Anterior Hip Pain – Gluteus Medius Big Ball Push Ups

This exercise targets the activation of your gluteus medius muscles of your pelvis and hip to help with your anterior hip pain. 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 posterior core strength to help offset the muscle imbalances that contribute to anterior hip pain. If you have any problems or questions with this exercise consult your local Physiotherapist before continuing.

Vertigo Treatment

Mark: Hi, it's Mark from TLR. I'm here with Iyad Salloum, he's the clinical director here in North Burnaby of Insync Physiotherapy. They're a multiple award-winning physiotherapy clinic and we're going to talk about something that's fairly common in the world these days, vertigo. What kind of treatment do you do for vertigo?

Iyad: Hey, thanks, Mark. Yeah, so vertigo is getting more and more common. And what we're seeing is as the population ages, it's spontaneously can happen with lots of people. Now there's a big difference, I think, between just general dizziness and vertigo. And that's probably important to clarify cause you know, dizziness, just the feeling of unease or feeling like you're going to tip over. You're just not quite steady on your feet, but vertigo is the sensation that the room is actually spinning around you. And that can be a little distressing for a lot of people. And there are lots of causes. One of the ones we're going to be talking about today is BPPV or benign paroxysmal positional vertigo.

Now it sounds like a mouthful, but that tends to actually account for about 20% of all the cases. And it's really simply put, you get a dysfunction in the organ in your inner ear that helps our brain figure out what our head is doing in space. So it's one of the ways that we figure out what's going on in the world around us.

Think of a coordinate that your GPS kind of watch will take in to just tell you where you are on this planet. So what happens at the BPPV is we have some loose crystals that are sitting on one of the organs, the organs in our ear kind of detect movement side to side or rotational. And one of those crystals can get dislodged in one of the canals in this vestibular organ.

So what happens is the crystals move separate from the rest of the head and they can move on their own because of the momentum of the fluid they rest in. And then people just perceive a movement. So they think one side of your brain listens to the ear saying, oh, look, this one's moving. When the other side and your eyes telling you you're not moving. So that conflict causes the spinning sensation to happen. 

Mark: So the symptoms would be that the room's spinning. Do I need to see a doctor for first? 

Iyad: You can see a doctor first or you can check in with most physiotherapists have enough training to basically identify a cause of this. So let's say in your basic graduate training in physio school you'll know the basic things about what kind of dizziness would look like an inner ear dysfunction versus something else.

So, for example, somebody who just had a head injury, you know, can sometimes have a bit of dizziness and vertigo, so they'll have two different types of things. And like most of us are good at identifying what's causing what and or if it's not the inner ear, maybe they'll follow you up with a recommendation to see your doctor.

If it's something let's say a heart problem, that's causing you to feel a bit lightheaded or dizzy, because most of us just think of dizziness is just one symptom when it's actually there's multiple types of dizziness. So yeah, seeing any primary care specialists like a family physician or a physio should be actually quite recommended. But if you having symptoms of spinning, you can just go straight to the physio right away. 

Mark: So not all, like you mentioned basic physio training, but not all physios are actually trained in how to deal with vertigo on the level that you have for instance. So what do I look for in a physio who's trained in this?

Iyad: So most of us will have some kind of training. And if you look online on anyone's write-up or description, you'll see something named vestibular rehab or vestibular physio, and the vestibular part stands for the inner. So that's something I would look for if you are having some kind of vertigo episode or spinning episode.

Now, like I said, the thing that we're going to specifically talk about today is BPPV, which has very short episodes of spinning whenever your head moves in a certain direction.  And it could be to the left, could be to the right, or it could be kind of up into the left or up to the right. So all of that can trigger these brief episodes. And it can be a bit distressing for the person, but it's actually also very treatable. 

Mark: So what causes this? 

Iyad: Anything from an impact to the head, to just a spontaneous thing that happens. We actually don't know. There's a lot of different theories about why it happens. But I wouldn't be surprised if like if you randomly, suddenly a person starts to develop it out of the blue.

And they feel sometimes that sensation in bed, is where usually they're first aware of it, where they roll over on their side and they feel a bit of the spins, you know, like after a night of bad drinking, can happen.

Mark:  And sticking your leg out of bed and on the floor, doesn't help.

Iyad: Definitely not. 

Mark: So what's a typical course of treatment?

Iyad: So first thing we want to do is actually just identify, is this actually the inner ear? Or is it something else? Like I said, a lot of us just think of dizziness as one big thing. If it is confirmed as a episode of BPPV, which is the loose crystal, there are some treatments that help reposition the crystals back to where you know, they came from.

So there's these kind of fluid filled sacks that the crystals usually are housed in. You would see a physio or even sometimes some doctors will do this. The treatment is to do one of a couple of techniques, depending on where that crystal is, to reposition it back in its place. And it tends to be, you know fairly traumatic in its effect.

Like you'll have a pretty good result almost always. And you can get a kind of a nice response. And then some people might have a bit of residual stuff, maybe from an older injury or some other impairment. And that's where the treatment then dovetails into more of a home exercise program to help address those things, to help you almost relearn how to use those and integrate those sensations back to normal.

Mark: So how long until the room stops spinning around? 

Iyad: Yeah, that's a very good question.  If it is BPPV, it's quite responsive, really quick. Most people will be anywhere from one to three treatments and they'll be pretty good. Like I said, if you have other causes of vertigo, like let's say a viral infection of the inner ear, those tend to be a little long lasting cause you're trying to deal with something a little different.

However, in cases of BPPV the episodes, when they do happen, tend to be very brief, but after treatment we see actually a significant reduction in that. And it's quite safe. And most people who actually have presented to the clinic have Googled it and tried their own home remedies. And I mean, the benefit of that is that it can never really kill you. It's in it's name, it's benign. It's a benign positional vertigo. So it's based on a certain angle that your head goes in and it's triggered. So trying a self-treatment at home isn't dangerous, but quite often people will try it a couple of times and if it just does nothing they'll come in and get it done with one of us. 

Mark: If you want your vertigo treated the right way, so you actually get feeling better fast, the guys to call in Burnaby are Insync Physio. You can reach them at 6 0 4, 2 9 8 4 8 7 8 to book some time to see Iyad and he'll get you straightened out. Or you can book online insyncphysio.com. Thanks so much Iyad. 

Iyad: Thanks Mark, appreciate it.

Lower Back Injuries – Core and Gluteus Medius 1-Leg 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.

This can help with lower back pain if your core stabilizing and Gluteus Medius muscle weakness is consistently causing your pelvis and low back to compensate. The weakness in this area can also be caused by your lower back pain, pelvis or a lower limb deficiency such a as previous ankle or knee injury that was not rehabbed properly.

If you have any problems or questions with this exercise consult your local Physiotherapist before continuing.

Running Related Leg 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 running related leg injury. If you have any problems or questions with this exercise consult your local Physiotherapist before continuing. 

Testimonial Rob Whitzman

Hey there, I thought I'd take a few seconds to talk about Insync Physiotherapy. Had a back injury for a couple of years and I just couldn't get it better. I went to lots of physios, lots of chiros, had all kinds of treatments. I was able to operate but it was very uncomfortable. Some days was excruciating.

And anyways, I thought I'd try something a little bit different.  I was told about IMS treatment and I went to Insync and got my IMS treatment. I happened to be really responsive to that treatment apparently. So one day later pain was 90% gone. Two days later, a hundred percent.

I'd never seen anything. Like it couldn't believe the results, but it worked really well. Have had a couple injuries since then. And IMS has helped in most of those occasions. Sometimes it's a combination of exercise, IMS, stretching. But I find that Insync Physios professionals always seem to have a solution.

Thanks a lot. 

Wrist Ligament Sprain Injuries – Functional Towel Extension Exercise

A common problem after spraining your wrist is a restricted pinching pain on the top of the wrist. Pain and loss in full extension can persist when trying to put weight through the hand with the wrist extended, like pushing yourself up from sitting or doing a push up. This can continue to occur even months after it’s fully healed because the movement dysfunction in the wrist has not been normalized. Here’s an exercise that can help restore this.

Start by identifying your scaphoid bone located between your two thumb tendons and the second bone called your lunate which is right beside it. You will also be using the webspace of your opposite hand. Roll up a hand towel and can grab it comfortably with your knuckles down.

Then wrap the webspace of your other hand nice and snug around the those two bones of your wrist with some downward pressure while pressing down with your affected wrist at the same time. Extend your elbow to provide weighted extension into your wrist, then release.

To add more functional weight resistance, bring one leg on the couch and go onto one foot on the ground to get a little higher. You can also stand up to add more weight resistance. Repeat this for 15 reps doing 3 sets 3 times per day.

This exercise should not cause any pain or discomfort. If you have pain or are unsure about what you are doing consult a local physiotherapist before continuing.

Wrist ligament Injuries – Isometric Strengthening

Start by using a light dumbbell weighing about 5 to 10 pounds. Grab the dumbbell with a neutral wrist facing palm up holding for 10 seconds, then turn the palm side down towards the floor and also hold for 10 seconds. Repeat this for 10 repetitions doing 3 sets two times per day.

This is an isometric strength exercise for the wrist when you have sprained it. It’s the beginning initial step to strengthen the dynamic muscle stabilization process for the hyper mobility or instability of your wrist once your sprain has healed enough to take on some more resistance.

Sacro Iliac joint Injuries – Torso Twists

Here’s a simple but effective exercise that can help with improving the rotation mobility in your spine in order to help with your sacro-iliac joint and pelvic injury rehabilitation.

Sit down on a chair with your feet flat on the floor & check your left and right arms into abduction like you’re making the letter “T”. Then check your hip and butt anchored to the chair with your hands.

Sitting with your legs wide and arms straight reach your hand down the inside of the leg to the ankle and reach your opposite hand up to the ceiling trying to create the letter “T” with your arms while your butt is anchored to the chair. Hold this position for 30 seconds doing 3 sets on each side 2x/day.

This is a great mobility exercise to do for the spine as a warm up and a warm down or for recoveries after you finished playing or training.

What is Sports Physiotherapy with Wil Seto

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Sports Physiotherapy in Vancouver. And we're going to talk about what is the difference between a sports physiotherapist and a regular physiotherapist? How are you doing Wil? 

Wil: I'm doing great Mark, thanks. Yeah so a sport physiotherapist is essentially someone who's completed what's called their diploma in sport physiotherapy through the division of Sport Physiotherapy Canada, which is part of our Canadian Physiotherapy Association. And so someone that has completed this extensive training they have the experience and the skillset to take care of athletes at all levels. So whether it's like high performance sports, like when you're working at a national or international level to national level provincial level or everyday activities. 

Mark: So, you know, just to maybe flesh that out a little bit, like you've worked at the Olympics, you've worked with specific national teams, whether they were in Canada or other countries in a range of different sports. So maybe just outline that quickly for us. 

Wil: Yeah. So as a sport physiotherapist we're qualified to work with Canada's high performance athletes in all settings, like I was saying. And so we have that skill set and training to be able to work with athletes and teams in daily training competitions, like you mentioned in world competitions and Olympic games. And part of what's helped give us that ability to do that is that there's this very stringent, I guess we call it an examination process where you know, you have to pass in order to actually achieve the credentials and the designation as a sports physiotherapist.

And essentially the Canadian Physiotherapy Association, they oversee this program, which is called the Clinical Specialist in Sports. And this program essentially allows the diploma in sport physiotherapy to be the designation of advanced clinical reasoning through sort of what's called like a peer review or competency-based program. And this is a national recognition program. And in fact, these are international standards as well. 

Mark: So if we could boil it down, like a physiotherapist goes through a tremendous amount of training to know the physiology, anatomy, all the rest of it, how everything interplays, how does that transfer then into being a sports physiotherapist? Like what's the difference? 

Wil: Yeah, that's a great question. So essentially the sport physiotherapist, has that experience, like I was saying, that skill set to work with people to return to sport or work or even things like life-related things and those aspects of a treatment plan.

So we can come up with a carefully planned progressive exercise program that will basically allow you to do those things and get you back to doing activities in a safe manner and reducing the risk of reinjury. And so there is definitely obviously like with that credential program where you have to have a thorough understanding of also a lot of other areas. So just with sports, there's other things to consider like concussion and treatment protocols for that too. And so with our background, we also have an extensive background in orthopedic knowledge and then the added skills that we've obtained and learning how to work with people on a clinical setting as well. That's very helpful. 

And the skill set of athletic taping. So then we are actually become very advanced in learning how to do those things to help athletes or even  non athletes, you know, like you sprained your ankle, but you're really active and you want to get back to just walking around, hiking, short little hikes or something like that to get you back moving again quicker, more safely and have a more comfortable experience doing that as well.

Mark: So at your clinic, you're sort of the leader of a fairly small Canada wide cohort of people who have the Sports Physiotherapy Diploma. What was the numbers again? There's what, 10,000 physiotherapists in 250, am I right somewhere in there, are sports physios? 

Wil: Yeah. So there's just over I think like 250, or I guess more recently, maybe 300 physiotherapists who are now sports physiotherapists in Canada. So there's a two-step process. There's sort of like your certificate level and then your diploma level, which is then you can say you're a sport physiotherapist. And then at the certificate level, there's something like, I think maybe just over 350 or 400 all across Canada.

Mark: So tremendous amount of training to get there, but then to simplify it, and no disrespect to regular physiotherapists in any way shape or form, but you guys become sort of the super physiotherapists. Can I make that distinction? You've gone to a whole other level of training that's specific to sports injury and sports rehab that a normal physiotherapist does not have.

Wil: Yeah, there's definitely some physios out there that you know, they may not have gone through the system that are excellent physios. And fortunately in our group, we have physios that are also going through that process, that our certificate holders and that are about to complete the diploma to become sport physios.

And I think the biggest  thing is that because this is not only a nationally recognized program, there's also international recognition. So when you become a sport visit therapist, you know, there's this international recognition of the credentialing of this program that is applicable across a lot of standardized countries where you can say that as a sport physiotherapist in Canada, you know, these are the standards that we hold. 

 I think a large part of this is that there's a huge skill set in what we do working with this clientele. You know, and obviously there's other skillsets that other physios that don't do this, like for example, I talked about concussion management and emergency protocols. And essentially what we are, as sports physiotherapists, is that our skill sets also include like I was saying, stuff like athletic taping, more specific stuff of functional return to sport training and functional activities. We're experts in the areas of getting athletes back to these areas because of also our exercise physiology training and stuff like sports massage and  concussion evaluation and management.

So, you know, really as a sport physiotherapist we have the skills and ability to work with larger organizations and to help with teams and athletes establish these comprehensive medical support systems for them whether or not it's like grass roots or high-level performance. And so as a sport physiotherapist with a diploma, you work with Canada's top athletes at all levels of sport. 

And what we do essentially, we've worked at all these different games and get all these experiences and now we bring it into the clinic and we can develop a treatment plan and help work with you. And also develop the clinical skills that we've received and gained from on the field, like at the moment of injury and all those things and take that and help our clients when they actually walk into the clinic on a clinical setting. So to me, something that's been very invaluable and that's really benefited a lot of my clients and a lot of the clients that I've seen that other sports physiotherapists I've worked with in the past.

Mark: So one of the things you are actually and not irregularly, somewhat regularly, you're right there at the field. Say it's soccer, you're there at the soccer field and they're training. And perhaps there's something that you're noticing that you might say, you know, what, if you added this component into the training system, you're going to have less knee injuries, for instance, because a lot of cutting. Say basketball. Could be hockey. Could be you name the sport. You're going to have that knowledge to say here's how to develop that whole tendon muscle strength system so that joint is protected and you're going to have less injuries. That's kind of the level of detail that you guys are trained to. Is that a fair assessment? 

Wil: Yeah. That's a really good question and some points that you bring up and I think as a physiotherapist, the best way to describe what we do to someone that's never really had physio is that we're movement specialists. So we help people move again. And as a sport physiotherapist, you take that to a whole new level.

And so now with the sports that I've worked with, you know as a sport physiotherapist, you're also required to, it's a requirement actually that you have a few sports that you work with specifically, so that way you can work with a team and manage the team. So, you know, that kind of complexity of that team management and you work with individuals sort of on a longitudinal scale. So you work with them throughout seasons. And then you also work with a breadth of different sports and different movements and activities that way you kind of have a broader scope of movement and stuff like that. 

So and that's really important because then as you start to look at how different sports can crossover, you'd be like, oh yeah, you know, I've worked with rugby, hockey, soccer, field hockey and all those fields sports, and they are really relatable in a lot of ways. But then there's also very, very small individual specific things to those sports and positions for players in each area. So someone who plays rugby that plays maybe in a scrum, you know, a lot of different rehab components to consider and movement dysfunctions to help them rehab through versus someone who plays ice hockey as a centre or even a goalie. 

So there's all these things you've got to consider. So I think that's huge. And so to answer your question, yeah, definitely, it gets into a little bit more specific in terms of us being movement specialists and having that bio-mechanical knowledge and applying that and being able to now use specific evidence-based practice exercises and things that we can do to help you get back in the game faster, more safe, and have a more enjoyable experience. 

Mark: So if you need some help with your sports injuries or non sports injuries, you can book an appointment at Insync Physio. They have two offices in Vancouver and in North Burnaby. Go to the website insyncphysio.com. You can book for either location or you can give them a call in Vancouver 604-566-9716. In North Burnaby 604-298-4878. Thanks Wil. 

Wil: Thank you Mark.

Shoulder Injury Rehab – Advanced Bird Dog

Start on the hands and knees with your spine in neutral alignment. Engage the inner core stability muscles of your lower spine by pulling the muscles below your belly button inward without changing your neutral spine posture.

Then, bring your hands forward on the mat and straighten the knees one at a time so that you’re on your toes. kick back and extend with one heel while keeping the hip square and lined up with the other hip and reach the opposite hand and arm forward. Hold this for 10 seconds doing 10reps on each side for 2-3 sets.

This is a great core stability strength exercise to help progressively strengthen your shoulder and upper quadrant core strength after you have injured it. If you have pain or are unsure about what you are doing consult a local physiotherapist before continuing.