Torticollis by Jennifer Olynyk, Physiotherapist

Have you or someone you know just welcomed a new addition to the family? If so, this article may be for you! Since the promotion of “Back to Sleep” as well as babies having to spend time in the NICU or PICU due to numerous conditions, head shape issues have been increasing. Torticollis can also be caused by trauma during birth, awkward positioning in the uterus and other conditions.
When a baby is born, the bones that make up their skull are soft and gradually overtime they begin to fuse. If during this time there is more pressure put on one side than the other, the baby’s head may start to flatten more on one side. This is called “Plagiocephaly.”. Sometimes the flattening can be severe and facial features can begin to shift as well. The most notable being a shift of the ear and forehead and an asymmetry between the baby’s cheeks and jawline. If a baby spends most of the time on their back or had to spend time in the NICU/PICU, there may be equal flattening on both sides resulting in “Braciocephaly.”
Often the first time this is brought to the family’s attention is at their 3 month check-up or vaccinations. If this has happened to you, don’t fret and stay off the internet!! Most of the time this condition results from a tightness or imbalance of strength between the babies neck muscles called the sternocleidomastoid or SCM for short. If this muscle is the culprit then the condition can also be referred to as Congenital Torticollis. Torticollis can have many different causes, some worse than others, but 80% are due to muscular issues from the SCM.
The condition is most apparent around 2-3 months or older. At this time babies are getting stronger and exploring their environment more. If you notice your baby tends to look one direction more than the other, especially when they are on their back, this may be an indication of torticollis. Often the first indication is the flattening at the back of the head.
Torticollis can be easily treated without any manipulations or medications. With gentle stretches and strengthening exercises, the baby’s neck muscles can even out and this will help with their head shape as well. It is best to see your physiotherapist before 6 months of age. This is due to the skull bones becoming increasingly fused as well as the creeping, crawling and rolling when babies begin to explore their environment.
If your healthcare provider or someone you know has brought this condition to your attention, don’t worry. Come see your physiotherapist for an assessment and treatment plan that works for you and your little one.
Jennifer Olynyk is a registered physiotherapist and associate at Sun City Physiotherapy’s downtown St. Paul Street clinic location.

Fall Prevention by Krista Smith, Physiotherapist

While many people consider seeing a physiotherapist to help with their recovery after an injury or surgery, few consider scheduling a physiotherapy appointment for injury prevention. When it comes to fall prevention, we observe and assess functional movements including your walking pattern, balance and lower extremity strength. A personalized program including education and home exercises can then be designed based on the information we gather from the assessment to help improve your strength, balance and walking pattern.

To avoid tripping while walking, it is important to develop a safe walking pattern. The swing through leg should be lifted high enough to properly clear the ground. A shuffle pattern can result in catching the toe and tripping. Also, since a large portion of walking is spent standing on one foot while the other leg is swinging through, we want to assess balance and stability on the stance leg. If unsteadiness is noted while standing on one foot, a walking aid such as a cane or walker can be beneficial to add stability and support. A physiotherapist can adjust a walking aid and provide instructions and a demonstration. A physiotherapist can also teach safe and effective exercises to help improve walking pattern and endurance for those who feel weak or unsteady while walking.

It is very important to stay active and keep moving. Daily physical activity is essential to maintain aerobic endurance, lower extremity strength and balance. It is never too late to start an exercise program. It is best to think of exercise as a slow gradual progression rather than an all or none activity. It is important that you find an activity that is enjoyable to you to stay motivated and keep active. This may include walking, hiking, cycling, swimming, tennis or golfing. In addition to aerobic activity, a physiotherapist can design an appropriate home exercise program to help improve endurance, balance, coordination and strength.

Krista Smith is a Registered Physiotherapist at the Sun City Physiotherapy downtown location.

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.

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.

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.

Full recovery after an ankle sprain by Krista Smith, Physiotherapist

It was a crisp autumn day when Sue decided to go for a hike. All of a sudden she caught her foot on the unstable ground and rolled her ankle. Her ankle was sore, swollen, tender to the touch and she felt unstable while walking on it. Eventually, after a couple weeks of rest, ice, elevation and gentle movement she was again able to resume most of her usual activities of daily living. She thought she would rest over the winter and be ready to get back to hiking in the spring.

Fast forward to spring. The snow is melting, the birds are chirping and Sue is getting ready to once again get back to hiking and soccer. This time though, she observes some odd changes. Sue notices that her ankle still feels weak and she is worried about slipping when she goes out for her long hikes. She decides not to play soccer in the spring out the fear that running on the field with opponents may result in rolling her ankle again. She even feels unstable while standing on one foot and very stiff in her ankle when having to kneel or squat.

Sue is a classic example of someone who has recovered well from the acute symptoms of an ankle sprain but has not done the proper rehabilitation to recover fully from the injury. Ongoing symptoms of stiffness, weakness and poor balance are common. If someone has been limping or using crutches for a period of time after the initial injury, general weakness in that leg is also quite common. Due to the residual ankle weakness and reduced balance, there may be an increased risk of rolling the ankle again with return to sports and activities.

A physiotherapist can help get you on track for a full recovery. During an initial assessment, a physiotherapist will ask you questions about your specific injury and assess your mobility, strength and balance. Based on the findings of the assessment and your specific goals, your physiotherapist can come up with a personalized home exercise program for you. Manual therapy, which involves hands on techniques, is also used to treat stiffness and reduced range of motion. Following a physiotherapy treatment program most people are able to safely and confidently return to their regular sports and activities.

Krista Smith is a Registered Physiotherapist and associate at Sun City Physiotherapy’s downtown, St Paul Street location. She can be contacted at 250-861-8056 or email downtown@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