The “R.I.C.E.” principle in its expanded form stands for REST, ICE, COMPRESSION, and ELEVATION. After injury, following the R.I.C.E. principle can limit swelling, protect the injured area, and relieve pain if used immediately.

In order to effectively put the “R.I.C.E.” principal to work for your injury, follow these steps:

• REST – this is important following injury in order to protect the injured area from further damage. Resting allows the body to use its energy effectively to heal the injured area. For instance, if you sprain your ankle, walking on the injured ankle can disrupt the healing process and prolong recovery.
• ICE – Applying ice to the injured area reduces blood flow and therefore reduces swelling. By reducing the swelling you are there by reducing the pain. There are many ways to apply ice, such as using crushed ice or a bag of peas, however it is good practice to place a moist thin towel between the ice and your skin. Apply ice for 15 to 20 minutes only. Leaving ice on for more than 20 minutes may cause unwanted damage to the skin and tissues. Leave ice off the area for at least 20 minutes before icing again. This process can be repeated many times throughout the day.
• COMPRESSION – Compression is another way to control swelling. Some people get temporary pain relief from compression. Use a tensor bandage to wrap the injured area If the injured area throbs or the bandage feels too tight, remove the bandage and wrap it more loosely. Compression is also a good way to protect the injured area from further damage.
• ELEVATION – Elevation is yet another way to reduce swelling and speed up the healing process. It involves raising the injured area above the level of the heart. For example, if you sprain your ankle, lie down on a bed or couch with your foot propped up on two or three pillows. Ideally, you can ice your ankle in this position, also.

If you are unsure as to the severity of the injury or you are unsure how to treat the injury, this is where an assessment by a physiotherapist can help guide your speedy recovery. Physiotherapy modalities such as electro physical agents, acupuncture and simple safe exercises can also assist in the healing process.

Ryan Bachmeier is a co-owner of Kelowna Manual Therapy Centre. Ryan is certified in Acupuncture and Intramuscular Stimulation (IMS).

To book an appointment with Ryan please contact our office at 250-860-5152.

The shoulder in its own right is a very complex joint.

When simplified the shoulder is a ball and socket joint of which also consists of muscles, ligaments, tendons, and bones. Most shoulder pain originates from injury to the soft tissues of the shoulder, but in some cases, especially when you experience both neck and shoulder pain, cervical disk disease or a problem with the bones or nerves in your neck may be the source of your problem. In other cases poor biomechanics involving the scapula (shoulder blade) can put undue strain on the rotator cuff muscles, tendons and ligaments. Furthermore, the thoracic spine (middle back) and chest muscles can influence how a shoulder moves and more so can interfere with the healing process.

Exercises that focus on strengthening the scapula to provide a stable attachment site for the rotator cuff muscles will help reduce pain felt in the shoulder joint. As well as mobilizations of the cervical and thoracic vertebrae will also influence how the nerves and muscles that control the shoulder blade will interact with each other.

Many acute and chronic shoulder injuries would benefit from a thorough physiotherapy assessment of the shoulder but also the other joints that influence the shoulder.

Ryan Bachmeier is a co-owner of Kelowna Manual Therapy Centre. Ryan is certified in Acupuncture and Intramuscular Stimulation (IMS).

To book an appointment with Ryan please contact our office at 250-860-5152.

Knee injuries are common in skiers and snowboarders because the knee is highly vulnerable due to the very nature of how our legs are attached to the skis or boards. The foot and ankle is locked in the ski/board. So if there is a fall and the ski bindings do not release, as they should, it is the knee joint that suffers as a result. Likewise on a snowboard, the bindings do not release and therefore as you tumble down a slope your body is at the mercy to how you and your board fall as a unit.

A vast majority of injuries on the slopes involve knee injuries.

Most injuries will heal with the help of knee support/braces and physiotherapy treatment. The very worst scenario is a injury that will require surgery. The three most common ski/boarding injuries are meniscus tears, tears to the anterior cruciate ligament (ACL), and tears to the medial collateral ligament (MCL). There are varying degrees of injury to these structures from sprains to complete tears. If this should happen, a knee brace can be of great benefit to help alleviate further sports injury. Custom braces can be used to support an already injured knee to allow you to continue your ski season, but they can also be used to prevent injury, much like a helmet can help prevent concussions.

A strong core along with strong quadriceps and hamstrings are also good ways to help protect your knees too. Prior to a full day of skiing or boarding it is important to get a good warm-up at the start of your day. This can be as easy as a green or blue run where you do a lot of turns to get the blood pumping in your legs. Also take the time to stretch the long muscles in your legs, hips as well as your back.

A very simple but effective common sense tip is to always avoid skiing or boarding when you are tired as evidence shows accidents are much more common at the end of the day.
So wise up and keep your knees safe on the slopes this year!

Ryan Bachmeier is a co-owner of Kelowna Manual Therapy Centre. Ryan is certified in Acupuncture and Intramuscular Stimulation (IMS). He is also a provider of DONJOY Custom knee braces.

To book an appointment with Ryan please contact our office at 250-860-5152.

The freezing stage is characterized by a gradual stiffening with a increase in pain.

The pain usually starts locally around the shoulder and is progressive in nature. Early on pain tends to be felt mostly at night or when the shoulder is moved close to the end of its range of motion. Common painful movements include doing up a bra, reaching into the back pocket, shampooing hair and pulling on a shirt overhead. The pain usually progresses to a constant intense pain at rest, which is aggravated by any movement of the shoulder.

A stiff shoulder with less pain characterizes the frozen stage.

The thawing phase is characterized by a gradual return of mobility and a further decrease in pain.

In the thawing phase, forward motion of the shoulder typically returns first. The mobility of the arm out to the side and behind the back will return later. To raise the arm, an individual will hike their shoulder blade to compensate for the lack of mobility.

The FS can last from 1-2 years. Most people will regain full use of their arm, although some individuals continue to experience a lack of mobility.

FS affects women more than men and is more common in the non-dominant shoulder.

Common risk factors for FS include:

• Trauma to the shoulder
• Diabetes
• Thyroid disease
• Increased cholesterol

Physiotherapy treatment should consist of manual physical therapy, exercises for mobility and modalities to decrease pain. The manual physical therapy is directed at the neck, upper back, shoulder blade and shoulder. The manual therapy can consist of joint manipulation, joint mobilization and soft tissue techniques. Exercises for range of motion help to improve mobility and are critical to maintain progress between visits.

It is worthwhile to try a course of physiotherapy to see if therapy can help speed up the recovery process. It is important that the therapy not increase the pain. It is okay to experience a temporary increase in pain during therapy but this should decrease to its usual level within 40 minutes. Improvements in mobility should start to be experienced in 3-4 visits, though more physiotherapy will probably be required. If no gains in mobility are noticed in the initial visits, physiotherapy may not be help, but a home exercise program should be continued. If the pain persists or if the therapy exacerbates the pain a cortisone injection may be a good choice.

Ross McKinnon is a co-owner of Kelowna Manual Therapy Centre. Ross is a Fellow of the Canadian Academy of Manipulative Physiotherapy.

To book an appointment with Ross please contact our office at 250-860-5152.

A previous blog showed the evidence for manual therapy and exercise in treating osteoarthritis of the hip and knee. If the physiotherapy is not effective or if the pain continues to increase then a total joint replacement may be necessary. A recent study published in the journal of strength and conditioning showed that individuals who undertook a ‘prehabilitation’ program prior to undergoing a total knee replacement demonstrated improved strength and function i.e. walking and stair climbing.

It is very common due to the pain and swelling that the leg muscles become weak. The good news is that no matter how bad the pain is an exercise program can be prescribed to improve strength and mobility.

The exercise program consisted of walking, as well as strengthening and range of motion exercises for the hip and knee muscles. So if you do have to undergo a total knee replacement you should consider seeing a physiotherapist to learn an appropriate ‘prehabilitation program’.

Ross McKinnon is a co-owner of Kelowna Manual Therapy Centre. Ross is a Fellow of the Canadian Academy of Manipulative Physiotherapy.

To book an appointment with Ross please contact our office at 250-860-5152.

After a dislocation the sooner the shoulder is reduced or “put back in” the better.

Icing and rest are critical in the next 48 hours to minimize inflammation. Gradual mobilization and strengthening can be initiated once soreness allows. If all goes well one can resume activity over the next 4-8 weeks. Some experts no longer advocate use of a sling although one can be used for short-term comfort. There is no reduced rate of dislocation with prolonged use of a sling and immobilization.

The bad news is that younger people who suffer a dislocation have a much higher rate of recurrence; some experts report an 80-90% rate of recurrence. Individuals aged 25 years and older will typically do well with a program of physiotherapy aimed at regaining proper shoulder mechanics and strength. Individuals aged 40 and older have a smaller dislocation rate of only 10-15% and should do also well with a physiotherapy program mentioned above. Unfortunately, older people who suffer a dislocation have a higher rate of concurrent rotator cuff tear.

A consequence of dislocation can be damage to the shoulders labrum. The labrum is like a rubber ‘O’ ring that works to deepen the socket. This type of labral tear is termed a Bankart lesion. Less common are bony fractures, ligament and muscles tears.

Symptoms of a Bankart Lesion can include:

• A sense of instability i.e. “don’t trust the shoulder”
• Further dislocations
• Catching, locking, grinding, popping sensations
• Aching of the shoulder especially at night
• Loss of strength and mobility

These complaints are common to many other types of shoulder pain but if they occur post dislocation then they require further investigation by your physician.

Ross McKinnon is a co-owner of Kelowna Manual Therapy Centre. Ross is a Fellow of the Canadian Academy of Manipulative Physiotherapy.

To book an appointment with Ross please contact our office at 250-860-5152.

Others can injure their lower back simply if bending to brush their teeth. The low back pain can come on instantly, with acute muscle spasm or locking. Sometimes it is impossible to move or to straighten to an upright position. Other acute low back pain can come on more slowly; up to 2 days post injury, as swelling gradually accumulates.

What to do

1. Relax! No matter how bad the pain is it will get better.

2. If the pain is less than 48 hours 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.

3. 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.

4. If you are unable to move or if movement greatly increases the spasm then you may require more rest. See the sleep position article for some advice on the best resting positions.

5. There is good evidence that Manual Therapy will get you better quicker. Research has proven that Manual Therapy performed in the first 16 days and when the pain is in the back and thigh is most effective.

6. Pain radiating down the leg will also improve with manual therapy but might also require 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. Modalities such as electrical stimulation can be of benefit.

8. 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.

Ross McKinnon is a co-owner of Kelowna Manual Therapy Centre. Ross is a Fellow of the Canadian Academy of Manipulative Physiotherapy.

To book an appointment with Ross please contact our office at 250-860-5152.

Coinciding with the wear and tear is swelling and stiffness. The joints most commonly affected are the hip and the knee. Another common finding is the muscles and soft tissue around the affected joint will tighten and spasm.

Signs of hip osteoarthritis include hip pain (the pain can be deep inside the hip, on the outside of the thigh or in the groin and leg) a decrease in mobility (in rotation, moving the knee towards the chest and extending the hip), morning stiffness that lasts longer than 60 minutes and a limp.

Signs of knee osteoarthritis include knee pain, clicking or grinding with motion, more than 60 minutes of morning pain, joint swelling and bony enlargement around the knee. As well a limp develops while stairs, squatting and rising from chairs become increasingly difficult.

Physiotherapy will work best if the signs and symptoms of arthritis are recognized early and receive treatment in a timely fashion.

A recent study in Arthritis and Rheumatism showed a substantial improvement of symptoms in patients with hip osteoarthritis after 9 visits of manual physical therapy intervention. There was improvement of pain, stiffness, hip function and range of motion. Another recent study published in Physical Therapy demonstrated a decreased reliance on medications and improved function in patients who had knee OA after 8 treatment sessions of manual physical therapy combined with supervised exercise and a home exercise program.

Mulligan mobilization with movement (MWM) for hip stiffness
Manual Therapy is beneficial as it works to improve the mobility of sore and stiff joints as well as the tight muscles around the joint. The manual therapy can take the form of joint mobilization and manipulation, soft tissue work on the muscles and stretching.

Exercise is very beneficial in the treatment of arthritis and can be in the form of home exercise and/or aquatic exercise. In Kelowna there are a number of pool programs geared towards individuals with osteoarthritis. Typically exercise programs include both mobility and strengthening exercises.

The best current best research supports manual physical therapy combined with exercise for hip and knee arthritis.

Ross McKinnon is a co-owner of Kelowna Manual Therapy Centre. Ross is a Fellow of the Canadian Academy of Manipulative Physiotherapy.

To book an appointment with Ross please contact our office at 250-860-5152.

Typical complaints include having to change positions frequently due to discomfort, having morning ‘stiffness’ that last for around 30 minutes, having to get out of bed in the night because of discomfort
and waking with headaches.

Improving sleep while dealing with an acute or ongoing painful condition is important, as the body cannot heal as well without a good sleep pattern.

It is useful to start with asking a patient to show the position that they sleep in. This position can then be adjusted, incorporating a variety of pillows to find a position that is more comfortable. Generally speaking a side sleeper should consider a pillow between the knees whereas a back sleeper should consider a pillow underneath the knees.

The type of pillow used with patients that complain of neck pain or headaches is considered.

The type of pillow recommended depends on the body type and the position that they sleep in. As a general rule a thinner pillow is better for those that sleep on their back while a thicker pillow is better for those that sleep on their side. The goal is to try to support the neck in a comfortable ‘neutral position’. Most people do not do well with the older cervical pillows made of foam, though the newer memory foam pillows seem better. Most people do well with regular polyester fill pillows. If that doesn’t work then a feather, water-filled or latex/memory foam pillow can be purchased. There is a huge amount of personal preference in pillows. Many cannot part with their favorite pillow, even if it is 20 years old!

Mattresses are supposed to have a life of around 10 years.

Some signs that you need to replace your mattress are an increased sag in the mattress, springs that pop or if the mattress has become lumpy. As well, consider a new mattress if you are increasingly waking up more stiff and sore than normal. There are a lot of new materials being used in construction including wool, silk, bamboo, latex foam, memory foam, etc. The bottom line is that you need to test a lot of mattresses, keeping in mind your budget. Initially when testing mattresses you should try a range of firm to plush mattresses to find which balance of plushness vs. support you prefer. You can then try to narrow down your decision. When testing a mattress you should lay on the mattress in different positions with your partner to check for comfort. The mattress should not sag towards the middle. As well there should be very little movement felt when your partner rolls over. There are countless types of mattress construction and brands so you definitely have to get out and try the mattresses before you buy. Plan on spending a lot of time trying out a variety of mattresses.

Signs you should consider changing your mattress

• The mattress has an increase in sag or a ‘valley’
• The mattress has lumps in the top or springs that are popping
• Waking with stiffness or soreness
• Waking when your partner rolls over or get out of bed
• Having to frequently change positions

Ross McKinnon is a co-owner of Kelowna Manual Therapy Centre. Ross is a Fellow of the Canadian Academy of Manipulative Physiotherapy.

To book an appointment with Ross please contact our office at 250-860-5152.

Sport Health is a program through Pacific Sport Okanagan that provides physiotherapy support to “carded” athletes. “Carded” athletes include BC development, BC elite, Canadian Elite and Podium athletes.

Pacific Sport Okanagan is a registered non-profit agency coordinating and delivering programs and services for athletes and coaches throughout BC.

Pacific Sport works in partnership with other provincial and local sport system providers to create a dynamic environment for sports excellence at all levels in BC by integrating world-class athlete services, coaching excellence and long-term sport development initiatives. The Pacific Sport Okanagan program provides these services to athletes and coaches throughout the Okanagan Valley.

Another great benefit to athletes from Pacific Sport is the Canadian athlete insurance program (CAIP), details can be found here. This program provides medical program reimbursement for athletes of all levels suffering both overuse and acute injuries.

Ross McKinnon is a co-owner of Kelowna Manual Therapy Centre. Ross is a Fellow of the Canadian Academy of Manipulative Physiotherapy.

To book an appointment with Ross please contact our office at 250-860-5152.