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

A Stretch A Day

- by Robina Palmer, Physiotherapist, Co-Owner Sun City Physiotherapist

One of the most important ways to avoid injury and to promote overall health is to begin stretching. Stretching is recommended for everyone, whether you are active or not.

Unfortunately, as we age, our muscles become shorter – this increases the need to stretch on a regular basis. When we stretch, we are realigning and lengthening the fibers within the muscle. Stretching improves our range of motion, promotes muscle balance, prepares our body for activity, helps our body recover from activity, decreases joint stresses/compression and minimizes unwanted muscle tightness and knots.

Stretching also promotes circulation and develops body awareness. It enhances performance by improving overall speed, balance, endurance, agility, and strength. And studies have shown that stretching will lead to quicker muscle toning.

Stretching before an activity or a workout is important, but stretching after the activity is more beneficial and crucial. Prior to the activity, gently stretch the muscles that are going to be used. Do not overstretch as this can lead to a less responsive muscle that is more prone to injury.

Stretches after exercise should be held for 20- 30 seconds and repeated 2-3 times each. The stretch should feel strong and uncomfortable, but NOT painful. No bouncing, as this triggers a reflex that causes the muscle to tighten and work against you.

Ideally, you should be stretching daily and performing additional, activity specific stretches before and after exercising.

Stretches feel better and are more effective if your muscles are ‘warm’ prior to stretching. Just moving around is usually enough to get the blood pumping and the muscles warmed and prepared for activity. If you just woke up, or got out of a car after an hour drive you are likely not warmed up enough. Just move around for a bit before you break into your stretching routine.

If you have an injury, dysfunction or problem, your Physiotherapist can develop a stretching routine that is specific for you and your condition. An assessment by your Physiotherapist will usually reveal what muscles need to be stretched and focused on.

This is provided as general information only and is not intended to be relied upon as medical advice. Robina Palmer is a registered Physiotherapist and co-owner of Sun City Physiotherapy. She can be contacted at Sun City Physiotherapy’s downtown, St. Paul Street clinic by calling 250.861.8056, or via email at: rpalmer@suncityphysiotherapy.com

What The Heck? Wry Neck?

- by Kevin Bos, Physiotherapist, Co-Owner Sun City Physiotherapist

You wake up in the morning and can’t turn or tip your head to one side without excruciating pain. It’s puzzling because you don’t recall any predisposing incident. You just may have been victim to the ever so common “wry neck”.

Wry neck is a common term to describe a kinked neck triggered suddenly, predominantly on one side of the neck, and usually precipitated by sleep. In most cases, through the night one gets, shall we say, too comfortable. Your neck relaxes and a particular joint settles into a position that gets it a bit stuck. As the joint settles into an awkward position as you sleep, the muscles gradually notice this and progressively go into spasm as a form of protection.

In some cases you may get woken from the pain and spasm, but in others you may not notice it until you go to move in the morning. In either case, your best plan of action is to get it sorted as soon as possible before the spasm becomes chronic tightness.

I have found quite a bit of success treating this with a manual therapy approach through a technique we call muscle energy. The trick is to get the muscle spasm and guarding down so the joint can return to a neutral position. Muscle energy is essentially a hands on manual technique of contract/relax where you and I push and pull together in specific ways related to cervical joint mechanics to release the muscle and joint restriction in order to restore normal joint motion. With classic wry neck, within a 2-3 sessions, most restrictions resolve.

There are some wry neck cases that are more stubborn. Often in these scenarios, the joint can have a meniscoid entrapment where synovial joint tissue gets caught in the edge of the joint disallowing the surface to rest freely. These are much more difficult to treat in that they may require a more specialized technique called joint manipulation to release the entrapment. Once again, most of these problems resolve within a few sessions.

It’s no fun to look at your friends sideways, the sooner you get it looked at, the sooner you’re back in action.

This is provided as general information only and is not intended to be relied upon as medical advice. Kevin Bos is a registered physiotherapist and Co-Owner of Sun City Physiotherapy. He has a Diploma of Manual and Manipulative Physiotherapy and holds a certificate in Sports Physiotherapy and IMS. He can be contacted at Sun City Physiotherapy’s downtown, St. Paul Street clinic by calling 250.861.8056, or via email at: kbos@suncityphysiotherapy.com

Do It Yourself Without Injuring Yourself

- by Robina Palmer, Physiotherapist, Co-Owner Sun City Physiotherapist

With all the new TV shows about home improvement and do it yourself projects, I have seen an increase in injuries in the clinic ranging from repetitive strain injury, back and neck strains, and muscle spasms. Many of us forget that a Do It Yourself (DIY) project can be strenuous and may involve movement and postures that we don’t normally do in our daily routines.

The best way to prevent unwanted injuries is to plan and be prepared. By being prepared, we eliminate, or at least minimize, the need for rushing – especially when a DIY project exceeds its estimated timeframe. This will allow for adequate rests and, hopefully, a pace that will ensure you are working in manageable chunks. Being prepared will also help to prevent the careless injuries that occur when we start rushing and forget or are unable to accommodate common safety practices. Remember that we often overestimate our abilities and underestimate the amount of work required.

Another way to prevent injury is to know your limitations. Know your tolerance for a particular activity and know when to ask for help. Recognize when you are tired and listen to your body when it starts to ache. This doesn’t mean you have to abandon the project, (although I use that card frequently with my husband) it just means that your body needs a break or a change in activity or posture.

Unfortunately, do it yourself projects aren’t always conducive to role model postures. In fact, they are often quite the challenge to adapt a biomechanically sound position that will minimize the stresses placed on the body. Here are four postures that will help to minimize the forces and stresses placed on the body during home renovations or home improvements projects.

Lying on the ground on your side, back or stomach will allow you to perform tasks at floor level (wiring, leaky pipes, blocked sinks). This position will put you on the same level as your job but will prevent the urge to kneel and crouch over.

If a task is at thigh level, try kneeling on the floor. This will allow you to keep your back straight. Use kneepads or a cushion to protect your knees if the surface is hard. Get up regularly to restore circulation and to avoid cramping. Avoid bending too far forward as this could strain your back. If you are unable to kneel, try sitting on a low chair.

Tasks that are at chest or head level are best addressed in the standing position. Make sure you minimize the need for reaching by being as close to the task as possible. Widen your stance to improve your stability. Move your feet when turning side to side to avoid unnecessary twisting and bending.

Projects that are overhead or high up may be made easier with a ladder. This sounds elementary, but I am often guilty of this. It is so much quicker to stand on tiptoes and strain to reach. What a difference that ladder makes – to actually see what you are doing and to not strain your arm and calf muscles. An extension pole is another way of reaching up high without compromising safety.

Make sure you drink plenty of water to help keep your muscles hydrated. At the end of the day, reward yourself with a hot bath or shower to relax those hard worked muscles. Try some gentle stretches for the back, neck, arms and legs.

Enjoy your masterpiece, or if you are like my husband and me, your work in progress.

This is provided as general information only and is not intended to be relied upon as medical advice. Robina Palmer is a registered Physiotherapist and co-owner of Sun City Physiotherapy. She can be contacted at Sun City Physiotherapy’s downtown, St. Paul Street clinic by calling 250.861.8056, or via email at: rpalmer@suncityphysiotherapy.com

Carpal Tunnel Syndrome

- by Nick Black, Physiotherapist

Are you getting burning or shock-like pains, numbness, tingling, or weakness in your hands? Are your symptoms particularly aggravated at night or with repetitive use of your hands? You may be experiencing the condition known as ‘carpal tunnel syndrome’.

The carpal tunnel lies between the wrist and palm, with the floor of the tunnel being formed by bones and the roof by a ligament that stretches from one side of the wrist to the other. Running through this tunnel are tendons and nerves that control the hand. Compression of the ‘median nerve’ as it passes through the tunnel, is the cause of those irritating and painful symptoms.

So why does this happen? Well, this compression can be caused in a multitude of different ways - thickening of the tendons or ligaments within the tunnel, bone abnormalities or swelling are probably the most common causes. This is usually the result of overuse through repetitive tasks such as typing or other activities that require prolonged awkward wrist postures. Pregnancy, diabetes, arthritis and obesity are also factors that can predispose to compression and damage to this nerve.

In all honesty, management of this condition can be quite frustrating! The most important step is identifying the specific activities and other factors that are responsible for your symptoms. Next you need to modify them - whether its straightening your wrists while typing or using the mouse, taking regular short breaks, incorporating varied wrist and hand positions within the task or even stopping the activity all together. This really does require a lot of discipline but is crucial if you are going to make a difference.

Bracing your wrist in a straightened position can also be beneficial, particularly if your symptoms are aggravated at night. This helps to avoid holding the wrist in prolonged positions that increase strain on the nerve. Check your local pharmacy for a suitable brace.

Your physiotherapist can provide manual therapy and guide you in wrist exercises that promote smooth movement of the joints, tendons and nerve within the carpal tunnel. This can help to disperse inflammation, increase joint mobility and prevent adhesions that may be responsible for compressing and irritating the nerve.

Surgical management may be indicated if pain is severe and persistent, or if significant hand weakness is present. This involves releasing the ligament that forms the roof of the carpal tunnel in order to decompress the nerve.

It is important to note that various other conditions can present with similar symptoms to carpal tunnel syndrome. It is always recommended that you seek guidance through your doctor or physiotherapist to ensure your health is managed appropriately.

This is provided as general information only and is not intended to be relied upon as medical advice. Nick Black is a Registered Physiotherapistand associate at Sun City Physiotherapy. He can be contacted at Sun City Physiotherapy’s Winfield clinic by calling 250.766.2544 begin_of_the_skype_highlightingend_of_the_skype_highlighting or by email at winfield@suncityphysiotherapy.com.