Neck Pain – Posture Retraining

With so many people doing so much sitting and being in front of a computer for so many hours of the day it’s no wonder that we see so so much neck postural related pain. And especially if you are sitting in a chair that has no to little back support like this one.

Then it’s a good idea to know and incorporate good posture so that you don’t develop neck and back postural pain.

The first thing you want to do in sitting is to make sure that your feet are flat on the floor so that your ankles, knees and hips are close to a ninety degree angle. Picture a string attached from your pelvis and that it connects through the front of your low back, up through your rib cage, then up through the front of your neck, your TMJ (or jaw ) and through the top of your head attaching to the ceiling. The front of your shoulders should line up vertically with your ears.

To open up the shoulders into neutral without pinching together the shoulder blades and over activating your rhomboid muscles, especially if you have rounded shoulders, simply turn the palms of your hands facing forward. Incorporating this into your daily habit is the ideal. You can practise holding this for 30 seconds repeating this every 45 minutes in a waking day.

If you have pain or any discomfort doing this book an appointment and have one of our Physiotherapists at either our North Burnaby or Vancouver locations to check things out.

Hamstring Strains – Progressive Strengthening Nordic Hamstring Curl

You can perform this exercise with your ankles secured under a bar, on a squat rack or wall bar or have a partner hold your feet and ankles down. Use a yoga mat to make it more comfortable for your knees.

Start by pulling in your inner core and keep it engaged the entire time. With your hands out in front of you, then slowly lower yourself down to the ground in a controlled manner into a push up position. Once you make contact with the ground, then push yourself back up.

Repeat this for 10 repetitions, doing 3 sets daily. This is an advanced level strengthening exercise for your hamstrings in conjunction with your core stability muscles.

If you have any pain or dysfunction while doing this exercises come into one of our clinics at either the Vancouver or North Burnaby locations to have one of our Physiotherapists check you out.

Finding Ease in the Effort: Understanding Pain

Hey everyone! My name is Anna Daburger, a physiotherapist at Insync Burnaby. I will be writing a blog series about pain – what it is, what it means & doesn’t mean, and what you can do to manage it better (and how physio can help!). This first post will be about understanding pain a bit better. Read along if you’re interested!

Do you remember the last time you experienced a paper cut, or a hang nail? Who would have known such a small cut in the skin could produce a disproportionate amount of pain? On the other hand, have you ever found a mysterious bruise somewhere on your body with no recollection of how it got there? The amount of pain is not necessarily indicative of the amount of damage sustained. You can have pain with damage, no pain with lots of damage and lots of pain with no damage.

I wanted to preface this discussion of pain with these questions to highlight how complex it is. Some other misconceptions in regard to pain include:

  • No pain, no gain. Persisting in the face of pain can be helpful initially, but use of this strategy can become maladaptive as time goes on, and it can actually cause more pain and triggering episodes (1). It is important to find the right balance between persistence and avoidance.
  • Hurt equals harm. Unfortunately, pain can be a poor guide. When we experience pain, this does not necessarily mean we are causing harm (2). The hurt that is experienced is sometimes less-so an indicator of tissue damage, and more-so an indicator of sensitivity of the nervous system – especially when pain has persisted past the tissue healing time frames.
  • Rest is best. A common traditional approach to pain has been favoring rest over activity. However, we now know that our bodies need movement to recover, and avoiding activities may make you more fearful of and sensitized to them in the long term. So, when you have pain or injury, there should be a period of initial rest; however, the next step will be reactivation of movement and resumption of activity. Physiotherapy can help you navigate it all!

Why do we have pain?

The purpose of pain is to protect you and to motivate you to change what you are doing. Pain is an alarm and alarms are designed to create action. With many acute injuries, the pain alarm is very useful, as it prevents you from keeping your burnt fingers on a hot surface. But the problem with many alarms is that they keep going off long after they are useful. 

The alarm system, or the brain, can start to lose touch with reality and gets very used to the pain & alarm response, even after our tissues have healed. In a way, it “learns” pain and this response becomes a habit (3). You become better at perceiving pain as your brain has become more and more familiar with it - like practicing a language over and over. You can think of it as a sensitive smoke alarm that goes off even when there is no fire. 

It is important to think of pain in the BioPsychoSocial framework; meaning that there are elements at the tissue level (bio), psychological level (emotions, beliefs and stress) and the social level (your support network and work life) that all can contribute to the pain experience. With this in mind, we can look at pain as the overflowing of a cup, an analogy I like to use from physiotherapist Greg Lehman (1):

The cup represents our life and all of the stressors we have in it. As pain persists, it becomes less about tissue damage and more complicated in terms of all the different life factors that can play a role. You can have a lot of physical, mental, emotional and social stressors and have no pain - but at some point, a new stressor can put you just over the edge. The water overflows, and now you have pain. 

Often people will have more pain when there are changes in the stressors in their life; pain can occur, or get worse, when we fail to tolerate and adapt to all the stressors.1 This means that we have a lot of options to help you feel better; and rarely is there just one thing that must be ‘fixed’. We can help to get you better by improving the things in the cup - like getting you exercising or sleeping better - or we can help you to build a bigger cup, so that you are more resilient to the stressors. Your physiotherapist can help you to do both of these things. 

References

  1. Williams AC, Craig KD. Updating the definition of pain. Pain. 2016 Nov;157(11):2420-2423
  2. Pain Science Workbooks [Internet]. Greg Lehman. [cited 2019Jun26]. Available from: http://www.greglehman.ca/pain-science-workbooks/
  3. Siddall PJ. Neuroplasticity and pain: what does it all mean? The Medical Journal of Australia. 2013;198(4):177–8.

Strategies for Managing Your Pain

This next part of the series will discuss how you can better manage your pain. When you come to your appointments, there are different hands-on techniques or modalities that we can use to help you with your pain in the short term. But it is important to remember that you only see your physiotherapist for 30 minutes out of your day – the other 23.5 hours are in your hands!

The experience of pain is unique to each person and is based on many factors that we explored in the previous article. As you can see, pain is complex. However, it’s management does not need to be complicated.  Pain management is possible through understanding pain and exploring evidence-based therapeutic interventions and self-care strategies. 

Exercise is medicine!

Many people in pain tend to avoid certain movements and exercise in general. However, there is now an abundance of evidence that has highlighted the positive effects of exercise and physical activity on both acute and chronic pain, overall daily function, and quality of life (1-3).  Studies have shown that it can be an effective way to reverse the downward cycle of deconditioning and worsening pain, and gradually over time can help those with persistent pain engage more in activities of enjoyment and daily living with more ease.

It is important to start gradually when beginning to exercise, and avoid pushing too far into pain. At the same time, it’s important to not let the pain scare you; a tolerable amount of pain with exercise is acceptable. It can be helpful to use the 0-10 scale to monitor your pain levels while exercising – if your pain increases by more than 2 points from baseline, you should modify the exercise to make it less provocative and to avoid a flare-up. You may be in a bit more pain for the remainder of the day, and this is okay – so long as the pain goes back to baseline by the next morning. With this approach, over time your pain threshold will get higher and you will be able to tolerate more exercise, slowly but surely. Your physiotherapist is an expert in this and can help to guide you!

Sleep is not for the weak!

What came first, the chicken or the egg? That is the ultimate question, and the same thing can be asked of sleep & pain. Recent research has shown that sleep and pain have a bidirectional relationship; meaning they share the same brain pathways (4), and thus influence each other very easily. So – are you sleeping poorly because you have pain? Or do you have pain because you are sleeping poorly?

After only one bad night of sleep, there is a decrease in the pain threshold which means it takes less to provoke it (5). We can think of it like a volume dial; our brains have the amazing ability to dampen the sound signals (turn down the dial) from the nerves in our bodies. With sleep deprivation, that ability to turn down the dial is reduced – therefore, the sound signal of pain increases (6). With sleep deprivation, the ability to cope with pain is hindered and makes everything more aggravated. Getting more sleep is not only crucial for our general health and happiness, but it also can have a protective factor against pain. 

Here are a few simple strategies that can help you get a better night’s sleep: 

  1. Keep to a sleep schedule; even over weekends (try to go to sleep and wake up at about the same time every day!). 
  2. Allow yourself time to relax and unwind at the end of the day. Try to dim or turn off lots of the lights in your house in the hour or two before bed to help that melatonin release. 
  3. Turn your heat down – humans are meant to fall asleep when the sun goes down and it gets cooler. Thermostats have made our modern sleep hygiene problematic! 
  4. Reduce the amount of gadgets/screens in your bedroom; they can be a distraction. 

Pacing – not too much, not too little, but just right.

Does this cycle look familiar? Perhaps you wake up one morning and you feel especially great – so you do more activity than usual (catching up on that never-ending to-do list!). However, if your body and brain aren’t accustomed to doing this much, it can trigger a flare-up of your pain, which then forces a prolonged rest to recover. Over time, this can lead to lower and lower tolerances for the activities that you are wanting to do, and can be extremely frustrating.

However, by slowly down initially and avoiding overexertion, you can avoid the “bust” component of the cycle. By doing just enough, over time we are able to improve our tolerance and do more; but if we do too much or too little, our threshold only tends to get lower. It’s a fine line that your physiotherapist can help you walk successfully. 

The important steps for pacing are: 

  1. Determine your baseline 
  2. Break up activities into smaller components
  3. Take frequent, short breaks as needed 
  4. Gradually increase the amount that you do 

An example of this would be noticing that your back pain tends to flare up after walking 5km. You then tend to spend the next few days resting, and then when you go out to walk again, your tolerance is no better – sometimes worse. A better strategy would be to either break up your walk into two 2.5km loops; one in the morning and one in the evening to allow adequate time for rest. Or, decrease your loop to 4km at once. If you are able to complete these walks with no “bust” of your pain, then it is a success – and over time, you can build your tolerance back up to 5km, and beyond!

Many individuals have found that when pacing is implemented into their daily routines, it can be very effective in helping things such as fatigue, pain levels, and tolerance of exercise and movement (7). Pacing can be a difficult skill to integrate into your life, and as physiotherapists we are here to help you find strategies that will work best for you.

References

  1. Hayden JA, Van Tulder MW, Tomlinson G. Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann Intern Med. 2005; 142(9):776-85.
  2. Babatunde OO, Jordan JL, Van der Windt DA, Hill JC, Foster NE, Protheroe J. Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence. PLoS One. 2017;12(6):e0178621.
  3. Geneen, L., Smith, B., Clarke, C., Martin, D., Colvin, L. A., & Moore, R. A. (2014). Physical activity and exercise for chronic pain in adults: an overview of Cochrane reviews. Cochrane Database of Systematic Reviews. doi: 10.1002/14651858.cd011279
  4.  Walker, M. P. (2018). Why we sleep: Unlocking the power of sleep and dreams. New York, NY: Scribner, an imprint of Simon & Schuster.
  5.  Walker, M. P., & Stickgold, R. (2009). Sleep and Memory Consolidation. Sleep Disorders Medicine,112-126. doi:10.1016/b978-0-7506-7584-0.00009-4
  6. Simpson NS, Scott-Sutherland J, Gautam S, Sethna N, Haack M. Chronic exposure to insufficient sleep alters processes of pain habituation and sensitization. Pain. 2018; 159(1):33-40.
  7. Guy L. Effectiveness of Pacing as a Learned Strategy for People With Chronic Pain: A Systematic Review. Am J Occup Ther. 2019; 73(3): 1-10. 

Injury Prevention and Performance Tips for Ultimate Frisbee – by Vancouver and Burnaby Physiotherapist

Hey, my name is Patrizio, I’m a Physiotherapist at INSYNC PHYSIO, both at our Cambie and Burnaby locations. I’m here onsite doing Physio coverage for The BC Place Ultimate Frisbee tournament.

Today we are helping out a lot with Sports Injuries and Doing some First Responder work. We see a lot of injuries at these types of events. So what I want to talk to you about is also some injury prevention. It’s good to warm up to get some circulation going, get the muscles ready for activity and to also to cool down with some stretching as well.

So one of the big stretches we like to encourage is the rectus femurs stretch and the hip flexor stretch, as well as the piriformis stretch. And then doing some core work is always a good idea in between games like doing a lateral lunge to step up as well as the “Dead Bug pose” as well. And that should keep you going. Alright, Thank you! 

Rectus Femoris Stretch
Prepare a nice cushion for your left knee to be on and a step stool to place the top of the foot on to have greater knee flexion. This will isolate the muscle stretch. Keep your posture nice and tall and imagine there’s a string pulling your whole spine upwards from your pelvis, right up your entire back and neck and up to the top of your head.

Then engage your inner core muscles tight below your belly button and keep your low back flat and contract your left butt muscles. Next, bend the right knee forward and keep your posture nice and tall without leaning backwards. Hold this stretch for 30 seconds and repeat 3 times for each side.

Hip Flexor Stretch
Kneel down onto your left knee. Then rotate it about 45 degrees past the midline of your body. To keep your posture nice and tall imagine there’s a string pulling your whole spine upwards from your pelvis, right up your entire back and neck and up to the top of your head.

Then engage your inner core muscles tight below your belly button and keep your low back flat. Next, bend the right knee forward and keep your posture nice and tall without leaning backwards. Then reach your left arm up pointing the fingers towards the ceiling nice and high and point your right finger tips to the floor. Hold this stretch for 30 seconds and repeat 3 times for each side.

Piriformis Muscle Stretch
Lie down on the ground with your right foot on the corner of a wall or door frame to stretch out the left piriform muscle. Start with your right knee at 90 degrees.

If you are really tight at the beginning then increase the angle of that right knee by moving further away from the wall or door frame. Cross your left ankle across your right knee and ensure that your buttock remain touching the ground firmly and your hips staying square to your body.​

Stabilize your right ankle with your right hand and extend that ankle into dorsiflexion upwards. Then push your left knee towards your other foot while you keep your inner core engaged and your pelvis nice and stable. Hold this for 30 seconds, doing 3 sets on the affected side daily. 

Side Step Lunge: One Arm Presses
Hold onto a 5 pound dumbbell with your right hand. Engage your inner core muscles and keep your posture in neutral. Do a side step lunge with your left foot to the left side and keep your knee pointing forward and over your ankle while you bring the dumbbell down towards that left foot.

Push back up through your left foot and bring your body weight over your right knee. As you flex your left hip, perform a 1-arm shoulder press with the right arm. Make sure your knee stays in alignment with your second toe, and over your ankle as you perform this exercise. Do 10 reps, 3 sets on each side. This exercise can help with progressive strengthening and rehab of your injured knee. It can help you become functionally stronger in jumping for Ultimate Frisbee like in skying the disc in those moments when you feel like you need a dynamically stronger core.

Core Strengthening: The Dead Bug
Hi everybody, just Simon here again. Just going to give you a simple core exercise to do just to strengthen the core. Core is very important like I said before because it creates a stable base just to power into the lower limbs. 

So the start position for this is if you just lie on your back, sort of hips and knees at ninety degrees, and arms up like I am here now, and then you're going to extend out your bottom left leg and extend out your right arm, nice nice straight and steady. Then you're going to come back to the start position. Then you're going to do the same on your right leg, extend out right leg and extend back your left arm. Perfect! 

Then you’re going to do 10 reps of each for three sets if you can.

Sacroiliac Joint Pain & Dysfunction – Piriformis Stretch

Lie down on the ground with your right foot on the corner of a wall or door frame to stretch out the left piriform muscle. Start with your right knee at 90 degrees.

If you are really tight at the beginning then increase the angle of that right knee by moving further away from the wall or door frame.

Cross your left ankle across your right knee and ensure that your buttock remain touching the ground firmly and your hips staying square to your body.​

Stabilize your right ankle with your right hand and extend that ankle into dorsiflexion upwards. Then push your left knee towards your other foot while you keep your inner core engaged and your pelvis nice and stable. Hold this for 30 seconds, doing 3 sets on the affected side daily.

When you have sacroiliac joint pain and dysfunction, this exercise can help to relieve it. 

Low Back Herniated Disc Injuries- Sloppy Push Ups

Start by lying flat on the ground, on a yoga mat or a firm bed. For the beginning stages of this exercise, lift your upper chest off the ground by supporting yourself on your forearms.

Take a deep breathe out to make sure your low back is relaxed in this position and your hips are on the ground. Stay here for 10 seconds, then lower and repeat.

To make this exercise harder, put your hands out in front of your head and push up from your hands instead of your forearms. This will help lift your chest even further off the ground and get more extension through the low back.

It’s still important that you are able to relax the back and glute muscles in this position. If you can’t do this, or if your hips come off the ground, you should revert back to the first stage of this exercise. Once again, stay here for 10 seconds & return to the ground. Do this for 30 repetitions, 3 times daily.

Sacroiliac Joint Syndrome- Gluteus Medius Muscle Strengthening Pistol Squats

With both sides of the pelvis level squat down on one leg sitting your butt back (like in a chair).

Keep the knee over the ankle and aligned with your hip and second toe while preventing it from moving past the toes as you squat. You also want to reach both arms out in front of you to keep balanced and bend your hips so your chest comes forward.

Your weight is on your entire foot as you come straight back up. Place the emphasis on pushing through the heel while squeezing your butt all the way back up. Repeat this for 10-15 repetitions doing 3 sets on each side.

Sacroiliac joint syndrome is a mechanical dysfunction of the sacroiliac joint causing pain and loss in mobility of the joint. It can present as pain in the low back, groin, buttock, thigh or posterior aspect of the sacroiliac joint area. It occurs when the sacroiliac joint ligaments are damaged or torn from trauma like a fall, motor vehicle accident, lifting, bending and repetitive strain or muscle imbalances. 

Knee Sprain and Strain injuries – Side Step Lunge One Arm Overhead Press

Hold onto a 5 lb dumbbell with your right hand. Engage your inner core muscles and keep your posture in neutral.

Do a side step lunge with your left foot to the left side and keep your knee pointing forward and over your ankle while you bring the dumbbell down towards that left foot. Push back up through your left foot and bring your body weight over your right knee.

As you flex your left hip, perform a 1-arm shoulder press with the right arm. Make sure your knee stays in alignment with your second toe, and over your ankle as you perform this exercise. Do 10 reps, 3 sets on each side.

This exercise can help with progressive strengthening and rehab of your injured knee. It can help you become functionally stronger in jumping for Ultimate Frisbee like in skying the disc in those moments when you feel like you need a dynamically stronger core. It can also help you with your 1-legged jumps in volleyball, basketball, rock climbing, or any other jump and reach type of sports or activities.

If you have any pain or problems or injuries, book in to see one of our Physiotherapists at INSYNC PHYSIO at either the Vancouver or Burnaby locations. 

Low Back Sprain and Strain Injuries – Kneeling Thoracic Rotation

Start by kneeling on the ground with the leg closest to the wall up in a lunge position. You can kneel on a yoga mat or pillow to provide extra cushioning and support.

Bring your arms up to 90 degrees in front of you, maintaining the arm that’s closest to the wall right up tight against the wall. Open up your other arm, like you are opening up a book, and try to get it as close to the wall behind you as you can without bringing your other arm off the wall.

You should feel a stretch in your mid back area. Return to neutral and repeat 10 repetitions doing 3 sets on each side. Make sure to keep your neck neutral without straining it, and follow the movement of your arm with your head.

If you can’t get your other arm against the wall, that’s ok. Bring it to the end barrier of it’s movement but don’t force it. A stiff mid back or Thoracic spine can contribute to lower back strains and sprain injuries and it’s usually a good idea to incorporate this into your lower back rehab.

Shoulder Rotator Cuff & Ligament Injuries – Strengthening Y-Pattern Muscle Activation

Start by bringing your elbows at your sides and holding the band in a W position.

Make sure there is some tension in the band. Maintain this tension and straighten the arms up overhead into a Y shape. The exercise will get harder the higher that you go.

Try to resist the temptation to bring your arms closer together at the top. Your arms should be directly above your head, not in front or behind. Think about engaging your upper back muscles. Do 3 sets of 10 repetitions.

This progressive strengthening exercise is really good for retraining the activation patterns and strengthening the rotator cuff muscles in co-ordination with some scapular muscle activation when you are looking to rehab your shoulder injury after straining the rotator cuff itself or spraining the ligaments associated with the shoulder joint. 

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