TMJ Dysfunction

Argh! Did you wake up this morning with a headache or face pain? Do your jaw joints make noise? Do you have limited movement to open or close your mouth, or get “stuck” in one position during movement? Do your ears sometimes ring? Are you clenching or grinding your teeth? It’s possible you have TMJ Dysfunction or TMD.

TMJ is short for TemporoMandibular Joint. It is the ball and socket joint of your jaw that is separated by a thin, soft piece of cartilage, often referred to as the Articular Disc. These joints can be felt in front of your ears.

TMJ Dysfunction or TMD is the imbalance or change in normal function of the bones, ligaments, capsule, muscles, disc or nerve components of the TMJ complex.

Some signs and symptoms of TMJ dysfunction can include facial pain, headaches, joint noise (clicking, popping), and limited movement or locking. Other symptoms include ear pain/ringing, hearing troubles, tooth pain, neck or shoulder pain and facial tingling or numbness.

TMD could be caused by head/facial trauma, a motor vehicle accident, dental issues, stress induced clenching or grinding of teeth, poor postural habits, and many others.

Clinically, the most common disorders seen are related to muscular overuse and dysfunction, as well as disc displacement disorders creating abnormal positioning of the articular disc within the joint.

Proper assessment, diagnosis, and successful treatment rely on a skilled physical therapy practitioner, with expertise in TMJ management. Treatment of TMD is often focused on desensitizing muscles or improving joint mobility through hands-on mobilization; restoration of normal functional movement pattern through exercise; and providing education regarding prognosis and self applied maintenance. Treatment may also include other muscle re-education techniques such as Intramuscular Stimulation (IMS). We look at other mechanical influences such as neck disorder and posture, to assist in maximizing treatment management. In some cases, we work with your oral practitioner (dentist, orthodontist, oral surgeon) – and other practitioners who deal with behavioral modification – to optimize results.

Vince Cunanan is a Senior Physical Therapy Clinician at Sun City Physiotherapy. He has with over 22 years of experience in the field of orofacial disorders and headache management.

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Dry Needling

Physio Articles

Dry Needling

You’ve most likely heard of acupuncture; and quite possibly IMS. They both fall under the category of Dry Needling. Dry needling is a technique that a trained physiotherapist can incorporate into your treatment plan. It involves the insertion of a fine solid needle through the skin barrier for therapeutic effects. The two most common types of dry needling techniques are acupuncture and intramuscular stimulation (IMS).

Acupuncture vs. Intramuscular Stimulation

The main differences between acupuncture and intramuscular stimulation (IMS) are the theories behind the treatment and the goals of treatment. Acupuncture targets many different body systems including, but not limited to, the musculoskeletal system, the digestive system, the nervous system, the cardiovascular system, and the respiratory system. On the other hand, IMS targets primarily the musculoskeletal system.

Acupuncture is based on Traditional Chinese Medicine (TCM) philosophy whereas IMS is based more so on western medicine. In TCM, pain is believed to manifest when there is a disruption of energy flow in the body. It is believed that the insertion of acupuncture needles into specific points can help restore this energy flow. Conversely in IMS, the needle is inserted into a tight and tender muscle band in order to release it. IMS has become quite popular in the last few decades and more research is coming out on its effectiveness as a therapeutic technique.

The benefits of acupuncture and IMS

Benefits of acupuncture and dry needling include reduction in pain and inflammation, acceleration in tissue healing, as well as restoration in function. According to TCM, acupuncture has also been proposed to have more holistic effects including reducing stress, improving energy and balancing the autonomic nervous system.

Common conditions that can be treated with acupuncture and IMS:

Lower back pain
Headache
Rotator cuff tendinitis
Tennis elbow
Piriformis syndrome
Muscle strains

How to prepare for your appointment for dry needling:

Ensure you have eaten before your appointment.
Let your physiotherapist know about your medical history and any medications you are currently taking. Be sure to include even over the counter medications as some have blood thinning properties.
Let your physiotherapist know if you’ve experienced any adverse events in the past following needling.

What to expect during your appointment for dry needling:

Although we always do our best to incorporate each patient’s desired treatment, the physiotherapist will always conduct a thorough assessment to ensure you are an appropriate candidate for dry needling.

Your physiotherapist will position you appropriately for acupuncture and dry needling. Whenever possible, your physiotherapist will have you lying down for the treatment. Your physiotherapist will wear gloves for dry needling. They will also sanitize the area to be needled. You will feel a light prick when the needle is inserted. For acupuncture, once the needle has penetrated the skin barrier, you may not feel the needle anymore. For dry needling, you may experience what is known as a local twitch response during treatment. It will feel as if the muscle very briefly grasps onto the needle.

Remember that you can request to stop needling at any time.

What you Should expect after your appointment for dry needling:

It is quite common to experience minor bleeding, bruising and mild/moderate pain during or after treatment. Although there is a possibility for more serious adverse events, these are rare. Your physiotherapist will discuss these with you prior to needling. It is important to pick a physiotherapist who is well trained in dry needling as some areas, particularly those muscles located around the lung fields, can be riskier. BC requires that all physiotherapists who wish to practice dry needling have practiced for at least 2 years prior to undertaking any courses. They also approve only those educational institutions who meet their standards for safe and effective practice.

We are pleased to share that every one of our Sun City Locations has at least one physiotherapist trained and certified in dry needling. If you wish to book with one of our certified physiotherapists, please give us a call and we’ll be happy to assist you in your recovery.

Katarina Green is a registered physiotherapist who is trained in both Acupuncture and IMS.

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“Ring Theory” – Integrated Systems Model

Health and Exercise

“Ring Theory” – Integrated Systems Model

Some people think the Integrated Systems Model (ISM), sometimes known as ‘Ring Theory’ sounds like hocus pocus. But here’s the general theory which I am elaborating on from the ISM’s founder, British Columbia’s Diane Lee.

Imagine the body is a series of rings. Your cranium, each vertebrae, the pelvis, shoulders, hips, knees and ankles. It’s easiest to imagine in your thorax where your ribs attaching to your thoracic vertebra create actual rings.

Now imagine that one of those rings shifts due to an injury or simply due to an adopted movement pattern. Another ring in the stack will shift to accommodate and maintain the body’s centre of gravity within its base of support (for example, your feet, if you are standing).

These are normal adaptations and usually don’t cause us any problems, especially if those rings align again when we go to move. If they remain however, a non-optimal alignment can result in increased stresses on a joint, muscle, or nerve for example. As you can imagine this can become a concern over time resulting in overuse injuries or preventing an acute injury from healing as quickly.

If we can find the ‘driver’ or the ring shift that makes the overall alignment during a task better, I believe that is the path to recovery.

Things I love about this model:

You choose a task you want to improve on. For example, if stair climbing is something you find difficult we’ll work on that together. Even if you have multiple areas of concern, choosing a task requires a focus on function versus pain. And as function goes up, pain typically comes down.
I correct possible drivers until I find the one that makes the task easier. Often, if you are open to it, you will feel the difference in your ease of movement and / or notice the difference in the alignment of your body right away.
Even if you don’t have pain, but just want to have more ease doing an activity, this model will work for you.
Injuries don’t have to be chronic. They can be acute. Often a few sessions after the initial treatment of an acute injury, I will use the ISM to help make sure that any possible reasons for your initial injury are addressed. For example, was your shoulder injury precipitated by a thorax that isn’t rotating optimally when you throw? Or is it more related to your hips?

Downfalls of this method of assessment:

You have to be open to it. I try my best to help you feel the difference after a correction is made but the reality is if you aren’t open to the idea, it won’t work for you. And that is okay. There are many ways to treat an individual. This is just one of them.
People who have never or are unwilling to turn inward and be sensitive to changes in their body’s state have the most difficulty buying into this method. But often, I will make one correction and they will have a ‘wow’ moment – their task is no longer as difficult, feels lighter and more free.

Who this approach is for:

Most often these are people who have tried many other therapies yet haven’t experienced satisfying recovery.
People with multiple areas of concern.
Those with acute or chronic injuries.
People who would like a particular task or activity to feel easier.

During my assessments clients often say to me, “Why are you interested in that old injury? Or in that condition?” It is because your story paints a picture of your possible drivers too. If the Integrated Systems Model interests you, I hope you’ll come in and share your story with me.

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Pregnancy and the Benefits of Pelvic Floor Physiotherapy

Womens Health

Pregnancy and the Benefits of Pelvic Floor Physiotherapy

There are two key times of pelvic floor education: during pregnancy, and after pregnancy.

During pregnancy, you can work with your Pelvic Floor Physiotherapist to learn how to properly strengthen and relax the pelvic floor. A strong pelvic floor is important, but so is knowing how to relax the pelvic floor muscles, especially during childbirth.

You’ll learn strategies in preventing or reducing back pain and pelvic girdle pain (i.e. pubic symphysis dysfunction, sacroiliac joint (SIJ) pain).

In addition to learning strategies preparing for childbirth (such as perineal stretching, labor and birth positions, and more), you’ll come to better understand strategies for early postpartum recovery, especially during the first 6 weeks. The topics will include pain relief measures, early bowel and bladder optimization, early phase pelvic floor strengthening, and scar care strategies.

Another key area of education you’ll appreciate during pregnancy is optimal postures and positions for activities of daily living (such as lifting and carrying techniques, getting in and out of a car, etc).

After pregnancy, you’ll appreciate the benefits of Pelvic Floor Physiotherapy equally

First, restoring pelvic floor muscle function and addressing any issues in postpartum recovery (such as urinary or bowel incontinence, or prolapse) can make a significant improvement to you quality of life.

Working with your Pelvic Floor Physiotherapist, you’ll learn to desensitize and mobilize scar tissue (e.g. caesarean scar, episiotomy scar, perineal tear scar). Addressing pain with sexual activities is a visited topic; as is Diastasis Rectus Abdominis (DRA) – which addresses assessment and rehabilitation strategies.

Other important advantage to working with your Pelvic Floor Physiotherapist postpartum is guidance in returning to an exercise program.

To learn more about about pelvic floor education and treatment, book an appointment today.

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Rotator Cuff Injuries

Shoulders

Rotator Cuff Injuries

We’ve all heard of our rotator cuff, but what role does it play in our everyday movement and how does an injury affect us?

The rotator cuff plays a crucial role in moving and stabilizing the shoulder, allowing for a wide range of movements. It is vital for maintaining shoulder stability and enabling proper shoulder function. It helps keep the upper arm bone dynamically centred within the shoulder socket, allowing for smooth and coordinated movements. So, how do we injure it?

A rotator cuff injury refers to damage or tears in the group of muscles and tendons that surround the shoulder joint. Common causes of rotator cuff injuries include repetitive overhead motions, trauma or injury, and age-related degeneration. Whether it’s due to a sudden injury or gradual wear and tear, a rotator cuff injury can significantly impact a person’s quality of life, limiting their ability to perform tasks such as lifting, reaching, or throwing. It is often painful and can lead to weakness, limited range of motion, and difficulty performing everyday activities.

It is important to promptly seek appropriate treatment to alleviate pain, restore strength, and improve overall shoulder function.

Physiotherapy is an effective treatment option for rotator cuff injuries. A physiotherapist will evaluate the severity of the injury, assess the range of motion and strength of the shoulder, and develop a customized treatment plan.

Initially, treatment may focus on reducing pain and inflammation through techniques like ice therapy, electrotherapeutic modalities, and gentle exercises. As the healing progresses, physiotherapy will involve a combination of strengthening exercises to target the muscles of the rotator cuff, as well as stretches to improve flexibility. Manual therapy techniques such as joint mobilization and soft tissue massage may also be employed to enhance shoulder mobility and reduce muscle tension.

Through a progressive rehabilitation program, physiotherapy aims to restore strength, stability, and function to the shoulder, enabling individuals to regain their normal activities and prevent future injuries.

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Spotlight on Scoliosis

Physio Articles

Spotlight on Scoliosis

Scoliosis is a spinal deformity – famously known as a “sideways” curve of the spine. It is most often found during adolescence and affects about three in every hundred Canadians.

As the spine curves it can cause changes in body morphology like unevenness in the hips, waist, and shoulders; a spot that “sticks out” on the ribs and/or back; and a shoulder blade that “pokes out”. Scoliosis patients may experience increasing symptoms as the condition progresses, such as pain, breathing difficulty, osteoarthritis, mental health problems, and decreased health-related quality of life.

Historically, scoliosis was managed by monitoring the curve and implementing bracing or surgery. However, in recent years, physiotherapeutic scoliosis specific exercises (known as PSSE) have made their way into the recommended standard of care for scoliosis patients. These exercises are largely aimed at preventing the progression of/reducing the spinal curve, and, for those who undergo surgery or bracing, optimizing the results. Studies have shown that PSSE are effective for decreasing pain, improving quality of life, increasing back muscle endurance and range of motion, and improving self-image.

Most people with scoliosis can lead a healthy, active life. But a better understanding of the condition can help you to better address your discomfort, and empower you to seek the best treatment possible. Schroth is one of the most widely studied and used forms of PSSE. it offered by Sun City Physiotherapy in Lake Country by International Schroth Scoliosis Therapist Tamara Oakley.

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Golf Injuries

Sports

Golf Injuries

Each year in the Okanagan, golfers like me take to the links to whack balls left, right, and occasionally down the middle of the fairway. It’s often a humbling experience.

The sport of golf requires coordination, strength, flexibility, and most importantly, mobility. From the ankles, knees, hips and upward into the spine, rotational forces are generated to create precision and speed at the time of impact between the club face and ball. The golf swing is too complex to correct in this article (if I could fix this problem entirely, I’d probably be on my way to retirement), but I can explain some hip and spine movement mechanics that can help reduce stiffness and improve mobility – to ultimately achieve a more accurate output.

:In most cases, golfers struggle to move their bodies into the correct position at impact, possibly causing a “slice” or “hook”. These types of swings happen by either coming across the ball with an outside-in swing plane, or an inside-out swing plane. During the golf swing the hips are required to perform internal and external rotation. The hip muscles must work in conjunction with one another to properly move the leg within the hip socket. An inability of the hip joints to do this can cause an increase in arm movement, leading to inconsistency at impact. This is the same for the spine. The lower and middle back (lumbar/thoracic), are required to rotate and side-bend. Stiffness through the above regions reduces mobility and therefor minimizes the club arc, causing golfers to reduce their backswing which affects their follow-thru.

Through range-of-motion-exercises synchronized with breathing, golfers can improve their mobility of the joints, as touched on above. Once improvement is seen with mobility, it’s imperative to strengthen into the new ranges of motion. Golf is like any other sport, you need to prepare your body to perform. Below will be some attached exercises that you can implement at anytime throughout the golf season. I can’t promise more birdies, but I can help ensure your body will feel better during your round of golf!

Spine Health Exercises For Golf

1: Thoracic Extension with Foam Roller

2: Thoracic Rotation with Foam Roller

3: Half Kneeling Thoracic Rotation with Foam Roller

4: Half Kneeling Oblique Thoracic Rotation with Foam Roller

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Planter Heel Pain – Plantar Fasciitis

Foot and Ankle

Planter Heel Pain – Plantar Fasciitis

What Is PHP?

Plantar heel pain (PHP), commonly known as Plantar Fasciitis, refers to pain beneath the heel that is typically worse with weight-bearing activities. It is commonly characterized by pain on the first few steps in the morning, tenderness on the inside of the heel bone and increased pain walking barefoot on hard surfaces. The plantar fascia is thought to be the main source of this pain.

Why Is Treatment Important?

Planter heel pain affects up to 10% of populations and predominantly affects sedentary middle-aged and older adults. It is estimated to account for 8.0% of all injuries related to running. It is the most common foot condition treated in physiotherapy clinics.

How Do We Treat PHP?

A recent best practice guide¹ suggests treatment for people with PHP should include stretching, taping, and individualized education. Patients may also benefit from shockwave therapy, followed by custom foot orthotics.

How Can Physiotherapy Help?

Your Physiotherapists can diagnose your heel pain as well as identify the risk factors which can trigger plantar heel pain. They can help you through the management of this condition with individualized treatment such as stretching, manual therapy, taping, and modalities (ultrasound, electrical stimulation or shockwave therapy). At Sun City Physiotherapy, we use an evidence based practice to treat your Plantar heel pain and get you back to pain free movement!

¹Morrissey, D., Cotchett, M., J’Bari, A. S., Prior, T., Griffiths, I. B., Rathleff, M. S., … & Barton, C. J. (2021). Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values. British Journal of Sports Medicine, 55(19), 1106-1118.

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National Indigenous People’s Day

Events & News

National Indigenous People’s Day

Leading up to June 21st, 2023 – National Indigenous People’s Day – we acknowledge that at Sun City Physiotherapy we are privileged to work, play, and live on the traditional and unceded territory of the Syilx (Okanagan) Peoples.

The College of Physiotherapists in BC recently integrated Standard 21 – Indigenous Cultural Safety, Humility and Anti-Racism to the Practice Standards, which focuses on 6 core concepts. In 2020, a report called In Plain Sight was released outlining discrimination and prejudice in the health care system against Indigenous Peoples in B.C. This report was eye-awakening to the importance of declaring each clinic’s commitment to culturally safe care, and treating with humility. We also encourage everyone to look into this report and ways in which ones own bias may come into play as clients, patients, citizens, and practitioners.

As practitioners, we deeply value the one-on-one relationships – this includes embracing cultural differences. This is particularly important for individuals who may have had negative experiences with healthcare providers in the past, such as discrimination or bias. By understanding factors, such as social determinants of health, and addressing them in care, our practitioners can improve outcomes for their clients and contribute to a more equitable healthcare system in British Columbia.

On that note, being culturally safe is an integral aspect of healthcare, and we stand by this statement at Sun City Physiotherapy. Culturally safe care entails creating an environment that is respectful, welcoming, and culturally appropriate for our clients of all backgrounds. We believe that clients from all cultures deserve to feel comfortable and receive effective care to meet their unique needs, while feeling safe and respected. We hope you feel a deep trust in our Physiotherapists, RMTs, kinesiologist, dietician, counsellor, and client care team. Fostering this model of care can also help reduce disparities in healthcare outcomes.

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Shoulder Pain in Throwers

Shoulders

Shoulder Pain in Throwers

Each spring, at the beginning of baseball and softball season, people will develop pain and soreness in the arm and shoulder when throwing, or after throwing. This can linger or worsen as the season goes, potentially zapping their throwing strength and their ability to participate when it could easily be corrected.

Typically, this pain is a result of overuse or strain on the rotator cuff muscles. Throwing is a very demanding task on the shoulder and requires a sturdy foundation of strength within the rotator cuff muscle group and mobility of the entire shoulder. When we go from not throwing through winter (except maybe the odd snowball) to getting out on the field in spring, it can be a very abrupt change, and therefore, overworks these small supporting rotator cuff muscles. These muscles can then become very tense or tight, and the tendons can become painful from being over worked. Combine this with poor or limited range of motion or mobility and it becomes even more challenging to throw comfortably.

Prevention can be addressed by doing some simple exercises to strengthen the rotator cuff so that it can better support the high demands of the throwing motion. Taking care to warm-up properly is vital. The rule of thumb should be, “warm-up to throw, don’t throw to warm-up!”. This will make huge improvement to comfort and performance.

Try these four quick basic warm-up exercises.

Arm circles: starting small at shoulder height moving to large circles
over 30 seconds. Forwards and backwards
AROM IR/ER starting at sides gradually moving up to 90 abd 30 seconds
Banded IR @ 90 Abd 2×15
Banded ER @ 90 Abd 2×15

Through physiotherapy, we can address excessive tightness, and work to improve strength. Manual therapy and IMS, which can help reduce pain and restore the range of movement needed to throw. Modalities can be applied to settle any inflammation which may have developed.

Education is key to better learn how to warm-up properly for throwing. It is equally important to identify which muscles need to be strengthened properly and how to do it. Your Physiotherapist can guide you through the steps.

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TMJ Dysfunction

Sun City Physiotherapy Locations

Phone: 250-861-8056

Phone: 250-762-6313

Phone: 250-766-2544

Phone: 778-699-2006

Dry Needling

Sun City Physiotherapy Locations

Phone: 250-861-8056

Phone: 250-762-6313

Phone: 250-766-2544

Phone: 778-699-2006

“Ring Theory” – Integrated Systems Model

Sun City Physiotherapy Locations

Phone: 250-861-8056

Phone: 250-762-6313

Phone: 250-766-2544

Phone: 778-699-2006

Pregnancy and the Benefits of Pelvic Floor Physiotherapy

Sun City Physiotherapy Locations

Phone: 250-861-8056

Phone: 250-762-6313

Phone: 250-766-2544

Phone: 778-699-2006

Rotator Cuff Injuries

Sun City Physiotherapy Locations

Phone: 250-861-8056

Phone: 250-762-6313

Phone: 250-766-2544

Phone: 778-699-2006

Spotlight on Scoliosis

Sun City Physiotherapy Locations

Phone: 250-861-8056

Phone: 250-762-6313

Phone: 250-766-2544

Phone: 778-699-2006

Golf Injuries

Spine Health Exercises For Golf

Sun City Physiotherapy Locations

Phone: 250-861-8056

Phone: 250-762-6313

Phone: 250-766-2544

Phone: 778-699-2006

Planter Heel Pain – Plantar Fasciitis

Sun City Physiotherapy Locations

Phone: 250-861-8056

Phone: 250-762-6313

Phone: 250-766-2544

Phone: 778-699-2006

National Indigenous People’s Day

Sun City Physiotherapy Locations

Phone: 250-861-8056

Phone: 250-762-6313

Phone: 250-766-2544

Phone: 778-699-2006

Shoulder Pain in Throwers

Sun City Physiotherapy Locations

Phone: 250-861-8056

Phone: 250-762-6313

Phone: 250-766-2544

Phone: 778-699-2006