Understanding & Tackling it!

What an interesting concept Pain is! According to the International Association for the Study of pain, pain is described as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. The first part regarding actual damage makes sense to most, however the second part of this definition leaves something to be desired. You might be thinking right now, are you telling me that I can have pain without having actual tissue damage? Absolutely, and this is what makes pain such a fascinating thing.

To better explain, its best to take a step backwards and explain why pain exists and what purpose it serves for us as busy, moving, functioning human beings. We have learned a lot about pain in the last 20 years and treatment of pain has really changed now that we understand more. At its roots, pain is a fantastic protective mechanism! 

Take for example, burning your finger on a hot stove element: if your finger touches the element, the receptors in your skin immediately send a danger signal to your brain (important note: NONE of our body’s tissues have pain receptors, only ones to send danger signals). 

Once this DANGER signal gets to your brain – which thankfully takes milliseconds – based on previous experience with hot stoves, likely having burned your fingers or other body parts before, and awareness of the situation, your brain will interpret this as a real danger and quickly send a PAIN signal to the finger. As a result of this PAIN signal reaching your finger, your brain reacts quickly to the rescue and you pull you finger away and run it under cold water to protect it and help it heal! Naturally, it’s a perfect protective mechanism.

As you can see from this example above, PAIN IS EXCLUSIVELY CREATED BY THE BRAIN.

Just In Your Head?

Does this mean that all pain is just “in your head”? No, all pain is real but it does mean that because its created by the brain, there are lots of factors that can influence this pain system. Some of these factors include stress, anxiety, emotions, beliefs around pain, expectations, fear, and activity levels. These all contribute to the sensitivity of ones pain experience – some will increase it (e.g. stress, anxiety, fear, negative expectations) and some will decrease it (good activity level, low stress, positive beliefs and expectations). This is why its important to talk to a health professional to figure out what may be contributing to your pain as research has shown that pain education is one of the most effective management tools.

Nocebo Effect

Lets re-visit the idea of having pain with no actual tissue damage. There is an emerging concept in pain science called the “nocebo” effect which tells us that symptoms like pain and illness can emerge from simply believing or expecting that we have been exposed to painful stimuli or potential illnesses! For example, in drug trials, a certain percentage of participants are given a fake drug (i.e. sugar pills) and told that they are taking the real medication and that there are some potential side effects. What we see with these trials is some of the participants report these side effects from a drug that they ARE NOT EVEN TAKING! (Source: nocebo effect). These participants think they are on the real medication and therefore think themselves into the side effects. Similarly, in research around perception of pain, subjects reported amplified pain ratings even with harmless stimuli when they were told to expect a painful stimulus! (Moseley & Arntz 2007).

As you can see, pain can be a tricky thing and because of this, it’s important to tackle your individual pain with a tailored approach. It is always easy and tempting to consult Dr. Google or ask your friends or family members that have had similar aches and pains but it is important to recognize that no two injuries or pains will be quite the same.


There are a few key points regarding pain that apply to almost all types of painful situations and injuries:

1. All pain is real and all pain is created by the brain
2. Many factors influence the pain experience and this makes it a very individual thing
3. Education around why you are in pain one of the most effective management tools!

Jeffery Jukes, Registered Physiotherapist Send Email
MPT, B.Sc., CAFCI(Acupuncture), IMS
Jeffery Jukes - Portrait
Jeff Jukes is a registered physiotherapist at INSYNC Physiotherapy in Vancouver. He has lots of experience working with chronic pain populations and therefore has done extra training and individual research to effectively help with all kinds of pain. Jeff’s treatments are multi-modal in nature and include hands on treatment, pain education, acupuncture, Intramuscular stimulation (IMS), and therapeutic exercises. Talk to Jeff regarding any type of injury or pain!

InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.

Pregnancy, Exercise & Massage Therapy


Let us start by reviewing the facts; 40-42 weeks is 10 months, not 9.  However, the amazing journey to motherhood can actually comprise a year-long (or more!) period of metamorphosis.  The question I hear repeatedly from patients during their pregnancy, (including the 3 months post partum ‘trimester’) is:

“Are Exercise and Massage Therapy Safe?”

The simple answer for uncomplicated and healthy pregnancies (and 4-6 weeks post partum following straightforward vaginal delivery) is YES. After receiving the go ahead from your midwife or obstetrician there are some simple guidelines to follow.


Pregnancy and exercise

According to the Public Health Agency of Canada’s “Healthy Pregnancy Guide”, Regular physical activity during pregnancy can:

• improve your mood and self-image
• help ensure appropriate weight gain
• help you relax and reduce stress
• promote better sleep
• increase your muscle tone, strength and endurance
• help build your stamina for labour and delivery
• speed up your recovery after labour and delivery
• help increase your energy levels

Two Main types of Exercise

There are two main types of exercise to consider: cardiovascular and strength training. While continuously monitoring your current pregnancy status thru the trimesters is important, you must also heed your pre-pregnancy level of fitness.

The Society of Obstetricians and Gynecologists of Canada advises that with the go-ahead from your health care professional, for those with at least 6 months of previous activity, “sports or workouts” can be safely continued. They further advise that for those with a history of inactivity, to start exercising in the second trimester; adopting a “low and slow” (low impact) regime including both cardio and muscle toning exercises.
There are many pregnancy specific exercise programs available in the community including yoga and weight lifting classes. If you or your health care provider have any questions regarding whether or not you are fit enough to participate, ask your fitness professional to use the screening tool, the Physical Activity Readiness Medical Examination for Pregnancy, produced by the Canadian Society for Exercise Physiology, available here:


  • avoid exercises in the supine position (lying on her back) past 16 weeks
  • avoid bouncing exercises, activities that cause falls and contact sports
  • stretches should be controlled
  • avoid abdominal exercises if diastasis recti (splitting of the connective tissue midline in the front abdomen wall) develops


Neck Massage

How it helps

Health link BC suggests the use of massage therapy during pregnancy as an aid for “relaxation and to help relieve muscle tension and pain”. The body makes many accommodations for the growing fetus and endures hormonal changes in joints to allow for eventual delivery. For some the resultant laxity or looseness in the joints is pain free but other women unfortunately experience aches and muscle pain adapting to the added weight and postural changes that occur during pregnancy.

The Massage Therapist’s Association of British Columbia suggests that massage therapy during pregnancy can:
  • Reduce general muscle tension and pain
  • Decrease stress, tension and anxiety
  • Improve mood and sleep
  • Decrease back and pelvic pain
  • Reduce headaches
  • Manage symptoms of edema and sciatica

What to Look For

Choose a therapist with the right training. All registered massage therapists in BC receive education that applies to the treatment of pregnant patients.

Be aware that special pillowing and modified tables may be used and/or your treatment position could eventually remain in side lying for your comfort and safety.

Certain essential oil usage during your treatments should be avoided. Rattray and Ludwig list these as: basil, bay, clary sage, cypress, fennel, frankincense, hyssop, jasmine, juniper, marjoram, myrrh, peppermint, rose, rosemary and thyme. (p 185, Clinical Massage Therapy, 2000)

In ALL pregnancies there are certain signs and symptoms that need to be addressed immediately! According to the Canadian Society for Exercise Physiology these include:

  • Excessive shortness of breath
  • Chest pain
  • Painful uterine contractions (more than 6-8 per hour)
  • Vaginal bleeding
  • Any “gush” of fluid from vagina (suggesting premature rupture of the membranes)
  • Dizziness or faintness

The Last Word

Every woman and every pregnancy is different. I know women who because of their pre-pregnancy athletic lifestyles completed ½ marathons at 7 ½ months gestation, managed step aerobics until 7 months and did yoga until the day of delivery. It would be folly to start training for a 10km timed event, if you were not already fit enough to complete one before pregnancy. And eventually, like a patient who stopped bike commuting to work at 7 months, safety must be your priority. 

Be smart, modify as necessary and listen to your body!

Call INSYNC PHYSIO at 604-566-9716 to book your Massage Therapy appointment today.

Michelle Robichaud, Registered Massage Therapist Send Email

Michelle has had varied experience in her massage therapy career, working in sports, spa and general practices in Vancouver, Whistler and Victoria.  After graduating from the WCCMT in 1996, she upgraded her basic diploma to enhance her practice skills and then went on to complete a Health Science Degree from Thompson Rivers University (2011). Michelle is a member in good standing with the College of Massage Therapists of BC and the Massage Therapists Association of BC.
After 15 plus years of practice Michelle remains passionate about her profession and is keen to continue learning; she loves helping people feel better. Michelle employs various techniques such as trigger point therapy, fascial release, joint play and Swedish massage to help address headaches, pregnancy related issues, sports injuries and work related concerns, such as low back pain.  From recreational sports enthusiast to computer programmer at the desk, many different people can benefit from massage therapy. 
Michelle stays active with her young family enjoying biking, hiking, yoga, golf and fitness classes.

InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.

Ultimate Frisbee Injuries

Ultimate Frisbee season is in full swing now! For those of you that play at a more competitive and elite level, you have most likely been playing consistently hard, and especially if you are planning on going to compete at The 2014 World Championships this August in Lecco, Italy!

World Ultimate Championships 2008

Stay Strong and Injury Free

The answer is in knowing how to train, prepare for games and recovery!


If you’ve been sidelined by previous injuries, it’s a really good idea to start up those specific
Functional Core Strength
Physiotherapy exercises. The focus is to achieve more neuromuscular balance through appropriate stretching and strengthening of your core, power and agility muscles. If you are playing through any type of pain, then you are most likely not playing at your full potential. Are you holding back 75% to 80% because of pain or stiffness? When you play through any injury, even if it is a minor one, you can develop compensation patterns and muscle imbalances that make you more susceptible to either a traumatic or a chronic repetitive strain injury.
World Championships 2010
When I worked with a team at The 2010 World Club Championships, one of the players had partially tore his rotator cuff from aggressive layouts earlier in his Ultimate Frisbee career. Being the best at his prime he was known for his ability to layout hard for the disc all the time.
Rotator Cuff muscle attachemnts
However, he waited too long before he sought out intervention for it and the injuries became full blown tears in his rotator cuff tendons. He shrugged off his aches and pain and stiffness to “Just playing hard”.



I also worked with another Ultimate Frisbee player that took just a couple of weeks to prepare for World Championships in Japan in 2012. He told me that he was experiencing some minor back pain throughout the summer with his job and never saw any Physiotherapy for it. After a long flight to Osaka, Japan he stepped off the plane with a sore back. After his first game he ended up herniating his lumbar L5 disc and couldn’t even walk for the rest of the week.

Being Proactive

Preparing then means to listen to your body and actually responding proactively to what it is saying to you. It means training to play. Doing an Ultimate Frisbee specific conditioning program can not only help you play stronger, layout harder, but help you last the season or make it to Worlds so that you can play your best injury free. Preparing also means doing adequate warming up and doing dynamic stretching before playing and then warming down and static stretches after you play. The most common type of injuries occurring in Ultimate is muscular strain injuries (over 76% – hamstrings, quadriceps, calves), followed then by ankle, knee, shoulder, head and rib injuries.

Core Strength

Core strengthening

If you have a strong inner core, you can prevent your hamstrings or groin muscles from being so overworked, which can lead to muscular strain. A hypermobile or unstable sacro-iliac joint (SI joint) can contribute to this. Wearing core shorts can also assist in helping you make it through the season or Worlds, but ultimately you want to strengthen your inner core correctly and ensure that your outer core functions in coordination with your strength and power and agility.


Recovery means many things. It means getting enough sleep, eating a balanced diet and getting enough protein and carbs, and that you warm down and stretch after every practice or game (stretching where you actually feel it instead of just running through the motions). The warm down phase allows you to check in with your body to see if there are any new aches & pains that you have after playing. Sometimes during a game and in the heat of the moment where you make a hard bid and layout for the disc, adrenalin is coursing through your body and you do not necessarily feel the pain. This is where you want to check in with your body.

What to Look For

If you have any new aches and pains, you can follow the “S.H.A.R.P.” rule and then apply the “R.I.C.E.” principle.


S: Swelling – Does the joint look puffy or muscle swollen more than usual after playing? Swelling can cause peripheral damage to healthy tissue surrounding the area that is affected due to the physiological / chemical response to an injury. It can also cause muscle inhibition of the muscles around the joint, which can then lead to compensated movement patterns. Limping, whether obvious or not, can cause detrimental altered movement patterns where muscles no longer work together and imbalances begin to occur.

H: Heat – Does the joint or muscle feel more warm / hot than usual?
A: Altered Function– Does it move differently than normal after playing?
R: Redness – Is there any unusual increased in redness than normal?
P: Pain – Is it more painful than normal?
If any of the following apply to you then you want to follow the “R.I.C.E.” principle.
R: Rest – This means trying no stress to the injury over the next 24-48 hours.
I: Ice – Apply a cold pack or ice with a damp cold hand towel on the area for 15 minutes and repeat it every hour for the first 24-48 hours if the swelling is particularly bad.
C: Compression – Wrap and compress the area to help control the swelling for the first 24 to 72 hours. Use a tensor bandage to wrap a cold pack or ice on the affected area.
E: Elevated–Having the affected area at or above the heart allows the swelling to drain better.
If you notice that after 72 hours that the unusual aches and pains are still there and especially if you catch saying to yourself, “I’m just going to play through it…” then it would be a really good idea to go get it checked out if you want to address the problem proactively and return to playing your best.


By getting at the root cause of your problem, we can help you connect with how you really want to move again!

World Games 2013 – Cali Columbia



Call INSYNC PHYSIO at 604-566-9716 to book your one-on-one appointment today.


Wil Seto, Registered Physiotherapist Send Email
BHSc(PT), BSc(Kin), Dip Sport PT, Dip Ortho PT, FCAMT, CG IMS
Wil has earned degrees in Bachelor of Kinesiology and Bachelor of Health Sciences Physiotherapy (B.H.Sc. PT) from McMaster University. He is a member of the Canadian Physiotherapy Association (MCPA) and a Fellow of the Canadian Academy of Manipulative Therapists (FCAMT). In addition, he completed post-graduate studies in Advanced Manual and Manipulative Physiotherapy (Dip. Manip. PT) and Sport Physiotherapy (Dip. Sport PT), and is certified in Intramuscular Stimulation (CG IMS).
Wil has been working for over 13 years as a Physiotherapist in the Lower Mainland. He brings a great sense of joy and passion in helping people recover from their injuries and getting them back in sync with their optimal health and maximum potential for sport, work or play.
Wil retired from playing elite level Ultimate Frisbee in 2001. He now spends his time outside of the clinic working with Australian Ultimate frisbee teams since 2008 at World Championships. He has helped Australian Ultimate Frisbee teams win silver medals at World Games in 2013 – Columbia & World Championships in 2012 – Japan, & Bronze at World Championships 2010 – Prague, Cz.

InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.

Managing & Treating Climbing Injuries

Climber’s Elbow, Stiff Necks & Shoulders

It’s climbing season again, which means it’s time to prepare and get stronger for upcoming challenges.

Flexor digitorum profundus muscle. Ventral view of the deep muscles of the forearm. FDP is shown in blue.
Ventral view of the deep
muscles of the forearm.
FDP is shown in blue.

Recently, I’ve treated a number of avid rock climbers coming into the clinic with a sore forearm.

Upon further evaluation, they were experiencing what I would call “climber’s elbow.”  There was pain on the lateral aspect of their forearms (lateral epicondyle) and weakness and pain throughout the extensor carpi radialis longus and radialis brevis muscle and tendons. 

Consequently, their finger tendons (flexor digitorum superficialis and profundus) were also being over worked and sore and needed to take time off climbing – That’s no good!

Assessing the issues

Upon further evaluation, they all had restricted mobility in their neck and entire spine and a couple of them at one point in the past have had bad whiplash, or some degree of it where they couldn’t even move their necks for a few days. 

On assessment, the spinal segments of specific spinal vertebral joints were locked and some of the major muscles that attach from the neck to the shoulder were either in a hyper-toned state or were in spasm and had shortened considerably. Overall, the biomechanics and the range of motion in the neck and shoulder were not even close to optimal and the whole upper quadrant, arm strength and mobility were deficient.

Primary approach to treatment

The approach to these types of injuries involves treating the body as a whole in how the fingers / hands work together with the shoulder, neck and the rest of the spine. A stiff and weak neck  will ultimately cause posture compensations when climbing; which will then lead to an abnormal increase in use of power through the shoulders and also the forearms and fingers.

Any slight tweaks in the shoulder like temporary rotator cuff impingement can lead to increased scar tissue in the shoulder capsule and then altered mechanics in movement. 

With altered mechanics in the shoulder, the forearm then will need to be utilized more and more power is applied through the finger tendons which lead to various issues of tendinopathies, tenosynovitis, ligament sprains and annular pulley strains / tears (annular pulley tears can sideline you from climbing from several weeks to quite possibly several months to a year depending on the severity of the tear).


Sternocleidomastoid muscle. Muscles of the neck. Lateral view.
Muscles of the neck. Lateral view.

Neck and Shoulder

With Manual therapy, we can ‘unlock’ the spinal segments of the neck facet joints utilizing gentle mobilization techniques to restore its mobility. Gentle stretching and mobility exercises can then be use to safely increase the flexibility of the muscles and soft tissue and to reinforce the gains in joint mobility. Specific core strengthening exercises can then be used to progress static and dynamic strength.

Scar tissue also usually builds up in either the front or back capsule of the shoulder from the impingement syndrome. 

Using gentle joint mobilization and soft tissue techniques, we can free up the shoulder to restore a more optimal range of motion. 


The forearm muscles also need to be released because the tightness actually puts a prolonged strain on the finger tendons thus not allowing them to fully recover from your repeated bouts of climbing. 

This is especially important for people that also sit in front of the computer typing for most of the day. In addition to restoring mobility, it is also extremely important to work on achieving muscle balance in the “whole upper quadrant” from the hand all the way up to the neck. 

Acute and Chronic Injuries.

If the injury in the hand or forearm is acute, cold baths 2’/2’ (2 minutes on / 2 minutes out) for 3-4 times twice per day is good to take the swelling down. 

If the injury is no longer acute (not hot and swollen) but still has residual swelling or continued joint tightness, then hot / cold contrast baths are ideal 2’/2’ (2 minutes hot / 2’ minutes cold) for 3-4 times twice per day. This is to help increase the blood flow and flush out the residual swelling that is there. 

Back to Climbing

As you get back into climbing, you need to be at least 75-80% strong in that whole upper quadrant and it’s recommended that you tape the fingers to give it support whether it’s a ligament or tendon injury or pulley strain, even if you no longer have any pain. 

It takes tendons and ligaments up to 4-6 weeks to fully strengthen and if you begin climbing too hard too soon, your muscles will get strong but your tendons, ligaments and pulleys will lag behind. 

Staying strong & Healthy

Do you want to stay healthy in order to send climbing projects or to just enjoy the rest of the climbing season injury free? Then the single one most important thing to staying injury free at this point 4-6 weeks post rehabilitation and climbing again is focusing on recovery. 

Recovery means keeping muscles loose and stretched out immediately after climbing, sports and activities and strengthening opposing muscles to the sport (climbing  – strengthening pectoralis major, triceps, deep neck flexor muscles and inner core stability strength). Also try implementing some cardio training (running and cycling); As this will increase your recovery overall, not to mention your body’s over endurance on longer climbs. Avoid over training (not taking enough rest days in between climbing sessions or doing too many heavy climbing sessions consecutively).

Wil Seto, Registered Physiotherapist Send Email 
BHSc(PT), BSc(Kin), Dip Sport PT, Dip Ortho PT, FCAMT, CG IMS
Wil has earned degrees in Bachelor of Kinesiology and Bachelor of Health Sciences Physiotherapy (B.H.Sc. PT) from McMaster University. He is a member of the Canadian Physiotherapy Association (MCPA) and a Fellow of the Canadian Academy of Manipulative Therapists (FCAMT). In addition, he completed post-graduate studies in Advanced Manual and Manipulative Physiotherapy (Dip. Manip. PT) and Sport Physiotherapy (Dip. Sport PT), and is certified in Intramuscular Stimulation (CG IMS).
Wil has been working for over 13 years as a Physiotherapist in the Lower Mainland. He brings a great sense of joy and passion in helping people recover from their injuries and getting them back in sync with their optimal health and maximum potential for sport, work or play. Wil has also been an avid rock climber for over 13 years and has a thorough understanding of what it takes to help you connect with how you really want to move again this climbing season!
InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.
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