DeQuervain’s Syndrome and Physiotherapy. By Krista Smith, Physiotherapist

Physiotherapy Can Help with DeQuervain’s Syndrome

Do you experience pain in your wrist near the base of your thumb? Did it come on gradually? Is it sore when you move your thumb or wrist? Does it hurt to grip, write, garden, hold a cup of coffee, cut vegetables or pick up a baby? If so, you may have a condition known as de Quervain’s syndrome.

DeQuervain’s syndrome involves the abductor pollicis longus tendon and extensor pollicis brevis tendon. These tendons connect muscles in your forearm to bones in your thumb. To help reduce excessive friction, these tendons travel in a tendon sheath. When a high load is placed on these tendons, such as a repetitive movement of the thumb or wrist, it can result in a thickening of the tendons and the sheath. Initially, symptoms are usually only present with certain aggravating activities, but if this injury continues to worsen you may experience pain at rest, swelling and tenderness at the base of your thumb and wrist.

Rest is the first step to treating de Quervain’s syndrome. This is often difficult when we use our wrist and thumb dexterity for so many daily activities. For this reason, it is not uncommon to see people who have had this condition for weeks to months at a time, with no significant change in symptoms. As a general rule, try to avoid any positions or movements that cause pain. A protective splint may provide some benefit in the initial stages of healing to help immobilize the wrist and thumb.

Physiotherapy can help treat this injury using a combination of education, modalities, manual therapy, soft tissue techniques and a progressive home exercise program. Since the tendons and sheath are often aggravated by repetitive movement or prolonged positions of the thumb and wrist, it also may be necessary to address your home or work ergonomics. When possible, modify to a neutral thumb and wrist position and take frequent breaks from your activity.

De Quervain’s syndrome usually begins with a gradual onset of symptoms, often when a new movement or activity is introduced that places increased demands on the tissue. An example is a mother with the new task of repetitively picking up a newborn baby. Physiotherapy can be quite helpful in the management of this condition. If you experience pain at the base of your thumb as the result of a trauma, such as a fall on an outstretched hand, it is advisable that you follow up with your doctor to determine if further investigations, such as an x-ray, are required prior to starting physiotherapy.

Krista Smith is a registered physiotherapist at the Sun City Physiotherapy downtown clinic. She can be contacted at downtown@suncityphysiotherapy.com

Running techniques to race fast and remain injury-free. Sun City Physiotherapy

This is the time of year where you are starting to ramp up your training for triathlons and running races. It has been shown that as many as 80% of runners sustain a running-related injury in a given year. So what are the reasons for so many running injuries? And how can they be avoided? 

Training schedule, running technique, and tissue strength/tolerance are three major determinants as to whether or not you will be sidelined with an injury this season. 

Here are more detailed explanations of the three common causes for injury:

Too much too soon. An overly ambition training schedule is a classic mistake. It is believed that as much as 80% of running injuries occur because of training errors. An easy to follow guideline is the 10% rule: avoid increasing your running mileage more than 10% from the previous week. 

Poor or inefficient running technique. A potential cause for injury is technique, or rather, a poor technique. It can result in too much impact too quickly (vertical loading rate) as you land. A high vertical loading rate can be caused by any of all of the following: heel striking with your foot too far in front of your hips (over-striding), a lack of bend in your knee or hip during landing, a lack of strength in core/hip musculature to help absorb impact. Instead, gradual increased training in a flatter/minimalist shoe (to reduce heel striking), increasing step cadence to approximately 180 steps per minute, and aiming to land softer or ‘quieter’ are all ways of reducing tissue overload.  
Core and hip muscle weakness. It has been shown that a lack of gluteal muscle strength can lead to increased stress on the knee and foot, resulting in a greater chance of tissue breakdown. Taking part in a consistent individualized strengthening program throughout the year can be a key component to avoiding injury. 

Remember, don’t wait until minor aches and pains turn into significant injury. Every runner is different, so book an appointment with Sun City Physiotherapy to determine how best to avoid injury this season.  Call 250-861-8056 to book your appointment today.

Swim techniques to race fast and remain injury-free. Sun City Physiotherapy

Swimming has a relatively low risk of sport related injury, yet, swimmers often complain of shoulder pain. This can be caused by muscle overuse and incorrect technique. By making stroke adjustments, you can not only minimize pain and prevent injury, but also improve performance.

The Physiotherapy Association of British Columbia (PABC) recently outlined some simple steps, call the Physio-4, that swimmers can use to reduce their chances for injury, prevent pain, and swim more effectively.

The Physio-4 for swimming:

Be mindful of body rotation. Never swim with a “flat body” as this limits the rotation of the shoulder along the axis of the spine. Develop a symmetrical way to rotate your body for an efficient breathing pattern and this will greatly reduce the risk of shoulder injuries.  

Enter the water with a flat hand. A hand directed outwards when entering the water leads to unhealthy internal rotation.  This is one of the most common causes of acute pain in the shoulder as it overuses the muscles.  It is best to enter the water with a flat hand, fingertips first. 

Maintain good posture. The saying “shoulders back, chest forward” applies both in and out of the water. Hunched or rounded shoulders can lead to a wide arm recovery that causes shoulder injuries and “cross-overs” in your stroke. Strengthening the muscles at the back of the shoulder and stretching those at the front will help prevent injury, and help you to swim faster.

Incorporate bilateral breathing into your swim workout. Breathing only on one side will develop the muscles on that side more than the other.  This can eventually lead to shoulder problems.  By breathing on both sides with every workout you can prevent this from happening.

Aside from these injury-prevention techniques, there are important things to remember when swimming outdoors. Never dive head first into water unless the depth is known. When swimming in lakes or oceans be aware of any natural hazards such as tides and rapids, never swim alone, and always let someone know where you are training. And always be mindful of boaters – because they may not always be looking for you.

If you are injured or in pain during or after swimming, or require an exercise program to help avoid or overcome shoulder injury, Sun City Physiotherapy can help. Call 250-861-8056 to book your appointment today.

Hip Disorders: Osteoarthritis & Bursitis by Brenda Walsh, Physiotherapist

Our hip joints allow us to do an amazing number of things – walk on two legs, pivot, squat, even kick a ball. It is an engineering marvel to combine the stability required to balance the weight of the torso over a structure the size of a golf ball, with the substantial degree of mobility available. The high demands on the hip joints can, however, take their toll over a lifetime.

Osteoarthritis is the most common hip disorder affecting adults. Primary osteoarthritis (OA) has no recognizable cause, while secondary OA is thought to occur due to altered joint mechanics or following joint trauma. Obesity, excessive loading due to occupational or sport demands can contribute to breakdown of articular cartilage. There is likely a genetic component as well. Muscle imbalances around the hip are also predisposing factors, as shearing forces or high compression load will cause abnormal wear and tear. Alignment issues of the low back, pelvis and leg can also contribute to abnormal forces around the joint.

Muscle imbalances occur as a result of weak, tight, or inappropriately recruited muscles. Our neuro-muscular system can develop certain abnormal pathways of firing, creating suboptimal movement, and potential damage to joint structures. If these are retrained before the cartilage damage is severe, it can halt the progression and reduce the symptoms of arthritis.

One of the most important groups of muscles for maintaining optimal compression and centering the ball, (or head) of the femur in its socket are the Gluteal muscles on the lateral side of the hip. Core strength and balance are also very important components of optimal hip health.

A second common diagnosis of hip pain is trochanteric bursitis. The most prominent lateral point on the hip bone is called the greater trochanter. It was commonly thought that the bursa overlying this point was the most common local cause of lateral hip pain. However, in a recent study, using real-time ultrasound, 80% of patients with lateral hip pain did NOT have bursitis. 50% of the 877 patients studied had tendinosus of their gluteal muscles, ie. a degeneration of the deep hip rotators tendon’s collagen in response to overuse, occuring when other stabilizer muscles weaken. It is part of what has been labeled Greater Trochanteric Pain Syndrome (GTPS).

Symptoms of both OA and GTPS can be similar. Pain from OA is usually felt in one or more of the following areas: the groin (most common), over the greater trochanter, or down the front of the thigh and knee. Usually, arthritis pain is reported with or after activity, progressing to pain at night or at rest.

With GTPS, point tenderness is noted at or behind the greater trochanter, typically worse at night, especially when lying on the affected side. Lateral hip pain with repeated stair climbing and squatting is more likely due to GTPS.

Maintaining adequate strength and flexibility of the hip muscles is an important component of treatment and prevention of both hip osteoarthritis and trochanteric pain syndrome. Physiotherapists are trained to assess these disorders. They can prescribe individual exercise where deficits in strength, mobility and balance are noted.

Brenda Walsh is a registered physiotherapist at our Glenmore clinic.

Off Season Prevention of Curling Injuries by Rob Heimbach, Physiotherapist

Attention Curlers!

The curling season has now come to an end, and most of us won’t step onto the ice again until fall. If you spent any part of the past season haunted by joint or muscle pain, this is the perfect time to do something about it. Absolutely every professional athlete knows that the off-season is the time to rebuild strength and recover from injury. Whatever your age and physical activity level, this same principle applies to you.

Curlers are most likely to experience pain in their shoulders, back or knees. This pain is most likely to affect either the delivery phase or the sweeping phase of the game. Sometimes it can take hours or even days after playing for the pain to subside, or it may lead to the use of pain medications. Pain is a big deal because it can stop your muscles from generating power and can affect your enjoyment of the game. Unfortunately, if not properly addressed, this pain can go on for years, getting worse and worse until it eventually leads to retirement from the sport.

Many of the aches and pains that we experience as curlers originate from a common source: muscle imbalance around the legs, back and shoulders. By building strength and flexibility in our muscles, it’s possible to achieve a consistent, balanced delivery and powerful sweeping. For example, a powerful push from the hack uses the strength in your quads while effective sweeping requires strong deltoids and latissimus dorsi. Conversely, weakness in your quads or tightness in the hip flexors will prevent you from getting low enough to be balanced and effective in your delivery.

The solution to this problem must include building strength and lengthening tight muscles. Since this takes time to do, it can be difficult to achieve during the curling season. A proper, targeted stretching and strengthening program, provided by your Physical Therapist, during the off season will make you a better shot maker while at the same time eliminate distracting aches and pains. By consulting with your Physical Therapist early in the off season, you’ll be giving yourself the best chance to return to the ice in the fall as a stronger and more comfortable athlete.

Rob Heimbach is a registered physiotherapist and associate at Sun City Physiotherapy’s Glenmore location. He can be contacted at glenmore@suncityphysiotherapy.com.

Nerve Pain and IMS by Sun City Physiotherapy

Intramuscular Stimulation, or IMS for short, is a technique used by physiotherapists since it was developed in the 1970’s in Vancouver by the pain specialist Dr. Chan Gunn. IMS is a total system for the assessment and treatment of chronic musculoskeletal pain that has a neuropathic cause. It is grounded in western medical science and there is a growing body of evidence to support its efficacy.

Neuropathy refers to when a nerve is not functioning properly once it has exited the spinal cord. Often this occurs without any structural damage to the nerve meaning that x-rays and scans may look normal. Some indicators of neuropathy are pain in the absence of tissue damage, delayed onset of pain after an injury (e.g. in whiplash), and pain that gets worse after doing more activity. There are other specific physical signs that suggest there may be a neuropathic cause to a persons pain too. These signs will be picked up during the assessment and will indicate whether that person is a candidate for IMS treatment.

When nerve conduction is reduced in neuropathy, one of the main results is that the muscles that are supplied by that nerve become tight and shortened. This in itself can cause pain and supersensitivity of the muscle so even light touch to that area can feel very tender. The shortened muscle will also create more stress on the adjoining tendons and joints which can create problems in these structures causing further pain. Some common conditions in which an underlying neuropathy can be a factor are whiplash, chronic low back or neck pain, headaches, tendinitis, shoulder pain, and groin pain.

IMS involves the use of very thin needles which are inserted into the muscles that have been affected by neuropathy. This creates a ‘grasp’ or cramp sensation which causes the muscle to release, which in turn takes the tension off the surrounding structures. In this way supersensitive muscles can be desensitized and the persistent pull of short muscles can be released. When performed well IMS has a remarkable success rate, reducing symptoms in even long term chronic conditions that may have been present for months or even years, giving long lasting and often permanent results.

Injury Prevention in Curling by Rob Heimbach, Physiotherapist

If you’re a regular league curler, whether recreational or competitive, then you’re surely familiar with the aches, pains and injuries that go hand-in-hand with the sport. Joints and muscles at the knees, back and shoulders are most vulnerable to injury. The good news is that by taking the following three preventative steps, you can minimize your chances of injury and maximize your enjoyment of curling this season!

Number one on my list is proper equipment. I can guarantee that if you curl long enough you’re going to fall once or twice. Over 90% of curling injuries result from a slip and fall. If you’re on the ice with any regularity, it’s worth ditching the runners in favour of a proper gripper and slider. Beginner curlers and young curlers in particular should also consider wearing a helmet when starting out. Scary fact: when you fall, your head is the body part that’s most likely to hit the ice first!

Number two is a proper warm up. But wait, there’s a twist. You need to actually get WARM. You need to increase your heart rate and body temperature! If you think that I’m stating the obvious, just look around at all of the curlers casually chatting or gently stretching before going on the ice. These activities will only warm you up if you’re doing them on a hot beach or in a hot yoga studio. Start by running on the spot, high-knees, butt-kicks, or doing jumping jacks. Follow that up with some curling-specific stretches including the legs and trunk, and you’ll be ready to hit the ice.

My third and final tip is this: get a qualified coach to take a look at your mechanics. I remember the first time that I saw my delivery and sweeping on camera, I was shocked at how awkward I looked! I’m not saying that you’re in the same boat; you might be perfect. But you may not look as good as you think you do. If you aren’t already getting regular coaching, an instructor can provide you with some insight into your technique. Improving your delivery and sweeping by optimizing the way that you load your joints and muscles will improve your performance and prevent overuse injuries. You’ll play better, and feel better doing it!

Keep these three points in mind and with any luck you’ll make it through the curling season with little to no time missed due to injury! If you do happen to run into any issues along the way, keep in mind that a visit to a physiotherapist can help you to get back on track. Happy curling in 2016!

For more information on curling injuries, prevention and exercise, join us for a free informational talk on Tuesday, January 26th at 6:30 at Sun City’s Glenmore location. Call 250-762-6313 to reserve your seat.

Rob Heimbach is a registered physiotherapist and associate at Sun City Physiotherapy’s Glenmore clinic. He can be contacted at 250-762-6313 or email glenmore@suncityphysiotherapy.com

Exercise after Pregnancy by Brenda Walsh, Physiotherapist

There are a few things a woman should take into consideration when resuming exercise after pregnancy: Pelvic floor strength and her abdominal muscles. Restoration and strengthening of the Pelvic Floor muscles is very important and should begin in the early days and continue weeks after delivery. Whether her delivery was vaginal or C-section, special attention needs to be paid to the post-partum woman’s abdominal wall. A widening of the gap between the two bands of the Rectus Abdominus muscle, known as Diastasis Recti, may not resolve spontaneously after pregnancy.

Pregnancy and childbirth puts a woman’s body through one of her life’s most strenuous events. Laxity in the ligaments, an increase abdominal girth, an exaggerated forward tilt of the pelvis can alter the center of gravity, affecting dynamic stability of the spine and pelvis. Combined with the load of carrying a new baby and breastfeeding, these added stresses to the spine can lead to postural fatigue and discomfort. Physiotherapists are experts at analyzing posture and alignment and can prescribe postural exercises and advice on body mechanics.

Kegel exercises are an important part of pre-natal health. The Pelvic Floor muscles (PFM) lie at the base of the pelvis, and run from behind the pubic bone to the tailbone. Differentiate a PFM contraction from the buttock muscles. To avoid increasing intra-abdominal pressure, don’t hold your breath and push. Instead, think of pulling the two side walls of the vagina toward midline, and lift up inside. Hold this contraction for 10 seconds, without holding your breath.
Immediately after a vaginal delivery, many women find it hard to feel a contraction in their pelvic floor muscles. It works much easier if “muscle memory” exists from previous practice.
If you’re having difficulty with this, an internal examination by a women’s health physiotherapist can determine the extent of the problem. Other concerns, such as uncomfortable scarring after an episiotomy, can also be addressed.

We have 3 layers of abdominal muscles. 100% of women have some degree of Diastasis Recti, or abdominal separation in their third trimester of pregnancy. At 8 weeks post-partum, if the gap is marked (greater than 2 fingers width), if untreated it will likely still be a problem after a year. Diastasis Recti can aggravate low back problems and result in a midline “doming” of the abdomen under load. The underlying cause is an abnormal increase in intra-abdominal pressure during exertion, not the pregnancy itself.

If you suspect you have a Diastasis, try to avoid activities that strain on the abdominal wall. This would include sit-ups, especially over a large ball, heavy lifting, yoga postures that include back bends, Pilates “100’s”. This is until you have learned to contract the inner Transversus Abdominus (TrA) muscle to support the wall.

Two thirds of women with Diastasis Recti have some level of Pelvic floor dysfunction. The Pelvic Floor muscles and TrA work synergistically to support the pelvic organs, especially during exertion. Good tone in these muscles helps to prevent and treat prolapse and stress incontinence, which can show up in mid-life.

Brenda Walsh is a registered physiotherapist and associate at Sun City’s Glenmore location. She can be contacted at glenmore@suncityphysiotherapy.com

Skiing and Snowboarding by Krista Smith, Physiotherapist

Ski and snowboard season is here!

I’m sure many of you skiers out there have already started to dust off your equipment, check the daily snow report and maybe even head to the mountain for some early season skiing.

We are fortunate in Kelowna to have so many great ski resorts nearby. Skiing and snowboarding are great ways to get some fresh air and exercise when it can be a challenge to stay active in Kelowna through the fall and winter. This is especially true lately when it has been so wet, cold and dark outside. Since most outdoor activities have wrapped up for the summer, I think that this is the perfect time of year to start conditioning your body in preparation for the upcoming ski season, if you are not already doing so. A good exercise program which addresses core and hip stability, balance, flexibility, muscle endurance and aerobic conditioning will go a long way to help improve your endurance and technique on the mountain to help you get the most out of your season.

If you are currently recovering from an injury or if you have just been sedentary for some time and are noticing a lack of strength, balance, range of motion or overall conditioning, it can be very useful to engage in a progressive rehabilitation exercise program prior to doing something more demanding on your body, like hitting the slopes for the day.

In the clinic, it is not uncommon to see overuse or traumatic injuries pop up as a result of unresolved muscle weakness, due to injury or sedentary behaviour, followed by more demanding or intense exercise. This excessive demand could come from lifting very heavy weights, running too fast or too far, attending an advanced exercise class or participating in a full day of winter activities. While the above examples may very well be a realistic long term goal, you may be putting your body at an increased risk of injury if you engage in an activity that your body is not adequately prepared for.

Exercise needs to be consistent and frequent, rather than all or none. Set a goal to exercise small amounts each day. An exercise program should include a combination of core stability, strengthening, stretching, balance training and aerobic conditioning.

If you are currently recovering from an injury or if you have been inactive for some time and are not sure where to begin, a physiotherapist can help get you on the right track, by developing a safe and effective individualized home exercise program based on your specific goals and current ability.

Krista Smith is a Registered Physiotherapist and associate at Sun City Physiotherapy’s downtown Kelowna clinic. She can be contacted at 250-861-8056 or email downtown@suncityphysiotherapy.com

Hockey Injuries by Jay Stone, Physiotherapist

Every Fall, thousands of Okanagan hockey players return to the local rinks. Although most will have a great year of pain free hockey, many will suffer an injury during the season.
The most common types of lower body hockey injuries suffered are to the groin and hip flexor muscles. These muscles cross the hip joint from the pelvis and either pull the thigh across the midline of the body (adduction) or upward into flexion. A certain amount of hip rotation also occurs during this. These actions are key movements during skating. They occur when pulling the leg back under your body, prior to push off or when turning and performing crossovers. These same muscles are also under stress when used to control end-range extension and abduction (hip movement away from midline of the body) during the push phase of the stride. In fact, it is during this controlled muscle lengthening (eccentric contraction) that the muscle most commonly fails and a strain occurs. These important muscles are also used to stabilize the body during shooting, brace during body contact, and when a player slips or catches an edge.
Hip strength imbalances, decreased hip mobility, poor core/trunk stability, and lack of a good dynamic warm up have all been associated with increased risk for these injuries. The age of the athlete and a previous hip injury are also predictive factors. An athlete can’t change their age or go back in time and erase a previous injury, but they can be proactive about the other factors.
Research suggests that hip adductor (groin) strength should be no less than 80 percent of abduction strength (outer hip muscles). This can be worked on by including hip exercises such as lunges that step into 45 degree quadrants and lateral directions as well as forward and back (lunge matrix). I also like the use of the lunge matrix because it works on hip mobility and hip stability in positions your hip often gets into during hockey. You can also focus on your core stability during these movements. Training your trunk to stabilize during the skating and shooting motion is paramount.
A dynamic warm up is a series of sport specific movements that are designed to prepare the muscles for use and are performed in a safe controlled fashion. In hockey these can include movements such as squatting, lunging and high knees to name a few. With the hockey teams I work with, I will often go through a series of 10 to 15 movements off ice before getting equipment on. As a Physiotherapist, my personal routine is to usually target a few specific movements by performing air squats and lunges with rotation in the dressing room prior to lacing up my skates.
Even with the best prevention, an injury can still occur. Hockey is an explosive game with quick changes of direction and plenty of incidental contact. If you do suffer an injury to the groin region that you think is a strain, I suggest you ice the injured area for the first couple days and abstain from pain provoking activities. You should not return to skating until you can walk and lunge without pain. Optimally, you should make your first session back a skating only session and not put yourself into a game until you know you can tolerate skating. If you do have pain that does not settle in a couple days, or you experience other symptoms such as pain with coughing, or numbness into your groin, you should have it assessed by your doctor or Physiotherapist. There are other conditions that can occur in the region that are more serious than a muscular strain and these should be ruled out. Recovery from injuries to the groin can take anywhere from 3 to 5 weeks and they have the potential to become chronic if not treated properly.
If you suffer from this type of injury, talk to your Physiotherapist about the best course of treatment so you can get back on the ice sooner.
Jay Stone (BSc.PT) is a partner at Sun City Physiotherapy. He holds his certificate in Sport Physiotherapy and consults for several local area hockey teams. He works out of the North Glenmore Sun City office. You can book an appointment with him by calling 250-762-6313.