Category Archives for "pain"

Mobilizing the Thoracic Spine

A tight upper back may be attributed to stiffness in the shoulder, neck, or back muscles surrounding the thoracic spine. Rounded or slump shoulders, having sway in the lower back, or a forward head position due to weak back extensor muscles, short and tight chest muscles, or weak abdominal muscles may result in an individual having poor posture. Poor posture can place tension in the upper back and may result in irritation or pain. Sports, weightlifting, irregular sleeping positions, or car accidents may also cause tightness in the upper neck and back region. Mobilizing and strengthening the muscles surrounding the thoracic spine may relieve an individual of stiffness or pain, while improving an individual’s range of motion and functioning. Remember to have a balanced, upright posture by standing tall, bringing the shoulders down and back, tuck your chin, and keep a neutral spine to work on better posture.

EXERCISES FOR A TIGHT THORACIC SPINE

1) Thoracic Rotations: 

Lie sideways on a mat or on the floor with both arms extended to one side and hands together. Bend the knee of the top leg to form a 90 degree angle. Place a long foam roller underneath the bent knee if you are unable to touch the ground with this top knee. Keeping your lower body in this position, twist your upper back by bringing the top arm over your body to the other side to touch the floor. Repeat 10-12 times, then lie on the other side and complete the same movement.

2) Cat-Cow: 

Begin in a table-top position with your knees hip-width apart and wrists shoulder-width apart on a mat or on the floor. Keep a neutral spine and head position. Move into the “cow” pose by inhaling as you drop your belly down towards the mat as you lift your chin and chest up to gaze toward the ceiling. Then move into the “cat” pose by exhaling as you draw your belly into your spine and round your back toward the ceiling. Repeat 10-15 times.

3) Seated Lateral Flexion: 

Begin seated in a chair with both feet planted on the floor or seated on the floor. Raise one arm up towards the ceiling. With your arm raised above your head, slowly bend to the opposite side. Return to the start position and lower your arm. Then raise the other arm and slowly bend to the opposite side. Repeat 5-10 times on each side.

4) Thoracic Extension with a Foam Roller: 

Place a long foam roller perpendicular to your spine on a mat or on the floor underneath your shoulder blades. Interlace your fingers and place your hands behind your head to support the weight of your head. Slowly push with your feet to roll the foam roller up and down the thoracic region. Maintain a neutral spine and engage your abs.

5) 4-Point Walk-Out: 

This exercise helps to re-train muscle activation in the shoulder blades and mobilizes the muscles surrounding the thoracic spine for a better functional recovery. Place your hands and knees in a four point or table-top position with a neutral spine. Engage the inner core and start by walking one hand out to one side, then back to the centre, and then to the other side, then back to the centre again. Put full equal weight each time you place your hand down. Maintain a neutral spine throughout the exercise. Repeat for 30 seconds for 3 sets.

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What is Cuboid Syndrome?

Ever feel pain or swelling on the side of your foot? These symptoms may be due to a condition called Cuboid Syndrome, also known as cuboid subluxation or lateral plantar neuritis. In addition to pain in the lateral mid-foot, redness and a restricted range of motion in the ankle may be present. This syndrome is typically associated with an inversion sprain of the ankle. This is when the foot is forced inwards causing the cuboid bone to sublux, or partially dislocate. The cuboid bone is located near the mid-point of the outer side of the foot and is one of the seven tarsal bones that make up the arch of the foot. It connects the foot and ankle as well as provides stability to the foot.

The peroneus longus muscle is a muscle that runs along the outer side of the lower leg and attaches to the lateral side of the foot. Repetitive strain of this muscle due to activities such as ballet, jumping, or running, may place tension on the cuboid bone. Commonly found in athletes, Cuboid Syndrome may also occur in sports such basketball, football, or soccer. Weight-bearing, uneven pavement, or quick changes in direction that occur in sports may aggravate symptoms. A third cause of this syndrome may be an individual’s altered foot biomechanics. Athletes who have over-pronated feet, also known as flat feet, may be more prone to cuboid subluxation.

Imaging such as x-rays, MRIs, and CT scans can be used to rule out other causes of pain. However, a cuboid subluxation can be difficult to diagnose and therefore, must be carefully assessed by a general physician or other health care professional.

STRENGTHENING

Daily strengthening and mobility exercises should be performed on a pain-free basis to prevent the foot and ankle from becoming weak or stiff. Watch the videos below on how to properly perform strengthening exercises:

Use a resistance band tied to a stable anchor and wrap it around the unaffected leg. With the affected ankle, stand either in front of the band or inside while keeping your posture tall and inner core engaged. Hike the foot with the band wrapped around the leg up off of the ground and slowly push the leg out to the side and then slowly return it back to the middle while keeping the foot off of the ground the entire time. Resist the movement with the standing leg by squeezing the butt muscles. Repeat this 10 times for 3 sets daily.
Start by putting your weight on the side of the affected ankle and hike the opposite foot up off of the ground. Remember to keep your inner core tight below the belly button. Then with the foot that’s off of the ground touch the first point in front of the ground, then to the side and then behind you, and then cross over to the other side of the body. Repeat the 4 points of contact (front, left side, back and right side) for 30 seconds 4 sets 4 times per day. As you get stronger increase it to 60 seconds 4 sets 4 times per day. If you have a fracture as a result of your injury or you are unsure if this is the right exercise for you to do, consult your physiotherapist before starting this exercise.
Starting with tall posture, engage your core muscles below the belly button by drawing the lower abs inwards toward the spine. Avoid arching the low back. With arms in a ready position do a one-legged squat with your body weight distributed equally over the foot. Don’t go any lower than a ninety degree bend in the knees, keeping your knees in alignment with your second toe and over your heel as much as possible. Hold for a good long second and then straighten back up with your butt muscles to the start. Do three sets of ten repetitions daily. 

TREATMENT

Other treatment options include foot support such as padding, taping, or orthotics to help stabilize the bones of the midfoot or correct for over-pronation. Rest from repetitive, weight-bearing actions such as jumping or running may help alleviate pain. Ice affected area for 10 minutes at a time to reduce swelling and inflammation. Consult your family physician, physical therapist, or podiatrist to perform a manipulation if the cuboid bone is suspected to be dislocated.


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How to Reduce Interscapular Pain

Persistent pain between the shoulder pains, or interscapular pain, may arise from a number of varying causes. The scapula is the bone that connects the humerus (upper arm bone) with the clavicle (collar bone) on either side of the body. The intrinsic muscles of the scapula include the subscapularis, teres minor, supraspinatus, and infraspinatus, all of which make up the rotator cuff. The major muscles surrounding the scapula that make up the interscapular region include the rhomboids, trapezius, and levator scapulae.

The rhomboids are two quadrate-shaped muscles that originate from the lower cervical vertebrae and upper thoracic vertebrae and attach to the medial border of the scapula. The rhomboids work to retract and rotate the scapula downwards. The trapezius muscle extend from the occipital bone of the skull to the lower thoracic vertebrae and attach to the scapular spine. Its action is to elevate and rotate the scapula upwards. Likewise, the levator scapulae run from the upper cervical vertebrae to the superior portion of the medial border of the scapula and works to elevate the shoulder blades.

CAUSES

One of the common causes of interscapular pain may be due to a muscle strain of one of the muscles described above from poor posture, lifting, or twisting motions from activities such as golf or tennis. Other causes may include trauma such as dislocations or rotator cuff tears, cervical or thoracic herniation, arthritis, heart conditions, cancer, gallbladder disease, scoliosis, or gastroesophageal acid reflux.

TREATMENT

Treatment begins by identifying possible underlying causes contributing to the pain between the shoulder blades. Poor posture occurs when the head is forward and shoulders are rounded. This stretches the rhomboid muscles excessively and causes the muscle to weaken. Correcting poor posture by taking frequent breaks from sitting, bringing your shoulders down and away from the ears, as well as evenly distributing your body weight to all sides may help relieve upper back soreness.
Active release, moist heat therapy, and intramuscular stimulation with a physiotherapist are effective ways to release tension in the back muscles.
Consult a physician or specialist to assess for gastrointestinal, pulmonary, and cardiac-related conditions as they may cause referred pain in the upper back region.
Watch the following videos below on how to stretch and strengthen key muscles in the shoulder region:

Rotator Cuff / Shoulder Impingement Rehabilitation:

Advanced Strengthening for Weak Shoulder:

Scapular Muscle Strengthening / Activation:

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How to Recover from Achilles Tendinopathy

The Achilles tendon is the thickest tendon in the human body. It attaches the gastrocnemius and soleus muscles (together known as the triceps surae) as well as the plantaris muscle to the calcaneus bone (heel) of the ankle. These muscles combined allow for plantar flexion at the ankle and flexion of the knee.

Tendinopathy of the Achilles tendon refers to a condition that causes pain, swelling, or stiffness at the tendon connecting the muscles to the bone. Commonly found in athletes such as runners, overuse of the tendon, may result in microtrauma or repeated injuries to the Achilles tendon. Wearing improper footwear, having poor training or exercising techniques, making a sudden change to your training program, or exercising on hard surfaces may also cause minor injuries to this tendon. Pain and stiffness may develop gradually and are typically worse in the morning. Pain is generally worse after exercise, but may potentially arise during training. Overtime, symptoms may be so severe that individuals may be unable to carry out their usual daily activities.

Recovery:

Rehabilitation occurs quickly or over several months depending on the severity of the injury. Although pain may be present, expert clinicians and researchers recommend continuing daily activities within one’s pain tolerance. As complete rest should be avoided as much as possible.

In the early stages of Achilles tendinopathy, a treatment called iontophoresis may be used to reduce soreness and improve function. This treatment involves delivering a medicine (dexamethasone) to the painful area. Ice packs are also effective in reducing swelling. Apply ice pack wrapped in a towel or dry cloth to the affected area for 10 to 30 minutes at a time.

However, researchers have found that Achilles tendinopathy is often successfully treated with strength training guided by a physical therapist. Strength training relies on using one’s body weight with or without additional weight for resistance to load the tendon and associated muscles to strengthen the calf. Do exercises slowly to decrease pain, improve mobility, and return to normal functioning.

Try these exercises below:

1) Heel-raise: Stand with your feet a few inches apart. Raise up on to your tiptoes and lift the heels by using both legs. Then lower yourself down using the affected leg. Perform 3 sets of 15 repetitions twice per day. This exercise can also be performed seated in a chair.

2) Calf stretch: Stand a few steps away from a wall and place your hands at about eye level. Place the leg you want to stretch about a step behind the other leg and bend the knee of the front leg until you feel a stretch in the back leg. Remember to keep your heels planted. Hold this position for 15 to 30 seconds. Repeat 3 to 4 times before switching to the other leg. Repeat twice per day.

3) Towel stretch: Sit with both knees straight on the ground and loop a towel around the affected foot. Gently pull on the towel until a comfortable stretch is felt in the calf. Hold position for 15 to 30 seconds. Repeat 3 to 4 times before switching to the other leg. Repeat two to three times per day.

Check out these videos:

Strengthen the Calf Muscles with 1-Legged Squats:
Roll Out Stiff Calves:

Reference: J Orthop Sports Phys Ther 2018;48(5):427. doi:10.2519/jospt.2018.0506
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Strain vs Sprain? How To Recover Optimally

Acute sprains and strains may impede performance and delay return to a sport. Proper management, treatment, and prevention is essential to recovering effectively. An athlete must first understand the definition and recognize the differences between a “sprain” and a “strain.” A sprain is defined as a violent overstretching of one or more ligaments in a joint. A sprain can result in pain, tenderness, swelling or bruising at the joint. A strain is defined as a stress or direct injury to the muscle or tendon. A strain may also cause pain when moving or stretching the injured muscle, but can also cause muscle spasms.

Grades of Strain:

1) Grade I – Mild Strain: slightly pulled muscle with no muscle or tendon tears and no loss of strength and low levels of pain
2) Grade II – Moderate Strain: partial tearing of the muscle or tendon at the bone attachment with reduced strength, moderate pain levels
3) Grade III – Severe Strain: complete rupture of muscle-tendon-bone attachment with separation, substantial loss in strength and high levels of pain

Grades of Sprain:

1) Grade I – Mild Sprain: minor tearing of some ligament, no loss of function
2) Grade II – Moderate Sprain: partial rupture of portion of ligament, moderate loss of function
3) Grade III – Severe Sprain: complete rupture of ligament or separation of ligament from bone, substantial loss of function

Proper RICE Treatment:

1) REST: Do not continue to use the affected muscle or ligament immediately after injury. Use crutches for the lower extremities (i.e. leg or ankle) and splints for the upper extremities (i.e. arm or hand)

2) ICE: Sudden cold may help constrict capillaries and blood vessels to slow or restrict internal bleeding. Place an ice pack between a towel or dry cloth. Apply ice every hour for 10 to 20 minutes at a time.

3) COMPRESS: Compression can help reduce swelling post-injury. Wrap the injured part firmly with an elasticized bandage, compression sleeve, or a cloth. Do NOT wrap the cloth too tightly as it may cut off blood circulation and lead to more swelling.

4) ELEVATE: Elevate the injured part about level of the heart to reduce swelling and pain. Place a soft object such as a pillow or piece of clothing to use as a prop below the body part.

Continued Recovery:

Continue to follow the above RICE method for two to three days post-injury. Daily stretching may help loosen the muscle. Key to prevention is to stretch the tight muscles and strengthen the weak muscles.

Watch the videos below on how to recover from a common ankle sprain or shoulder strain:

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How to Avoid Gastrointestinal Problems During Exercise

What should I eat or drink when exercising?

Many gastrointestinal (GI) problems can occur even if one trys to avoid eating before or during exercise. Studies suggest that approximately 30-50% of athletes experience some type of gastrointestinal issue that can impair performance and delay recovery.

The three main causes of GI problems:

1) Physiological
2) Mechanical
3)  Nutritional
During intense exercise, especially when dehydrated, blood flow to the intestines is reduced. This is believed to be one of the main factors leading to the development of GI symptoms.

General Symptoms:

  • nausea
  • vomiting
  • abdominal angina
  • bloody diarrhea
  • other abdominal symptoms (from mild discomfort to sever ischemic colitis)

Classification of Symptoms:

1) Lower GI Tract
2) Upper GI Tract

Runners tend to experience lower GI tract symptoms such as flatulence (excessive gas), diarrhea, or urgency due to the repetitive impact and reduced blood flow to the gut. On the other hand, cyclists may experience upper GI tract symptoms  due to the increased pressure on their abdomen while in an “aero” or crunched position of the body. These mechanical effects may be minimized with training.

Tips for Athletes:

1) Avoid high fiber foods in the day and several days before competition
2) During training, diet with adequate fiber will keep the bowel regular
3) Avoid aspiring and non-steroidal anti-inflammatory drugs (NSAIDs)
4) Use of NSAIDs prior to a race is strongly discouraged, especially for athletes with a history of GI problems
5) Avoid high-fructose foods (especially drinks that exclusively contain fructose)
6) Avoid dehydration as it can excaerbate symptoms and start races well hydrated
7) Ingest carbohydrates with sufficient water or drinks with lower carbohydrate concentration to prevent very high concentrations and osmolalities in the stomach
8) Practise new nutrition strategies and make sure to experiment with pre-race and race-day nutrition plan many times before the race day to reduce the chance of GI symptoms from occurring
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How Do YOU Experience Pain?

Pain is a distressing experience associated with actual or potential tissue damage with sensory, emotional, cognitive, and social components (Williams & Craig, 2016).

Positive pain refers to non-injury pain that is exertional and related to reappraisal, whereas, negative pain is injury and damage-causing pain that is associated with catastrophizing. Catastrophisizing include feelings of hopelessness, inability to cope with situation, or ruminating on pain and injury, all of which may lead to avoidance behaviours that increase the risk of injury.  Negative pain is potentially correlated to neuromuscular deficits such as Achilles tendinopathy which reduces muscular endurance or meniscal tears which lower muscle activation. It can delay or prevent return to a sport or possibly lead to chronic pain development (McDougall, 2017).
Elite athletes are able to withstand higher levels of pain and make better use of pain in performing well in their sport.
What can you do to better cope with pain?

1) Education: better knowledge of pain and ways to reduce pain or anxiety

2) Goal Setting: specific, measurable goals that provides direction

3) Imagery: a method used in a rehabilitation setting to reduce stress hormones by anticipating pain 
4) Graded Exposure: exposing oneself to fearful situations to show no more harm


5) Social Support: increase support from family, friends, and teammates

6) Relaxation: reduce tension and anxiety with deep breathing and low-intensity activities
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How Can Flat Feet Lead to Poor Posture?

Prolonged sitting in front of a computer, in a car, or at a desk can result in poor posture habits that ultimately cause a wide range of problems such as chronic back or neck pain.

Flat feet is a key risk factor for poor posture. This foot condition can be caused by genetic factors, weak arches, injuries, arthritis, tendon ruptures, or poor footwear. It occurs when there is a collapse in the foot arch which causes the feet to overpronate, or roll inwards. This places high stress loads to the ankles, knees, hips, and lower back, which lead to pain and stiffness throughout the body.

A few tips to keep the body in alignment is to bring your shoulders down and away from your ears to not hunch the upper back. Evenly distribute your body weight to the front, sides, and back of the feet. Remember to take frequent breaks during long periods of sitting or staring at a screen. Lastly, proper footwear or orthotics, and strengthening or stretching of the deep neck flexors, trapezius muscle, abdominal muscles, and hip muscles may help correct poor posture.  
Watch the videos below for some quick and easy exercises to help alleviate pain and strengthen muscles for good posture:

Chronic Neck, Shoulder, Elbow Pain or Stiffness: Ulnar Nerve Flossing

Strengthening Hips, Pelvis and Low Back: “Psoas March”

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Do I Actually Have Tendinitis?

The term “tendinitis” is frequently used by injured individuals, family practitioners, and medical specialists. Commonly present in the Achilles, lateral elbow, and rotator cuff tendons, many still believe that there is a large inflammatory component in overuse tendinitis and anti-inflammatory medication can be used to treat this condition.

According to Assistant Professor Khan of the Department of Family Practice at the University of British Columbia (2002), “ten of 11 readily available sports medicine texts specifically recommend non-steroidal anti-inflammatory drugs for treating painful conditions like Achilles and patellar tendinitis despite the lack of a biological rationale or clinical evidence for this approach.”

Patients who present with a painful overuse tendon condition more likely have a non-inflammatory pathology. Studies have revealed that the cause of tendon pain arises from collagen separation. Collagen is the main structural protein found in connective tissues. When these tendon fibrils become thin, frayed, and fragile, they begin to separate and become disrupted in cross section. This leads to an increase in tendon repair cells rather than inflammatory cells.

There is limited evidence of short term pain relief and no clear evidence of effectiveness when relying on anti-inflammatory medications. A more appropriate term would be to use “tendinopathy” to acknowledge that the overuse condition is not in fact tendinitis. Correctly utilizing this term provides patients with a more accurate description of their condition, prevent ineffective pharmacotherapy, avoid medical costs, and allow time for collagen to repair. Tendon disorders realistically take months rather than weeks to resolve. Allow time for rest and slowly incorporate exercises for area of concern. See a physiotherapist for proper diagnosis and treatment options.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122566/

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5 Exercises for Stronger Scapulas

Weak scapular muscles can lead to an array of injuries including shoulder impingement, rotator cuff tears, and other shoulder-related pains. Pain may be followed by a restricted range of motion and may severely worsen if left untreated. Strengthening the scapular muscles can provide long-term benefits for rehabilitation and performance. Try the five following exercises below:

LYING DUMBBELL PRESS:

1. Lie down flat on a bench with a light dumbbell in each hand.

2. Hold the dumbbells on either side of your chest with the palms facing away from your shoulders and your elbow at a 90 degree angle.

3. Push your arms upwards and feel your shoulder blades separate. Remember to keep the dumbbells parallel to each other until the very top of the press.

3. Inhale and slowly bring down both dumbbells to the sides of your chest until you reach the 90 degree angle at the elbow. Breathe out on your next rep. Perform 3 sets of 10 reps.

WALL PUSHUP:

1. Stand a few steps away from a wall, then place your hands on the wall so that they are slightly more than shoulder-width apart and arms are locked out.

2. Maintain a neutral back and neck, then slowly lean towards the wall by bending your elbow.

3. Squeeze your shoulder blades together as you lower yourself and hold this forward position for 2-3 seconds.

4. Slowly straighten your arm and relax your shoulder blades. Repeat 10 times.

BAND PULL APARTS:

1. In a comfortable standing position, hold a light band in between both hands about shoulder-width apart.

2. Pull the band as wide as you can, then slowly bring the arms back to the starting position. Perform 3 sets of 10 reps.

Y-RAISES:

1. Lie on your stomach on a bench or Swiss ball with a light dumbbell in each hand.

2. Straighten your arms so that the dumbbell is in front of your head.

3. Lift the dumbbells up, keeping your arms straight, to make a “Y” shape with your torso.

4. Slowly lower them down. Perform 3 sets of 10 reps.

ISOMETRIC DUMBBELL HOLDS:

1. Hold a very light dumbbell straight in front of you at approximately 45 degree angle.

2. Maintain this position for about 10 seconds.

3. Then, slowly lower the dumbbell to the side of your body. Perform 10 holds on each side.

BONUS: Watch this video to learn an extra exercise for the scapula muscles!

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