Exercise and Arthritis - The GLA:D Way

Arthritis can be a life-changing disease. I have arthritis myself - I feel your pain!

As physiotherapists, we treat a lot of arthritis and hear a lot of misconceptions - “I shouldn’t squat down, that’s bad for my knees” or “I’m supposed to rest when my hip hurts”. But what if we told you this way of thinking is wrong? What if we told you that you could gain some control over your pain simply by changing the way you move?

The research has come a long way. Want the up-to-date info? Keep reading!

Top Ten Facts About Osteoarthritis (aka OA)

1. It is not “something that just happens” as we age! It is a disease that develops slowly over years and years, often not being diagnosed until quite late in the process.

2. Over 20% of people in Canada have arthritis, most of that being OA. I don’t know about you, but that number blows my mind.

3. OA affects young people as well. I was diagnosed with arthritis in my mid-thirties after years of chronic ankle sprains (prior joint injury - a big risk factor!) and I’m not alone. 60% of people with OA are younger than 65 when they are diagnosed and that’s usually after several years of going undiagnosed. We exist!

4. Meniscal tears and muscle weakness are early signs of OA. Research has also shown the faster we treat these with appropriate exercises, the more you can delay the onset of OA symptoms.

5. You do not need an X-ray for an OA diagnosis. In fact, X-rays are only 30-40% accurate in detecting OA. X-rays usually only pick up OA in the later stages. In other words…

6. Ignore the X-ray. Did your X-ray come back negative? Or maybe it shows “bone-on-bone”? Great news - it doesn’t matter! X-ray findings do not predict or define your symptoms or how you function. It doesn’t matter if you have the tiniest bit of OA or the worst case ever - what matters is how it feels, how strong you are and what you can do with it.

7. Physiotherapists can diagnose OA. We do this by listening to your symptoms, testing out your joint and taking a close look at your risk factors.

8. Losing 5% of your body weight can really help reduce your joint pain for those who are overweight. The force that goes your through your knees with each step is equivalent to four times your body weight. If you take 10 lbs off the scale, 40 lbs of stress are removed from your knees when walking.

9. Motion is lotion - your body is meant to move, even when OA is an uninvited guest. Physical activity helps lubricate the joint and maintains the health of the cartilage, even if there’s not much left.

10. Only 2% of people with hip and knee arthritis will go on to get a replacement. The decision to get a joint replacement is often a difficult one and based on many factors. That leaves a whole lot of people in need of management strategies.

The Best Thing We Can Do For OA?
EXERCISE

Research has shown again and again and again that exercise:

• has better long term pain control than drugs

• improves the health of cartilage

• helps delay (or even completely avoid!) surgery and all the possible complications that comes along with it

So what kind of exercises should you be doing? Well we are GLAD (Ha! Get it? No? You’ll get it in a second…) you asked!

Introducing The GLA:D (TM) Program

The Good Life with Osteoarthritis in Denmark (also known, thankfully, as GLA:D) (TM) program was developed by researchers in, you guessed it, Denmark!

GLA:D (TM) is a group exercise class for those suffering with hip and knee OA. This six week program’s goal is to teach participants about OA and give them the best we have at combating it: appropriate exercises done properly.

The research behind GLA:D (TM) has some incredible findings:

• 30% reduction in pain levels at both 3 and 12 months after the program

• More than 50% reduction in use of painkillers

• Half the anxiety around fear of movement and damaging joints with activity

• Less than a third of sick time from work

• Significant improvement in quality of life

GLA:D (TM) has four components:

1. Initial assessment - Before you even get started in the program, a physiotherapist will do a one hour 1:1 appointment with you to make sure you’re appropriate for the GLA:D program, test out your hip or knee and go over all the exercises with you.

2. Education sessions - Over 2 or 3 classes, participants learn about osteoarthritis and its risk factors, symptoms, coping strategies and self help tools. They will also learn about the science behind pain and how they can use this to help control their own pain.

3. Exercise sessions -12 sessions of physiotherapist-led group classes lasting an hour each. These sessions focus on neuromuscular exercise - strengthening muscles with a huge focus on control throughout the whole movement.

4. Outcome measures - At the beginning of the program and then again at 3 months and 12 months afterwards, participants will be contacted by researchers about their adherence to the exercise program, their pain levels and how they are functioning. This data is used for public health funding and future research.

Starting in January 2021, Ladner Village Physiotherapy will offer the GLA:D (TM) Program online!

For details on registration, head on over to our GLA:D Program page.

Ready to go? Register at (778) 630-8800 or by email - we are so excited to meet you!

Meet Trevor!

Trevor Reid is our latest addition to the clinic and we are thrilled to have him! Originally from Langley, Trevor’s passion for physiotherapy may only be rivaled with his love of all things aviation. Learn more about Trevor below!

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

I’m an aviation and space fanatic, I spend countless hours reading about aviation and space in my spare time. I plan on obtaining my pilot’s licence within a few years!

When did you decide you wanted to be a physio?

I decided to pursue physio in high school as my favourite classes were always PE and biology. Therefore, physio was the perfect career for me as it allowed me to work in a field that combined my interest in physical activity and science. Additionally, I have spent many hours attending physiotherapy from various injuries throughout my life. These experiences motivated me to pursue such a rewarding career.

Which sports are you into?

I enjoy weightlifting, soccer, and hockey, but football is my favourite to watch!

Where did you grow up?

I grew up in Langley and only just recently moved to Vancouver.  

What is your favourite orthopaedic condition to treat?

My favourite orthopedic condition to treat is shoulder pain. Specifically, I enjoy treating impingement syndrome. The shoulder is an amazing region of the body and it typically responds very well to physiotherapy intervention!

What makes you happiest?

Travelling! I think my next trip will be somewhere in Europe! 

LIGHTNING ROUND!!!!!

Cats or dogs? Dogs

Favourite food? Salmon Sushi

Favourite dessert: Tuxedo cake

Favourite Junk food: Ben and Jerry’s half-baked ice cream

Beach or mountains: Mountains

Favourite colour: Red

Favourite music: Country music

Favorite day of the week? Saturday

Nickname? Trev

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

Favorite holiday? Christmas

How long does it take you to get ready? 15 minutes

Invisibility or super strength? Invisibility

Is it wrong for a vegetarian to eat animal crackers? Frowned upon

Dawn or dusk? Dawn, I wake up at 6:30-7am every morning

Do you snore? No

Place you most want to travel? Normandy beaches in France

Last Halloween costume? Bottle of ketchup 

Favorite number? 16

Have you ever worn socks with sandals? Noooo

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

Would you want to live forever? No, 115 years seems long enough for me

What's for dinner tonight? Steak, rice and veggies

Meet Hamraj!

Some of you will recognize Hamraj Sidhu from his time with us as a physiotherapy student. We are so excited he has decided to join our little clinic! Read more about Hamraj below including why physiotherapy was his calling and how he may be able to get you an “in” with the British Royal Family.

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

In 2011, I sat with The Duke & Duchess of Cambridge, Prince William and Kate (as well as Prime Minister Steven Harper, the Governor General and more) during the opening ceremony of the Calgary Stampede.

When did you decide you wanted to be a physio?

I always knew I wanted to be in health care but did not know exactly what field. It wasn’t until the end of my second year of university when I began to work at a physiotherapy clinic as a Kinesiology co-op student that I really developed a passion for the profession. After this experience, I spent the remaining two years of my undergraduate degree taking additional courses such as advanced Human Anatomy and Physiology, Sports Injuries and Prevention, and more to help further my interest and knowledge.

Which sports are you into?

Basketball and rugby. I developed a passion for basketball at a young age and was involved in multiple clubs and organizations that travelled to compete. Rugby was a second sport that I enjoyed a lot! I developed a lot of friendships and life skills through sport.

Where did you grow up?

I grew up in a small town of 5,000-6,000 people called Mackenzie in Northern BC. Snow would last up to 8 months there!

What is your favourite orthopaedic condition to treat?

Anything to do with the shoulder! I just find the shoulder complex extremely fascinating with all the different joints involved and areas to look at that can contribute to someone’s symptoms.

What makes you happiest?

Being with family and friends! I also really enjoy my fitness routine at the gym because that it my 1-2 hours where I can completely turn off my brain from everything.

LIGHTNING ROUND!!!!!

Cats or dogs? Dogs

Favourite food? Pizza

Favourite dessert: Chocolate cake

Favourite Junk food: Chips

Beach or mountains: Mountains

Favourite colour: Blue

Favourite music: R&B + Hip hop (and a mix of other genre)

Favourite day of the week? Saturday

Nickname? Hamu

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

Favourite holiday? Christmas

How long does it take you to get ready? 15-20 minutes

Invisibility or super strength? Invisibility

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

Dawn or dusk? Dusk

Do you snore? Apparently I do sometimes?

Place you most want to travel? Greece

Last Halloween costume? Solar system

Favourite number? 23

Have you ever worn socks with sandals? Yes, definitely

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

Would you want to live forever? Vancouver, we have everything here!

What's for dinner tonight? Fettuccine Alfredo

Meet Anh!

Hailing from the Northern coast of British Columbia, Anh Duong brings a wealth of dance expertise to our clinic. Learn all about what makes Anh tick and why we are so excited for her to join us!

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

I did not learn how to ride a bike until I was 23 years old. Our family was never the outdoorsy type and my parents just never saw the need for me to learn. Luckily I have awesome, and very patient friends.  

When did you decide you wanted to be a physio?

Growing up as a dancer I’ve always had an interest in how the body moves. I also grew up in a family that values health and wellness. During my first year at university, I took an anatomy course and fell in love. I thought to myself, “how do I combine my values around health and well-being, my passion for dance, and my newfound love for anatomy all into one?” and physiotherapy was the answer. 

Which sports are you into?

Dance! I’ve trained in ballet, jazz, tap, contemporary, modern, hip hop, and acrobatics. I also recently started playing tennis but I’m just happy if I can get the ball over the net.

Where did you grow up?

Prince Rupert BC, the rainiest city in Canada.

What is your favourite orthopaedic condition to treat?

Hips, ankles and feet, all of which I, myself, have had problems with in the past.

What makes you happiest?

I am happiest in the dance studio. But may also be caught smiling when eating delicious food with family and friends.

LIGHTNING ROUND!!!!!

Cats or dogs? Dogs

Favourite food? Sushi

Favourite dessert: Crumbled apple pie, the crumble is a must!

Favourite Junk food: Nachos

Beach or mountains: Beach

Favourite colour: Rose gold

Favourite music: R&B

Favorite day of the week? Saturday

Nickname? Just Anh

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

Favorite holiday? Lunar New Year

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? nope

Dawn or dusk? Dawn

Do you snore? Don’t think so

Place you most want to travel? Japan, South America, Rome   

Last Halloween costume? A basketball player.

Favorite number? 9

Have you ever worn socks with sandals? This should be a crime

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

Would you want to live forever? Nope

What's for dinner tonight? Butter Chicken

What Is A Pessary?

Nicole Coffey is our resident pelvic health guru and expert on all things related. Read as Nicole answers a Q& A about what exactly a pessary is and who could benefit from one.

What is a pessary? I get this question a lot.

A pessary is an internal vaginal support device typically made of medical grade silicone. They are generally used by women who experience bothersome symptoms from prolapse (when one or more of the abdominal organs including the bladder, uterus or rectum descend and decrease the space within the vaginal canal - find more information in my earlier blogs Part 1: What is Prolapse? and Part 2: I Have A Prolapse! Now What?). This can lead to symptoms such as vaginal heaviness, pressure, a sensation that something is “up there”, or noticing tissue protruding from your body. There might also be bladder and bowel symptoms such as incomplete emptying. Pessaries can also be used to treat urinary stress incontinence, which is accidental urine leakage with activities such as coughing, sneezing, jumping, running, and so on. The pessary acts like an internal shelf to hold the organs up, keeping them away from the entrance of the vagina.

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Typical Pelvic Floor Anatomy

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Uterine Prolapse

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Inserted Pessary

For some people, surgery is an option. For people who do not want to have surgery or who are not surgical candidates, a pessary can be a fantastic option for treatment. (For the record, pelvic floor exercises are also awesome and can help as well, but we are talking about pessaries today).  

So what holds people back? Pessaries can be intimidating. But have no fear, I am here to show you that they aren’t so bad after all!

Take a look at the most common questions I get about pessaries:

1.       Do they hurt?

No! The best thing about a pessary is when it is inserted you can’t feel the pessary and you can’t feel your prolapse! This is why they are so magical. Some women who have a history of vaginal pain (such as pain with intercourse and tampon use) might have discomfort while inserting and removing the pessary. Other women report an initial discomfort when inserting and removing the pessary until they get the hang of it but the majority of users report no pain.  If you do feel pain when inserting and removing the pessary and you are post-menopausal you might benefit from vaginal estrogen cream (this is an excellent conversation to have with your doctor).

2.       Are they hard to get in and out?

Not really. Some styles are trickier than others and require a little bit of skill, but with a little bit of practice you will be a pro at managing your pessary.

3.       When do I wear it?

This is mostly up to you. Some women only wear their pessaries during high intensity exercise. Some women insert it every morning and remove it every night. Others wear theirs for 3-5 days at a time. If a gynaecologist fits you with a pessary there is an option to wear it for longer periods (up to 3 months at a time), but this again is a conversation to have with your specialist.

4.       Can I have intercourse when I am wearing my pessary?

Usually no. There are some types (ring pessaries) that would allow for penetrative vaginal intercourse, but the majority of pessaries need to be removed for intercourse.

5.       How soon after having my baby can I be fit with a pessary?

I personally do not fit people with pessaries before 12 weeks post-partum because your body is still healing and changing. I also do not fit people who are currently pregnant. Again, if you see a gynaecologist they will be able to work with you in these situations as needed.

6.       I don’t have prolapse but I leak urine, can I still use a pessary?

If you leak urine due to stress incontinence (coughing, running, jumping, etc.), a pessary absolutely can help. It will probably just be a slightly different type and you likely will only have to wear it at times that you leak such as while at the gym. A pessary will not help with urge incontinence (leaking due to a very sudden and strong urge to pee).

7.       How do I know what size and type I need?

This one is unfortunately a little tricky. Fitting a pessary is a combination of experience, art, and some trial and error. During your appointment I discuss with you which type of pessary I think would be best for you to try first and why. Then we proceed to try a few different sizes and shapes as needed until the perfect one is found. Sometimes this happens right away and sometimes it takes a few tries. It might take more than one appointment but it is worth it in the end to have a pessary that fits properly.

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If you have any further questions about pessaries or would like to book a pessary fitting, book online, send us an email at clinic@ladnervillagephysio.com or give us a call at (778) 630-8800.

Headaches - The New Guidelines

When I came across these clinical practice guidelines, I was a little giddy - you may have noticed the excitement in my instagram post. When the Veteran’s Affairs/Department of Defence Clinical Practice Guideline For The Primary Care Management of Headache dropped a few weeks back, I poured myself a glass of wine and settled into my favourite patio chair for a quiet evening of evidence-based practice. Here are some facts I pulled out of the 150 page document:

1. 66% of people will experience a headache disorder in their lives. Sixty-six. SIXTY-SIX. That number blew my mind. I knew it was a common thing to experience, but I never would have guessed THAT common.

2. Women are more likely to experience migraines (15-18%) than men (6-10%). These migraines are often triggered by hormone fluctuations and are most prevalent in women of childbearing age.

3. The three most common types of headaches are:

   1. Tension-type headaches - these can last anywhere between 30 minutes to 7 days and are characterized by pain on both sides of your head and a pressing or tightening feeling. Tension headaches do NOT pulse and are typically not aggravated by life - they just happen.

   2. Migraines - lasting typically from 4-72 hours, migraines usually take over one side of your head with moderate to severe pulsing or throbbing pain, sometimes with a whole host of other symptoms (nausea, vomiting, light and noise sensitivity, visual or auditory auras and more!). Migraines are often triggered by physical activity, such as climbing the stairs, or other triggers in foods or the environment.

   3. Medication-overuse headaches - I’ll be honest, this one surprised me as making the “Top Three” list. These are a result of overmedicating with anything from over-the-counter meds like Tylenol or Advil, or the heavy hitters like opioids and triptans. (If you think this may be you, please speak with your doctor before changing your medication use)

So what kind of headache do you have?

Headache Diary

First things first - you need a headache diary. By tracking the time, medication used, triggers and patterns of your headaches, we can figure out what kind of headaches you’re experiencing and the best method of attack for your headaches. To make an accurate diagnosis, you should track your symptoms for at least a month - this gives us enough data to identify patterns and come to a more accurate diagnosis.

Now, for the big question - what can you do about your headaches? Let’s go through migraines and tension-type headaches separately.

Migraines

The best treatment option for migraines we have right now is the right medication. There are a whole host of them out there with various levels of evidence behind them - in fact, most of them are listed in this clinical practice guideline! If you have a migraine diagnosis or think you should, I urge you to speak with your physician - they can help you decipher your symptoms and figure out the right meds for you.

The other big treatment approach for migraines is trigger modification. Has your headache diary helped you figure out something in your diet is causing your headaches? Or maybe you’ve realized reading in the car can bring one on? Identifying and removing or dealing with these triggers is huge!

Tension-Type Headaches

With tension headaches, medications are also great. We have other non-pharmaceutical options with research behind them, including:

1. Physiotherapy for your neck - research is supporting more and more the use of manual therapy and exercise for the neck to help reduce headaches. This could mean traction, release of muscles in your neck, strengthening of the deep postural muscles or stretching of the tight muscles in and around your neck - it depends on you!

2. Aerobic exercise and progressive strength training - it turns out that getting your heart rate up and your body strong is one of the best things you can do for you head. For starters, any exercise that gets your heart rate up also gets your body making new blood vessels including in your brain. Add general body strengthening to that and your head becomes easier to hold up all day, reducing the tension in your neck.

3. Mindfulness and meditation - we are finally at a place in the medical community where mindfulness is mainstream! We know thought patterns can influence our bodies and the pain we perceive. We also know we can harness this for our own benefit through mindfulness practice. Not sure where to start? Apps like Calm and Headspace are a great place to get your feet wet - I like anything with a body scan!

Wondering about acupuncture and IMS? Right now, the research hasn’t come down on one side or the other, instead saying “more research is needed”. I interpret that as follows: if you’re someone who typically benefits from needling, it’s worth a try. If it doesn’t work for you, we have other options!

If you suffer with undiagnosed headaches, print out the headache diary, fill it out for a month and discuss the results with your family practitioner. If tension-type headaches are the problem, give us a shout - we would love to help you get your headaches under control!

As always, if you’d like to book an appointment you can do so online, via email or by phone at (778) 630-8800.

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

Knee Arthritis 101: The Basics

Arthritis is a big topic and there is no way I could cover it all so today I am just going to cover some of the basics to help you understand what is going on with your body.

First of all, it’s important to note that there are many types of arthritis. The two most common types are:

1. Degenerative arthritis, also known as osteoarthritis (OA for short)

2. Inflammatory arthritis such as rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis

Today we will be discussing osteoarthritis of the knee.

Here are the top five things you absolutely need to know about arthritis:

1. Arthritis is not a catastrophic diagnosis. You can continue to thrive and lead an active lifestyle with an arthritic knee and it’s not the end of the world. 

2. Exercise is your best friend. Say this with me, three more times!

3. X-Ray findings are not proportionate to functionality or pain levels. Someone who describes “occasional stiffness” in their knee might have a “severe” x-ray, while a “mild” x-ray might belong to someone who describes unbearable pain that keeps them awake at night. X-rays do not give the whole picture!

4. Most knee pain from arthritis is from structures around the joint, and that pain can settle. It’s not the cartilage nor is it the outer compact bone causing the pain in your knee. 

5. There are things you can do to slow the progression and maximize your function.

Let me say this loud and clear:

Maintaining an active lifestyle is one of the best things you can do if you have arthritis!

Let’s look at a classic scenario.

Meet Stacy. She’s 62 and tweaks her knee while out for a run. That weekend she goes away for a vacation with her family. They play golf, tennis, and even go kayaking! Now her knee is quite sore and even swollen. Stacy decides to rest for a few weeks figuring she just over-did it while away. But it’s still swollen two weeks later.

She goes to her doctor, who orders an x-ray. The x-ray uses technical terms like “osteophytes” and “joint space narrowing”. She is told she has arthritis in her knee. That night Stacy has company for dinner and a friend, let’s call him Gary, said he has the same thing! Gary says his knee is “bone on bone” (and demonstrates grinding with his knuckles together while making an awful scraping noise) because all his cartilage has “worn away” and that his friend Steve had to have a knee replacement and limped for months.

Now Stacy is devastated. She doesn’t want arthritis and she certainly doesn’t want a knee replacement. She feels doomed. 

What happens next? 

Option A: Stacy is scared and wants to protect her knee. So Stacy stops playing tennis and stops golfing, she hires someone to do her gardening and doesn’t even really walk the dog anymore because if running hurts than walking probably isn’t great either right? (I want you to know it hurts me deep down inside to type that). But when Stacy suddenly stops exercise and spends many hours per day sitting her knee gets stiffer and her muscles get weaker.

In her mind this has confirmed her worst fears that her knee is in awful shape (look how quickly it’s deteriorating!) and tries to protect it further by resting even more. This cycle of inactivity can is bad news bears. 

It also doesn’t have to be this way. 

Option B: Stacy doesn’t worry about Gary or his friend Steve because she knows nothing about their situations and her doctor didn’t mention surgery at all. Stacy’s knee is still a bit stiff and sore so she modifies her activities for a few weeks. Runs on the dyke become walks with the dog and she tries pickleball with a few friends instead of tennis. To her delight the knee pain improves! Her muscles have stayed strong from her modified activities and she still enjoyed her time out and about. Now Stacy is in a position to gradually rebuild and reintroduce activities she enjoys as she is able. (This scenario is a lot better if you ask me). 

I will say it again: exercise is your best friend.

You are not wearing out the joint further by exercising. It is the most effective treatment for early and moderate knee OA (not to mention other health benefits). Exercise helps you maintain range of motion and strength. It is a lot easier to maintain strength and range than build it back up again after it has been lost.

Also, do not underestimate the benefits of exercise for the rest of your body. Many people who get an arthritis diagnosis self-impose activity restrictions and become more sedentary. This can have detrimental health benefits including increased risk of high cholesterol, heart disease and diabetes. Further, muscle weakness and joint stiffness can be contributing risk factors to falls. People with osteoarthritis experience 30% more falls than those without.

There is no use going too hard all day every day and being in extreme pain just for the sake of it but don’t stop all activity completely. You have to find a middle ground between activities that are challenging vs. aggravating (which is easier said than done). A physiotherapist can give you recommendations on which activities can be modified and help you figure out strength and range of motion exercises that are appropriate for you specifically. 

Ok, so I hope you get it by now. If you have arthritis you should exercise. But let’s keep going, shall we? Let’s discuss why this diagnosis doesn’t have to be all doom and gloom.

What causes the pain in knee arthritis?

The cartilage that degenerates has no nerve endings nor does the hard compact bone beneath it. So they cannot be the source of the pain. So which structure is actually responsible? 

The three main causes of knee pain associated with arthritis are:

1. Periosteum - the thin lining of tissue around the bone, it has nerve endings and supplies blood to the bone. If it tears it will hurt. 

2. Synovitis - Synovium is the connective tissue lining of the joint itself. It can become inflamed and very painful. Synovitis can feel like joint tenderness or pain, swelling, and nodules (hard lumps). 

3. Bone edema - This is more common in women who have underlying osteopenia or osteoporosis since the bones are already weaker. When stress on the bone increases, as is the case with arthritis, the deeper central layer of the bone can become swollen, which feels like a deep and intense ache. 

Remember:

• Not everyone with OA has these issues.

• If you do experience pain from these structures it will likely settle down over a few weeks or months and your knee pain and function will return back to baseline. It’s not forever.

• Like I mentioned above, the severity of an x-ray does not correlate with pain or disability.

• Treatment should not be based off of the x-ray.

• Do not let a bad x-ray be the reason you stop your favourite activity.

• Do not let a bad x-ray make you afraid of feel doomed.

• Please please please do not get surgery just because the x-ray is bad especially if everything else is great! (Disclaimer: obviously I am a physiotherapist and not your surgeon, so I’m not the one making calls on surgery. But if a surgeon is pushing for you to get surgery and you feel completely fine I would be asking why they feel it is necessary. They might have an excellent reason - that’s cool, making calls in grey areas is what they do all day every day so their opinion should be considered - I just don’t want you getting surgery because a friend of a friend had their knee done so you figure you might as well join the club). 

The Arthritis Foundation provides a very general list of things you can do to slow down the arthritis progression and keep you are healthy and active as possible. These include:

• Maintain a Healthy Weight: Excess weight worsens OA. Combine healthy eating with regular exercise to maintain a healthy weight.

• Control Blood Sugar: Many people have diabetes and OA. Having high glucose levels can make cartilage stiffer and more likely to break down. Having diabetes causes inflammation, which also weakens cartilage.

• Maintain Range of Motion: Movement is medicine for joints. Make a habit of putting your joints through their full range of motion, but only up to the point where it doesn’t cause more pain. Gentle stretching, raising and lowering legs from a standing or seated position, daily walks and hobbies such as gardening can help.  Listen to your body and never push too hard.

• Protect Joints: Make sure to warm up and cool down when doing exercise. If you play sports, protects joints with the right gear. Use your largest, strongest joints for lifting, pushing, pulling and carrying. Watch your step to prevent falls. Balance rest and activity throughout the day.  

• Relax: Find ways to reduce or avoid stress through meditation, listening to music, connecting with friends and family, doing fun activities, and finding ways to relax and recharge.

• Choose a healthy lifestyle: Eating healthy food, not smoking, drinking in moderation and getting good sleep will help you to feel your best.

I really hope you feel slightly better about an arthritis diagnosis. This is something that can be managed.

If you have any questions about your arthritis or are looking for some specific suggestions to help your daily life please contact the clinic via email or phone us at ( 778) 630-8800. We look forward to meeting you!

Ask A Physio: Any Tips for Mouse Finger Pain?

So I don’t know about you, but COVID has certainly pushed me to using my computer a lot more. A. Lot. More. My body is feeling it, too - my neck is stiffer than it was, my hands are tired and my shoulders make a lot of noise after a long session on the computer.

We know that prolonged postures of any kind - standing in one spot, sitting still - aren’t great for anyone. Our bodies are for movement and all too often we get stuck in postures for hours at a time. When that prolonged posture is on the computer, that finger and wrist pain is often directly related to the position of the neck and shoulder as much as it is the wrist and hand.

So what should you do? The best thing you can do is set an alarm for 30 minutes and make a point of moving and stretching your body. If you have two minutes (or less!), this movement and stretching routine can help combat the stiffness and soreness associated with prolonged computer use.

Without further ado, presenting:

Top Ten Exercises for Computer-Related Pain

1. Shake it out! - I love a good shake - who doesn’t? Sit up straight, take your wrists and hands and give them a good shake, letting your fingers fly.

2. Chin to chest - Something we often forget is how much posture contributes to pain further down the chain. Sit up straight and tuck your chin into your chest, feeling a stretch down the back of your neck. Hold this for 10ish seconds.

3. Ear to shoulder, then a twist - Still sitting up straight, lean your ear to your shoulder and hold it for about 10 seconds. Then twist your head so your nose gets closer to your armpit; hold this for another 10 seconds. Repeat on the other side.

4. Shoulder rolls - Still sitting up straight (are you sensing a theme yet??), roll your shoulders up to your ears then squeezing them back and down, pushing your shoulder blades as far down your back as you can. Bring your shoulders forward then back up to your ears. Do this 5 times.

5. Wrist stretch - Stretch your right arm in front of you and bend your wrist and fingers back. Use your left hand to pull your right fingers further back, feeling a stretch in your forearm. Hold for 10ish seconds and repeat on the other side.

6. Prayer stretch - Place your hands together in a prayer position in front of your chin. Lower your hands down, keeping your palms together and feeling a stretch in your forearms. Hold for 10ish seconds.

7. Finger stretch - Place all your finger tips together - think Mr. Burns from the Simpsons - and push your fingers together. Keep your fingers together and pull your palms away from each other. Stretch your thumbs away from your other fingers. Feel a stretch for 10ish seconds.

8. Wrist circles - Draw circles with your wrists! 5 in one direction, 5 in the other.

9. Hand fist and open - Squeeze your hands into tight fists for a few seconds. Then stretch your hands out wide, reaching your fingers out as far as you can for a few seconds. Repeat 5 times.

10. Finish this off with a final shake!

Looking for a print out of this program? Here it is in PDF form, with pictures!

The better you support your body with proper ergonomics (see our previous two ergonomic blogs here and here) and frequent movement breaks, the less likely you’ll suffer from computer related pain. So set that alarm, stretch it out and stay pain free!

As always, if you would like to book an assessment with one of our fabulous physiotherapists or our amazing massage therapist, give us a call at (778) 630-8800 or email us at clinic@ladnervillagephysio.com.

Finally - do you have a burning question one of our physiotherapists can answer? If you’d like to #askaphysio, we would love to answer!

Runner's Knee

Patellofemoral Syndrome is a classic injury that causes pain around your kneecap. It is also something that I myself am dealing with right now. Also known as “Runner’s Knee,” it’s usually a dull achy pain that is worse with going up and down stairs, running, jumping and squatting. It can also get cranky when you sit with your knees bent for a prolonged period of time such as watching a movie. It is very common and the cause can be multifactorial, so I am hoping that this post will give you a basic understanding of what may be going on with your knee.

Inside The Knee

First, let’s go over the anatomy of your knee shall we? Your knee is actually more than one joint! There is the big joint between your femur (thigh bone) and your tibia (shin bone), but there is also a joint between your femur and your patella (kneecap). In fact, your patella sits in a little groove at the base of the femur and when you bend or straighten your knee the patella glides up and down it’s little groove.

This is all fun and games until it starts to hurt. There are generally a few contributing factors for patellofemoral pain, I have listed a few of the more common culprits below:

• Overuse: Activities that require high levels of repetitive stress on your joints are more likely to cause Patellofemoral Syndrome. All of that running and jumping can cause irritation underneath the kneecap as it rubs up and down over the femur.

• Alignment Issues between your hips, knees and ankles: If your hip muscles are weak then your form can suffer. Have you ever done a squat and noticed that your knee kind of collapsed into the midline rather than staying aligned and straight? That is hard on your knee. People with that technique error have a higher incidence of Patellofemoral Syndrome. If you can’t control your knee when you are standing still you are most likely not in control when you are running or jumping or stepping off of a curb either. If you do something incorrectly for about 30-60 minutes straight & 3-5 times per week, that can result in a LOT of misdirected force.

• Women are more prone than men to patellofemoral injury: It is speculated that this is because of wider hips (so the knees more naturally bias inwards). Strengthening your outer hip muscles (such as the gluteus medius) can help prevent or correct the inward collapse of your knee.

• Muscle imbalances: There are four separate parts to your quadriceps (the big muscles on the front of your thigh). If the outer muscle is stronger than the inner muscle (which is often is) then the patella gets tugged toward the strong side. This also can cause it to track improperly in its little groove.

• Inappropriate footwear:  If you overpronate or have flat feet you could likely benefit from a shoe that has cushion and support rather than a minimalist shoe.

• Being overweight: When you are going down stairs your knee experiences three times your body weight in forces and pressure. If you weigh 200lbs then each knee is taking 600lbs. The forces are even higher (4-5 times your body weight) when you squat to tie a shoelace or pick something up off of the floor.

• An injury: Falling on your knee or dislocating a kneecap can increase chances of patellofemoral pain.

What Can I Do About It?

Because patellofemoral pain is multifactorial, there is generally not one simple answer that will give you a quick fix (bummer, I know). For this reason, I strongly suggest making an appointment with a physiotherapist so they can properly assess your personal situation. Treatment will involve the following:

• Addressing your risk factors and will likely include strengthening your quads and your hips

• Suggestions for altering your current training program will also be made

• Tape may also be helpful to alleviate painful symptoms temporarily

FAQ: Is biking instead of running a good option?

The is by far the most common question I get from runners with knee pain who are looking to maintain their cardio and activity levels while they rehab their knees.

My answer? Maybe, but not necessarily.

I know that is an extremely vague answer but here is why. Although biking has less overall force going through your knees compared to running, it is still a repetitive activity that involves a lot of knee bending and straightening. If your seat is too low or too far forward this can make your knee bend too much with each revolution, putting unnecessary excess force through the knee. Also, having the gear of your bike too high can cause increased force through the knee. For some people it is a viable alternative to running while others find that biking is still too aggravating. It really needs to be assessed on a case-by-case basis.

For those who are curious this is how I ended up with my sore knees…

I popped both of my children (40lbs each) into a bike trailer and proceeded to ride for 20+km while hauling them behind me. It was my first time riding my bike in several months, my seat was too low, the load was too high, and the volume was too much. Should I have known better? Probably. Was it a fun day? Absolutely. Will I rehab my knees back up to running the distances I want and get back to squats with resistance? Of course! Will it take some time and patience……. Also yes.

Good luck running out there everybody!

As always, if you find yourself battling a running injury of any kind please call us at 778-630-8800 to make an appointment with one of our skilled physiotherapists so we can get you back on track as soon as possible.

The Rotator Cuff

A few years ago, I took my then three year old daughter skiing for the first time. It was exhilarating! I held her between my legs as we swooshed down the hill, both of us giggling the whole way down. On the second run she wanted to try by herself, so I went a bit ahead to catch her. Down she comes and I grab her with my left arm, feeling a crunch and a bit of a snap in my shoulder as I did. Uh oh, I thought - did I just feel that? My shoulder was sore but we skied another run, had some celebratory hot chocolate and went home.

The next morning, I couldn’t lift my arm without intense pain. Washing my hair was next to impossible. It was agony. I knew I had damaged my rotator cuff and it was time to get to work.

What is the rotator cuff?

The rotator cuff is a group of 4 muscles - the supraspinatus, infraspinatus, Teres minor and subscapularis (not pictured - lives on the underside of the shoulder blade) - that attach the humerus (aka the upper arm bone) to the scapula (aka the shoulder blade). These muscles aren’t big - the supraspinatus is roughly as thick as my thumb! For the amount of work these muscles do, they certainly aren’t as beefy as you would think.

What does the rotator cuff do?

The rotator cuff has 4 main jobs:

1. Supports the shoulder capsule - have you ever eaten chicken wings and noticed the white little nubbin that connects the bones? That, dear reader, is a capsule! A capsule surrounds every movable joint in your body, protecting it and making sure the synovial fluid (aka the lubricating fluid) greases those hinges, so to speak. The rotator cuff surrounds and helps support the shoulder capsule, giving it more structural integrity as the shoulder moves through its incredible range of movement.

2. Keeps the shoulder in its socket - if you look at the bones of the shoulder and strip away everything else, it looks like a really big golf ball on a golf tee. The rotator cuff acts like bungee cords attaching that golf ball down to the tee - a few springs to help guide the shoulder to where it should be.

3. Moves the shoulder - this is where the “rotator cuff” gets its name from: it rotates the shoulder! These four muscles are key to lifting your arm up to your side and getting your hand to reach up behind your head and your back. If you’ve ever had issues with your rotator cuff, you’ll know things like putting on deodorant, putting on a jacket or reaching for your seat belt in the car are particularly problematic.

4. Fine tunes the shoulder movements - not only do these muscles move the shoulder but they also act to smooth and fine tune movements. Think of when you’re reaching for that glass of wine - you want your movements to be as smooth and accurate as possible. Your rotator cuff is one reason for your successful wine grab!

How do you injure your rotator cuff?

There are two main ways people injure their rotator cuffs:

1. Overuse and repetitive strain - anyone who uses their shoulders a lot, especially with overhead movements, are susceptible to rotator cuff strains. Baseball players, electricians, carpenters and hair stylists are perfect examples of people who often have their arms up and aggravate their shoulders over time.

2. Acute strain - this is just like my story above. It may be your dog pulling unexpectedly on their leash or your toddler jumping into your arms when you weren’t quite expecting them to jump.

Once it’s injured, how do you fix it?

There are two main keys to shoulder rehabilitation:

1. Posture - posture is key to shoulder health. Remember that the rotator cuff muscles attach the shoulder blade to the humerus. When someone sits with rounded shoulders, their shoulder blades sit further away from their spine and at more of an angle. This means the humerus sits more forward in the socket and puts the rotator cuff muscles in a disadvantageous position - they have to work a lot harder to function. Over time, this leads to degradation of the rotator cuff. When you have proper posture, your shoulder blades are much more likely to sit back where they should, allowing your rotator cuff to work properly.

2. Strength - this is key to everything, isn’t it? For your rotator cuff to be working, it needs to be strong. But it’s just not the rotator cuff, it’s everything else that interacts with the shoulder - rhomboids, traps, lats, biceps, triceps, I could go on! - as well as everything that’s involved with posture. That. Is. A. Lot. And while it can seem overwhelming, that’s where we as physiotherapists come in. This is where we guide you on what to do and when, with how much weight and when you can move on to harder things.

For more information on rotator cuff rehabilitation, check out Physio-Pedia’s page on the rotator cuff.

Shoulders are dynamic - they have a huge range of movement and we use them all day. When pain sets in, it can often feel like they will never get better. But with a proper assessment, we can figure out why your shoulder is hurting, get to the source of the problem and do something about it.

If you would like to have one of our therapists look at your shoulder - or anything else! - give us a call at (778) 630-8800 or email us at clinic@ladnervillagephysio.com.

Joy

I am starting to love the ritual of Sunday mornings. It usually goes like this: we have a lazy breakfast (this morning, it was poached eggs on toast), then the kids go play outside while I sip a London fog and and peruse the New York Times.

I opened up the Times this morning to a special section simply titled “JOY”. It was filled with articles about finding joy in forgotten and unexpected places (acronym included!): “The Joy of Consuming an Obscene Number of Calories Before Noon (J.O.C.A.O.N.O.C.B.N)”, “The Joy of Picking a Fight (J.O.P.A.F.)” and 12 others that brought many a smile to my face.

“The Joy of Jogging Very, Very Slowly”? This one very much spoke to me.

This got me thinking: what has brought me joy in these times? What may bring you joy, if you haven’t found it already? Here’s my list of things that have brought me hidden and unexpected joy.

The Joy of Getting Dirty in the Garden (J.O.G.D.I.T.G.)

My garden! Carrots and radishes and spinach, oh my!

I’ve never been a gardener. It’s not that I wasn’t interested necessarily - I’ve always loved a burst of colour amongst a sea of green. But it’s never been something I did. At the beginning of this whole thing, I asked my husband to build me some planter boxes so I could try my hand at growing things. He was skeptical - the only thing I’ve managed to keep alive are the kids, plants be damned - but he acquiesced and built two beautiful raised beds for me to plant anything I wanted.

Turns out: I’m a gardener! I love it. I love training the peas and tomatoes up the trellis. I love the science of it, the art of it. Learning what to plant with what, what foods they need, what to plant where and why. It’s soul filling in a way I didn’t know it would be.

The Joy of Terrible Yoga (J.O.T.Y.)

The more I practice physiotherapy, the more I’m turning to yoga postures to stretch, to activate, to control a movement I need my clients to focus on. It could be a simple Child’s Pose for someone with a stiff shoulder or back or a flow between Downward and Upward Dog for those suffering from dizziness.

Full disclosure: I’m terrible at yoga. TERRIBLE. My balance sucks, my grace in movement is… graceless? Is that a word?

But I’m loving it. I love doing it. It FEELS good. The worse I am at it, the more I laugh at my terrible-ness and the more joy I find in it. The best is doing it with my kids - there’s something particularly enjoyable about learning something from scratch with your mini-mes. (We’re really into Cosmic Kids Yoga - Jamie is awesome!!)

The Joy of The Aimless Drive, Bike Ride and Walk (J.O.T.A.D.B.R.W.)

Like most of you out there, I’m busy. I have a full time job, a partner, two kids and responsibilities. A seemingly endless list of responsibilities. I usually try to pair movements with extra function - going up the stairs? Take this laundry basket! Going for a walk? Pick up some lettuce! The more efficient I can be, the more time I have for myself… right? Although, it never seems to end up that way.

We have gotten into the habit of a bike ride after dinner. My kids take turns leading. Where are we going? Who cares! We’re having fun! It’s freeing in a way I forgot about and so happy to have experienced again.

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What are your New Joys? What has brought you happiness during these past few months? We would love to hear it!

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!

Have An Empty Wine Bottle Lying Around?

So I know we’re all in the same boat here. We’ve been staying home for over a month, which has probably included a lot of vegging out, binge-watching old movies, and baking more cookies than we could ever eat. We think about working out but gyms are closed, and it’s just so hard to get motivated for a home workout. Then you check your phone and see Nicole’s blog telling you it’s time to start strength training. What to do??

Don’t worry, I am here to help! All you need is one wine bottle (and don’t tell me you haven’t consumed at least ONE bottle of wine!). Fun fact: an average empty wine bottle weighs about 2.5lbs – personally my preferred dumbbell! Got your wine bottle? Let’s get started!

Here are 5 exercises that YOU can do AT HOME with just one empty WINE BOTTLE! This is a full body workout and has both easier and harder variations so no matter where you’re at in your fitness journey, this workout is for you!

Exercise #1: Triceps Curls in a Bridge

Lie on your back with your knees bent. Lift your hips up into a bridge position. Bring your arms up so that they are directly over your shoulders with the wine bottle held horizontally between both hands. Bend your elbows so that the wine bottle goes towards your head – but don’t let it hit your head!

Easier variation: Take out the bridge and just do the triceps curls!

Harder variation: Make it a single leg bridge!

Exercise #2: Biceps Curls in a Wall Sit

Position yourself with your back to the wall like you are sitting in a chair, knees bent to around 90 degrees. Grab the wine bottle with both hands and bend and straighten your arms while keeping the elbows tucked at your side.

Easier variation: Take out the wall sit and just do the biceps curls! Or drop that wine bottle! (gently)

Harder variation: Extend out one leg at a time!

Exercise #3: Side Plank Star

Get into a side plank, on your forearms or on your hands, you pick…just make sure you’re engaging all of those lovely shoulder muscles so your shoulder is not collapsing down! Grab that wine bottle and hold it up in the air.

Easier variation: Plank on your knees, drop that wine bottle and put your hand on your waist!

Harder variation: Wrap the wine bottle under your body and back up into the air (just like the picture on the right)!

Exercise #4: Wine Weighted Lunges

Grab that wine bottle with both hands and lunge one foot forward, dropping the back leg down so that your knee is bent to around 90 degrees. Step back and do the other side.

Easier variation: Drop the wine bottle. You can even use your free hands to now hold on to a chair for support!

Harder variation: Add a rotation with the wine bottle towards the side of the lunging foot with each lunge. Pulse it out at the bottom of the lunge. Do some walking lunges. So many options!

Exercise #5: Wine Weighted Side Stepping Squats

Grab the wine bottle and get into your best squat – you got it, able to see and wiggle your toes! Now step to the side while staying in your squat. Don’t forget to change directions!

Easier variation: Just squat, forget about the side steps. Do mini squats if you don’t want to get down low.

Harder variation: Add in some overhead presses with the wine bottle as you side step!

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Want to make this a full blown, 30-minute total body workout? Just do each of the above exercises for 1 minute and take a 1 minute break after exercise #5…Then repeat 5 times!

For those of you looking for a bonus challenge…Do this workout with a FULL wine bottle, and then pour some out to celebrate when your 30 minutes is over.

As always, to book an (online!) appointment, give us a call at (778) 630-8800, email us or visit us at ladnervillagephysio.com.

I don’t know what you’re waiting for – happy workout! 

Injury Prevention in Running - Part 3: Strength Training

Nicole Coffey, one of the owners of Ladner Village Physiotherapy, is a life long runner with several half marathons under her belt. This blog is the final instalment in a three part series on common running injuries and how to prevent them. Enjoy!

The sun is shining, the grass is green, and it’s a great day for a run!

The gyms are closed and options for exercise are more limited these days. As a result, more and more people have been lacing up and pounding the pavement, which is awesome if you ask me. But (and there is always a but) the cold hard truth is that running comes with a 50% injury rate. My last few blogs (Part 1 and Part 2) have covered some common misconceptions people have about preventing running injuries as well as some of the most common training errors I see in my clients who are injured (see below for a quick review). Let’s now focus on what you CAN do to prevent running injuries.

Do you remember being in high school and the teacher would say “this will be on the test- if you only remember one thing, remember this.” Well, dear reader, this is the take home message. There IS something you can do. It’s not a nutritional supplement that magically makes you bigger/faster/stronger (but if you ever find one of those let me know okay?). It’s not stretching for 20 minutes per day (even though you’ll be extra flexible), and it’s not buying a fancy new treadmill or a new running outfit (although those do sound snazzy).

The answer is strength training!

Many runners I know avoid the gym at all costs. They worry they’ll get too bulky and heavy and it will slow them down, or they think if they go into the gym they will hurt themselves and it will negatively impact their running. But this is not what the research shows. The research shows that strength training is one of the best things you can do to increase running performance and decrease running injuries. For maximum benefit and impact on running strength training should account for 20% of your training.  

Strength training has several benefits for runners:

1. Increased running economy

2. Increased running power output

3. Prolonged point of exhaustion

4. Reduced risk of overuse injuries

What kind of strengthening should you be doing?

• Lift heavy weights. That means doing exercises such as squats, calf raises, farmer’s carry and deadlifts at 60-80% of your maximum effort will give you more benefit than doing more reps at lower weights.

• Plyometrics and other explosive exercises such as lunges, jumping and hopping.

How often should you strength train?

One or twice per week is good. Because the strength training is done at such high load and intensity you only need to do it twice per week during your “off season” or “training season.” When in “race season” strength can be well maintained with only one session per week as long as the intensity is correct (in addition to your running of course).

What else do I need to know?

• Don’t go nuts. Technique here is still critically important. If you have never done weighted resistance exercise before you need to learn proper technique before you start loading up the barbells. If you don’t know how to do these exercises get someone who is qualified to teach you. Youtube is not your friend here.

• Be ready. This is also assuming you don’t already have a pre-existing injury. If you do, get help with it and rehab correctly before implementing new aspects to your training program.

Lifting heavy loads and doing explosive exercises can help increase muscular strength, making you a stronger and more efficient runner with less chance of overuse injury.

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“Uhhhhh You’re forgetting something Nicole, I can’t go to the gym right now because of a little thing called COVID-19.”

I know that right now you don’t have access to a full gym and weight rack right now, BUT exercises like:

• single leg jumping

• hopping

• lunges

require no extra equipment and can definitely be incorporated into your routine at home right now. Once restrictions have been lifted we can all get back to the gym.

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Looking for the other instalments? Check out Part 1 - Running Volume and Part 2 - Footstrike! Here’s what we have learned so far:

Common Mistakes:

1. Increasing volume too quickly, resulting in overuse injury

2. Putting too much emphasis on stretching, which does not reduce overuse injury rates

3. Trying to make yourself a “mid-foot striker” when you are naturally a “heel-striker”

What Can You Do To Decrease Injury:

1. Increase volume by no more than 10% per week (includes distance AND intensity)

2. Increase cadence by no more than 10% (aim for 160-180 steps per minute)

3. Re-allocate some of the time you spend stretching and focus on strengthening instead.

Happy running everybody - enjoy the sunshine! 

As always, if you have an injury that you would like assessed or if you need assistance with technique please call our clinic at (778) 630-8800 and we will be happy to help! 

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References:

1. Beattie, K., Kenny, I. C., Lyons, M., & Carson, B. P. (2014). The effect of strength training on performance in endurance athletes. Sports Medicine, 44(6), 845-865

2. Berryman, N., Mujika, I. Strength Training for Middle – and Long-distance Performance: A Meta-Analysis in International Journal of Sports Physiologiy and Performance. 2017:13: 57-64

3. Blagrove RC, Howatson G, Hayes PR Effects of Strength Training on the Physiological Determinants of Middle- and Long-Distance Running Performance: A Systematic Review. Sports Med. 2018 May;48(5):1117-1149. doi: 10.1007/s40279-017-0835-7.

4. Lauersen J, Bertelsen DM, Andersen LB (2014) The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials British Journal of Sports Medicine 2014;48:871-877

5. Mikkola J, Vesterinen V, Taipale R, Capostagno B, Häkkinen K, Nummela A (2011) Effect of resistance training regimens on treadmill running and neuromuscular performance in recreational endurance runners, Journal of Sports Sciences, 29:13, 1359-1371

Ergonomics: The At Home Edition

So you’ve found yourself working from home all of a sudden. Kids are underfoot, you don’t have a proper office or even a desk to claim for yourself and the online video meetings seem to be endless. Chances are, you’ve had to improvise. Maybe you’ve been waking up, staying in your PJs, and curling up in bed with your laptop. Or maybe you find yourself sitting cross legged on the couch, laptop down on the coffee table.

I saw an article recently compiling “unglamourous” photos of people’s at home workstations. There were photos of people balancing their laptops on recycling bins, using ironing boards in their bathrooms – there are definitely some very creative people out there. This may have all been fine for the first couple of days, but now that it’s been a few weeks, I’m guessing you’ve probably started noticing some new aches and pains that only seem to appear after a day working from home. Is your neck starting to throb? Low back feeling angry?

The good news is, that doesn’t have to be your new reality! And no, you don’t need to order the fanciest ergonomic chair, or that automatic sit-stand desk! The great news is that even if you don’t have access to a desk at all, there are simple ways that you can make your own ergonomic work station at home, using things you probably already own!

Why Is An Ergonomic Set Up So Important?

Let’s start by quickly reviewing why an ergonomic set up is important at all. You’ve probably already noticed that your body doesn’t react well to sitting cross legged with your body hunched over, neck curled down while you work on your laptop for 5 hours. But why is that?

First of all, our bodies were not designed to be in any one static posture for hours on end, so even if you are in a so-called “perfect ergonomic set up” it is still very important that you change your position and take moving breaks regularly. But when we are in a prolonged poor posture, the effects are worsened as some muscles remain in a shortened position while others are overly stretched. Therefore, we want to remain in a relatively neutral position. (For more information, check out our previous blog on the physics behind ergonomics.)

How do you do that? Focus on these three things:

1. Screen Height: The top line of your screen should be just around eye level or slightly below and within arm’s reach so that your neck can remain in a neutral position rather than constantly looking down or craning forward. If you don’t have an external monitor you can adjust, you can stack books under your laptop or monitor until you attain the correct height. Don’t have a ton of books? You could use an upside down laundry hamper, tupperware, shoe boxes, old boardgames - the options are endless!

2. Keyboard and Mouse: If you are using a laptop, the keyboard height may now be too high for your wrists/arms. This is where getting an external keyboard and mouse can be so pivotal. While external monitors are often quite pricey, an affordable keyboard and mouse are much easier to find. You can now set up the keyboard and mouse in a way that your wrists are not curled up or down, with your elbow bent at around 90-100 degrees by your side, and arms supported. The position of your keyboard/mouse should also be close enough to you that you are not having to reach to use them.

3. Chair Set Up: If you’re going to be sitting, you want your hips and knees to be bent to around 100-120 degrees, with your feet supported – no dangling feet! Find a box, books, anything that can support your feet while maintaining a height that will allow the above set up to happen. You can also use a rolled up towel or small cushion to support your lower back, and maintain your natural lumbar curve.

Change Your Position Frequently

So now that you know the basics of how to set up your work station ergonomically, you can change it up, while maintaining the essentials. This is important as the best posture is a changing posture. This means you can stand or walk on the spot while working, while maintaining all of the above elements. And if you don’t want to have to keep adjusting your work station, take short but frequent stretch breaks (every 30 minutes or so). Get up and do a quick lap of your room, move your neck, do a few lunges.

Some Big No-Nos

• Clutter: If there’s a lot of clutter under your work area, there won’t be any space for your legs and feet to sit comfortably. If there’s a lot of clutter around your work area, you’ll be constantly reaching over things to get to what you need, resulting in unnecessary repetitive strain. Place what you need close by, and remove what you don’t need.

• Poor Lighting: Glare, or light reflected off of your work surfaces into your eyes, can be not only irritating, but can also result in more aches and pains if you end up in a poor posture trying to avoid the glare, or leaning to see your work better. To avoid this, position yourself so that you are either sitting beside or parallel to the window, and between lights in your room. If you have overhead lighting, make sure your screen is at a right angle to the work surface.

And there you have it - easy and simple ways you can make working from home way easier on your body. And most importantly...don’t forget to keep moving! Check out our blog on fun ways you can keep moving while in quarantine.

Looking for some individualized tips to tweak your own at home workstation? We are here for you! Book online, email us at clinic@ladnervillagephysio.com or call us at (778) 630-8800.

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RESOURCE LINKS:

1. WorkSafeBC [Internet]. Worksafebc.com. 2018 [cited 7 April 2020]. Available from: https://www.worksafebc.com/en/resources/health-safety/books-guides/how-to-make-your-computer-workstation-fit-you?lang=en&origin=s&returnurl=https%3A%2F%2Fwww.worksafebc.com%2Fen%2Fforms-resources%23q%3Dcomputer%2520workstation%26sort%3Drelevancy

2. Office Ergonomics: Practical solutions for a safer workplace [Internet]. Lni.wa.gov. 1995 [cited 7 April 2020]. Available from: https://www.lni.wa.gov/IPUB/417-133-000.pdf

Stretching!

Ahhhhhh stretching. I’m not going to lie, it’s not my favourite thing. I used to brush off my lack of flexibility with a light-hearted “sorry, I don’t bend that way” until one day a client totally called me on it! We were talking about yoga and I was saying that I preferred running and the gym because “I don’t bend that way.” And she said “saying you’re too inflexible for yoga is like saying you are too dirty for a bath. The worse you are the more you need it!” And…. I think she was absolutely right. I actually might have given her a high five.

Touché dear client, touché.

Since then I have definitely incorporated more stretching into my fitness routine. But here is the thing, it’s important to know why you are stretching. What is the goal? Are you aiming for more range? Trying to avoid injury? Trying to warm up or cool down?

A lot of people view stretching as the magical answer to preventing and healing all injuries but this simply isn’t true.

There are a lot of different categories of stretching including static, dynamic, and pre-contraction stretching (more commonly known as PNF). What I have written below applies to good old-fashioned active static stretching (meaning you are doing the stretching to yourself, not someone doing it for you).

Stretching increases blood flow to muscles, can be psychologically relaxing and increases flexibility.  That new-found flexibility has it’s own set of benefits including improved performance in physical activities and decreased risk of injury for certain activities.

Should everyone just start stretching everything right now???? Not necessarily. Again, you have to remember the goal. Below I have given a few examples to outline situations when stretching is great vs some times when it is not-so-great. These obviously are not extensive lists but I just wanted to give you an idea about some things that we as physiotherapists are thinking about before we give you a stretch.

When Is Stretching Is Not Helpful?

• If someone is hypermobile (eg. they have too much “wiggle room” in their joints) then stretching can be detrimental because they are adding even more range of motion to a joint that already moves too much! This will increase risk of injury. (A super quick screening test to tell if someone is hypermobile is to look at the Beighton Score.)

• Stretching won’t prevent an overuse injury. This is a common misconception and not supported in the research.

When Is Stretching Great?

• People who sit at a desk all day often experience muscle shortening (hamstrings, hip flexors and pectorals are major culprits). Then when these people try to be active, they have increased risk of injury because their muscles are too tight to allow full range of motion. In this instance stretching muscles can help maintain their natural length, avoid shortening, and possibly avoid an injury.

• For jumpers. Volleyball, basketball, soccer and ultimate players - we’re looking to you! During a jump the tendon and muscle are stretched as they land to absorb energy. That energy is then needed as they recoil to rebound and jump back into the air (think of a giant elastic being stretched then snapping back). If their tendon is lacking length that jumper is at higher risk of hurting themselves as they land and take off repeatedly.

• In general, most stretching is safe as long as it is done with proper form and technique.

If you are going to stretch, here are some things to consider:

• Don’t stretch cold muscles. Doing an intense stretch on cold muscles can increase your risk of injury. A brisk 5-10 minute walk could be your warm up, or something similar to the dynamic warm up (see below). Or you can do your stretches after your workout when your muscles are already nice and warm!

• Hold it, don’t bounce. You should focus on a gentle, slow, sustained stretch of at least 30 seconds. Bouncing can harm your muscles.

• Be gentle. I used to think that a stretch was only effective is my muscles felt like they were about to snap in half. But you catch more flies with honey and muscles are no exception. You should keep the intensity of your stretch at a 3/10, which is enough to feel some tension it but not enough for it to hurt. On this note, remember to breathe!

• Use caution. If you have a pre-existing injury or a chronic ongoing issue, stretching might not be the answer. Maybe you need strength instead. Maybe you need to adjust your technique with the situation that is causing the injury. We can help you figure this part out!

• Be consistent. Stretching is also similar to other types of exercise in the fact that consistency is key. Stretching two days per month will not affect your flexibility in the same way that running two days per month won’t help you with your cardio.

• Stretching does not count as a warm up. A sustained static stretch (where you hold a certain position for >20 seconds) completed before a high-power activity such as sprinting decreases power output and increases injury risk. 

Instead of starting your workout with stretching, you should be doing a dynamic warm-up: swing your legs, do some squats, jog on the spot… move the limbs and joints you are about to move gently through their range of motion before beginning the more intense part of your exercise. Spending 5-10 minutes at the beginning of your workout warming up will help lower your risk of injury.

Looking for some guidance on your stretching routine with your aches and pains? We are here for you!

Book on online appointment - call us at (778) 630-8800, email us at clinic@ladnervillagephysio.com or book online.

Happy stretching!

Telehealth and Pelvic Floor Physiotherapy

Most of us have a little extra time on our hands, for better or worse, so why not spend some time taking care of yourself? Let Nicole help part of that “new and improved you” be your pelvic floor. 

Hello everyone,

Crazy times… I know everyone is filled to the brim with COVID-19 comments and statements so I’m going to skip that whole part and suffice it to say that life in these past two weeks has been significantly different than what we are used to. But if I’m being completely honest, I am actually enjoying the change of pace. I have always said I wished I had more time. More time with the kids, more time for myself, even more time for chores (yes, I’ve found that folding laundry doesn’t seem like quite the torture it used to).

The other thing that has started to emerge is my desire to start chipping away at the “to-do” list that I’ve been putting off for “when I have more time.” And one of those things on my list is a desire to take better care of myself. I know! Self-care! What a concept! I think now is the perfect time to implement a program for myself because I know I will be able to stick to it! I mean, really, if I can’t find the time now then I doubt I ever will. 

That got me thinking, how many other women now have a little extra time on their hands and they’re trying to make the best of it? My guess is a lot!

Now may I be so bold as to suggest that one potential form of self care could be in the form of finally addressing your pelvic floor dysfunction? Have you leaked “forever” and it’s only a little bit so you have just tried to ignore it but it’s actually something you would rather live without? Are you finding now that you are home you are going to the bathroom much more frequently? Do you have to rush there? Are you taking longer walks and noticing vaginal heaviness or pressure once you get home?

I can help you with all of these things! Ladies, I want you on the trampoline WITH your kids, not sitting on the sidelines. If you have any concerns about urine leakage, prolapse, pain with intercourse or any other sort of pelvic floor dysfunction now is a great time to deal with it. 

You may ask - but isn’t your clinic closed right now? 

We are still open.

Although our in-person clinical visits are temporarily postponed due to social distancing, our physiotherapists still care how you are doing and we still want to help! We are open and available to support you in any way we can. And right now one of those ways is through “Skype-style” appointments! 

There are many strategies and exercises that I can give you so that you can start working towards your goal right away in the comfort of your own home!

I know the concept of online physiotherapy is new, but I have been so pleasantly encouraged by how successful it is! The assessment and education that is provided for the first day of a pelvic floor assessment in clinic is identical to what is done during an online appointment. Eventually there will be some limitations as some parts of the assessment and treatment can only be conducted in person (for example, an internal exam or the use of my biofeedback machine as needed). Once the clinic is up and running again I would be thrilled to meet you in person to complete those aspects of the treatment. 

What does an initial pelvic floor telehealth appointment look like? 

After booking an appointment you will receive a link via email. At the time of the appointment I will video call you through a secure line. You can answer the call on your phone, a tablet, or a computer (as long as it has a webcam and microphone). 

I will then proceed with the appointment as if we were in the clinic! This involves asking you approximately 1500000 questions (just kidding 😉) about your concerns regarding your bladder, bowels, sexual health, pain, general health, exercise habits and anything else that might be important in order to understand your issue and help you reach your goals. 

The next chunk of time will be dedicated to extensive education you about the dysfunction you are experiencing, why it happens, and what we can do about it. I will then talk you through strategies and exercises that you can do at home and give you a home exercise program that is specific to your needs so you can start your road to recovery and normalcy! 

At the end of the appointment we can decide if it would be appropriate to have an online follow up or if the follow up can be postponed until we can meet in person.

Of course, if you would rather delay your assessment until a time when it can be completed in person I completely understand and would be happy to see you once we are up and running again.

For general information about pelvic floor rehabilitation please see our website https://ladnervillagephysio.com/pelvic-floor-physio

You can find general information on Telerehabilitation here: https://ladnervillagephysio.com/telehealth

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If you have any questions or would like to book an please feel free to email me directly at nicole@ladnervillagephysio.com or you can call the office at 778-630-8800. 

I hope you are well. Take care!