Gone are the days of health practitioners recommending bed rest and immobilization after surgery or an acute injury. Today, doctors are encouraging early rehabilitation as the research suggests it is safe and leads to a speedier, better recovery.
Treatment has become more proactive and hands on than in the past. Rather than waiting for your body to take its natural course, today’s physical therapists aim to create change and make corrections. We help guide the healing process. If left to it’s natural course, the body will take the path of least resistance. This often alters our movement patterns and develops compensations that wreak havoc on other areas of our body.
Even after surgery, such as a spinal disc laminectomy, patients are up and in physical therapy the next morning after surgery. For a shoulder surgery to fix a torn rotator cuff, patients used to be in a sling for 6-8 weeks. Now, practitioners are encouraging being out of the sling intermittently and starting physical therapy by the first week. Simply, use it or lose it!
In the past, many practitioners relied mainly on modalities to help with pain. Muscle stimulation, ultrasound, heat and ice for example. While these modalities still play an assistive role in pain relief, physiotherapists utilize a more hands on approach called manual therapy. Our intimate knowledge of how joints move and function and where muscles attach and originate help us affect joint mechanics, muscle flexibility and pain relief.
When bed rest or long periods of immobilization have been prescribed in the past, musculoskeletal complications such as loss of muscle strength and endurance, contractures, disuse osteoporosis and degenerative joint disease have been shown to occur. Cardiovascular complications may include increased heart rate, decreased cardiac reserve, hypotension and thromboembolism (blood clots). The side effects of staying in bed or being too sedentary when injured are also associated with an increased risk of stress and depression. A 2004 study published in the Joint, Bone and Spine Journal found that patients with lower back pain, who were prescribed bed rest by doctors, came back with complaints of chronic pain 32% of the time.
A 2017 study in the New England Journal of Medicine, found that athletes with severe muscle injuries recovered quicker and returned to their sport faster when they initiated rehab earlier rather than later. “Starting rehabilitation 2 days after injury rather than waiting for 9 days shortened the interval from injury to pain-free recovery and return to sports by 3 weeks without any significant increase in the risk of re-injury.”
Early rehab with regular and controlled exercises in combination with manual therapy has been shown to speed recovery and improve your overall function sooner than if left to time alone. Don’t take the “wait and see” approach to your recovery! It’s never too early to start the healing process and learn what you can do to facilitate movement and pain relief. Whether you are post-operative or have a mild injury, we have the knowledge and the tools to get you heading in the right direction.
If you watched the athletes of the Rio Olympics and noticed them sporting round bruises on their bodies – you saw the effects of “cupping”. Trendsetters like Gwyneth Paltrow and Jennifer Aniston have also donned the marks on the red carpet! Cupping is an ancient technique in which therapists use special cups on your skin for a few minutes to create a suction effect. This suction draws circulation to the surface and may leave these round bruise-like marks.
This suction and negative pressure effect is used to encourage blood flow, loosen muscles and myofascia tissue. The myofascial system is a network of connective tissue throughout our body that connects the skin to muscles and surrounds our organs. The distraction and suction of cupping techniques can help to stretch and release this connective tissue. It is commonly used to relieve pain, stiff muscles, anxiety, fatigue, migraines, radiating pain, and inflammation in our bodies.
The cups may be made of glass, bamboo, earthenware, or silicone. The technique dates back to ancient Egyptian, Chinese, and Middle Eastern cultures. One of the oldest medical textbooks, the Ebers Papyrus, describes how the ancient Egyptians used cupping therapy in 1,550 B.C.
The practice of cupping is like an inverse massage. Instead of compressing and massaging the tissue, the cups cause a distraction and pull the skin, muscle and tissue apart from each other. The cups may be used with heat or needles for various effects. It may be used directly on an injury site, or along meridians or nerve pathways to release tension, encourage circulation, or reduce inflammation at those locations. Cupping has also been used to help speed the process of a nasty cold, cough or allergy symptoms. It has been shown to help boost immune function by moving blood and lymphatic fluid throughout the body.
Poor circulation can lead to a buildup of toxins in the body. This build up can be the root cause of many different health conditions. Cupping can help to reduce stagnation in our body. This increase in blood flow to an area also brings nutrients, platelets, white blood cells and fibroblasts to aid in healing. This technique helps to heal knots and adhesions so can be great for scar tissue or a stubborn injury that just isn’t getting better. This is why many athletes have recently turned to this therapy to help their bodies recover faster from intense workout sessions.
If you are interested in trying cupping or have an injury that is just not getting better, the therapists at Bragg Creek Physiotherapy would love to help you out!
Taking Charge of Change
It is often said that change is the only constant in life. Yet, we seem predisposed to resist change because of the risks associated with it. If we don’t embrace changes in our life and our surroundings, we are bound to lose ground and become stagnant. No matter how we look at it, life is full of changes.
As the summer winds down, we need to adjust our time, our family activities and our schedules. As time passes, we have to re-evaluate our goals and our behaviours. As health care practitioners, we have to adapt to ever changing technology, research and perceptions of health care. For example, the notion of “self-care” is a growing theme in the medical community. The need to provide people with the tools to take more responsibility for their own health in a proactive manner. To educate, inform and promote health habits, such as staying mobile in their everyday lives, is integral to our profession. Two thousand years ago, Hippocrates had the right idea when he said, “If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.”
Increased focus on prevention and promotion of health and well-being will result in a healthier population, delayed chronic conditions and cost savings in health care overall. The idea of regular fitness check ups, similar to dental hygiene, could greatly reduce your risk of injury, improve your balance and flexibility and keep you on track for a lifetime of motion. There is such potential for growth in this field. The importance of actively engaging people in their rehabilitation, encouraging behaviour changes and being proactive in the education of prevention. A 2008 systematic review found “strong evidence that integrating treatment of cognitive and behavioural factors into physiotherapy was effective in improving function and decreasing pain intensity. Physiotherapists are well placed to provide information and address barriers where they are encountered and to use tools to enhance self-efficacy and adherence”.
September is a good time of year to reset, and the staff at Bragg Creek Physiotherapy are excited about the year ahead. With a new owner and manager at the helm, we are excited to implement some changes at our clinic. Bragg Creek Physiotherapy Ltd (BCPL) has officially changed ownership/management and is excited to continue to provide exceptional physiotherapy and allied health services to the Bragg Creek and surrounding areas. Steve Resta, a current physiotherapist at BCPL, with over 27 years of clinical/management experience will take over the reins from long time clinic owner/physiotherapist, Lisa Le Poole. BCPL will continue to provide all current services during this time of transition and would like to thank Lisa for her vision and commitment in developing such a prominent and reputable business. We are excited to begin this new chapter by rebranding the business and creating innovative changes in the near future. BCPL looks forward to connecting with both previous and new patients as we ensure ongoing support for your health and well-being.
“Change is inevitable…except from a vending machine.” – Robert C. Gallagher
Is sleep becoming a pain in your neck?
Sleep…wonderful sleep. We all likely don’t get enough of it, but when we do, we sure don’t want it to be causing us pain! Whether your sleep position is causing you discomfort or an unrelated injury is causing you to lose sleep, these precious hours in our day are crucial for our health and well being.
Pain related sleep loss affects millions of people around the globe. A 2015 Sleep in America Poll, found that 57% of the adult population experience pain during the night, whether it’s chronic at 21%, or an acute episode, at 36%. This correlates to another main concern related to both sleep and pain – poor health. Shorter sleep durations and poor sleep quality have been closely linked to stress and poor health.
This is a broad topic and one that can take many tangents! Let’s start with discussing some common sleeping positions and why they may be doing more harm than good. As well, I’ll identify some helpful tips on achieving a better nights sleep.
A pillow should position your head so that it’s in a healthy, neutral position. If your pillow is too high or too low, your neck will be side bent for several hours of the night. This can cause compression on one side of the neck and a stretch on the other. This may cause people to wake up with a kink in their neck that may lead to a nerve impingement and pain radiating down the arm. Consider a feather or memory pillow appropriate for your size that molds to the shape of your neck.
Inevitably this position wreaks havoc on both the neck and lower back. Stomach sleepers have a favorite side they like turning their head to during the night, which causes muscle shortening on one side and muscle lengthening on the opposite side. The cervical spine is fully rotated one direction, placing stress on discs and surrounding soft tissue. Regardless of the firmness of your mattress, the lower back is placed in slight extension while stomach lying. This position places the lumbar extensor muscles in a shortened position and compression on the lumbar discs. There really is no modification for this position – just try to avoid it all together! Placing pillows in front and behind you in a side lie position can help prevent you from sneaking on your stomach throughout the night.
This is typically the best position to sleep in. However, if not supported properly, this position can put stress on the hips, pelvis, low back, shoulders and neck (that doesn’t sound good!). Again, the pillow height is key to keeping your spine in neutral. The lower shoulder should be out straight or bent at the elbow. Try avoiding tucking that lower arm under your head. This puts stress on the rotator cuff muscles, the shoulder joint capsule, and surrounding nerve tissue. The upper arm should be resting on a thick pillow that keeps that arm level with your upper shoulder. Avoid curling that upper arm in and rolling forward onto it. Regarding the lower body, if your legs are off set (one is straight, the upper is bent), your lumbar spine is in rotation and the upper hip is on a stretch. This may cause lower back pain, sacral joint pain, hip muscle imbalances and nerve pain that may radiate down the leg. A pillow placed between the knees and ankles can work wonders for lower back, hip and knee pain. The lumbar spine remains in neutral, the pelvis is in neutral and the hip, knee and ankle are aligned. Another option is to keep the knee of the upper leg just slightly tucked behind the lower knee. This will also help to keep the spine and pelvis in more optimal alignment.
Besides sleeping positions here are a few ideas shown to promote a better nights sleep:
A lack of exercise can contribute to poor sleep. Muscle tension and stress can build up in the body and exercise has been shown to increase endorphins, and decrease anxiety and depressive symptoms. However, vigorous exercise too close to bed can disrupt sleep by increasing your body temperature and stimulating your brain and muscles. Most research recommends exercising at least 3 hours before bedtime to let your body wind down and relax.
Yoga has been described as a union of mind, body, and spirit. The series of poses promotes relaxation, breathing and flexibility. A study on kundalini yoga for the treatment of insomnia found a significant improvement in sleep efficiency, sleep time, number of awakenings and quality of sleep after 8 weekly 30min sessions.
The intake of caffeine, alcohol and nicotine has been shown to have a pronounced effect on sleep, causing insomnia and restlessness. Watch for hidden sources of caffeine such as in chocolate, cold and other over the counter medicines. Cutting back on sugar can help sleep disruptions through the night as well.
Eating certain foods may help restore the natural sleep cycle in our bodies. The mineral magnesium has been deemed a natural sedative. A deficiency of magnesium may cause difficulty sleeping, constipation, cramps and pain. Foods rich in magnesium are legumes, seeds, dark leafy greens, almonds, and whole grains.
Acupuncture improves the body’s functions and promotes the natural self healing process by stimulating specific anatomic sites, commonly referred to as acupuncture points. In Traditional Chinese Medicine, insomnia often stems from a kidney energy weakness.
Establishing a healthy routine through nutrition, exercise and proper positioning throughout the night may help you achieve a more restful sleep. If you are experiencing pain from an injury that is keeping you up at night, we can help you determine how and why. Don’t let those sleepless nights add up – it may cost you more than your sanity!
It’s All in Your Head
There is considerable attention in the media these days about concussions. Especially with the snow and ice and kids in school playing a variety of sports, there is a risk of concussions at any time of the year. In fact, recent studies have shown that the overall incidence is actually higher than we thought, the effect of multiple concussions is cumulative, and that a symptom free waiting period before returning to sport or more strenuous daily activities has a beneficial impact on recovery and repeat concussions.
To simplify, a concussion is a blow to the head. There are two distinctions regarding concussions: direct and indirect. A direct concussion is a direct hit to the head, as in boxing or hockey, perhaps when a shoulder pad gets crashes into another player’s helmet. An indirect concussion is more difficult to identify and understand. This may occur in motor vehicle accident (where there is whiplash and the head does not make contact within the car), a child falling from the monkey bars (perhaps the child lands on his butt or even shoulder and the head gets jarred but doesn’t hit the ground), or two soccer players collide mid- field. There is movement of the body and head but inside your head, the brain gets thumped against the inside of the skull. There may or may not be a loss of consciousness. Both distinctions are considered concussions, with trauma to the brain, and medical attention is required.
It is important to be educated on concussions as an athlete and a parent. Contact sports, non-contact sports (where falls or collisions may occur incidentally), car accidents, falls off ladders, slipping on ice, or falling off playground equipment – the risks are all around us! Being aware, understanding the signs and symptoms, and knowing how to manage concussions could have a significant effect on you or your child’s cognitive abilities.
Research tidbits: A 2009 study in the Journal of Neurosurgery, shows there is a period of vulnerability of repeat concussions within 7-10 days of the first concussion. This “second impact syndrome” is potentially life threatening and having over three concussions will likely result in some degree of cognitive impairment. A UBC research study showed that athletes with multiple concussions are 7.7 times more likely to demonstrate a major drop in memory performance compared to athletes with no previous concussions.
How to recognize a concussion?
There are physical signs, clinical symptoms, potential changes in balance, cognition, behaviour and sleep. Symptoms may include headache, nausea, feeling dizzy, blurred vision, ringing in the ears, poor concentration, feeling foggy and confusion. There may be a difficulty processing simple cognitive tasks such as counting backwards from 10, knowing what you had for dinner last night, knowing the date, or adding simple figures. Sleep disturbances, drowsiness, irritability, slowed reaction time, depression, and balance loss may be some physical signs to be aware of. If any ONE OR MORE of these signs and symptoms are present after an incident, it is important to seek medical attention right away. Headaches are one of the most common symptoms after a concussive episode. They may be due to strain on soft tissue structures, nerves, muscles, joints in the neck or stress related. Do not take a “sit and wait” approach. It is important to actively manage ANY symptoms following a concussion and seek medical attention.
If signs and symptoms worsen at any point, that is an indication there is increased pressure or swelling in the brain and is a medical emergency. It is not uncommon for symptoms to be delayed following a concussive episode; therefore close observation of the individual for 7-10 days following the incident is essential.
How to manage a concussion?
Knowing the signs and symptoms is the first step.
The next step is to monitor the individual. This information is based on the most recent evidence from the Zurich Consensus on Concussions, an international conference of world experts. It used to be common practice to wake up the person throughout the night to monitor their symptoms. The latest evidence suggests it is important to rest and get sleep. Therefore, if the individual wakes up on their own – ask them questions and monitor their symptoms – otherwise, let them rest. This should continue for the next 24-48 hours.
The most recent research also recommends avoiding the use of medication. This is to prevent the masking of any pertinent symptoms as well as potentially thinning the blood and increasing bleeding.
It is recommended to avoid driving, activities that require alertness, and alcohol. The temporary reduced cognitive function may be risky. Following these guidelines will result in a safe and speedier recovery from a concussion.
Returning an athlete to sport
If an athlete so much as has a minor headache after a collision in sport, they will likely be removed from the sport for the rest of the day and monitored closely. This may also mean a loss of school time as well. The following six steps are recommendations from the Zurich Consensus for returning the athlete to their sport. (1) They need to be asymptomatic for 24 hours (2) They will then be tested with light aerobic exercise to see if any signs or symptoms return. This may be bike riding, a light jog or the elliptical. Light exercise raises the heart rate and blood pressure and the athlete is monitored for how their system adapts. If all is clear for another 24 hours, they proceed to step 3. (3) Increased intensity of activity – such as light strength resistance, running, jumping, plyometric exercises. If at any step there is an increase in any symptoms, you return to step 1, rest for 24 hours or until symptom free once again. (4) Introduce sport specific activity without any contact drills. Work on balance and coordination such as kicking a soccer ball across the field or stick handling the puck. (5) More aggressive drills are introduced, still avoiding contact. Play a full period, go hard, try to max out the system and see how the athlete tolerates it. (6) Introduce game play such as contact drills, one on one agility and skill drills. The individual should continue to be monitored closely. This six step process of returning an athlete to sport will typically take 7-10 days. 80-90% of concussions resolve in 7-10 days, but may take as much as long as 3 months to a year for full recovery. These steps can be modified for someone who isn’t involved in team sports but simply wants to return to their favourite activities such as tennis, running or skiing. It’s important to slowly challenge yourself and make sure your brain is ready for the increased blood pressure, heart rate and endurance!
Equipment is an important factor in reducing and avoiding unsafe collisions. Helmets in hockey need to be checked regularly for defects and cracks. Face mask screws and straps may loosen which can lead to extra motion and at impact, a concussion. Face mask and chin straps should fit snugly to prevent the helmet from moving too much on the head. The Canadian Dental Hygienists Association reports that every individual involved in contact sport has at least a 10% chance each season of sustaining an orofacial injury. Injuries to the face and jaw can carry significant medical, financial, cognitive, psychological and social costs. Most orofacial injuries can be painlessly avoided by using a mouthguard. Mouthguards help to prevent fractured teeth and facial bones, temporomandibular dysfunction, lacerations and bruising. The Canadian Academy of Sport Medicine agrees in their position statement on head injuries and concussions, that “mouthguards be worn during participation in soccer, due to the dental protection and the possible role in concussion prevention”.
Helmets (for all sports) and proper equipment can significantly reduce injury risks when worn properly. If there is a direct blow to the head with a helmet on the helmet should be discarded as the internal safety mechanisms may be compromised.
With a better understanding of how to recognize and manage concussions, our athletes, kids, family and friends will have a much safer and speedier recovery from this injury. The physiotherapists at Bragg Creek Physiotherapy would be happy to discuss, assess and treat any concussion related injury you may be concerned about.
The elbow is a joint complex made up of 3 joints. These joints are surrounded by a joint capsule and several ligaments (elastic type bands that connect bone to bone) that add stability and support to the joints. Muscles from the upper arm attach below the elbow and create flexion and extension movements (bicep and tricep muscles). Muscles from the medial and lateral epicondyles form the forearm muscles that act to move the wrist joint into flexion, extension, rotation and side to side movements (radial and ulnar deviation). There are also structures called bursa in the elbow. These are fluid filled sacs that cushion between muscles and bones. A commonly injured bursa in the elbow is the olecranon bursa that sits at the back of elbow. Normally you cannot feel the bursa, but if inflamed, it can become largely swollen and painful.
The three main nerves that pass through the elbow originate in your neck and branch down the arm to give sensation, nutrition and strength to the muscles. The median, radial and ulnar nerves run through muscles and around joints. They can be affected by inflamed muscles, tight muscles or joint dysfunctions. Commonly, the ulnar nerve can be affected as it is near the surface on the inside of the elbow. When you hit your “funny bone” and get a shot of pain down your arm, it’s actually your ulnar nerve! Pins and needles or pain radiating to your forearm or hand could be caused by a nerve impingement at your neck, shoulder or elbow. If the nerve or circulation is comprised somewhere along the pathway, the muscles will not be getting proper nutrition. This can lead to pain, tightness and dysfunction.
Repetitive strain is a common problem on the forearm muscle groups. This can be caused by work habits, repetitive sport activities, poor postural habits, technique faults, trauma, or muscle imbalances.
Tennis Elbow: Lateral Epicondylitis
This is an inflammation of the common wrist and finger extensors. These muscles attach to the outside bone of the elbow and act to extend the wrist and fingers. Inflammation can occur anywhere along these muscles, but commonly affects the area where the tendon is attaching to the bone on the outer elbow. This injury is commonly caused by overuse such as repetitive gripping, squeezing, or hammering. This may lead to microscopic tears in the tendon that result in inflammation and pain. Typically this injury begins with a gradual onset of dull, intermittent pain, but can progress to a sharp, continuous pain. Occasionally the nerves are irritated and this can result in radiating pain, tingling or numbness to the hand and fingers
Golfer’s Elbow: Medial Epicondylitis
This is an inflammation of the common wrist flexors. These muscles attach to the inside bone of the elbow and act to flex the wrist and fingers. The same process can occur as described above, but is less common than tennis elbow. Work or sport technique errors, weak forearm muscles, direct trauma or repetitive overuse are common factors that contribute to golfer’s elbow.
How is elbow pain treated?
A thorough exam is conducted to determine where pain and dysfunction may be coming from. Posture, active range of motion, strength, and joint stability are examined at the neck, shoulder, elbow, wrist and hand. Areas of tightness or joint dysfunction are treated with manual therapy techniques such as joint mobilization, soft tissue release and stretching. Modalities for pain or inflammation such as ultrasound, acupuncture, or Intramuscular Stimulation may be incorporated. Postural education and activity modification and appropriate strengthening exercises are an important part of the rehabilitation process.
A few tips for relief locally at the elbow are:
Give the affected muscles a rest and avoid repetitive gripping, lifting, and carrying. This doesn’t mean do nothing at all! It means when using the injured arm, attempt to do less, take frequent breaks, stretch often (4-5x/day), relax the hand and avoid excessive gripping motions.
Carry objects with elbow bent to 90 degrees rather than a straight arm. This reduces the stretch on the nerve tissue and muscles are stronger in a shortened position. If pain is at the outer elbow, carry objects with the palm facing upwards to give the outer forearm muscles a rest.
Wearing an elbow brace can reduce the stress on the muscles. It can be worn at all times if you’re experiencing constant pain, otherwise wear the brace just during aggravating activities.
Golfers are Athletes too!
There’s a stereotype out there that golfing is a relaxing, cruise around in carts sort of activity. In the older days, men wore puffy pants and women wore skirts and fancy hats! A lot has changed over the years, regarding golf attire and golf fitness. There is a huge focus now on sport specific biomechanics and strengthening exercises for every activity. As in every sport, the key to improving your technique and performance is to train specifically for that sport. Yes, general fitness activities will improve your flexibility, endurance and overall strength. However, focusing on sport specific movements will be what takes you to the next level in your game.
As we age, the most common complaint in the game of golf is losing distance and power. While it’s true, we tend to become less flexible and lose some muscle mass, there are certain flaws in golf technique that contribute to this problem and there are exercises that can really make a difference to improve your swing.
Golf Teaching Pro and Coach, Arlen Bento Jr., has summarized three common mistakes we make in our technique that contribute to this loss of distance and power in our swing. He calls them the “death moves”! Swing technique flaws that kill distance and power. The first one he calls Over the top: this is a common mistake where from the top of the backswing, one comes up and over the ball, falling in front of the swing plane during the downswing. We have an instinct to want to come down on the ball fast and hard to get power, but if we are beyond the proper swing plane and our weight is too far forwards, we have lost the ability to utilize the torso and abdominal muscles effectively.
The second mistake he calls is Casting: at the top of the backswing, the wrist angle is lost as one flicks the wrist just before coming down into the downswing (as if casting a fishing rod). Again, this unlocks the power built up in our torso, abdominals and arms at the top of the backswing and results in a less powerful downswing. The third common mistake is Standing Up. We are all guilty of that one at some point! This occurs when we pull up during the striking of the ball and lose the proper hip rotation required to power the swing. These common faults often happen together which is even more challenging to correct!
Fortunately, there is a great tool that helps to alleviate these faults, build sport specific strength, balance and endurance. The golf “strength trainer” is a tool that has a golf handle attached to latex tubing. You could create a homemade version with a shortened golf club and theraband or tubing. One end can be looped around your foot or anchored in a doorframe and by holding the club handle you mimick various phases of the golf swing. The tension in the tubing helps you to maintain correct posture at the top of the backswing - and in a sense, the tubing is trying to pull you back down the way you came up. It is also more difficult to fall out of the ideal swing plane or stand up during the downswing, as the line of the band is drawing you down. Doing several repetitions in the various phases of the golf swing can build muscle memory, strength and endurance. For example – a right handed golfer loops the tubing around his left foot and rotates up into a backswing. Come back down to neutral stance and repeat the backswing again. An alternate move would be to hook the tubing onto the right foot and repeat the phase of golf stance to follow through. Because there is tension in the band throughout each movement you are working against the resistance of the tubing pulling up into a backswing then controlling the release of resistance during the downswing.
There are a couple great products on the market that are golf specific with a built in golf handle and tubing apparatus (no handy work required!). One is called the Strength Trainer at fitforegolf.com and another is the Power Swing Trainer at GolfGym.com. Both websites offer instructional videos and a variety of exercises to perform.
We also hold Strength and Conditioning Golf classes at Bragg Creek Physiotherapy that involve a variety of golf specific exercises to improve your core strength, flexibility, endurance and power. Please check out our website or facebook page for further details or call the clinic to inquire. Spring is here, golf courses will soon open, and we want to get you in shape to have the best golf season yet!
Lower Crossed Syndrome
What is Lower Crossed Syndrome?
This term refers to muscle imbalances in the pelvic region. We commonly see tight lower back extensors matched with tight hip flexors and weak abdominal muscles matched with weak gluteal muscles. This criss cross pattern of imbalance in our body creates joint dysfunctions, poor movement patterns and likely pain in the lower back, pelvis, hips or knees. Our bodies are very accommodating and take the path of least resistance. When one muscle group is tight (lower back and hip flexors), the opposing muscle groups (abdominals and glutes) are inhibited in function so that they relax to accommodate the contraction on the other side of that joint. This is a process called “reciprocal inhibition”.
What causes this imbalance?
Posture, posture, posture! We hear it all the time and there are activities we just can’t avoid. Driving to work and sitting at our computers are the most common, but we often carry these poor posture habits around with us elsewhere. Poor exercise technique, standing postures, physical inactivity, and imbalanced strength training (focusing on the same areas). The development of these muscle imbalances occurs over time. This sets us up for a vicious cycle of habitual movements and using other muscles to compensate. Eventually this results in pain somewhere in our body as certain structures break down from overuse and strain.
We commonly see weak gluteal and abdominal muscles. When these muscle groups are weak, their function is compromised and the hamstrings and lower back muscles are recruited to assist in activities such as walking, running and squatting. This leads to overuse and tightness of the hamstrings and lower back and further weakening of the glutes and abdominals. Our sitting posture and a common standing posture of an anterior pelvic tilt facilitate tightness in our hip flexors (the quadriceps and iliopsoas muscles). The iliopsoas muscle originates on the anterolateral surface of the lumbar spine and travels down to the front of the hip joint. Due to these attachment sites, this muscle is shortened when we sit and when tight, pulls on our lumbar spine in standing.
How can we correct this?
Body awareness and posture correction are two important aspects you can focus on through your day. Identifying these imbalances, learning how to stretch properly and strengthening weak muscles are what will take a little work and practice! While there isn’t one approach that works for everyone, there are a few tips that may help you identify some imbalances in your body.
Standing posture – take a look at yourself in a mirror from the front and from the side. Do you let your belly hang forward and have excessive curvature at your lower back? Do you have a flat buttock? Do you round at the shoulders and have too little curvature at your lower back? Try standing up against a wall with your feet a few inches from the wall. Stand tall, shoulders back, head against the wall (keep chin slightly tucked). You should have some curvature at your lower back and behind the neck. How does this position feel?
Lay on your back with your knees bent and feel the difference between an anterior pelvic tilt (arching your lower back) and a posterior pelvic tilt (flattening your back into the floor). Can you find a neutral zone? Can you keep your neck flat with a slight chin tuck position?
Glute squeezes. Can you squeeze your butt muscles? Can you squeeze the left and right independently and the same amount? Think of squeezing your glutes while you are walking, running, and xc skiing.
Lunge stretch. Place one foot on a secure chair or stair, stand tall through the torso, abdominals drawn in and slowly lunge forward, bending your front knee and keeping your standing leg straight. You should feel a stretch through the front of your standing leg (maybe your calf too!). This can be progressed to a lunge position with one knee on the floor (wedding proposal position).
Other exercises such as squats, plank, bridging, and the child’s pose stretch can also be beneficial. As these exercises have multi-joint involvement and require proper technique, it is best to seek professional advice, be properly assessed and receive an individual exercise program. All our physiotherapists at Bragg Creek Physiotherapy are well versed in these common but troublesome muscle imbalances and we would love to see you before more sinister injuries crop up!
Come and see us for a professional biomechanical assessment so we can find and treat any relevant muscle imbalances, pain or movement dysfunctions you may have.
Align Yourself – Lower Leg Injuries
As all you outdoor enthusiasts in the Foothills embark on summer trail running, hiking, biking and sunny dog walks we see an increase in hip and knee issues. These injuries may be traumatic in nature, a trip and fall, land on a hip or twist your knee. More often than not, we find they are related to common muscle imbalances in the hip and lower leg.
One aspect we always assess is the alignment of the lower leg during movement, such as a squat. A single leg squat is especially indicative of alignment problems in the lower leg. This movement requires the pelvis and lumbar spine to stay neutral as the hip, knee and ankle all flex in sequence.
If there is poor coordination and alignment along these joints, we aim to figure out where it may be coming from. Weak abdominal muscles, such as the transverse abdominus – the deepest abdominal layer and spine stabilizer, can contribute by not being efficient in stabilizing the spine during motion. The gluteal muscles may contribute by not being efficient at stabilizing the pelvis as the hip is flexing. If the gluteal muscles are weak, the pelvis will slightly drop on one side and cause the knee to fall inwards (which is caused by the hip adduction). The hip is not able to maintain it’s neutral position. This motion of the knee falling inwards can put stress on the soft tissues surrounding the kneecap. Iliotibial Band Syndrome (IT Band), Patellofemoral Pain Syndrome, and tendonopathies are common problems that develop. This mal-alignment at the knee can also wear and tear the ligaments and meniscus structures, putting you more at risk of ligament tears (MCL, ACL), meniscal derangements and bursitis issues (Baker’s Cyst for example).
Locally at the knee, the inner quadriceps muscle may be underdeveloped. A previous injury, postural habits, or general de-conditioning may cause this. The Vastus Medialis Oblique (VMO) is important in the last 30 degrees of knee extension (think going down stairs, gradual downhill hiking). The VMO largely contributes to the proper tracking of the patella (kneecap) and coordinated motion throughout knee extension.
Further down the leg, the ankle and foot may contribute to hip and knee problems as well. A pronated foot, when the inner arch of the foot is flattened, may contribute to the knee falling inwards during a squat. As the body weight is shifted more onto the big toe and inner aspect of the foot, the knee is drawn towards the big toe and the whole lower leg rotates inwards. A previous ankle sprain may also contribute to this issue as the ankle joint may be stiff and prevent the knee from flexing directly over the ankle. Plantar fasciitis, achilles tendonopathies and Morton’s Neuroma nerve impingements may develop.
Some remedies used for these common problems are taping procedures to encourage proprioception (joint and muscle awareness) and relieve tension on stressed tissues, Active Release Techniques/soft tissue stretching for tight and overused muscles, Electrical Muscle Stimulation to help engage de-conditioned muscles and exercise prescription. Specific exercises tailored to your unique posture can be the most helpful in prevention and healing. This is what will make the difference in reshaping your movement patterns and teaching your body proper mechanics. Here are a couple great exercises that help target some of these common issues.
Assume a sitting position with your back up against a wall, hips and knees bent to 90 degrees, and your torso straight. Place a soccer size ball between your knees, ensuring that your legs are parallel with knees over the ankles and aligned over the mid forefoot. Squeeze the ball with your knees and hold for 5 seconds. Relax, but don’t remove the ball yet. Repeat with 10 squeezes, held for 5 seconds each.
Sit in a chair with an elastic theraband looped around both ankles. Keeping your knees together and bent at 90 degrees, pull your right foot away from the left (your left leg is the anchor and stays still until you switch sides). As if your lower leg is a windshield wiper – it moves back and forth. This motion is actually coming from the hip – hip internal rotation – which is targeting the smaller hip stabilizers. Repeat 2 sets of 20 reps on each side.
It is worth having a full body assessment if you are experiencing any of the common injuries mentioned above. We can tailor a specific exercise program suitable for you and the activities you enjoy.
The Neck bone is connected to the Shoulder bone…
Neck and shoulder pain are intimately related. People may experience shoulder pain when they really have a neck problem and conversely, neck pain may mask a shoulder problem. Neck and shoulder pain so commonly overlap that some refer to it as ‘schneck pain’!
Muscle attachments, nerve pathways, body mechanics, and posture all play a role in how the neck and shoulder are related. Many muscles attach from the shoulder blade to the cervical vertebrae. As we move our neck in various positions we rely on the shoulder blade, collarbone and upper rib muscle attachments to help stabilize, so our neck has a solid base to move upon. Nerves from our neck region supply motor (movement) and sensory function to our shoulder region and arms. A dysfunction in the neck, caused by trauma, poor posture, or arthritic conditions, may cause radiating pain to the shoulder or arm. This is called ‘referred pain’. Referred pain is pain perceived at a location other than the original painful stimulus. The most common theory of this phenomenon is that strong pain messages running along nerves may excite or overwhelm adjacent nerves, causing pain to be felt where that series of nerves innervate. A common example of referred pain is the left arm pain experienced during a heart attack. Another interesting one is the gall bladder attack that manifests itself in the shoulder, typically the right shoulder. Even though the gall bladder is located in the abdomen, people may experience an onset of pain in the shoulder. Isn’t the body a wonderful mystery?
The shoulder is a ball and socket joint consisting of the shoulder blade (scapula) the humerus (upper arm bone) and the collarbone. A large range of motion occurs at this joint, making it susceptible to injury. Shoulder pain may stem from tendonopathies, muscle strains, fractures, dislocations, joint instabilities, frozen shoulder, or pinched nerves. A pinched nerve may originate in the neck and cause pain in the structures that nerve innervates down the arm. Or, a peripheral nerve may be locally damaged by a traction or compression injury. A traction injury may occur in sports, such as the “stinger” in football or hockey where the shoulder gets suddenly pushed downward and causes pain, tingling or numbness down the arm. A compression injury, such as the Saturday Night Palsy (aka Radial Neuropathy), may occur if you fall asleep slumped over a chair and wake up without the use of your arm. (flashback University days!)
When is the shoulder the likely culprit? Most often shoulder pain stems from injury, wear and tear to the rotator cuff muscles. This may be a gradual or sudden onset of symptoms. Often pain develops locally in the shoulder or upper arm, is dull and aching with pain upon movement. Pain may radiate into the upper arm, but not often past the elbow, pain may persist at night and may be eased when you rest your arm.
When is the neck the likely culprit? Again, pain may be gradual or sudden onset depending on the mechanism of injury. Often pain develops in your shoulder blade or sides of the neck, it is often sharp, stabbing, burning or tingling that may radiate down your arm past your elbow or even your hand. This pain may persist at rest or be aggravated with neck movements or overhead arm movements. Pain may be relieved with neck support or a correction of your posture.
A thorough examination is important to determine the cause of your neck or shoulder pain. A physical therapy examination will assess your posture, neck and shoulder range of motion, strength, body mechanics, muscle imbalances (what is tight, what is weak), specific joint mobility and nerve tension tests. Treatments may involve manual therapy to target tight muscles and joint dysfunctions, posture correction, modalities such as ultrasound or acupuncture to speed healing, and of course exercises to help you restore optimal body mechanics. Avoid self diagnosing this complex region of intimately connected muscles, nerves and pain pathways! We are here to help get you back on track. The physiotherapists at Bragg Creek Physiotherapy have treated many, many shoulder injuries, as it is a very common issue that typically doesn’t resolve on it’s own. If you have been dealing with a stubborn injury all summer, now is the time to face the music and get yourself properly assessed and on your way to recovery.
The shoulder plays a large role in many activities and sports such as swimming, golf, hockey, baseball, tennis and volleyball. Shoulder problems are common, frequently difficult to manage and often become chronic. They are typically overuse, inflammatory type lesions, such as tendonitis and bursitis. Occasionally capsule and muscle tears may occur. High impact activities and falls may cause fractures and dislocations.
The shoulder complex is made up of three bones, which are connected by muscles, ligaments and tendons: the humerus (upper arm bone), the scapula (shoulder blade), and the clavicle (collarbone). The humerus sits against the scapula and forms a ball and socket joint, called the glenohumeral joint. This type of joint allows a large range of motion in all directions. Because the “socket” of the scapula is fairly flat, there are several layers of muscles, ligaments, and connective tissue that help to hold the “ball” of the humerus in place.
There are four main muscles that help stabilize the glenohumeral joint. These muscles are collectively called the rotator cuff and are made up of the supraspinatus, infraspinatus, teres minor, and subscapularis muscles. These four muscles together provide dynamic stability of the shoulder during all ranges of motions. They work in conjunction with the more global, larger muscles such as the deltoid and upper trapezius. This is why many rehabilitation programs focus on the control, awareness, and strength of these smaller cuff muscles rather than general strengthening exercises initially.
Other structures at the shoulder include cartilage, capsule and bursae. Bursae are fluid filled “sacs” that help to decrease friction between two tissues. For example, the subdeltiod bursa protects the rubbing of the deltoid muscle against the humerus. Bursae can be a source of inflammation and pain if repetitive movements cause excessive friction, resulting in a bursitis.
Rotator Cuff Injuries
Rotator cuff tendinosis is an inflammation of one or several of the tendons of the rotator cuff muscles. Tendons attach the muscle belly to the bone. Over time, repetitive motions can cause micro-tears of the tendon and result in inflammation and pain. The supraspinatus muscle is the primary stabilizer of the glenohumeral joint. It also assists in abduction (lifting outwards) and is the most commonly injured tendon. Overuse, muscle imbalances, age related degeneration, and repeated overhead motions can cause shoulder tendonitis. Neck involvement, such as a C5/6 disc lesion or degeneration, is always considered when evaluating shoulder pathologies. When this muscle is injured almost every movement of the arm causes discomfort which is felt in the upper arm rather than the shoulder joint itself.
When the tendon becomes inflamed, the tendon thickens and swells. This can result in an impingement syndrome, where a tendon or bursa gets “pinched” between joints or other muscles during movement. Typically this involves the supraspinatus tendon, the subdeltoid bursa, or the long head of the biceps tendon. Pain is felt with elevation of the arm.
Further wear and tear of these tissues due to age, poor posture, poor movement patterns, and overuse can cause a rotator cuff muscle tear. Common symptoms of a muscle tear or tendonitis are pain with active movement, weakness, limited range of motion, and a catching sensation with lowering the arm.
Another common tendonitis in the shoulder involves the long head of the biceps muscle, bicipital tendinopathy. This muscle sits in the front of the glenohumeral joint and extends down to the elbow. Symptoms may include pain with shoulder and elbow flexion, and rotating the forearm: the motion required when using a screwdriver, and local tenderness along the front of the shoulder.
Early intervention is important with shoulder injuries to prevent compensatory movement patterns. As the shoulder complex involves coordinated movement from the clavicle, scapula, humerus and the thoracic spine – it is important to address these factors early.
There are several barriers to the recovery of shoulder injuries that can contribute to the degeneration of the surrounding soft tissue structures. Repetitive and prolonged overhead activity can pinch both the supraspinatus and biceps tendons. This repeated compression can cause micro-tears in the tendons and restrict the blood supply to those structures. Further swelling and thickening can occur over time. The supraspinatus in particular has an inherently poor blood supply. This makes this structure even more susceptible to damage with repetitive use and overhead activities. A lack of activity, or deconditioning, can also be harmful. When there is pain with movement and one opts to rest and avoid aggravating positions – poor posture, muscle atrophy and weakness can occur that may further disrupt the mechanics at the shoulder joint. Frequent sleeping on the same side can also compress the joint and soft tissue structures over prolonged periods of time.
Poor posture is deleterious for most areas of the body! The shoulder and neck complex is commonly affected. Rounded shoulders, slouched posture, and the chin poked forward is commonly seen. This posture causes the neck to be compressed, especially at the C5/6 vertebrae, discs and nerve roots which innervate the shoulder area. The upper back and scapular muscles tend to lengthen and weaken, thus hampering the stability and proper movement pattern at the shoulder. The shoulder joint can “drift” forwards and stress the anterior shoulder muscles, which may cause tendonitis and impingement.
There are a variety of treatment options for acute and chronic injuries. Icing an acute injury for the first 48-72 hours can help reduce inflammation and pain. Avoiding overhead activity and limiting movement to pain free ranges initially can reduce the impingement (pinching) of certain structures. Gentle range of motion exercises, using pulleys, a cane or assistance from the other arm, can encourage circulation and reduce stiffness. Maintaining proper posture can reduce muscle imbalances and reduce stress on affected structures. Stand tall, relax the shoulders and slightly tuck the chin. Gradually progressing to strengthening exercises that incorporate the neck, upper back, chest and shoulders will help to create balance, awareness and coordination of this complex joint.
Rehabilitation of the shoulder can be a complex process, the longer an injury is allowed to continue without being treated, the more the body compensates, making recovery a longer process. As for all injuries, the sooner you seek treatment following an injury, the quicker the recovery & your return to the activities you enjoy.
Don’t Injure Your Summer
Here are a few tips to keep you safely enjoying the activities you love during summer. We see an increase of overuse injuries at this time of year from excited adventurers who jump out on the trails to bike, hike, run, golf, or start digging in the garden. Rain or shine, it is just a treat to be rid of some snow – so I know you are eager to get out there and enjoy our short reprieve! Whatever your activity of choice, staying hydrated, flexible, warmed up and well conditioned is paramount. Here are a few common activities we tend to see overuse injuries from and some helpful tips to keep in mind…
You may think GARDENING couldn’t possibly be “exercise”. However, your body is bending, twisting, reaching and doing motions you likely haven’t done in a year! Shoulder tendonitis, knee issues and lower back strains are common problems seen with the rigors of gardening. Save your back and the environment with these helpful tips:
Warm up with a light walk around the garden to limber up and reduce the chance of a muscle strain
Back bends – place your hands on your hips with your feet shoulder width apart and gently bend backwards at the waist. Hold 2-3 seconds, repeat 5x. If standing is uncomfortable, this can be done laying on your stomach and propped up on your elbows. This gentle back extension will warm up your lumbar discs. This is also a good one to do after gardening or yard work to avoid stiffness.
Chest stretch – place hands at shoulder height on either side of a doorframe, your feet staggered. Gently lean through the doorframe feeling a comfortable stretch across your chest.
While digging – lean forward with a straight spine, bend at the hips and knees and avoid twisting your back to throw the dirt. Stand up, move your body and turn the shovel to rid of the dirt.
While lifting – use a wide stance and bend at the hips and knees, keeping your spine straight. Keep objects close to your body to avoid reaching and straining your shoulders and back.
Use a bench or table for smaller projects and knee pads or a cushion when kneeling.
When it comes to GOLFING – stretching and warming up will have you hitting stronger with less effort. Key areas to stretch are torso rotation, shoulder circles, hamstrings and a lunge stretch for the calves and hip flexors. Oblique abdominal sit ups and the side plank will give your back more power and stability in the downswing and follow through. Standing on one foot (try closing your eyes) will challenge your balance and joint awareness and benefit your golf swing.
While HIKING out on the trails, protect your knees and avoid slips and falls by using walking poles. Assisting your balance and keeping you standing taller will save your lower back and take stress off your knees. Stay well hydrated and keep a bag of GORP on hand to keep you fueled. Stretching your calves, hamstrings and hip flexors after your hike will help avoid that delayed muscle soreness you typically get on Monday!
If you like to RUN and are having knee issues – focus on your behind! One of the most common causes of knee problems is weak gluteal muscles. These muscles control hip rotation, stabilize the pelvis and have fibrous connections down to the knee (the iliotibial band). Hip and lower back problems can also stem from muscle imbalances between the gluteals and surrounding muscles.
Stretch your piriformis – in sitting, cross an ankle over the opposite knee, sit with a straight spine and lean forward at the waist. You should feel a stretch in your butt on the same side as your bent leg.
Side leg lifts – lay on your side with your lower leg bent and your upper leg straight. Keeping your spine and pelvis still (laying along a wall helps with this) raise your upper leg about 12”. Ensure your leg stays straight along your body and avoid lifting it forwards, toes can be pointed slightly downward. Repeat 3 sets of 10 reps.
Lunges are a good ‘sport specific exercise’ that help lengthen your stride and improve your running pace. Ensure good knee alignment over the mid foot, keep the torso tall and hips level. Try walking lunges forward and backwards to challenge your balance and coordination.
These are just a few tips to get you ready for a great summer. If you are still dealing with any lingering issues from the winter, come on in and we’d love to help you get on track for the summer. The physiotherapists at Bragg Creek Physiotherapy also provide personalized fitness programs to help you meet your goals. Don’t delay, our summer is short and we want you out there enjoying every minute of it!
Is social media causing you neck pain?
There is a new diagnosis in town and it’s been nicknamed “Text Neck”. With the emergence of smartphones and hand held devices for all that you do, we are seeing a growing number of repetitive strain injuries caused by the poor posture we adopt while hunched over our phones. Even in teens and adolescents there are more incidents of neck and shoulder problems than ever before.
The typical texting, emailing, and facebooking posture is your head dropped forward for extended periods of time. This changes the natural curvature in the neck and causes the shoulders to round forward or lift up towards your ears. Over time, this malalignment can strain muscles and put wear and tear on the soft tissue structures and joints of the neck and upper back. In an ideal posture, our neck is designed to support the weight of our head, which is about 10-12 lbs. Research has shown that for every inch your head is tilted forward, you double the load on those muscles. In the typical “text neck” posture, with your chin down to your chest, this can put 60 lbs of force on your neck muscles. Ouch!
Smartphones aren’t all to blame. This is also the typical posture we adopt while on our laptops, reading in bed, slouched in a soft chair, or studying on the couch. This slouched posture can also affect our lungs ability to fully expand and flush our brains with oxygen. Inhaling less oxygen makes our heart need to pump harder to distribute blood throughout our bodies. Several hours spent in these poor positions can be detrimental to our general health, both physically and mentally.
Neck pain in teenagers is commonly characterized by pain and tenderness in the neck, muscle weakness or tightness in the neck region, limited range of motion of the neck, and possible radiating pain to the head, shoulders or back. When complaints of neck pain include symptoms such as a rash, fever, nausea, generalized muscle weakness or swollen lymph nodes – consider something more sinister such as meningitis or Lyme disease and seek immediate medical attention.
How to prevent neck pain and still stay connected?
Maintain appropriate posture – sit up straight and check that your ear is in line with your shoulder
Take frequent breaks – look up, do shoulder circles, tuck your chin backwards, rest the neck
Ergonomics – maintain the monitor at eye level, use a good chair with a supportive back rest, have feet flat on the ground
Use headsets or earphones
Avoid being on the laptop or doing homework in bed or on the floor
Good computer habits are essential for the young generation. They are learning to swipe and play and read on hand held devices from the age of two or younger! Frequently changing our position and encouraging our children to do the same can help to alleviate these repetitive strain injuries. If you or your child are suffering from a crick in the neck, we would love to get you straightened out and feeling better. The summer is short and this one has been beautiful. We want you to enjoy every minute of it. Happy Summer!
The 5 W’s of Pain
Pain is one of the central factors affecting our quality of life. Pain can also be one of the most debilitating experiences. On one hand, pain can be a good thing that is essential to protect us and to warn us of impending danger to our bodies. Pain can protect our body while it is healing and help us avoid further damage. On the other hand, pain can be frustrating, all consuming, and affect many aspects of our life – emotionally and physically.
All of us have experienced some degree of pain in our lives. Most things in life worth learning involve some degree of falling, getting hurt, and getting back up again! Furthermore, as we age, we are at more risk of suffering from pain due to illness, disease, arthritis and musculoskeletal injuries.
Pain is a feeling triggered in the nervous system. There are many descriptions of pain – it may be sharp, dull, constant, intermittent, localized or all over. Pain can come from many different sources in our body such as skin, bone, muscle, vascular and joints. To simplify, there are two stages of pain: acute and chronic. Acute pain is our alarm system. This tells us that something harmful is happening to our body. Pain lasting 3 months or longer is classified as chronic. In the chronic stage of pain, both physical and emotional stress is involved. It is not always clear what causes chronic pain.
A thorough medical examination is required to rule out serious conditions such as infections, rheumatoid arthritis, thyroid issues, and autoimmune disorders. Less serious, but still medically important to address are issues such as fractures, ligament sprains, muscle/tendon tears, nerve root compressions, whiplash injuries and the like. With an appropriate treatment plan of physical therapy – such as joint mobilizations, exercises, and muscle retraining – many of these musculoskeletal conditions will typically heal in 6-8 weeks. Why do some issues go on for months or even years?
In order to understand our natural stress response, it is helpful to understand a bit about our nervous system. The nervous system is a complex network of information “highways”. This consists of our central nervous system – the brain and spinal cord, and our autonomic nervous system – branches from the spinal cord that reach our extremities, bones and organs. The autonomic nervous system (ANS) controls our internal environment and consists of the sympathetic nervous system and the parasympathetic nervous system. The sympathetic nervous system (SNS) facilitates our “fight or flight” responses. When we sense fear and danger our SNS kicks in to increase the heart rate, raise blood pressure, reduce digestion, increase ventilation, and cause certain muscles to tense. This is all good news for our survival when we have an emergency to react to. Adrenalin and cortisol are two key hormones responsible for the body’s reaction during the fight or flight response. This natural stress response is usually self-regulating. This is where the parasympathetic nervous system comes in – our “rest and digest” response. As the adrenalin and cortisol levels drop, the body lowers the heart rate, lowers blood pressure, increases digestion and returns to a happy balance.
If stressors in life are always present, you are constantly feeling stressed, fearful, tense, or nervous, the fight or flight response system stays turned on. The long -term activation of the stress response system, and the subsequent overexposure to cortisol and other stress hormones, can disrupt your body’s natural processes. This puts you at risk of many health related problems.
Many research studies have focused on the emotional aspects of chronic pain. Results show that fear, depression, perceived injustice (ie. not my fault!) and catastrophization of pain were significant risk factors for the development of chronic pain. Another study showed that thoughts alone can trigger an inflammatory response in tissues due to the activation of the autonomic nervous system (natural stress response). This overload of the fight or flight response in our body eventually lowers our pain threshold. This means that postures, movements and activities that normally do not cause pain, start to become aggravating and painful. This is known as nervous system hypersensitivity, or hyperalgesia.
This hypersensitivity, and subsequent chronic pain, is driven by a cycle of inactivity, sleeplessness, irritability, negative emotions = release of stress hormones = more pain! Fortunately many studies have also focused on how to decrease this nervous system hypersensitivity. There is a way out of this vicious cycle of persistent pain! Studies have shown that exercise, sleep, laughter, hopefulness, positive thoughts and emotions all play a role in the release of endorphins (“happy chemicals”) and thus help to decrease hypersensitivity and raise our pain thresholds.
When to take control and reduce your potential risks? Start now! Studies show that people who learn to actively cope with pain have better recovery. To prevent sliding into that vicious cycle there are steps you can take to reduce your pain, whether you have an acute injury or suffer from chronic pain.
We all experience some degree of natural degeneration and wear and tear in our joints – but muscles, joints, and spinal discs become unhealthy with prolonged inactivity. Begin a progressive exercise program, maintain a healthy diet, hydrate, use relaxation techniques, BREATH, yoga, cycling, swimming, use of mobility aids, strength and flexibility programs. These are all ways that can facilitate blood flow, improve mobility, improve your sleep, release endorphins and help to improve your mental health. As studies have shown not only physical efforts but positive thoughts and good mental health make a difference to our pain thresholds. When there is so much accessible information out there it is easy to be misinformed and get into the habit of self- diagnosing. This can perpetuate the fear of pain, and the hopelessness that has been found to influence the chronic pain cycle. Ensure you take baby steps and pace yourself. This will help your system slowly adapt and gradually reach that happy balance once again.
Where to seek help? As physiotherapists, we have extensive knowledge of how the body works and have specialized hands-on skills to assess, diagnose, and treat symptoms of illness, injury and disability. Our goal is to restore your strength, function, movement and overall well-being. We will assess strength and weaknesses, gait, posture, balance, joint range of motion, and functional movement. Our treatment includes education (a big part of demystifying pain and injury!), exercise, and manual therapy. This may include joint mobilizations, muscle trigger point release, Active Release Techniques (ART), acupuncture/IMS, and muscle pattern retraining. How can these techniques help to affect pain?
Manual therapy techniques can stimulate and elongate connective tissue surrounding joints and help to activate nerve structures that are transmitting pain signals to our brain. Acupuncture has been shown to stimulate the release of endorphins and other neurotransmitters like seratonin (a mood enhancer). Exercise promotes physical and mental health and improves sleep. So, laugh a little, smile and get moving right on into Bragg Creek Physiotherapy so we can help you!
What’s the point?
What is all the buzz about acupuncture? It seems to be everywhere now and there are many different techniques and terminologies – Traditional Chinese Medicine (TCM), dry needling, trigger point needling, Intra Muscular Stimulation (IMS)…
What does it all mean?
Firstly, acupuncture is a safe and effective, natural and drug free way to eliminate pain and restore health. This practice originated in China and has been around for over 2000 years! Recently, western medicine has expanded its horizons and many practitioners are incorporating this into their practice – such as physiotherapists, chiropractors, medical doctors, and naturopathic doctors. There are various types of acupuncture techniques used, where a thin needle is inserted through the skin, but nothing is injected (dry needling). All techniques use pre-sterilized disposable needles of various lengths that pierce the skin or muscles. These needles are typically left in the tissue anywhere from a few seconds to 20 minutes. Occasionally, the needles are hooked up to a small electrical current, called electro-acupuncture.
Classical acupuncture, or Traditional Chinese Medicine (TCM), involves inserting needles into specific points along 12 meridians on our body. These meridians are channels of energy mapped out along the surface of our skin that relate to internal organs (small intestine, gall bladder, heart, liver…). Needling certain points along these meridians is believed to help restore imbalances in the flow of Qi (“chi”), or energy throughout our body. Anatomical or medical acupuncture are Western forms of acupuncture that integrate current knowledge of anatomy and physiology with classical acupuncture techniques (TCM). Motor point needling, functional dry needling, myofascial acupuncture all describe similar techniques used to target the neuromuscular junction of the muscle (where the nerve innervates the muscle) or trigger points in the muscle belly. Trigger points are tight, palpable knots that can be painful and often refer pain to other areas of the body. These techniques specifically target injured muscles that have contracted and shortened from distress. Dry needling may provide nearly instantaneous relief from the painful trigger point as well as improve function and mobility.
Intramuscular Stimulation (IMS) is another form of dry needling. IMS is a total system for the diagnosis and treatment of myofascial pain syndromes. Initially developed by Dr. Chan Gunn in British Columbia in the 70’s, this technique follows the neuropathic model of pain. The needling sites often target both the locally tight muscle bands associated with the nerve root at the spinal level that may have become irritated and hypersensitive. For example, elbow pain and a local tendinopathy may have its origins at C6 where the nerve root is exiting the spinal cord. If you only treat the local elbow symptoms, you wouldn’t be targeting the whole system.
How does it work?
The penetration of a needle into normal muscle tissue should be painless with no effect. Penetration into tight, shortened muscle tissue that is supersensitive will cause a ‘grasp’ of the muscle around the needle. This is often described as a cramping sensation. When this occurs, a stretch receptor in the muscle is stimulated which then produces a reflex relaxation phase. Secondly, the needle causes a micro irritation that draws blood to the area and stimulates the healing process. Thirdly, by relaxing the tight muscle bands the pressure on surrounding nerves, joints and soft tissue is reduced. Increased muscle flexibility, joint range of motion and reduced pain can be achieved. It is common to experience some discomfort when tight muscle bands are being released. This is similar to the soreness experienced after a deep tissue massage or an intense workout. This sensation is temporary and may last from 12-48 hours. There is also the potential for a superficial bruise, but this is not serious.
All forms of acupuncture are thought to directly stimulate local nerves in an area, thereby stimulating impulses that connect to the spinal cord and brain. These impulses help stimulate the production of endorphins in the brain, our natural pain relief hormones. Furthermore, neural pathways are stimulated that inhibit the pain perceived in our body, therefore causing an analgesic effect. In other words, happy hormones are released in our bodies that help to decrease the pain!
Often practitioners use a combination of these techniques. Classical acupuncture points can stimulate weak muscles and direct energy / blood flow to an area to alleviate pain, improve circulation, and speed the healing process. Motor and trigger point release can target those stubborn knots that reduce flexibility, compress nerves and cause pain. The combination of these treatments in addition to manual therapy and prescribed exercises can be very effective in restoring muscle balance, function, alleviating painful syndromes, and enhancing performance.
Our physiotherapists at Bragg Creek Physiotherapy are trained through the Acupuncture Foundation of Canada as well as post-graduate courses in IMS and Motor point acupuncture. If you are struggling with a stubborn injury that just isn’t getting better, these techniques might just help you achieve the next stage of healing.