Gunn IMS

By Jacqueline Render, PT

We are excited to announce that we are now offering Gunn IMS at BodyTech Physiotherapy!

Gunn IMS is a dry needling treatment technique for the treatment of chronic myofascial or neuropathic pain.

Myofascial pain is felt as tight, sensitive musculature with muscle banding, often felt as “knots” or “trigger points.” You may experience pain from the shortened muscles directly, or from chronic pain on the tendons or compression of the joints the muscles pass over. Often, people with myofascial pain find that they are unable to stretch to relieve the muscle tightness. It is often made worse by activity or exercise. People with myofascial or neuropathic pain will often describe deep aching, burning or shooting/stabbing pain or sensitivity to pain beyond what would be considered normal for that situation. The affected area may feel heavy or different compared to the other side or other areas of the body. There may also be changes to the hair or skin around the affected regions.

Chronic myofascial pain often has sensory, motor (movement) or autonomic changes that indicate problems with the function of the peripheral nervous system. Many chronic pain problems fit into the myofascial pain spectrum, some examples include: achilles tendinitis, bursitis, tennis elbow, shin splints, plantar fasciitis and piriformis syndrome.

Gunn IMS can be very effective for chronic pain that is not resolving with traditional approaches to treatment. [1] The goal of IMS treatment is to stimulate the nervous system and release muscle shortening caused by dysfunction, to allow a “reset” to the nervous system, and create an environment at a cellular and nervous system level to promote healing. This “reset” to the system stimulates the nervous system, which calms it, improves movement patterns and relieves pain associated with dysfunctional muscle tension. It creates an opportunity for you and your therapist to progress rehabilitation.

What is dry needling?

Dry needling is a class of treatments that use fine, solid needles to penetrate the body’s tissues.  Any form of needling that does not inject a substance into the body is considered “dry needling.” Acupuncture and IMS are considered dry needling.

Is it painful?

IMS needles are inserted into a patient’s tight bands of muscle. The insertion of the needle is not painful and often not even felt by the patient. When the needle penetrates the tight band of muscle, a sensation of heaviness or cramping occurs. This is necessary for the therapeutic effect, but it is short lived, usually only lasting for seconds. Patients may feel some heaviness or aching in the treated muscles for a day or two after treatment, much like the feeling of muscles after a workout.

How does it work?

There are a few ways that IMS works. The first is that it creates a local reflex to the nervous system that allows the muscle to relax. The second is that is creates a small amount of local inflammation, which activates the body’s healing responses. A third is that if applied to tight muscles that cross the spine or an irritated joint, it reduces compression through the joint or on the nerves as they exit from the spine

Is it safe?

Our physiotherapists have been extensively trained in the safety of this treatment both in application of the treatment and in screening patients for this treatment. Your therapist will discuss the risks and potential benefits of treatment with you before determining if this is an appropriate treatment option for you.

Please note, this treatment is not appropriate for those with bleeding disorders or who are currently pregnant.

Who would benefit from this treatment?

Gunn IMS is possibly indicated for:

– Individuals with chronic pain that lasts beyond normal healing timelines for an injury, or pain that may have occurred without any specific injury

• Individuals who have recurrent pain
• Individuals with syndromes that are long-lasting and failing to progress (e.g. Tennis elbow, achilles tendinitis)
• Individuals who have plateaued with other treatments
• Individuals with symptoms of nerve dysfunction (a ‘wiring problem’)
  • Sensations of heaviness or aching in one or multiple limbs
  • Sensation that their limb feels ‘different’
  • Individuals who are unable to strengthen a muscle no matter how hard they work it
  • Individuals who are unable to stretch a muscle no matter how much you try to stretch it

Your physiotherapist will ask you questions and assess you to determine whether this is a treatment that could possibly benefit you.

What to expect?

Your physiotherapist will perform a full examination including your personal report of your pain, medical history and goals for treatment. They will perform a full musculoskeletal examination to determine the treatment most appropriate for you. This assessment may look different than other physiotherapy examination, as they are looking for signs of nervous system sensitization or dysfunction. Points for needling will be chosen based on the location of your pain, and the sensitivity of your nervous system.

Gunn IMS can be applied as a standalone treatment, but it is often combined with manual therapy and a home exercise program geared towards the individual patient.

How do I prepare for this treatment?

You can prepare like any other physiotherapy appointment. It will be important for your physiotherapist to access the skin of the areas being treated. Bring a pair of shorts with you, and for women, a tank top or bra/sports bra (that opens at the back) that you are comfortable wearing. Your physiotherapist can also provide you with shorts or a gown, if you prefer.

I am interested in Gunn IMS treatment, how do I book?

If you would like to book a physiotherapy appointment, call or email our clinic. When booking, mention that you are interested in IMS and you will be booked with a practitioner that is certified in Gunn IMS.

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Is Virtual Physiotherapy for you?

BodyTech 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

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:

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!

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.

Immediately 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

Timely 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.

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

Injury Prevention and Physiotherapy

By Cassandra Kroner, PT

It is a common misconception that you only need to see a physiotherapist if you have an injury or pain. Physiotherapists have a wide range of skills, and recognizing the risk for future injury is one of them. Injury prevention is applicable to all individuals, regardless of their activity level, from the office worker to the athlete, and especially for those with previous injuries that could reoccur.

Repetitive Strain Factors

• Occupation
• Training errors
• Age
• Excessive or repetitive loads
• Inappropriate footwear
• Structural abnormalities
• Muscle control
• Core stability
• Joint alignment
• Muscle strength and flexibility imbalances
• Previous injury
• Posture

In general there are two types of injuries – traumatic and repetitive strain. Traumatic injuries are easier to understand, as they are the result of a singular event that causes damage. On the other hand, repetitive strain injuries occur when stressors that normally do not cause harm are repeated to the point of causing micro trauma that builds over time until the tissue becomes inflamed and injured. These injuries tend to begin subtly, and gradually increase in severity. Combined with the multi-factorial list of possible contributing factors, repetitive strain injuries can be challenging to diagnose and treat. However, in most cases repetitive strain injuries can be avoided with a good injury prevention and maintenance program.

A Common Factor: Muscle Imbalance

When an individual is involved in one specific sport or has a repetitive aspect to their job, the muscles are put under a great deal of strain to repeatedly perform the same movements. Sedentary jobs involving prolonged postures can have similar effects with certain muscles constantly working for long periods. Over time, muscle imbalances develop as the muscles that are being used the most continue to get strong while the reciprocating muscles become lengthened and weak. These muscle imbalances can cause movement restrictions that affect performance and increase stress on the body. Increased stress on muscles, joints and ligaments eventually leads to a repetitive strain injury.

The First Steps Toward Injury Prevention

Getting started on the road to injury prevention is as simple as booking an appointment with a physiotherapist. If you are unsure how injury prevention could apply to you or if you could be at risk for injury, speaking with a physiotherapist can help clarify your needs and goals. The same expert assessment skills physiotherapists use to diagnose injury will be used to proactively assess for risk factors that could lead to future injury. Your lifestyle, the demands of your job, and the specific sports or activities you participate in will be considered, along with the assessment findings, to develop an individualized treatment plan. This plan could involve manual therapy to correct joint restrictions or muscle length imbalance, strength and flexibility exercises, correction of movement patterns, and education.

By addressing several predisposing factors to injury, the body is optimally prepared to handle the demands of the workplace or sport. This can translate to decreased frequency and severity of future injuries, with the added benefit of a shortened recovery time in the event an injury does occur. Don’t wait for an injury to strike to take charge of your health!

The Sitting Solution

By Carla Cranbury, PT

Let’s face it, we sit a lot. Between working, commuting, and watching television, the Canada Health Measures Survey found that most Canadian adults spend 9 hours and 48 minutes of their waking time being sedentary. Most of us know that physical activity is good for us, but did you know that just sitting less (regardless of exercise) can also be beneficial in the long term?

A study published in 2009 followed more than 17 000 Canadians for 12 years. Over the twelve years they compared the participants’ daily sitting time and leisure time physical activity with mortality rates of various causes. What they found was that the amount of daily sitting time was positively associated with mortality rates from all causes, except cancer. Basically the more people sit, the higher the risk of mortality. This even includes people who are physically active, showing that high amounts of sitting time cannot be compensated for with exercise, even if it exceeds the current minimum physical activity recommendations.

Other studies have echoed similar findings. A seven year study reported that people who spend less than half their time sitting have a lower risk of mortality than those who spend more than half their day sitting. Another six year study reported that women who spend 16+ hours sitting per day have an elevated risk for cardiovascular disease compared with women who sit for less than 4 hours a day.

These studies are not to say that physical activity is not important – it still is, and it is still beneficial for your health. Physical activity also contributes to decreased time spent sitting.  What these studies are saying is the physiology associated with excessive sitting is different than the physiological benefits of exercise, and therefore excessive sitting cannot be compensated for with periods of exercise.

So now that you know, what can you do?

If you work at a desk most of the day, sitting can be hard to avoid. Some options are:

• Ask your work if they can accommodate an ergonomically sound standing desk
• Take frequent breaks from sitting to walk around
• Go for a walk on your lunch break
• Walk to your co-workers desk to talk to them instead of sending an email
• Park at the back of the parking lot to get a few extra steps
• Take the stairs!
• Take frequent standing breaks throughout the day
• Discover new ways to be active during your leisure time – ditch the TV and get outside

It’s the small changes to your daily routine that can add up and make a big difference. The best time to start is today!

References

Katzmarzyk, Peter T. et al. “Sitting Time And Mortality From All Causes, Cardiovascular Disease, And Cancer”. Medicine & Science in Sports & Exercise 41.5 (2009): 998-1005. Web.

“Directly Measured Physical Activity Of Adults, 2012 And 2013”. Statcan.gc.ca. N.p., 2017. Web.

Manson, J.E., P. Greenland, and A.Z. LaCroix. “Walking Compared With Vigorous Exercise For The Prevention Of Cardiovascular Events In Women”. ACC Current Journal Review 12.1 (2003): 29. Web.

Weller, Iris and Paul Corey. “The Impact Of Excluding Non-Leisure Energy Expenditure On The Relation Between Physical Activity And Mortality In Women”. Epidemiology 9.6 (1998): 632-635. Web.

Why dancers need the perfect balance of strength and flexibility

By Kelsey Jack, PT

My ballet teacher once told me that given a choice between having strength and flexibility, she would choose strength. This has always stuck with me as there is such an emphasis on flexibility within the dance world that often there is a lack of focus on building the strength required to make use of that flexibility. This enhanced focus on flexibility instead of a balance between strength and flexibility creates muscle imbalances. If dancers work to improve their flexibility and ignore balancing the strength around the joints, it leaves the dancer vulnerable to injury.

Why is balancing strength and flexibility important?

Stability is provided to joints from a combination of passive and active structures. Passive structures include the bones that make up the joint and the ligaments that surround it and support it. Active structures are the muscles and tendons that act to both maintain stability and move the joint. Focusing on passive, static stretching, as is often the case in dance, can lead to instability of joints as the ligaments that are meant to stabilize the joint become stretched out and no longer provide joint support.

Flexibility, or range of motion can be divided into two categories: passive and active. Passive range of motion is demonstrated by how high a dancer is able to lift their leg using their hands whereas active range of motion is how high a dancer is able to lift their leg using their hip muscles and is demonstrated by doing a step like a developpé.  Practically speaking, flexibility without strength limits active range of motion and will hinder the height of legs when performing steps that involve controlled movements and sustained positions.

Back bends are a good example of a movement that is common in dance where strength is required to balance the flexibility of the spine. Dancers without good core strength and control will hinge through their spine, relying on one or two segments to gain all of their movement through. This leaves the spine vulnerable to injury as the ligaments and discs are relied on for support. Ideally when doing a back bend the spine should form a “C” curve. Many teachers instruct dancers to breathe up and extend through the top of their head into their back bend to encourage control into this movement pattern. Engagement of the abdominals and stabilizer muscles of the spine are required to move through each segment of the spine in a way that supports the passive structures of the back to create the desired curve.  It is subtle differences such as these in how a dancer moves, using strength to control their flexibility, that improves the quality of movement and decrease the future risk of injury.

Evidence to support strengthening to increase flexibility

As dancers are often concerned about their hip flexibility, a study was done looking into the best way to increase hip active range of motion. The researchers compared three stretching programs over a six week period. The first group of dancers completed a strengthening program where they worked at strengthening their hip flexors at the end of their available range of motion. The second group completed a “light” stretching program for their gluteals, hamstrings, calves, and quadriceps muscles, holding each stretch for 1 minute. This group was asked to perform stretches at an intensity of 3/10 on a scale where 0 is no stretch and 10 is an intense stretch that elicits a burning sensation. The third group performed the same stretches but at a “moderate-high” intensity which was rated as 8/10 on the same scale. The study found that all three groups had an increase in their passive range of motion but only the strength training and the low intensity stretching groups improved their active range of motion. The strengthening group saw the greatest improvements in both passive and active range of motion which is explained by the hamstrings relaxing as the hip flexor is contracted. This allows the hamstring to lengthen while the hip flexor is strengthened. Intense stretching without strengthening (as in the high intensity group) leads to lengthened, weakened muscles which functionally hinder a dancer’s ability to make use of their range of motion. This study demonstrates that exercises that specifically train the hip flexors progress flexibility in a way that translates into dance.

Strengthening allows dancers to maximize their flexibility without compromising the integrity of their passive support structures and increasing their risk of injury. A physiotherapist can assess a dancer’s strength and flexibility and develop a program that will safely allow a dancer to increase their flexibility while strengthening the muscles needed to support their joints, improve performance, and decrease risk of future injury.

References:

Wyon MA, Smith A, Koutedakis Y. A Comparison of Strength and Stretch Interventions on Active and Passive Ranges of Movement in Dancers: A Randomized Controlled Trial. Journal of Strength and Conditioning Research. 2013. 27(11)3053.

How Physiotherapy Can Help With Osteoporosis

By Lana Kovacevic, PT

Osteoporosis is a condition of reduced bone strength that causes bones to be more likely to break (1). It is a progressive disease in which the density and quality of bone decreases over time making it more fragile. Current trends show that more and more people are affected by osteoporosis each year (1). Among Canadian men and women, an estimated 1 in 4 women have osteoporosis compared to 1 in 8 men (1).

Why is osteoporosis so concerning?

The major threat to healthy aging and independent mobility for those with osteoporosis is the risk of sustaining a fragility fracture. A fragility fracture is a broken bone that results from minimal trauma or stress – stress which typically would not cause a bone to break (1). An example would be breaking a bone in the wrist or hip after falling from standing height (1). After an initial fragility fracture, you become more than two times as likely to sustain another fracture in the future (1). The most common bones to be injured are those of the wrist, upper arm, ribs, spine, pelvis, and hip (1).

Who is at risk for osteoporosis?

Canadian guidelines recommend that all postmenopausal women and men over the age of 50 years be screened for their risk of osteoporosis (1). A diagnosis is made following an X-ray that measures bone mineral density. This test is recommended for those who have at least 1 major or 2 minor risk factors (1).

Figure 1: Some key major and minor risk factors for osteoporosis (1)

Major Risk Factors	Minor Risk Factors
Age over 65 years Family history of osteoporosis fracture Early menopause (before age 45) Glucocorticoid therapy for more than 3 months Falls	Smoking Diet low in calcium Body weight less than 57 kg Rheumatoid arthritis

How can I check if I am at risk for osteoporosis?

A convenient online tool for estimating the risk of osteoporosis fracture exists called the FRAX® Fracture Risk Assessment Tool. Click on this link to get an estimate of your personal risk. If you are concerned about your risk for osteoporosis, it is best to consult your family doctor.

How is osteoporosis treated?

Apart from medical management with medication and supplementation, exercise is a key component of treatment. Exercise has been shown to slow the loss of bone mineral density and reduce the risk of falling (1). This means that exercise can be beneficial for both preventing osteoporosis as well as managing symptoms for those already diagnosed with osteoporosis.

Can physiotherapy and exercise help if…

…I’m concerned about developing osteoporosis in the future?

For anyone at an increased risk of osteoporosis or those with a family history of osteoporosis, taking part in weight-bearing physical activity and activity that involves some impact is best for preventing bone loss. Starting this type of exercise at a younger age may make you less likely to suffer from osteoporosis in older age.

…I’ve already been diagnosed with osteoporosis?

For those with osteoporosis, exercise is important to help minimize bone density loss. It is also critical for reducing the risk of falling and therefore, a broken bone. Risk of falling is higher for people with poor strength, balance, posture, and with poor postural stability. All of these factors can be addressed and improved with a proper exercise program.

…I’ve already had a fragility fracture and want to avoid having another one in the future?

A safe exercise program is also beneficial for those who have already suffered a broken bone associated with osteoporosis. Less than 20% of women (or 1 in 5) and 10% of men (or 1 in 10) who have had a fracture are given the appropriate treatment to prevent a future fracture (2). It is important to restore safe movement patterns during recovery from a fracture as well as to reduce the risk of sustaining another fracture.

Each person is unique and should have an exercise program that is tailored to their specific needs. A physiotherapist can assess, treat, and teach you how to reduce your risk of osteoporosis, manage your symptoms, and improve your general health and physical functioning.

Reference:

1. Brown JP, Josse RG. 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ. 2002. 167(10); S1-34.
2. Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, et al. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ. 2010. 182(17): 1-10.

Shin Splints

Medial tibial stress syndrome, commonly called “shin splints”, is a term used to describe pain and tenderness felt on the inside, lower border of the shin bone. Shin splints are commonly experienced by athletes who take part in activities involving repetitive running and jumping, particularly after a sudden increase in activity level (either duration, distance or intensity). The repetitive stress placed on the bones, muscles and joints of the lower leg during these high impact activities may result in irritation and inflammation of the shin bone (tibia).

Shin splint pain is usually described as a dull ache. It usually develops slowly over time, first being noticed at the end of activity. Some athletes may complain of pain at the beginning and end of activity, but not affecting their performance. Over time, pain will commence during activity and eventually may be felt during regular day to day activities such as walking. As shin splints progress, they also make the lower leg sore to touch.

There are a number of factors that may predispose an athlete to develop shin splints including: flat feet, rigid arches, muscle weakness, and/or muscle tightness. Other contributing factors may include running downhill, running on hard surfaces, running in worn-out footwear, or playing sports with frequent stops and starts (e.g. basketball, squash, tennis). While the pain presentation is often similar across individuals, there are a variety of bio-mechanical abnormalities in the pelvis, hips, knees, and ankles that can also lead to the development of shin splints.

Proper treatment requires a detailed assessment by a registered Physiotherapist to identify and target the contributing factors as well as the location of pain. Treatment includes rest, ice, specific joint mobilizations, an individualized stretching and strengthening program, and if needed a gradual return to regular activity. During recovery, aerobic fitness can be maintained with low impact activities such as swimming and biking. If left untreated, the repetitive stress on the tibia may result in a stress fracture yielding a longer recovery time.

A physiotherapist can perform a full assessment to determine the exact cause of an athlete’s pain and develop a treatment program to relieve pain, facilitate return to activity, and prevent future injury.

Physiotherapy for Carpal Tunnel Syndrome

Carpal Tunnel Syndrome
Carpal Tunnel Syndrome is pain, numbness, and tingling, in the wrist and hand particularly in the thumb, index and middle finger. This syndrome affects approximately 3-6% of the general population. The carpal tunnel is a small passageway at the wrist that tendons and the median nerve run through as they travel into the hand. The tunnel is surrounded by bone and connective tissue so it does not easily stretch or expand, making structures within it susceptible to irritation which can cause the median nerve to be compressed. If left untreated and the condition worsens, symptoms may progress to include weakness in the hand.

Causes and Risk Factors
A combination of several of the following factors can increase the risk of developing carpal tunnel syndrome:

• Chronic stress on wrist/hand – typically affecting the dominant hand, often due to working posture or repetitive motions (eg. using computers for several hours a day, assembly-line workers, musicians, using vibrating power tools)
• Trauma to the wrist (eg. fracture, sprain) – can cause damage to the nerve or swelling to other structures that will narrow the carpal tunnel
• Pregnancy – hormonal changes can affect tendons and cause swelling
• Arthritis – bony growths into the tunnel narrow the space
• Congenital Predisposition – women and smaller individuals may have narrower carpal tunnels, reducing space for the nerve
• Diabetic or Metabolic Disorders – negatively affect the body’s nerves

Symptoms
The most common symptoms of carpal tunnel syndrome include:

• Gradual onset of pain, burning, tingling, numbness or itching in the palm, thumb and/or index and middle fingers
• Feeling of weakness and swelling in the hand, with difficulty grasping small items, making a fist and performing fine motor tasks
• Urge to shake out the hand to relieve the tingling sensations

In the early stages, symptoms will often be intermittent. However, as the condition worsens symptoms are more severe and begin to persist for longer periods of time. Pain and numbness tends to be worse at night for a lot of individuals.

Treatment
It is advised to seek treatment from a professional as soon as carpal tunnel symptoms arise as the condition will not typically resolve on its own.

Medication: Over the counter anti-inflammatory drugs (eg. Ibuprofen) may provide short term relief from mild symptoms. Corticosteroid injections are a much stronger anti-inflammatory, and may also be a temporary option to help relieve pressure and symptoms for those with relatively mild symptoms.

Physiotherapy: Seeking help from a registered physiotherapist is one of the best options for treatment of carpal tunnel syndrome. Physiotherapy will include manual therapy on your wrist to improve the mobility of the joints and stretch tight muscles and tendons in the wrist and fingers, helping to remove any scar tissue buildup that may hinder recovery. The Physiotherapist will also incorporate nerve gliding techniques to help improve the mobility of the median nerve through the carpal tunnel. Ultrasound may be used over the carpal tunnel area to reduce inflammation which helps to relieve symptoms. Your physiotherapist may also suggest a brace or splint to immobilize the wrist while working or performing aggravating activities. They will provide education about activity modification to avoid aggravating positions, such as holding the wrist in a flexed (bent) position. Your physiotherapist will also prescribe specific stretching and strengthening exercises for the fingers, thumb, hand and arm to progress through later stages of recovery. They will provide education on proper posture while working to prevent relapse.

Surgery: With very severe cases of carpal tunnel syndrome where nonsurgical treatment does not provide any relief, surgery may be an option. The surgery typically consists of cutting the roof of the carpal tunnel, to provide more room for the tendons and median nerve and decrease compression. Full recovery back to original strength in the hand may take 6-12 months.

While carpal tunnel is a relatively common condition, it is often misdiagnosed, thus it is a good idea to seek treatment from a registered physiotherapist upon the onset of symptoms in order to have the best chance of full recovery and to prevent irreversible damage. Your physiotherapist will be able to recommend appropriate treatment options, whether that be manual therapy, bracing, or if necessary, surgical intervention.