Kelowna Manual Therapy Centre Blog

What is IMS?

Intramuscular Stimulation (IMS) is an effective treatment for musculoskeletal pain syndromes caused by nerve irritation (termed neuropathy). Neuropathy is described as a nerve that is not functioning properly but has normal structure. The neuropathy results in pain, muscle shortening and spasm, localized tenderness in the muscle, and localized swelling around the spinal segments. Temperature changes, sweating changes and/or altered sensations around the spine and extremities can also be present.

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What is Achilles Tendinopathy and what to do about it
 
Tendinopathy has replaced the term tendinitis to reflect the latest research on the source of the tendon pain (look for future articles to come on the causes of tendon pain).
 
Achilles Tendinopathy is common in elite and recreational athletes, active individuals and 'weekend warriors'.
 
The most common type of Tendinopathy is in the midtendon, i.e. about 1” or so above the attachment to the heel bone. Less common is an insertional Tendinopathy, which is pain at the Achilles attachment into the heel bone. The site of the pain can be swollen and/or thickened or normal in appearance.  The pain can be brought on by activity and becomes increasingly painful as the activity progresses.  However, quite commonly the Achilles pain will diminish as the tendon “warms up”.
 
The first goal of manual physical therapy is to decrease the stress on the achilles which is termed unloading.  Unloading must include a careful biomechanical assessment of the foot, ankle, knee, hip, pelvis and lumbar spine looking for areas that can increase the stress on the achilles. The problem areas are addressed by a combination of joint manipulation, joint and soft tissue mobilization, stretching, therapeutic exercise, taping and modalities such as electrical stimulation.  
 
The unloading component can also involve wearing the correct footwear, using a heel lift, taping, using a night splint and possibly orthotics. Often a ‘low dye’ foot tape, which supports the arch, is used to determine if orthotics will be helpful.  The most critical component of unloading is education on  what activities can be continued during the acute phase, how often, how far, and what intensity i.e. how much walking or running can be continued during the acute phase.   
 
The second goal of manual physical therapy is to begin a specific therapeutic exercise program.  If the tendon pain is quite acute or occurs during the competitive season, isometric exercises have shown very promising results.   Isometric exercises involve a prolonged static tensioning (10-30 seconds) of the calf muscles and achilles tendon.
In less acute situations a therapeutic exercise program consisting of both eccentric and concentric exercises are utilized.  An eccentric contraction is tensioning a muscle and tendon while it lengthens, while concentric exercise is tensioning the muscle and tendon while it shortens.  The latest research and expert opinion supports incorporating both the eccentric and the concentric exercises.  The exercise program is designed to put a gradual increase in strain and loading on the achilles to reduce pain, promote healing, improve flexibility and increase strength.  There is a fine balance between applying the correct amount of loading and not overdoing it.  Sport specific and harder plyometric-based exercises can be added later if needed.
 
It is important to continue with the exercise program as quite often results are not immediate.  It may take months to see an improvement in symptoms.  Once the symptoms become manageable it is important to continue with a regular achilles  loading ‘maintenance’ exercise program.
 
It is best to check with your manual physical therapist about the correct exercise dosage and technique before starting an exercise program on your own.  A program should be individualized and based on the best available research and clinical judgement.
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Top 12 Tips for Plantar Fasciitis / Heel Pain

Heel pain is a common condition.  Pain in the arch of the foot, where it meets the heel, is most commonly diagnosed as plantar fasciitis.  Typically the pain is worse with the first few steps in the morning, or the first few steps after inactivity.  The pain maybe worsened while running or prolonged walking and standing  The pain can be, but is not always, reduced with light activity.  The heel pain typically comes on gradually and progressively.  On examination there is local tenderness on the bottom of the heel bone towards the arch.  The tenderness may extend into the arch itself.  

A manual physical therapy examination will identify the root causes of the heel pain.   Typically the heel pain is brought on by a sudden increase in the amount or intensity of weight bearing activities i.e. a large increase in running distance or standing longer than usual at work.  The strain on the plantar fascia can be exaggerated by the bony alignment of the lower limb as well as muscle weakness and tightness of the foot, ankle, lower limb and spine.  Commonly there is a lack of mobility in the joints of the ankle and muscle tightness around the ankle.  It is also common that an increase in pronation, which flattens the arch, can put extra strain on the plantar fasciitis.  It is very common for the plantar fasciitis to be increased in the fall after a change to less supportive summer footwear.

Manual physical therapy treatment of plantar fasciitis is multifactorial:

 

Manual therapy:

Manual Therapy techniques are used to improve joint mobility and improve soft tissue flexibility around the foot and ankle.  This is done through hands-on joint and soft tissue mobilization/manipulation.  The soft tissue techniques typically include trigger point release which have been proven to help reduce plantar fascia pain.

 

Check the rest of the leg and lower back:

A manual therapist will check the rest of the spine for other underlying biomechanical faults and muscle imbalances in the leg and lower back, pelvis and hip.  A manual therapist will also check for altered mobility of the nerves and soft tissue in the leg and spine.

 

Tape to unload:

It is very helpful to unload the plantar fasciitis with sports tape.  This type of taping is termed ‘low dye’ taping.   Typically the pain relief felt is significant and immediate.  Taping the plantar fasciitis is also helpful in determining if orthotics will be beneficial.  With low-dye taping a 50% improvement in pain is expected before recommending custom or non-custom orthotics.

 

Custom or non-custom orthotics:

Both custom and non-custom (over the counter) orthotics have been proven to be helpful. Some individuals will do well with over the counter orthotics while others, due to the shape and biomechanics of their foot, will need a custom made orthotic.

 

Assist healing with physiotherapy modalities:

A manual therapist may assist the plantar fascia in healing through use of physiotherapeutic modalities such as ice, electrical stimulation and ultrasound.

 

Exercises for mobility:

A manual physical therapist will provide an individualized exercise program to improve mobility.  An exercise program would also address any other muscle tightness and/or lack of mobility in the low back, pelvis, hip and leg.  Stretching of both the calf muscles and plantar fascia has been proven to reduce plantar fascia pain.

 

Strengthen the plantar fascia:

There is evidence that a specific plantar fascia ‘high load’ strengthening program can be beneficial in reducing pain and improving the health of the plantar fascia tissue.   In the research study individuals who undertook the specific strengthening program along with stretching and arch supports had better outcomes than only stretching and arch supports.

 

Strengthen the rest of the leg:

Quite often limping to avoid heel pain creates muscle imbalances through the lower limb.  Through examination of your walking pattern and manual muscle testing the changes can be addressed by specific therapeutic exercise.  Recent research has demonstrated strength deficits in the toe, arch and ankle muscles in individuals with plantar fasciitis.

 

Education:

Education is provided to reduce strain on the plantar fascia through changes in footwear, work habits, activities and training factors.  It is important to gradually resume weight bearing activities in a systematic manner appropriate for the stage of healing.

 

IMS dry needling:

Another treatment option with more ‘stubborn’ cases is IMS dry needling of the foot, calf and lower back muscles.

 

Night splint:

A night splint, which keeps the foot held at a 90° angle all night can be used.   The night splint allows the plantar fascia and calf muscles to be positioned under slight tension, to improve mobility and make the first few steps in the morning less painful.

 

Medication:

Another option is to see your family doctor to discuss the use of medication or a referral for further investigation and treatment if you are not improving as expected with manual physical therapy treatment.

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WHAT TO DO IF YOU HURT YOUR BACK

Low back pain is a very common occurrence and is said to affect 80% of people at some time in their life.  Common causes of acute low back pain are sudden unexpected movements, such as bending and lifting while twisting, or trauma, such as a fall or a motor vehicle accident.  Other back injuries can occur in some individuals simply by bending over to brush their teeth, sneezing, or while doing other simple tasks.  The low back pain can either come on instantly, with acute muscle spasm or ‘locking' (sometimes it is impossible to move or to straighten to an upright position), or it can come on more slowly (up to 2 days post injury, as swelling and muscle spasm gradually accumulates) .

What to do:

1) Relax! 

No matter how bad the pain is it will get better.  Back pain is very common and while it can be debilitating the more anxious and stressed you are, the more the pain will increase.  Focus on staying positive.  Keep reminding yourself that you will improve.  Find a comfortable position and use relaxation breathing techniques.  This can very helpful in reducing pain .

2) Ice or heat.  

If the pain is less than 48 hours old, use ice.  Use heat if the pain has been present for more than 48 hours. Heat can be in the form of hot showers,an electric heating pad, a microwaveable pad or hot water bottle.  Heat works best when an area is achy.  The ice can work to numb the area and is especially good if the injured area feels hot and burning.    Some people find relief alternating between ice and heat provided the best relief.

3) Stay Mobile

Try to remain as active as the pain will allow. Some discomfort with moving around is normal. Research has proven that keeping active i.e. puttering around (stand a little, sit a little, walk a little) will allow you to get better faster.  Strict bed rest, while once commonly prescribed, will typically slow down your progress.  

4) Find the best positions to rest and sleep.

If you are unable to move or movement greatly increases the spasm and pain, then you may require more rest.  Finding comfortable positions for sleep and rest is important to unload your back as it gets tired or the pain starts to increase.  See the sleep position article for some advice on the best resting positions.  

5) Get treatment.  

There is good evidence that manual physical therapy will get you better faster. Research has proven that manual physical therapy for acute low back pain performed in the first 16 days is most effective. 

6) Leg Pain? Learn the right exercises and positions and try traction.  

Pain radiating down the leg will also improve with manual therapy but also requires specific exercises and/or positioning to relieve the pain. Traction can be of benefit especially when the leg pain is radiating below the knee.

7) Pain relief with physiotherapy modalities.

Physiotherapy modalities such as electrical stimulation, i.e. TENS or IFC, can be of benefit.  Electrical stimulation works to block the pain impulses that are being transmitted, providing an analgesic effect.  As the impulses are blocked the muscle spasm will relax.

8) Prevent a reoccurrence. 

Talk with a manual physical therapist about recommendations to try and prevent the acute pain from happening again.  This can involve education on posture, sport techniques, lifting, etc.  It can also involve learning a specific therapeutic exercise program to improve mobility, improve joint stability and improve strength.

9) Medication?  

If the pain is constant you may benefit from anti-inflammatory medication.  If the pain is keeping you from sleeping you might consider a muscle relaxant.  If the pain is unbearable then you might consider a pain reliever. It is best to discuss this with your physician or pharmacist.

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How to Prevent Back Pain 

Though it can be difficult to entirely prevent back pain, you will reduce the likelihood of injuring yourself by following these tips.  If you are already suffering from low back pain they can help prevent a recurrence.

Work smart – one of the biggest risks for back injuries is repetitive bending and twisting.  Learn how to bend using your hips rather than your back.   Make sure that when you pivot, either standing or sitting in a rolling chair, you turn with your whole body, not just your trunk.

Posture, posture, posture – There has been a lot of news lately about how unhealthy prolonged sitting is for our general health. It also is unhealthy for our backs.  The soft tissue in our back, i.e. muscles and ligaments, gradually lengthen while they remain in one position.  This is a phenomenon called ‘creep’.  This gradual elongation can begin to cause stiffness and pain once you are in a position for too long.  So stand and sit properly, use a proper chair and change positions every 15-20 minutes.  Consider a sit/stand desk if you have an office job to allow frequent changes in position.

Avoid unusual strenuous activity – It is common to injure the back after or during unusually strenuous activity, i.e. gardening all weekend in the spring or shoveling after a heavy snowfall.  Don’t push yourself to exhaustion.  Make sure to take breaks during an activity and reverse the position you have just been working in.

Maintain a healthy weight – Carrying excess weight puts more strain on the spine.

Regular exercise - Regular exercise is one of the best methods to prevent low back pain.  Regular exercise should include a cardiovascular component like walking, hiking, biking, etc.  This should be done at least 3 times per week for 30-40 minutes.  You should work up a sweat and huff and puff a little.  Develop a stretching routine that helps you work properly and allows you to participate in your sport with minimal strain.  Sitting and bending properly requires good hip flexibility in the muscles in the back of the hip.  Walking and running require good flexibility through the back of the hip.  Strengthening exercises are also important and should work all the major muscles groups.  Make sure that the exercise is at an appropriate level for your fitness.

Exercise sensibly – Regular exercise is crucial for good health and keeping your back healthy.  However make sure that the exercise is at an appropriate level.  Unfortunately many people are so enthusiastic at starting an exercise program that they can injure themselves.   Take an honest evaluation of your health and proceed in a sensible manner.  A ‘good rule of thumb’ is that you shouldn’t increase either the intensity or length of an exercise session by more than 10% at a time.

Do those exercises properly – Learn how to do strengthening exercises with correct technique.  Physiotherapists spend a lot of time working with clients on how to perform exercises properly and at an appropriate level of challenge.  Squats, dead lifts and core exercises are the three most improperly performed exercises.

Activate the core – A combination of old injuries, postural habits, the sports and activities we take part in, our posture and body type can result in muscle imbalances.   These muscle imbalances can have the effect of not allowing us to activate our core properly.  Very often there are muscles that don’t activate correctly and need specific exercise to be re-activated.  Working with a manual physical therapist can help you identify what are the best specific exercises to learn to reactivate your core. 

Stop smoking – Recent studies have concluded that that development of back pain was significantly associated with smoking, high blood pressure, and high cholesterol.  See your doctor for help in stopping smoking if you need it.

Sleep – If you are suffering from poor sleep you aren’t utilizing your natural recharging system.  A good sleep restores our body’s chemicals that help us stay healthy. You can try some of the positions mentioned in this article.  Try to avoid napping during the day, as it can disturb nighttime sleeping.  Avoid stimulants such as caffeine, nicotine, and alcohol close to bedtime.  Stay away from large meals close to your sleep time. Get regular exercise, as it is important for a proper sleep cycle.  However, strenuous exercise should be avoided in the evening. Relaxation exercise like gentle yoga, gentle stretching and relaxation breathing can be done before bed to help initiate a restful sleep.  Make sure to get outside in the daytime.  Establish a regular relaxing bedtime routine. Avoid using electronics such as computers, laptops, phones and iPads before bed. These devices have been linked to altering our sleep pattern by reducing a sleep chemical called melatonin and increasing our brain activity.

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Physiotherapy Hours

Monday: 9:00 – 6:00
Tuesday: 8:00 – 5:00
Wednesday: 9:00 – 5:00
Thursday: 8:00 – 6:00
Friday: 8:00 – 5:00

Massage Therapy Hours

Monday: 9:00 – 5:00
Tuesday: 9:00 – 5:00
Wednesday: 9:00 – 5:00
Thursday: 9:00 – 5:00
Friday: 9:00 – 5:00

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Our Location

Contact KMTC

1934 Ambrosi Road Kelowna, BC V1Y 4R9

250.860.5152
[email protected]

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