Spring is here, the park gates are open! Soccer and baseball players are out on the fields and tennis players on the courts. Our clinic becomes busy this time of year as our community becomes more active and the risk for injuries increases. Many of the injuries we see can be prevented, or at least less severe, simply by being more educated about the most effective methods for warming up and cooling down before and after your activity. 

You may be aware of the longstanding debate on stretching. In fact, there is some research that implies that static stretching before an athletic performance may actually be detrimental and play no role in decreasing risk of injury. However, we cannot assume that just because static stretching prior to an athletic event may not be recommended, doesn’t mean that static or other types of stretching aren’t beneficial at other times for other reasons; whether you are an athlete or not. Let’s explore what flexibility and stretching are really all about; and if, when, and why we should stretch. 

Flexibility is the ability to move a joint smoothly, without injury or damage, through its complete range of motion. Many components can influence flexibility such as muscle lengths, ligaments, fascia, the joint itself, and even skin. We will be
exploring the muscular component.

When a muscle is shortened or tight, your joint will be less able, or unable, to complete its full movement. So if you quickly kicked a soccer ball, it may result in a muscle strain or injury if the hamstring muscles at the back of the thigh are tight. However, if the muscles were ‘flexible’ enough, they would have been able to withstand that range of movement without any tear or injury.
Studies have shown that increasing joint range of motion by increasing muscle flexibility by stretching does indeed reduce the risk of injury (Hartig&Henderson). Improved flexibility of certain muscle groups can also improve postural alignment and body mechanics, therefore reduce incidences of repetitive strain injuries and other conditions such as back, neck or shoulder pain.

So, if we know flexibility and stretching are beneficial, why are many experts questioning it? Actually, they are not saying that stretching isn’t beneficial, but rather, that certain types of stretching are better than others depending on when they are performed.

There are many different types of stretching, but we will discuss two main types of stretching, static and dynamic. Dynamic stretching is when muscle action produces active movement to result in a stretch, such as with gradually deepening walking lunges or increasing amplitude of arm circles. Static stretching is when muscle groups are placed and held for approximately 30
seconds in a lengthened position, and no movement occurs. There are several more subcategories of effective stretching methods within these main categories that your physiotherapist may introduce to you, but for simplicity we’ll stop here. 

Research shows that dynamic stretching is preferred over static stretching prior to an athletic event (to improve performance and decrease risk of injury during performance). Research also shows that static stretching is instrumental in increasing overall joint range of motion, therefore decreasing risk of injury, and is most safe and beneficial when performed when muscles are warm,
typically after the activity.

Therefore, the most effective warm up routines should involve actively warming up the large muscle groups by gradually increasing the speed and amplitude of the activity (deep lunges, arm and leg circles, light running drills, jumping jacks, etc). If you are experiencing a particularly tight area, take time to perform a prolonged static stretch to those muscles once you are warm. Post-activity, it is highly recommended to perform prolonged static stretches to help improve and maintain muscle lengths to decrease risk of injury. Your physiotherapist can show you the stretches that are most safe, effective, and specific to your activity.

Maintaining an overall healthy lifestyle including regular stretching, strengthening, balance exercises, a healthy diet, and stress management are often overlooked, but all very valuable, for injury prevention! 

Yoga has become extremely popular and trendy in North America. More and more people are using yoga as a means to improve their health physically, mentally, emotionally, and spiritually. Yoga is even being used as a therapy in our western healthcare system. So what is yoga and is it safe to use as a therapy? 

Yoga is a system of health that was developed about 5000 years ago that enables you to use your body, mind, breath, and spirit as one unit, therefore enhancing and promoting an overall balanced lifestyle of health and wellness. There are a wide variety of yoga styles, approaches, and teachings. The most common yoga practices in our western world involve yoga postures, breathing methods, meditation, philosophy and principles.

Medical Therapeutic Yoga applies yoga principles and techniques to specific injuries, dysfunctions, or imbalances. It is an emerging profession that has grown because of its effectiveness in delivering a holistic approach to healing with a focus on self-empowerment. Medical research shows that it is among the most effective complementary therapies in treating health problems, including chronic low back pain (American College of Physicians/American Pain Society, 2007).

Physio-Yoga Therapy is a type of rehabilitation therapy that combines both evidence-based Physiotherapy and Medical Therapeutic Yoga. Physiotherapists use evidence-based treatment methods to help you restore and maintain optimal movement and function as well as provide education on health maintenance and injury prevention. As licensed health care professionals, physiotherapists have extensive training and knowledge about how the body functions, and use specialized manual skills to assess, diagnose, and treat a variety of injuries, disease symptoms, and disabilities.

Is Physio-Yoga Therapy safe? Yes, as long as the Physiotherapist (PT) has the proper training and credentials as a PT and as a Medical Therapeutic Yoga Practitioner. The knowledge and skills of a licensed healthcare professional, such as a PT, ensures the individual assessments and treatments are safe and effective. NOT all yoga poses are safe or appropriate for everyone. Yoga poses and physio exercises are modified to adapt to each individual’s need. Also, a PT is well trained to know when it is necessary to make a referral to a specialist or back to your physician. 

A typical Physio-Yoga Therapy session includes a variety of yoga postures, breathing practices, meditations and lifestyle modifications combined with physiotherapy manual techniques and exercises specifically designed to address your needs.

When practiced regularly and safely, the benefits are numerous. Physically, yoga postures and breathing techniques can improve muscular strength, flexibility, postural alignment, body awareness, breathing patterns, bone strength, immune function, optimal body weight, sleep patterns, digestion, circulation, and normalize blood pressure. Mentally, it can improve your alertness, concentration, reduce stress and anxiety, and improve your ability to relax. Some common conditions that can be addressed are back/neck pain, musculoskeletal injuries (shoulders, hips, knees, etc), osteoarthritis, osteoporosis, fibromyalgia, chronic pain, high blood pressure, Irritable Bowel Disease, migraines/headaches, pregnancy, anxiety, rheumatoid arthritis, scoliosis, urinary incontinence.

It is worthy to note the role Physio-Yoga Therapy also plays in disease and injury prevention.
The key benefit is an overall state of health and well-being! 

Shelly is offering a FREE talk about Physio-Yoga Therapy at Sun City Physiotherapy in Winfield on Tuesday, Feb.28 at 7pm. Please call the clinic to reserve your spot at 250.766.2544.
Bring all your questions you’ve ever had about yoga! 

It is a fact that 53% of women between the ages of 20-80 years old experience urinary incontinence (the inability to control the bladder) at some point in their lives (Culligan &Heit, 2000). Less than half of these women do not even mention it to their physician (Burgio, 1994) perhaps because they are too embarrassed, or simply because they think it is normal to experience ‘a bit of leakage’ when they sneeze or laugh.  Or, that it is normal after pregnancy or with age.  Or, that it is normal because their mom, sister, and best friend all experience a ‘bit of leakage’ too.  But it is not normal.  Yes, it is common, but not normal.  Urinary incontinence can be prevented and treated in most cases.

The two main types of urinary incontinence are stress and urge.  It is important to know the difference between the two, and know which one you may have, in order to treat it accurately. However, it is common to have a combination of the two as well. 

Stress incontinence is what occurs when the pelvic floor muscles(PFM’s) have become too weak to stop the flow of urine during actions that put pressure or stress on the bladder, such as coughing, sneezing, laughing, twisting, or lifting.  Pelvic floor weakness can result from the muscles being overstretched during childbirth or even from low estrogen levels, such as during menstruation or menopause. 

Urge incontinence is when there is a sudden ‘urge’ to urinate with an inability to control the bladder.  This happens when the pelvic floor muscles are chronically tense to the point of fatigue, and consequently give out at inappropriate times.  If the PFM’s are consistently tense, without knowing how to relax, release, and control them, other problems in addition to urge incontinence can arise like low back pain, irritable bowel syndrome, interstitial cystitis, and painful intercourse. 

Many people believe that the popular Kegel exercises which consist of ‘squeezing’ the PFM’s will solve the leakage problems. However, this is not necessarily the case.  If your incontinence is due to chronically tensed PFM’s that are fatiguing (urge incontinence), then simply performing Kegel exercises may actually be worsening your problem! Learning how to release your
PFM’s in conjunction with diaphragmatic breathing would be more beneficial for someone with urge incontinence. If your incontinence is PFM weakness due to being overstretched or inadequately activated, then correctly prescribed Kegel exercises can help.  But Kegel exercises do not address all of the muscles that are important for a healthy pelvic floor. Kegels are still only a small part of the overall treatment of this dysfunction.  

Treatment of incontinence may begin by learning how to activate, release, and control the PFM’s.  PFM training with a physical therapist has been recommended for women suffering from stress urinary incontinence and for prevention of urinary incontinence during pregnancy and after delivery (Britnell, et al 2005). Successful physiotherapy treatment protocols also include hip adductor and deep abdominal muscle strengthening, lumbar or core stability training, and prescription of exercises that address postural mal-alignment or hip tightness that may be contributing to pelvic floor weakness.  Education regarding bladder irritants in the diet can also be included in your treatment plan.

Yoga and Pilates have also been shown to improve both types of incontinence due to their ability toaddress the above areas.  

A physical therapist trained in this area will be able to help diagnose which type of incontinence you may have, and help develop an appropriate treatment plan.  Treatment need not be invasive and usually consists of 4 to 6 visits.  The assessment typically consists of a series of questions followed by a physical examination of postural alignment, hip, pelvis and abdominal strength and flexibility testing.  Although incontinence is common, it can be treated. So whether you are a new mom or a retiree, you can still continue to enjoy a healthy lifestyle knowing you have confidence in controlling your bladder!

Whether you are preparing to hit the ski hills this season, play golf next season, perform fall yard work, or simply are wanting to continue to walk and perform all your household chores with ease and efficiency, it is important to be knowledgeable about core stability and how to apply it while performing any sports or activities of daily living. Most people have heard of the term ‘core
stability’, but few people actually truly know what it is and how to correctly engage it.

The ‘core’ is a group of muscles that surrounds the back and abdomen and is best described as a cylinder of muscles. The main function of the core is to stabilize and protect the spine and pelvis when the rest of the body is in motion. There are 4 main muscle groups that make up the inner core: Transversus Abdominus (TA), Multifidus (MF), Pelvic Floor muscles (PFM), and the diaphragm. TA is the deepest abdominal muscle that wraps around your abdomen like a corset, and is connected to tissue surrounding the spine. When TA contracts, it is similar to the corset being tightened, therefore assisting in increasing the pressure inside the abdomen which provides increased stability to the spine. MF is a deep lower back muscle which makes up the back part of the core. It is an important postural muscle that helps keep the spine erect. The PFM’s are the bottom part of the ‘cylinder’ or core. The diaphragm makes up the top part of the cylinder. When all of these muscles contract simultaneously, they help to maintain the pressure in the abdomen which then provides the stability to the spine and pelvis. It is important to note that the timing of these muscles is mandatory for effective core stability. For optimal core stabilization, all the muscles will activate together and just prior to any body movements and are ideally maintained throughout all movement, all day!

A common misconception is that "strong abdominals protect the spine". In fact, as described above, the abdominal muscles make up only one part of the core. Furthermore, only the deep abdominal muscle, TA, is involved in protecting the spine. The famous "6-pack" or Rectus Abdominus muscle that many fitness fanatics train actually plays no role in protecting the spine. Additionally, you may already be performing ‘core stability’ exercises, but instead of activating your TA correctly, you may be using the Rectus Abdominus (as evident by the abdominals ‘tensing’ and popping out and up) to compensate for the TA that you
aren’t quite sure how to find. This is a very common mistake and can lead to back pain. So please ensure you are performing your core exercises correctly! 

Adequate core stability not only reduces strain on the spine, but also helps maintain optimal postural alignment which will help reduce risk of injuries whether you are playing sports, doing housework, or sitting and driving. Core stability is also an important part of any rehabilitation program. Not only back or pelvis injuries, but even injuries such as hamstring or shoulder strains should incorporate core stability as part of the rehab process. A strong core means a strong foundation from which our limbs can move more safely, with more power and efficiency, and with less risk of injury.

Core stability is also an essential part of any regular workout routine. Whether you enjoy recreational sports, competitive sports, or simply enjoy working out at the gym, addressing your core can improve your abilities and enhance your overall performance.

To ensure you are correctly engaging your core and to incorporate safe and appropriate core exercises to suit your needs, it is wise to invest your time with a qualified specialist for a few sessions first.  If you experience low back pain or are dealing with specific spinal dysfunctions, then a visit to your physiotherapist or other trained health care professional is essential to ensure the most safe and effective core exercises are prescribed for you!

Do you experience pain in your jaw? Perhaps radiating to your ear, face, neck, and even your shoulder? Does this coincide with difficulty opening or closing your mouth while talking, chewing, laughing or yawning, or your jaw locking? You may be experiencing a dysfunction in your temporomandibular joint (TMJ). The TMJ joins the lower and upper jaws and is the joint responsible for opening and closing your mouth, as well as any side to side movement of the lower part of the jaw (which is important for chewing and articulation of speech). You have a right and left TMJ. You can actually feel the movement of the joint by palpating just in front of the ears as you open and close your mouth. There is a disc that is in between the joint that enables a
smooth gliding motion. If this disc does not glide properly, you may experience clicking or popping sounds.

There are a variety of factors that can cause TMJ disorders, and often times it is a combination of factors that need to be
addressed in order for treatment to be effective. Some of the common causes include the following: 
1) Poor postural alignment.
If you have habitually poor posture over time, this can greatly affect the position of your head and neck, creating chronic muscle imbalances, which in turn can affect the mobility of your TMJ. 
2) Behavioural habits that create muscle tension around the jaw muscles such as grinding or clenching
your teeth, excessive gum chewing or biting your nails.  A common underlying cause of poor habits can be stress related. 
3) Trauma to the joint. 
4) Arthritis in the joint.
5) Dental problems such as abnormal alignment of the teeth when the upper and lower jaws are
brought together (malocclusion).
6) Hormonal changes. Research suggests that estrogen levels can also play a role in TMJ pain (Craft, 2007.)

Treatment of your TMJ disorder may require more than one health care professional due to the nature of the potential causes. 
Dentists, orthodontists, ear/eye/nose/throat specialists, physiotherapists, massage therapists, physicians, psychologists, and
endocrinologists may be some of the professionals involved in your treatment.  It is essential to ensure your health care professional determines the cause(s) of the origin of your TMJ disorder before effective treatment can begin. Treatment may include the following, depending on the cause: 
Addressing your postural dysfunctions by prescribing specific strengthening or stretching exercises specific to your deficits. This also includes education about your alignment and movement patterns at work, whether you sit at a desk or have a more physical job. A physiotherapist can assist you with this. Addressing any unhealthy behavioural habits (grinding, clenching, nail biting) can be challenging. It is helpful to look at the underlying cause, which frequently is related to stress. Learning how to effectively
manage your stress levels is important not only for your TMJ disorder and the muscle tension surrounding the joint, but is also important for many other systems of your body. Relaxation methods, breathing methods, appropriate exercise, regular yoga practise or perhaps some small changes in lifestyle choices can all contribute to improving the way you handle your stress. Physical Therapy can address any TMJ instabilities, inflammation, or stiffness in the joint by manual therapy methods, electrotherapeutic modalities, and prescriptive exercises to address the specific dysfunction. A visit to your dentist is
important to ensure you have a thorough assessment of your teeth/mouth alignment and to determine the need for night splints or guards or any other treatment option.  Occasionally, there may be a more serious problem where you need to be referred to another specialist. Symptoms that include loss of hearing, nerve involvement, weight loss, or
persisting pain and immobility despite ongoing treatment indicate a visit back
to your physician for a referral to an appropriate specialist.

Being healthy and fit takes effort.  We all know that there are many factors that contribute to living an overall healthy lifestyle, including diet, activity level, social well-being, managing stress levels, and being physically fit, just to name a few. 

Physical fitness is an important factor that can improve one’s quality of life. There are several components that make up basic
physical fitness: strength, flexibility, power, agility, muscular endurance, cardiovascular endurance, co-ordination, and balance. 
I want to discuss the often overlooked, but extremely important component, balance. An astonishing fact:  Falls are the second leading cause, after motor vehicle collisions, of injury-related hospitalizations for ALL ages, accounting for 29% of injury admissions. (Canadian Institute for Health Information, 2004). Obviously, there are situations where falls cannot be prevented; however, frequently they can be avoided if we understand the underlying systems that contribute to balance.

Balance is the ability to control the body’s position. The body either controls its position statically, as in standing on one leg, or
dynamically, as in walking on uneven or slippery surfaces. Several physiological systems work together to influence balance.  Sensory input from the eyes detects changes in position.  The inner ear controls balance by monitoring the position of your head
(vestibular system).  Our nervous system is involved in processing information which determines how quickly and efficiently we are able to respond. Our musculoskeletal system is also very important for balance.  We need to have adequate joint range of motion, muscle flexibility and strength in our ankles, knees, hips, spine, and shoulders in order to safely and effectively ‘right’ ourselves when we are losing balance.  

Balance dysfunctions can be addressed and treated, provided that your health care provider knows what system or systems are
involved in the balance problem.  Once the source of the poor balance is identified, then your balance can be improved by improving the function of the impaired system. Occasionally the impaired system may not be able to be improved due to
certain medical conditions.  In that case, your balance can still be improved by enhancing the function of the systems that are already working well. 

Even if you don’t have a serious balance dysfunction, it is still important to include balance training in your regular exercise routine. Many fitness centers have group fitness classes that incorporate balance in their sessions.  Yoga and Tai Chi have
also been shown to improve balance.  If you understand the components of balance and seek out guidance to help you train your balance, you can significantly improve it, therefore reducing risks of falls or even minor injuries such as recurrent ankle sprains.  Optimizing "balance" can contribute to improving and maintaining your quality of life!

Four out of every five North Americans will suffer from back pain at some point in their  lives.  Research shows that two out of every three people that experience back pain cannot even identify any  specific mechanism of injury, “it just happens”.  But WHY does it happen? Can it be controlled, managed, or prevented? As a physiotherapist, these are questions that my patients have been asking me since I started practising 13 years ago. I’m always amazed at how little our society knows about simple back
health, but have we ever really been educated on basic back care? Growing up, we have been taught how to brush and floss our teeth to maintain good oral health and we even know how to maintain our vehicles so they run efficiently and safely. But  somewhere along the line, basic back care education for our own bodies is missed.  Most people seem to understand they need to “use the legs when lifting or bending, strengthen the abdominals and back, and exercise”. Unfortunately, when I see my patients, they are commonly performing exercises unsafely or incorrectly, or not at all.  Rarely do I see optimal posture or correct use of body mechanics with bending, lifting, or bed mobility. Additionally, most people have poor core stability (or rarely know
exactly what that even means) and tight lower extremity muscles that both play a role in back pain.

There are many factors that play a role in back pain, many different ways it manifests and many different ways that it can be addressed. We can’t discuss this all in one article, but in my experience, I feel that the majority of cases have to do with how we use our bodies and can be prevented.  Here are some tips that can help PREVENT back pain: 
    
1. Frequent position changing:  prolonged sitting or forward flexion puts the most load on the low back and can contribute 
to disc problems. Prolonged standing or repetitive movements can also place unfavourable strain on the spine. Frequent mini-breaks or position changes may seem ‘time consuming’ and unproductive at the time, but it can save you from  debilitating pain in the long run.  

2. Use correct body mechanics: getting in/out of bed, bending forward to tie your shoes, reaching, lifting and carrying are just a few of the activities we do daily that can eventually cause back pain if not performed correctly. It is simple to learn, but accurate instruction and even demonstration from your physiotherapist can be helpful.

3. Optimizing postural alignment: positioning your spine so that it maintains its 3 natural curves is key to a healthy back. When these healthy curves become too flattened or too arched, it can compress the vertebrae and the discs in between, causing pain or irritation of the nerves coming out of the spine.  Whether you’re sitting, walking, lifting, exercising or sleeping, your spine should primarily be in its optimal position. 

4. Proper footwear:  improper shoes can affect your postural alignment and can cause certain lower extremity muscles to  become shortened which can contribute to back pain. Orthotic inserts may be beneficial for some people.

5. Manage your stress:  many scientific studies have shown that stress is a major factor in back pain. Find effective ways to manage your stress. There are numerous approaches that are not within the scope of this article. Finding time to mindfully
unwind and participate in a regular exercise regime (performed correctly) has been shown to assist in stress reduction. As a Yoga Therapist, I consistently observe myself and my clients effectively managing stress in life through living a yogic lifestyle.  It's NOT the amount of stress or load in your life, it's HOW you carry it!

6. Overall physical health: maintain a healthy diet and body weight; perform regular stretches, strengthening, and spinal
stability/mobility exercises in a safe and effective manner.
 
Unmanaged back pain warrants a visit to your doctor to rule out a serious medical condition. Your physiotherapist has the skills to assess and treat a variety of back conditions and knows when to refer back to your doctor if further investigation is required.