All posts in Physiotherapy

Motion is lotion

Motion is lotion

Understanding the “Why” behind Movement & Exercise

How do our mindset and beliefs around exercise affect the decisions we make? This blog explores the nitty-gritty of the “why” movement and exercise are beneficial to you in order to help you make the change you are seeking.

As Physiotherapists, one part of our job is to provide evidence-based education to our patients about the importance of movement and exercise. Movement can be active (something you do) or passive (something that is done to you such as joint mobilisation or muscle/nerve/fascia release as common examples). Saanich Physiotherapy  and Sports Clinic prides itself in providing an engaging holistic approach to your health & wellbeing. Movement and exercise are but one part of that approach.

We are each of us unique. We come with complexities and intricacies that make us who we are. In order to delve deeper to understand the “why”, it is important to highlight that all injuries are not the same, even if they are the same injury. Equally so, all pain is not the same, despite the pain seeming to originate from a particular region. Confused? It’s ok, it’s a little bit complex, but I promise to break it down for you so it’s easy to digest. No-one likes pain and our brains are wired to take short cut’s. It’s part of being human. We all want a quick fix. We don’t have time for this pain or injury. It’s stressing us out. Sometimes a quick fix can work to provide some temporary relief, and that’s ok. However, there is usually more to the story and so I will tell you about what we’ve learnt from the many 1000’s of patients we have had the pleasure of helping by getting to know their stories around exercise and movement.

If you’ve tried quick fixes and you haven’t solved the issue your internal voice may speak up and tell you to “do exercises to fix the issue”. That seems logical. Then you probably google it.

Movement and exercise to fix an issue

If logic has taken you on a bypass route straight to a Dr Google search or an Instagram video providing a generic or formulaic approach to exercise as a “fix”, the bypass route will not provide all the answers you need and may even steer you in the wrong direction. There is nothing wrong with information however, which information is critical. Which exercises? When to do them? How many to do? How often to do? When to increase? When to decrease? When to change? What if I get worse? Do I persist? Do I modify? How should I modify? These and many more questions will not be answered by trying to skip the longer scenic route with your physiotherapist as your co-driver and guide to improving your skill. Heading straight to the bypass route either solo or with only partial information that applies to you specifically will often lead to an aggravation of your pain and a delay in the healing process.

Please don’t stop reading here as there is so much more to share with you. Your Physiotherapists job is to know people and people are like complex ecosystems. Bodies – brains, hormones, muscles, bones, tendons, ligaments, nerves, fascia, neural networks, chemicals transmitting signals everywhere, emotions, expectations, histories, unconscious and conscious biases and everything that makes you tick, it’s all interacting with your environment, with other people, constantly re-evaluating. How amazing is that? People are awesome. You are awesome and that is why you need a multifaceted and complex problem-solving approach to your treatment. That is what we do. There are no exceptions. None of us can say we are exempt, we don’t get to opt-out, as we are all made up of the same pieces, it’s just that our jigsaw puzzle, once completed, like our neural networks and their interconnectedness, looks different to anyone else’s. And that is the beauty of people and everything each of us brings with us.

Mindset and Beliefs

Before we look at the “why” exercise is important, it is imperative to understand the mindset and beliefs we each carry within us in relation to movement and exercise. Simply hearing the word “exercise” can invoke a range of varying emotions and responses in each of us. These responses are based on our subconscious and conscious biases, our way of thinking, our past and recent experiences.

We all know exercise is supposed to be good for us – but “knowing” is simply often not enough to make the leap to effect a change in our behaviour, specifically around learning and developing new patterns of behaviour. In order to learn and lay down new habits, we must “do”, we need to act and we must “repeat”. Another vital link to laying down new patterns of behaviour is attributing a positive meaning to our new “doing”, in this case, exercise. Here we explore a range of common responses to exercise prescription or even the thought of doing exercises and the likely mindset linked to each.

This could be anything from:
*a closed mindset response – I am not doing that
*a negative mindset response- I don’t want to do that
*a stress response – I don’t have time
*a fear response – I can’t do that
*an avoidance response – that doesn’t apply to me
*an unsure response – I didn’t know that could help
*an angry response – I don’t want exercises. I just want someone to fix me
*a curious mindset response– how will that help me, can you tell me more so I can understand?
*an open mindset response – I will do my best to execute that
*an eager response – what can I do to help myself
*an overeager response – If I just do a lot of these this should fix my issue
*an honest response – I may not have the time, nor energy, but I understand that this can help me so I’ll give it a try
* a mindful response ­ I will tell myself I’ve done a good job when I do my exercises, even if it’s not as often as it could be, I am doing the best I can at this moment.
*a non-judgemental response – I will not tell myself off if I don’t do my exercises as this is not helpful to me learning new patterns of movement and exercises.

Exercise prescription – Finally the nitty-gritty of why exercise and movement are good for us

Exercise prescription can be given for a range of reasons too. The majority of the physiotherapy patient population are prescribed exercises for improving the functionality of a muscle – it may be weak, lacking endurance capacity or overactive and tight. A muscle can also be slow at responding to input from our immediate surroundings which can affect our sense of balance and lead to issues such as falling over.

However, exercise can be given for other reasons too, such as pain modulation, down-regulating an overactive and sensitized nervous system, improvement in bone density, decreasing stress hormones (ie cortisol ) and substance p ( a neurotransmitter & neuromodulating chemical responsible for providing information back to our central nervous system about pain sensations in the body), to minimise and manage the inflammatory chemical response to acute injury or chronic stress on the immune system ( there are many inflammatory mediating chemicals that are produced inside our bodies such as histamines, prostaglandins and bradykinin – this one increases the bodies sensitivity to pain).

Exercise and diet may also assist in the management of overproduction of pro-inflammatory hormones (such as insulin and eicosanoids). An overproduction of these hormones can lead to chronic hyperactivity of our immune system and the development of immune system disorders (including but not limited to rheumatoid arthritis, Crohns’s disease, asthma, ulcers, cancer, atherosclerosis {heart disease}, sinusitis and more ).

Exercise decreases the levels of TNF (tumour necrosis factor) and CRP (C-reactive protein), which are both involved in systemic inflammation. In order to maximise the benefits of exercise and avoid chronic inflammation, we need to ensure we allow sufficient time for your body to recover after each strenuous exercise session.

Foods that increase the inflammatory response in our body are sugars, refined carbohydrates, saturated fats, trans fats, omega 6 fatty acids, MSG, gluten and casein (arthritis.org ).

Exercise can help us to get to sleep (when we get into a regular morning exercise routine our brain produces a sleep chemical called melatonin and exercise also stimulate the brain to produce a chemical called adenosine which makes us feel sleepy). Your circadian rhythm (your natural sleep/wake cycle) is maintained with regular exercise and therefore your sleep patterns are maintained consistently. This is very important in the management of pain and mental health stability.
Exercise regulates our mental health by reducing the body’s arousal, anxiety and depressive symptoms (after exercise our brain produces endorphins, dopamine, norepinephrine, and serotonin and these chemicals make us feel happy and improves our sense of wellbeing ).

Exercise helps our brains remain engaged. As we age, our brain needs to keep learning new things to keep it active and exercise can play a major role in keeping neural circuits in our brain open or creating new neural circuits. By engaging in exercise, we effectively slow down the process of ageing. Working on proprioception, which is your brains understanding of where you are in the world, you can improve your balance reactions, allowing you to do more for yourself and prevent falls.

So that is my condensed version of the nitty-gritty of why exercise is good for us. For me, I enjoyed sharing with you my passion for moving and I hope you learned a few new things too; and now both you, who has most likely sat for a length of time to read this article and me, as I have sat for a lengthier time to write this article, need to get up and move.

More

Treating Chronic Pain

Treating Chronic Pain

Breaking the cycle of chronic pain. What is chronic pain?

Upto one in five Canadian adults suffer from chronic pain. It affects one in five people globally and is the primary reason people seek medical treatment. In most cases, chronic pain starts with an acute injury or illness. Sometimes, what can happen, is that even after you’ve healed from an injury, surgery or other conditions, the pain continues. If the pain lasts longer than 3 months it’s then considered chronic pain.

Chronic pain syndrome can then be considered short term pain, or acute pain, that doesn’t go away and has a physical and psychological impact on a person’s life. Chronic pain syndrome often creates secondary complications such as sleep deprivation, depression, irritability and fatigue, affecting a person’s personal and social relationships.

What is Pain?

Pain functions as a warning signal. The nervous system senses danger and responds to it with actions called guarding responses, designed to protect and defend us from further injury or harm.

Muscle tension, decreased range of motion, anxiety, fear of movement, increased sympathetic responses (raised heart rate, increased blood pressure, change in respiration) and a mechanism called low pain threshold (becoming excessively sensitive to pain and minor impulse or stress to the body region cause pain) are all consequences of the guarding response. This is the way the body protects itself from future painful incidents.
In chronic pain, even after the injury has healed, this mechanism remains and continues to affect the body creating a vicious cycle of real pain.

Your Brain and Pain

When we adopt this instinct to guard ourselves against future pain, it actually does the opposite and keeps feeding your pain cycle and increasing symptoms including pain (scientific research “Pain Processing in the Human Nervous System: A Selective Review of Nociceptive and behavioral Pathways). This guarding mechanism is most likely to occur to those people that view their pain or condition as a threat, rather than something that just is and that in all likelihood can be overcome or at worst worked through towards acceptance and continuing on with life in as normal or your new normal way as possible.
Being extremely apprehensive about your injury and symptoms, avoiding activities believing that that may be harmful, stress and negative emotions are coupled with autonomic, endocrine, and immune responses which may amplify pain through a number of psychophysiological pathways prolonging your “fight or flight” response to the original injury. This will lead to a downward cycle of deconditioning, weakness, muscle spasms and/or tension, increased anxiety and depression.

What can Saanich Physiotherapy and Sports Clinic do to help reverse pain?

Part of our job as physiotherapists and massage therapists is to help you and guide you, our patients, to overcome any fear avoidance behaviour (learned fear), such as fear of movement, by using not only hands-on treatment, dry needling or exercises, to target your injury or pain, but to talk to, explain and assist you in understanding the way that pain and our brain works. We can help you to overcome or negate some of these non-helpful brain responses. By doing this we help you to down-regulate your brains protective response in order to minimise your pain experience.

Working with you in this 1:1 way, taps into your brain and nervous system. Your brain and nervous system is complex. We can work with you to change your neural pathways and learned patterns of thinking and beliefs that in turn produces more of your own natural brain chemicals like endorphins. This resetting and rebalancing, forming positive neural/brain connections, plays a large part in you overcoming your injury or pain experience.

Of course, each individual person is unique and we all come with our own history and life story that also plays a major part in how we experience pain and how we as therapists target your particular treatment. The way we think about our pain and ourselves, how we act and what kind of self-talk we undertake can all play a major role in the way that our Physiotherapists work with you, our patients who suffer from injury, pain, chronic pain, pain sensitivity, learned fear, anxiety, and depression.

More

Knee Osteoarthritis

Knee Osteoarthritis

What is it?

Osteoarthritis (OA) is a common degenerative joint disease that affects almost all the joints of the body. The knees are some of the most commonly affected joints, with many people experiencing at least a small degree of osteoarthritis over the age of 40. The disease is characterized by degradation of the cartilage that lines the surfaces of the joint, growth of osteophytes or bony spurs, pain, stiffness and swelling.

What are the symptoms?

Stiffness in the morning that lasts less than 20 minutes and pain with movement, clicking, crepitus, swelling and a generalized reduction in joint range of motion are all common symptoms of osteoarthritis. As OA is a progressive disease, the condition is categorized into stages to help describe symptoms and guide treatment. Early stages of OA may have only mild symptoms, however as the disease progresses, a joint replacement may be required.

What causes it?

While aging is the most significant risk factor for the development of OA, it’s not an inevitable outcome of growing older. Other factors that may predict the development of OA are obesity, family history, previous joint injury, high impact sporting activities and peripheral neuropathy. It is thought that abnormal wear and tear or stress on the joint is the primary cause of OA. It is also important to note that many people will have changes on X-Ray that show OA, however, will have no symptoms – which indicates that simply having OA is not a sentence for having pain.

What is the treatment?

Your physiotherapist is first able to help diagnosis and differentiate OA from other conditions that may have similar symptoms. An X-Ray can confirm the diagnosis and can be helpful in determining the best course of treatment to follow.

While OA is a progressive disorder, there is often a significant improvement that can be made simply by addressing lifestyle factors and any biomechanical factors that may be contributing to pain.

How can physio help?

Your physiotherapist is able to guide you with strengthening exercises to support the joint, advice for adapting your exercise routine and can even help you to lose weight, all of which have been shown to have a positive impact on the symptoms of OA.

If surgery is the right course for you, your physiotherapist is able to guide you through this treatment pathway, helping you to prepare and recover from surgery to get the best outcome possible.

None of the information in this article is a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.

More

Swimmer’s shoulder

Swimmer’s shoulder

With ninety percent of the driving forces coming from the upper body, it is little surprise that swimmer’s shoulder is a common condition in swimming. The shoulder is a complex joint, and as swimming placed it under load, an appreciation of its function and limitations can help keep the body injury free. This is especially true for those who swim very regularly or have poor stroke technique, as they are most at risk.

Shoulder mobility as a strength and a weakness

Compared to other joints in the body, the shoulders and hips have an unparalleled range of motion. This is due both of them having ball and socket joints capable of a 360 degree conical movement. However, stability for each of these joints differs. The hip joint fits snugly like a ball in a glove, as the rounded head of the thigh bone, fits into the deep, cup shaped socket of the pelvis. Unlike the hip, the shoulder has a small flat socket about half the size of the ball, along with several other bones, plus a collection of muscles and tendons that support this wide range of motion. Although one of the largest and most complex joints in the body, its unique structure is also a weakness, as the shoulder accounts for up to 20% of all athletic injuries and is the most commonly dislocated joint in the body.

This balance between shoulder mobility and stability is put to the test during sports that require overhead motion. Racket sports such as tennis, or throwing sports like volleyball require two or three patterns of overhead movement. Swimming however, requires multiple overhead movement patterns and a steady conical 360 degree motion of the humerus, the bone of the upper arm. This bone fits into a socket of the scapula, more commonly known as the shoulder blade, which has a cuff of cartilage called the labrum. This ring of rubbery tissue helps keep the ball like head of the humerus in place.
As the humerus fits loosely into the shoulder joint compared to the hip, a collection of muscles and tendons known as the rotator cuff, provide support for raising and rotating the arm. To further aid fluid motion there is a small sac of fluid called a bursa that protects and cushions the rotator cuff tendons. It lies between the rotator cuff and the roof of the shoulder blade, which has two bony projections, the coracoid process and the acromion, which is above the bursa and attaches to the clavicle. Otherwise known as the collar bone, the clavicle, makes up one of three bones of the shoulder, the other two being the previously mentioned humerus and scapula. These three bones are connected to the shoulder by four joints, one being the ball and socket joint of the humerus and scapula, one for where the scapula meets the ribs at the back, and two for the clavicle which joins the scapula at one end and the chest bone at the other.

All of these structures have the potential to be injured, and as such swimmer’s shoulder can derive from a variety of sources. An appreciation of the forces at work upon the body during swimming, can provide a greater understanding of the root cause of swimmer’s shoulder.

The sources of swimmer’s shoulder

Good swimming technique requires a greater range of motion and flexibility of the shoulder compared to other sports and plays a major role in the upper body’s ability to provide locomotion. This placing of the shoulder under load, is further increased since swimming is performed in a fluid medium. As opposed to air, water creates greater resistance and forces upon the structures of the shoulder.

In one study, two thirds of the elite swimmers reported shoulder pain. In some cases swimmer’s shoulder can involve irritation to the tendons of the rotator cuff muscles, but it can also be due a range of painful shoulder overuse injuries such as impingement. This is where the shoulder blade’s bony point that joins with the collar bone, rubs on the rotor cuff and bursa. This can then lead to inflammation of the bursa, known as bursitis, or tendonitis.

The four tendons that make up the rotator cuff and one of the bicep tendons are most commonly affected by tendonitis, once again as a result of wear. Like with any other joint in the body, the ligaments, tendons, and muscles around the shoulder can tear or become loose. This can lead to instability in the shoulder and the chance of greater injury, such as a tear to the the ring of cartilage that holds the humerus in place, or dislocation. Also these areas can be affected by chronic conditions such as osteoarthritis.

The repeated overhead motion of the arm in swimming and pressures placed upon the shoulder joints in water, mean that immediate care of a newly acquired injury and preventative measures are essential. Seeking physiotherapy treatment can identify the exact area of injury, alleviate pain and then planning can be put into place to regain stability, strength and flexibility. For example a gym program with some simple strength and flexibility exercises can be easily prescribed. Through future self management of the swimmer’s shoulder condition there lies the opportunity to proactively train the body so as to minimise the risk of injury.

Managing shoulder health

First of all as with any inflammation injury, the PRICE principle should be applied to the shoulder. This is achieved by protecting the injured area, resting the shoulder, applying ice for 15-20 minutes every two to three hours, compression with a bandage and elevation of the arm above the level of the heart.
Once the area has recovered due to rest or treatment by a physiotherapist, and a strengthening plan has been devised for the injured area and surrounding structures, then it is time to venture back into the water. At this point advice from your physiotherapist, doctor should be taken and the help of a qualified swimming professional or experienced swimmer could ease the transition back to the pool.
After all investigating and understanding proper swimming stroke technique, could prevent a relapse of injury and aid in the rehabilitation of an recovered shoulder. It is also important to know the limits that a recovering shoulder can take, being sure to train conservatively so as to avoid tired muscles. This is also true for those who are injury free, as training at a limit within the body’s fitness level will maintain stability of the shoulder and aid correct function.

Prevention through correct technique

Swimmer’s shoulder can develop with all styles of swimming, with freestyle, backstroke and butterfly seen to be the most responsible for injury, as the arms circle overhead. Although the most gentle looking, breast stroke still places pressure on other parts of the body, and like the other styles, requires good technique to avoid injury. So an option could be to vary the types of swim stroke performed, as this can provide rest and recovery to muscles, joints and tendons that would otherwise be overworked. Refining the technique and building the strength of each swimming stroke style can also avoid other swimming conditions that effect the knees, neck and lower back.

In general terms there are four areas of swimming technique that can aid protection against shoulder injury. As with land based activities, good posture is essential, so keeping the shoulders back and the chest forward will help. Next is developing symmetrical body rotation, that is encouraged by a balanced left and right breathing pattern. This allows for better support to the rotator cuff and generates more power by engaging the muscles of the back and core.

Regarding the best practice for stroke technique, hand placement as the arm enters the water and the shape of the arm when pulling through the water, are also essential in injury avoidance. It is best to have a flat hand as it enters the water at the start of a stroke. This is fingertips first, rather than thumb whereby the arm is rotated outwards. Lastly as the hand then catches the water and pulls through, the elbow should be high so that the water is pushed back, rather than down when the elbow is dropped or the arm is very straight.

More