Kelowna Manual Therapy Centre Blog

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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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Spring Biking Tips

 

Starting biking in the Okanagan is a wonderful thing after the winter.  This article will provide some tips on how to safely transition to spring time biking.

 

Tune-up your bike:

If you put your bike in storage without a fall tune-up your bike will need some checking and adjusting.  You can either take your bike to a local bike store or, if you are competent and you have the tools, tune it up yourself. 

A Tune up should include:

Tire inflation to the correct PSI (check the sidewall and then adjust for your weight/riding style).

Test the shifting.

Check brake pads/rotors for wear.  Ensure that the brakes pull to close evenly without rubbing and that there is good power.

Lubrication of chain and jockey wheels.

Visual inspection of the frame for cracks, etc.

Bolt Check. Check that all the bolts are still tight (a torque wrench designed for bikes is a great investment, especially for a bike with carbon fibre components).  You never want to experience a handlebar loosening on a downhill!  Also check that the quick release or bolts on the wheels are properly adjusted.

Check that the rubber on your tires is in good condition i.e. there is no cracking or significant loss of tread. 

Clean your bike, especially the drive train.  

Consider replacing your chain and or cassette (gears).  These components wear together and if they are too worn you will need to replace both.  If you replace the chain often enough (depending on how much you ride) you can get by with replacing only that component.

If you ride with clipless pedals, check the cleat and replace if worn.  Also replace the bolt that holds the cleat onto the shoe if they are starting to wear down.

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Check your comfort:

If you had discomfort on your bike last year or you are riding a new bike, get your bike properly fitted for you.  If you had discomfort last year, it will probably return again this year once you start to increase the length of your rides.  A thorough bike fit should include an examination of your flexibility and strength, as well as your position on the bike and pedalling technique.  Addressing the muscle impairments, pedalling technique and adjustments to the bike will make a huge difference in comfort.

 

Start Slow and Spin:

Make sure to build up your kilometres in a gradual fashion even when the sun is shining.  Pick a distance or length of time roughly half or your usual ride from the previous year and build on that.  A 10% increase in riding time per ride is a good rule of thumb.  Make sure you redevelop your spin, aiming for 90+ RPM’s on the flats.  Focus on trying to make completes circles with your legs.  Pay attention so that each leg is working the same.  Avoid a lot of big hills to start to avoid over stressing your knees

 

Check your helmet:

There doesn't seem to be a consensus on when to replace your helmet.  Some helmet companies recommend every three years, other companies have no recommendations.  Personally, I replace my helmet every three years as buying a helmet is a small price to pay for a healthy head!  All the companies will agree that a helmet should replaced after a crash where you hit your head.  At all times the helmet should fit properly according to the company’s user manual.  I hate to see both and adults and kids wearing helmets that don't fit properly and are essentially useless in a crash.  Buy the lightest helmet you can afford to take the load off your neck.

 

Invest in bike shorts:

Yes, that chamois does wear out and get thin.  I am a huge fan of great shorts even if you have a great seat.  Invest in the best shorts you can afford!

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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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Hip Pain - Impingement ?

 Hip pain caused by impingement is initially felt in the front of the hip as either a pinching or tight feeling.  The pain is most commonly felt while the hip and knee are bent up towards the chest i.e. while stretching or performing yoga poses such as the ‘pigeon’.   The pain can then spread to a more generalized hip pain.  Pain can also be felt in the front of the hip or groin with movements such as crossing the legs, running or walking.  Individuals will often feel like they want to keep stretching the front of the hip, which in fact will exacerbate the pain.  Furthermore, continuing to move the hip into the painful motion will continue to aggravate the pain and will not ‘stretch out’.  Associated with the hip impingement are a variety of other diagnoses such as; hip flexor strain, hip tendinitis, iliopsoas bursitis, and groin ‘pull', labral tears and early osteoarthritis.
 
The most common finding is excessive muscle tension in the gluteal and rotator muscles at the back of the hip.  The hip joint is designed for the ball part of the hip to ‘spin’ in the socket.  Excessive tension and compression through the muscles in the back of the hip will push ball forwards in the socket during movement and/or at rest.  The hip pain is caused by the front part of the ball pinching against the soft tissue in the front of the hip socket.  The soft tissues in the front of the hip can be very tender to touch.
 
A thorough examination and history taking is required by a manual physical therapist to determine if you have hip impingement and how best to manage it.  There are many causes of hip pain that should be examined to allow for the correct diagnosis.  The physical examination involves looking at posture, movement patterns, strength and mobility of the hip, pelvis and lower back.  These three areas function together and any loss of mobility or muscle imbalance will place greater strain on the other regions.  The examination will also identify daily habits that are contributing to the pain i.e. sitting posture, standing posture, sleep position, etc.
 
Manual physical therapy treatment that will use a combination of manipulation, mobilization, IMS dry needling, soft tissue work, and stretching will help restore normal mechanics.  One of the best manual therapy techniques to restore hip mobility was invented by New Zealand physiotherapist Brian Mulligan and is termed a mobilization with movement.
 
A specific therapeutic exercise program will be taught to reinforce correct posture and movement patterns, and improve range of motion and strength.
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Knee pain is a common complaint at Kelowna Manual Therapy Centre. This article deals with knee pain that gradually increases, rather than knee pain that is caused by an acute injury.  Treating knee pain must involve taking a thorough history as well as physical examination.  A Thorough history-taking and physical examination will help determine whether the knee pain is the primary problem or the ‘victim’. In other words, a manual therapist will look for the root of the problem.  The knee pain can be the source of the problem, or caused by problems in the lower back, pelvis, hip and/or foot and ankle.

Commonly, non-acute knee pain is brought about by about by stresses transferred from other areas.  For example, tightness and weakness around the hip can cause a lack of control and an increased angulation of the knee with bending.  This is termed “Valgus collapse”.  This is one of the most common causes of knee pain seen with ‘overuse’ injuries.

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PIC: Poor knee control as a result of hip muscle tightness and/or weakness

Another example is tightness in the calf muscles or stiffness in the ankle joint will put an increase in stress on the knee by causing an increase in twisting forces on the knee.  Excessive pronation can also contribute to increased knee stress.

Manual Physical Therapy treatment will use a combination of manipulation, mobilization, IMS dry needling, soft tissue work, stretching and strengthening to help restore normal mechanics.  Orthotics can be used if it is determined that increased foot pronation is contributing to the knee pain.  A specific therapeutic exercise program will be taught to reinforce correct movement patterns.

The therapeutic rehabilitation program will follow one or more of the following principles:

  • Correct knee, lumbar, pelvis, and hip alignment with exercises. This involves good control of the ankle, knee, hip, pelvis and lumbar spine with movement.  Movement patterns that mimic the activities that were painful are focused on as part of the rehabilitation.  Rehabilitation exercises must be kept pain free.
  • Initially, exercises will be used to minimize ‘sheer’ stress on the knee. If the knee remains centered over the foot rather than allowed to move forward this will reduce stress on the knee.  As the exercise program progresses increased loading will be used.  There are a varieity of methods used to increase that load i.e. moving from both legs to one leg, adding weight, adding speed, adding unstable surfaces, etc.
  • An emphasis on eccentric (muscle and tendons working and lengthening) exercises are used for sports that require this type of loading i.e. downhill trail running.  Eccentric exercises are useful to prevent and treat knee tendinopathy.
  • Attention to the type of activities and training previously discussed here.

 

 

 

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OVERUSE INJURY PREVENTION AND RECOVERY FOR RUNNING ATHLETES

Overuse injuries are common in recreational and elite running athletes training for endurance events. 

Overuse injuries take two forms, which often overlap.  The first is simple overuse where an athlete has increased their training or has a sudden change in training to a level that has over stressed the tissue.  Treatment is to identify the stressful event(s); decrease the inflammation and provide rest to the injured area.

The more common overuse injury is when the painful injured tissue can no longer handle the demands placed upon it.  This requires a more in depth assessment to determine what the causes of the injury are.  Quite commonly the injured area is the ‘victim’of stiffness, lack of mobility and/or control while another place in the body is actually the ‘culprit’.  For example, if a runner is complaining of knee pain (the victim), ‘the culprit’might be a lack of hip mobility and strength which has put extra stress on the knee.   All the intrinsic and extrinsic factors need to be examined.

Intrinsic Factors Extrinsic Factors
Biomechanical exam of joint mobility Training Methods
Bony structure: Spine and limbs Shoes, Orthotics
Ligament stability  
Muscles Activation /Strength  
Body Awareness / Balance  
Posture, Running Style  

Ideas for injury Prevention and Recovery:

 

Proper warm-up:

A dynamic warm-up.  Gradually increasing the pace and intensity of the warm up is important, especially with higher intensity exercise.  Static stretching before activity has been shown to be detrimental to performance.  There is also evidence that activities such as strength and balance exercises incorporated into a workout can prevent injuries.

 

Active recovery:

An active recovery or cool down is very important after hard workouts to help flush out lactic acid.  It should consist of 15-20 minutes of gentle movement.

Differentiate muscles soreness from injury soreness:

Delayed onset muscle soreness is common a day or two after a strenuous session.  There is no harm done in continuing to exercise.  Joint soreness is an indication that the joint itself has been stressed and requires more rest.  Signs would include swelling or a ‘puffy’joint and tenderness.  If body parts continue to ache or are painful longer than 1-2 weeks they should be assessed.

Correct training 

A gradual increase in training is necessary.  A 10% increase seems to be a good rule of thumb.  Remember that while it is important to gradually increase training volume and intensity, adequate recovery allows the body to build up stronger.  High intensity training requires around 36-48 hours of recovery before another high intensity session should be undertaken.  A good guideline is, the higher the intensity of the session is, the longer that recovery should be.  Knowing your body is key for any athlete, i.e. knowing when to push and when to rest.

Cadence:

A stride rate 180-200 strides per minute for runners has been shown to reduce injuries as there is less impact per stride.  Simply count the number of steps (each time one foot touches the ground) over 10 seconds aim for 15-16 steps.

Technique:

Runners should consider a soft landing (mid foot/forefoot strike), with a slight lean forward at the ankle, while keeping a tall chest.   A running gait assessment which involves running while being videotaped for analysis by the Pedorthotists at Okaped can be very useful.  Other running coaches can be used for ongoing technique correction.

Footwear/Orthotics:

An in-depth review of modern footwear is beyond the scope of this article.  It is best to visit a local shop like Fresh Air Experience who have trained staff to help you determine the best running shoe style for your foot type.  Orthotics can be very helpful, either custom or over the counter.  Again, these are best recommended by professionals such as Okaped.  If Orthotics are being considered, foot taping , which simulates an orthotic, can be very helpful to to determine if orthotics will help.

Strong core:

A strong stable core i.e. abdominal, back and hip muscles, provide a good base to stabilize, propel and transfer energy.  This allows an athlete to maintain good form and technique even when fatigued.

Adequate flexibility:

Adequate flexibility is necessary for the demands placed on the individual i.e. hip mobility for runners.  This is probably more important as we age.  Static stretching should not be performed prior to a work out,.  Dynamic movements and a good warm up are better.   Static stretching prior to a work out has been shown to be detrimental to performance.  Static stretching (20-30 second hold) should be performed only after a workout.

Strength training:

Correct strength training has been shown to help prevent injuries in sport.  You can also consider eccentric strength training as this has been shown to improve flexibility and strength in certain muscles groups.

Old injuries:

Deal with old injuries in the off-season that lingered during or after your competitive season.  With an increased training load they will most likely reappear.

Adequate sleep:

There is some research that ongoing sleep deprivation, longer than 1-2 nights, interferes with our hormonal balance that regulates recovery.

Nutrition replacement:

A great resource is the coach.ca website.  It has a sport nutrition section. Eating properly is important on a routine basis and a post workout combination of carbohydrates and protein is critical for recovery. 

Compression:

Compression socks have become quite popular with some claims of improved athletic performance.  Scientific evidence suggests that they can assist with post-exercise lactate acid clearance and decreasing swelling.

Cold baths:

Cold baths have become popular and are theorized to reduce the inflammation that has occurred with a strenuous workout. Cold water may help recovery and can be used for around 10 minutes. It is not necessary to have an ice bath.  Cold water of 24°Celsius is okay.  Contrast baths of cold and warm water may also be beneficial though not very practical.  This involves a 1 minute cold (10-15°celsius) then 1 minute warm  (37-40°celsius) for 7 cycles.  Anecdotally submerging the legs into the lake post run can also be of benefit.  None of these cold baths are enjoyable and take a lot of mental toughness!

Biomechanical evaluation:

Have a physiotherapy assessment, either to deal with nagging injuries or prevent an overuse injury from occurring.  The Kelowna Manual Therapy physiotherapist will examine the above mentioned extrinsic and intrinsic factors (Table 1), and work with you to help establish a treatment plan.

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Sciatica - What it is and what to do about it.

Sciatica is a very common condition that affects many of us at some point in our life.  Sciatic pain is typically a sharp electrical pain or dull ache that radiates down either one or both legs.  The more swollen and irritated the nerve is, the further down the leg the pain goes.  Typically the pain is felt in the lower back, buttock and leg, though some only feel pain in their buttock and/or leg.  The sciatic nerve is the largest and longest nerve in the body.   It is made up of nerves from the 4-5th lumbar, and 1st-3rd sacral nerve roots.  Nerves are normally able to handle compression and stretching that is part of day to day living without causing problems.  Due to some traumatic event, or an unusual or prolonged activity, i.e. bending and twisting in the garden all weekend, or a long drive,  the nerve can becomes swollen (inflammation).   Sciatic pain is often associated with changes to the structure of the spine, i.e. degenerative changes such as degenerative disc disease, disc bulging and herniated discs, etc.  Though it is important to understand that these degenerative changes are not always the cause, many of us have herniated discs and will never know it!  The degenerative changes themselves are typically not enough to create the sciatic pain.  It is the overdoing what are body can handle that causes the problem.   The swelling is a signal for the brain to protect the area causing the back and/or leg to become painful and sensitiized.  The swelling and sensiitization can then make movements and postures of the back and leg very uncomfortable.

Sciatic pain is usually worse with either sitting or walking/standing.  Sometimes the pain is worse with both.  Sciatic pain can come on very suddenly or can be gradual in nature.  Sciatic pain maybe also present in signs of nerve compression like pins and needles, loss of feeling or loss of strength in the leg muscles.

Sciatic pain can typically be managed very well with a combination of manual physical therapy, activity/posture modification, time and medication.

The manual physical therapy first starts with a history taking to identify where the pain is, what has caused or is causing the problem, what you have found worsens or eases the pain, any other past medical history, medications, hobbies, sports, work, etc.

The physical exam will involve:

  • Looking at your mobility to see if particular motions increase or decrease the pain.
  • Testing the physical health of your nervous system.
  • Palpation and mobility testing of the vertebrae.
  • Testing movement and/or positions to determine which relieve or aggravate the leg pain.

Once the physical exam is completed treatment can be undertaken.  There is good evidence that Manual Physical Therapy will get you better more quickly.  Treatment can consist of:

  • Manual therapy techniques directed at improving vertebral mobility to open the space or take pressure off the nerve.  
  • Exercises designed to improve mobility, open the space for nerve and/or reduce tension on the nerve.  
  • Education on pain management strategies, postures, sleeping position and activities to help reduce the pain.
  • Physiotherapy modalities such as electrical stimulation, heat and ice to help with pain.  
  • Lumbar traction can be performed in a variety of positions to help reduce pain.

At home it is important to:

  • Be patient and relax.  There are lots of scary stories and words associated with sciatica i.e. 'slipped discs', 'pinched nerves', etc.  Our body does an amazing job in dealing with the stress and strains we put it through.  Our body and nervous system does well dealing with the natural wear and tear we go through as we age.  Sometimes we over do it, then we need some treatment and need to let things settle down.  The more stressed and anxious you are,  the worse the pain will be.  Deep breathing and progressive muscle relaxation exercises can really help.
  • Find and use the positions and postures your manual physical therapist has suggested.
  • 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 quicker.  
  • Find and use sleeping positions that will help alleviate the pain.
  • Use ice and/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.
  • 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.
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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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Contact KMTC

1934 Ambrosi Road Kelowna, BC V1Y 4R9

250.860.5152
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