Vancouver Physio Nirushan Guruparan – Sports & Knee Focus Injuries

What inspired me to become a physiotherapist? Well, when I was a kid, I grew up playing a lot of sports. I played a lot of soccer. We were playing tennis, I did some TaeKwonDo, I did swimming as well. And so I was really immersed into athletics as a kid. And if I wasn't playing the sports, I was either watching them on TV, reading about them, I would read sports autobiographies.

I would read about fitness, dieting, nutrition. Those are always the things had me interested in what was a kid. And when I went to university, I took a lot of courses in physiology, biology, biomechanics and sports psychology. Those are the type of stuff that really was driving me to learn more about my profession and different professions in general.

And I also knew for myself that I want to be in a field where I can actually help people in person and learn about people's stories, where they came from. And I know I wanted to help them in some way or form and physiotherapy became the ultimate profession that had basically everything I was looking for in one.

And that's what inspired me to become a physiotherapist. If I wasn't playing or watching sports. I was actually doing a lot of drawing. I would draw anything from like buildings to humans, to animations, to cartoons. Drawing was what I did for a long period of time. I mean, if you talk to any of my friends before I was 18, they would know me as the art guy and the drawing guy. 

So when I finished university, the other profession that was looking at was something called a medical illustrator. It's basically a combination of anatomy, physiology, type of human biology and art together. So if I have to choose another profession, that's not physio. That would probably be the best fit for me. 

In my free time, I like watching a lot of movies, new TV shows. I love listening to music, R&B and hip hop are some of my favourite genres. So if you know some good R&B music right now, please give me some recommendations.

I love going to concerts. I love hanging on my friends. I just recently moved here from Toronto. So you'll find me calling my friends in Toronto quite often throughout the days, these days. And I love traveling a lot and I've gone to Mexico. I actually grew up in Italy for a couple of years. So that's something, so that's a place I would like to go back. I'm originally from Sri Lanka as well. So I definitely need to head back home at one point, but I'm new to BC and I'm excited to go hiking. So that's going to be a new hobby that I can't wait to explore. So if you have any suggestions on hiking trails and you come see me, please let me know some recommends. 

I like treating all areas of the body and everything is unique and I love learning about the human body, but if I had to pick one area, it would probably be the knee. I've always been interested in with the structural integrity of the knee, either loaded and the different injuries that affect the knee.

It's always interesting to kind of figure out how like your feet and basically your hips kind of all impact the way your knees are moving and working. The knees are actually commonly injured in sports. So obviously when I was growing up, that's one of the things I'm always curious about, like how long is it gonna take for my favourite players has come back from injury.

As well on a personal level, I actually had knee pain. That's probably one of the first exposures I had to physical therapy. I had a hard time just accelerating, decelerating, moving quick, and I knew how debilitating it felt to be able to perform at a good level. I couldn't catch my next man. So the knee has always been close to my heart as an area that I like to treat.

Shoulder Rotator Cuff Climbing Injury Rehab Resisted Bear Walk

Start in 4 point position on your hands and the forefoot or the balls of your feet with your knees greater than 90 degrees with 4 feet Resistance bands tied diagonally from opposite thumb webspace to ankles.

As you place one hand forward bring your opposite foot forward as well. Do this while you also keep the shoulder blade muscles and your neck position in neutral. Repeat this for 30 seconds 3 sets 2x/day.

This is a great progressive core stability muscle strengthening exercise for rehabbing your shoulder and rotator cuff injuries. 

Physiotherapist Pelvic Health with Mecca Clipsham

Mark: Hi, it's Mark from TLR. I'm here with Mecca from Insync Physiotherapy in North Burnaby. She's a physiotherapist for pelvic health, and we're going to talk about pelvic health. How are you doing Mecca?

Mecca: Yeah, so I treat people with pelvic floor dysfunctions and that would be, you know, anyone who's experiencing pain in their pelvis region or someone who pregnant or post-pregnancy. There's quite a lot of things. The pelvic floor is a group of muscles that forms the underside of the pelvis.

So you imagine that area between your seat bones, your tailbone, and kind of the front of your pelvic bone. That's the pelvic floor and it helps with bowel function, bladder function, sexual function, support of all those internal organs. So anyone who is experiencing any sort of bladder or bowel problems such as leakage, like unwanted leakage or incontinence, or sexual function dysfunction could benefit from pelvic floor physiotherapy. 

Mark: So how common is this? 

Mecca: It's more common than you think actually. A lot of women experience incontinence, which is an unwanted leakage of urine throughout their lives, kind of from early adulthood, all the way to older age. Quite common around pregnancy as well as with older age. And it's something that people kind of think that is a normal thing, which it actually is something that's not normal and something that there is possibly a solution too. And pelvic floor physiotherapy can definitely help with some of those symptoms.

Mark: So what would be some of the other symptoms that somebody would come in and get treatment? 

Mecca: So any sort of pain in the area. So pain with sexual intercourse or any sort of sexual activity. Pain with even like rectal pain. That could be something that could benefit. Pain with urination or bowel movements.

Some other pain conditions such as bladder pain. Even the conditions such as endometriosis, we can't treat medically, but we can actually help with some of the symptoms that are related to that. 

Mark: So what's causing some of this stuff? 

Mecca: So some of the stuff that causes the pain and causes the symptoms is actually the kind of dysfunction of the pelvic floor muscles. So sometimes they can be too tight and people are unable to relax that area. And that can cause quite a lot of pain. Sometimes they're not strong enough or people are unable to coordinate that part of their body. And that can cause some unwanted leakage of urine or pre and post pregnancy, for example. 

As we understand, pregnancy puts a lot of stress on that area of the body. It's a lot more weight on that area of the body and that can cause some unwanted leakage and also even some pain in the area. That can be treated by pelvic floor physiotherapy. 

Mark: So how do you go about diagnosing what actually is going on and maybe a course of treatment?

Mecca: Yeah. So what we do is we take a really thorough history from a patient. So just finding out a lot of information about what's been going on and what their symptoms are and what their history is, what sort of other medical treatments they've had. And just kind of get to know them and who they are.

And then we go into an assessment. So an exam. So we look at them kind of as a whole person. How do they move? How do they breathe? All that kind of thing. And then the real difference between pelvic floor physiotherapy and regular physiotherapy is that we've actually been trained to do internal exams.

So what that looks like is similar to like a gynecology exam. It's actually an internal vaginal exam or internal rectal exam. So that's kind of the difference between a regular physio and pelvic floor physio, is that we have the training to do that. And that actually gives us a really good sense of what's going on with some of these muscles. Because a lot of these muscles are more internal and we can't really see what's going on or understand what's going on without doing that internal exam. 

Mark: And what would a typical course of treatment look like and how long does it take to have some improvement. If that's even possible sometimes. 

Mecca: Yeah. So that will vary from patient to patient, just like any sort of treatment. It's very unlikely that it's a one time treatment. Sometimes it might take several weeks to several months, depending on how long the person has been experiencing their issues.

Mark: And what are the things that you're giving people to do or you're getting them to do when they're in office.

Mecca: Yeah. So it's very similar to regular physiotherapy. There's a lot of education and a lot of information that is actually, things that people don't necessarily realize that should be common knowledge. So lots of education, lots of even like some lifestyle modification, exercises. So pelvic floor exercises. The most common thing that people think of is kegels, which can be part of it, but it's not everything. Because there's a lot of people that can't actually relax their pelvic floor. So instead of needing kegels, they actually need more relaxation exercises. So yeah, those are kind of the main things. There's also some manual techniques that we can use to work on people's pelvic floors as well. 

Mark: So if you have some issues with your pelvic floor, if you've got pain there, if you've got problems with incontinence, the person to see in North Burnaby is Mecca Clipsham. She's at Insync Physiotherapy in North Burnaby. You can book online at or you can call to book at (604) 298-4878. Get in to see Mecca. Get better. Get moving better. And get those issues looked after. Thanks, Mecca. 

Mecca: Thanks Mark.

Persistent Post Concussion Syndrome with Iyad Salloum

Mark: Hi, it's Mark from Top Local, I'm here with Iyad Salloum he's the clinical director of Insync Physio in North Burnaby. And we're going to talk about persistent post-concussion syndrome. What is this Iyad? 

Iyad: Yeah, so there's the common tale of like, you have two different kinds of populations that get this potentially. So you have the athletes who, you know, is playing a contact sport like anywhere from soccer to hockey, to lacrosse. They get an impact. They suffer from a concussion and then a few weeks on they're still unresponsive. They feel like they're not improving, they're not improving in the same trajectory. You'd expect it to with just time. 

Then you have another group that we see quite commonly, which is after a motor vehicle accident. So anything that involves a sudden movement to the head, a rapid acceleration deceleration kind of will potentially lead to a concussion. And then, you know, a few weeks on these people seem to struggle specifically coping with things like screen work if they’re office workers or if they're students like reading and studying. If they're athletes going back for a job, for example. 

There's all these things. And then the interesting part about it is the symptoms are so varied. As we know about concussion, no two are the same. Heterogeneous group. So some people have an issue with a light sensitivity. Some people will get dizzy. Some people get a headache. So really it's a whole kind of gamut of symptoms that we assess and treat in clinic.

And in this group, particularly where it's really confusing for them because you know, usually you'd expect things to just get better with time as like when you roll your ankle or a few of those things. But here it seems to kind of lag a little past where they think it is and you know, the reason that is, is because A, the brain's a bit more complex and B, sometime as we kind of delve into these maybe maladaptive patterns where we try to protect ourselves a bit too much, or maybe we go a bit too hard into our return.

So there's the two extremes where you do very little or your do too much. And this is kind of where we come in to help regulate that system a bit more. 

Mark: So, is there an obvious cause as to why one particular person with a similar injury would get better quickly and another person wouldn't? Is there anything that's been defined in science before? 

Iyad: Million dollar question. So far we know there are a few risk factors. So things that make you more likely to get it. So people who have had several concussions seem to cause this. If you have involvement, for example, of a few other things like the neck and the vestibular organ, which is in our inner ear, which helps us kind of balance and kind of track objects through space.

Those are very simple things that we talk about, but they actually are quite complex neurological processes. So it all depends, I guess on the person too. So it's like sometimes if they've had several concussions, that's a factor. There's some genetic reasons that we think it is. Sometimes the severity of the initial injury and then sometimes it's just the lack of education on this area where people return to quick or don't return at all. 

Sadly, we still see some bad advice out there where people sit in dark rooms for a week, which is crazy because I don't know when the last time you had to sit in a room without your phone, without reading, without running, without walking in a dark room and just do nothing. Sounds like solitary confinement to me. So I think that's a big reason why we see persisting symptoms too is it's just outdated advice, let's call it. 

Mark: So when you're diagnosing this, does it make any difference what the symptoms are when you're going through the history of someone? Do they have a history of a lot of concussions? What actually happened? How severe was it, et cetera. I guess it's graded in terms of the injury then. Okay. Someone's really light sensitive. Is that a different course of treatment than somebody who's having balance issues? 

Iyad: Yeah, that's a great question. And yes, the answer is yes. So if your main impairments are visual in nature, we'll try to target that system a bit more. If your main kind of impairments that we pick up as the vestibular impairments, we try to target that too. I usually will consult an occupational therapist on this too, where they are really good at planning and pacing.

Like this is kind of the grand scheme of things. It's like, you need to be able to preplan things in concussion, because there's a bit of a battery life that once you exceed, it seems like the symptoms go a bit way off kilter. And doing this where you're just kind of trying to mentally track things is really, really tough.

So we have a foundation of just like people being more aware of their symptoms and planning their days out and trying to separate their activities until, let's call them mentally draining intense activities, to let's say something that's light and easy. And then the exercises or the treatments will be focused on what are the specific impairments.

If you have a primarily balanced deficit, we'll try to target that a bit more in treatment. Versus if you have a visual deficit, try to I'll start with that in treatment. It'll rarely be a solo practitioner working on this. I usually will consult several team members like even optometrists if there's a lot of visual disturbances. Or occupational therapists are pretty easy one to kind of tag in here, but then often people might have some other kind of ongoing mental health issues where we actually really need to tag in our colleagues too.

So yeah it's quite complex, but it's also what makes it kind of fun. Cause it's not really a cookie cutter thing. I'll never be able to hand a printout of here's the five exercises to get rid of your concussion. We're not there yet at least, where we can classify people like that. Based on a cookie cutter recipe or we just hand it out. 

So for now, yeah, we have to treat the impairment and it tends to be very, very different person to person. 

Mark: So clearly no typical course of treatment. What are some of the things that you would do for instance, that for light sensitivity and the vision system being impaired or impacted by the concussion as compared to say a balance issue?

Iyad: Yeah, the balances should be pretty straightforward. We've got to figure out what's causing that. So it's going to be one of three things. The three systems could be a visual impairment, so like some people will actually perform better when the visual system is a bit clear, let's say. So there's different therapies we try. For example, seeing if we can optimize their visual field, get them to focus on certain things while they balance, or even maybe get them to focus less sometimes. Sometimes we try to get a little too tunnel vision. 

There's other things for vision could be as simple as where we try different tools, like some of them are called binasal occlusion and a few other things, or even prism glasses that an optometrist would recommend sometimes.

While we train that system, we definitely want a great screen exposure. So if you had just tell somebody to go stand in front of your laptop for 12 hours, I'm expecting them to fail there. So we suggest different filters, for example, like a lot of technology nowadays has a night shift mode and that could be very helpful. So we'll do that. We'll be very specific. And then the amount of screen time that we do. 

And then obviously we'd want to pay attention to sleep hygiene because initially we'll get a lot of sleeping habits where people want to sleep more. But then as that kind of throws the entire sleep cycle off, we actually see people kind of fall down a bit of a slippery slope and then we need to address that system a bit more too.

So, yeah. Meanwhile balance, I mean, we'll figure out if it's a vestibular problem. Sometimes it could be due to BPPV, which is where you have a crystal gets out of place into one of the surrounding canals in the ear. And we can treat that very easily with an Epley maneuver or a barbecue roll. Those are just two different treatments that we use for that. 

But if it's just an impairment in the system, there's lots of exercises that we could use to target those. We actually have a lot of tools in our toolbox here and that's the good news because sometimes it feels like when people have been in this for awhile, that it's just never ending. And it is quite taxing to feel that way. So we try to help whatever way we can. 

Mark: All right. If you've got any kind of persistent post-concussion issues going on, you need expert help. And the guys to see are Insync Physio in North Burnaby, (604) 298-4878. And you can also book online at Or the Vancouver office. There's also experts at (604) 566-9716 to book. Got a book ahead. They're always busy at Insync Physio. Get some help. Get some expert team work on your concussion syndrome and get feeling better quickly. Thanks Iyad. 

Iyad: Thanks Mark.

Pre and Post Pregnancy Physio with Mecca Clipsham

Mark: Hi, it's Mark from TLR. I'm here with Mecca from Insync Physiotherapy in North Burnaby. She's a physiotherapist for pelvic health, and we're going to talk about pelvic health. How are you doing Mecca?

Mecca: I'm good. Thanks. How are you Mark?  

Mark: Good. So I've never been pregnant. Thank God. But I guess there's some things that happen to women when, before and after they've had a baby. Why would they want to see you specifically?

Mecca: So when someone is pregnant, there's a lot of stress and pressure on their pelvic floor. And there's a lot more weight in their pelvic region due to their pregnancy. So coming to see a pelvic floor, someone who specializes in pelvic floor physiotherapy, can be helpful just to get an assessment before the baby comes.

So in pregnancy, usually in the second trimester would be a good time to come just to get an assessment of how their pelvic floor is functioning and a little bit of education on how to keep it healthy. And you know, there's some things that we can go over. Prepping for birth. And then after birth as well after having a baby, your pelvic floor can change.

And it's good to get that assessed and looked at because there are a few things that can happen. A lot of people experience pain in their pelvic region while they're pregnant. And that's something that we can work on. Some people who are pregnant experience incontinence, which is just unwanted leaking. May happen before or after pregnancy.

And coming to see a physiotherapist who works with pelvic floor can help mitigate some of those symptoms. Another thing that happens with pregnancy is there's a possibility of prolapse. So prolapse of pelvic organs, and that's another thing that we can address.

Mark: If you're pregnant, thinking about getting pregnant or have been pregnant and you've got any of these issues going on or want to be prepared, because this is fairly common. The person to see in North Burnaby is Mecca Clipsham at Insync Physiotherapy. You can book online to see her at or you can call the office at (604) 298-4878. You got to call ahead. She's busy. Thanks Mecca. 

Mecca: Thanks Mark.

Shoulder Rotator Cuff Climbing Injuries Belly Ball Dribble

Lie on your stomach on top of a built up mat 5-8 inches high. Keep your feet wide apart with toes to the ground, with your face and chin clearing the mat and your arms straight and wide grasping a large exercise ball on the ground.

Dribble the large exercise ball with both hands while you keep your front lower core engaged and lower back straight. Prevent your low back from going into extension. Activating the lower quadrant core muscles will enhance and optimize your strength and movement patterns to your full potential.

Repeat this for 10 seconds doing 10 reps 2sets daily. This can be progressed by increasing your dribbling up to 20 seconds for 5 reps 2 sets and ultimately to 30 seconds for 3 reps 2 sets.

Another great strengthening exercise to rehab from your rotator cuff shoulder injuries! 

Rock Climbing Neck Injury Rehab Resisted Bear Walk

Start in 4 point position on your hands and the forefoot or the balls of your feet with your knees greater than 90 degrees with 4 feet Resistance bands tied diagonally from opposite thumb webspace to ankles.

As you place one hand forward bring your opposite foot forward as well. Do this while you also keep the shoulder blade muscles and your neck position in neutral. Repeat this for 30 seconds 3 sets 2x/day.

This is a great progressive core stability muscle strengthening exercise for your neck after sustaining an acute or chronic type of injury. 

TMJ with Iyad Salloum

Mark: Hi, it's Mark from TLR. I'm here with Iyad Salloum of Insync Physio in North Burnaby. He's the clinical director. And we're going to talk about a very common kind of issue. TMJ, what is TMJ? 

Iyad: Yeah. So the TMJ is your temporomandibular joint. So it's kind of right here, it articulates kind of at the base of our skull. And you know, you need it to eat. So it's to chew your food and all that stuff. So temporomandibular disorders or TMD is what most people will kind of be familiar with are, when you have a dysfunction in that joint system and the way the muscles kind of work around it. So we actually see that quite a bit in clinic. And it's often funny how many people are surprised that it's something that could be treated by somebody who works in any musculoskeletal practice, like ours.

Mark: So what kind of symptoms would it be? Would this be where your jaw is clicking or is it where you got actual pain in the joint? Pain when you're biting into something? And what would make the difference between me going to the dentist and coming to a physio? 

Iyad: Oh, fair enough. Yeah. So like easiest distinction would be anything to do with your oral health would be good to see a dentist first. So things, for example, like if there's issues that you might need some more interventions or like even something as basic as a cleaning, anything related to that like kind of how your gums are receding or not, all these kind of classic oral hygiene issues or just oral health issues would be best left for the dentist.

We primarily deal with issues of the joint and the muscle. So common symptom would be somebody who's struggling to open their jaw actually. And this could happen funny enough, after holding your jaw open for a long period of time. Like I've had people after a certain procedures where they have no other option, but to hold their neck and their mouth in a position for too long.

And then it becomes really challenging for them to either bite or to open. And this is where I guess we come into play. Where we can do an assessment. Sometimes the assessments easy to do on the outside, where we're able to feel how things move and just visually assess it. And then other times we can do an internal assessment where, don't worry me glove up and it's sanitary, and we go right in and we see and feel how those joints and muscles are behaving. So there's lots of options that can happen that way. And a common one that's often forgotten is, jaw pain can happen as a result of issues in the upper neck. So after a long period of time, impairments here can actually lead to dysfunctions there.

So this is how we quite often, like we'll spot these in clinic where somebody is coming in for treatment of headaches or neck pain, and you know, through talking a bit more, you realize that they're struggling to have apples and stuff like that. So then you start to link the two together and often it's funny, some people you treat the neck and the jaw kind of will resolve itself. And then in some cases we might need to target the jaw a little more specifically. 

And another group will be the ones who clench their teeth at night. So, that's quite common and it happens for a multitude of reasons. Sometimes it's hard for us to control what we do at night. So then people wake up with extreme job pain sometimes in the morning and they feel like it's really takes them a while to warm up those musculature, especially around here in deep in the inside. So those are common cases that we will see. 

And yeah, the symptoms tend to be either like clicking or pain with opening or pain with closing and biting. And in some cases we see deviations where the jaw will go to one side or the other. And that will be an issue on one side. So you have one side that's dropping or depressing properly. And the other side that's not. So we see that moving side to side. So this is where people say, oh, I have a crooked bite.

Mark: So what's causing all this. Is it just like you mentioned that that could be neck problems, but what's actually causing the issues in the joint itself? 

Iyad: Well, I mean, a common example would be somebody who let's say, imagine if you're in your job, you sit too long. And if you sit for long enough in the same position without too much variety you could develop some tension or issues in your low back or your neck or your shoulders.

So prolonged positioning is a big one. Prolonged habits. Sometimes it's a manifestation of other things. So where people, let's say unconsciously will clench their teeth. Sometimes it's the result of trauma, like, you know, classic knock the face. We see that a lot from sports, for example, where somebody will get tackled or something like that.

And then there's the positions that, like, let's say you're doing a procedure, having something worked on and you have to hold your neck and head and your jaw open for a certain period of time. And then, I mean, yes, it's necessary to deal with another issue, but then it can also cause some jaw pain.

 It's a joint there's muscles there and the behaves very similarly to other joints where other muscles interact with it. So if you hold your head up all day for hours at a time, you might get a bit sore there. And it's the same thing in the jaw.

Mark: So when you're diagnosing this, what are you looking for? 

Iyad: We look for this functions in, let's say opening and closing. Sometimes we'll just look at their bite. We will ask subjectively, quite often the patient's the expert on this, because they've been living with it for a while and then they decide to come in and get it checked out.

So yeah, those are the things we'll tend to look at. We will also look at the neck and in depth and we'll want to get a good history if there's any, for example, impact or trauma and things like that. Because we will just kind of give that a second consideration. But yeah, this is not necessarily the same as let's say somebody who has a dislocated jaw from a big impact. In that case, we would usually refer them to the right place to get that dealt with. But in here, it's just kind of think of it as like an achy, dysfunctional joint. That's either moving too much or not moving enough. And in some cases it's a control issue.

Like it's funny the way you would think about how, when you sprained an ankle, it becomes hard to stand on it for awhile. You can develop these same motor control issues in the jaw. So which case we have these corrective exercises that can actually help address these things. 

Mark: Typical course of treatment?. 

Iyad: Yeah, it does tend to respond pretty well, which is the good news. We have a multitude of tools in our tool belt. So from basic education on things to kind of temporarily, maybe back off of to things to do more of. We'll definitely include some neck work in there. Exercise and also potentially hands-on manual therapy. We will sometimes do an internal assessment and treat whatever we see as a main kind of restricted area.

And it doesn't have to be anything crazy invasive. And in some cases people have had success in the past using dry needling to some of the muscles in the area. So those tend to work pretty well. But it's not again, we try to kind of go with the most minimally invasive, most comfortable approach first.

And then most people will get a couple of exercises to help kind of keep up their newfound, let's say function or their improvements that are kind of done in the clinic. And yeah, they tend to respond pretty well with a combination of those things. 

Mark: If you have TMJ happening, some pain in your jaw. Get in and get it looked after at Insync Physio. You can book online at If you're in North Burnaby, you can call them at (604) 298-4878 or in Vancouver on Cambie and King Edward (604) 566-9716. Insync Physio will look after your TMJ and get you chewing properly again, real quick. Thanks Iyad.

Iyad: Thanks Mark.

Rock Climbing Neck Injury Rehab Belly Ball Dribble

Lie on your stomach on top of a built up mat 5-8 inches high. Keep your feet wide apart with toes to the ground, with your face and chin clearing the mat and your arms straight and wide grasping a large exercise ball on the ground.

Dribble the large exercise ball with both hands while you keep your front lower core engaged and lower back straight and so you prevent it from going into extension. Activating the lower quadrant core muscles will enhance and optimize your strength and movement patterns to your full potential. Repeat this for 10 seconds doing 10 reps 2sets daily.

This exercise can be progressed by increasing your dribbling up to 20 seconds for 5 reps 2 sets and ultimately to 30 seconds for 3 reps 2 sets.

If you have any bad or questionable pain or discomfort discontinue this exercise and consult your local physiotherapist before continuing. 

Neck Pain and Headaches with Wil Seto

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio in Vancouver and North Burnaby. We're going to talk about neck pain and headaches. How are you doing Wil? 

Wil: I'm doing great, Mark. 

Mark: So what kind of, obviously your neck or your head is going to be hurting, so what other symptoms might people have or why would they want to come and see you about this?

Wil: Yeah, so these types of headaches that are neck related are 20% and it usually is followed by, you know, it can be non traumatic, so not followed by an injury, but is most common followed by an injury.

And the main symptom is that it's usually on the same side that you have the headache but it can be on both, but it's usually on the same side. Particularly when you have problems with movement or postural issues that bring on the pain in the neck, which will also bring on the headache pain.

Mark: So those are the causes. So it could be, you've been in an accident or fallen or been hit somehow in playing sports. Jarred some way and that's caused a neck problem, but then that radiates up into your head or you don't even feel the neck necessarily. It just suddenly you have a headache. 

Wil: No, usually it's related to neck pain and it's usually on the same side. And the other really important thing to understand too, is that if it's sort of this like unusual type of headache and is not related to any neck pain and especially if it's like all of a sudden and it's unrelenting. Then I strongly, we strongly recommend seeing a medical practitioner and getting a medical diagnosis for it.

It could be something else that's a little bit more serious. But when it comes to related to the neck pain, the neck pain and the headache. It's definitely something that is correlated when you have an issue, like if you're moving and you have postural issues related to bringing it on and it will normally elicit that headache. So they usually go hand in hand. 

Mark: So those posture issues could be from how you're sitting, while you're working, for instance, if you're at home on your laptop or how you slept that night kind of thing, are those also possible causes? 

Wil: Yeah, absolutely. And then what ends up happening sometimes too, like you're talking about posture, like if you're on the computer too long, like, you know, we're just with what we've kind of shifted over to now with working at home now more these days. That you have a lot of imbalances that can occur. Or then you have a lot of muscles that are then always on and then your core stability muscles that are now really basically down trained. And that need to be strengthened a little bit more. 

Mark: So when someone comes in with this, how do you go about diagnosing it? 

Wil: Yeah, so first you need to rule out a bunch of other things just to make sure. And so with this type of headache related neck pain, the common term is called cervicogenic. And really this cervicogenic type of headache, there's really a few main causes that we already talked about briefly. We're looking at whether or not is a joint related, is it muscle related or is it ligament related. And so we can ascertain and really determine whether or not it's coming from one of those three areas. And that's when it usually is correlated with a headache. 

Mark: And based on what you found then, does that determine what the course of treatment is going to be? 

Wil: Yeah, there's really good research studies and good clinical basically results shown that combining manual therapy, so manipulations of the joints. And also movement of the joints with what's called mobilization techniques with using your hands. And also soft tissue techniques that open up the soft tissue to allow things to move a little bit better combined with specific exercises. Are really good for basically helping with these types of syndromes and dysfunctions.

Mark: So that would be the typical course of treatment as you get a little bit of lovely massage and movement, but also then you have exercises that you do in office and then go home with and continue to do. Is that right? 

Wil: Yeah, because the idea is that you want us to reset things a little bit more in the muscular system as well. So things that are really like tight and imbalanced in that way, that are not letting go, you want to reset that, let that to relax, and then you need to work on training the movement pattern function of other muscles that are just not working properly. And so that way that compliments them and gives you a more optimal posture and movement in the neck.

Mark: So, of course it depends on the injury, but how long would it normally take to have some relief of the pain, whether it's in the neck, head or both? 

Wil: It really depends. Like the studies have shown that it can be fairly immediate, like within a couple of sessions. And then if it's like something that's long standing, it's a chronic issue you know, if there's more going on in the joints. Then it could take a little longer and it could be sort of a longstanding thing. So really depends. But in our experience, you know, working with clients that have this issue, if it's not an issue that's involving a lot of things in the joints, then it really can take as little of even one session I've seen, up to like a few sessions, you know, and it's completely gone. But the hardest part is retraining the whole muscle movement patterns and the whole optimizing the movement function. 

Mark: So, if you want to get headache free and neck pain free, the people to see in Vancouver or North Burnaby are Insync Physio. You can book online at or you can call the Vancouver office to book 604-566-9716 or in North Burnaby 604-298-4878. Get in there and get feeling better and moving properly. Thanks Wil. 

Wil: Thanks Mark.