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.

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.

The Latest on Lower Back Pain by Graham Gillies, Physiotherapist

The Latest on Lower Back Pain

With all of this mild weather we have been experiencing in the Okanagan it really does feel like spring is just around the corner. I’m sure many of you have started to do some work in your yards in preparation for the gardening season. Each year during the start of spring there is something that comes along with the longer days and warmer temperatures: lower back injuries. So what can we do to avoid hurting our backs? A recent study published in the Journal of Arthritis Care and Research looked at just shy of a thousand patients over the age of 18. They found 8 different risk factors for lower back pain. In order of highest to lowest risk the 8 factors were: distraction during a task, manual tasks involving awkward postures, manual tasks involving objects not close to the body, manual tasks involving people or animals, manual tasks involving unstable or unbalanced objects, manual tasks involving heavy loads, moderate or vigorous physical activity, fatigue/tiredness. Being fatigued tripled the odds of suffering a lower back injury, while distraction increased the risk by 25 times! So based on this recent information when you are getting outside to do your yard work or gardening this spring make sure to remember this list and try to avoid these risk factors. Take frequent breaks during your day to avoid fatigue. When lifting, bring objects close to your body and focus on what you are doing to avoid distraction. When lifting, bend at your hips and knees (sticking the butt out) while keeping a straight spine to minimize dangerous pressure on the spinal discs and joints. As well, a recent study done at the University of Sydney in Australia found that almost half of the lower back injuries they looked at occurred in the morning between 8 and 11 am. The cause is yet unknown but it is thought that it may be due to the fact that your spinal discs fill with fluid overnight, making them more susceptible to pressure in the first few hours of your day. It makes sense then to take your time in the morning when possible and make sure your muscles and joints are warmed up before jumping right into your ‘spring cleaning’. Of course we don’t live in a perfect world where we can always completely avoid risk of injury. But keeping some of these latest study results in mind I hope that you can stay healthy during this upcoming spring season.

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 and acupuncture 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.

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

Vertigo & Dizziness by Robina Palmer, Physiotherapist

‘Vestibular Rehabilitation’ is an area of focus in my physiotherapy practise – I am often asked what exactly that means. The vestibular system (involving your inner ear) is responsible for sense of movement, body orientation and balance. The vestibular system (along with our eyes, muscles, and joints) send constant feedback to our brain about our body’s movement and orientation.

Dysfunctions, disorders, trauma or viruses that affect the inner ear can be a potential cause of vertigo, dizziness, decreased balance, tinnitus (ringing in the ears) or a change in hearing. As a vestibular therapist I can assess the potential causes of the mentioned symptoms and provide treatment to help decrease dizziness, vertigo and improve balance.

Dizziness is the umbrella term that refers to a sensation of abnormal, unwanted, movement – a feeling of unsteadiness, lightheaded or feeling ‘off’. Vertigo is a more specific term and implies that there is a rotational component to your dizziness – either the room is spinning around you or you are spinning in the room. Both vertigo and dizziness are symptoms, not a diagnosis, so part of my job is to figure out the possible cause and provide treatment.

One of the most common conditions within the inner ear that I treat is a condition called BPPV – benign paroxysmal positional vertigo. BPPV is caused by a crystal that is free floating within the inner ear. The signs and symptoms are pretty easy to recognize (vertigo brought on when lying flat, rolling in bed, looking up to the ceiling or bending forward). Treatment for BPPV is also quite effective.

It is also important to recognize that not all causes of vertigo or dizziness are associated with problems in the inner ear. Cardiovascular (heart) disorders, thyroid conditions, anxiety, migraines, neck disorders/injuries and neurological conditions are all potential causes.

Robina Palmer is a registered physiotherapist and partner at Sun City Physiotherapy. She can be contacted at the downtown St. Paul Street location or email her at rpalmer@suncityphysiotherapy.com

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.