Category Archives for "Leg Pain"

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. 

Leg Nerve Irritation – Simon Kelly

Mark: Hi, it's Mark from TLR. I'm here with Simon Kelly. He's a physiotherapist that Insync Physio in Vancouver. They are multiple time, best physios in Vancouver award winners as voted by their customers. And Simon's going to talk about leg nerve irritation. What, what is this all about Simon? 

Simon: Hi Mark, how's it going?. Thanks for having me again. Yeah. Just going to talk a little bit about the leg nerve irritation and you know, a lot of times it's hard to pinpoint where the irritation is actually going from. But most of the time that actually come from the lower back region, somewhere between L1 down to L5 vertebrae.

A lot of times, you know, people get quite worried that it can be something quite serious, like a disc irritation or a disc compression and things like that. And on occasion it actually is those things, but the very, very small percentage of people that actually need to go for surgery. So it's good to be not too scared in the beginning, but of course it's good to get checked my physiotherapist as well.

The other thing just to bring to mind just for some people as well, is when the nerve is already irritated, as it comes out in the lower spinal column, it kind of brings down the threshold of nerve. So we've all heard of the sciatic nerve pain, but you know, it's things that are usually not painful, like sitting and then become painful. 

So I kind of use the analogy, it's like water coming out of a hose and then you step on the hose and the water stays coming out and it doesn't really affect it that much, but then you step on it in another location, irritated in the nerve root and then irritated from sitting. And it's the sitting then can drive the threshold down. And that's when people really come into us reporting lots of tingling, numbness and irritation, referring down to leg. Call it double crush syndrome, which actually sounds pretty scary actually. But a lot of the time it can be really fixed. 

Mark: So if I was experiencing this, I might not necessarily be feeling pain in my lower back, but I might feel it in my legs. Is that why we're kind of referring to leg nerve irritation? 

Simon: Yeah, absolutely Mark. Yeah, like it doesn't always have to be linked with a major nerve, like traumatic back injury. Sometimes it can just be progressive in nature. And, you know, as we get older, we get stenosis, that's like a narrowing in the spine in the lower back as well.

Lower population or lower aged population people usually it's not like a stenosis or degeneration and things like that. But in my experience 99% of the time, once you kind of eliminate the information at the primary source, whether it's the lower back or sometime as it passes through to the bum muscle, aka the sciatica, will eventually go away.

That's where we come in then in the clinic and it's all about the education on what movement somebody can do. And if you know, you can fix the back pain, but if you don't tell someone not to sit for long periods of time on a hard surface, that's going to keep irritating that nerve and it's going to be ongoing for quite a long time.

Mark: So how do you treat it? 

Simon: So that's it yeah, first of all, when the client comes in, we do need to figure out, first of all, where it's coming from if we can. Either the back, usually it is the back or usually as it passes down through the bum muscle and sometimes it is two areas. So we have to treat both. So in clinic we do a lot of hands-on treatment. We do a lot of needling in the lower back just to kind of decrease, it's kind of like the hypertonicity of the muscle, so the muscles get really tight around the nerve. And this is a common mistake that a lot of people make is oh, the muscle must be tight. Let's stretch it, but stretching in this occasion is not really, the muscle is tight because the nerve is sending a signal to the muscle to protect it.

In other words, please, please leave me alone. But what people do then is they kind of throw petrol on fire and by stretching it, and that really really irritates the nerve. So a lot of the stuff we do is actually a nerve flossing or nerve glides, we call them. Where you're actually gliding. You're actually gliding the nerves. You're not actually stretching it. You're actually just moving the nerve as one unit by different movements in the clinic, I can't really show you on the video here now, but that helps desensitized the nerve. And once the nerve becomes desensitized, it stopped sending the signal to the muscle and the muscle relaxes and it's not in spasm. Preventing you from moving or causing pain essentially. 

So by eliminating inflammation around the nerve, obviously you can do ice in a bit of rest for that too. And by doing these nerve glides, especially in the earlier stages of rehab, you can eliminate all that spasm that a lot of people complain about.

Mark: And is that why you use the needling? Is that also help with the relaxation of the nerve? 

Simon: It kind of helps more so the muscles around it Mark, to be honest, so the muscles it does help relax the muscle around it. But the primary objective will be to get that nerve moving normally without, without irritating by fully stretching it, or we all like that feeling of a nice stretch, but in this particular occasion that's really, really, really bad to do. 

But you're right yeah. The muscle spasm, the needles just help release that to give someone a bit more mobility in their back. Again, in the earlier stages. Once that's all the settlement and we have certain tests in clinic we use to kind of see what the nerve mobility is like. We can obviously go back into strengthening it, and a lot of core work, a lot of lower back stability stuff. And obviously depending on what the client does, back to running or higher end plyometric stuff. 

Mark: So what's a typical treatment protocol like this. What does it normally take for somebody to get back to doing some of that stuff? Of course it's individual, but what would be the typical timeframe?

Simon: Yeah, absolutely Mark, it is very individual dependent on a person's circumstances, but you're probably looking at maybe 8 to 10 weeks, like kind of from start to finish and obviously take that with a grain of salt, depending on the population and different ages and different activities. But yeah, 8 to 10 weeks, depending on the irritability and also dependent on when we kind of catch it.

How limited and how what kind of was the mechanism of injury as well, may also have to be taken into account for sure. Was a traumatic or was it more gradual? For example, traumatic can sometimes take a little bit longer. 

Mark: So what's the common cause of this kind of leg irritation referring from the back?

Simon: Yeah. One of the common cause, just lots and lots of excessive sitting even Mark, especially if it comes on gradually and naturally grows, especially in this pandemic or in general. Sitting for long periods of time, sitting on hard surfaces. You know, if you kind of think about it, like older people get a lot of pressure sores because they can really move their body in bed when they get very, very odd.

It's kind of a bit like that. I mean at an extreme level, obviously somebody can move a little bit in the younger population. But you're kind of depriving the nerve of sort of nutrients through blood flow as well. And eventually it hits a certain threshold where it gives you that signal of maybe tingling down the leg, where it's like, wow, you really need to get the pressure off this nerve as it's passing through the bum muscle. 

There is obviously traumatic, more traumatic stuff as well. If you had a fall off a ladder and you injured your lower back, for sure, that obviously you'd have to go for x-rays to make sure you had no fractures or anything like more serious, but once all that's been cleared, you know, it's a matter of really just getting rid of the inflammation. The treatment is not very different. It might take a bit longer though on a traumatic situation. 

Mark: So if you've got tingling in your legs. If you've got pain, that you suspect might be from your back, but it's in your legs, in your sciatica. Get in to see Simon Kelly at Insync Physio. You can book online at insyncphysio.com or you can give them a call (604) 566-9716 to book your appointment, you have to call and book ahead. He's busy, but he'll get you feeling better as fast as possible. Thanks Simon.

 Simon: Cheers Mark, thank you

Shin Splints Simon Kelly

Mark: Hi, it's Mark from Top Local. I'm here with Simon Kelly of Insync Physio in Vancouver. One of Vancouver's most popular physiotherapy clinics, many time winners of best physiotherapists in Vancouver. And today we're going to talk about a really common issue shin splints. How are you doing Simon?

Simon: How's it going Mark,  thanks for having me today. Yeah, shin splints Mark. I'll talk a little bit generally about the topic and I might relate it to a recent case study, I had a bit as well. We've all heard about shin splints, the layman term, but we call it ATSS, which is anterior tibial stress syndrome, which sounds a bit fancier. 

That's more so pain to the front of the shin and more to the outside of the shin. And then you have MGSS, which is media tibial stress syndrome. That's probably the more common one where you feel it more distally or at the end of your leg sort of on the inside of the shin bone. So a lot of people kind of get this pain when they're kind of increased their running too quickly essentially. A lot of pain down the inside of that shin, or sometimes it can be a change in footwear a change in surface and things like that. So it's important obviously to diagnose, did the person take up running or any sort of activity, like lots of jumping, lots of high-impact activity, that's kind of leading is kind of pain.

And it's also very important not to run through this pain because you can develop stress fractures or another thing called exertional compartment syndrome. So our job would really be deciphering, is it actually true shin splints because that's like an umbrella term or is it one of those other two things. But very important not to run through that pain. Some injury yes, it's okay to run through it a little bit and just kind of monitor it, but certainly if you keep going, you can develop that stress type fracture and the pain is very on the shin. Shin splints is more diffused where you kind of feed it along the shinbone for like three or four inches. That's kind of how we decipher that a little bit as well.

And obviously an x-ray will tell you if you do have a stress fracture and the exertion and compartment syndrome, usually pain just comes on after you start the exercise, because blood is filling into the compartment of the lower leg. And then it expands and there's a mesh around the lower leg and it can expand out actually.

So that's when you know, that's the difference in it. And you might have tingling in your lower leg. It's very important not to continue that because you can create nerve damage and things like that. 

Mark: So how do you diagnose it, just by the pain? 

Simon: Yeah, good question Mark. Well, first of all, you'd take the history and you kind of ask them are they doing lots of running. It doesn't have to be running necessarily. It can be like lots and lots of walking even. A lot of people are doing 10,000 steps lately. I don't know why humans have a fixation on it. You do 10,000 steps every day and you're not used to it, you can benefit from walking as well, or even just a combination of running and walking might just throw you over the edge to develop this, too.

 When the person comes in, they usually say, yeah, I feel this at nighttime or sometimes after the walk, you don't always feel it while you're doing the activity actually. So will you feel it at rest and you will feel it when you push along the inside of your shinbone or the outside of your shin bone.

So that's kind of how we diagnose it. As opposed to exertional compartment syndrome is more, you just feel it after a few minutes of getting into the exercises that increased the blood flow, but the minute you stop, there's no pain at rest. There's actually no pain when you push it either.

So there are kind of too big differentiating factors. And you don't want to keep running through it. Like I said, it's very important that you don't. I know it's important that we look at the footwear and the surface, if you're, a lot of the times people run on concrete, which is quite unforgiving under the foot, and it's better to run on maybe grass and some trails are sometimes better if there's not huge amounts of inclines and declines. So we try and alter that as well. 

Usually for the treatment part of it, I just stop them running for maybe a week or two completely, and then just reload it very, very gradually. And we do a lot of stuff here in the clinic, a lot of  massage, some needling of those muscles that join onto of the inside of the shin especially, it usually stays behind the calf muscle that joins in at the back, which is responsible when we come down from running or from the jump.

Just micro tearing on the inside and basically the micro tears aren't getting a chance to heal before somebody goes running again. And then it just develops into this lots of pain. 

Mark: So the treatment protocol is pretty straightforward, but what if I wanted to prevent it? If I'm going to up my mileage, I'm going to engage in a new fitness program. Is there things that I could do that would help it? Would rolling my shins, very unpleasant experience, but would that help? 

Simon: Yeah, you could roll out your shins Mark and honestly it really is just listening to your body a little bit. You know how much you can load, how quick, you know, and there's no real magic answer to that. There's every individual is slightly different on how much, but usually people will come in and say, they might say something like after my fifth kilometre, it starts to come on a little bit and then it's worse afterwards. So you kind of have an idea in relation to that individual, like five kilometres is kind of where we're at right now. So that's your limit, and maybe they might take a day off and back again, or they might do it again the following day. So you'd really have to just, a bit of trial and error there really. Rolling it out, strengthening up your calf muscles in particular are definitely stuff to do to try and prevent it from happening.

Sometimes if it's more chronic or you've tried a few techniques here in physio, you can go maybe to a podiatrist and look at insoles. There is a bit of a link in some of the literature saying like an over-pronated foot or a flat foot, and definitely predispose you as well. So I'd like to try and not give people insoles right off the bat and see if we could get it right but that's something I might come back here with, if we tried everything in our tool bag and it didn't work, that would be something I'd look into. 

Mark: And this is just from a personal interest kind of point. Is there any research around the new kind of movement towards going more towards barefoot shoes? Like the really non-supportive shoes that you wear that strength your foot has to strengthen rather than being over supported? 

Simon: Yeah. There's a lot of research out there, Mark, and even there's, I think it's like everything in the world, you can find 10 research papers that say that for the pros of barefoot running and that's how we were back in the wild, back in the day, running her own hunter and gatherers. Like there was no need for all the support. Why do we have it now? But then there's other arguments saying like, well, we didn't have tarmac and concrete and a lot of hard surfaces that we're running on now.

So that's a very good question. It's a very good question. When I started my physio career, I was sort of told that insoles where to where to go. But as I developed throughout my career, I sort of, it's only from a personal perspective that I don't want someone to have something in their foot, forever. If they really don't need it. But I'm not negating getting an insole or if you've tried everything else, then I kind of go back to the insoles, as I think it is beneficial indefinitely some scenarios, for sure. Especially someone who's an athlete and really want to continue through their running or they're in competition and they can really afford to wait, then we go towards insoles for sure.

Mark: And what kind of length of treatment are we looking at? What's a typical, I know it's individual, of course, maybe this is really individual, but what would be the, is it three weeks? Six weeks. 

Simon: Yeah. And you're on the money there, Mark. You know, some people like literally, if you just stop running for two weeks and you just slow gradually, it could just literally be four, six, eight weeks. It just really depends. Every physio might be slightly different. It might get you to run and just cut down your mileage and you still might be okay. I just like to go for two weeks, just give it a total break, until it's not too tender on to palpation or on touching clinic here. And then we'd obviously do all the strength and exercise in those sessions. And then we'd go back to do more higher impact stuff because it has the higher impact stuff. 

So like running and jogging that really do create a lot of tension on the inside of that shin bone. So yeah, you're probably looking at four, six, eight weeks max, for sure. 

Mark: So there you go. If you got shin splints, the guy to see is Simon Kelly. You can reach him at Insync Physio in Vancouver. You can book your appointment at (604) 566-9716 or check out the website insyncphysio.com. You can book online there. Or if you're in North Burnaby or the Burnaby area, they have a clinic there as well. You can reach them at (604) 298-4878 or again, book online at insyncphysio.com. Thanks Simon. 

Simon: Cheers Mark. Thank you.

Simon Kelly – Lower Leg Tendinopathy

Mark: Hi, it's Mark from Top Local. I'm here with Simon Kelly of Insync Physio in Vancouver, BC. He's a physiotherapist at one of the top rated physiotherapy clinics. Many time winners of best physiotherapists in Vancouver as voted by their customers. Today we're going to talk about something that I'm sure a lot of people run into. Especially if they're very active with walking or running it's lower leg tendonitis. Pain in your lower leg. What's the deal going on here, Simon? 

Simon: I'm Mark, thanks for having me. Yeah, I just going to talk through a case study that I had there during the week. A guy who had something called peroneal tendonitis.

Basically it's a tendon that runs down the outside of the leg. A lot of walkers aggravate this tendon and it can be due to a number of different factors really. Sometimes it's maybe they changed their footwear. Might've changed the surface they're running on. Or they just might've increased their workload. And then a little bit too quickly, which I know a lot of people do this. That's the most common thing as well. So it can be debilitating and a little bit scary to someone who hasn't had it before. 

So this guy was 25 years old. He actually had a spontaneous pneumothorax, which means his lung spontaneously collapsed on occasion. So he had a long period of time out from running. And he was just trying to get back into running, I think a month after this collapse and he was starting to do two to four kilometres running. Where he was running, they had made a new path where he usually runs and it was an uneven surface because of COVID, they wanted to keep the paths kind of socially distance.

So that was kind of the angle, I kind of thought maybe he went a bit too quick and maybe to surface he's running on a bit of a camber. And no roads we run on are actually truly flat. If you want to be honest about it, they're all a little bit slightly at an angle, not incline decline, but more of an angle of the foot so it would be turned sideways.

So he came into clinic. That was his kind of background story. We did a few tests to prove it was this peroneal tendonitis, where you kind of evert the foot out against resistance and that creates pain in the foot. Sometimes going up onto your toes can also create a little bit of discomfort because it does what the calf must've does as well.

So that was kind of a the general diagnosis and how we diagnosed him initially. 

Mark: So what was the course of treatment? 

Simon: The course of treatment Mark, there's four reasons really peroneal tendinitis can go up. If you're running on a surface, like I said, like a camber, we really needed to tell him to stop running. But eventually we would add back in running, but on a flatter surface as possible. Usually it's tight calf muscles as well. So not just the pernoneal itself, but all the calf muscles in the back are usually a bit tight that can predispose you to excessive use of this tendon. And like a lot of volleyball players and dancers, if you can imagine them up on their toes. 

He wasn't in this case up on his toes, but that was one of the reasons that you can get peroneal tendonitis. So initially stop all the aggravating factors, stop running and let's load this tendon progressively. Isometrically is how we load it first. Isometrics are where you move the tendon against the resistance, but you're not moving through range.

So that just helps decrease the pain, settle down all the inflammation. And then we got him back in running, into a running program, but a little bit slower. Would footwear, because sometimes it can be from over pronation as well. I meant to mention that earlier on, actually. Just good footwear or good support.

And then we told him to stop running. When he does go back running to run on a flat surface, not running the track that he was running on. And to just go a little bit slower, maybe just try a couple of hundred metres in a straight line, and then we just took it from there, Mark. That's how he presented over the coming weeks.

Mark: And so after the of course of treatment, what was the result? 

Simon: Absolutely Mark, so obviously when his lung was re-inflated at this point, that was another thing I meant to say, for his endurance. We had to keep an eye on his breathing and his endurance. So that was actually fine. I asked him that every time he came in. He went back into proper pairs of shoes. His calf was relaxed and he was back running, you know, five to six kilometres every other day, without any pain. Just best afterwards, few adjustments that we made. 

Now he doesn't have to not run in that path ever again. But I told him that he'd have to start adding in uneven surfaces just towards the end. So he'd just run on that path again, and he had no problems whatsoever. So he's back up and running and back into action. 

There you go. If you need some help with your lower leg, if you're having some issues with a change in your fitness program, that's causing you some pain or any part of your body, give Simon Kelly a call. You can reach him at the Vancouver office of Insync Physio. You can book there at insyncphysio.com either in Vancouver or Burnaby. The Vancouver office number is (604) 566-9716. Burnaby is (604) 298-4878. Give him a call. Simon will get you straightened right out. Thanks Simon.

Cheers, Mark. Thanks very much.