Kelowna Manual Therapy Centre Blog

What is Virtual Physiotherapy Care?

Sometimes called tele-health or tele-rehab, a virtual visit is similar to a Facetime or Skype video call, but we use specialized secure software to accomplish physiotherapy goals.

We can check your movement online, demonstrate and discuss therapeutic exercises and instruct you to understand how to correctly perform the therapeutic exercise, educate you on your injury, and more.

How will I connect to the call?

We use Doxy.me for our virtual physiotherapy visits. We will send you an email that has the key details for the visit including an appointment time and a special “link” that you click to enter the visit. You can call the clinic at 250 860 5152 or This email address is being protected from spambots. You need JavaScript enabled to view it. to book an appointment time.

What device should I use?

Ideally, if you have a laptop/desktop with a webcam and microphone that you know how to work, that gives you the best view of the exercises and other content we use. However, a tablet or phone
will work for your first connection as well. Use what you are most comfortable with and we can discuss any needed changes in your first visit.

Who can I call if I have difficulties with the connection?

We all know online video sessions are not without their problems! There are many different variables that can sabotage even the most well-planned call! If you are having difficulty, call our office at 250 860 5152 our staff
are trained in helping you connect.

Are there any other tips for me?

• Once you have arranged a tele physiotherapy appointment, you will receive a log in clinic to the doxy.me application. Google chrome seems to be the most reliable for audio and video. You will be
  cued to allow the app to use your devices camera and microphone. More information doxy.me can be found at https://doxy.me/patients .
• Use a pair of headphones to begin the session or have them close by. These will solve a lot of audio issues.
• Practice how you will position the camera on your device so that your physiotherapist can observe you exercising.
• Give yourself lots of space! This is physiotherapy after all, and it is likely we will have you move. Don’t feel bad if things go wrong. This is new service for all of us and we are working out how it works
  best. You will not be charged if something stops you from having a quality visit.

ACUTE INJURIES

Acute injuries are initially treated with the PRICEM principles.  The sooner the PRICEM principles are initiated the better.  Remember that swelling may increase over the first 48 hours.

P - protect the injured area from further injury such as the use of crutches, limited weight bearing, etc
R - rest the injured area</li>
I - ice the injured area 10-15 minutes at a time up to every hour
C - compression to limit swelling through use of a tensor bandage, etc
E - elevation of the injured area
M - medication/modalities such as anti-inflammatory medication, ultrasound, electrical stimulation, etc.

Injured tissue goes through three overlapping stages of healing

1. Inflammatory - the body reacts to the injury by swelling and begin to lay down new collagen tissue.  The new collagen is weak therefore stress should be minimized.  This stage lasts 7-10 days.
2. Fibroblastic - this stage lasts 4-6 weeks and is characterized by increased density of new collagen tissue.  Gradual stress through the injured area is critical to resume optimal function.
3. Maturation - this stage can last up to one year and the collagen tissue remodels itself in reaction to the stress placed upon it.

The key to rehabilitation during the acute phase is to gradually increase the stress placed upon the tissue matching the stages of healing and the severity of the injury.

OVERUSE INJURIES

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 identifying the stressful event(s); decrease the inflammation and providing rest to the injured area.

The more common overuse injury is where the painful injured tissue can no longer handle the demands placed upon it.  This requires a more in depth assessment to determine what is the cause of the injury.  Quite commonly the injured area is the ‘victim’ of stiffness / lack of mobility and or control elsewhere in the body termed the ‘culprit’.  For example if a runner is complaining of lower back pain ‘the victim’, while ‘the culprit’ might be a lack of hip mobility, putting extra stress on the lower back.  The assessment should include looking at the intrinsic and extrinsic factors of each individual.

Intrinsic Factors:

• Biomechanical examination of joint mobility and stability
• Bony structure: Spine and limbs
• Ligament stability
• Muscles Activation /Strength
• Body Awareness / Balance
• Posture

Extrinsic Factors:

• Training Methods
• Shoes, bike, other equipment

Injuries are common in recreational and elite athletes training for endurance events.

Injuries can be roughly classified as acute, such as rolling the ankle while trail running or overuse.  Overuse injuries can be caused by a sudden increase in training or the injured tissue can no longer cope with the demands placed upon it.

PREVENTION

Active Recovery
An active recovery of 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, other than putting up with the soreness 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 other areas continue to ache or are painful, longer than 1-2 weeks should be assessed.

Correct Training
A gradual increase in training in 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 rule of thumb is the higher intensity the session the longer that recovery.  Knowing your body is key for any athlete, knowing when to push and when to rest.

Cadence
Stride rate 180-200 strides per minute for runners, 90-100 RPM for cyclists

Technique
Runners should consider softer landing (midfoot/forefoot), slight lean forwards at the ankle, tall chest.  A proper bike fit is important for cyclists and triathletes.  A coach should be employed for swim technique analysis.

Strong Core
A strong stable core provided a good base to propel and transfer energy.  This allows an athlete to maintain good form and technique even when fatigued.

Adequate Flexibility
Adequate flexibility for the demands place on the individual ie. Hip mobility for runners, hamstring flexibility for cyclists, shoulder and thoracic mobility for swimmers.  This is probably more important as we age.  Static stretching should not be performed prior to a work out, dynamic stretching and a good warm up is 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 after a workout.

Old Injuries
Deal with those old injuries in the off-season that linger 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, that has a sport nutrition section found at http://www.coach.ca/sport-nutrition-tips-p138189. Eating properly is important on a routine basis but a post workout combination of carbohydrates and protein is critical for recovery.  Good information can be found at http://www.coach.ca/recharge-and-replenish-recovery-nutrition-p144453.

Compression
Compression socks have become quite popular, with some claims of improved athletic performance.  Best scientific evidence is that they assist with lactate acid clearance post exercise and decrease 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.  Standing in our lake after a workout is also recommended.  Contrast baths of cold and warm water may also be beneficial though not very practical 1 minute cold 10-15 Celcius then 1 minute warm  (37-40 Celcius) for 7 cycles was advocated.

Footwear
Consider changing running shoes every 1000 km or so.  It is also wise to have two different pairs of shoes that you can rotate.  Make sure you have your footwear checked by a store with knowledgeable staff that can help you pick the right shoe.

Most people have heard about it, but many are confused as to what this acronym stands for and how important it is to kick start the healing process.

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:

1. 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.
2. 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.
3. 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.
4. 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.

It is reported that one in six Canadians over the age of 15 is affected by arthritis. Osteoarthritis is one form of arthritis. This degenerative condition is characterized by wear and tear on the cartilage between joints.

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.

Sleeping Advice

Poor sleep is a common complaint in a Physiotherapy practice.

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 throughout 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.  If you are tossing and turning due to discomfort it is best to get up and out of bed, try to move around, try some gentle exercise or movement before getting back into bed.

To help fall asleep a new technqiue called 'congnitive shuffling' developed by Luc Beaudoin, a Simon Fraser University professor, can be very helpful.  The technqiue involves either focusing on words or random objects to change your brains focus.  You can read more here or listen here for more information.  Professor Beaudoin also developed an app called 'MySleepButton' that helps coach you along the way.  The website for the app also has some great tips here.  While this technique was developed for stress and insomnia the technique can be helpful to improve sleep loss due to discomfort and pain.

It is useful to ask a client 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

Kelowna Manual Therapy Centre is pleased to announce that we have now teamed up with Pacific Sport Okanagan as a Sport Health physiotherapy provider.

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. http://www.pacificsport.com

Another great benefit to athletes from Pacific Sport is the Canadian athlete insurance program (CAIP), details can be found Canadian Athlete Insurance Program: http://www.cscpacific.ca/Images/ProgramsService/2011_ACS_CAIP info.pdf

This program provides medical program reimbursement for athletes of all levels suffering both overuse and acute injuries.