IMS
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.
Sports
If you’re a regular league curler, whether recreational or competitive, then you’re surely familiar with the aches, pains and injuries that go hand-in-hand with the sport. Joints and muscles at the knees, back and shoulders are most vulnerable to injury. The good news is that by taking the following three preventative steps, you can minimize your chances of injury and maximize your enjoyment of curling this season!
Number one on my list is proper equipment. I can guarantee that if you curl long enough you’re going to fall once or twice. Over 90% of curling injuries result from a slip and fall. If you’re on the ice with any regularity, it’s worth ditching the runners in favour of a proper gripper and slider. Beginner curlers and young curlers in particular should also consider wearing a helmet when starting out. Scary fact: when you fall, your head is the body part that’s most likely to hit the ice first!
Number two is a proper warm up. But wait, there’s a twist. You need to actually get WARM. You need to increase your heart rate and body temperature! If you think that I’m stating the obvious, just look around at all of the curlers casually chatting or gently stretching before going on the ice. These activities will only warm you up if you’re doing them on a hot beach or in a hot yoga studio. Start by running on the spot, high-knees, butt-kicks, or doing jumping jacks. Follow that up with some curling-specific stretches including the legs and trunk, and you’ll be ready to hit the ice.
My third and final tip is this: get a qualified coach to take a look at your mechanics. I remember the first time that I saw my delivery and sweeping on camera, I was shocked at how awkward I looked! I’m not saying that you’re in the same boat; you might be perfect. But you may not look as good as you think you do. If you aren’t already getting regular coaching, an instructor can provide you with some insight into your technique. Improving your delivery and sweeping by optimizing the way that you load your joints and muscles will improve your performance and prevent overuse injuries. You’ll play better, and feel better doing it!
Keep these three points in mind and with any luck you’ll make it through the curling season with little to no time missed due to injury! If you do happen to run into any issues along the way, keep in mind that a visit to a physiotherapist can help you to get back on track. Happy curling in 2016!
For more information on curling injuries, prevention and exercise, join us for a free informational talk on Tuesday, January 26th at 6:30 at Sun City’s Glenmore location. Call 250-762-6313 to reserve your seat.
Rob Heimbach is a registered physiotherapist and associate at Sun City Physiotherapy’s Glenmore clinic. He can be contacted at 250-762-6313 or email glenmore@suncityphysiotherapy.com
Womens Health
There are a few things a woman should take into consideration when resuming exercise after pregnancy: Pelvic floor strength and her abdominal muscles. Restoration and strengthening of the Pelvic Floor muscles is very important and should begin in the early days and continue weeks after delivery. Whether her delivery was vaginal or C-section, special attention needs to be paid to the post-partum woman’s abdominal wall. A widening of the gap between the two bands of the Rectus Abdominus muscle, known as Diastasis Recti, may not resolve spontaneously after pregnancy.
Pregnancy and childbirth puts a woman’s body through one of her life’s most strenuous events. Laxity in the ligaments, an increase abdominal girth, an exaggerated forward tilt of the pelvis can alter the center of gravity, affecting dynamic stability of the spine and pelvis. Combined with the load of carrying a new baby and breastfeeding, these added stresses to the spine can lead to postural fatigue and discomfort. Physiotherapists are experts at analyzing posture and alignment and can prescribe postural exercises and advice on body mechanics.
Kegel exercises are an important part of pre-natal health. The Pelvic Floor muscles (PFM) lie at the base of the pelvis, and run from behind the pubic bone to the tailbone. Differentiate a PFM contraction from the buttock muscles. To avoid increasing intra-abdominal pressure, don’t hold your breath and push. Instead, think of pulling the two side walls of the vagina toward midline, and lift up inside. Hold this contraction for 10 seconds, without holding your breath.
Immediately after a vaginal delivery, many women find it hard to feel a contraction in their pelvic floor muscles. It works much easier if “muscle memory” exists from previous practice.
If you’re having difficulty with this, an internal examination by a women’s health physiotherapist can determine the extent of the problem. Other concerns, such as uncomfortable scarring after an episiotomy, can also be addressed.
We have 3 layers of abdominal muscles. 100% of women have some degree of Diastasis Recti, or abdominal separation in their third trimester of pregnancy. At 8 weeks post-partum, if the gap is marked (greater than 2 fingers width), if untreated it will likely still be a problem after a year. Diastasis Recti can aggravate low back problems and result in a midline “doming” of the abdomen under load. The underlying cause is an abnormal increase in intra-abdominal pressure during exertion, not the pregnancy itself.
If you suspect you have a Diastasis, try to avoid activities that strain on the abdominal wall. This would include sit-ups, especially over a large ball, heavy lifting, yoga postures that include back bends, Pilates “100’s”. This is until you have learned to contract the inner Transversus Abdominus (TrA) muscle to support the wall.
Two thirds of women with Diastasis Recti have some level of Pelvic floor dysfunction. The Pelvic Floor muscles and TrA work synergistically to support the pelvic organs, especially during exertion. Good tone in these muscles helps to prevent and treat prolapse and stress incontinence, which can show up in mid-life.
Sports
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.
Sports
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!
