Low Back Pain

Is it a slipped disc? Is it a pinched nerve? What did I do to my lower back? These are questions that many of our clients have been coming into the clinic with. Hi, everyone it's Wil here from Insync Physio Sports Orthopedic Rehab Clinics. Back pain certainly can be painful, unpleasant and inconvenient, but what's not certain about what back pain is, is what causes it most of the time. 

Our physiotherapists have had clients come into our clinics with these exact questions and concerns about their lower back pain and dysfunctions. So the main thing to understand is that the cause of lower back pain in every back injury is not the same.

So for example, one client came into the clinic to see one of our physiotherapists with radiating pain going down her leg. Turns out that she had just had some imbalances in stiffness from her spine from a lack of mobility. And she didn't have a herniated disc or a slipped disc that she was worrying herself to death over. And she actually got better in just a few sessions. 

Another client came in with right butt pain. His progress was a little slower and our physiotherapist referred him back to his family physician to get further investigations done. Turns out that he had some more major wear and tear going on in the lower segments of his spine. But eventually he was able to get back to his sports, albeit more slowly and carefully after about four to five months. 

So the real key to getting better from your back pain is really understanding what causes it. And also what are the ways that you can actually approach to not only getting it better, but preventing it from actually happening again. Research studies indicate that if you don't rehab your lower back injury properly, then you actually have an increased chance of re-injuring it again, and even worse than you did the first time. 

So instead of consulting Dr. Google, I would highly recommend consulting a trained physiotherapist that can treat the root cause of your lower back pain and injury. That way you can really connect with how you really want to move again.

Back Pain and Low Back Injuries – Gluteus Medius Big Ball Push Ups

This exercise targets the activation of your gluteus medius muscles of your pelvis and hip.

Have the back of your ankle and heel pushing back on the front low side of a big ball against the wall. In side lying, make sure that your torso is not too far back or bent too much forward to avoid your hip being in a flexed position. With your spine and hip in neutral position push the back of your ankle and heel up to the top part of the ball maintaining contact on the ball the entire time.

A few key things to look for is to keep the toes pointing forward and towards your own nose so that you’re not rotating the hip and the toes upwards while you push the ball upwards. Bring the ball back down and repeat this 10 times for 3 sets on each side.

This is a great exercise to build more functional core and pelvic muscle strength after a low back injury. If you have any problems or questions with this exercise consult your local Physiotherapist before continuing. 

Ankle Sprain Injuries – Airplane Transitions

Start with one lower leg length away from the wall. Plant the foot on the ground with the standing leg. Hip hinge into the wall and make sure you hinge at the hip and not bending through the knee.

Keeping your pelvis, navel, and the centre of your chest in a straight line, pivot through the hip, turning your pelvis over the standing leg.

You should be feeling it through the side of your hip, back of your gluteal muscles, and the upper part of your hamstring.

This is a great exercise to build more functional strength to help with the rehab of your ankle sprain injuries. If you have any problems or questions with this exercise consult your local Physiotherapist before continuing. 

Knee Pain – Heather Camenzind

Mark: Hi, it's Mark from Top Local. I'm here with Heather Camenzind and she's a physiotherapist at Insync Physio in Vancouver in the Cambie Street area. And we're going to talk about knee pain while running. How are you doing Heather? 

Heather: I'm good. Thanks for having me Mark. 

Mark: So knee pain from running. This is a new thing, or there's been an increase in it because of something. 

Heather: Yeah, it's not a new thing, treated a lot of it before. But I'm seeing an increase in the past year. I think with the current status of our globe and with the pandemic, we're seeing a lot of people that have taken up running as their form of exercise with the gym schedules being modified and closed. So I'm seeing an uptake in the clinic with knee pain. 

Mark: So is there specific things that cause knee pain from running? 

Heather: There's many different causes. But a lot of them that we're seeing is a breakdown for the underside of the knee cap. So it's basically, it's a rubbing on the underside of the kneecap on the end of the femur bone. And there can be different causes to why that breakdown is happening. And so that's why a physiotherapist can help with that. 

Mark: So what's the protocol. What does treatment look like when you're faced with a client coming in? 

Heather: Yeah, a typical treatment will start with a history of how long that they had the pain. Where does the pain, can they describe it? And you just have a good chat about that. And what are some factors that may be contributing to that? So changes in current training schedule, have they significantly increased how much they're running or the terrain that they're running on? 

Other things that can affect it are their footwear? Have they made a change to their shoes? Or lifestyle changes. So that's what we're seeing a lot of right now is the lifestyle changes. I think people are trying to be active, but we're also told to stay at home a lot right now. And so I think people are sitting more than they typically would in the past.

Mark: So give us a couple example things of how you would treat this. Couple of causes, a couple of treatments. 

Heather: Yeah, so different ways that we can treat it is sometimes it's just that the hip flexors and the quads are more tight. And so we have to release the tension through there. So the physio might work with some manual therapy on that, and then give you some exercises such as foam rolling, and some stretches to open up the quad and the hip flexors.

Another common thing that we're seeing is that people are weak in their glute muscles. So, especially their glute medius muscle. That's the muscle on the side of your hip that helps control the alignment of your knee. And a lot of just like leg lifts out to the side. Or like your figure four stretch is a very common stretch that people know, are ones that can help with that hip tightness that will help with the alignment of the knee.

Mark: And what's I know it's case dependent, of course, but what would be a more typical treatment program and what might it affect how effective it is? 

Heather: Yeah, so different things that can affect like how much progress you see is a, I counsel people on is kind of like, the more often you do your exercises and how frequent you do them, you'll get a better bang for your buck so to speak. If you're consistent with them, you'll notice progress sooner and faster. If you're maybe do them once a week, yeah, you may get there. It will improve. It'll probably just take a lot longer. So the more consistent that you are at home the better it is. You only really see your physio probably once a week maybe for maybe half an hour, 45 minutes an hour, if you're lucky. So there's so many more hours in the day that you can be working on things yourself. 

The other thing is just, can the physio diagnose and figure out what is the major contributing factor for you? Is it just a modification that needs to be done to your training program? Have you increased things too quickly? Or can they narrow in on the specific weaknesses that are contributing to your knee pain. Such as glute weakness, or maybe it's your running shoe? So it's proper diagnosis of what is the main cause. And then you'll start to see progress. Typically we see progress within six to eight weeks that you're seeing significant progress with it.

Mark: And I guess depends on how much the pain is and the cause whether somebody has to totally stop their running program in order to let the healing happen. How does that work? 

Heather: Exactly. So some people come in and they're, they're very flared up. Everything is hurting, just walking and it's very sore. Those people benefit from just allowing their nervous system, allowing their body, the inflammation that's there to calm down.

So we have to say, I'm sorry, you have to stop running right now. Others it's maybe their knee pain only comes in 45 minutes into their run or something. It comes on later and then their body tolerates it quite well. They don't really get too aggravated after. So those people we're able to work with them and just modify their running program and get them doing the right exercises. And then we're able to maintain their running. So it depends on the person. And sort of a case-by-case basis on what I typically recommend for them. 

Mark: So if you put the work in and you listen to your physio and have the right shoes and don't crank it up too much, within six weeks, eight weeks, you're probably back running as hard as ever and all the things you want to do without pain.

Heather: That's the hope. Yeah, definitely. 

Mark: So there you go. If you want some expert advice on how to deal with your knee pain while running, or any kind of knee pain or any kind of shoulder problems or neck or back, or you name it basically toes to the top of your head, this is a person to call. Heather Camenzind. You can reach her at Insync Physio to book an appointment. Insyncphysio.com book online. You can see there, they've got both the Vancouver and Burnaby booking systems are hooked up. Very easy to use. Or call the office at 604-566-9716. Thanks Heather. 

Heather: Thank you very much. Bye.

Pandemic Back Pain

Mark: Hi, it's Mark from Top Local. I'm here with Wil Seto, Insync Physio in Vancouver, many time winners of Best Physiotherapists in Vancouver, Best Physiotherapists Clinic, and will himself has one Best Physiotherapists in Vancouver as voted by his customers. And of course, today, we're going to talk about something that's a little bit different pandemic back pain. What the heck is pandemic back? 

Wil: Yeah. Yeah, they basically you know, with this pandemic that we're all living through right now, it's just a lot more people working at home and trying to set up whatever they think is you know, sort of a workstation or an office it can be ranging from like super great ergonomics to really poor. And I still see the people that have the great ergonomics. To especially the people that have poor ergonomics, you know, back pain. 

And so the other thing that's also important to understand with how this pandemic back pain is also the history behind each individual. Like I can say right now before the pandemic, like I used to see maybe like 25, 30% of this in the clinic on my caseload, and it's jumped from like 25 to 30% to more than 75% of everybody, if not more, like they have some form of this pandemic back pain. So someone comes in for, yeah, it's my shoulder and they're trying to stay active, but then they also work at home a lot.  But then my, yeah, my neck and my back also hurts too. 

And so a lot of it is posture related. So when we talk about pandemic back pain, it's really just the postural insufficiencies. And if you have a preexisting injury, or co-existing injury and that can actually contribute to that pandemic back pain even more. And so obviously, you know, that's a huge factor, but then if you've never had any history and you start getting this pandemic back pain, then that's also another can of worms.

So, you know, if you're doing a lot of sitting and I've said this to a lot of people before and sitting is like the new smoking. It's basically, so horrible for your body. And when you're sitting, especially if you're doing a lot you know, that's all you do 8, 10 plus hours a day. Your hip flexors will get really tight and everything just stiffens up and you get obviously lack of blood flow in your whole body and the muscles.

And then you get all this compression in certain areas in your spine. Then what happens is that your body learns that. And then you start to develop a new normal for your range of motion and your mobility. And then also the muscle extensibility, you know, so the joint mobility, joint range of motion and the muscle extensibility, all that starts to adapt to your new way of working and how we've been working mostly from home now, a lot of people.

And so someone that doesn't have a previous history, now this is the thing that I want to talk about today, because this is the thing that really has been on rise with the whole pandemic. And so I started to see all these muscle imbalances. So the biggest thing is really when you have a lot of imbalance happening in your hips and like, I see people like they wanted to try and get a running a little more, but then if their hips are super tight, then they're going to start having issues in their lower back. Like your hip flexors are really tight. It can change the alignment. And the positioning of your pelvic bones and then cause more compression in your lower back. And it can increase your what's called your lumbar lordosis, which is a natural curve in your lower back.

And so there's like, you know, a few main hip flexors, muscles that make up your hip flexors. And so when you're sitting all day long, you know, those hip flexors will just shorten. And then if you're not doing things that augment that by trying to switch up your position, stand a little bit, sit a little bit, then that will start to be adaptively more sore.

And even with standing, you know, someone comes in, I had a client that came in , I stand all day long. I don't know why my back hurts. Well, you know, it's that long position. And if your hip flexors are tight to begin with, and you're standing all day long, then now your back is going to have that increase a lordotic curve even more. And then you're getting even more compression in certain areas. 

So they did some research studies where they looked at even just the imbalances that are happening in the hips and if certain areas are less flexible or less mobile, and then you have weaknesses in certain areas, then, you know, when you go to walk or you go to run, you know, that's going to be accentuated.

And so then you're going to start to have the sort of repetitive strain and what we call running related injuries. And I treat a lot of runners. We treat a lot of runners in the clinic and we have like a treadmill to look at, the biomechanics and to really assess, you know, the mechanics of running.

And it's interesting to see before we even get them on the treadmill. It's like, you got all this going on and just by looking at alignment and movement, we can already do a lot of things to help with that. 

Mark: So the answer isn't having a standing desk like I have here, it's a standing and has sitting desk because I have listened to my good friend Wil and I don't stay in one position all the time. I like to talk standing up though. I feel more natural with that, but it's switching between the two on a regular basis is really important all day long. 

Wil: Yeah. As a ergonomic strategy yes. And then if you're like looking into getting into something that you haven't really done before, if you're doing a little bit more of, or if you're doing a lot more sitting now, and then you're still maintaining your sport of running or whatever it is. Looking at making sure that you have that mobility in your hips. Have that mobility and the strength to be able to compliment you to keep doing, or to start that new sport or activity that you want to do.

Mark: Yeah. So what's the treatment protocol? What's the prognosis for somebody with pandemic back pain? 

Wil: Yeah. So with someone that has never had a trauma or anything like that, and it's just sort of creeping up on them. And the most common thing that I find is all these muscle imbalances. So we want to start to correct that. We want to basically start to get areas in the hip, areas in the back even to be more mobile. So it's about the mobility of the joints. The mobility of the whole segments around the back so it's also the upper back. So if it's lower back pain that you're getting, then you want to make sure everything above there is moving well. And then the hips and pelvis are moving well. 

And then the supporting strengthen core stabilization. And so there's a lot of different things that we can do in the clinic, obviously, that kind of help facilitate that from doing a lot of like soft tissue release techniques that, even getting in there with some IMS with some dry needling kind of thing, and then very specific exercise rehab stuff to really kind of facilitate that process.

Mark: And typically what's the more of a normal treatment course. 

Wil: Yeah, it ranges like it can be someone like, you know within a session or two they're like, wow. It's from like, you know, an eight out of 10 pain to like now it's like a one to two out of 10 pain. And just one or two sessions to like, it takes them up to like maybe even four or five sessions, depending on how chronic and how long you've left it for or they left it for. Yeah to basically up to maybe even eight to 10 sessions and be like, I'm totally 100% better. 

Mark: Well, let me ask you a little bit of a wild card question here, because I bet you see this a lot. People come in, they feel better, they got some exercises, they kind of started doing it. And over time a month, two, three months later, they're not doing those exercises anymore. Is that a really good way to do things? 

Wil: Yeah, obviously not. And I think the biggest thing is that a lot of the times, once it becomes out of sight then becomes out of mind. So the pain goes away and then you think you can let it slip. And then once the imbalances start to come back and you may not even be symptomatic, I may not have pain, but once those imbalances that to creep up, then it's a lot harder to try and rectify that. But you can, you definitely can because you know, it just takes a little bit of work. But then sometimes it gets to the point where now you're in this pain and this function, and then, you know, it becomes desperate. But yeah, it's definitely not ideal. 

Mark: So, if you're desperate with back pain, the guys to see your Insync Physio. We highly recommend that you don't wait until you're desperate and go and see Wil because they'll get it fixed up really quickly and get you on an exercise program that will keep you fit and healthy and surviving this whole pandemic hoo-ha in a much better way.

So reach them at their website insyncphysio.com. You can book online for both of their offices right there. Or you can call. For Vancouver at the Cambie Street office is at (604) 566-9716. Or in North Burnaby, you can call (604) 298-4878. Get yourself booked. Get in there. Get feeling better. Let's survive this thing. Wear a mask.

Thanks Wil. 

Wil: You bet. Thanks Mark.

Dislocated Shoulder

Mark:  Hi, it's Mark from Top Local. I'm here with my good friend Wil Seto of Insync Physio in Vancouver, many time winners of Best Physiotherapists and Wil himself voted Best Physiotherapist in Vancouver by his customers. How are you doing Wil? 

Wil: Hey I'm doing great. Thanks Mark and thanks for that shout out.

Mark: So we're going to talk about dislocated shoulders today. What's a dislocated shoulder? 

Wil: Yeah so I've been thinking a lot about this, currently I have several clients that I'm treating right now with dislocated shoulders and really what it is is basically, you have like a sprain that happens in the shoulder joint. So your shoulder, you have some kind of trauma. And so you have like this ligament and capsule tear usually. And what happens is that the actual arm bone or the head of the humerus basically goes out of alignment and physically goes out of its socket. And so it's actually extremely painful.

And when you have a dislocated shoulder you usually want to go to the doctor, go to the ER, get a doctor to relocate it. So if you ever actually experienced a dislocated shoulder from even just doing recreational sports, which is totally possible, like, you know, maybe just biking and then you don't clip out in time and then you go to put your arm out and you fall and you can dislocate your shoulder even just from something like that. And so your shoulder just goes out of alignment and it's a huge deformity that you can see. And it's, like I said, it's super painful. 

So what it is not. It's not like just a sprain, like it's not just the ligaments being torn and then, you know, the biggest thing is that it comes out of the socket. So when you relocate it, a few things can happen. You're kind of putting it back in the alignment, but like when it becomes dislocated, like I was saying the ligaments, the capsule, and also the cartilage and also the rotator cuff. So there's a lot of structures that could potentially be damaged.

And so that's why you do not want to relocate it yourself. And usually you get put under some kind of local anesthetic to have the doctor to help you relocate that. So my actual professional experience working with teams and the athletes, I've been there where athletes, I've had like a handful of athletes that have actually dislocated their shoulders and  brought them to the ER and on a few occasions, a few of them, the self relocate.

And so that's okay. But like, you don't want to try and do it yourself because even in that process of trying to put it back in yourself can actually cause damage to those structures that I mentioned, like from the ligaments, but especially the cartilage and the rotator cuff itself, so like the tendons and the muscles. 

Mark: So you're not doing the movie thing where you're pounding your shoulder to the wall, trying to relocate it yourself. It's way too painful for that. Am I right? 

Wil: Yeah, yeah, yeah right yeah. When you say that, I think of like what's his name? Mel Gibson from Lethal Weapon, right? Yeah. It's definitely not a party trick that you want to like show everybody when you're, I mean I guess as the zoom party thing, now, Hey look what I can do. But really it's definitely not something that you want to do because the more you dislocate it, and relocating it back you're increasing the chance of injuring the cartilage.

And, and like I said, the rotator and the muscle and tendons and stuff like that in there. So then when you do it enough times you know, like, let's say you do that like even three times in a period of three months, and it's like super loose and you go through a lot of rehab and it's still like, you know, you're never going to get a hundred percent and you're kind of wanting to probably look at the surgical option to really tighten things up in there. So basically, that's what you want to avoid. 

Mark: So what's the course of treatment for a dislocated shoulder once it's, I guess after you've iced it and swellings down a little bit where you can actually start working on it. What's the course of treatment? 

Wil: Yeah I actually have a client right now, just dislocated his shoulder and he's done it multiple times. And now the interesting thing about him is that he's done it on both sides. So I was just like, wow. And so another thing I should also mention is that he does this thing called subluxing his shoulder. So I should just go over briefly what that means. So a subluxation is basically when a shoulder dislocates, but then relocate on its own pretty quickly.

So that's called a subluxation, so it kind of goes out and it goes back in. So those are obviously a lot better because it means that usually it doesn't come out as badly. And then when it kind of goes back in on its own, then it's less damage, like usually it's in and out. So, you can even have a little subluxations as well where it goes out a little bit and goes back in kind of thing. 

So thinking about this specific client who has multiple dislocations and subluxations at the same time. One of the things that also be aware of is that he has a tendency, he has loose joints to begin with. So right away the protocol for him definitely get his range of motion doing things to make sure that he stays mobile. That's super important. And then the second thing, like you said in addition to making sure the swelling go down, all that stuff, the range of motion and mobility, the second thing is actually doing some specific strengthening in that area to really just stabilize.

Strengthening what we call the stabilizers, not just the rotator cuff themselves, but even just the muscles around like the whole shoulder, like their shoulder girdle. So you know muscles like the serratus anterior, mid to lower traps especially and rhomboids. And then even like things that you know, where they're needing to just do a lot of specific things where they're trying to get specific ranges functionally with resistance, but even like into the rotator cuff proper, like I was saying, and making sure that that stabilizes the actual shoulder joint proper, which is where the ball sits right in the socket. So doing a lot of isometric stuff initially.

Mark: And what's the typical treatment course? 

Wil: It varies, depending on how much damage is done. One of the things that this specific individual asks is Oh, so like how badly is it sprained or is it just like, you know, dislocated and then my capsule torn or whatever, and he didn't even think about the rotator cuff. That was the interesting thing. So on assessment, he actually had damaged what I thought to the rotator cuff. And clear weakness and stuff going on in there, and certain tests test positive for that. So we have to address that as well. And so something like that, that's gonna take a little longer. 

When you're looking at something that's a little more mild and minor and, you know, and this is the thing that I don't like to say, like with a dislocated shoulder, there's never a minor dislocation. Like it goes out and it's out. And like I said, it's painful.

And so you're looking at anywhere, initially just to get it going, we want to maintain his range, but in order to even just to be like functional and doing things, and if he's like got a physical job, you know, you're looking at like at least four weeks, just to be able to do things functionally. 

To get back into doing a sport, that's very sports specific training on what he need to do. If they're a volleyball player, they're gonna have to train specifically for that ranges, right. That can be anywhere from two, three, four up to six months depending on the damage that's done in there. And it could be even longer if he needs a surgical intervention, you know, for other stuff that's happening.

My guess, you know, with a specific individual, because there was so much laxity there, he's probably going to need a specific procedure that tightens up that capsule a little bit more. But then there's going to be a little bit more data that can be needed to see what the integrity of the rotator cuff looks like. Because if that rotator cuff, which is basically the tendons that give the dynamic stability, which is basically the muscle tendons you know, because the shoulder is like a 360 degree sort of range of motion, joint. You know, if that's the damage, then that needs to be repaired, especially if he wants to get back to the sport that he wants to so avidly wants to do. And he's been doing this for decades now. 

Mark: So dislocated shoulder. If you've been the unfortunate recipient of this wonderful experience, the guys to call are Insnc Physio. The Vancouver Cambie Street office is at (604) 566-9716. The North Burnaby office near Willingdon on Hastings Street, (604) 298-4878. Or check out the website. You can book online there, very simple, very straightforward insyncphysio.com. Thanks Wil. 

Wil: You bet Mark.

Sacro Iliac Joint Injuries – Gluteus Medius Big Ball Push Ups

This exercise targets the activation of your gluteus medius muscles of your pelvis and hip. Have the back of your ankle and heel pushing back on the front low side of a big ball against the wall. In side lying, make sure that your torso is not too far back or bent too much forward to avoid your hip being in a flexed position.

With your spine and hip in neutral position push the back of your ankle and heel up to the top part of the ball maintaining contact on the ball the entire time.

A few key things to look for is to keep the toes pointing forward and towards your own nose so that you’re not rotating the hip and the toes upwards while you push the ball upwards. Bring the ball back down and repeat this 10 times for 3 sets on each side.

This is a great exercise to build more strength in your pelvis after a sacro-iliac joint injury. If you have any pain and problems with this exercise or are unsure about what you’re doing consult your local Physiotherapist before continuing. 

Knee Ligament Sprain Injuries – Airplane Transitions

Start with one lower leg length away from the wall. Plant the foot on the ground with the standing leg. Hip hinge into the wall and make sure you hinge at the hip and not bending through the knee.

Keeping your pelvis, navel, and the centre of your chest in a straight line and pivot through the hip, turning your pelvis over the standing leg. You should be feeling it through the side of your hip, back of your gluteal muscles, and the upper part of your hamstring. 

This is a great exercise to build more core strength to help with the rehab of your knee ligament injuries. 

Rotator Cuff 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 through the rotator cuff muscles.

This is a great exercise to build more strength after a rotator cuff injury. 

Sacral Iliac Joint Injuries – Airplane Transitions

Start with one lower leg length away from the wall. Plant the foot on the ground with the standing leg. Hip hinge into the wall & make sure you hinge at the hip and not bending through the knee.

 Keeping your pelvis, navel, and the centre of your chest in a straight line & pivot through the hip, turning your pelvis over the standing leg.

You should be feeling it through the side of your hip, back of your gluteal muscles, and the upper part of your hamstring.

This is a great exercise to build more core strength to help with the rehab of your sacro-iliac joint injuries.