Shoulder Health. By Jordan Ruder, Physiotherapist

Get Your Head Around Your Shoulders this Summer!

With summer fast approaching, many of us are jumping back into one or more of our favourite fair weather activities, be it golfing with an orchard view, volleyball on the sandy beach, swimming in the crystal clear Okanagan lakes, playing tennis with friends or a little extra gardening for all of you green thumbs! Whatever the summer activity of choice, we all hope this warm weather finds us ready to tackle the ‘fun in the sun’ at full steam without having to worry about those pesky aches and pains that often set in over the winter.

One aspect that many summer activities have in common is that you will undoubtedly require a pair of healthy shoulders to fully enjoy them. As a practising physiotherapist treating patients with various conditions and injuries for almost a decade, I must say that shoulder pathology and dysfunction are some of the most common conditions walking in and out of our clinics on a daily basis.

When you dissect this shoulder issue further, there are a few key things that make the shoulder one of the most biomechanically impressive but also one of the most vulnerable regions to injury in our body.

First of all, the shoulder is the most mobile joint in the human body. The ‘ball and socket’ anatomy of the shoulder allow for movement that we see in no other body region. Whether it be flexing the shoulder 180 degrees overhead to smash a beach volleyball or fully externally rotating your shoulder during your golf swing follow-through, the shoulder girdle demonstrates phenomenal flexibility.

This fantastic mobility in the shoulder girdle however comes with a price. In order for this flexibility to be functional when teeing off with your driver on 18 or lifting heavy pot of flowers up on your deck, the shoulder requires a significant amount of dynamic stability. This dynamic stability is accomplished by work of a few important muscles that surround the very flexible shoulder joint…most notably, the rotator cuff as well as other scapular stabilizing muscles.

For our shoulders to remain healthy and function at the high levels required for our summer fun, this balance between flexibility and stability must be maintained.
Some common conditions and injuries that we as physiotherapists assess and treat where shoulder flexibility and stability become compromised include; Shoulder Impingement, Tendinitis/Tendinopathy, Bursitis, Rotator Cuff Tears, Shoulder Dislocations/Separations, Frozen Shoulder, and Scapulothoracic Dysfunction.

If your summer involves getting or staying active and you want your shoulders to be ready for the action, book a consultation and some treatment with your physiotherapist to ensure your shoulders are ready to shoulder the load!

Jordan Ruder is a Registered Physiotherapist and Associate at the Downtown location of Sun City Physiotherapy. He is a member of the Canadian Physiotherapy Association and is also a Fellow of the Canadian Academy of Manipulative Physical Therapists (FCAMPT). He can be contacted by phone at (250) 861-8056 or by email at downtown@suncityphysiotherapy.com.

Hip Strengthening by Graham Gillies, Physiotherapist

Your Hips: The ‘Core’ of the Problem?

I think most of us by now have heard about the importance of strengthening your ‘core’. But did you know that the most important part of your core for preventing hip, knee, and ankle injuries are your hip muscles? Your hip muscles or ‘glutes’ are the largest group of muscles in your lower body and are a part of your core that are often much weaker than they should be.

So what exactly are the hip muscles responsible for? Strong hip muscles keep your spine, pelvis, knees and ankles in alignment. If your glute muscles aren’t strong enough your hips rotate and drop, your knees move inward and your feet flatten (pronation). All of these motions create more strain on the joints, ligaments and tendons of your lower body. This excessive strain often leads to injury and persistent pain. Achilles tendinosis, patellofemoral knee pain, iliotibial band (ITB) syndrome, and piriformis syndrome are all common injuries linked to weak hip muscles. Research is also showing that hip weakness is a major risk factor for non-contact ACL (knee ligament) injuries.

So why do our hip muscles become weak in the first place and what can we do about it? The latest research done by Dr. Powers who is a physiotherapist in Los Angeles, shows that our brains have only a very small area dedicated to controlling the hip muscles. It is unclear why this is the case but it may explain why the majority of us don’t naturally use our hip muscles during activities such as: running, walking and hiking. The good news is that the same research shows that exercise can change the way our brains work.

In the study, patients that took part in specific hip strengthening exercises, actually showed changes in brain function. The areas on the brain controlling the hip muscles became larger after only a week of exercise! This is important because the larger the area of your brain dedicated to a certain muscle group is, the easier it is to ‘turn on’ and strengthen that muscle. Keep in mind though, these strengthening exercises need to be done for a minimum of 3 months in order to get significant strength improvements in the muscle.

So if you suffer from ongoing hip, knee or ankle pain, strengthening your hips may be the key to getting over your injury problems. Visit your local physiotherapist and ask for an assessment on your hip strength. If your muscles are weak your physiotherapist will give you the proper home strengthening exercises to address the weakness. Through these exercises you can change your brain to help change your pain.

Graham Gillies is a registered Physiotherapist and co-owner at Sun City Physiotherapy Winfield. Graham is a fellow of the Canadian Academy of Manipulative Therapy and a certified Gunn IMS and Acupuncture practitioner. He can be contacted at the new Winfield location by phone: 250-766-2544 or email:ggillies@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.

Snowmobiling aches and pains by Tess Mihell, Physiotherapist

On February 2, the groundhog told us that spring will arrive soon. But don’t fear – the sledding days are not yet over. If you are looking to maximize your snowmobiling adventures or to try the activity for the first time before the snow disappears, then this is for you.

Like any other activity, it is important to understand the risks and how to prevent injury. In this case I’m not talking about injuries from accidents, although that is still very important to take precautions to avoid. My focus is instead on the aches and pains you may experience throughout your body.

Snowmobiles have come a long way from the original 20 ton machine that was first designed for log hauling, with most modern machines weighing over 500 lbs and able to reach speeds of 110 mph (Heisler 2010). With prolonged time on the machine you are exposed to awkward positions for your upper body, long periods of sitting with a forward bent posture, and vibration stresses. Not to mention the heavy lifting, pulling, and pushing when you need to get out of a jam. Common aches and pains from riding are the low back, neck, shoulder and the occurrence of white-finger syndrome (Heisler 2010).

I’m not suggesting you quit your sport! There are certain factors that can be modified to prevent you from injury, and to keep you more comfortable.

A factor to the aches and strains is the ergonomics of a snowmobile. One of the most important parts to adjust is the steering bar (Rehn et al. 2005). Ideally it should be close enough to your body and have the grips oriented in a way so that your wrists aren’t bent, your shoulders aren’t hiked up and you do not have to reach so far forward. This will put you in a more comfortable posture for your upper limbs and your lower back, as well as lowering the grip force you need to use. Specific positions are to have your wrists neutral, elbows bent 60-70 degrees and if you have a seat back, for it to be tilted back 45 degrees (Heisler 2010). Grips should ideally be about 1.5” in diameter to lessen the grip strength required to steer (Heisler 2010). When looking at buying a snowmobile, also consider its seat suspension. Whole-body vibration, which will occur even on groomed trails, puts the discs in your back at risk for injury (Bovenzi and Hulshof 1999).

There are other factors to consider beyond just the ergonomics of your sled. Here are things you can do to prevent injuries:
Avoid sitting too long in poor posture: When you sit, you lose the normal curve in your low back. This is made worse by bending forward. The posture in combination with the machine’s vibration puts the discs at risk of injury. When possible, alter how you sit so that you back isn’t arched so much.
Wear appropriately warm mitts: Vibration of the upper limb, along with cold exposure, can contribute to the occurrence of “white-finger syndrome” which increases the chances of frostbite. It will also affect your ability to grip properly (Heisler 2010). To minimize this risk, stay warm!
Keep strong: Think of sledding as you would another sport – one that requires strength and endurance. Keep your body fit, and flexible, during the week to prepare you for the weekend adventures.
Listen to your body: If you’re getting fatigued, it’s time for a break. That is when you have a greater chance of adopting poor postures, or hurting yourself with the sudden jolts and turns.

And of course, listen to your body if you’re experiencing pain. Delayed onset of muscle soreness, DOMS, has been reported to last about 1-3 days after snowmobiling (Heisler 2010), but if it extends beyond that, or if you’re finding you’re getting weak (a loss of grip strength is commonly reported) – seek out care from a health professional.

Enjoy the rest of the sledding season, have fun, and stay injury-free!

Iliotibial Band Syndrome by Sun City Physiotherapy

Running is a popular activity that can help maintain or improve your cardiovascular fitness and in some cases help you lose weight. There are many different reasons to run but often there is a goal set that may include 5Km, 10Km, half marathon, or full marathon.
When training for longer runs including 10km, half and full marathons it is important to remember that the training schedule should take place over long periods of time to allow your muscles and joints to accommodate for the increased strain that will be placed on them during the long run. As a physiotherapist, I treat many runners with all sorts of injuries. Some of the most common injuries include plantar fasciitis, achilles tendonitis, muscle strains, and Iliotibial band friction syndrome (IT band syndrome).
IT band syndrome is a repetitive stress injury that occurs when the iliotibial band glides over the lateral femoral condyle on the outside part of the knee. The iliotibial band is the thick band that runs from the outside of the hip down to the outside of the knee. It is a common injury for long distance runners (20-40 miles/week) but is not limited to only long distance runners. Running on various terrains can increase the risk of developing this condition. Up and down hills, graded slopes, and cambered roads have all been shown to increase the risk. This syndrome may also be found in other athletes or weekend warriors such as cyclists, weight lifters, and participants in jumping sports.
With IT band syndrome there is rarely a history of trauma. Patients will often complain of knee pain that may be difficult to localize and usually increases with repetitive motions like running. The symptoms usually get worse with changes in training surfaces, increasing mileage, or training on crowned roads.
Studies have found that long distance runners with IT band syndrome have weaker hip abductor and glut muscles on the involved leg compared to the uninvolved leg. The hip abductor muscles are located on the outside part of the hip and help prevent the leg from moving towards the centre of the body. It is also noted that fatigued runners are more prone to having their hip adduct (move towards the centre) and internally rotate (leg turns inwards) which causes more friction on the iliotibial band and therefore the symptoms get worse.
The management of IT band syndrome usually includes: 1) activity modification (usually decreasing mileage). 2) New running shoes. Shoes should be replaced about every 500km. 3) Heat or ice. 4) Stretching the IT band. 5) Strengthening the hip abductors and glut muscles.
If you are interested in pursuing long distance running you should: 1) follow a certified training schedule. 2) Make sure the shoes you are wearing are the right shoes for you. 3) Increase your mileage slowly to allow your body to accommodate for the increased strain. 4) Hit the gym – muscle weakness can cause problems down the road. 5) Go in for an assessment with a health care professional if you start to experience aches and pains that aren’t going away.

Tennis Elbow by Sun City Physiotherapy

Tennis Elbow – you don’t need to play tennis to get it!

Tennis elbow is so called as one of the reasons you can get it is from faulty technique in a tennis shot. This is only one of the ways that you can get tennis elbow though, it can come on from many other activities that involve a lot of wrist and forearm use.

The medical name for this condition, lateral epicondylitis, gives us more information about where the problem occurs. The lateral epicondyle is a small bony prominence on the outside of the elbow and is the point of attachment for the tendons of the wrist extensor muscles. These muscles run up the top of the forearm and play a role in movements such as bending the wrist back, making a fist, and twisting the forearm.

Lateral epicondylitis occurs if these muscles are used more than they are used to, resulting in pain and damage to the tendon where it attaches onto the bone at the lateral epicondyle. If you have tennis elbow, you will likely report an increase in pain when gripping tightly or shaking hands, using a screwdriver or twisting a jar, or any activity that requires wrist and hand use. The outside of the elbow can be very sensitive to touch, and you may find it will get very stiff, especially first thing in the morning.

In order to treat tennis elbow, it is important to identify the reason why it became injured in the first place and correct that. Apart from stopping the aggravating activity, there are often other contributing factors that need to be changed in each individual case. These can be related to our own anatomy in the elbow and arm, movement patterns which are overloading and therefore damaging the tendon, or factors relating to the equipment being used.

A physiotherapist can identify the changes that need to be made in each individual case and implement these. As well as this there is specific treatment that can be done to the tendon to ensure optimal healing such as friction massage and laser, and a stretching and strengthening program should be implemented too to ensure the muscles and tendons are in good shape to be able to cope comfortably with being used in the future.

So even if you don’t play tennis, you can still be affected by tennis elbow. Taking the right action will take your pain away.

Classification of Whiplash Injuries by Darrell Skinner, Physiotherapist.

Motor vehicle accidents (MVA) are sometimes an unfortunate consequence of modern reliance we have on automobile transportation. Previous to the invention of the car, there was “railroad neck”, and also a whiplash variation termed “roller-coaster neck”. Motor Vehicle accidents are sometimes termed “motor vehicle crashes” to suggest the preventable nature of some accidents. When a crash does occur, there is usually a chain of events including visits to the auto body shops, ongoing communication with insurance claims agents, and visits to many different health care professionals.

Despite advancement in sophisticated safety equipment for cars, bodily injury can sometimes result from accidents. Although the impact can occur in less than a second, the resulting injuries can persist for weeks or months. The neck (cervical spine) is the most common area of involvement, however, the mid back or low back can also sustain trauma. The shoulder or chest area can also be bruised by the restraint effect of the seat belt.

Injuries to the cervical spine are termed “whiplash-associated disorder’ or WAD for short. As with most conditions and injuries, there is a spectrum of severity. Following much consultation, the Quebec Task Force on Clinical Classification of WAD developed a five point scale of severity in 1995, which is well recognized within the health care and insurance fields. With Grade 0, or WAD 0, there are no physical signs, and the person does not complain of symptoms or usually seek help. At the other extreme end of the spectrum is the most severe WAD IV injury in which X-rays indicate a fracture or dislocation and require urgent medical attention. WAD classification is determined by a detailed and comprehensive clinical examination. Fortunately, most of the whiplash injuries sustained in a crash are classified as WAD II or III, and are commonly treated in physiotherapy practice. Clinical features include pain, and limited range of motion due to muscle spasm, sprained ligaments, and inflamed joints. Irritation of the neurological system can manifest as symptoms of numbness or tingling extending into the upper or lower extremities.

Physical therapists are very familiar with performing a detailed assessment and can help with determining the degree of injury that a person has sustained. A physiotherapy treatment plan is determined based on the degree of injury and time since the accident. Early in treatment when the condition is still very acute, it is common to suggest use of ice to decrease inflammation and pain relieving physical electrical modalities can also be used. As the person’s symptoms decrease, gentle mobilization, range of motion exercises, and progressive strengthening exercises are commonly introduced. Progress with treatment is individual and dependent on many factors. There are numerous practice guidelines, however, which suggest a return to normal daily activities as soon as possible, and treatment that promotes return of function is most helpful. A physical therapist is well trained to help assess your whiplash condition and provide an individualized treatment plan.

 

Carpal Tunnel Syndrome by Sun City Physiotherapy

Carpal tunnel syndrome is a common wrist and hand injury.  It occurs when one of the major nerves called the median nerve is compressed within the carpal tunnel of the wrist.  This may occur for a number of reasons but some of the more common reasons include: pregnancy, gout, trauma (repetitive or direct trauma), or infection.  Carpal tunnel can happen at anytime, however it is more common between the ages of 40-60 and women tend to be affected more often then men.

This condition is characterized by burning wrist pain and numbness or tingling within the hand.  This often occurs at night and the patient usually wakes up due to the symptoms.   In some cases the pain can radiate to the forearm, elbow, and shoulder.

Some of the other symptoms reported by patients include poor sensation in the hand, weakness of the hand, cramping in the hand, reduced temperature in the hand, and sometimes shaking or flicking the hand relieves the symptoms.  There may also be muscle wasting around the thumb.  Movements of the hand are often pain free, however some resisted movements around the thumb can be painful.

Diagnosing carpal tunnel syndrome is often done based on the patient’s medical history.  Your physiotherapist or physician will take you through a series of tests and if carpal tunnel syndrome is suspected a nerve conduction test may be ordered to confirm the diagnosis.  Diabetes should be excluded, as it can be a risk factor for carpal tunnel syndrome.

Mild cases can be treated conservatively.  This may include splinting, activity modification, diuretics, and NSAID medications.  Techniques such as contrast baths, which are alternating baths of cold and warm water, may be used in some cases to control inflammation and swelling.  A physiotherapist may give you specific exercises that can be helpful with a patient’s recovery.  For more persistent or severe cases, corticosteroid injections or surgery may be required.

Wrist and hand injuries are often difficult to diagnose so if you are experiencing symptoms of this nature it is recommended that you see your health care professional to have it taken care of.

The Frozen Shoulder by Sun City Physiotherapy

Frozen shoulder is a condition that gets its name from the way it causes a gradual stiffening of the shoulder joint, ‘freezing it up’. The proper term for this condition is adhesive capsulitis – adhesive implying stuck and capsulitis meaning inflammation of the capsule.

Although a very common condition affecting approximately 2% of the population, the exact cause of frozen shoulder remains a mystery. In most cases there is a trigger such as straining the shoulder that then develops into a frozen shoulder, but in many cases it is idiopathic i.e. it just happens. When it is triggered, the capsule – that is the connective tissue sack – that surrounds the shoulder joint undergoes a change in elasticity from being somewhat loose and stretchy to being tight and without much stretch.

When it does happen, it follows a distinct pattern of which there are three stages.

The first stage is the freezing stage and is characterized by the onset of a quite intense pain in the shoulder and upper arm and a gradual seizing up of the shoulder. It becomes very difficult and painful to lift the arm up, rotate it outwards, or reach behind your back. This stage typically lasts about 3-6 months then frozen shoulder moves into stage two, the frozen stage, in which the pain starts to subside but the stiffness remains. The shoulder will begin to feel more comfortable in stage 2 but as it is still very stiff, its function remains limited. Again stage 2 can last anywhere between 3 and 6 months before progressing onto stage 3, the thawing stage, when the stiffness finally begins to resolve and the shoulder range of motion is restored.

Although every frozen shoulder will go through these 3 stages, the duration of each stage can vary in each case. Most of the time a full recovery will be made but occasionally full pain-free range of motion does not return. In order to optimize recovery, physiotherapy can help to restore range of motion with techniques such as mobilizations and muscle energy techniques. A prescribed home exercise program is also important so that you can work on stretching the shoulder every day at home. Along with this there are many treatments the physiotherapist is able to do to help control the pain particularly in the early stages of frozen shoulder. This will enable a much more effective stretching regime, which can ultimately lead to a quick and fuller recovery.

Falls by Tess Mihell, Physiotherapist

By Tess Mihell

 

The winter Olympics in Sochi was filled with scary crashes in nearly every sport. Hearts sank when seeing chances at a medal slip, the pain on the athletes’ faces, and some of the injuries that resulted. We probably all know someone who has, or have ourselves, taken a big spill at the local hill.

 

But that’s not the only place where falls can occur, especially during this time of year with the fluctuating melt and freeze of roads and walkways. Slips and trips can happen in the community, even in our own homes, for a variety of reasons. Sometimes we can walk away from them with little injury, other than to our pride, but unfortunately sometimes injuries occur.  In order to avoid beginning the spring season hurt, it’s good to know what the risk factors to falls are and to address any concerns that may exist.

 

Some readers may recall a previous article I wrote about vertigo– a condition that makes you feel like you or the world is spinning. This or other conditions of the vestibular system can contribute to feeling dizzy or losing your balance. The vestibular system is partially located in the inner ear, and gives our brain information about where our head is relative to gravity. When it is affected, a conflict of information between the vestibular system and other sensory systems happens. Some related conditions include: Benign Paroxysmal Positional Vertigo (“BPPV”), labryinthitis or neuritis (types of infections), or Ménière’s disease. This in turn may cause vertigo, dizziness, or unsteadiness. Some of the causes of vertigo or dizziness can be treated to help you feel more stable on your feet.

 

Weaknesses in the legs or trunk, sensory conditions of the feet, or decreased ‘proprioception’ (the information about where a body part is relative to the rest of the body) are other risk factors for falling. Proprioception, balance, and strength can be trained through regular exercise. Tai Chi and Yoga are examples of programs that assist in reducing fall risk. However some people require exercises tailored to their individual abilities and needs. It is important to evaluate whether a particular exercise is safe and appropriate for you. Having an understanding of the exercise and of your own abilities is helpful, but when in doubt, it is helpful to consult a health care provider, or discuss with the instructor.

 

Risk factors for falling don’t only exist within our bodies, but also in our environment. It’s important to note that while the temperatures have been going above freezing, those cold nights and days can result in a layer of ice. Slowing your pace over these areas, wearing proper footwear, and always being aware of the conditions will help. Within your home, having adequate lighting, keeping the floors and hallways clear of obstacles, and keeping rugs or carpets secured down will also reduce your chances of tripping.

 

With the example of the Olympic sports of skiing, snowboarding and skating, big falls occur frequently. It’s not often a case of needing to address strength or balance, and rarely is the environment controllable. For these activities, it’s important to protect yourself as much as possible. Wrist guards are light, can fit under gloves, aimed at reducing the risk of a facture when impacting the ground. A common injury with falling is the FOOSH – a ‘Fall Onto an Outstretched Hand’. A brace will keep your wrist in an ideal position and can absorb some of the force to reduce, but not eliminate, the likelihood of a wrist fracture. If you ski, braces also exist to protect the thumb, which can be injured by the ski pole.

 

If you feel you are at risk of falls, or have an injury after taking one, it is important to see a health care professional to either assist in the prevention of, or in the rehabilitation after, a slip. Reducing the risk can be easy in some situations: adjusting your footwear, modifying your gait aid if you use one (for example, attaching an ice grip onto a cane), making changes to your home environment, or partaking in a strength and balance program designed for your needs. In some cases, dizziness or lightheadedness occurs as a side-effect from medication, so speaking to your doctor may help. From a physiotherapy context, your strength, balance, vestibular function, or any combination of those factors can be assessed and treated as is appropriate for you.