Use Your Natural Back Brace

- by Fabienne Moser, Registered Physiotherapist; Associate, Sun City Physiotherapy

Since summer has finally arrived, you may be spending regular time in the garden. And with gardening, comes the effects of these activities on your lower back? Has that old back strain flared up again? If so, it may be time to take the initiative to prevent your back pain from getting worse.

The goal with rehabilitation and prevention of lower back pain is to find the optimal balance between movement and stability. The spine itself is relatively unstable and needs the help of the muscular system to maintain its stability. Without the muscles that control each intervertebral segment, the spine would be free to move around in many different ways. However, that degree of freedom of movement would cause all kinds of wear and tear on back structures such as discs, nerves, and joints. One way in which the body helps maintain the stiffness of the spine is by using the co-contraction of different core muscles. These muscles are your body’s natural built-in back brace.  It is essential that these muscles not only work appropriately, but also are strong enough to keep the spine stiff, especially with activities such as lifting and shoveling.

The Transverse Abdominus or “TA” is one muscle in particular that has been getting a lot of attention when evaluating and treating lower back pain. This muscle makes up the deepest layer of your core musculature and encircles the abdomen, just like a synthetic back brace would. The “TA” tends to be weak in many people with a history of lower back pain. It is therefore suggested you learn how to activate and strengthen this muscle statically, as well as dynamically, in order for it to support your spine.

One-way to learn how to do this is to perform a “suck, squeeze, and squeeze” motion. The “suck” component involves subtly drawing your belly button inwards towards your spine.  This movement would be similar to what one would do when walking into a cold lake, or trying to fit into a tight pair of jeans. You then “squeeze” your gluts together as well as “squeeze” your pelvic floor like you’re trying to stop yourself from going to the bathroom.  It is best to first learn how to do this motion lying down. Try to hold it for a few seconds while still remembering to breath. Once you learn to hold this contraction for longer, transfer it into day-to-day activities like walking, gardening, and working at a desk.  As this muscle gets stronger it will start to work together with the other, more superficial, core muscles to stiffen the spine and prevent further back injury.

Your physiotherapist can teach you more on this topic, and show you how to improve your core stability.

This is provided as general information only and is not intended to be relied upon as medical advice. Fabienne Moser is a registered Physiotherapist and associate at Sun City Physiotherapy at the Downtown, St. Paul Street clinic. She can be contacted at Sun City Physiotherapy’s downtown, St. Paul Street clinic by calling 250.861.8056 or via email at downtown@suncityphysiotherapy.com

Tennis Elbow Season

- by Adam Bernard, Registered Physiotherapist

Lateral epicondylitis or tennis elbow is a common injury we see as physiotherapists.  It involves inflammation around the bony aspects of the outside of the elbow.  This can be a painful experience and can have a long healing process. 

It can be caused by direct trauma to the outside of the elbow or more commonly by overuse of the wrist extensor muscles.  Wrist extensor tendons attach to the outside part of the elbow and are responsible for controlling some of the movements of the wrist.  The dominant hand is most often the side that is affected.

Lateral epicondylitis usually presents with some or all of the following: diffuse achiness, morning stiffness, occasional pain through the night, pain with gripping, dropping objects, or tender to touch the outside of the elbow.   Lateral epicondylitis is not limited to problems at the elbow as the shoulder and neck can also have a contribution to the onset of pain.   The elbow pain can start acutely where the pain is abrupt or the pain can be a gradual onset.

Many jobs require heavy lifting, repetitive motions, or prolonged gripping which can all lead to lateral epicondylitis.  It is common in jobs such as construction/electrical or jobs that require large volumes of typing.  There are a number of recreational activities that can cause this type of injury.  As we move into summer some of the more common activities include kayaking, wake boarding, golf, squash, racquetball, weight lifting, baseball, and of course tennis.

There are a number of treatments used to treat tennis elbow.  One common treatment you may see people using is a tennis elbow brace which can help reduce the strain on the affected muscles and tendons.  Other treatment options may include:  rest, ice, modalities such as ultra sound and IFC to reduce inflammation, stretches, and strengthening. 

Some ways to minimize your chances of developing lateral epicondylitis include: 

1) Reducing repetitive activities or using your non-dominant hand more often. 

2) Reduce forceful grasping. 

3) Take frequent breaks. 

4) Break up lifting heavy loads into smaller more manageable loads.  

In terms of sport it is important to ease yourself into the sport as the new season starts.  You don’t have to go on a 3 hour kayak on your first day out! 

Following a few or all of these guidelines may help reduce or avoid this painful condition that can so often take months to heal completely. 

This is provided as general information only and is not intended to be relied upon as medical advice. Adam Bernard is a registered physiotherapist and associate at Sun City Physiotherapy’s Glenmore’s location. He can be contacted at Glenmore@suncityphysiotherapy.com

The Perennial Golfer's Elbow

- by Jay Stone, Registered Physiotherapist, Co-Owner Sun City Physiotherapist

The 2012 golf season is now starting at many courses in the Okanagan and soon every avid golfer will be in full swing. In past years I’ve usually written this early article about the basics of good injury prevention. These include golf strength conditioning, performing a warm up and stretch before playing and making smart decisions around the golf course that could limit the impact of the swing on your body. This year I decided to write about a specific golf condition that affects the inside of the elbow. In Physiotherapy we call this condition medial epicondylitis of the elbow. The lay term is golfer’s elbow. This condition is not to be confused with Tennis elbow, which also affects the elbow, but in a different location.

Golfer’s elbow occurs on the inside of the elbow, where the forearm flexor muscles attach to end of the upper arm bone (the humerus). In a golfer it will usually occur on inside of the trail side elbow. The trail side elbow would be the right elbow of a right handed golfer. This injury can occur from over gripping the club or from wrist action during the swing. More commonly it happens after a sudden force such as when you hit a shot too fat. For those of you unfamiliar with the term hitting the ball fat, it means taking a little too much divot or earth when you swing down on the ball. When the club suddenly hits the ground too hard the body is forced to absorb that force. The inside of the trail side elbow is one area that takes the brunt of this force.

The golfer will feel pain on the inside of the elbow, made worse with gripping and flexing the wrist. There may be swelling present but often it is very mild. On subsequent swings pain may be felt at impact with the ball. If you feel you’ve suffered this injury then you should focus on icing the inside of your elbow for 15 minutes every couple hours for the first 2 days after injury. Very gentle stretching can be done by using your other hand to extend your wrist and fingers. A light stretch should be felt along the inside of the forearm. To make the stretch stronger you should also keep the affected elbow straight during the stretch.

There are braces on the market that go around the forearm and apply pressure to the forearm muscles. These braces work to dissipate the force put on the elbow by the muscle contraction so they can be helpful during the healing process. When you do start playing again, you should make sure you get a good warm up prior to playing and perform the wrist stretch I described above a couple times after some light swinging. Once you are playing, be aware of shots that have the potential to cause extra stress to the elbow. An example may be a ball sitting down in the rough or nestled up near a root.

Lastly, remember that this injury doesn’t only occur with golf. If you start getting pain on the inside of you elbow after shovelling or doing some other work around the house, you can also use the advice I provided to treat it and guide your progression back to activity. If you condition is not getting better you should seek advice from your health care provider.

This is provided as general information only and is not intended to be relied upon as medical advice. Jay Stone is a partner at Sun City Physiotherapy. He also holds his certificate in Sport Physiotherapy and has extensive experience and education in Golf specific rehab. Jay can be reached at Sun City Physiotherapy’s Glenmore clinic by calling 250.762.6313, or via email at jstone@suncityphysiotherapy.com

Protect Your Spine and Improve Your Posture With Basic Pilates Principles

- by Yun Cheung, Registered Physiotherapist, Sun City Physiotherapy, Kelowna

The rise in popularity of Pilates as a form of exercise for fitness and rehabilitation has been largely due to reports that it can help to improve posture and strengthen the ‘core’ muscles to help support and protect the spine. So how can you reap some of the benefits of a Pilates practice and make it part of your daily routine without attending a Pilates class?

First, it is important to understand the basic Pilates “Principles”. There are 6 basic principles in the original Pilates Method, as developed by Joseph Pilates: Concentration, Control, Precision, Centering, Fluidity, and Breathing.

In general, the emphasis is placed on mindful, focused, intentional movement. The Centering principle reminds one to activate through their “core” muscles (known as the “Powerhouse” in Pilates) before moving. These muscles include: 1) the Transverse Abdominals, the deepest layer of abdominal muscles that wrap around the torso like a girdle and work to stabilize the spine while allowing flexibility of movement; 2) the Multifidus muscles, small muscles that connect and stabilize the vertebrae (bones that make up the spine); and 3) the pelvic floor muscles (otherwise known as your Kegel muscles).

Breathing is also included in this list. Breathing is used in Pilates to activate the Powerhouse or core muscles in preparation for movement. It also helps to facilitate and control the speed of movement.

Next, try to see if you can find and practice the following, lying on your back. Keep your knees bent with your feet flat on the floor.

Step 1: Find your Breathing Principle. Focus on finding your breath, breathing in (inhaling) through your nose and breathing out (exhaling) through your mouth. Inhale deeply, thinking of taking air in all the way down to the sides and bottom of your lungs. Most people breathe using shallow breaths, with their chest moving up and down. In Pilates, breathing is taught so that the ribcage moves laterally, or in and out like an accordion.

Step 2: Try to maintain the rhythm of the breath (avoid holding your breath) and see if you can activate your Transverse Abdominals by GENTLY pulling your bellybutton in and holding it there.

Step 3: Maintain the breath and the gentle Transverse Abdominal activation and see if you can add in a GENTLE activation of the pelvic floor muscles. Most people relate to their pelvic floor muscles as the muscles they would use to stop the flow of urine. In this case, you want to achieve a subtle activation as though you are aiming to “slow the flow” instead of stopping it entirely.

Once you had a general sense of trying to activate your Transverse Abdominals and pelvic floor muscles while maintaining your breathing, try to see if you can practice this in different positions, such as sitting and standing. Many people find it very effective to try to find their muscle activations kneeling on hands and knees. Try taking a 30-second break at frequent intervals throughout your day. Find your breath, your core muscle activations, and maintain for 5 breaths. Gradually increase the number of breaths and the length of time you maintain the muscle activation. Also see if you can keep the rest of the body relaxed, trying to avoid creating new tension in other areas, such as your neck and shoulders.

Remember that this will take practice; like learning to ride a bike, it may take some time to master. The goal is to work towards being able to maintain the breathing and gentle activation of the core muscles before layering in other movements, such your daily activities (e.g. lifting a bag of groceries or placing dishes in the dishwasher). You can also try to incorporate these ideas into your recreational activities as well. For example, see if you can find your breath and your core muscle activation before your next set of bicep curls at the gym. See if you can do the same while biking, running, or kayaking.

Over time, the breath will flow easier and the muscle activations more automatic. Then you can stand a little taller and tell your friends, “I do Pilates!”

If you have an injury, dysfunction or problem, your Physiotherapist can develop a specific exercise routine that is specific for you and your condition. An assessment by your Physiotherapist will usually reveal which areas need to be addressed.

This is provided as general information only and is not intended to be relied upon as medical advice. Yun Cheung is a registered Physiotherapist and Kinesiologist at Sun City Physiotherapy. She is a Stott-certified Pilates instructor and a Certified Strength and Conditioning Specialist. She can be contacted at Sun City Physiotherapy’s downtown, St. Paul Street clinic by calling 250.861.8056 or via email at info@suncityphysiotherapy.com.

Protect Your Spine and Improve Your Posture With Basic Pilates Principles

- by Yun Cheung, Registered Physiotherapist, Kinesiologist, Stott-Certified Pilates Instructor

The rise in popularity of Pilates as a form of exercise for fitness and rehabilitation has been largely due to reports that it can help to improve posture and strengthen the ‘core’ muscles to help support and protect the spine. So how can you reap some of the benefits of a Pilates practice and make it part of your daily routine without attending a Pilates class?

First, it is important to understand the basic Pilates “Principles”. There are 6 basic principles in the original Pilates Method, as developed by Joseph Pilates: Concentration, Control, Precision, Centering, Fluidity, and Breathing.

In general, the emphasis is placed on mindful, focused, intentional movement. The Centering principle reminds one to activate through their “core” muscles (known as the “Powerhouse” in Pilates) before moving. These muscles include: 1) the Transverse Abdominals, the deepest layer of abdominal muscles that wrap around the torso like a girdle and work to stabilize the spine while allowing flexibility of movement; 2) the Multifidus muscles, small muscles that connect and stabilize the vertebrae (bones that make up the spine); and 3) the pelvic floor muscles (otherwise known as your Kegel muscles).

Breathing is also included in this list. Breathing is used in Pilates to activate the Powerhouse or core muscles in preparation for movement. It also helps to facilitate and control the speed of movement.

Next, try to see if you can find and practice the following, lying on your back. Keep your knees bent with your feet flat on the floor.

Step 1: Find your Breathing Principle. Focus on finding your breath, breathing in (inhaling) through your nose and breathing out (exhaling) through your mouth. Inhale deeply, thinking of taking air in all the way down to the sides and bottom of your lungs. Most people breathe using shallow breaths, with their chest moving up and down. In Pilates, breathing is taught so that the ribcage moves laterally, or in and out like an accordion.

Step 2: Try to maintain the rhythm of the breath (avoid holding your breath) and see if you can activate your Transverse Abdominals by GENTLY pulling your bellybutton in and holding it there.

Step 3: Maintain the breath and the gentle Transverse Abdominal activation and see if you can add in a GENTLE activation of the pelvic floor muscles. Most people relate to their pelvic floor muscles as the muscles they would use to stop the flow of urine. In this case, you want to achieve a subtle activation as though you are aiming to “slow the flow” instead of stopping it entirely.

Once you had a general sense of trying to activate your Transverse Abdominals and pelvic floor muscles while maintaining your breathing, try to see if you can practice this in different positions, such as sitting and standing. Many people find it very effective to try to find their muscle activations kneeling on hands and knees. Try taking a 30-second break at frequent intervals throughout your day. Find your breath, your core muscle activations, and maintain for 5 breaths. Gradually increase the number of breaths and the length of time you maintain the muscle activation. Also see if you can keep the rest of the body relaxed, trying to avoid creating new tension in other areas, such as your neck and shoulders.

Remember that this will take practice; like learning to ride a bike, it may take some time to master. The goal is to work towards being able to maintain the breathing and gentle activation of the core muscles before layering in other movements, such your daily activities (e.g. lifting a bag of groceries or placing dishes in the dishwasher). You can also try to incorporate these ideas into your recreational activities as well. For example, see if you can find your breath and your core muscle activation before your next set of bicep curls at the gym. See if you can do the same while biking, running, or kayaking.

Over time, the breath will flow easier and the muscle activations more automatic. Then you can stand a little taller and tell your friends, “I do Pilates!”

If you have an injury, dysfunction or problem, your Physiotherapist can develop a specific exercise routine that is specific for you and your condition. An assessment by your Physiotherapist will usually reveal which areas need to be addressed.

This is provided as general information only and is not intended to be relied upon as medical advice. Yun Cheung is a registered Physiotherapist and Kinesiologist at Sun City Physiotherapy. She is a Stott-certified Pilates instructor and a Certified Strength and Conditioning Specialist. She can be contacted at Sun City Physiotherapy’s downtown, St. Paul Street clinic by calling 250.861.8056 or via email at info@suncityphysiotherapy.com.

T4 Syndrome: A Pain In The Neck...And More!

- by Vanessa Milot, Registered Physiotherapist

Last week a patient came to the clinic reporting numbness and tingling in her hands every morning when she woke up. The tingling resolved within a few minutes but would occasionally return during the day particularly if she was driving or sitting at her computer. She had no recent injuries, but reported mild pain and stiffness between her shoulder blades and in her neck. During the assessment I noticed that two of the joints in her upper back weren’t moving very well and she had a sizeable muscle spasm next to this area. It became clear that she had T4 syndrome which is common injury that is often misdiagnosed due to its non-specific symptoms.

What is T4 syndrome? The spine is divided into three main sections: cervical spine (neck), thoracic spine (upper back), and lumbar spine (low back). The thoracic spine, also known as the T-spine, is comprised of 12 vertebral bones. These bones are connected to one another by a central disc and two facet joints on either side. Together, these joints allow both stability and movement in the upper back. Excessive sudden loading or repetitive movements placing stress on the spine can lead to injury or dysfunction in one or more of these joints. Nerves lie in very close proximity to these joints and, if aggravated, can lead to paresthesia (numbness and tingling), muscle spasm or pain. T4 syndrome is named as such because the joints at and around the 4^th thoracic vertebrae are particularly vulnerable to stress and thereby injury.

Some symptoms of T4 syndrome include glove-like paresthesia (hands falling asleep), pain or stiffness in the neck or upper back, headaches, numbness in the face, and weakness and pain in one or both arms and shoulders. It is important to get these symptoms assessed by a health care professional because many injuries and illnesses often have a similar presentation of symptoms. It is the responsibility of your doctor or Physiotherapist to determine a proper diagnosis.

What is the treatment for T4 syndrome? Physiotherapy treatment, as well as home stretching and exercise, can help to resolve these symptoms. Here is a quick home exercise. If you have access to a foam roller, try lying on your back with the roll perpendicular to your spine. Let your body relax over the roll and gently bend and extend your knees so the roller glides up and down your upper back. It should feel like a deep tissue massage.

Physiotherapy treatment for T4 syndrome can accelerate the healing process, ensure optimal recovery, and reduce chances of re-occurrence. Treatment may include: education regarding posture, exercise and activity modification, mobilization or manipulation of the neck and back, massage, dry needling, electrotherapy (e.g. ultrasound, IFC) and assistance with safe return to work and daily activity.

If you think you have T4 syndrome it is important to get it treated early to maximize recovery and minimize suffering!

This is provided as general information only and is not intended to be relied upon as medical advice. Vanessa Milot is a Registered Physiotherapist and Associate of Sun City Physiotherapy. She can be contacted at Sun City Physiotherapy’s Glenmore clinic by calling 250.762.6313, or via email at Glenmore@suncityphysiotherapy.com

One Size Does NOT Fit All!

- by Darrell Skinner, Physiotherapist

Remember what it was like to ride your kid sister’s bike, or slipping on someone else’s shoe? We instinctively know when something just doesn’t fit right. Industrial design has considered ergonomics for some time and most items that we use, from automobiles to furniture and clothing, to tools, are all based on the concept of “average” sized males or females. Items that are custom made for us are usually a pleasure to use or own. The concept of what is an “average” sized individual has also changed over time. The average height of a man aged 20-74 years increased from just over 5'8" in 1960 to 5'9½" in 2002, while the average height of a woman the same age increased from slightly over 5'3" 1960 to 5'4" in 2002, and the average weight for both sexes has increased dramatically during this time.

The science and study of physical ergonomics involves matching the specific person to their environment. Not only is it uncomfortable to use items that don’t fit, but it also predisposes an individual to increased mechanical stress on joints and muscles. Muscles and joints work most efficiently when used in their midrange of available movement. Awkward postures such as prolonged reaching or twisting eventually stresses the body beyond it reparative abilities and symptoms can develop. Sustained postures will reduce blood flow and increase tension in muscles of the neck or back leading to the development of persistent pain. Postural awareness and exercise is a key component of ergonomics and self-correcting one’s posture frequently throughout the day is helpful in minimizing strain. Workers in settings with poor ergonomics tend to be less productive and suffer more absenteeism, and employers are beginning to appreciate the benefit of ergonomic work site evaluations. Poor ergonomics are also thought to be a major contributing factor to the development of repetitive strain injuries, such as tennis elbow and carpal tunnel syndrome. Once these injuries are established they are often difficult to treat and manage. The ideal goal of ergonomics therefore is to help proactively identify risk factors and prevent injuries.

Ergonomics are often considered in context of the office or workplace but the principles can be also applied to activities of daily living or sports. Bikes, golf clubs, or tennis racquets are all examples of items that are most efficient when individually sized to the person. Tools around the house such as pruning shears for gardening or snow shovels can also be ergonomically designed. Physiotherapists are very knowledgeable in identifying potential ergonomic risk factors to prevent the development of injuries, and also consider ergonomic and postural factors once an injury has occurred. Ergonomic advice from a physiotherapist can help you in recovering from an injury and the prevention of injuries, increase productivity, and improve your golf game.

This is provided as general information only and is not intended to be relied upon as medical advice. Darrell Skinner is a registered physiotherapist and associate at Sun City Physiotherapy. He can be reached at Sun City Physiotherapy’s Glenmore clinic by calling 250.762.6313, or via email at Glenmore@suncityphysiotherapy.com