Vestibular Exercises for Tired Caregivers of Little Ones

Does this story sound familiar? You go see your favourite physiotherapist who gives you a bunch of great, well-intentioned exercises perfectly targeted for you and your body. By the time you get home, life hits - the laundry needs attention, someone needs to make dinner and someone is crying. How are you supposed to get it all done?!

For caregivers of littles, this often presents a huge challenge - how do you get your exercises in while still managing everything you have going on at home?

When it comes to vestibular exercises, I have come up with a great list that you can try at home. As always, check in with your vestibular therapist to make sure these exercises are appropriate for you.

Devon’s Top Ten Exercises for Vestibular Stimulation With Babies & Toddlers

1. Create an obstacle course with tape

Grab some masking or painter’s tape and start taping lines on the ground. Tape a long, straight piece down and walk heel to toe on it; tape a zig-zag on the ground to walk along; tape some shapes to jump into - you are only limited by your creativity!

Bonus points if you use different colours of tape and assign different rules to different tape colours. For instance, move slowly on the yellow tape, fast on the green tape and backwards on the blue tape.

2. Play Floor is Lava

Grab all the pillows you can find and scatter them around the room. Go from one pillow to the next, making up rules as you go. Let your little one pick a pillow to “sink into the lava” or decide that all the blue pillows sunk.

3. Peak-A-Boo with movement

For the super-littles, a game of peak-a-boo is a great place to get some vestibular input. When you close or cover your eyes, move either forward/backward or up/down - that movement with eyes closed will give your vestibular system a nice kick. Remember to do this one in sitting if you’re quite off-balance with eyes closed in standing!

4. Ring Around the Exersaucer

If you have a little sitting in an exersaucer, jolly jumper or even on a blanket on the ground, walk around them in some kind of silly walk while making eye contact and having your head turned toward them. You could be a penguin, a hopping bunny, a gorilla - whatever you’d like! The bigger and more exaggerated the movement, the better!

5. The Hokey-Pokey

If you want to get your body moving, do the Hokey Pokey! You can move as much as you want and even close your eyes for parts of it to give you a real challenge. Putting your head in? Drop that head as far down as you can!

6. Toy handoff

A common vestibular exercise I prescribe is looking at something in your hand while moving your head. This is easy to do here - when you grab a toy to hand your kid, look at the toy as you turn and move towards your kid without allowing your eyes to come off of the toy.

7. Yoga

You may be thinking, how am I supposed to do yoga with little kids around? My kids and I started down Cosmic Kids Yoga together during the pandemic and they loved it. Give it a try! It even became a regular thing in our home before lunch.

8. Silly walks

Create your own silly walks with your littles! High kicks, wobbly knees, spins… take turns creating a silly walk and having everyone else copy it. If you have one walking little and one non-walking little, holding the baby while doing your silly walk gets your bonus points!

9. Tickle fights

Honestly, the vestibular system and spontaneous movement are made for each other. Tickle fights are such a great way to engage in unpredictable movement patterns and react to their movements. Add some rolling around and you’ve got the whole package!

10. Patty Cake

When playing patty cake, keep your eyes switching back and forth between your hands - this gives your vestibular system some great stimulation.

Remember - make sure you’re safe to do any and all of these exercises, especially ones in which you are closing your eyes and moving through space. The last thing you need is a fall! If in doubt, check in with a vestibular therapist about which exercises are appropriate for you.

If you need the help of a vestibular therapist, call us at (778) 630-8800, book online or email us.

Ask A (Vestibular) Physio - Why Is My Vision Blurry?

Here’s a classic story from a new dizzy patient:

I spent a few days really dizzy, with the world seemingly spinning around me even though I was staying still. After those first few days, the spinning and moving stopped but my balance has been terrible since.

Not only that, but everything is blurry! When I try to read, I can’t keep the words in focus. I went to my eye doctor but they said my vision hasn’t changed, even though I can’t see anything!

What’s going on?!

This, dear reader, is a direct result of inner ear dysfunction! But wait, you may ask - how does the ear control the eyes!?

It’s time for a deep dive into the VOR.

What is the VOR?

The Vestibulo-Ocular Reflex, also known as the VOR, is the most adaptable (re: trainable) reflex in the human body. Here’s how it works:

• When your head turns to the left, the semi-circular canals in your ears sense the head rotation and send that signal to your brain.

• The brain then quickly (and I mean quickly - this happens in a few milliseconds!) sends a signal to your eye muscles to move your eyes the same amount to the right

This allows your eyes to keep things in focus even when your head is moving. (Want to know a secret? I love this reflex - I get rather excited talking about it! Can you tell?)

When does the brain use the VOR?

In short, all the time! When you walk, when you breathe and even when your heart beats, your head is moving. The VOR is critical to stabilizing vision so everything stays in focus when you are out and about in the world.

Without a fully functional VOR, things can quickly become blurry and out of focus. This occurs with vestibular neuritis and labyrinthitis.

How does the VOR actually work?

Who’s ready to get nerdy with me? It’s time for a deep dive into neurology!

Your inner ears send signals to your brain constantly. When your head is stationary, both ears send signals at about 100 beats per second to your brain. When you turn your head to the right, your right ear sends a faster rate of signals (for example, 120 beats per second) and your left ear sends a slower rate (say, 80 beats per second).

It’s this difference between the signals from your ears that triggers reflexive eye movement. Your eyes can stay focused on your target (whether that’s a book, the basketball hoop you’re shooting at or the person you’re in conversation with) without you even thinking about it.

Without this reflex, the world very quickly becomes blurry and out of focus. Any head movement can lead to blurry vision.

How does a problem with the VOR occur?

Anything that disturbs the function of the inner ear and the signals it sends can affect VOR. When your inner ear has a deficit, it sends signals to your brain at a lower rate.

For example if you have a right ear deficit, your right ear’s baseline rate of firing at rest may only be 80 beats per second. If your left ear is still sending signals to your brain at 100 beats per second, your brain perceives this difference and thinks you are rotating to the left.

Inner ear dysfunction such as labrynthitis and vestibular neuritis, concussions, vestibular migraines and other vestibular and neurological conditions can lead to VOR deficits.

Can we fix a broken VOR?

You bet we can! The VOR is the most adaptable and trainable reflex in the human body. Vestibular therapists give specific exercises with the primary purpose of training this reflex back to function.

If you’re looking for a vestibular therapist in Canada, visit Balance and Dizziness Canada for a list of certified vestibular therapists. We love what we do and would love to help you!

To book with one of our vestibular therapists, book online, send us an email or give us a call at (778) 630-8800.

Cognition and Vestibular Disorders - So Much Brain Fog!

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

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

You just feel dumb.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The success of vestibular rehabilitation relies on three key components:

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

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

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

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

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

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

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

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

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

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

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

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

Motion Sensitivity - Part 2: Top Ten Exercises!

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

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

Before we start, here are some disclaimers:

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

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

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

My Top 10 Motion Sensitivity Exercises

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

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

2) Play on the swing set

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

3) Go on the see saw

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

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

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

5) Watch the clouds while you walk

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

6) Log roll down a hill

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

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

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

8) Play some focused catch

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

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

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

10) Do some chair spins

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

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

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

Motion Sensitivity - Part 1: What Is It?

Stephanie Yip is one of our vestibular therapists here at Ladner Village Physiotherapy. In Part 1 of her two part series on motion sensitivity, Stephanie explains what motion sensitivity is, why some people suffer from it and what we can do about it. Enjoy!

As a kid growing up, cars were my nemesis. I still have vivid memories of throwing up on pretty much every family road trip, and even worse, throwing up in my friend’s dad’s brand-new car on the way to a soccer game. Planes were even worse. One of my earliest memories is of me as a 5-year-old, non-stop projectile vomiting on a 12-hour flight, with everyone around us handing us their puke bags since I had used up all of my own. As I got older, my motion sensitivity got a bit better in the sense that I didn’t necessarily puke during every car ride, but I would still feel sick within minutes of being in any moving vehicle.

How many of you can relate to this? After sharing with friends, I discovered that there are so many of us out there, struggling with cars, buses, boats, and thinking that this is something we just have to live with. Well, I am here to share with you all the greatest revelation which has completely turned my world upside down.

This does not have to be our reality.

There is a solution. Just like how we rehabilitate and strengthen our ankle after a sprain, we too, can rehabilitate and strengthen our vestibular system to improve our motion sensitivity!

But let’s back this up, and start with…

What is motion sensitivity?

There are two main types of motion sensitivity. One is considered visually induced motion sensitivity in which you experience symptoms due to complex visual environments. Do you ever find yourself feeling sick at the grocery store as you scan the aisle for that one type of flour you need? Does scrolling on your phone too quickly make you feel loopy? If so, this may be the type of motion sensitivity you have.

The second type is the one we mostly think about when we think of motion sensitivity, and that’s why it’s called true motion sickness in which symptoms are caused by passive motion. Passive motion means that you are not actively moving but something is moving you i.e. being in a car or boat.

What are some common symptoms of motion sensitivity?

After sharing my experiences with friends, I’ve discovered that everyone experiences motion sensitivity quite differently, so this list of symptoms is definitely not all-encompassing. Personally, I get a weird background headache, followed by a woozy feeling in my head almost like I’m floating. Despite my earlier experiences of nausea and vomiting, I rarely feel sick to the stomach now unless I’m on a tiny boat with very choppy waves. On the flip side, many of my friends have described nausea as their main symptom. Other common symptoms include fatigue, imbalance, increased sweating, disorientation, palor (aka looking quite pale), excessive production of saliva, and burping.

So you’re probably thinking great, I definitely get motion sensitivity, but why does this have to happen to me?? Do you ever watch your kid reading in the backseat and think man, why can’t I do that?

Why do I get motion sensitivity?

If you’ve been an avid reader of our blog, you will already know that our sense of balance comes from three main sources: the vestibular system, the visual system, and the somatosensory system. (In case you missed it, check out our earlier blog posts on the vestibular system here and here.)

People who get motion sensitivity often rely too much on their visual system, which means their brains can easily be tricked. If you’re sitting in your parked car, and the truck next to you starts moving, your vestibular system is telling your brain that you’re not moving, but your visual system is saying the opposite. If you’re someone who over relies on their visual system, that system will take over, convince the brain that you are indeed moving, and make you feel really sick. This can also be referred to as visual vestibular mismatch, or VVM.

So what can you do about it?

Treatment for motion sensitivity

If you’re a lifetime sufferer of motion sensitivity, you’ve probably already tried Gravol, ginger pills, cracker nibbling, looking straight ahead when the car is moving, etc. etc. But all of these things are only band aid solutions to help you cope. What if you could cure your motion sensitivity?

Just like an ankle sprain, there is no magic wand that can cure you in an instant, but there are many exercises you can do to start training yourself so that you no longer experience motion sensitivity. There are two main elements you will need to work on:

1. We need to train the brain to stop its over-reliance on the visual system, and to start relying more on the vestibular system instead. How? Take the other two systems away. Stand on your cushy couch, close your eyes, and don’t fall over.

2. We need to gradually desensitize or habituate the brain so that it can tolerate these icky situations more and more. This means that yes, we do need to trigger those symptoms to train the brain, but only mildly. You should feel only mild symptoms that resolve within 5 minutes. What that may look like totally depends on the individual. For some, that may mean 1 minute in the car as a passenger. For others, it may mean getting on a roller coaster if that’s the only trigger they have.

For more exercises that you can easily incorporate into your everyday life, check out part 2 of our motion sensitivity series where I will be sharing my Top 10 Motion Sensitivity Exercises. Some of them are actually pretty fun and include playing video games or hanging out with your kids, so be sure to check out that post when it goes live!

If you want to get started on your motion sensitivity rehabilitation, give us a call at (778) 630-8800 or book online at ladnervillagephysio.com .

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References

Pavlou M, Quinn C, Murray K, Spyridakou C, Faldon M, Bronstein AM. The effect of repeated visual motion stimuli on visual dependence and postural control in normal subjects. Gait Posture. 2011;33(1):113-118. doi:10.1016/j.gaitpost.2010.10.085

Roberts RE, Da Silva Melo M, Siddiqui AA, Arshad Q, Patel M. Vestibular and oculomotor influences on visual dependency. J Neurophysiol. 2016;116(3):1480-1487. doi:10.1152/jn.00895.2015

https://www.360neurohealth.com/blog/207141/vestibular-rehab-in-patients-with-motion-sensitivity

Nice To Meet You Again!

If someone on the street asked me about our clinic I would probably say something like “Ladner Village Physiotherapy has three physiotherapists and a massage therapist. We take pride in offering specialized services such as pelvic floor physiotherapy and vestibular rehab.”

But there is more to us than just that. So as we prepare to re-open the clinic after being away for two months I would like to give you the inside scoop and re-introduce the real us. The “us” you might not know about at first glance. What random experiences have we had that could help us treat you better? One physio might be a better fit for you than others (for example if you horseback ride see Nicole, if you rock climb see Stephanie, and so on). Of course if you are ever wondering who to see our lovely front desk staff will be able to point you in the right direction. But, here is some insight into what we have to offer.

So who are we?

Devon

Devon is one of the owners of Ladner Village Physiotherapy. She has two young girls and is a lover of board games, skiing and ultimate frisbee. She would cut off her right arm to travel around the world and is usually planning her next adventure. Devon is our resident vestibular rehabilitation guru and is always up to date on current events.

Who should see Devon?

• Concussion clients - Devon can help with many aspects of concussion and runs a concussion circuit every Friday morning. It’s filled with all kinds of fun things - obstable courses, puzzles, balance exercises and things that involve a lot of post its and lasers. She’s always having fun with them!

• Vestibular clients - Do you spin when you wake up in the morning or lie down at night? Does the world move a little more than it should? Diagnosed with BPPV, Menieres or labrynthitis? Feeling off balance? Devon will pick you up and plunk you back on solid ground. She educates you extensively (be careful about asking her questions, she gets very excited and will start talking about neurotransmitters) about what is going on and what you can do about it. You can be confident that Devon is providing you with excellent care.

• Ankles - Devon has more experience than most when it comes to ankle injuries and she will gladly help you on the road to recovery with your own injury.

• Gardeners - Gardening is hard! There is bending and lifting and twisting and reaching. Devon is here to make sure you don’t hurt yourself while you enjoy your yard.

Stephanie

Stephanie is cheery and lovely and has the cutest little pup you ever did see. But what you might not know is that she is also probably the most hardcore out of the group (competitive rock climber!!), does yoga and paddle boarding and is a published author! She an an incredible thirst for knowledge and is constantly learning more about her craft.

Who would be great to see Stephanie?

• Rotator cuff issues - Stephanie is the one for you. She will get that rotator cuff behaving like no other. Just imagine being able to lie on your side again or put a jacket on without worrying which hand you put in first! Heaven.

• Rock Climbers - Stephanie is small and mighty and an excellent rock climber. She is there to make sure your body is ready to handle that dyno you’ve been dying to try.

• Skaters – fun fact, Stephanie used to teach skating lessons, which is more than Devon and Nicole can say (Nicole still stops by running into the boards, Devon usually just falls). So, hockey players and ice dancers alike, if you need some help with your skating mechanics, she is the physio for you!

• Dizziness and imbalance - As a sufferer herself, Stephanie has an intimate understanding of how vestibular issues can affect your life. She is here to help you with your symptoms and help you get your life back!

Nicole

Nicole is also an owner at Ladner Village Physiotherapy. She grew up in Ladner and still lives here with her family. She loves any activity that involves fresh air (picnics included) and wants to know all about you, your favourite hiking spots and your best chocolate cake recipes. In her “previous pre-child life” Nicole also played soccer and did some horseback riding! Please tell her stories about your horses so she can live vicariously through you.

Who should see Nicole?

• “Mom stuff” - Nicole is the resident pelvic floor therapist. This means you can talk to her about absolutely anything including, but not limited to: posture when breastfeeding, how to carry your baby in an ergo without hurting your back, exercise during pregnancy, exercise after baby, accidental urine leakage, prolapse, painful intercourse and everything in-between. If it’s pregnancy or baby-related she has got your back and will not rest until you are feeling AWESOME.

• Runners - Although Nicole refers to herself as a “jogger” rather than runner, she has a few half marathons under her belt and can help you with your training, your gait, and treat your overuse injuries to get you back on the road.

• Baseball/softball players - Nicole played competitive softball for MANY years (as a catcher). She understands throwing and batting mechanics, plus she wants to hear all about the epic double play from last game.

• Pelvic Floor Dysfunction - Pelvic pain? Accidental leakage of urine or feces? Prolapse? Nicole is there for you. She can help. The biggest thing she hears is “why didn’t I know about this sooner.”

What do we love about our clinic?

• Sessions are one on one. They always have been, they always will be. You will never be “juggled.” We know your time is important and you don’t want an appointment to take up a huge chunk of your day. Your time slot is yours and we are dedicated to you completely during that time.

• The physical space. We spent a long time designing the space to be exactly what we needed. Private treatment rooms, a super long hallway, you name it we planned it that way and we are so thrilled with it.

• Our clients. This is our community. We live here, we work here, some of us grew up here. We could not be more thankful for our fantastic clients who make coming to work such a pleasure.

• Technology is our friend. All of our equipment is up to date and we are constantly buying new equipment to keep up our learning and training (coming soon- a virtual reality system for Devon’s vestibular clients).

• We are constantly learning. The best part about our field of health care is that it is constantly evolving. We get very excited about the courses we take to further our education within our chosen niche and we take the time to train each other and practice our techniques. We strive to be our best so we can be confident that you have received the best care that is highly skilled and evidence based.

For our returning clients, we cannot wait to see you again! If you’ve never been here before, we’d love to meet you! Give us a call at (778) 630-8800 or email us at clinic@ladnervillagephysio.com to book your next appointment.

See you soon!

How Do We Learn? Neuroplasticity, Of Course!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Happy learning!

Labyrinthitis & Vestibular Neuritis - Why Do I Feel So Off?

As a vestibular therapist, the second most common thing I treat is typically caused by an inner ear infection. It can go by a few different names - labyrinthitis, vestibular neuritis, peripheral vestibular hypofunction - but at the end of the day, they all mean the same thing: your ear is not working properly. I don’t have the equipment to figure out if the problem is coming from the nerve or the end organ and, quite frankly, it doesn’t matter - they act the same. I group them together in one name: Unilateral Vestibular Hypofunction, or UVH for short.

Here’s my story: I got hit by a flu when I was a physiotherapy student at UBC. I remember sitting on the couch, trying desperately to stop Oprah from oscillating on my TV. After a few days of spinning, overwhelming nausea and an inability to walk without holding onto someone or something, I managed to get on the bus (big mistake) and go to class. The professor noticed that I wasn’t at my best - she looked into my eyes and simply said “go home”. What I didn’t know at the time was my eyes were jerking back and forth (called nystagmus) - my professor caught it and figured out what was going on. With vestibular exercises and some time, I got back to “normal”.

Why do I say “normal”? I will always have an inner ear deficit. When I’m really tired or fatigued, by brain can’t compensate for the deficit as well as it normally does and I get a bit symptomatic. Here’s the difference between me now and me then: I know what I can do about it. I know how to settle my symptoms and get control back. This is what I help other people learn to do.

Why do UVHs happen?

Most people hate this answer but it’s usually the common cold or flu - it was for me! Other viruses and bacteria have also been linked to UVHs but it’s usually a virus that needs to run its course. Unfortunately, it typically damages the ear in the process. When this happens, the signals between the inner ear and brain are disrupted. This results in a bunch of symptoms that can either pass on their own or stick around for a lot longer than you want them to.

What are the symptoms of a UVH?

This list is long! The vestibular system affects several aspects of the brain with vision and balance being the two most common ones. I don’t let people say they’re dizzy (learn why here), so people with a UVH often complain of the following:

• Weird head feelings - cotton head, foggy head, vice head, light headed…

• Blurred vision or difficulty reading - almost like the world is oscillating (sometimes a bit, sometimes a lot!)

• Off balance

• Nausea, often with vomiting

• Tinnitus, or ringing in your ears

• Decreased hearing

• Typically aren’t bad drivers but are terrible passengers

• Hates grocery stores and places with lots of visual stimulation (think Costco or your kid’s hockey game)

• Symptoms are worse with fatigue and stress

• Tends to veer to the side when walking - partners will complain they push them off the sidewalk

• Difficulty concentrating and multitasking

What can I do about it?

A lot! During your assessment, we figure out where your deficits are. Maybe your balance isn’t bad but you can’t keep your eyes stable for the life of you. Or maybe you can move your head beautifully but as soon as you look up, you fall backwards. We break down your symptoms and give you exercises designed to challenge your system’s weaknesses.

More importantly, we figure out how those symptoms are affecting your life. If you’re a golfer, it’s critical you maintain your balance through your swing and change your gaze direction quickly. If curling is your passion, your dynamic balance needs to be on point. Whatever you love to do becomes our goal and focus.

If you’d like a few exercises to try now, check out my previous blog on my Top Ten Vestibular Exercises for Life.

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As always, if you’re suffering from a vestibular condition and you’d like to book an assessment, book online or give us a call at (778) 630-8800.