Tips For Healthy Cycling. By Nick Black, Physiotherapist

Cycling orchard lined roads, touring between vineyards, cruising the Kettle valley railway, flowing down trails at Smith creek, or eagerly awaiting completion of the Okanagan rail trail – cycling offers something for everyone in the beautiful Okanagan.
After an injury or surgery, my patients commonly ask “do you think I’m ready to get back on my bike?”. More often than not, the answer is “yes”. The bicycle is such a fantastic tool for rehabilitation and exercise, producing low impact forces on the body, while promoting lower limb range of motion and strength. However, whether your goal is rehabilitation, fitness, competing in the next triathlon, or just plain enjoyment, you should be aware of some common aches and pains that can stem from time on your bike.
Necks, backs and knees are the most common areas of complaint from cyclists. Sure, cycling is low impact but it can also require long periods of time in sustained postures. When a muscle is in a prolonged contraction its blood flow is limited, its pH level drops becoming more acidic, at which time the muscle will begin to fatigue and complain. Experiencing muscle fatigue and mild pain is a normal process of getting stronger, however only when balanced with adequate recovery time! Prolonged load beyond your tissues tolerance and inadequate recovery time are the primary reasons for injuries on the bike.
If you’re new to cycling or getting back on the bike after a long hiatus, I would encourage you to adhere to the following three principles. 1) Get your bike properly fitted to you. A well fitted bike creates an efficient posture, significantly reducing unwanted loading on your neck, back and knees. Your local bike store can guide you in this process. 2) Start low and build slow. Gradually increasing the load on your bodies tissues and allowing recovery after a ride will allow your tissues to adapt, becoming more tolerant to prolonged postures on the bike. 3) Develop your core strength. The concept of ‘core strength’ is an over promoted concept but when it comes to cycling, having strong gluts and lower back muscles will help to maintain an efficient posture for producing power through the legs and minimizing strain on your back in the process. Consider consulting a physiotherapist or exercise professional for a few core strengthening exercises that can be performed off the bike two to three times a week.
The benefits of cycling far outweigh any of the potential aches and pains mentioned above. Train smartly by adhering to the above principles and continue to experience the joys of cycling in the Okanagan. Maybe I’ll see you at this years Apple triathlon?
Nick Black is a registered Physiotherapist at Sun City Physiotherapy Winfield. He can be contacted at the new Winfield location by phone: 250-766-2544 or email:winfield@suncityphysiotherapy.com

Shoulder Pain by Graham Gillies, Physiotherapist

Do you lie awake at night with an aching shoulder? Do you feel sharp grabs of pain while reaching up into the cupboard or into the back seat of your car? Did your shoulder pain start one day without any injury that you can remember? Shoulder pain can keep us awake at night and limit our day-to-day activities – even the most basic ones like washing our hair or getting dressed. In this article we are going to talk about how shoulder problems can start and what there is to do about it.

First let’s talk about what is inside your shoulder. The shoulder is what we call a ‘ball and socket’ joint. This means that the top of the upper arm bone has a ‘ball’ like surface, and this ball connects with the concave surface of the shoulder blade, similar to a golf ball sitting on a tee. This type of joint (like your hip joint) is build for maximum mobility. Having so much mobility is a good thing because it allows our shoulder and arm to reach in all different directions. However, this excess mobility can also predispose the shoulder to injury.

Almost everyone has heard of the rotator cuff. The rotator cuff is a group of 4 muscles responsible for protecting the shoulder. These are often the muscles that are injured in the shoulder because they can become pinched inside the joint (referred to as ‘impingement’). The rotator cuff muscles work alongside the muscles of your shoulder blade to ensure that the ball is always positioned in the centre of the socket so as to avoid pinching, inflammation and pain. Impingement can occur if any of these shoulder muscles become tight or weak or if the neck and upper back are too stiff to allow for proper arm movement.

People that spend a large portion of their days sitting often become very weak in their shoulder blade muscles while at the same time also becoming tight in their chest, upper back and neck. Others spend a lot of their workday doing repetitive movements with their arm that also can create irritation and muscle imbalances in the shoulder. At night many of us tend to lay on our ‘favourite’ side while sleeping which squeezes the blood out of the shoulder thus causing further irritation and preventing recovery from the strain during the day.

If you start to have shoulder pain the best strategy is to avoid the movement that is creating the pain and to ice the shoulder for 15 minutes 2-3 times per day for the initial 3 days (after 3 days switch to heat for 20 mins, 2-3 times per day to increase blood flow/healing). Make sure to continue to move the shoulder in motions that don’t hurt in order to prevent your shoulder from getting stiff. Also try as best as you can to not sleep on the painful shoulder at night in order to allow healing.

If the pain does not subside within a week it is advisable to see your health care professional so that the specific reason for the shoulder pain can be diagnosed. In physiotherapy, pain control and stretching out tight muscles are usually the initial goals. Treatment then fairly quickly progresses to focusing on strengthening specific muscles as well as increasing overall flexibility. Often the conversation of prevention will focus on daily stretching or Yoga as well as emphasizing good posture while sitting.

I hope that you have learned a little bit about how the shoulder works and what can cause shoulder pain. If you are starting to have nagging shoulder pain or tightness, remember that it is much easier to deal now then ‘down the road’. Happy spring (summer) everyone!

Graham Gillies is a registered Physiotherapist at Sun City Physiotherapy Winfield and is a fellow of the Canadian Academy of Manipulative Therapy and a certified Gunn IMS practitioner.

Bladder Incontinence by Sabina Lee, Physiotherapist

This one’s for the ladies.

Ladies, have you notice the increase in the number of bladder leakage commercials on TV these days? Brands like Poise and Always have caught on that there are a large number of women who experience bladder leakage on a daily basis. These commercials are great in one aspect because they open up doors for women to have conversations. This is important because these issues may be embarrassing to discuss with friends and therefore are often sealed behind tight lips or talked about only in doctors’ offices. The downside to these commercials is that they make you feel like a pad is the best way your bladder leakage can be addressed. Many women who have bladder leakage do not seek information regarding the underlying cause, the type of bladder leakage they have or additions ways it can be addressed.

To fill in some of the gaps – there are essentially three types of bladder leakage. First there is stress incontinence (loss of bladder control). This type usually occurs because the pressure exerted on the pelvic floor is too forceful for weakened muscles during a cough, sneeze, laugh or any event that increases intra-abdominal pressure.

The second type of incontinence is called urge incontinence. This type of leakage is usually behaviour driven and occurs because of toileting cues and conditioning surrounding your learned habits. For example, you just pulled into your drive way – before you pulled up there was no urge to go to the bathroom. However, now that you are in the driveway you are frantically rummaging through your purse to grab your keys, you found them. Now, to make it to the front door you waddle the whole way there because all you can think about is emptying your bladder and by the time you get the lock open you may have already leaked before you made it to the toilet.

The final type of incontinence is called mixed and is a combination of stress and urge. In addition to using these products there are other ways to treat bladder leakage. One of the treatments for stress incontinence comes from gaining body awareness and control of your pelvic floor muscles and retraining them to turn on before a cough and sneeze. The treatment for urge incontinence involves behavioural retraining surrounding your current toileting habits.

Now that you are aware there are more options, perhaps it’s time for you to take control of your leakage and contact a physiotherapist who treats women’s health in an effort to reduce or eliminate leakage.

Sabina Lee is a registered physiotherapist at Sun City Physiotherapy’s Winfield/Lake Country clinic.

Intramuscular Stimulation (IMS) by Graham Gillies, Physiotherapist

Intramuscular Stimulation (IMS): What is it and how can it help get rid of your chronic pain?

In this article I am going to focus on the treatment of chronic muscle and nerve pain and why it can be so difficult to find a solution for this type of pain. It is estimated that over one third of the adult population in North America suffers from chronic pain. That is a staggering statistic! This means that 1 of out of every third person out on the street is dealing with ongoing daily pain. Research shows that suicide is nine times more prevalent in people with chronic pain than with depression and it is estimated that in the United States, chronic pain affects more people than diabetes, cancer and heart disease combined.

So is chronic muscle and nerve pain so common? To understand this question we have to look at the gradual process that happens to all of our bodies to some degree over many years. As harsh as it sounds, the reality is that as we age our bodies are slowly ‘rotting’. By the time we reach our 50’s and 60’s we will all get some amount of arthritis in our spine. How fast we ‘rot‘ depends on a variety of factors including our overall fitness levels, nutrition, the types of jobs we do, family genetics and any traumatic injuries we sustain along the way ie. motor vehicle accidents. As the arthritis in the spine progresses, the nerves that exit the small spaces between each spinal bone (vertebrae) start to become irritated. In response to this irritation, the muscles that these nerves supply then start to form tight bands. These bands are the ‘knots’ you feel when you rub sore muscles. The muscle bands not only cause pain but they also begin to pull at joints and tendons as well as compress the already sensitive nerves at the spine. These tight bands often do not respond to traditional treatment approaches such as stretching, massage and spinal manipulation.

A form of treatment that has been gaining popularity in the last 5 to 10 years for chronic muscle and nerve pain is Intramuscular Stimulation (IMS). This treatment technique was developed by a Doctor in Vancouver by the name of Dr. Chan Gunn. Dr. Gunn developed this technique while working with people who were injured on the job and whose pain was not going away with traditional treatment approaches. What he found in these patients was that by stimulating their tight muscles with an acupuncture needle, the pain very often significantly improved or in many cases disappeared.

So the key to addressing this chronic pain process is to release the muscle tension. In an IMS treatment, when the needle enters the taut band the muscle will ‘grab’ the needle and a deep, cramping sensation is felt. Once the muscle grabs it then typically will ‘reset’ itself and begin to relax. When the tight muscle relaxes, a decrease in pain should follow. IMS is now being recognized and used by physiotherapists and doctors around the world to treat chronic pain of musculoskeletal origin. If you are suffering from ongoing muscle or nerve pain and haven’t had success with traditional types of treatment, IMS may be worth trying. For more information about IMS visit:www.istop.org

Graham Gillies is a registered Physiotherapist at Sun City Physiotherapy Winfield and is a fellow of the Canadian Academy of Manipulative Therapy and a certified Gunn IMS practitioner.

Know Pain or No Gain by Nick Black, Physiotherapist

The phrase “no pain, no gain” would probably be the leading misconception about pain that I hear – live by this slogan at your own risk. Why? Because first and foremost, pain is a protector. Pain is a wonderful and fascinating perception that helps to keep us out of danger. I can certainly sympathise that when you’re experiencing persistent or intense pain, its hard to see it as “wonderful” or “fascinating” but it truly is a remarkable defence mechanism that we possess.
When you step on a nail, twist your knee or tweak your back, what comes to your defence first? The simple answer is pain. It’s your first warning of actual or even potential tissue damage. Yes, that’s correct – “potential” tissue damage, meaning your body is smart enough to tell you to withdraw from danger before the damage is done. Wow! When tissue damage does occur, such as a strained ligament, tendon or muscle, your body sends all its best healing products to the area in the form of ‘inflammation’. The brilliance of inflammation is that it increases the sensitivity of the danger detectors (receptors) in the damaged area, which send more danger messages to the brain where they are processed and a pain experience can result. What do you think of that? Essentially, your body doesn’t just heal you with inflammation but it also tells you about it through the feeling of pain as a way of changing your behavior, allowing the area to rest and heal more effectively.

If you understand that the experience of pain is a critical response when the body feels threatened or in danger, then you will see how the slogan “no pain, no gain” will quickly lead you astray. Instead, us ‘pain geeks’ like to encourage the slogan – “know pain or no gain”, meaning that if you understand why you are experiencing pain and what it means, you are more likely to adopt the appropriate behaviour to encourage recovery.

The story of pain can get rather complex but equally as fascinating. Like any of our body systems, our defence systems can sometimes get a bit carried away and malfunction. This is often the case in the event of persistent pain – a story that will have to wait for another time. Until then, remember “know pain or no gain”.

Nick Black is a registered Physiotherapist at Sun City Physiotherapy Winfield.

Keeping you work-safe, and out of the physio clinic. By physiotherapist Tess Mihell

 

As a physiotherapist, I assess and treat injuries that occur in the workplace. These can be sudden (acute), or gradually over time (overuse). Overuse injuries come from repeated stresses that cause micro-damage of muscles, ligaments, or joints. Over time the micro-damage turns larger, and pain and weaknesses become apparent. Overuse injuries are quite common, difficult to diagnose, but relatively easy to prevent.

Any job comes with some degree of risk of injury. Knowing what your risks are, and working together with your employer or organization to minimize these risks is important for keeping your body happy and work-ready.

When possible, look at your work environment to see if anything is within your control to be changed. I will use physiotherapy as an example: There are times when I can modify my environment in order to make a task easier on my body. I can raise and lower the treatment table, or my stool on which I’m sitting, or in some cases I can use equipment that is ergonomically friendly.

Other times, the environment is not ideal, but also not in our power to modify. This is when you need to think of your body mechanics – the way you use your body to perform a task. Here are some general tips, from head to toe, of ways you can keep good body mechanics. This list is not exhaustive so it is important to consider each task you have to do individually, and what risks may be involved.

Head and neck: a common posture that is a big no-no is the forward head posture where the chin juts forward and hinging occurs about one vertebra in the lower neck. Any time you are in an upright position, keep a nice gentle chin tuck, with the back of your neck long.

Upper body: the other common poor posture is the rounded shoulder posture. When in this position too long, the muscles in the front of the chest get tight, and muscles in the back get long and weak.  Also avoid hunching your upper back, which can also contribute to a forward head posture. Keep your shoulders pulled back, with your chest open and proud.

Arms: working repetitively above shoulder height can put you at risk of an injury called ‘impingement’ in the shoulder. When it is possible, avoid having your hands overhead, or above shoulder height, especially if lifting. This can mean using a step if you’re trying to reach high, or finding ways to better position yourself around your task. Avoid repetitive reaching away from the body; if it is possible, put your body closer to where you’re working.

Hands and fingers: if your job involves a lot of bending of your wrist or fingers, gripping or grasping, it is important to stretch those tired muscles, and to strengthen the opposing muscle groups to balance it out. If you work at a computer, look to see what your wrist position is at the keyboard or the mouse. Ideally, they shouldn’t be bent up toward you too far, and the bottom of your wrist shouldn’t sit on a hard surface for a prolonged time.

Low back: Lifting techniques and proper sitting posture can make a big difference in low back pain! If you sit a lot, try to support the normal curve of your spine either through a ‘lumbar support’ or a rolled towel. For those who lift during the work day, remember the following important points. Keep the load you’re lifting close to your body. If what you are lifting is below waist height get into a lunge, or a squat position and stick your bottom out like you’re going to sit in a chair. This helps to preserve a ‘neutral spine’ – which is slightly arched.  Lastly with regards to lifts, or picking anything up / putting anything down of any weight, avoid twisting and bending simultaneously.

Legs and feet: avoid twisting your body when you have a foot, or both, planted. Wear footwear that is supportive, and appropriate for your job. If you have been prescribed orthotics, ensure you wear them while working, to help support your feet and legs. If sitting, change up your position: try not to sit all your time with legs crossed, and if you do cross your legs, try to balance how long each is the leg on top.

If you do notice new pain or weakness, attend to it as soon as possible. While many injuries require 4-8 weeks to heal at the level of the tissue (although you may return to some functions during that period), this time frame can be made longer if the injury doesn’t have a chance to heal, or if it gets re-aggravated. Be conscious of what you feel, what your job demands are, what may have caused it, and how that risk can be minimized. Seek help when help is needed, be it through your work’s first aid service, or a health professional.

Helping Kids ‘Keep the ball rolling’ By physiotherapist Tess Mihell

 

The sun is shining. Birds are singing. Blossoms are blooming… and the soccer balls are flying! Soccer is the most commonly played sport in the world enjoyed by all ages. In 2005, about 20% of children younger than 14 years of age participated in soccer, a number which is likely higher now.

Training in organized sports during the younger years has been shown to, improve general health, have psychological benefits, and enhance performance in physical activities. However, children and adolescents are at risk of injury with sports, and special considerations need to be kept with regards to their growing bodies. Studies have shown higher risk in younger age groups, particularly those under 15.

The leg joints and muscles are commonly hurt, with strains, sprains, and bone or cartilage damage. Injuries can occur due to a traumatic event, or overuse, in either a game or in practice. While some aches and pains are relatively minor, the sprain receiving the most attention in soccer is the ACL tear. The risk of this season-ender is high due to the nature of the sport with quick changes of directions, cutting manoeuvres, sudden stops with a foot planted on the ground, and collisions with other players.

The good news? Injuries can be prevented! Training programs exist specifically for soccer players and have been shown to reduce the risk of injuries, including the ACL tear. These programs are based on well designed studies, and can be carried out by an individual experienced with this kind of training: this could be, for example, a coach or a physiotherapist.
The programs decrease injury risk by:
Decreasing muscle fatigue
Improving stability of the trunk, pelvis and joints of the leg
Optimizing balance between muscle groups
Increasing balance
Improving body technique and body mechanics.
Special training programs for young soccer players often involve a cardiovascular warm-up, strength building, stretching, agility drills, and exercises with fast, powerful movements (plyometrics).
Note to any young athletes reading: remember all those dreaded drills of burpees, hopping over cones, and jumping on/off high steps? Try to smile through them, and think of how much you’re lowering your risk of being kept out of the game.

Having a history of previous injury increases the chances of getting hurt again. The high rate of re-injury suggests players often return to sport with incomplete healing or rehab. Factors to preventing recurrence of an injury include: completing a rehab program specific to the individual, gradual return to training and competing, use of bracing and taping if appropriate, and consulting a professional to ensure the young athlete is ready before returning to sport.

Another injury risk factor that can get overlooked in the young is the occurrence of a ‘burn out’, which can happen with over training. Some signs to watch for include:
Sleep changes
Persistent aches and pains
Decreased physical performance
Changes to mood and attention
Decreased academic performance
If you note these signs, consider if over-training is a factor. Consulting your coach or health professional is important for recognizing burn-out and preventing injury. An appropriate training program will be intense enough to obtain desirable goals, without resulting symptoms of overtraining.

Participating in organized sports has many benefits for children and adolescents. To prevent injuries to stay in the game: consider incorporating a special supervised training program, give time for injuries to heal, and be aware of signs of overtraining. As the temperatures soar into the double-digits, the clouds give us reprieve, and the spring sports recommence, I hope you and your young athletes stay injury-free… and have a ball!