Let’s Talk About the Complexity of Pain

What is Pain?

Pain is an unpleasant complex experience that occurs in response to a potential threat to our body’s tissues. No one really wants to have pain and if you do get pain you typically want to get rid of if ASAP. What we need to remember is that pain is normal and necessary to our survival as it is our body’s alarm system. The alarm system is there to help bring our attention to potential threats and to change our behaviour to avoid the threats if necessary. 

Everyone experiences pain differently. The way we experience pain depends on many factors such as the following: the severity of tissue injury, our emotional responses, previous experiences with pain, cultural experiences, the social and physical environment, our sensory inputs from receptors in our body, beliefs and knowledge about pain and our expectations about the consequences of pain.

For example: A person who is a major league soccer player that fractures their ankle will feel the pain very differently compared to a 65 year old person who is relatively sedentary because the soccer player may feel anxious about how is he going to make money if he can’t play soccer, whereas the 65 year old who generally is not very active will not have much change in their day. 

How Do We Experience Pain?  

When your body is injured in some way whether it be from stubbing your toe, repetitive use of you shoulder or appendicitis, the receptors and nerves in your body send this information to your brain and it is your brain that decides whether or not you feel pain. These receptors in your body are called nociceptors and they respond to thermal, chemical or mechanical changes on the tissues. For example, when you place your hand on a hot stove top the receptors in your fingers and hand sense that the temperature has changed. They then send messages to your brain about the temperature change and your brain decides if this change in temperature is a threat and if you should feel pain to make you take your hand away from the potential threat of a burn.

The signals from the nociceptors do not create pain. It is the brain decides that receives the signals from the nociceptors and other information such as your memories of pain, your beliefs about pain, your emotions at the time of the signal, your expectations and the information about the environment and uses all the information to decide whether or not there is a threat of damage and whether we should feel pain. The brain may decide that a nociception signal is not important and that we do not need to feel pain, so we ignore it. An example of this is when we are sitting in a chair the receptors in our bottom notice the change in pressure an send this signal to the brain. The brain then takes the information from the signal, and the environment and decides that sitting in the chair is not harmful so therefore we do not feel pain.

An analogy that can be helpful understand pain is to think of pain like a ship that is sailing in the ocean. The receptors are the lookouts on the ship, and they notice lights in the distance (these are the potential danger signals). The brain is the captain of the ship and makes all the decisions about how to sail.

The lookouts notice lights in the distance and tell the captain about them. The captain then considers his memories about these waters and takes in information about the environment. Maybe the captain knows these waters well and knows that these waters are safe and pirate free. He would then decide that the information was good to know but not very important, he may tell the crew members not to worry about it and they continue to sail as normal. This is like the when you sit in the chair and the brain decides that it is not a threat, so you continue sitting as normal without pain.

But if the captain is concerned by the information because he has never sailed these waters before and thinks that the lights may be pirates coming to rob the ship, he may tell the other crew members to stay on high alert. This is like when you place your hand on the hot burner and the brain creates a pain experience to make sure you are aware of the potential threat. He may even change the way he was sailing to avoid the pirates. This is like when pull your hand away from the burner because of the pain to avoid the threat of a burn.

Types of Pain

Pain can be either acute or chronic.

We tend to consider acute pain as pain that has a “mechanism of injury” such as a fall, motor vehicle accident, slamming your finger in a door etc. Acute pain typically is short lived, most times is not present past 3 months (BUT not always) and usually follows the stages of tissue healing (which are outlined in the picture below).

Chronic pain is when the pain is occurring for a longer period of time. It is often disproportionate to the stages of tissue healing and may or may not have a mechanism of injury that explains why the pain is there. Chronic pain can be very complex and is not fully understood. Chronic pain is usually pain that is present past the usual tissue healing process. Meaning that the tissues have likely healed, and no more damage is likely being done. But a reason we may still get pain is because our tissues have become more sensitized. If you think of the body as a ship again. Sometimes even through the ship has long since cleared the pirate-infested waters the captain and the crew remain hypervigilant to be sure they are safe. This means that now, even normal and helpful signals such as lighthouses, and ship horns may be perceived as threats. This can be the same as if we are in pain for a long time the entire system including the nociceptors and the brain become hypersensitive to all the information that even the normal signals that the brain usually ignores will be considered threats and you feel pain even though there is no tissue damage occurring.

Management of Pain

Management of pain can be complex because of all the factors that contribute to pain. Therefore, management of pain may have to be individualized. Pain management can include many things such as resting the area of injury, use of modalities such as ice or heat, education by a health professional about exercises, work or activity modifications, education about what to expect, healing duration as well as management strategies of stress or anxiety.

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Lymphedema Management

What is Lymphedema?

Lymphedema is a condition where excess fluid collects in the tissues of the limbs causing swelling (edema). Lymphedema is a common complication after removal or damage to the lymphatic system. The lymphatic system is a group of small vessels in the body that is an important part of the immune system. It is there to work together with the circulatory system to remove toxins, waste and other unwanted materials from the body. It also has a large role in fighting against bacteria and viruses and for maintaining fluid balance throughout the body. If there is damage/disruption to the lymphatic system then it is not able to drain the fluid properly and results in excess fluid build-up. Lymphedema can occur either due to a congenital abnormality in the lymphatic system or it can occur as a result of cancer surgery, radiation therapy, infections, inflammatory conditions, cardiovascular diseases and injury and trauma. 

What are the Symptoms of Lymphedema?

Lymphedema symptoms include: 

  • Swelling of either a part or whole leg or arm including the fingers and toes
  • Limb may look cold, shiny and white
  • May have difficulty wearing jewellery or watches, difficulty fitting into clothing or shoes
  • Heavy or tight feeling in the limb
  • Loss of range of motion in the swollen limb
  • Aching in the affected limb
  • Tingling/numbness in affected limb
  • Thickening and hardening of the skin
  • Fatigue 

Who is at Risk of Lymphedema? 

There are certain factors that can increase someone’s risk of developing lymphedema and may indicate progression, severity or outcome of lymphedema. Risk factors Include: 

  • Surgery with dissection of lymph nodes in the armpit 
  • Scar formation 
  • Radiation of the breast, axillary, internal mammary, sub clavicular or inguinal lymph nodes due to cancer
  • Varicose Vein Stripping 
  • Poor nutrition
  • Thrombophlebitis 
  • Immobilization 
  • Air Travel 
  • Drain and wound complications/infections
  • Axillary Web Syndrome 
  • Seroma formation 
  • Advanced Cancers 
  • Obesity 
  • Congenital Predisposition 
  • Trauma to the at risk limb 
  • Chronic skin disorders and inflammation 
  • Hypertension 

What can I do to Decrease the Risk of Developing Lymphedema? 

If you are at risk of developing Lymphedema due to a congenital abnormality in the lymphatic system or as a result of cancer surgery, radiation therapy, infections, inflammatory conditions, cardiovascular diseases and injury and trauma, the following are some things to try to help reduce the risk. 

  • Take care of nails and skin and keep them clean (watch out for hang nails and cuts)
  • Doing daily skin checks for cuts/sores/wounds and tending to them quickly and appropriately 
  • Maintain an optimal body weight (BMI < 30 Kg/m2
  • Eating a balanced diet 
  • Avoiding trauma to the area at risk 
  • Avoid wearing tight clothing and jewelry 
  • Avoiding exposure to extreme cold and heal 
  • Avoiding blood pressure tests on at risk arm 
  • Using sunscreen and bug repellent to prevent trauma in terms of sunburn or bug bites
  • Wearing lymphedema garments if they have been prescribed to you 
  • Activity/Exercise as tolerated
  • Elevating limb and avoiding a dependent position of the limb for too long 
  • Wearing comfortable and support shoes 

Signs of Cellulitis

Having lymphedema makes you more susceptible to infections. A common infection that affects people with lymphedema is Cellulitis. Cellulitis is a potentially serious bacterial infection of the deep layer of the skin. If you notice the following signs and symptoms of cellulitis it is important to seek medical attention immediately. 

  • Redness of the skin 
  • Swelling 
  • Warmth 
  • Pain and tenderness 
  • Drainage and leakage of the skin 
  • Tender lymph nodes 
  • Fever
  • Increase in fatigue/tiredness compared to usual

What is Lymphedema Treatment and How Will it Help?

Lymphedema is a chronic disease that can have a significant impact on quality of life as movement can become harder and more fatiguing but it is manageable. Physiotherapy treatment can be a useful tool in the management of the symptoms of lymphedema. During treatments physiotherapists can help provide you with tips and education that can help reduce the risks of developing lymphedema, help with possible prevention and/or help manage symptoms so that if you develop lymphedema is can be less severe. 

When you are first coming for treatment your physiotherapist will start with an assessment. A lymphedema assessment at BodyTech Physiotherapy will include a detailed subjective history of causes, symptoms as well as an examination of your functional abilities and measurements of the affected limb. Physiotherapy treatments will be individualized based on the assessment results and will focus on teaching how to manage the lymphedema at home through the use of education, individualized exercise programs, lymphatic massage/self-lymphatic massage and bandaging when appropriate. Physiotherapy treatment can help with decreasing lymphedema severity, improving the condition of the skin and limb shape, improving the function of the affected limb, decrease symptoms of lymphedema and improve overall function and quality of life. 

References: Jodi Steele: Lymphedema Workbook 2015 (Cited January 28, 2021)

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Why is your core so important?

By Courtney White, Registered Physiotherapist

Have you ever wondered what makes up your core, why is it important, or how to safely train your core without getting back pain? Keep on reading to find out these answers and more!

Your core is more than just the muscles that you can see. There is a group of muscles below the big six pack muscles that wrap around you like a corset. Their job is to support you during every movement. This inner unit is like a TRANSFER STATION. To get power generated from your legs all the way to your shoulders, it must pass through the inner core. So, if you do not have proper control over your core, that power will not move between your upper and lower body as smoothly as you want it to.

What Makes Up the Inner Core Unit?

The inner core consists of the following: the diaphragm, the pelvic floor, transversus abdominus (TA), and multifidus. Collectively, these 4 structures create a CORE CANISTER.IMG_5235-01Pic for Core

Diaphragm: The diaphragm is our primary breathing muscle and it forms the top of the core canister. The diaphragm is the component that has the primary control over the intraabdominal pressure within the canister. It moves up and down as you breathe which changes the space in the abdomen and as a result, influences the pressure within the core canister.

Pelvic Floor: The pelvic floor is a group of muscles that form the bottom of the canister. It supports the weight of all the internal organs within our abdomen, assists with bowel and bladder control, and helps to control the intrabdominal pressure along with the diaphragm. The pelvic floor is partners with the diaphragm. When the diaphragm moves up and down, so should the pelvic floor.

Transversus Abdominis (TA): This muscle connects the top and bottom of the canister as well as creates the front and sides of the core canister. It runs deeper than the external six pack muscles that you can see. Its role is to support your lower back during movement and transmit forces between your upper and lower body.

Multifidus: This muscle forms the back of the core canister and runs along the spine. Multifidus serves as a primary support for the spine, pelvis, and hips.

[1]Canister

What Are the Functions of the Core Canister? 

  1. To support the back, pelvis, hips, and trunk during movement
  2. To serve as a transfer station for power and energy between the upper and lower body
  3. To assist with bowel and bladder control
  4. To improve performance during physical activity

How Does the Core Canister Work?

To gain a stronger core overall, it is important to learn how to “pressurize” the core canister. Previously, inner core training has focused largely on tensing the walls of the core canister through focused contractions of TA. Learning how to activate the diaphragm and pelvic floor was often missed or brushed over. More recent evidence now suggests that breath is the driving force behind influencing the intrabdominal pressure. Therefore, the diaphragm is the leader behind pressurizing the core.

When you breathe in, your diaphragm contracts and pushes down into the abdominal cavity which increases the intraabdominal pressure. In response to this increased pressure, the pelvic floor relaxes and lengthens to accommodate the abdominal organs translating downward. During your inhale, the pressure in the front part of the core canister is increased as your belly expands. This is counteracted by multifidus in the back as well as TA which work together to try and keep the intraabdominal pressure evenly distributed. When you breathe out, the diaphragm relaxes and rises which decreases the pressure within the core cannister. As a result, the pelvic floor should normally contract and rise.

[2]GifCore blog

How Do We Train the Core Canister? 

Many people focus on crunches, planks, and other large abdominal exercises when training the core but negate breathing. Learning to connect your breath with movements is the key to developing a stronger core. It will allow you to control the intrabdominal pressure within the core canister. Exercises like planks and crunches are not necessarily bad exercises as they can be very effective later if you first learn to optimize the control of your core canister.

The first step is to learn how to engage your diaphragm through diaphragmatic umbrella breathing. Once you have achieved this, it is time to add in the pelvic floor so that you learn how to engage your diaphragm and pelvic floor together as a unit, referred to as piston breathing. You can also learn how to connect and activate TA and multifidus to further optimize your control over the core canister. However, it is important to highlight that the goal here is to learn how to change the size of your core canister by recruiting all these muscles together, rather than focusing solely on how to contract each specific muscle. Once you have learned how to control the pressure within the core canister, it is now time to perform bigger movements that require you to maintain control over the canister while doing a larger activity.

Check out our post on our Facebook and Instagram pages (dated May 21, 2020) for exercises you can try at home to increase your control of the core canister!

What Can Happen If You Do Not Have Control Over Your Core? 

It is not uncommon to have a weak inner core or lack control over your core canister. This can originate from prolonged sitting and slouching which distorts and changes the shape of the core canister (see part B in Figure 3 below). This positioning leads to breathing through the accessory muscles in your neck and chest, decreasing the engagement of your diaphragm. As you can see in the figure below, this puts a lot of strain on the lumbar spine which can lead to pain and injury. Ideally, your core canister should look something like part A in the figure below where the intraabdominal pressure is equally distributed. Without proper control over your inner core, it makes it very difficult for you to be able to hold your body in a good position during exercise and physical activity. This increases your risk for injury.

[3]DNS-Scissor

Now that you have learned more about what the core is and why it is important, if you have any questions or are interested in setting up an appointment with one of our Physiotherapists, contact us today! We will be happy to help you achieve your goals by developing an individualized treatment plan. 

BodyTech Physiotherapy

Text References

Diane Lee & Associates: core training vs. strengthening (internet). South Surrey: D G Lee Physical Therapist Corp; (cited 2020 May 22). Available from: https://dianeleephysio.com/education/core-training-vs-strengthening/

Key J. ‘The core’: understanding it, and retraining its dysfunction. Journal of bodywork and movement therapies. 2013 Oct 1;17(4):541-59.

Pronatal Fitness: the first move to teach your clients (internet). 2018 July 18. (cited 2020 May 22). Available from: https://pronatalfitness.com/2018/07/18/360-breathing/

Image References 

[1] The role of the diaphragm. Digital Image. Chiroup.com. Nov 2016. [Accessed on 2020 May 22]. Available from: https://chiroup.com/the-role-of-the-diaphragm/. 

[2] Breathing variations. Digital Image. S. McLaughlin. Aug 2019. [Accessed on 2020 May 22]. Available from: https://www.alignforhealth.com/self-care-for-pain/category/core%20stabilization 

[3] The “pop can” core. Digital Image. J Smeaton. Apr 2019. [Accessed 2020 May 22]. Available from: https://www.depthtraining.ca/the-pop-can-core/.

Is Virtual Physiotherapy for you?

knee painBodyTech Physiotherapy is offering virtual physiotherapy appointments with our most experienced therapists. All you need is a phone, tablet or computer. It is as simple as clicking a secure link to connect with us in a video chat.

What to expect?

Your first appointment with us will be an assessment. The Registered Physiotherapist will ask questions to complete a history and gain a complete understanding of your injury in order to provide a diagnosis.

You will be asked to do a series of movements to allow the therapist to examine your range of motion and strength, as well as be able observe how you move and perform certain tasks. You may be asked to demonstrate walking, stairs, sitting, standing or any movement pattern specific to your injury.

Treatment

Based on the findings from your assessment, the therapist will be able to cue and correct your movement patterns. You will also be given specific exercises to help in your recovery. Your therapist may give you some self-directed treatment techniques, or teach another person how to assist you with these techniques.

You will have a chance to ask questions and clarify your abilities and restrictions. Your therapist will educate you about your condition and provide suggestions on how to modify your activities if needed.

Still not sure if virtual physio is right for you? Schedule a free 10 min phone consult with one of our therapists.

Call 519-954-6000 or email: info@bodytechphysio.ca

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Vestibular Rehabilitation

By Jackie Render, PT

Balance.jpg

Vestibular Rehab is used to treat dizziness, vertigo, as well as feelings of being off-balance and unstable, blurred vision, or generally feeling “off.” A vestibular assessment at BodyTech Physiotherapy involves a detailed history, a central nervous system screen (examination of reflexes, cranial nerves, cerebellar tests), vestibular function testing, and balance testing.

What is the vestibular system?

The vestibular system is a sensory organ that lies inside your skull and connects your brain with your inner ear on each side. The vestibular system contains organs that sense gravity as well as organs that sense acceleration (turning, bending, spinning etc.). The brain uses the information from both vestibular organs to determine how the head is moving in space, for postural responses, to stabilize vision, and for balance. It shares close connections with your hearing organs and some conditions may also affect your hearing in addition to the vestibular system.

What are the symptoms of a vestibular problem?

Dizziness from the vestibular system often presents as vertigo – the illusion of movement. A person with vertigo will often feel as if the room is spinning or they are spinning within the room. Other people may describe dizziness or the room shifting or tilting. You do not need to feel dizzy to have a vestibular problem. Many people with vestibular problems will feel off-balance and unstable, or report blurred vision or generally feeling “off.”

What causes dizziness?

dizziness.jpgDizziness can come from many areas. It can be caused by medications, blood pressure changes, the brain, the neck, or from the vestibular system. Approximately 20-30% of the population experiences dizziness in their lifetime, and vestibular disorders account for a large proportion of dizziness. 

Why does it happen?

People experience vertigo due to a change in nerve signals from one or both of the vestibular organs. This change in nerve signals results in a mismatch of signals from one ear compared with the other and change can be a result of many factors.

Some common causes of Vestibular problems are:

  • Benign Paroxysmal Positional Vertigo (BPPV)
  • Vestibular Neuritis or Labyrinthitis
  • Unilateral or Bilateral Vestibular Hypofunction
  • Meniere’s Disease
  • Vestibular Migraine

Vestibular problems can also be caused by structural changes to the inner ear such as structural defects, autoimmune conditions, blast injuries, as well as aging. Concussions may result in vestibular disorders either through injury to the vestibular system itself, or to the connections it has inside the brain.

It is estimated that over 35% of adults in the United States have a vestibular dysfunction that requires medical attention.

What is vestibular rehabilitation? How can it help?

Vestibular rehabilitation is a proven combination of progressive movements or exercises aimed to address the person’s areas of dysfunction. This is achieved by retraining the brain to maximize recovery or central nervous system compensation. Vestibular treatment is highly individualized and will vary depending on the condition, the presentation, and the individual’s goals.

Exercises for vestibular rehab fall into the following categories or themes:

  1. Gaze stability – working on the ability to keep your eyes focused with head movements
  2. Habituation – exercises to help make aggravating movements more tolerable
  3. Balance – either sitting, standing or while walking depending on the individual’s abilities, to help maximize postural responses
  4. Maneuvers for BPPV – a series of specific movements to help relocate crystals that may become loose in the inner ear; home exercises may also be required to settle symptoms

As the individual progresses these exercises are often combined together to increase the challenge. A combination of eye, head and body movements, mental activity, or functional tasks may also be added to help make the vestibular responses more automatic.

Why should I have treatment?

Dizziness and imbalance can have a significant influence on quality of life. They can make you feel anxious and isolated. You may feel fearful of falling or of movement bringing on symptoms. Individuals with vestibular dysfunction are often reluctant to turn their head when they are standing or moving. Those with BPPV may be fearful of looking up or lying down because of fear of symptoms. Over time this can lead to neck and upper body pain. If you feel your dizziness or imbalance makes you more cautious with movement, or interferes with your daily life you should consider a vestibular assessment. A vestibular therapist can provide you with information about your condition and appropriate treatment options to help restore your quality of life.

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Treatment for a Blocked Milk Duct

By Kelsey Jack

Blocked ductFor nursing or pumping mothers a blocked milk duct is something that can happen with a sudden onset. Early treatment of a blocked milk duct is recommended to prevent progression of the condition. If not treated a blocked milk duct may turn into a condition called Mastitis, a bacterial infection in the breast that requires immediate medical attention.  Fortunately, at BodyTech Physiotherapy all of our therapists are trained to provide ultrasound treatment to help clear the blocked duct. 

What is a Blocked Milk Duct?

Milk ducts are tubes that connect the glandular tissue where the milk is produced to your nipple. There are approximately 15-30 ducts in each breast. A combination of the let-down reflex and proper latching from your baby helps to pull the milk along the ducts and out the nipple. Blocked milk ducts occur when there is a clog in one of the ducts that affects how milk is able to drain.

What causes a Blocked Milk Duct?

Although the causes of a blocked milk duct are not fully understood, common risk factors include:

  • Poor latching
  • Residual milk
  • Irregular, short, or skipped feeds
  • Pressure on the breasts such as tight clothing or restrictive gear

How can I tell if I have a Blocked Duct?

Symptoms of a blocked duct include:

  • Tender or painful area of the breast
  • Lumpy, ropey, or firm feeling breast tissue
  • Swelling and redness around the affected area
  • Warmth over the affected area

Additionally, you may find that your baby is fussy about feeding from that breast as milk flow can be slower than usual.

Signs of Mastitis

Mastitis is inflammation of breast tissue caused by an infection. A blocked duct has the potential to develop into mastitis if left untreated. Other causes include a cracked or sore nipple that allows bacteria to enter the breast. If you develop mastitis, medical treatment is required as soon as possible.

Symptoms of mastitis include:

  • Fever and chills
  • Increased feeling of being run down or tired
  • Increased redness and swelling around the affected area
  • Pain or burning in the breast while feeding
  • Muscle aches and pains

What can I do if I have a Blocked Duct?

Most blocked ducts will resolve on their own within 24-48 hours, however several things can be done to help the issue resolve more quickly:

  • Continue to breastfeed on the affect side. Try and point your baby’s chin towards the area of hardness. It is also beneficial to use breast compressions while your baby is feeding to aid with drainage.
  • Heat to affected area
  • Soak affected breast in a warm, Epsom Salt bath. You can also massage the affected area while the breast is soaking.
  • Massaging the affected area, starting closest to the nipple and working away. Always massage towards the nipple to aid with drainage. Some women find using an electric toothbrush to massage helpful.
  • Pump or hand express after nursing
  • Wear loose fitting clothing and a bra that isn’t overly constrictive
  • Rest as much as possible

How can Physiotherapy help with a Blocked Duct?

If the above self-treatments are unsuccessful at resolving the blockage, therapeutic ultrasound with a trained Physiotherapist can be used to resolve the blockage. The ultrasound treatment is applied directly to the area of the blocked duct. Immediately following a blocked duct treatment pumping or feeding the child is required to help clear the duct. One treatment is often all that is required to resolve the issue. If two treatments on consecutive days do not resolve the issue, further medical attention is recommended.

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Cupping Therapy

By Tim Penner, Registered Massage Therapist

Cupping therapy is a technique using cups applied to the skin to treat an array of illnesses. Used for centuries, its popularity continues to grow as people seek alternative and natural methods for treatment. Cupping stimulates healing by pulling blood to the region being treated. It promotes new blood flow to the area and removes stagnant blood which causes an anti-inflammatory effect by encouraging the body to release white blood cells, platelets, fibroblasts and other healing substances. Cupping is an effective technique to stretch fascia and muscles by helping to separate the different layers of tissue through the use of suction.

Cupping therapy uses cups, made of soft silicone and hard plastic, to suction soft tissue.  It is this vacuum effect, or negative pressure that provides a therapeutic result when applied to the skin. Many types of cupping therapy have been developed over the years. At BodyTech Physiotherapy our massage therapist uses 2 different types of cupping techniques: massage cupping and dry cupping. Massage cupping is usually done in a massage therapy treatment in which the cups are applied to the skin and moved around. Dry cupping is slightly different as the cups are applied to the skin and the affected body part is moved around to create a stretching effect.

Is cupping for me?                          

Massage or dry cupping can be used for many different conditions. The effects on the body include helping decrease stress, encourage relaxation and improve circulation. It can also be used to decrease swelling in certain areas and can help improve respiration when applied to the ribs and chest.  When it is used in conjuntion with massage and in specific areas, it helps reduce tension in muscles, and fascial tissue restrictions. The combination of massage and cupping leads to improved range of motion and posture. It can reduce tone in the muscles, help to improve flexibility and aid in reducing fascial adhesions left behind by old injuries. Cupping can help with many conditions such as low back pain, fibromyalgia, whiplash and tendonitis.

Some conditions that can be treated with cupping

  • Tendonitis
  • Fibromyalgia
  • Frozen shoulder
  • Low back pain
  • Whiplash
  • Tension headaches
  • Carpal tunnel syndrome
  • Plantar fasciitis
  • Sprain/strain
  • Golfer/tennis elbow
  • IT band friction syndrome

cupping1                cupping2

Low back pain                                      Iliotibial Band Friction Syndrome

Along with the conditions listed above, cupping also can be beneficial to the people suffering from the effects of Parkinson’s and Multiple Sclerosis, as well as using it to aid in rehabilitation after a major injury or surgery.

The most common side effect of cupping therapy is the bruised appearance that you see after the treatment is completed. The discolouration of the skin is only on the surface of the skin and does not generally cause pain after the massage. The bruised appearance can last for a few days or even up to a week. If significant bruising occurs your therapist will promptly remove the cups and discuss the effects with you.

Overall, cupping therapy can be beneficial to almost everyone. Just like massage, every treatment is specific and individualized to each client and their needs.

Concussion Management Part 2: How Long Does Recovery Take?

By Cassandra Kroner, PT

In part 1 of the concussion management blog series we covered how the brain is affected following a concussion, common symptoms, why early intervention is critical, and how physiotherapy can help optimize recovery. One of the most frequent questions people have following a concussion is about recovery time – ‘when can I go back to work full time?’ or ‘when can my son/daughter play soccer again?’. It can be helpful to understand the general stages of injury and potential progression of symptoms:

concussion blog image_jan2019

The initial days following a concussion are considered the acute stage of injury, and cognitive and physical rest is critical at this time. After 7-10 days of adequate rest the chemical balance and blood flow in the brain has been restored, and symptoms that continue are known as post-concussion syndrome. Some symptoms can last upwards of 6 months or years post injury. It is important to keep in mind that not everyone will progress through all three stages, and the length of time symptoms last will vary between individuals.

Why Recovery Can Take Longer

There are a number of factors that can complicate and prolong recovery, and these can help us predict if symptoms are likely to persist longer than the usual 6 weeks. A history of migraines, mental health conditions such as depression or anxiety, or learning disabilities, have been found to increase recovery times. Additionally, visual or vestibular dysfunction or a high number of initial symptoms following a concussion usually indicate prolonged recovery.

History of Concussion

People who have had a previous concussion are more susceptible to have another one due to a lower threshold for injury after each concussion – meaning the next concussion can happen from a lower severity injury than the first time. Additionally, there is often an increased number of symptoms and a longer recovery time after each subsequent concussion. A concussion at a young age risks disruption of brain circuits yet to be developed, and also creates a wider window for repeated future concussions.

Repetitive hits that are common in sports such as hockey or football, which do not cause a concussion, are known as sub concussive trauma. Research has shown this repetitive trauma can result in increased reaction and processing time, memory impairments and increased chance of making mistakes. These effects can place an athlete at an increased risk for a concussion during sport. If the athlete does sustain a concussion at this point, the brain has a diminished reserve capacity to manage injury, and the effects of subsequent concussions are cumulative and result in increased impairment in function with each concussion.

Additional Injuries

Another complicating factor is the presence of other injuries, such as whiplash or neck sprain/strains, that can occur with falls or car accidents. These neck injuries alone can cause similar symptoms to a concussion including headaches and dizziness, and in combination with a concussion can result in more severe and prolonged symptoms. Having an assessment by a physiotherapist can determine which symptoms are from the neck injury and which are from the concussion – resulting in individualized treatment strategies to target the cause of each symptom.

To conclude, although concussions can be an invisible injury, they need to be properly managed and rehabilitated just like any other injury. This management includes assessment to determine the cause of symptoms, specific treatments to address each impairment, and strategies to manage recovery at home. Visiting a physiotherapist trained in concussion rehabilitation will ensure that both concussion symptoms and neck injuries are addressed. The goals of treatment are to restore physical and cognitive function while facilitating a safe return to work and sport. Awareness and education about concussions and treatment options are important to ensure that people don’t suffer unnecessarily from prolonged symptoms – this is where a trained Physiotherapist can help!

BodyTech Physiotherapy

Osteoporosis and Exercise

By Lauren Harding, Registered Kinesiologist

What is osteopenia and osteoporosis?

unnamedOsteopenia and osteoporosis are conditions characterized by a loss of bone mineral density (BMD). BMD is a measure of the quantity of minerals (calcium and phosphorus) in a precise volume of bone. The difference comes in their severity.

Osteopenia indicates a lower BMD causing bones to be generally weaker. This bone weakness becomes more pronounced with osteoporosis as the bones become more brittle and porous (filled with air pockets), ultimately increasing the risk of fracture. Though less severe, osteopenia is a serious risk factor for developing osteoporosis.

Osteoporosis is often labeled as the ‘silent thief’ since bone loss occurs gradually, typically without symptoms. However, these four factors can signal underlying osteoporosis:

  • Loss of height over time and/or development of a stooped posture
  • Sudden back pain without any obvious cause
  • Fracturing after a seemingly minor incident

 

How are these three conditions treated?

An excellent approach is early intervention physiotherapy treatment, accompanied by a well-designed exercise program. It is important to consult your doctor before starting a new exercise plan. As with any exercise, there is always risk associated.

Osteoporosis Canada recognizes exercise not only for increasing cardiovascular endurance, but also as a fundamental component to protecting your bones. Exercise maintains bone mass and builds muscle strength, as well as increases flexibility and range of motion, balance and coordination. Benefits also include reduced pain and inflammation, while promoting loss of excessive weight. Additionally, the risk of falling is reduced.

 

What types of exercise should I be doing?

There are 5 types of exercises recommended for individuals with osteopenia and osteoporosis:

Types of Exercise How Often Should I Do These?
Aerobic 3 to 5 days per week, a minimum of 150 minutes per week
Strength Training 2 to 3 times per week
Balance Every day
Stretching Every day
Posture Training Always

 

Aerobic Exerciseunnamed

Aerobic exercise is considered any continuous, rhythmic activity that strengthens and stimulates the heart and lungs, thereby improving the body’s use of oxygen. It is recommended that ALL adults get 150 minutes of moderate to vigorous physical activity a week, or about 20 to 30 minutes per day, for at least 10 minutes at a time. During moderate-intensity activity, your heart beats faster and you breathe harder. The rule of thumb is that you are able to talk during these activities, but you are working too hard to be able to sing. During vigorous-intensity activity, your heart beats faster still and you continue to breathe harder. You are unable to say more than a few words at a time during vigorous activity. It is important with osteopenia and osteoporosis to do weight bearing aerobic exercises. Examples of weight bearing aerobic exercises include:

  • Brisk walking, dancing, stair climbing, running, step aerobics, hiking, jogging, jump rope, and treadmill walking/running

 


Strength Training

Elderly_exercise

In order to increase your muscular strength, you must work against resistance until your muscles feel tired.

This helps to reverse muscle atrophy, a condition that occurs when your muscles start to waste away due to lack of use. Furthermore, resistance training strengthens the muscles surrounding your joints, ultimately reducing further joint damage and decreasing risk of injury. ALL adults should do 2-3 days of strength training a week. Exercises using free weights (dumbbells), exercise bands or weight machines are strongly recommended. Examples include:

  • bicep curls, sit-to-stand, lunges, rows, calf raises, bridges, triceps kickbacks, countertop push ups

 

Balance Exercises

Balance exercises help maintain your footing when an unexpected movement occurs in your daily life. Improving balance and coordination can reduce your likelihood of falling, therefore decreasing your fracture risk. Ironically, in challenging your balance, you run the risk of falling. For this reason, you must always take precautions such as having a chair nearby to hold onto. When you are training your balance, there are two main types of balance exercises:

  • Static Exercises – Stand still in one spot holding a certain posture in order to practice balance. For example, standing on one foot on the floor.
  • Dynamic Exercises – Balance is challenged more with adding movement. For example, walking ina straight line while touching the heel of one foot to the toe of the other with each step.

 

Stretching

unnamed (1)As you age, you lose flexibility which can increase your stiffness and discomfort, often preventing you from staying active. Stretching exercises help you to counteract this by increasing the range of motion of your joints and improving your flexibility. It is important to note that stretching should always be done after the muscles and the body are warmed up since stretching cold, stiff muscles increases your risk of injury. Just like in balance training, there are two main ways to stretch:

  • Static Stretching – Take the muscles to their end range of motion and maintain that position for at least 30 seconds in order to enhance soft tissue and muscular flexibility.
  • Dynamic Stretching – Functional, multi-joint movements that typically increase in range of motion and speed as the body begins to warm up.

While both are effective, dynamic stretching has been shown to be more beneficial than static stretching as a way to warm up prior to activity since it has been found to improve balance, strength, reaction time and agility. Static stretching, however, is still important and is most beneficial when performed at the end of exercise as a cool down. Static stretching can also be done separately when the body is warm as part of an everyday attempt to improve body mechanics, posture and flexibility.

 

Posture Training

unnamed (1)We all have a natural curve in our spine, however, weak back muscles and/or spinal fractures can cause an excessive forward curvature of the spine. Rounding of the upper back is known as exaggerated kyphosis. This puts pressure on the front of your vertebrae, placing them at even great risk of fracture. Posture training exercises help to improve the alignment of your spine by correcting shoulder, back and neck positioning. Focus should be placed on exercises that strengthen the back muscles and reduce forward head posture. Abdominal exercises that strengthen the core muscles, help to maintain good posture as well.

 

To Sum Up

An exercise program is a vital component in the management of osteoporosis.

Regular participation in aerobic and strength training is fundamental, as well as balance, posture management and stretching.  All in all, physical activity for individuals with osteopenia or osteoporosis can promote bone health and overall quality of life.

BodyTech Physiotherapy

Concussion Management Part 1: The Role of Physiotherapy

By Cassandra Kroner, PT

What is a Concussion?

Concussions are a type of mild traumatic brain injury. Common causes include car accidents, sports, falls, or workplace accidents. Concussions can result from direct impact to the head, or from forces elsewhere in the body such as sudden acceleration or deceleration that cause an  injury to the brain and brain-stem.  The result is damage to cells and chemical imbalances that disrupt normal brain function.

Concussion Head imageImmediately following injury a sequence of chemical processes occur as the brain attempts to restore its normal balanced state. This increased activity in the brain is happening at a time when blood flow is decreased to the site of injury, creating an increased demand for energy. The resulting impairments in neurological function can cause a variety of signs and symptoms:

Physical Behavioural/Emotional Cognitive
Headache Drowsiness or fatigue Feeling foggy
Nausea Irritability Trouble thinking clearly
Vomiting Depression Feeling slowed down
Blurred or double vision Anxiety Difficulty concentrating
Balance problems Sleeping more than usual Difficulty remembering
Dizziness Difficulty falling asleep Trouble finding words
Sensitivity to light or noise Sadness Confusion

 

First Steps Following Injury

Concussions are often under-reported and misdiagnosed, and it is important to note that loss of consciousness is not necessary for a diagnosis. Contributing to the difficulty in identifying concussions is the lack of imaging or other tests to aid in diagnosis. Unless there is bleeding or swelling in the brain, the changes that occur with a concussion are not visible on a CT or MRI. If a concussion is suspected, an evaluation by a physician is recommended, and unless symptoms are severe or quickly worsening it is usually not necessary to visit the emergency room. Once the diagnosis is established and conditions requiring further medical treatment are ruled out, treatment should begin immediately.

Early Management

HeadacheTimely intervention following a concussion is essential to ensure optimal management and recovery. An outdated approach to concussion treatment is to stay in a quiet dark room until symptoms are resolved. With a growing demand for evidence-based treatment strategies, there is a wealth of new research that refutes this old-fashioned ‘dark room’ approach. Although complete rest is recommended for the first 48-72 hours after injury, research supports a more active approach to recovery following the initial rest period. Prolonged physical rest can lead to de-conditioning, depression and fatigue, making it more difficult to return to the previous level of physical activity.

Complete physical and cognitive rest immediately following a concussion is critical to ensure adequate energy supplies for the brain as it attempts to heal. Excess physical or cognitive exertion at this time will use precious energy that the brain needs and can result in exacerbation of symptoms and prolonged recovery. Physical rest means no exercising and caution with exertion around the house. Cognitive rest should focus on refraining from activities that require concentration (schoolwork, reading), as well as visual attention (television, video games, computer or phone use). Alternative options are listening to music or audio books.

Importance of Physiotherapy

A visit to a physiotherapist with advanced concussion management training is recommended for a detailed assessment following a concussion. Your physiotherapist will take a thorough history and can assess visual and vestibular symptoms, balance, cognitive function, and any additional injuries sustained at the time of concussion. Recommendations for the initial rest period as described above will be tailored to each individual, and further suggestions for management of symptoms will be provided.

Treatment plans involve a carefully monitored graded program of exertion to assist with a safe return to work/school and then sport. Every individual will experience a different set of symptoms following concussion, and as a result there is not a ‘one size fits all’ approach to treatment. This is why having a professional guide you through recovery is valuable. Specific and progressive exercises will be provided to target deficiencies in the vestibular and visual systems. To facilitate a gradual return to school or work, suggested accommodations would be provided to minimize symptoms and maximize participation. Additionally, manual therapy to address complaints such as neck pain or headaches can be part of treatment. Once the individual has returned to school or work, physical exertion testing is the last step before being cleared for sport.

Recovery time frames vary between individuals, but for many people, symptoms resolve in a month or less. However, there are a number of factors that can delay or prolong recovery. Stay tuned for part 2 of the concussion management blog series to learn more.

BodyTech Physiotherapy

Update: Continue reading on part two of our Concussion Management blog series.