A Running Analysis at Saanich Physio involves one of our experienced Physiotherapists observing and assessing how you run. We will watch you in real time and also video you, so that we can analyse your form in slow motion.
This kind of analysis is helpful whether you have an injury or if you want to know if you are running with optimal technique. We will explain our findings to you, with analysis of how certain movement patterns or imbalances may contribute to your injury or efficiency as a runner.
We highly recommend this no matter what level of ability you are, whether a beginner, weekend jogger or competitive athlete.
We Are Runners
We feel that in order to understand runners and running injuries, it’s helpful to be a runner yourself. Our Physiotherapists are all keen runners and between them have competed in short and mid distance track events all the way up to half marathons, full marathons and ultra-marathon distances.
We watch you run in real time, then record you and analyse your form using slow motion video. We will outline how your form compares to the ideal. We will only look to change particular elements of your form if it is impacting on your injury, efficiency or if it will help you prevent injury.
We focus on education, with a clear explanation of our findings and how they impact your body. We work with you to achieve a more efficient running technique.
Our aim is to get you back running as quickly as possible if injury is stopping you. We will provide specifically targeted exercises and a return to running program if needed. Our aim is to help you achieve a stronger form, become more efficient, and prevent injury.
Our experienced Saanich Physiotherapists will analyse your running technique and help you achieve better form to prevent injury and maximise efficiency.
Your Physiotherapist will start by discussing your running program and injury history with you.
They will then video you running. From observing you in real time and also through slow motion recording, they will explain what ideal running form is and how your technique compares.
Based on the findings from the video analysis we can give you specific and individualised cues to help improve your form. You will have a chance within the session to practice this on the treadmill and review your video footage.
A biomechanical assessment may also be performed to test your joints and muscles for flexibility and strength. From this information we will create a specific and focused treatment plan that will work to correct your imbalances and help you become a better runner.
Three Steps to Better Form
Video analysis and running assessment software
Biomechanical assessment of your strength and flexibility
Personalised video home exercise program which can be accessed on your smartphone or computer
Patellofemoral joint injury/runner’s knee
Tibialis posterior tendon injury
Iliotibial band syndrome
Hip impingement, labral injuries
Chronic strains and sprains
What is Dry Needling?
Dry Needling is a specialised form of treatment that we use for reducing your pain and inflammation. Your trigger points are targeted with acupuncture needles to treat your pain, muscle tension, injury, and dysfunction. Dry Needling treatment is highly effective and you will often feel immediate pain relief as your muscles relax.
Common injuries treated with Dry Needling
Headaches & Migraine
Carpal Tunnel Syndrome
Hip & Knee Pain
How does Dry Needling work?
Needles are usually used to target painful trigger points in muscles. The penetration of the needle causes a micro-trauma that increases blood flow and alters the chemical balance in the muscle, assisting with muscle relaxation and healing.
The stimulation of pain receptors also causes the body to release opioids (e.g. endorphins). These are natural pain relievers in your brain. Their release provides further pain relief to you.
Your muscle may respond with a twitch response to the needle stimulation. This is a highly effective form of dry needling treatment and you often feel immediate benefits from this form of release. Your muscle releases tension and lengthens. Substance p, a pain chemical in your body, as well as inflammatory chemicals are eliminated around your trigger point. Flushing out these nasty chemicals can provide a longer lasting pain relief.
How is Dry Needling different to Acupuncture?
Acupuncture generally refers to the traditional Chinese medicine which is based on stimulating the flow of Chi (energy) through the meridians of the body, whereas Dry Needling is based on anatomical and neurophysiological principles. While the dry needles are the same and many of the ideas behind acupuncture are still applicable, the principles behind the use of Needling are very different.
Often people may use the term acupuncture when referring to Dry Needling so if you have had acupuncture in the past it could have been Dry Needles.
Is Dry Needling Physiotherapy safe?
Dry Needling Physio is very safe. There are certain factors that may make you unsuitable for Needling or that require extra care to be taken (e.g. Diabetes) but your Physio will consider these. All dry needles are sterile and used once before being disposed of safely in a sharps container.
Will Dry Needling Hurt?
One of the great advantages of Dry Needles over deep tissue massage for muscle release is that there is generally less pain both during and after treatment.
Most people don’t feel the insertion of the dry needle. When the needle penetrates the trigger point, you may feel an initial twitch or deep ache that quickly settles to become a light dull ache, warmth, heaviness or nothing at all. This is far better than the constant feeling associated with a firm massage that would be required to achieve an equal effect.
After Dry Needling Physio treatment there is often no or little soreness. Sometimes you may feel slightly tight, sore or an ache for a short time (up to 1-2 days). This again is invariably much less that than felt after massage and soft tissues techniques.
The Piriformis Muscle
Do you have pain in your buttock? Low Back Pain? Your Piriformis muscle may be the culprit.
Your Piriformis muscle is a small, deep, buttock muscle. Many of us have a tight piriformis muscle which can cause pain issues in your gluteal/buttock region as it passes right over your sciatic nerve. When your piriformis becomes tight it can compress your sciatic nerve and start creating all kinds of issues. Many of us sit at computer desks for many hours on most days. This essentially means that you sit on your sciatic nerve, gluteal muscles and piriformis muscle every day. If your nerve is calm and not irritated, that feels ok but if it is stirred up from a tight piriformis muscle your gluteal and buttock region can become extremely painful.
Symptoms of piriformis muscle syndrome
If your piriformis is irritated you may feel pain in your buttock region, pain down your leg, numbness and tingling traveling into your leg and foot, pain on sitting, standing and squatting down.
Our therapists determine if your sciatic nerve pain is originating from your piriformis muscle or from your spine. If your piriformis muscle is the culprit, you will feel like your pain originates in your buttock regions, not your spine. Another distinction between the two origins of your pain is that with a tight piriformis muscle you usually won’t have muscle weakness in the affected lower limb side whereas you if your pain originates from your spine you may get symptoms down the affected limb side.
Some men have had a sciatic nerve irritation caused or aggravated by sitting on their wallet in their back pocket. “Note– Never sit on your wallet” Piriformis muscle pain doesn’t have to be isolated to the muscle itself. You can have SIJ (sacroiliac joint) pain and wider spread gluteal muscle pain too.
Piriformis Muscle Treatment
Your physiotherapist will first identify the cause of your pain and symptoms. This may include a biomechanical assessment of certain movements involving your lower limbs and pelvis. We will then target hands-on treatment to release your tight Piriformis muscle. We will also assess and treat any tightness or symptoms around your other gluteal muscles and lower back if they are contributing to your pain issues. Treatment techniques that may be helpful include IMS Dry needling and Shockwave Therapy.
K. Raveendran MD, Trauma Surgeon
International Journal of Surgery
Volume 24, Part B, December 2015, Pages 113-114
Extracorporeal shock wave therapy (ESWT) was first used in vivo for the disintegration of renal and ureteric calculi in 1980 followed shortly by its use for gallbladder calculi in 1985.
In 1988, the use of these acoustic waves was tried successfully for the treatment of nonunion of long bone fractures in Germany. In the nineties, shock wave therapy was used for the treatment of plantar fasciitis, lateral epicondylitis (tennis elbow) and calcific rotator cuff tendinitis.
Over the last two decades the use of ESWT has grown by leaps and bounds, and this special issue with twenty invited articles will try to inform you of the current concepts in the use of ESWT.
There are five original full-length articles and 15 review articles covering the cellular mechanisms and the clinical uses of ESWT. The first invited article is a prospective study by Gerdesmeyer et al.  showing that bone mineral density (BMD) increased six weeks after ESWT, and was statistically significant at twelve weeks. However it is not clear whether this effect on BMD is permanent or regresses after a few months. This study is very exciting as it indicates the possibility of treating osteoporosis with ESWT.
The experimental study by Santos et al.  from Brazil showed an increase of sulfated glycosaminoglycan in rat femurs after the application of ESWT. This suggests that shock waves can prolong anabolism of GAGs and also may have systemic effects. This study helps us to understand the multifactorial effects of ESWT on bone healing. Sukubo et al.  studied the effect of low dose shock waves on macrophages in vitro and showed their probable role in the prevention of fibrosis.
In this article from Taiwan, Kuo et al.  showed that the union rate was 100 percent after the application of ESWT twelve months from initial surgery (8 out of 8 patients), and 42.9 percent when applied after twelve months (6 out of 14 patients). This study albeit small is very encouraging for this difficult condition of atrophic nonunion. It also showed that ESWT could be followed by additional surgeries without any adverse effects. Atrophic nonunion is due to compromised vascularity, and ESWT through its neovascularization effect facilitates bony union.
This original paper on radial shock wave treatment in patients with plantar heel pain by Rompe et al.  is significant as it validates the successful use of radial as compared to focused shock waves. It also shows that a simple programme of manual stretching exercises after ESWT produces significantly better results at four months after initial therapy.
The blasting of urinary and biliary calculi is purely mechanical but low energy shock waves have shown a mechanotransduction effect on the biochemistry of the cell. This has helped us to understand the healing powers of ESWT in various tissues. Cheng and Wang  acknowledge that the biological mechanism of shock waves in bone is still unknown. In this review they cite many studies on the molecular basis of bone healing, improvement of osteonecrosis and osteochondrogenesis. Shock waves do not induce cracks or micro damage the bone. ESWT may replace surgery for nonunion of long bone fractures without the surgical risks.
The review by d’Agostino et al.  traces the history of ESWT to its present status, where the concept of mechanotransduction helps us to understand why acoustic waves can lead to tendon and bone healing. This article and its many references will help us to understand how ESWT is a healing procedure.
ESWT in Achilles tendinopathy is a well-established indication and this review by Gerdesmeyer et al.  of the current evidence updates our knowledge of this fairly common condition. The article documents the high evidence of published studies of the efficacy of ESWT in Achilles tendinopathy and concludes that shock wave therapy is the most effective modality of treatment for chronic Achilles tendinopathy.
The review of the treatment of chronic patella tendinopathy with ESWT by Leal et al.  reinforces the excellent results of ESWT in the treatment of various tendinopathies in the last fifteen years. The best results are achieved when used in combination with eccentric exercises and standardized physical therapy protocols. The title of this review on lateral condylitis (tennis elbow) says it all. This is an overuse syndrome and is one of the most treated conditions with ESWT. This article by Thiele et al.  documents the historical use of shock wave for lateral condylitis since 1996 with mixed results in initial studies. Later studies showed more positive results. Efficacy has been well demonstrated and treatment procedures standardized. Only Level 1-b studies were included in this overview and the authors concluded that repeated applications of ESWT should be performed before resorting to surgery.
The review by Moya et al.  on current knowledge of evidence based ESWT for shoulder pathology emphasizes the excellent results for calcific shoulder tendinopathy. This is one of the two main indications for the use of ESWT in musculoskeletal disorders together with plantar fasciitis. However shock wave therapy is being increasingly used for non-calcific shoulder tendinopathies. The review also highlights the rare complication of humeral head necrosis (two reports). It has also been often used for frozen shoulder, bicipital tendinitis and postoperative shoulder stiffness. However these indications are still controversial.
Is ESWT the first choice treatment for fracture non-unions? Schaden et al.  believe it to be so after long personal experience and an extensive review of the literature in this article. There are more than twenty publications reporting on the good results of ESWT in fracture non-unions with practically no side effects. A non-union gap of more than 5 mm in long bones is a negative factor for a successful outcome. ESWT should be used after failed internal fixation or with the addition of a plaster cast, orthosis or an external fixator.
Two reviews on the use of ESWT for avascular necrosis of the femoral head by Wang et al.  and Russo et al.  describes this fairly new therapy for this difficult condition. Although the exact mechanism is unknown, histopathological studies of retrieved femoral heads have shown viable bone and cellular proliferation after ESWT. Studies have shown that ESWT is more effective that the gold standard of core decompression and bone grafting for early avascular necrosis of the femoral head.
By: K Ravenndran, MD Trauma Surgeon
International Journal of Surgery
Volume 24, Part B, December 2015, Pages 113-114
The good results have led surgeons to extrapolate the use of ESWT in adult osteochondritis dissecans. This review by Thiele et al.  on osteochondritis of the knee and talus published studies on this relatively new indication. The authors conclude that shock wave should be considered before any surgical intervention in early cases.
We continue on our journey on bone treatment with the use of ESWT in stress fractures by Leal et al. . This comprehensive review of stress fractures in general is worth reading. ESWT is a relatively new treatment modality. There are several case reports and series with encouraging results for the use of ESWT in stress fractures.
Myofascial pain syndrome and fibromyalgia always evokes mixed feelings among doctors and this comprehensive review by Ramon et al.  helps us to understand the pathophysiology of this common disorder. ESWT is a novel therapy for these painful conditions and should be done together with a supervised exercise programme. These indications are still under investigation.
We leave the field of musculoskeletal disorders for other fields like the skin and the heart. ESWT is also used for erectile dysfunction but this special issue did not include this indication as it is still under experimental use.
The review on the use of ESWT for diabetic foot ulcers by Wang et al.  shows that shock wave, both radial and focused is effective in the treatment of diabetic foot ulcers. It has also been used in non-diabetic ulcers and skin flaps to improve flap survival. This review also highlights that ESWT is more effective than hyperbaric oxygen therapy for diabetic foot ulcers.
A metaanalysis of the treatment of cellulite with ESWT by Knobloch and Kraemer  reviews eleven clinical studies with five randomized controlled trials. Both focused and radial devices were used, and there was improvement of the cellulite severity scale (CSS) in the treated groups after twelve weeks. However the studies used various mixed techniques that have been listed in the metaanalysis. Long term follow up beyond one year was lacking.
Shock wave therapy of the heart is still in its infancy and this review by Holfeld et al.  is a comprehensive review of this new and exciting indication. If ESWT can regenerate ischaemic heart muscle, it will be a milestone in cardiac treatment.
In 1997, Haupt  wrote ‘In patients in whom conservative treatment has failed, surgery used to be the only choice, but its success rate barely exceeds that of shock wave therapy and surgery can still be done if shock wave therapy fails. Extracorporeal shock waves will have an impact on orthopedics comparable to its effect in urology.’
Almost twenty years after Haupt wrote this, sadly many surgeons, doctors and allied medical personnel are unaware of ESWT or believe it to be akin to alternative medicine.
The FDA approved the use of ESWT for the treatment of plantar fasciitis in 2000 and the treatment of lateral condylitis in 2002. I hope that this special issue will be a valuable tool and a reference to the further study of ESWT in the coming years.