Wall Angels – Postural Neck and Back Pain

The wall angel is a simple exercise to open up your shoulders and strengthen the postural muscles of your back. It will also help improve shoulder rotation, normalize activation of muscle patterns in the upper back, scapular mobility, front of the shoulders and chest areas.

Start by standing tall with you butt, shoulder blades and head touching the wall. Keep your head up and your chin slightly tucked in and lower back from over arching. Bring your forearms up against the wall with the elbows bent. Then slide them up and down in the comfortable range making wall angels for 10 repetitions doing 3 sets each day.

If you’re unsure about the exercise or have any uncertainty about what you’re doing, consult your local Physiotherapist before continuing.

Whiplash Associated Disorder – Adam Mann

Mark: Hi, it's Mark from Top Local. I'm here with Adam Mann of Insync Physio in Vancouver. Insync has been voted over and over best physiotherapists in Vancouver as voted by their customers. And Adam's an expert in all sorts of things. And today we're going to talk about whiplash associated disorder. What the heck is this? 

Adam: So whiplash associated disorder is basically in its classic form a hyperextension injury of the neck. But really it's just a rapid movement of the neck, which causes some strain of the very deep muscles inside of the neck that connect to some of the vertebraes.

Classic example is after motor vehicle accidents. So people get rear ended and they're neck hyperextends and then some of the muscles and stabilizing tissues in the front of the neck may get stretched and it's considered a very wide spectrum of injuries. So, yeah, that's basically whiplash.

Mark: So I'm sure it happened in many other things. If you're falling, in different sports or if you fall rock climbing and get it hyperextended backwards or skiing or hockey checked into the boards from behind, soccer, et cetera, et cetera. So, how do you treat it? 

Adam: So it really is quite complex. And that's the thing, you said it exactly. It doesn't have to come from a motor vehicle accident. It can come from a sports injury, any sort of rapid motion in the neck. And because the force, which is acting on the neck or the direction where the neck was moving, can cause particular muscles to be strained. And so overall the presentation is quite complex and it's case specific. 

Today I was going to talk about one case in particular where someone was T-boned, and they were hit from the side, so their neck was whipped over to the right side. And so they had experienced a whole bunch of pain just rating down onto the left shoulder and neck. So how did we treat it? Good question. 

The first thing we did was, we had to check some of the secondary injuries. So the assessment was quite complex because this person also received a bruised rib from the seatbelt and was experiencing what we call cognitive fog, which is a sign of a concussion. So when we assessed it, we want to make sure we weren't missing anything.

And so we ruled out a lot of the red flags that might occur. We did that through a thorough cranial nerve assessment, and we also looked at some of the ligaments in the neck to make sure that the neck was stable. We found that it was stable and then we could move on to the proper safe orthopedic treatment.

Mark: So, what does that consist of, safe orthopedic treatment? What do you actually do? 

Adam: Good question. So for this person in particular, it involved a little bit of manual therapy, so making sure that we could relax some of the tone of the muscles in the area. So in particular, the way I describe this, is that you have stabilizer muscles and these are posture muscles that help to make sure that we can move in a controlled manner.

And then we have moving muscles. This is an oversimplification, but, in general, those are the ones that we use for lifting and for moving. And in particular after this type of injury, I find that a lot of the muscles that are moving muscles really, really tense up and they try to take on the role of the posture muscles.

So the first thing that I found pretty effective is once we found this person was safe and physiotherapy was the right option, was to just kind of get those muscles to relax and then work on some of the deep neck flexors. So these are muscles that are really, really, really deep into the spine that you can't palpate or feel. And we work on stabilizing those. 

So we teach them an exercise where really we're just rocking the neck back and forth, quite gently in the pain free range. We do it in a way where we're not tensing up all the other muscles that would cause more injury. So that's the start of the treatment.

When we're talking about how we progress treatment from there, we have to deal with some of the other injuries that this person also suffered. So they had a bruised rib. So we worked on basically mobility in the chest area or the thorax. And we started eventually doing some basic concussion exercises, which would involve some eye tracking or vestibular movements.

And then from there, once we had strengthened the neck and we were able to gain more active range of motion, like mobility through the chest and through the neck, we were able to start some strengthening. 

Mark: So that's the protocol basically you followed, what's the general prognosis and in this case, how long did it take to get better, but what's more typical?

Adam:  So this was a complex case. So it took a little bit longer, took about, I'd say 12 weeks. Because it was a motor vehicle accident. It was an ICBC claim. So we actually were able to get a vestibular therapist to assist with some of the concussion related symptoms. And that can take a long time. So depending on how severe or significant of a concussion it is, it can take a year or two. But in this case, we were able to get that person's pain under control within 12 weeks and their range of motion back up to normal. And their concussion had subsided after about eight weeks. So that's the outcome of the case. 

Mark: And more typically with other folks?

Adam: Whiplash associated disorder is usually broken down into four categories. So the first category is just pain. The second category is range of motion and pain deficits. The third category is if there's actually a nerve injury, this person didn't have a nerve injury. So they were whiplash associated disorder two. And whiplash associated disorder four is actually like a fracture. So again, when we look at the categorization, she was a whiplash associated disorder two. And that was like a big spectrum. And I would say, you know, 12 weeks is quite typical, but if someone is a very minor whiplash associated disorder, it can be, you know, eight weeks, six weeks, four weeks. It's really a big spectrum. 

Mark: There you go. If you've had a whiplash injury in recent times, which is the best time to address any kind of injury. Or if it's been something that's been nagging and bothering you and you need some help, you want to get rid of that pain. Insync Physio, ask for Adam Mann. You can book online  at insyncphysio.com. They have two offices, Vancouver and North Burnaby. So if you want the Vancouver office, you want to talk to a human being (604) 566-9716 to book, or in Burnaby (604) 298-4878. Thanks Adam. 

Adam: Hey, have a good day.

Dequiverians – Texting Syndrome – Adam Mann

Mark: Hi, it's Mark from Top Local. I'm here with Adam Mann of Insync Physio in Vancouver. How are you doing Adam? 

Adam: Doing well. How are you doing Mark? 

Mark: Good. So we're going to talk about something really a bit bizarre, but very common I think, or more common, perhaps texting disease or the dequiverians syndrome. What is this? 

Adam: Dequiverians syndrome is basically a tendonitis of the thumb and so it can be quite painful to the point where it's debilitating. And I was going to talk about a client who is a waitress and also a guitarist. And so she was using her thumb a fair bit to strum and it got to the point it started as like a nagging ache, but then she was carrying coffee pots to her customers and she was constantly turning that pot over. She just felt extreme pain to the point where she almost wasn't able to hold onto the pot. 

And you said it, it's actually kind of nicknamed in the medical field as the texting disease, because when you're using your thumb a lot to text, which we all do nowadays, it's an overuse injury. So it can typically cause inflammation of the muscles on the outside of the thumb. 

Mark: So how do you go about assessing this and determining what exactly is going on?

Adam: Yeah. So in this case, a big clue is pain location and then we do a thorough orthopedic assessments. We looked at her grip strength. We looked at her wrist range of motion. We also looked at her thumb movements. We checked the ligaments and bones in the area, and then we found where the inflammation was. And there's a couple of special tests, which stress that area. So we gently perform those tasks and were able to find out that there was some inflammation in the tendon called the extensor pollicis longus, and at that point we had a diagnosis. 

Mark: So, how did you go about treating, I guess does it vary from the first treatment onwards or how did that protocol work?

Adam: So a lot of this is education because it is an overuse injury. So we explain how to stretch some of the muscles in the hand that might be excessively tight when strong, and then how to strengthen the muscles that were aggravated in a safe manner. So the idea is that the thumb muscles on the outside of the hand are not strong enough to handle the load that she's putting in on it.

So there is a period of rest. And then, eventually we have to increase load capacity so the tendon can handle that load. First session, though, we definitely did some gentle isometric contractions, which are just contractions without movement of the inflamed tissue. And that really did take the pain away.

So there is some research that shows that isometric contractions can reduce pain or have an analgesic effect. The other thing we did since she was actually off work, she wasn't able to carry coffee and we all know how grumpy we get when we don't get our coffee, we taped her thumb. So we restricted range of motion into the painful direction, so she could actually work and she could trust herself that she wasn't going to stress the thumb in any way and be able to lift things.

We taught her a couple of stretches of the thenar eminence or those tight muscles in the front, in the palm part of the hand, in here. And together that was our first treatment basically. 

Mark: So future sessions, how did it progress from there? 

Adam: Yeah. So again, just a bit of load management. We start with kind of increasing the intensity of the isometric contractions. We start to make sure that we address some of the deficits that we found in grip strength. So we found that she was a lot weaker, even in her dominant hand in terms of grip strength. And then we taught some more advanced thumb strengthening exercises with movement and that sort of thing. And we were able to increase her amount of time without the tape on her hands. So she could start working without tape. And that was really helpful. 

Mark: And how is she doing now? 

Adam: Well, she's playing guitar. I don't think she has any shows due to COVID-19, but, she's working and she has no pain. So we were able to get this problem under control pretty quickly. 

Mark: Well, allow me to throw a curve at you. This is something that I have. Oh, are these things any good? 

Adam: Well, I would say certainly they're good. One of, interestingly enough, I just read a study that shows that grip strength, especially for elderly females, not necessarily you Mark, is one of the best indicators of longevity. So grip strength as we get older is really important. And so if you're working on your grip strength I'm impressed.  

Mark: So if you're having any issues with your hands from texting too much, it might even be bothering your neck a little bit. 

Adam: Absolutely. 

Mark: Insync Physio in Vancouver. You can book Adam Mann online at insyncphysio.com. They have two offices, one in Vancouver and if you want to talk to human being (604) 566-9716 is in Vancouver or in North Burnaby, six Oh four, two nine eight four eight seven eight to book. You have to book, they're always busy. Adam's always busy. He's an expert in this kind of stuff, but he'll get you feeling better and back doing all your favourite activities as soon as possible. Thanks Adam. 

Adam: Hey, have a good day. Keep on working out that grip strength.

Shoulder Impingement Wil Seto

Mark: Hi, it's Mark from Top Local. I'm here with Wil Seto of Insync Physio. He's the owner. He's the professional. He's the one of the top rated physiotherapists in Vancouver year after year after year as voted by his customers. And Insync is one of the top physiotherapy clinics. We're going to talk about shoulder impingement today. How are you doing Wil? 

Wil: Yeah, I'm doing well. Thanks for having me on, so yeah, shoulder impingement. Well what is it, first of all? So it's like saying like I have shoulder pain, you know, you don't really know, you can Google it, you know, consult Dr. Google, and then they'll give you the definition of what it is. Basically it's like when you have the structures in your rotator cuff and read that sort of bony area getting impinged basically. And, so really, when you look at what that means, it's when you have a lot of imbalance happening in through there.

So, I'm thinking about a specific client who happens to be another rock climber. And she's pretty avid rock climber. She's a boulderer. And, and it wasn't a particularly one incident that happened, she came into the clinic and she was just saying like, yeah, I just noticed gradually my shoulder was starting to get more sore.

And I mean, she was still climbing at the time. And she's a pretty high level, like recreational climber, like doing things that are pretty advanced on a recreational level. And, so anyway, she presented with these symptoms. And, first of all, like, you know, we got also clear other things just to make sure that it's not coming from the neck and all that stuff, because we want to make sure that there's not, you know, issues in terms of radiating down from spinal nerves and all that stuff. So that's a clear little test that I do. 

And then the other thing is really, now that we start to look at, okay, is it really coming from the shoulder? Okay, well, what's causing it. And so there could be many different things causing it, and it could be an underlying, actual pathology or issue with the rotator cuff itself.

So you can get an injury in the rotator cuff without a traumatic injury. And how that looks is that if you have a lot of imbalances there to begin with or if you're doing something, a sport, or even it doesn't even have to be a sport, it can be like, you're a painter and you're an electrician. You're doing stuff overhead all the time. And you're always going to put a lot of stress in your rotator cuff. And so what happens when you do a lot of that stuff overhead, or if you're sleeping on it a lot, you're decreasing the blood flow to the area, and then you're also straining it and stressing it all the time.

So you can have micro strains that happen. So then with the micro strains, then it causes the integrity of that area to be less strong. And then you can have sort of this gradual thing happening, where then you get the muscle imbalances with whatever sport or activity that you're doing that also ended up, you know, causing you to compensate and you start to use those as your strategies for how you use that shoulder. 

So ultimately with this person, She presented with a lot of that cause she liked to do specific types that we call problems in the gym and she was a bowler primarily. And so with her doing these types of specific problems, you know, meant that she was always using these type of muscles.

And also in climbing, you do tend to use a lot more of your lats and teres and so the posterior chain. And so she was very imbalanced there to begin with. So when I did assess her, I was pretty confident that her issue was just a pure impingement thing that it wasn't from like a micro strain of the rotator cuff, because there was specific things that we did that helped me identify that.

And so basically first treatment, we addressed the issues that I thought was causing this and then, gave her some exercises and did the manual therapy to really help guide the shoulder and facilitate a process that was able to bring things back into more normal alignment and better movement.

It was almost night and day. Like she came back to see me the following week. And she reported something like, yeah, it was getting like a three to four out of pain, you know? And it was only coming on right after climbing. And then she's like, yeah, I had no pain whatsoever. But then the thing for me that I was looking for on the second session was how was her strength now?

How was she able to now like maintain this because that's really key. Because I see this kind of stuff and my goal to help her is to not just take away that pain off the first session and be like, Oh wow. You're like, that's like magic. And I'm like, well, no, it's not magic. It's actually, you know, this is what's going on.

And so I really educated her and you know what that means because then, as I helped her in the second session, then I have to give her things that work on the areas that she doesn't know where she's weak. Because there was a lot of areas that she was not recognizing that she needed to actually strengthen in her core stability related to the stabilizing muscles of her scapular and her actual whole shoulder complex.

So, I started progressing her strengthening and her core stability program in a way to really benefited her. And I think she came in for a followup session to progress those exercises. And she didn't have any problems. And then because she's in the climbing community and I'm a rock climber myself, she reached out to me and she hadn't been having any more trouble.

And so that's the kind of thing what I typically see with a shoulder impingement, that's not involving anything more sinister. 

Mark: So without that initial shock traumatic injury, this is just an over use or imbalanced problem basically, it's fairly simple to look after if it's addressed in a timely manner.

Wil: Yeah, exactly. And that's totally bang on. With her, she was just not, actually it's funny, because she was just not even stretching after sessions and she had been pushing the grade a little bit more. And so there's always these little indicators of how it started. And then once it's there and you know, they're like, Oh, well I tried to look up stuff to stretch and then you kind of hit a point of no return where you, you can if it's just tight, but then, you know, sometimes it's hit and miss. So it's tricky that way. 

Mark: If you want to get better fast, if you want an expert help on how to do it, give Insync Physio call. You can reach them in Vancouver, (604) 566-9716. They'll get you feeling better. Or in North Burnaby, (604) 298-4878. Got a call and book ahead. They're busy all the time. Check out the website if you want to book online, makes it easy, insyncphysio.com. They'll get you feeling better and moving well and doing all the activities that you want to pursue in your life. Thanks. Wil. 

Wil: Thanks Mark.

Birgit Holm Testimonial

Hello, this is a testimonial video for Wil at Insync Physiotherapy. My kids and myself have been going to Insync Physiotherapy probably for the last 10 years. 

When my kids were younger, they were in sports. My son, a skateboarder and the soccer player, my youngest daughter, a gymnast, and on several occasions they had injuries and, I would take them there and get treatment as well as, advice on what kind of exercises to do to improve the condition and help heal the injury?

One occasion in particular, my son had a skateboard accident and hurt his ankle. I immediately called Wil and said, what do I do? Do I go to emergency? What do I do? And we talked about what the symptoms were and how it looked. He said, you know what Birgit, bring them in right now. And we'll do an assessment and we'll let you know if he needs to go to emergency.

Well, that was just perfect. There was no waiting in the emergency. Just went straight in. We took him in, they did the assessment and fortunately in that case, we didn't have to go to emergency. So it was just such a time saver and such a peace in that moment to know that Wil's team, you know, can take care of my family and provide amazing advice to help my kids heal. To make sure that they wouldn't have any longterm affects from their injuries.

So I really cannot recommend Wil enough. He's been amazing support for my family, as we are all very active and we need to rehabilitate quickly so we can get back to having the fun we love to have.

So thank you so much Wil and your team for all of your amazing support over the years.

Biceps Strain

Mark: Hi, it's Mark from Top Local. I'm here with Wil Seto of Insync Physio in Vancouver. One of the best physiotherapists in Vancouver, many times as voted by his customers as one of the top physios. And we're going to talk about bicep strength today. How are you doing Wil? 

Wil: Hey, Mark thanks, I'm doing really well. I appreciate the shout out. So yeah, we'll talk about bicep strains today. There's a couple of different areas that you can actually strain it.

So this one particular person, he was a really avid rock climber and he was in his late twenties  when you know, had the injury. And it was actually a rock climbing injury where he ended up hyperextending his arm. And, he basically straightened his long head on his biceps.

And that's typically the, like for the biceps, the one that you tend to actually strain because you actually have two, that's why it's called biceps. You have the long head and the short head. And he strained it, at the actual point where it attaches to the shoulder, which is called the origin point.

And, you can also get issues happening, kind of more towards the elbow, which is called the insertion point of the long head of the biceps and your short head also attaches on there too. But with this one in particular, it was a traumatic injury. And, it looked like it was also a few other things going on too.

So when you have this kind of an injury where, especially with this mechanism, with this particular person, you know, he ended up hyperextending because he broke off the hold with his right arm and he held on with his left and it ended up hyper extending that left.

He had this pain that was ongoing. For probably a good two or three months until he actually had some proper physio. And so basically when we went through the process of looking at what was happening, one of the things that you have to consider, especially pain in the shoulder, you have to actually look at the shoulder and assess that and see what was going on because the long head of the biceps actually attaches close to the rotator cuff and sort of like, helps and assists with rotator cuff function. And so we had to clear all that stuff first and then really start to differentiate and look at okay, yeah so is it just the biceps tendon and is it just that area?

And the other thing was also looking at other components because with the long head biceps injury, with this type of mechanism, you can also injure the capsule because that's where the biceps long head attaches and also the cartilage. 

So there's a specific term that we use in the physio world called the SLAP lesion. So SLAP is just an acronym for a superior labral anterior posterior injury. And so that involves like the long head of the biceps. And so the speer capsule, interior aspect of that whole area, and the labral is basically the cartilage.

And so, this person came in, like two, three months after the injury and was only able to move their arm about around this high. And they were actually getting some physio somewhere else and it just wasn't really helping. I think what I was assessing too was also the whole shoulder. The whole shoulder and everything, what was going on and I realized that, you know, we had to actually address all the stuff that was going on. And so, the long head of the biceps was definitely the main thing in question. And as we sort of started treating him and it started progressing, a little bit by little bit, and it was getting better actually within the first two weeks. I had made a suggestion and I said, because of the mechanism of injury and what I thought was going on, which was this SLAP lesion, that we get an MRI. \

And interestingly enough, they were able to get an MRI set for like three months pretty quickly after they saw me. But then, we actually got full range back within like a month. And so a month of working on this issue of not being able to fully flex and come out this way and he had full flection and also behind the back motion. So there's range of motion was like 100% after four weeks. We also worked on the strength and surprisingly six weeks later got him back rock climbing.

Mark: So there you go. If you need some help with your shoulders, your biceps you've injured yourself. It could be rock climbing. It could be throwing baseballs. It could be many of the things we use our shoulders for many different actions, the guys to see our Insync Physio. You can reach them in Vancouver at (604) 566-9716. Or in North Burnaby, (604) 298-4878. Check out the website insyncphysio.com. You can book online there. You can pick the physio you want to see. Wil's in real demand so it might take a while to see him, but he is one of the very best in Vancouver. And thanks a lot Wil.

Wil:  Thanks Mark. And oh, one more thing to add I almost forgot that he did get that MRI scan done, and it did show a long head biceps tear along with a superior interior capsule tear and some cartilage damage. 

Mark: But he's all good now and back climbing. 

Wil: All good. Now and back climbing. 100%.

Rotator Cuff Injury

Mark: Hi, it's Mark from Top Local. I'm here with Wil Seto of Insync Physio in Vancouver. One of the best physiotherapy shops in Vancouver, multiple time winners of best physiotherapists in Vancouver and their star, their owner, Wil Seto who's many times voted the best physio in Vancouver as voted by his customers. And we're going to talk about a real common issue, traumatic rotator cuff injuries. Wil how are you doing? 

Wil: Yeah. Hi Mark. I'm doing great. Thanks for having me on today. So yeah, rotator cuff injury. So when we talk about rotator cuff traumatic injuries, they can obviously be quite worrisome and when you have that happen, you're kind of left wondering, you know, like what should I really do about it? 

Mark: So just for those who might not know, rotator cuff, that's a real common term we heard about it in baseball. What is the rotator cuff? 

Wil: Yeah excellent question. So we like to refer to it as like a rotator cuff interval, but to keep it simple, like when we think of rotator cuff, it's primarily composed of four muscles and tendons that attach onto the arm or in the shoulder joint.

And, so, you know, I don't want to complicate it too much, but basically the names of them, there's four of them and have your supraspinatus, infraspinatus, teres minor and subscapularis. So you have the four rotator cuff muscles that basically, what they do, is they act like a suspension bridge. So if you think of like, you have those four muscles and they, create this like ability to stabilize your shoulder because your shoulder has this 360 degrees of motion and movement, right. So that's the primary function. Then you also have your capsule and your ligaments that are intimately connected with that.

Mark: So when you injure your rotator cuff, you basically you've hurt your shoulder, doing something with your arm and shoulder, basically. 

Wil: Yeah, exactly. So I see this a lot and you know, many different sports, but one in particular, who was a gentleman that, had a fall from skiing. And I mean, he's quite an athletic gentleman to begin with and he does rock climbing, but his specific thing that he did, he actually fell down skiing like from last year. And it really struck me because I remember like he came in and, you know, he did have some limited range of motion and he definitely was, a kind of person that was very functional to begin with. you know, like right after the injury.

And so he really wanted to get better at fast. He was always pushing it. There are specific tests that we do to really pinpoint and really isolate, okay you know what part of the rotator cuff? And so when we looked at his shoulder, you know, definitely had  all the compensation issues already right away, that was going on, like just, you know, his lats and his pecs were kicking in. And so certain muscle imbalances were already there. Whether they were preexisting, but definitely I think it was because of the injury. And, ultimately, what we wanted to do, is we wanted to do more of the conservative measure in terms of taking them through the physio portion of it and looking at range of motion, getting his motion back, looking at getting his strength. And really starting to hone in on activation of that rotator cuff. 

Talked about the rotator cuff is, if you think of the four of them, it's like a suspension bridge. And when one of them is injured, then now you have this imbalance, so then now it poles differently and so we want to try and get that other one that's been injured to heal and to kind of get that working properly. And then all the other ones sort of follow suit as well. And then kind of just be able to provide this what you call dynamic stability in that whole shoulder joint. Because the shoulder, what makes it really unique is that, like I was saying, it provides you this 360 degrees of movement.

If you can imagine like a baseball, you know, sitting on a golf tee, right. And then you have all this cartilage that, kind of makes it a little bit deeper. So the bowl, but then it needs to be stabilized by muscle because it's not like your elbow or your knee where you have a stop right there where you can, you know, be able to limit your range. And that's why it's more like the 360 degrees type of motion. 

And then there's a lot of other factors to consider with regards to, you know, looking at the muscle control round the whole shoulder blade. So if you have, all this compensation going on, when you have an injury, then you have to address that. So we won't try and normalize that. 

So, basically the first three or four sessions, we really, we looked at normalizing things and then trying to get the motion back and get the activation patterns. And quite honestly, if things weren't progressing well or they're progressing quite slowly, then I would refer over to a specialist like one of our sports medicine physicians that we have in the back of our pocket, so to speak who really likes to take on clients of ours and we can get them in to see them pretty quickly. And so that's a real benefit to be able to do that, because then they're able to get through the process and I communicate with them. I work with the sports medicine physician to be able to expedite certain things and to look at, you know, do we need to get a scan, like an MRI or something like that. 

So it, it happened to be that this person needed that, you know, his progress was really slow and it turned out that he had a full on thickness tear. It was like a pretty large, like more than three quarters of his rotator cuff was torn. And so they decided to operate because it was, you know, definitely the weakness part of it. That's where you really find, you know, that this dysfunction, he wasn't complaining of pain very much other than the fact when it limited his motion. But the reason why he couldn't go all the way up was because when we tested him and obviously the strength was really poor. 

So, he ended up getting somehow fast tracked when we got them to see the sports medicine physician. He had surgery. And so the surgery was the thing that he elected to do because he's very active and he wanted to be able to rock climb and ski and all that stuff. And that was actually a year ago. 

So, you know, and I've seen him since, and he's actually back rock climbing and skiing again without any problems, but that's been a full year of rehab for his surgery. So it's been really a success story in that way.

Mark: So if you fallen on yourself and you find that you got a lot of pain in your shoulder, if you've injured it playing some sport or recreational activity, or it could even happen in a car accident. The guys to see are Insync Physio, they're experts at getting you back moving properly in your life. Reach them at their Vancouver office (604) 566-9716 or in North Burnaby, (604) 298-4878. If you want to book online, you can do that at their website insyncphysio.com. It's really simple to use, and it will get you able to pick whichever physiotherapists you want to see. Thanks a lot Wil. 

Wil: Thanks Mark.

Simon Kelly – Shoulder Dislocation

Mark: Hi, it's Mark from top Local. I'm here with Simon Kelly of Insync Physio in Vancouver. One of Vancouver's best physiotherapy clinics, many time winners of best physio therapy clinic in Vancouver as voted by their customers. And Simon's a physiotherapist there. He's actually from Ireland of all places originally so, love the accent, love what he's got to say. He's an expert at getting you feeling better. And we're going to talk about shoulder dislocation today. A really painful subject. What was going on with this client Simon? 

Simon: Cheers Mark, thanks for having me again. This client was a snowboarder, a 30 year old. He came in, I think it was two weeks after the injury. Had lots of shoulder pain was sort of cradling his arm across the chest kind of like in a sling position. And his wrist was kind of hanging down like so. Pretty limp. 

And so we had a discussion what happened obviously? So he was snowboarding, so it was pretty traumatic. He said his shorter dislocates pretty frequently. I think he said  like anywhere between 20 and 25 occasions in his lifetime, but generally it just goes back in and he started rehabs himself he says. But this time was a little bit different because he had like no use of his wrist. That's why his wrist was hanging down like so. A lot of the nerves that supply those muscles had been damaged, which was kind of a new presentation to him. 

So he was pretty worried when I first saw him actually. So we went through this objective that was pretty important stuff to know. And there definitely was some nerve damage. I had to clear the neck first because sometimes the nerve roots come from the neck, so the neck seem to be intact.

But we have a lot of nerves that pass through our top of our shoulder. You call your brachial plexus. And before they go under the clavicle on top of the first rib, and they can sometimes do damage going down into the arm and into the forearm and into the wrist. So first protocol for him was actually to send him for an X Ray and make sure he hadn't fractured the top of the humerus. Because one of the nerves, the radial nerve, brings the wrist up. So it extends the wrist. In other words, that's why his wrist was down. So I was hoping that he had fractured the top of his arm. 

Good news for him, that differential diagnosis was ruled out because he didn't have any fractures. No Hill-Sachs fractures is a fracture in the humerous and no humerous fracture in a different part of the humerour. So that was all good. In theory, we should of probably sent him for a MRI at that moment, but it was going to take a long time and he just wanted to start rehab. So we got right into it basically. 

So, first protocol was to really get his nerves firing up again. We done that by putting on electrical muscle stimulation. It's called EMS kind of like jumping a car is the analogy I would use. We're just kind of getting electrical nerve impulses firing from the muscles to the brain. In other words, to get this wrist moving. So, like he also had no triceps, so he couldn't extend his arm above his head, which means against gravity. So very, very weak at that moment in time. So then we just started firing up with the electrical muscle stimulation and got it working. And then his wrist started to come back moving again which was fantastic. 

So most of the work early on was getting his nervous system back working, I suppose the wiring from his brain to his forearm. And then rest of the treatment was really just stability in the shoulder. And he had to avoid the high-five position initially because the shoulder can come out forwards. So we avoided that initially, but then we do eventually have to go into that as the weeks progress, because he clearly has to use his arm in functional positioning if he wants to go back snowboarding again. 

So we did rehab. We got him back. I did send them to a neurologist just to be extra safe a few weeks in just to be sure to the nerves weren't completely damaged. And he said it's all okay. It should come back in three to six months, which it did. And he was back on the slopes within five or six months after that injury.

However, I did say to him based on the 20 dislocations that he did that previously, that he might want to go and see an orthopedic specialist just because . It was pretty stable when I left him, but I really wanted him to get it checked out even further, just to be sure. He may need surgery at some point in the future, but he really wasn't a big fan of going under the knife.

So that's kind of where I left him. We definitely stabilized and it was definitely pretty good when I left but I would have liked another opinion from a specialist. Which is what he was going to do. 

Mark: So would that be because the ligaments have been stretched or /and tendons have been stretched too far?

Absolutely Mark. Like when, like someone who's dislocated his shoulder that many times. You know, it's highly likely that it's going to kind of continue to dislocate unless you get a surgery. So those ligaments and tendons are going to be overstretched. It's going to be too lax in your shoulder and it's going to continue to fall.

And in his case, he was actually starting to damage some of his nervous system. So that was something I really wanted to get across to him, even though he was young and a 30 year old male, and he was clearly an adrenaline junkie. He wanted to get back on the mountains. I had to give them that information, expert advice to be like, look I think you still need to see an orthopedic surgeon just to tighten up their shoulder and you might be looking at surgery. In your own best interest, if you want to stay on just slopes for the coming few years. 

Is there any, ongoing protocol that you would have recommended to him to try and help with that? 

Simon:  Absolutely Mark. Yeah. I would've of given him a huge amount, not a huge amount, but a couple of very important exercises to kind of standardize the shoulder. Sometimes we do closed kinetic chain exercises like wall pushups the where hand is actually fixed. That's a bit safer because the bottom of the hand is fixed. And then we do open kinetic chain, which is when your hand is free in space like mine. But I would have been going into this position eventually, which we were doing actually and he was coping pretty, pretty well. 

It's just on this occasion based on his history, clinically, he seemed pretty stable, but just that many dislocations. For me, I was like, maybe he needs to see a specialist too at the end. But yeah, for sure, we gave him lots of stuff to work on in his own time. Which he should be doing actually every couple of weeks for numerous months after that, based on his history.

Yeah because if he's snowboarding, he's probably going to fall again. He's probably going to fall on his shoulder one way or another, whether it's with his arm outstretched or just directly on the shoulder and that ballistic impact. Could easily, if it's loose already, it's going to dislocate it again. Right?

Absolutely. Like he kind of appeared to think it was kind of okay, because it just kept relocating, but I was trying to tell him that you can't just continue to go on like this forever. But I liked his enthusiasm and his positivity. Is probably why he got better so well but, same time he may have been looking at surgery at some point. And that was my opinion when he left.

But very interesting case with the nerves and that in his arm. Seeing him progress against gravity was pretty, pretty interesting. And it can come back. That's what I would like to get across with this video. Pretty scary when you're in your wrist is hanging down like that. And you're wondering, is it severed or is it ever going to come back. Nerves usually regrow one millimetre a day, when they're damaged. So it can grow back in other words, we just have to make sure it grows back correctly, and you get all the movement back into your arm. 

Mark: There you go. If you need some help with your shoulders. Got shoulder issues and you don't want to be 80 years old and still have, you can't sleep on your side because your shoulder is so buggered from not looking after it. The guys to see Insync Physio, give Simon Kelly a call. You can reach him at the Vancouver Cambie Street office (604) 566-9716. Check it out. If you want to book insyncphysio.com. You can book for both Vancouver and the Burnaby office, or if you're in Burnaby, give them a call there at (604) 298-4878. Call. Get in there. Get after it. Get looked after sooner rather than later, so that you can enjoy the rest of your life. Thanks Simon. 

Cheers, Mark. Thanks very much. See you soon.

Simon Kelly – Lower Leg Tendinopathy

Mark: Hi, it's Mark from Top Local. I'm here with Simon Kelly of Insync Physio in Vancouver, BC. He's a physiotherapist at one of the top rated physiotherapy clinics. Many time winners of best physiotherapists in Vancouver as voted by their customers. Today we're going to talk about something that I'm sure a lot of people run into. Especially if they're very active with walking or running it's lower leg tendonitis. Pain in your lower leg. What's the deal going on here, Simon? 

Simon: I'm Mark, thanks for having me. Yeah, I just going to talk through a case study that I had there during the week. A guy who had something called peroneal tendonitis.

Basically it's a tendon that runs down the outside of the leg. A lot of walkers aggravate this tendon and it can be due to a number of different factors really. Sometimes it's maybe they changed their footwear. Might've changed the surface they're running on. Or they just might've increased their workload. And then a little bit too quickly, which I know a lot of people do this. That's the most common thing as well. So it can be debilitating and a little bit scary to someone who hasn't had it before. 

So this guy was 25 years old. He actually had a spontaneous pneumothorax, which means his lung spontaneously collapsed on occasion. So he had a long period of time out from running. And he was just trying to get back into running, I think a month after this collapse and he was starting to do two to four kilometres running. Where he was running, they had made a new path where he usually runs and it was an uneven surface because of COVID, they wanted to keep the paths kind of socially distance.

So that was kind of the angle, I kind of thought maybe he went a bit too quick and maybe to surface he's running on a bit of a camber. And no roads we run on are actually truly flat. If you want to be honest about it, they're all a little bit slightly at an angle, not incline decline, but more of an angle of the foot so it would be turned sideways.

So he came into clinic. That was his kind of background story. We did a few tests to prove it was this peroneal tendonitis, where you kind of evert the foot out against resistance and that creates pain in the foot. Sometimes going up onto your toes can also create a little bit of discomfort because it does what the calf must've does as well.

So that was kind of a the general diagnosis and how we diagnosed him initially. 

Mark: So what was the course of treatment? 

Simon: The course of treatment Mark, there's four reasons really peroneal tendinitis can go up. If you're running on a surface, like I said, like a camber, we really needed to tell him to stop running. But eventually we would add back in running, but on a flatter surface as possible. Usually it's tight calf muscles as well. So not just the pernoneal itself, but all the calf muscles in the back are usually a bit tight that can predispose you to excessive use of this tendon. And like a lot of volleyball players and dancers, if you can imagine them up on their toes. 

He wasn't in this case up on his toes, but that was one of the reasons that you can get peroneal tendonitis. So initially stop all the aggravating factors, stop running and let's load this tendon progressively. Isometrically is how we load it first. Isometrics are where you move the tendon against the resistance, but you're not moving through range.

So that just helps decrease the pain, settle down all the inflammation. And then we got him back in running, into a running program, but a little bit slower. Would footwear, because sometimes it can be from over pronation as well. I meant to mention that earlier on, actually. Just good footwear or good support.

And then we told him to stop running. When he does go back running to run on a flat surface, not running the track that he was running on. And to just go a little bit slower, maybe just try a couple of hundred metres in a straight line, and then we just took it from there, Mark. That's how he presented over the coming weeks.

Mark: And so after the of course of treatment, what was the result? 

Simon: Absolutely Mark, so obviously when his lung was re-inflated at this point, that was another thing I meant to say, for his endurance. We had to keep an eye on his breathing and his endurance. So that was actually fine. I asked him that every time he came in. He went back into proper pairs of shoes. His calf was relaxed and he was back running, you know, five to six kilometres every other day, without any pain. Just best afterwards, few adjustments that we made. 

Now he doesn't have to not run in that path ever again. But I told him that he'd have to start adding in uneven surfaces just towards the end. So he'd just run on that path again, and he had no problems whatsoever. So he's back up and running and back into action. 

There you go. If you need some help with your lower leg, if you're having some issues with a change in your fitness program, that's causing you some pain or any part of your body, give Simon Kelly a call. You can reach him at the Vancouver office of Insync Physio. You can book there at insyncphysio.com either in Vancouver or Burnaby. The Vancouver office number is (604) 566-9716. Burnaby is (604) 298-4878. Give him a call. Simon will get you straightened right out. Thanks Simon.

Cheers, Mark. Thanks very much.

Hand and Finger Injuries – Intrinsic Muscle Strengthening

Have you sustained a hand or finger injury, whether it’s a minor sprain by jamming it or something more serious like an annular pulley ligament tear? After letting the injury heal enough, then you need to work on strengthening the intrinsic hand muscles.

Start with the forearm vertically with the fingers pointing straight up. Keep your wrist straight and avoid bending it by bracing it with your other hand. Then perform finger flexion with your “MCP joints” or the knuckle joints of your index to pinky fingers. Do 3 sets of 30 reps daily.

If you’re unsure about the exercise or have any uncertainty about where you’re at with the recovery of your hand or fingers, consult your local Physiotherapist before continuing. 

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