Hand and Finger Injuries – Rock Climbing Rehab – Hand Intrinsic Muscle Strengthening Part 2

If you’ve injured your finger tendon or a pulley ligament from rock climbing, then doing specific strength training for them can help you better rehab from it.

Start with your wrist in neutral, not flexed or extended. Then flex your index to last fingers at the knuckle joints only - or the Proximal Inter phalangeal joints, and then spread all the fingers apart (into abduction).

Return the fingers together and repeat this for 30 seconds doing 3 sets 2 times daily.

This exercise can help you heal, recover and rehab more effectively and increase your contact strength after a hand or finger injury from rock climbing. If you have pain or are unsure about what you are doing consult a local physiotherapist before continuing. 

Neck Pain – Heather Camenzind

Mark: Hi, it's Mark from Top Local. I'm here with Heather Camenzind of Insync Physio in Vancouver. And we're going to talk about neck pain. Are you seeing a lot of neck pain these days, Heather? 

Heather: Yes, I'm seeing quite a bit of it actually. So I'm seeing one person in particular, she's coming in for a lot of neck pain. Due the pandemic, she's working from home. So we've been working a lot on her home set up just including trying to raise her computer up a little bit for her. Not working on the couch in a slouch position. So she's trying to create a desk, like situation for her. 

But we're also talking about just trying to increase her movement quite a bit and trying to build in ways that she can do that throughout her day. 

Mark: So what does that look like? 

Heather: Yeah. So I think just with people working from home a lot, and we get stuck in this work, work, work mode. And we're forgetting that when we were going to the office, how much movement, just that in itself builds in throughout the day. 

The act of getting yourself ready. The traveling to your workplace, walking from the train or your car, to the amount that you've actually looked and turned around and moved your neck and head. And now people are, we're waking up. We're probably looking on our phones for the news or something in the morning, and then we're plugging into the computer. We're not really actually moving quite as much as we want to. 

And a lot of people are doing exactly what we're doing. We're Zoom or talking video conference. So a lot of people are in, and they're describing these meetings to me. And some people say they're all day they're six hour meetings that people are on their computers and they're looking straight ahead. 

If you were in your office, you would turn and look at people and maybe you would stretch, get up for a glass of water. And all of that movement that was built in throughout our day is lacking now. So we're trying to develop strategies with clients that they put a timer on for themselves. To remembering that they get up and they move around their apartment or house, something that they're moving half an hour or every hour, at least every hour. Encouraging people to get up, do some stretching, just stretch your neck, doesn't even have to be a big stretch. Just move your neck, twist your neck, look over your shoulder.

And then also I've been encouraging people to reach over their heads. This is so good. It gets your shoulders going, gets your mid back moving. That gets really kind of rounded and hunched. So just reaching overhead. It actually feels really good to just reach overhead. And just to give your body a little kind of movement and some shape because we're so forward these days. 

So it strategies like that, just it's nothing simple. It's just remembering to do it. And we were getting in this work, work, work mode that we feel like we have to be on all the time, I think. And we want to change those habits for people. That you don't get that like, couple of minutes chit chat with people that you used to when you were going to get your water, your coffee or something like that. Those things are lacking these days.

Mark: So when someone comes in with neck pain like that, how do you diagnose it? And then what's the protocol to get them feeling less neck pain. 

Heather: That's a great question. So a lot of it's just history kind of figuring out what could be contributing to their neck pain. Some people have a history of a prior car accident or a ski accident or something like that.

So knowing people's histories of what could be potentially contributing to something is key. So we do a detailed history. As well as then we just talk about what your day looks like in general. When you experience the neck pain? Is it in the morning or is it in the evening? Is it all day long? Could that neck pain be contributing to headaches that people get. A lot of neck pain refers up and contributes to headaches for people. So detailed history is very important. 

And then we go into just a basic assessment. So looking at how people move. Can they rotate? Can they twist? How do they do that? Also looking at their shoulder mobility, kind of like I referenced earlier, reaching up over your head. And also their mid back. So a lot of neck pain can be contributed to stiffness in the shoulders as well as through like the chest and the thorax. So your mid back. So we want to make sure that those things can move and have the ability to move as well. 

Mark: So, how do you actually treat for that? Is that all manual manipulation, like getting in there and loosening things up? Is it the horrors of needles? How do you actually get it loosened up?

Heather: It's often a combination. So you chat with people about what they're comfortable with. Often some manual therapy, so hands-on therapy. So working on the joints, getting those moving can be something as simple as like massage, just some, some muscle release and fascial release a little bit in there.

Some people, or actually a lot of people respond well to needles. It doesn't have to be needles though, but IMS is a great way to release muscle tension. And then From there, it's teaching the client, talking to them about movement strategies. Like I referenced earlier. 

They can only see me so much. They can see me probably for about half an hour in the week and the rest is up to them. So we try to kind of use the analogy as I'm their coach. We kind of talk about the strategy and they kind of go and try to implement the strategy. So moving and then a lot of it's stretching. So teaching them how to stretch properly.

And then also sometimes it involves some strength. So just getting your mid back muscles stronger, but a lot of it I find we can get with just implementing some movement strategies or stretching on a daily basis. 

Mark: And how often, or how much of a contributor is, are these evil devices that we tend to want to spend way too much time staring down at. 

Heather: Yeah. So I think it's all a big portion and we're actually seeing younger and younger people come in and start to complain about neck pain. And it's because we're on devices so much and often the way they are it's like as you said, you're looking down all the time. And so it's contributing to, people just kind of this like head, we call it head forward posture. So it's kind of this chin poke. So teaching people to sit up tall. And it doesn't mean it has to be like strong military posture that makes our backs really sore really quickly.

So it's just imagining, something's just pulling you up tall and you don't have to be perfect posture, but just upright posture, is key. 

Mark: Perfect, and how long to relieve kind of this sort of neck pain that you're seeing a bit of a epidemic of these days. 

Heather: Yeah, it varies on everybody. It depends on what would be the contributing factors. Sometimes just teaching people to move more. And if they're compliant and they actually do what they should do, they can alleviate their neck pain quite quickly. They find the movement really helps. Some people, it takes a little bit longer.

If there's something else that maybe is underlying there. You talk to a lot of people and they're having an acute moment of neck pain. But you start to talk to them and they do have a history of kind of a chronic neck pain. You're like, yeah every once in a while, it kind of, people say, goes out.

Can get a kink in the neck. You wake up funny and you can't move. So those people tend to maybe take a little bit longer. So if it's just something acute, like just, you woke up with something and it's your first time of neck pain, or you are having just this kind of epidemic, as you say, of lots of neck pain, just from people working at home.

If they elicit strategies at home, they can be quite successful and maybe it takes a few weeks, maybe a month to kind of make those changes. It takes time to change habits but maybe a month to six weeks. And then sometimes if it's something else that's a little bit more complicated would take a little bit longer.

Mark: If you have neck pain, if you have a pain in the neck, divorce him. Yeah. Other than that, call Insync Physio. You can book an appointment to see Heather at insyncphysio.com. Or you can call the office on Cambie Street, (604) 566-9716. Book your appointment. Get in there, get your neck pain solved. Thanks Heather.

Heather: Thanks, bye.

Hand and Finger Injuries – Rock Climbing Rehab – Hand Intrinsic Muscles

If you have a finger tendon or annular pulley ligament injury, then doing strength training for the intrinsic muscles of your hand and fingers can help you rehab much better!

Start with your wrist in neutral, not flexed or extended. Then flex your index to last fingers at the knuckle joints only - or the Proximal Inter phalangeal joints. Return the fingers to the start position and repeat this for 30 seconds doing 3 sets 2 times daily.

This exercise can help you heal, recover and rehab more effectively and increase your contact strength after a hand or finger injury. If you have pain or are unsure about what you are doing consult a local physiotherapist before continuing. 

Low Back Pain & Injuries-One Leg Looped Band Bridges

Wrap a looped resistance band around your thighs just above your knees. Engage the core muscles below the belly button by pulling them inwards while you keep breathing.

Ensure your knees are aligned with your ankles and your hips while you take up the slack in the looped band. Push through your heels with the feet flat on the ground and bridge the butt up keeping both sides of the pelvis level with each other.

Then straighten out one leg, hold it here for 10 seconds, and then bend your knee and lower your butt back down. Repeat this for 10 repetitions doing 3 sets daily.

This exercise progression helps to further strengthen and rehab the functional strength of your low back whether it’s a chronic pain issue or more of a weakness from an acute injury that you have experienced. If you have pain or are unsure about what you are doing consult a local physiotherapist before continuing.

Neck Pain & Injuries – Raise the Roof!

Loop the band around your hands and have your elbows bent at 90 degrees by your side. Keeping your palms facing downwards towards the floor, spread your palms so that the hands are in line with your shoulders.

Driving through the elbows, and keeping your hands shoulder width apart, slowly elevate your hands to the level of your face and up over your head. Do not lose the parallel alignment of your hands and arms and do not bend your elbows (flexing your biceps).

You should be feeling this work through the back of your shoulders, and the back part of your neck and upper back.

This is a great exercise to build more core strength in your neck if you are recovering from chronic neck pain or a neck injury. If you have pain or problems doing this exercise consult your local Physiotherapist before continuing. 

Leg Nerve Irritation – Simon Kelly

Mark: Hi, it's Mark from TLR. I'm here with Simon Kelly. He's a physiotherapist that Insync Physio in Vancouver. They are multiple time, best physios in Vancouver award winners as voted by their customers. And Simon's going to talk about leg nerve irritation. What, what is this all about Simon? 

Simon: Hi Mark, how's it going?. Thanks for having me again. Yeah. Just going to talk a little bit about the leg nerve irritation and you know, a lot of times it's hard to pinpoint where the irritation is actually going from. But most of the time that actually come from the lower back region, somewhere between L1 down to L5 vertebrae.

A lot of times, you know, people get quite worried that it can be something quite serious, like a disc irritation or a disc compression and things like that. And on occasion it actually is those things, but the very, very small percentage of people that actually need to go for surgery. So it's good to be not too scared in the beginning, but of course it's good to get checked my physiotherapist as well.

The other thing just to bring to mind just for some people as well, is when the nerve is already irritated, as it comes out in the lower spinal column, it kind of brings down the threshold of nerve. So we've all heard of the sciatic nerve pain, but you know, it's things that are usually not painful, like sitting and then become painful. 

So I kind of use the analogy, it's like water coming out of a hose and then you step on the hose and the water stays coming out and it doesn't really affect it that much, but then you step on it in another location, irritated in the nerve root and then irritated from sitting. And it's the sitting then can drive the threshold down. And that's when people really come into us reporting lots of tingling, numbness and irritation, referring down to leg. Call it double crush syndrome, which actually sounds pretty scary actually. But a lot of the time it can be really fixed. 

Mark: So if I was experiencing this, I might not necessarily be feeling pain in my lower back, but I might feel it in my legs. Is that why we're kind of referring to leg nerve irritation? 

Simon: Yeah, absolutely Mark. Yeah, like it doesn't always have to be linked with a major nerve, like traumatic back injury. Sometimes it can just be progressive in nature. And, you know, as we get older, we get stenosis, that's like a narrowing in the spine in the lower back as well.

Lower population or lower aged population people usually it's not like a stenosis or degeneration and things like that. But in my experience 99% of the time, once you kind of eliminate the information at the primary source, whether it's the lower back or sometime as it passes through to the bum muscle, aka the sciatica, will eventually go away.

That's where we come in then in the clinic and it's all about the education on what movement somebody can do. And if you know, you can fix the back pain, but if you don't tell someone not to sit for long periods of time on a hard surface, that's going to keep irritating that nerve and it's going to be ongoing for quite a long time.

Mark: So how do you treat it? 

Simon: So that's it yeah, first of all, when the client comes in, we do need to figure out, first of all, where it's coming from if we can. Either the back, usually it is the back or usually as it passes down through the bum muscle and sometimes it is two areas. So we have to treat both. So in clinic we do a lot of hands-on treatment. We do a lot of needling in the lower back just to kind of decrease, it's kind of like the hypertonicity of the muscle, so the muscles get really tight around the nerve. And this is a common mistake that a lot of people make is oh, the muscle must be tight. Let's stretch it, but stretching in this occasion is not really, the muscle is tight because the nerve is sending a signal to the muscle to protect it.

In other words, please, please leave me alone. But what people do then is they kind of throw petrol on fire and by stretching it, and that really really irritates the nerve. So a lot of the stuff we do is actually a nerve flossing or nerve glides, we call them. Where you're actually gliding. You're actually gliding the nerves. You're not actually stretching it. You're actually just moving the nerve as one unit by different movements in the clinic, I can't really show you on the video here now, but that helps desensitized the nerve. And once the nerve becomes desensitized, it stopped sending the signal to the muscle and the muscle relaxes and it's not in spasm. Preventing you from moving or causing pain essentially. 

So by eliminating inflammation around the nerve, obviously you can do ice in a bit of rest for that too. And by doing these nerve glides, especially in the earlier stages of rehab, you can eliminate all that spasm that a lot of people complain about.

Mark: And is that why you use the needling? Is that also help with the relaxation of the nerve? 

Simon: It kind of helps more so the muscles around it Mark, to be honest, so the muscles it does help relax the muscle around it. But the primary objective will be to get that nerve moving normally without, without irritating by fully stretching it, or we all like that feeling of a nice stretch, but in this particular occasion that's really, really, really bad to do. 

But you're right yeah. The muscle spasm, the needles just help release that to give someone a bit more mobility in their back. Again, in the earlier stages. Once that's all the settlement and we have certain tests in clinic we use to kind of see what the nerve mobility is like. We can obviously go back into strengthening it, and a lot of core work, a lot of lower back stability stuff. And obviously depending on what the client does, back to running or higher end plyometric stuff. 

Mark: So what's a typical treatment protocol like this. What does it normally take for somebody to get back to doing some of that stuff? Of course it's individual, but what would be the typical timeframe?

Simon: Yeah, absolutely Mark, it is very individual dependent on a person's circumstances, but you're probably looking at maybe 8 to 10 weeks, like kind of from start to finish and obviously take that with a grain of salt, depending on the population and different ages and different activities. But yeah, 8 to 10 weeks, depending on the irritability and also dependent on when we kind of catch it.

How limited and how what kind of was the mechanism of injury as well, may also have to be taken into account for sure. Was a traumatic or was it more gradual? For example, traumatic can sometimes take a little bit longer. 

Mark: So what's the common cause of this kind of leg irritation referring from the back?

Simon: Yeah. One of the common cause, just lots and lots of excessive sitting even Mark, especially if it comes on gradually and naturally grows, especially in this pandemic or in general. Sitting for long periods of time, sitting on hard surfaces. You know, if you kind of think about it, like older people get a lot of pressure sores because they can really move their body in bed when they get very, very odd.

It's kind of a bit like that. I mean at an extreme level, obviously somebody can move a little bit in the younger population. But you're kind of depriving the nerve of sort of nutrients through blood flow as well. And eventually it hits a certain threshold where it gives you that signal of maybe tingling down the leg, where it's like, wow, you really need to get the pressure off this nerve as it's passing through the bum muscle. 

There is obviously traumatic, more traumatic stuff as well. If you had a fall off a ladder and you injured your lower back, for sure, that obviously you'd have to go for x-rays to make sure you had no fractures or anything like more serious, but once all that's been cleared, you know, it's a matter of really just getting rid of the inflammation. The treatment is not very different. It might take a bit longer though on a traumatic situation. 

Mark: So if you've got tingling in your legs. If you've got pain, that you suspect might be from your back, but it's in your legs, in your sciatica. Get in to see Simon Kelly at Insync Physio. You can book online at insyncphysio.com or you can give them a call (604) 566-9716 to book your appointment, you have to call and book ahead. He's busy, but he'll get you feeling better as fast as possible. Thanks Simon.

 Simon: Cheers Mark, thank you

Tennis Elbow – Wil Seto

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto. He's the owner. He's the chief physiotherapist of Insync Physio in Vancouver. Two offices, one in North Burnaby, one on Cambie Street in Vancouver. Many time winners of best physios in Vancouver and Wil himself, has been voted best physiotherapist in Vancouver, numerous times by, all of that coming from their customers. And we're going to talk about elbow problems today. How are you doing Wil? 

Wil: Yeah, I'm doing great. Thanks Mark. So probably the most common type of elbow injury or elbow dysfunction is this thing that everyone's heard of, it's tennis elbow. And so it's funny because really only 5% of people that have this type of injury or dysfunction, actually get it from playing tennis.  And I think the majority of it is from other sports, like other racket sports. 

And when you actually break it down to the three main things is like even like your job, like what you do for work. So if you have a job where you're lifting. And more than like, I think what they say, like two to five kilograms of weight  repetitively, like 10 times even just 10 times a day, you know, as your full-time job, that can actually be one of the risk factors.

 To even just a repetitive use of your hand and arm doing things like typing. To even like, if you're using tools that are basically handheld tools as your main implement for your job, then that's going to be another big risk factor. So there's a lot of things when you're looking at what causes it, but really 5% of it is really from actual tennis.

Mark: So, is it a tendon problem, a ligament problem, muscle strength problem. What's kind of the root cause of kind of things that are more common that all of us do. Lifting five to 10 kilograms isn't very much, honestly. So how come that causes elbow problems? 

Wil: Yeah. It's the tennis elbow. Yeah. So really it's the overuse and the overloading, which then causes the inability of the actual tendon that attaches. And so the tennis elbow is on the outside of the elbow. And so basically the issue arises where you start to get this overuse and wear and tear. And I'll say like, so I'll save the name, but basically, the common name when you look it up on the internet, it's lateral epicondylitis.

And so with this overuse issue, you have the degeneration that's happening in the tendon and what in effect happens is that then you start to not be able to heal as fast and you keep like doing things that basically say what's your normal load and because you have this ongoing issue, then you're actually going into overload. So you have to dial it back a little bit. And then there are things that you want to do to be able to start to actually you know, get it better and rehab it. 

But essentially what it is is it's like an injury to the tendon. It starts off as an overuse, but then it becomes a degeneration of that actual tendon. And that's basically what it is. 

Mark: So patient comes in, outside of their elbows hurting. You diagnose they've got tennis elbow. How do you treat it? What's the normal protocol? 

Wil: Well, the first thing that and I'm just thinking about a couple of clients that I'm seeing right now, and it's really important that you actually diagnose what's causing that elbow pain.

I mean, first of all when someone comes in with that kind of pain, it's usually like a gradual onset. So you can get traumatic like tennis elbow or the lateral epicondylitis. I've seen that before, too. Like working with hockey players, you get whacked with a hockey stick or lacrosse players get whacked or some kind of trauma in that area. But that's actually very uncommon. The more common thing is sort of that, Oh, you know, like it just gradually started happening. 

And so in part of that ascertainment of what's going on, you know, the history of what the individual does, is sort of complete that picture a little bit more. It gives us more of a bigger picture of what is causing this. 

And now the other thing is that when we're assessing it, we're also looking for a few different things. Like we're also making sure that, okay, so this isn't like an entrapped nerve. So that's important to also assess. And that this isn't possibly some kind of you know, degeneration of the joint, like an arthritis because when you're looking at the lateral elbow, right. 

Or if it's coming from the neck, so that's actually really important too, because is it like a disc thing that's causing a pain down in your lateral elbow or even a shoulder thing. And so those are really important things that we need to be able to clear first, before we condense and say yeah, you know, this is like a tennis elbow thing. 

And so then when we look at treating it, so if we have like a tennis elbow and quite commonly, what happens is that they may actually have a neck issue that's referring down. And so maybe like a double whammy. So they have a neck issue that probably precipitated a dysfunction in the elbow, and in this deficiency, which then led to now a breaking down of that tendon in the lateral elbow. So now they have two things going on. So in order to actually treat the tennis elbow, you also have to start treating stuff happening in the neck.

So I was telling you about this one patient that I saw who actually has just that. Where their issue in their neck you know, they just with the pandemic and everything that's going on, they're doing a lot more work on their computers, sitting and, you know, admitted his posture wasn't great. And he's also a pretty active guy, you know, he likes to hike, does mixed martial arts and his activity level took a bit of a backseat, but essentially he was doing a lot more computer work and mousing. And then the thing that also made it a little bit more complex was that he had a  previous injury in his elbow, like 15 years ago, but that kind of all cleared up. But that seemed to be something that was kind of pretty vivid in the back of his mind, so he brought that up. 

Mark: So what was the treatment? 

Wil: Basically when we looked at it, we had to treat both his neck. Basically the nerve was being affected. And he had a lot of nerve tension going along that whole segment related to the outside of his elbow. So we had to really start to mobilize that system and work on mobilizing his neck, but then the actual injury to the elbow we also had to treat too.

So we had to actually work on, there was some stiffness in the joint. But it was related to, I think, this overuse issue that he was having. And so we started doing some specific manual therapy to mobilize that. And actually the literature shows that that's actually really effective and in my clinical experience you know, combining that with specific exercises, which is really the key in terms of rehabbing this to be able to get this stronger. So there's a few key things and exercises that I can go over here with you after too.

Mark: So let's jump in. What kind of exercises? 

Wil: Well first of all I guess like one of the main things is how really acute it is. If it's really super bad, then we wouldn't be jumping into too many things to strengthen too much right away. But some of the things that we really want to work on the concept of isometric strengthening. So what isometric strengthening is, basically strengthening a muscle in constant tension without moving it. 

So basically if you break it down there's three types of movements when you look at muscles, like let's take the biceps for example. So if I'm shortening and if I'm doing this and I'm shortening, that's called concentric. And if I'm lengthening, that's called eccentric. So I can do concentric strengthening and eccentric strengthening of my biceps or isometric, where I'm just holding the weight.

Same thing applies with the elbow. So I have a three pound weight here, and if I'm working on isometric strengthening, I want to just support that on a table. And I just want to hold it. I want to just hold it for you know, depending on how acute it is, you know, 10 seconds is usually a good start and you want to work up to like 15 seconds. And just like, a couple sets of 10, once a day to start and building it up to like a couple of times per day.

So that's a really good start to just to get the strengthening in that actual tendon. So studies have shown that that's actually really beneficial. And then you can start to move into a little bit more eccentric contraction. Which is the lengthening of the muscle. 

Now, a couple of other really interesting implements that I have with me here. I want to show and go over with you guys is basically how to recover. So I'm thinking about this client of mine, who is a rock climber, but also does a lot of computer work and has been working exclusively from home. And his workstation is not that great. And he also plays a little bit of tennis as well, which is kind of funny combination tennis and rock climbing.

So a really important part of making sure you manage this is having enough rest and recovery, but also how you do that. So if you're doing a lot of activities, even if you have a job where, like I was mentioning earlier where you're handling tools all day long. Or you're lifting stuff repetitively for two hours or you're lifting things that are around two kilograms, at least 10 to 15 times a day. Then you want to do things to relax the muscles because the muscles get really shortened and tight and it actually causes more tension and fatigues the tendon a little bit more, because the tendon is always the weaker part. 

So before I actually showed the two implements there, I just want to give a full disclosure that I don't actually have any sponsorships or getting the gratuities from these companies of the products that I'm going to actually talk about.

So the first one is this device called the Rolflex and I love this thing for myself personally. Because as a rock climber myself and doing a lot of things with my hands and arms, I get really tight. And it's a really relatively inexpensive little tool and device that you can purchase for under a hundred bucks.

And I use this every time after do any kind of physical activity, like rock climbing or even gardening, I'll do like a couple of hours of gardening. And what it is is just basically a self massager for your arm. And you can use it for other parts of the body, but for the forearm it's so amazing. It's got two foam density pads here, one flat one here, like cylindrical. And then one that has like three different types of beads. And they're high density foam. And they're really super durable. I've had this thing for over two and a half years, and it's still almost looks brand new. And I use it like every day. 

And so basically how this guy works is you can adjust it depending on how big your arm is. And then what you do is you basically have a little lever here that you hold with the other hand. And then if you want to work the lateral arm muscles or the outside arm muscles, then you're just basically squeezing the top grips here. And then you're sliding your hand through and going nice and slow. And you're giving yourself a nice, good little arm massage. You can do a minimum of five to seven minutes up to 10 to 15 minutes, if you want. Hitting a few key muscles in your forearm, basically. And you can do that also for the inside of the arm as well. So this is the Rolflex. 

And then the second thing that I have here is a little bit more pricey, but it's a device that I just got recently and it's called the Theragun. And so the Theragun is like a little bit more of a luxury type of self massager. And it's got like four power settings and I can demonstrate it here for a little bit in a second. It's got like a high density foam knob and this is the basic model and it runs for around 400 bucks. But it's quite good actually. 

I'll show you the first setting here. It's actually the lowest setting and it's pretty  powerful just on the low setting. So all I have to do is just run through certain angles onto the four muscles on the front and on the back. And you can do as little as like five to six minutes. And it is a good way of self massaging the arm. 

So those are two little tools, little implements in terms of what I do for recovery. Now, obviously there's other specific type of exercises and stretches that you can do. But I wanted to just kind of show that because I think those are neat little tools and toys. 

Now the other thing that you can also do to really help support that forearm, is to get a brace. You can get a little tennis elbow brace. So it can be like a neoprene type of brace that fits over the arm like a sleeve or like basically a little cup. So you want to just find one that fits you and that you're comfortable with. And usually the best test is that when you try it on and then you try and do the thing that would aggravate it, it's actually not painful. 

And the idea behind those braces is that it actually absorbs the force. So instead of your tendons and your muscles taking on that force, which when the muscle takes on the force, it transmits it back up to the tendon. Then the brace itself actually absorbs that force and impact. So yeah, essentially those are the things that you can do to really help in addition to the exercises that I had talked about. 

Mark: If you got tennis elbow, if you have pains in your elbows, you have pains anywhere in your body. The guys to see Insync Physio, call them to book an appointment. (604) 566-9716 in Vancouver. Or in North Burnaby, (604) 298-4878. You can also book online, very convenient, very easy, insyncphysio.com. You can pick and find which therapist you want to see. Massage therapists. Physiotherapists. They got them all. They'll look after you. They'll get you feeling better and happy and back doing your favourite activities as fast as possible. Thanks Wil. 

Thanks Mark.

Hip and Buttock Pain: Self Ball Release

Place the release ball on the Gluteus Medius muscle located just below the superior aspect of the pelvic bone called the Iliac crest. Then roll on to the ball and bring your forearm to the ground.

Go back and forth with partial weight and then to progress it with full weight on the release ball. Go slow and relax into it while you roll it out for up to 3 minutes in a couple of different points in the muscle.

This is a great self ball release technique to ease up stiffness and pain into the hip area. If you’re experience abnormal pain or are unsure about what you are doing, consult your local Physiotherapist before continuing. 

Rock Climbing: Hand and Finger Injuries

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto. He's the owner, the principal physiotherapist of Insync Physio in Vancouver. Many time winners of best physiotherapist in Vancouver. His office has won best physiotherapy clinic in Vancouver, numerous times. And they're one of the best. Wil, how are you doing? 

Wil: I'm doing great. Thanks. I'm doing awesome. 

Mark: So we're gonna talk about rock climbing, specifically hand and finger injuries, which might be kind of counter intuitive to people who haven't done this, but it's really common in the rock climbing community. What's going on here?

Wil: Yeah. So finger and hand injuries are one of a subset of injuries that tend to be more exclusive to climbing and it's quite easy to really sustain injuries into your fingers and specific type of injuries, which I'll discuss. And it's easier than you think to get injured.

Let me give you a perfect example. I'm a climber, I'm a very avid climber and I really know, you know, the ins and outs of like preventing these types of injuries, but yet I've had some pretty serious injuries into my fingers. And I still, you know, can't prevent them from happening in the moment.

So I know better now. I'm wiser. So it's interesting, right? It's one of these things that I think sometimes with climbing, it's a sport where you just, all these things, adrenaline rush and you overtrain and injuries can happen. So you just have to be wise about what you do. 

Mark: So what's the most common cause of these kinds of hand and finger injuries. Is it from trauma, from stress, from falling? Is it from over-training like you mentioned, is it just the heat of the moment? Kinda chronic stuff?  Where's most of this coming from?

Wil: Yeah. So that's a really good question, Mark. It really comes down to not enough recovery. So as beginner climber, when you first get into the sport, you can overtrain and not actually allow your tendons and your ligaments and especially your pulleys to actually fully recover before you do your next climbing session.

And as you become more of an intermediate and especially a competitive climbers, that actually compete, then what ends up happening is, at that level of climbing and training, you know, you're really pushing yourself even more where sometimes you haven't fully recovered. And you have another training session where you're probably maybe 75% recovered and then you're stressing those ligaments and those tendons and the pulleys even more.

So I think one thing that'll be really helpful is to really just go over a really basic understanding and anatomy lesson. So there's a diagram here that I want to pull up and it's just a really basic diagram of the pulleys and the finger tendons. So if you actually look at it, when you look at the finger, the finger tendons actually are made up of two parts.

So you have what's called the superficial part. So basically that's the flexor digitorum, superficialis, the FDS, and that's the green tendon and it attaches, you can see how it goes all the way along to this, the middle bone of the finger. So let me actually just reorient you in the anatomy of the finger bones.

So your metacarpal is actually your hand and then your fingers actually made up of the three bones, which is proximal phalanx, the middle phalanx and the distal phalanx. And so you're flexor digitorum superficialis, which is one of the parts of the finger tendons attaches onto, right just distal or just away from one of the pulley ligaments, which I'll kind of describe in a second here. And so the deeper tendon, which is the flexor digitorum profundus extends all the way down to the distal phalanx, which is basically the tip of the fingers. 

And so you have, there's a tendency to have a lot of overuse happening called tendinosis. Which you can develop swelling and over use in the tendon and it gets thickened. And that can be a huge problem when you're over-training and you get these types of overuse injuries in the tendons. It's very common. I see that quite a bit. And so that can happen a lot around that A3 pulley and on that flexor digitorum superficialis tendon. 

So the interesting thing about climbing injuries that are a little bit more related to the pulleys now. So let me give you a little description of what the pulley is exactly. So as you can see on the diagram, so there's five pulleys in your fingers. And so they're labeled A1 to A5.

And so what a pulley actually is, a ligament that binds the tendon close to the bone. To provide a pulley structure to give your tendon more leverage. So when you think about climbing, you think about the tensile forces that you're producing. You want to, obviously, as you start off climbing, as a beginner climber, or if you've taken a large chunk of time off for whatever reason, if you've had kids like myself, or if you've just had an injury to something else where you couldn't climb or work or whatever it is, you want to start to really condition, not just those tendons that I just talked about, but even the pulleys. So what that means is that it's a gradual process and you want to load them lightly and allow them to recover. So that way you can basically increase the optimal loading gradually. And you always want to work within an optimal load.

So when you first start off, your optimal loading is gonna be lower. And then as you get stronger and as you build more strength into those tendons and into those pulleys and ligaments and your ultimate loading will be up to here. And where you have a injury starting to happen is when you start to go beyond that optimal loading.

So when you have a big layoff, you're obviously in suboptimal loading, so you're down here and then you go back to training and then now you may hit a bit of optimal loading, but then you go into overload and that's the danger zone. It's basically when you underload and then you go up to overloading and then your tendons just basically are the weak points and so are your pulleys. 

And so the pulleys, the main ones that usually get injured, as you can see from the diagram are basically your A2 and your A3 pulleys. And I actually myself had an A3 pulley ligament injury along with the flexor digitorum superficialis tendon and having a tendinosis issue, which is inflammation and overuse and a partial rupture of the A3 pulley.

So one of the things that you can really look for is just basically like sometimes there may not even be pain during a session. It may come after, or you may hear like a pop in your finger. And you may get like swelling right away and it may balloon right up like a sausage. And so there's sort of guidelines that you want to actually take in terms of how much time off. Sometimes if it's just a minor strain, you don't need me to take any time off, but you want to decrease the amount of climbing that you do from say, like, if you're like climbing at a 100% to like less than 50%.

And essentially there's five different grades of assessing and diagnosing your, any of the pulley injuries or ruptures or tears. So when you look at like the first grade, it's really just a very minor strain, that's less than 25% of it being injured. And so at that point, you know, depending on how sensitive and what's going on, usually there's not really much swelling and you don't typically feel anything during the session you feel it like afterwards, and then especially the day after.

And so you don't necessarily have to take time off, but depending on what's going on, you might want to take a few days off to let that, if there is a bit of swelling to let that calm down, and then you can actually starts in light climbing within a week or two. But light being like safe, you're like you know, an avid climber that climbs that a 100% of 512, then you're only going to be doing 510s and really easy stuff. And certain specific holds you're going to actively try to avoid. 

And you get in to grade two, then it's going to be more than 25% or less than 50% partial tear. And then at that point too, you want to take at least a week off, really let things settle down and then you can get back to the climbing.

As you get into the higher grades, grade three is a complete rupture. Here you want to take, depending on the nature of what else is going on, if you have other flex or tendon issues happening with overuse, and if you have other ligament injuries then you want to actually take a good, full two weeks off minimum. It can be up to two, maybe up to four weeks. 

And in some cases, you know, if it's like really swollen and if it is a grade three injury, actually, you might need to immobilize it. So it's really important to get that swelling down initially. And then you do want to start to activate it and mobilize, do some therapy and I should actually reiterate that in the first two grades, grades one and two, you also want to do some active therapy and doing some things to get things moving and to actually rehabilitate it pretty quickly. But you're not going to be climbing right away for sure at a grade three, which is complete rupture. 

A grade four injury is where now you start to have, you know, more than one of the pulleys being ruptured. So it could be like a full rupture of your A3 that we talked about and maybe a rupture of your A2. Here you want to definitely stop climbing for a certain amount of time and immobilize it to help take the swelling down and decrease the strain on the pulley so that it has a chance to heal. And that's actually really important at this level of an injury for your pulleys. 

And then we're looking at like a grade five injury. The grade five injury, it's basically a full rupture to multiple pulleys, but also damage to ligaments and structures of other areas like your flexor tendons and with this. And also grade four, I'm not an expert in this area in terms of surgery, but this is where we might want to get a little bit more referral base and have a consultation with a specialist when we think it's a grade four and a grade five. Because that's where, you know, it's been a lot of benefits shown to have some kind of more intervention to really stiffen up those areas. Because essentially if you want to get better and get back up to the level of climbing that you were before, which is possible. Totally possible. You know, when you have multiple ruptures, especially if they're full ruptures, then you want to possibly look at some more expert intervention into that.

Mark: So for the first three grades, what's the kind of treatment protocol that people would typically be looking at?

Wil:  Yeah, definitely a conservative management. And what that means is the first two to four weeks, definitely activation of your rehab stuff to really get the mobility going. That act of actually getting the finger tendons moving and gliding through the sheath and in the blood flow is really helpful for the healing process. And you don't want to overstress it either. So you got to let it heal. Let the swelling settle down before you, you start to progress to that.

And then once that settles down and you progress to that, then you want to actually start the load it a little bit. And the loading can be even just things that you can do not climbing wise, but just doing things where you're strengthening with certain implements, like, hand putty and certain things with elastic bands and really getting the whole kinetic chain too. So it's not just the hand and forearm, but also the shoulder and your core stability. Because that all is going to play a factor into it. 

And then when you're looking at you know, climbing, that's where you really want to actually start loading it a little bit more because that will actually help and taping when you're climbing, you know, can actually help with decrease, decrease the forces in the actual pulley to help with your recovery process. And specific types of taping, like H taping, which you know, I can describe it in a later segment or provide a picture to that as well.

Mark: So some of this, I guess, is from people with access to climbing walls, indoor gyms, something that's not all that new, but for an old guy like me, it's completely foreign. I mean, we used to go outside and have to climb. So you weren't able to climb into winter unless you were ice climbing. And not that I climbed very much, but this new access kind of, and the ability to be there almost every day has probably allowed people to address their muscle strength way faster than they address their tendon and ligament strength. Is that a fair statement? 

Wil: Yeah. I mean, there's definitely an accuracy to what you're saying, Mark. And one of the biggest things, like I mentioned before is that you know, when you start off too soon, it's the optimal loading that you want to be able to stay within that optimal loading zone. And so when we go back to that concept of that, then when you're looking at your muscles, your muscles are always going to be stronger.

They're going to get stronger, faster as well. So when you start you know, training sessions ramping them up, or even just starting training, if you've taken a big layoff, your muscles are going to get stronger faster, but it's the tendons that need to recover. That take longer recover. And they're usually the weak points, their tendons and the pulleys are usually the two weakest points.

And so when you're actually looking at that optimal loading zone, then you you're actually thinking about taking that optimal loading zone into more of a graduated higher and higher, like graduated level like this for your tendons and for your ligaments and for your pulley.

Mark: Yeah. So there you go. If you had a hand injury climbing, Hey, if you're climbing, you probably have had. The guys to see who are experts in it. Wil what did you want to say? 

Wil: No, I was just gonna say that so there's actually really interesting statistic that 15% of 200 climbers that they surveyed in a two year period, have had a hand or finger injury. And then when they looked at competitive climbers that actually competed and whatnot, that increased up to 40%. And that was just in a two-year period of 200 climbers. 

Mark: If you've got hand problems and you want to get back climbing, the guys to see are Insync Physio. You can reach them at (604) 566-9716. Or just go to the website. That's the Vancouver office on Cambie Street. The North Burnaby office is at (604) 298-4878. The easiest way is to go to the website insyncphysio.com. There's online booking there. You can set it up. You can try to get in to see Wil, he's an expert and a fellow climber, but he's always super busy and booked ahead.

They're all experts in this kind of stuff. They all talk and work together. They're going to get you feeling better fast, and if they can't, they will refer you to the right people who will be able to get you better fast. Insyncphysio.com. ThanksWil. 

Wil: Thanks Mark.

Knee ligament Injuries – Big Ball Curls

When you injure your knee ligaments an important part of the recovery process is to begin to strengthen it properly. Big Ball Curls do just that!

Lie down on the ground with your lower legs and the back of your calves and heels on a big ball. Keep your arms on the ground, knees straight and the inner core muscles for your lower back engaged so that your back stays in neutral.

Then lift your butt up off the ground while maintaining your balance and then curl the ball in towards your butt with your heels activating your hamstrings and posterior hip muscles. Hold this for a good second with the knees fully flexed and then slowly straighten the knees push the ball away from you.

Keep your butt off the ground the whole time for ten reps and then come down for a rest after one set of 10 reps. Do 3 sets of 10 in total.

This is a great exercise to build more functional core and knee strength after injuring it. If you have any problems or questions with this exercise consult your local Physiotherapist before continuing. 

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