency and urgency

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If you would like to know more about these or have an evaluation by one of our pelvic floor physiotherapists please feel free to contact the clinic at 778-630-8800 or clinic@ladnervillagephysio.com to book an appointment.

Overhead Shoulder Pain in Volleyball Players

Kheya McGill graduated from UBC with a Bachelors Degree in Kinesiology. A lifelong Tsawwassen resident, Kheya has recently joined Ladner Village Physiotherapy as a registered kinesiologist. In this article, she reviews the most common causes of shoulder pain in overhead movements common with volleyball players and five great exercises to help combat the pain.

Shoulder pain is common in volleyball players, particularly while arms are in the overhead position. The shoulder is one of the most mobile joints in our body, meaning it is also one of the most unstable joints. If you enjoy playing volleyball (or other overhand activities such as lacrosse, tennis or fly fishing), chances are you’ve experienced shoulder pain at some point whether that be soreness, stiffness or sharp pain.  

What causes overhead shoulder pain?

Common causes of overhead shoulder pain include:

• Shoulder impingement - A shoulder impingement occurs when tendons get “impinged” or compressed between the head of the humerus (aka the arm bone) and the bony architecture of the scapula (aka the shoulder blade). When you lift your arm overhead, the space between these bones in your shoulder decreases and increases pressure on the tendons. This can cause irritation, which can lead to an impingement. 

• Rotator cuff injury - The rotator cuff is a group of 4 muscles which surround your shoulder. These muscles help move the arm and scapula, while protecting the shoulder. Rotator cuff injuries are common and can occur for many reasons, including overuse, trauma, or degeneration. (Need more on this? Read our blog on the rotator cuff!)

• Osteoarthritis - A degenerative joint disease, osteoarthritis causes problems with the cartilage, synovial membrane, ligaments and bone in a joint. Osteoarthritis can cause tissue loss, remodeling, inflammation and lead to loss of normal joint function. A history of shoulder injuries leads to a higher risk of developing osteoarthritis here. Remember, arthritis isn’t just seen in “old” people!! (For more on osteoarthritis, read our blog!)

How can I improve my shoulder pain?

Although these injuries are all quite different, the good news is all of them can be improved with the right exercises! Here are a few of our favourite exercises and stretches to add to your routine: 

1. Internal and external rotation with band 

Using a band, secure one end of the band to a stable point (we suggest tying a large knot in one side and securing the band behind a door).

Internal rotation: 

• Grab the band with your hand so that the band is pulling your hand away from your body

• Bend your elbow and tuck it gently into your side

• Move your hand from the outside of your body towards the inside, bringing your hand closer to your belly
  

External rotation: 

• Turn your body around so the band is now going in front of your body and pulling your hand towards your body

• Bend your elbow and tuck it gently into your side

• Move your hand away from your belly while keeping your elbow tucked in
  

2. Shoulder flexion with resisted external rotation 

• Put a band around your forearms and bend your elbows at 90 degrees 

• With your arms shoulder width apart, place small amount of tension in the band, and lift your arms up from the shoulder
  

3. Thoracic spine openers

• Start laying on your side, with your hips and knees bent in front of you 

• Place both arms straight out in front of your chest 

• Keeping your bottom arm on the floor, reach your top arm across your body and towards the floor on the other side, opening the chest 

• Follow your top hand with your head and eyes, and then slowly return to starting position
  

  4. I, Y, T, W’s 

• Laying on your stomach, face down, with your arms overhead, thumbs pointing upwards (You may want to place a folded dish towel under your forehead - this helps you keep a neutral neck and breathe!)

• Pick a position (I, Y, T or W) and raise your arms, pulling your shoulder blades together

• Lower your arms back down to the ground, and repeat

• Try in each position to target different muscle groups
  

5. Pectoral stretches 

• Standing next to the corner of a wall, place your forearm against the wall, with your arm and shoulder at 90 degrees

• Lean your body forward until you feel a stretch across your chest

• Play around with the height of your arm to stretch different portions of your pectoral muscle
  

There you have it! Five simple exercises you can do at home or add to your daily workout routine to improve shoulder pain and scapular stability. 

If you’re suffering from shoulder pain, give us a call at (778) 630-800, email us or book online to seek treatment from a physiotherapist or to work with a registered kinesiologist.  

Five Simple Strategies for Symptom Management Post-Concussion

Stephanie Yip is one of our vestibular therapists here at Ladner Village Physiotherapy. Since her own concussion many years ago, she has been passionate about learning as much as she can about concussion rehabilitation. Here, Stephanie shares a few of her favourite strategies for symptom management post-concussion.

Have you (or a loved one) suffered a concussion? Are you finding yourself struggling with day-to-day tasks? Are you constantly overwhelmed by the onslaught of bright lights, noises, and people coming and going? Are you hiding in a dark room by late afternoon?

If you’ve answered yes to one or more of these questions, you are not alone. There are over 200,000 concussions diagnosed in Canada annually, and those are only the ones that are reported. When healing from a concussion, symptoms can be difficult to control.

Only about half of people know what to do when they or their loved ones suffer a concussion. For what to do in the first days and weeks after a concussion, check out Part 1 of our series So You’ve Had A Concussion and download Concussion Recovery 101.

Here are a few simple strategies that you can start implementing right away to start easing your symptoms when you’re having a bad day.

Full disclaimer: these are tools for symptom management, and can be used throughout the day to help you cope. These are not meant to replace concussion treatment/rehabilitation.

Five Strategies for Post-Concussion Symptom Management

1. Palming

This is my personal favourite strategy. Let’s say you’re at the grocery store because you desperately needed eggs but it’s a lot busier than you expected, and you are suddenly hit with a wave of dizziness as you scan the aisles. You want to run and hide in a dark room except there’s nowhere to go.

What do you do? Create your own “dark room”! Cover your eyes with your palm and bathe your eyes in darkness. Look forward into the black and count as you take 10 deep breaths. This works as a recovery tool and you can use it anytime you need a quick break from your surroundings.

2. Musician’s Earplugs

After a concussion, your brain becomes very inefficient at filtering out background noise. This is why you’ve probably noticed yourself yelling at the kids for playing their video games too loudly, or maybe you’ve suddenly developed a newfound loathing of the lawnmower. It can be tempting to start wearing earplugs or noise cancelling headphones to cope. The problem with this is if you start perpetually living in silence, you’ll never learn to tolerate noise again, which will stall your recovery.

Instead, give musician’s earplugs a try. These earplugs have varying levels of filter, so you can choose the least amount of reduction that you can tolerate. You’ll still be able to hear the lawnmower and hold a conversation with a friend, but you won’t want to rip your hair out.

3. F.lux

Do your eyes fatigue easily after using your computer or phone? I promise I’m not sponsored by F.lux but I do love their software.

F.lux is basically a fancier version of the “night mode” setting on your phone. F.lux makes your computer screen look like the “daylight” depending on the time of day, so it will be a warmer glow at night, and then brighter like sunlight during the day. You can adjust the settings to your bedtime so it gradually changes as your day progresses. You can also just keep it “warm” all the time if that’s what you’re able to tolerate that day. (But as your physio, you know I’ll be getting you to gradually increase the brightness over time...’cause that’s the only way we get better!)

4. Reading Tips

Reading is hard after a concussion! But that doesn’t mean you can’t still read and enjoy all the books you used to.

Try placing a piece of paper under each line as you’re reading. This reduces the amount of visual input that your eyes have to take in and filter and allows them to track the letters with less difficulty.

Large font books or enlarging the font on your kindle can be another lifesaver.

Audiobooks can also be a great option, and can even be used as a restful activity. I know they can seem daunting, but try starting out with some easy teen lit (think Harry Potter, Twilight or the Hunger Games) and make sure you like the voice of the reader! Before you know it, you’ll be listening to audiobooks every night.

5. Surface Orientation

Do you ever feel like you’re floating or walking on clouds? I’ve had clients also describe it as walking with pillows for feet. Or maybe you just get hit with waves of dizziness throughout the day. This one is for you.

You can do this sitting, standing, or lying down, depending on the situation you’re in. Whichever position you’re in, find something very firm and solid to stand, sit, or lie on. If you’re near a wall, press your full back against the wall. Focus on the feeling of your feet on the ground, your bum in the chair or the wall on your back. Really focus on each part of your skin that is touching the surface. Take a few deep breaths. Continue focusing on the firm surface you are supported against, and tell yourself that you are not moving. Imagine that gravity is gently pulling you straight down into the surface of the chair, wall, or floor. Check in with yourself. You should feel more grounded.

There you have it – five simple, easy strategies you can start implementing right away. And don’t forget the importance of sleep hygiene, exercise, and pacing!

Remember that concussion rehabilitation does not come with an instruction manual - there is no one-size-fits-all approach. A person dealing with persistent concussion symptoms needs a team experienced, knowledgeable and up-to-date with the latest evidence. Surround yourself with a good team to help navigate your way out.

If you have any questions about concussion 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.

Meet Sofy!

Our newest orthopaedic and pelvic floor physiotherapist, Sofy was born in Taiwan before moving to Kimberley, BC at a young age. She eventually ventured down to Vancouver to complete her degrees and now calls this beautiful city home. Growing up in the East Kootenays introduced Sofy to many sports and outdoor activities, where she spent most of her time in the mountains or at the golf courses. Besides being a physiotherapist, Sofy is also an artist. She loves oil painting and everything art! 

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

I moved to Kimberley because I had terrible eczema and allergies living in Taiwan and Kimberley was the only place that magically made my symptoms disappear (after exploring several countries and cities).

When did you decide you wanted to be a physio? 

I wanted to become a dentist since I was 8 years old. It wasn’t until 3rd year university when I realized that I couldn’t talk to people if I was working inside of their mouths. I love talking and getting to know people as well as learning about how the human body works. After exploring a few different professions, physiotherapy seemed to be the perfect fit!

Which sports are you into? 

Golf, golf, and golf! Tennis in the summer, squash in the winter. Rock climbing, spikeball, and volleyball are pretty fun too. 

Where did you grow up?

Taiwan and Kimberley BC. 

What is your favourite orthopaedic condition to treat?

I like them all! Each body part is fascinating in their own ways in my opinion, hard to pick a favourite. I took a special interest in hands and the upper extremities early on in my career, but now I like to treat everything. 

What makes you happiest? 

Camping on top of a mountain or painting away in my little studio. 

LIGHTNING ROUND!!!!!

Cats or dogs? Dogs

Favourite food? Thai food

Favourite dessert: Tiramisu 

Favourite Junk food: Instant noodles

Beach or mountains: Mountains

Favourite colour: Baby pink

Favourite music: Pop

Favorite day of the week? Sunday

Nickname? Sof, Meng (but I really don’t like it)

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

Favorite holiday? Christmas

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

Invisibility or super strength? Invisibility

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

Dawn or dusk? Dusk

Do you snore? I “breathe loudly” 

Place you most want to travel? Nepal, South America

Last Halloween costume? Cannot remember the last time I dressed up

Favorite number? 3

Have you ever worn socks with sandals? Whenever I’m too lazy to put on shoes

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

Would you want to live forever? No

What's for dinner tonight? Turkey burger with yam fries

Yep, she painted that.

What is Kinesiology?

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

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

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

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

What kind of training does a kinesiologist have?

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

Is a kinesiologist like a personal trainer? 

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

What can a kinesiologist do for me?

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

• Create an exercise plan that is safe and realistic

• Identify muscle imbalances through assessment of your movement

• Help with maintaining fitness while you deal with an injury

• Develop an exercise rehab program to address an injury

• Ensure proper exercise technique to avoid unnecessary injury

• Provide motivation and accountability to stick with your exercise program

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

Is kinesiology covered by my extended health benefits?

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

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

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

• 12 visits with a kinesiologist

• 25 visits with a physiotherapist

• 12 visits with a registered massage therapist

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

Do I have coverage if I have a WorksafeBC claim?

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

What will my session look like?

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

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

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

• phone at 778-227-8030

• email at clinic@ladnervillagephysio.com

• book online

We look forward to meeting you!