Mark: Hi, it's Mark from Remarkable Speaking. I'm here with the Iyad Salloum of Insync Physio in North Burnaby, BC, Canada. And we're gonna talk about radiculopathy, which is as funny name for when you have pins and needles in your shoulder. Maybe going down your arm, even a dull ache in your arm, and it's coming from your neck. What the heck is going on Iyad? 

Iyad: Yeah, radiculopathy, it's a bit of a mouthful and a lot of people use different terms to describe it. That's the medical term. The general population sometimes calls it a pinched nerve, which might or might not be accurate because nerves get sore for lots of reasons beyond just pinching.

So, basically people with this present with, usually we tend to see them quite acutely in the clinic. Either in physician's offices or in physio practices, if they've had this before, so they'll kinda come to us directly. And it presents with them being, you know, suddenly over like a very short time, being unable to move their head and neck because of quite intense pain.

And they report sometimes that the pain's actually worse in the arm and in the shoulder blade, then it is in the actual neck. But they can't move so well. They get fuzzy sensations in their arm. And then one of the things that we are trying to look for in the clinic is to try to figure out, does this person actually have just a sore nerve, let's say a nerve that's quite sensitive or is it something that actually has a bit of loss of conduction?

Because you can actually impact the nerve to a point where you lose a bit of its ability to send electricity through. So we would do a pretty thorough assessment with these and try to figure out what we're dealing with. But yeah, pins and needles is a common complaint. You sometimes can get dull aching. You can sometimes get burning sensations. Some people tell you, I feel like I've just left the dentist here. You know, like it's kind of completely numb. So it depends, I guess, on what nerve from the neck has been sensitized or affected. And then, you know, that kind of can manifest in a multitude of ways for symptoms.

Mark: What causes this? 

Iyad: So lots of different things. You can have a cumulative, it's like a bunch of stuff can actually make a nerve sore. So for example, your general health is quite significant here. And your overall kind of I guess overall health is quite significant. And in determining whether you develop symptoms or not.

So give an example, somebody who is potentially like a longtime diabetic with type two diabetes can have an easier time to kind of synthesize the nerve because of that condition. Meanwhile, somebody else who might not have that might need a bit more, let's say of an attack on that system before they can kind of experience symptoms or loss of function.

So most of the time it tends to be either chemical irritation from inflammation in the neck or a direct pressure. So it could be things like disc bulge, could be a bunch of other things that could just kind of directly put pressure on it. So the compression can happen and that can cause symptoms.

And there are other less understood things like, let's say gradual narrowing of the spaces in the spine that seem to sometimes matter. And sometimes don't matter at all. And that's kind of where it's a bit confusing. If we just follow, for example, x-rays to diagnose this and MRIs because lots of people have these abnormal findings and have completely fine necks and no arm pain or loss of function.

So it really seems to be an unnecessarily complicated area, but the diagnosis tends to be a mix of clinical, which is basically what we would assess in clinic. And we do a physical exam along with sometimes we would do something called a nerve conduction study where our physician colleagues would trying to figure out which areas specifically is affected by testing how well that nerve is conducting electricity. And usually we would do that when we were expecting some kind of loss of function in that system.

Mark: And would this be from sleeping wrong? Would this be from picking up somebody the wrong way, like your grandkids?

Iyad: I think that would be an oversimplification to say that one can cause it, you know, these things tend to happen gradually over a long period of time. And then, you know, just because something happened, let's say the one night you slept wrong or like the time you picked up your grandkid and they kind of kicked out at you, doesn't mean that specific thing was caused. But yeah, it seems to be kind of a gradual process over time. And then eventually you become aware of it and some people go on to develop really debilitating symptoms and other people somehow can shrug it off quite easily and never really even know that something's there. Even when we scan them and we see something, and then they say, Hey, I've never had neck pain. 

So that's usually what happens, but if it's progressed to the point where we're getting symptoms down the arm, usually yeah, most people will kind of report that it's been happening, you know, in the last week or so. And it's just kinda started outta the blue. That's most of the time. I've had somebody who said one time, they were reaching over to their phone to turn off their alarm and then they felt this. So I'm pretty sure that they've done that every day for the last 20 years as a working professional and it can't be that this one time was the one that they did it wrong. So it's kind of happens. 

And that's probably the most confusing part of these injuries is that you're kind of wondering why did this happen? It just seems to happen over time from an accumulation probably of stresses on the body. 

Mark: What's a typical course of treat? 

Iyad: Great question. So, first thing we wanna do is figure out what we're dealing with. So if you're dealing primarily with a painful nerve versus an actual nerve that's lost function, we would kind of do things a bit differently but not also that differently. So if a nerves lost function, we wanna kind of monitor for any other signs that we would warrant a referral out.

We just wanna make sure that that person is progressing in the right direction and not kind of losing more function. If somebody has, let's say a painful condition only where we assess the conduction ability and they'll have normal strength, they have a little more sensitivity in the skin where the area's hurting, but everything else seems to be fine. The reflexes are fine. We would treat them with a multitude of things. We have lots of things that we could do. Our most important thing seems to be at this point is just telling them what to do at home, because it can take quite a bit of time for it to resolve fully. But if you know how to control certain symptoms and to actually move through some things and maybe avoid certain things for a temporary period of time, you do a lot better.

So that's what we would do on the education side. Try to identify those provocative movements, the things that feel good and getting people to just stay, you know, as active as they can be to help the healing. The other thing is, we would counsel them on, like, for example, sleeping positions and things like that.

Those are all really important because if you're not sleeping, you could do everything right. And that's gonna just basically be the equivalent of running to stay healthy and then smoking a pack of cigarettes after, it's just gonna cancel each other out kind of thing. And then we would do a bunch of stuff in the clinic.

So we have lots of tools from manual therapy. We would do anything from mobilizations on the neck to help desensitize it. There's nerve mobilization that can also desensitized nerve. And then we also can work on the affected soft tissues. We could do certain taping, embracing that can actually help certain things.

Again, it would just depend on what area and how bad their symptoms are in the beginning. And maybe if it's just that thing in isolation, or if they have five other things going on, that would probably change the course of treatment. But that's kind of the stuff we would do. And it would take, usually most people will see kind of a bit of an improvement after first four to six weeks, but then the full recovery process can be quite a bit longer.

And that's something that's really important for people to know. Because sometimes they think they're not recovering if it takes them three to six months. But that's actually what a typical recovery can be sometimes. It's just the body needs time to adapt back to normal. 

And I guess I'll give you an example, if you are wanting to go back to wrestling, as a sport versus wanting to go back just to walking your dog every day. I think your recovery's gonna be quite different. We'd need to build you up a lot more if we want you to be able to handle the stresses of wrestling versus just walking around the block a few times. So all of that stuff kind of factors into the planning of the treatment and the timelines and all that stuff.

Mark: So if you want some expert treatment, if you've been diagnosed or feel like you have some issues with radiculopathy or numbness, burning pain, pins and needles in your shoulder and arm and you want to get back to jumping off the top rope and giving the people's elbow to people. The guys to see are Insync Physio in North Burnaby. You can reach them at their website, insyncphysio.com. Or you can call in book (604) 566-9716 is the Cambie office. Burnaby is (604) 298-4878. You have to call and book ahead. They're always busy. Thanks Iyad. 

Iyad: Thank you.

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Wil Seto of Insync Physio in Vancouver. And today we're gonna talk about arm pain coming from your neck. How you doing Wil? 

Wil: I'm doing good. Thanks. How about you, Mark? 

Mark: Good. So this doesn't seem to make sense really. How can you have arm pain from your neck?

Wil: Yeah. So I guess the first thing to really understand is the different kinds of neck issues that you can get. And you can have four basic types, I guess, to really narrow it down. And you look at what's called standalone neck pain. So you have this type of nonspecific neck pain that doesn't affect anything else. And so you have this pain that's happened, whether it's like a traumatic injury, you know, or something like that. Or you wake up in the morning and you sleep wrong on it. And you kind of have this neck pain that you're experiencing. And it's just neck pain, so there's no other symptoms. And it could be stiff. And it could be not be stiff. 

And then you have neck pain, with a headache related symptom, like you have neck issue, neck pain related with headache stuff. And that's quite common when you have this referral of the things going on with your neck joints that refer up into the head. And so that neck joint related pain or the technical term is called cervicogenic headache. Because the headache is coming from referral points from joints in your neck. And so the muscles get all really tight too as well. And they can also refer right into the base of your skull. 

And then the third type is sort of like this whiplash type of associated neck pain or disorder and there's all these classifications with that where it's like trauma. So I did mention trauma earlier, but I meant like more trauma.

That's kind of like, you know, you wake up, that's still, I consider that trauma, but it's not like acute trauma where you've had an accident. Right. So with the third type. The whiplash associated trauma is like a specific sort of acceleration and decelerated force. And basically you can either have pain in your neck without issues with motion, but you have pain. Or you can have limited range of motion. Or you can also have that with now it goes into the fourth category, which is neck pain with arm pain.

And so the technical term of that, I guess is, ridiculopathy or neuropathy. And so when you look at the neck pain with ridiculopathy or neuropathy, that's when the actual pain in your arm you know, and we've had this on our physio team where clients have said to our physios. Yeah, I think I've got tennis elbow and then they've been treated for, with some other healthcare providers and, you know, and it didn't help at all. Like they're treating their tennis elbow or what supposedly thought was tennis elbow or some kind of overuse thing going on in their arm. But in fact, if you do a thorough assessment and you do this clinical examination and look at where is their arm pain coming from, it's actually coming from their neck.

And so when you start treating that and you look at you know, the cause of that, and you start putting the pieces together and you treat that whole picture, then you start to actually affect that arm pain. Because you can get referral from your neck all the way down in your arm. And especially if, you know, someone that it may not even be an accident, it could be an accident, but it may not be an accident. And it may be like something that's just gradually happened over time. 

So I can think of a client that one of our physios had. Who said, yeah, you know, like they were talking about this patient who had arm pain. They said, yeah, the other healthcare provider was basically treating them for tennis elbow and it just wasn't getting you better. Well it was because it wasn't really tennis elbow is what she told me.

And started treating this client for their neck issue. And within a few treatments, their arm pain was dissipated from like an eight out of 10, which they would feel, for like a 3 out of 10. It's a process. Because these things developed over time for this person, and it was something that wasn't just over like a traumatic incident and this person didn't have any issue with them to begin with.

I mean, like traumatically speaking. They did have other non sort of repetitive going on. Cause they were on the computer a lot, and they did some sports that probably wasn't super helpful, like boxing, but never had an injury that they could remember. So the proper diagnosis or the proper assessment of what's causing the arm pain is really important. It's the first step.

Mark: So as an athlete, can I diagnose this myself? Is there something that's obvious so that you could point to and say, well, this is often what it feels like that's different than just regular tennis elbow or arm pain that would indicate it or do I have to come and see you really to get the testing done to find out?

Wil: No, that's a good question. So I think one of the biggest things is like you know, you can confuse it. It's very confusing because you're like, oh yeah, you know, I'm hurt because sometimes that area, it becomes more sensitive. So you have this sensitization of that arm, so that's why it legitimately feels like it's just arm pain and you may not actually have neck pain.

Like it just maybe neck stiffness until we start poking around in there and be like, oh yeah, my neck hurts a little bit. It hurts a little bit there. And so some of the things that you can sort of just rule out quickly for yourself is you can just do a lot of like resist detecting. So if it's like a tennis elbow thing, you know, like aside from the fact that it feels more sensitive and it's a little bit sore.

Like with this person, they were, it was interesting because there's like two things really hurt it the most, like doing weighted chin ups and doing pushups. And so, oh, that's interesting. So then I was thinking, yeah, it could be maybe like something related locally. Around that area of their arm. But then when I actually put them through the test, which you can do on your own or an athlete can do on their own, like just test yourself, do some simple, wrist resistant testing with your arm bent, arm straight. And then do what I call like sort of the P symbol with the arm straight and then resist. And then do that with it bent. And if you're getting the reproduction of that pain that you're experiencing when it's sort of that yeah, when you touch it, then that's usually a good indication. Oh yeah, maybe there's something going on. Because that's actually testing the structures related to tennis elbow.

So I don't know if that helps if it's sort of a initial thing. Cause that is actually a really quick test that you can do. Because sometimes if you just touch it, it can be sensitive. But if you're doing specific things to test for if it's sore and weak, then it could be maybe a tennis elbow thing. But if it's just weak and it's not sore, then it might not be. 

So the other key thing too, is if it is a tennis elbow thing, if it's an overuse thing, and if you're doing exercises to work on releasing the muscles, like tough massage and stretching, And then you're doing some specific strengthening for, and that doesn't get any better in like a couple weeks. And that's when you want to get it looked at. Maybe there's more to this that meets the eye. And you know, as great as Google can be, in terms of being a good resource you know, sometimes you just gotta get it looked at you know, if it's beyond that stage of like two weeks and especially if you're like, yeah, I want to start to play more tennis. I want to start to play more Ultimate Frisbee or rock climb or whatever it is that, you know, using your arm more. 

Mark: When you're working on a person's neck to reduce the stiffness or the pain that's referring down into that person's arm. What kind of stuff are you doing?

Wil: Yeah. So really good question. So one of the biggest things is, so there's three things that we're looking at in terms of the rehab process. So there's increasing mobility. So we want to increase the mobility of like the whole thing that's affecting the arm. 

So there's the neck. And the things that basically come up in attach neck, so the nervous system. So if we inspect the mobility to the neck and allow it to move better, then that's gonna allow things to move better all the way down. And then also the muscles around the neck. So if the muscles are just basically really super tight, if everything is always on like this. And then that's also gonna add more compression and also affect the movement patterning of how you rotate or how you flex or how you extend your neck. And so that's gonna also affect what's happening all the way down with the nervous system and how you use those muscles.

So that mobility issue with the muscles and the joints and the nervous system. And then being able to get your core strength to stabilize all that. And so then that way we can now focus on the third thing, which is basically the functional strength. So really getting in there and mobilizing and increasing mobility is one of the first key things to start.

Mark: There you go. If you suspect or been told you've got arm pain and it's not going away because you're doing the right things to heal it, come into Insync Physio and get it looked at. It might be something else. It could be referred from your neck for instance. And this is pretty common. I'm guessing is that accurate Wil?. 

Wil: Yeah, it's actually very common. I can't give you the exact percentage, but our team, our physio team, we see it a lot. 

Mark: There you go, if you want experts helping you out. They can diagnose this and get you on the right path so that you're feeling better and can get back to your sports sooner rather than later. Insync Physio. You can book at insyncphysio.com or you can call the Vancouver office at (604) 566-9716 to book or in North Burnaby, (604) 298-4878. Get in there. Thanks Wil. 

Wil: Thanks Mark.

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

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

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

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

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

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

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

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

Wil: I'm doing great, Mark. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Wil: Thanks Mark.

Start in 4 point position on your hands and knees with 4 feet Resistance bands tied diagonally from opposite wrist to ankles. Keep your posture in neutral with your low back core engaged and prevent your shoulder blades form collapsing.

Begin with a neck warm up by flexing your head and neck down by bringing your nose to your sternum. Slowly bring your head back up extending your neck and rotating it to the left side. Repeat this for 5 reps to warm up for both sides.

Then after your 5 reps for each side add left finger, hand and arm reaches with right hip heel extensions. Repeat this for 10 reps on each side for 3 sets daily.

This is a great functional core neck strengthening exercise for rock climbing training and performance. It’s designed to help you retrain and optimize your best neck movement and strength patterns.

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

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto he's the owner of the chief cook and bottle washer. Not really. He's the big chief at Insync Physiotherapy in Vancouver and North Burnaby. And we're going to talk about rock climbing neck injuries today. How are you doing Wil? 

Wil: I'm doing well. Thanks. And I have actually washed bottles for a job once before, so. 

Mark: Me too actually. So, rock climbing neck injury. So this doesn't seem like it would be a very common thing. How common is injuring your neck while rock climbing? 

Wil: Well, you know, it's interesting, it's more related to sort of the chronic issue and I guess you could classify it as repetitive strain. And there's a couple of different aspects to it.

So one of the common ones that you know, if we put a label to it, we call it the belayer's neck. So for people who like basically, you know, belay and they climb like this, and they're always basically shortening up those muscles. Now there's a few aspects of belayer's neck. And then just in general, people who are like climbing really hard, but aren't doing a lot of mobility work to really make sure that they're recovering the full mobility of their neck and their spinal joints and their associated areas that around the neck. Because there's a lot of muscles that attach from the neck to the shoulder and then from the neck to the upper back and all that stuff.  

Mark: So the symptoms would be pain, I would assume. 

Wil: Pain and stiffness. Those are the biggest ones. And occasionally it can get bad enough where you have like a radiating pain or nerve pain. So that's where it gets a little bit more extreme where there's like a sort of a pinched nerve. 

Mark: And the causes are basically, like you said, it's chronic it's from looking up all the time or maybe not having great biomechanics for other things because you haven't worked on it. And so you're using your neck in a way that it's not really meant to be, or trying to compensate using your neck muscles. Is that. 

Wil: Yeah. So what happens is that there's an imbalance once again. And you have a lot of tightness in certain muscles, and sometimes it's tight in the front too. And obviously really tight in the back. And so what ended up happening is that you don't get the proper extension in your neck and you're actually pinching in and only moving in limited joints and extension through the neck when you should be extending throughout every segment in your neck.

So that's important to understand because then when you're looking at the muscles that they get really tight. Then it contributes to that effect. And so what we need to really help people understand, like climbers understand you know, the mobility work to get that moving, even when it doesn't feel symptomatic is really important to do. Especially if you're an avid climber or especially if you're a competitive climber and someone is looking at increasing your training level to really hit personal goals. 

Mark: So someone comes in. They're a rock climber. They've got neck problems. How do you diagnose it?

Wil: Yeah. So one of the main things, I was saying earlier that you know, that you can get from like limitation and the movements and the mobility, and the pain could also be coming on a little bit more where it's more than just stiffness and soreness. Now it becomes like, Oh, pain, I can't even like look up. To even like radiating pain down the arm where they may not even have pain in the neck. So we need to differentiate and figure out which one of those are, right. So we have to look at, is it coming from the joint? Is that why you're getting the issue. 

Most likely, it's a combination of that with the imbalances in the muscles. And then if it's a pinched nerve, we have to figure out okay, which areas. And then start to alleviate that. Because we want to make sure that we start to get that moving properly as well, so it alleviates that.

Mark: So depending on what the diagnosis is, that determines what the course of treatment is going to be. 

Wil: Absolutely. And then just a little bit more on the whole, like radiating pain and the nerve pain, you know, if we find something that's a little more serious, something that we think that requires more medical diagnosis or getting to have your family physician to take a look at it. It's important because maybe there's some going on there where it's affecting the nerve health. And so when we assess that and examine it we can determine how much is it being affected in the nerve. 

Mark: And in terms of, because climbers want to get back climbing right away again, how soon can they get back to it typically?

Wil: Pretty soon. I mean like you can still keep climbing. Like I'm treating a climber right now, who's had a past history of a pinched nerve. But no longer has that, but presents with some symptoms of weakness related to the pinched nerve, which he doesn't even know about, which is interesting. And still climbing. Still training hard and addressing this issue. So that's an example from one that I'm treating right now who had that. 

Another example, I'm treating someone who it hurts just to look up and then we look at his movement is so stiff that even when he brings his arms up you know, he can barely bring his arms up to here. How can you even possibly climb? And it's been sort of gradually building up. It's interesting. He's just noticing how he's more stiff and more stiff. And he tries to do things that stretch it out before he climbs and really open things up more forcefully and it's just, he's so compressed.

He doesn't realize that, you know, the more that he's climbing right now, the more he's making it worse. And he has definitely sort of a lot of weakness in a lot of other areas that are most likely related to the nerves in the neck. So here are we going to tell him reign it in a little bit and let's just give it a week's rest and then we'll get you back climbing in a week. And then we've got to do more of a gradual step approach. And this is quite common, too. I see a lot of people that are like that. 

And then we have another example of another climber who doesn't have any radiating pain. Doesn't have any weakness. It's just stiff and they can keep climbing as normal as well. So two, three treatments and they were good. And got him on an exercise program, building on manual therapy, mobilization techniques to work the joint. Keep them moving and get the muscles that needed to be strengthened and really work on, you know, relaxing and resetting those muscles that are really tight. That way things work more properly. 

Mark: How important is it that the climbers follow the exercise program you give them, in terms of how well they're going to, over the long-term not have this problem recur? 

Wil: It's pretty important. And I think it's funny because you know, we take them through maybe a couple of treatments, and then give them the exercises, they're doing and they feel great. But then I'll see them again in a year or maybe a couple of months, they've increased the training more and ask them well, what's different other than the training.

Oh, I haven't done my exercises that much. And so it's important because the exercises that we give you are individualized to what's going on. So we look at what needs to be targeted and what needs to you know, really be emphasized in terms of even like warm-ups and stuff. And so when those aren't being done and you figure a climber and you're like pushing and increasing the intensity, then it's an obvious recipe for something to happen in the future. If you're going to continue climbing, at an avid level and especially at a competitive level.

Mark: If you're a rock climber in Vancouver with some neck issues, stiffness pain, you want to get it fixed. The guys to see are Insync Physio. You can reach them in Vancouver at 604-566-9716 they're on Cambie and King Edward or in North Burnaby, 604-298-4878 to book. Or of course you can book online at insyncphysio.com. Thanks Wil.

Wil: Thanks Mark. 

Start in 4 point position on your hands and the forefoot or the balls of your feet with your knees greater than 90 degrees. As you place one hand forward bring your opposite foot forward as well.

Do this while you also keep the shoulder blade muscles and your neck position in neutral. Repeat this for 30 seconds 3 sets 2x/day.

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

Start on your knees and lie with your belly on a balance ball while you engage your core stability muscles of your lower back to keep your posture in neutral.

Hold a lacrosse ball in your hand with your elbow up and knuckles pointing down. Open your palm releasing the ball and quickly rotate the forearm backwards and then quickly rotate it back to catch the ball with your hand without letting the ball fall to the ground. It’s important to only pivot through the elbow and not the entire arm and shoulder. Repeat this for 30 seconds doing 3 sets for each side daily.

This exercise can help rehab the functional core strength of your upper quadrant when recovering from a neck injury. If you have any pain or difficulty doing this exercise, consult your local physiotherapist before continuing. 

Mark: Hi, it's Mark from TLR. I'm here with Iyad Salloum from Insync Physio in Burnaby. He's the clinical director director of the North Burnaby office. Insync has two offices in Vancouver and in North Burnaby. And today we're going to talk about dizziness from your neck. From your neck? How do you get dizzy from your neck?

Iyad: That's a good question, Mark. So basically the way you find yourself when you're walking, when you're moving, when you're doing all kinds of stuff is your brain gets signals from all over the body. And then it puts them together and in a way, processes them. And then you get this kind of thing where you're able to sit up straight and, you know, walk in a straight line and all that stuff. So some of the feedback that we get comes from our neck. And our neck's, really a rich area when it comes to all these kinds of little sensory nerves that send lots of signals to our brain to interpret. 

So sometimes we get people who, let's say a hockey player who, you know, smacked really hard into the boards. And they get diagnosed with a concussion and then a few weeks on, a few months on, they're still experiencing some headaches and some dizziness. 

So I know like last week, my colleague, Heather filmed an excellent video with you about headaches that could originally I guess started from the neck where the neck gets really sensitized and it can kind of give you these fake symptoms that look like you have head symptoms, face symptoms.

And this is really no different. The way you want to think about it is this, we have our vision that tells us what's happening. So you get to see what's in front of you. You could tell what's straight and what's not. We have our inner ear, which helps us figure out where our head is moving. So that's the vestibular organ. And then you have our neck.

So for example, imagine if you have a mismatch in those three signals, so your eyes are telling you you're facing straight ahead, your inner ear is showing you facing straight ahead and you're not moving. But your neck is kind of perceiving a movement, slightly different. So it says maybe you're a bit on your side or you're a little bit there.

So that mismatch is basically what could produce some feeling of unsteadiness and most people just label it dizziness which this general vague term. But really it's just a confusion between your senses. 

Mark: So the symptoms are dizziness. Is it more from when you're moving? You would notice, because that's sometimes I think we talked about that the last time. Is that a movement thing or is it you're still and you just you're like you described your one spot and you're feeling dizzy suddenly. How does it manifest? 

Iyad: Yeah. Most people will feel it when they're moving. And that's when they'll tell you, like, you know, I turn my head and I get this and they think, you know, you go on your Google and you think, oh, I got this loose crystal that's in my inner ear that's causing this. And you know, that very well could be a thing. But most people will feel that with movement. If in really sensitive cases where it's like super aggravated, you will sometimes feel it at rest, but you'll feel just a bit off. You know, that's kind of the sensation, they'll say, oh, I feel like I'm on a boat. I'm just kind of, things are rocking a bit slowly here. 

So yeah, most people, I would say it's an impairment with movement and, you know, that's, I think if you think about that, that's the whole purpose of rehab is to kind of help you get more comfortable with movement. And that's where I guess a treatment program will be very helpful. 

Mark: So how do you go about diagnosing this?

Iyad: There's quite a few tests. So what we will do usually in an exam is we will do a neck exam. If we suspect a concussion, we could do some kind of tolerance test where we get the heart rate up a bit to see if just a spike in heart rate will cause this symptom. So that's one potential reason. 

The other thing is we'll do an assessment to the vestibular system where we try to kind of challenge some of those reflexes that our inner ear is responsible for. So usually it's a bit of a process of elimination. It's not this. It's not this, it's not that. And then we have some specific tests for the neck where we basically test how well you can locate centre with your eyes closed, for example, and we have these tests that test for joint position error. We get you to close your eyes, perform a task, and then turn your head one way and come back and see how well do you land on the centre again. 

That could be again, another tool that we can use to figure out if there is something coming from the neck. And we'll find it in most people is it's never just an either or. You can also have these overlapping things. Like you could have a concussion and you can also have neck symptoms from the impact. For example, if the hockey player into the boards.

So it tends to be you know, we worked through the impairments one by one, and that's kind of how we figure out exactly what contribution is coming from. Just the general system to the neck to the inner ear. So there's lots of treatment options, which is great. But some, you know, manual therapy to the neck, it can be very, very helpful in some cases. 

You know, manual therapy is not just for loosening up joints and loosening up muscles and improving movement. It also gives us a lot of, because these areas are so rich in sensory nerves and you pay a lot of attention to your neck, the neck serves your five senses really, if you think of any treatment delivered there can actually enhance your awareness of the area. So you'll get a temporary improvement sometimes just with one treatment of like a hands-on technique to the neck. 

And, you know, our therapists are experienced in different styles of treatments, but they all seem to work pretty well in this population. The other one, which is really important is there's some exercises that are specifically targeted towards that. There is no one size fits all because you're going to get people with different impairments. 

Some people who have an issue only when they're standing and turning their head. Some people when they're sitting and turning their head. And some people when they turn their body, but their heads stay still. So like think of a swimmer who's swimming and just rotate their torso while their head still basis forward. So you try to kind of target the exercise approach to fit the impairment, instead of just giving this handout sheet that, you know, here you go, this is what you do in case of a headache or dizziness case.

So yeah, it tends to be a bit of a mix of some balance and control of the neck, which is something that a lot of people don't think about, but the neck, like any other joint needs to move well. You need to have good strength around it and you need to have good control around it. 

Mark: And what's the typical course of treatment. I know it's going to obviously be very individual, but what's the more typical timeframe?

Iyad: So initially let's say we would assess if there's any loss of range of motion, we would try to get that going. There's usually a lot of fear based around moving the head. Cause you're kind of worried about triggering an episode of dizziness.

So it tends to be a small exposure program almost. Where we try to kind of get people to practice moving with or without different cues. We would do a neck strengthening program as part of this. But yeah, the sequence of progression tends to be, let's say if you're really low functioning at this point, because it's so symptomatic. We would start very minimal and kind of progress you onto that.

And that could go anywhere from a four week treatment program, to six months, depending on how sensitized everything is and how much is at play here. And how long has it been a play? 

In some cases it could be on the faster side where, you know, they're fairly high functioning and they only get this kind of episode when they're doing something very specific. Like when their other senses are very challenged, like imagine walking on a tight rope and then turning your head, you know, well, that's going to challenge your balance system quite a bit more than if you were just sitting still and turning your head. And the reason is, we have amazing senses in our body that can compensate that.

Like your vision. So often that's just kind of covering a lot of those deficits and you know, your inner ear is so good at that, the vestibular organ. So it'll depend on what's involved. But yeah, it could be anywhere from four weeks to six months. And you know, the idea is you would need reassessment for you to actually figure out what timeline we're looking at because it's never going to be, oh, we know exactly from the first day, how long are you going to be.

 So it's more like we judged the improvements week to week, and then that'll give us a better idea because we have more data to judge how you're going to progress through your treatment. 

Mark: If you having some dizziness, you've had some neck issues of some sort, perhaps. Turning your head is causing you to feel a little bit loopy, perhaps call Insync Physio. You can book online at insyncphysio.com. You can call a North Burnaby location to make your booking as well 604-298-4878 or in Vancouver, 604-566-9716. Get it looked after. The sooner you start, the sooner you're going to be feeling better and a little bit more oriented well in space and time. Thanks Iyad. 

Iyad: Thanks Mark. Appreciate it.