Category Archives for "physiotherapy"

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.


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

Diana in Europe!

Diana, who works front desk at both the Burnaby and Cambie InSync Physio clinics, recently returned from her trip to Europe! Diana and her dragon boat team, Dragon Zone Premier, had the opportunity to compete at the 2018 Club Crew World Championships in Szeged, Hungary as one of the five Premier teams representing Canada. Her team placed 6th overall in the world with 48.803s in the 200m Mixed Premier Standard Boat Grand Final, 5th overall in the world in 500m Mixed Premier Standard Boat Grand Final, and 4th overall in the world in the 2km Premier Mixed Standard Boat Final. 

Following her competition, Diana got to see the beautiful emerald waters of Plitvice National Park, hidden blue caves near the island of Hvar, and the historical city walls of Dubrovnik, Croatia. 

Diana also got to explore the ruins of Pompeii as well as the Roman Forum and Colosseum in Rome, Italy.

One of her highlights was seeing the rows of colourful houses on the island of Burano and watching a talented glassmaker create a horse made of glass on the island of Murano, Italy. 

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

5 Strengthening Exercises for Dancers

Overuse injuries are commonly found in dancers due to their intense training regimes. Nearly 60 to 90% of dancers experience an injury or multiple injuries during their careers (Steinberg, Siev-Ner, Peleg, et al., 2013). These injuries include chrondromalacia patella (“runner’s knee”), Achilles tendinopathy, and metatarsal (foot) fractures. Some major causes of injury may be due to anatomic structure, genetics, training regime, improper technique, floor surfaces, age, body mass index, muscle imbalance, nutrition, and menstrual function (Steinberg et al., 2013).

Dance typically includes being on the toes and forefoot in a extreme plantar flexion position, known as “en pointe.” Individuals with poor balance and landing techniques will experience higher ground reaction forces which may subsequently strain the back, knees, and ankles. Incorrect form in many non-professional dancers entail a valgus knee position (knees caved inwards) and hip adduction. Conversely, mature, experienced dancers are able to rely on stronger hip and knee joint muscles to stabilize themselves during landing from jumps. Young dancers also experience lower back pain. Causative factors include high preseason training intensity, history of low back pain, low body weight, scoliosis, and stress fracture in the pars articularis of the spine (Steinberg et al., 2013).

Studies have recommended minimal exposure for young dancers to overload exercises, especially those involving the spine and caution with extensive stretching exercises (Steinberg et al., 2013).

Prevention

Here are a few essential tips to reduce the risk of injury:

  • Wear proper footwear and clothing
  • Drink fluids regularly
  • Do not dance through pain as it will exacerbate the damage
  • Practice correct dance technique 
  • Take adequate breaks during and between dance sessions
  • Ensure proper warm-up and cool-down (approximately 5-10 minutes)
  • Use preventative taping and/or braces if necessary

Strengthening

1) Woodchops – hold a light dumbbell or single cable in the highest pulley position with both hands and bring the weight downwards diagonally to the side of the leg opposite to the starting position. Remember to keep a flat back and tight core through out the motion. Repeat 8 to 12 reps on each side.
2) Lateral Step Downs – stand beside a step or a box, then place one foot on the step. Lift the other leg upwards by bending the knee to 90 degrees. Then bring the foot back down to the ground. Repeat 8 to 12 reps before switching sides. 
3) Core Stability – place your stomach onto a ball and keep the spine in a neutral position. Keep the inner core muscles engaged and reach one arm up in front with the opposite leg extended back. Hold for 3 to 5 seconds before switching sides. Repeat 10 times on each side.
4) Superman Deadlifts – hold a light dumbbell to the same side as the leg that will be extended back on. With a nice tall posture, engage the core and bend forward at the hips while you extend the leg back and reach forward with the opposite arm. Repeat 10 times on each side.
5) Squat Jumps – start with a tall posture, engage the core muscles by drawing the lower ab muscles inward toward the spine. Avoid arching the low back, with arms in a ready position, do a one-legged squat with the body weight equally distributed over the foot. Lower the body downwards by bending at the knees, then jump straight back upwards by engaging your glute and thigh muscles. Repeat 10 to 15 times for 3 sets.

Steinberg, N., Siev-Ner, I., Peleg, S., Dar, G., Masharawi, Y., Zeev, A., & Hershkovitz, I. (2013). Injuries in Female Dancers Aged 8 to 16 Years. Journal of Athletic Training48(1), 118–123. http://doi.org/10.4085/1062-6050-48.1.06
InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.

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:

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

Which is Better for an Injury: Ice or Heat?

Ever wondered whether to use ice or heat for your sore muscles, your healing fracture, or any injury? Both ice and heat have been commonly used to treat an array of injuries, but when to use either one is critical in preventing further damage and promoting faster recovery.

Acute irritation or inflammation of a muscle, ligament, or tendon is typically treated with ice. The cold application reduces inflammation and numbs the pain, especially when the superficial tissues are red, hot, and swollen. The inflammatory response associated with damage to tissues is a defence mechanism in the human body that lasts for the first several days to protect against infection. The response involves immediate changes to blood flow, increased permeability of blood vessels, and flow of white blood cells to the affected site.

ICE APPLICATION

Ice can be used for gout flare-ups, headaches, sprains, and strains. It is crucial to apply ice to the site of injury during the first 48 hours post-injury to minimize swelling. For soft tissue injuries such as muscle strains or ligament sprains, an ice massage involving elevation of the injured body part above the heart and circular movement of an ice pack around the affected area may promote faster recovery of these acute injuries. Apply for 10 minutes at a time, then take a break from icing for another 10 minutes. Repeat this process 3 to 5 times a day. Remember to wrap the ice pack in a dry cloth or towel.

HEAT APPLICATION

Heat can also be used for headaches, sprains, and strains as well as arthritis or tendinosis. Heat causes blood vessels to dilate which increases blood flow and relaxes tight or stiff muscles and joints. Do not use heat during the initial inflammatory response as this will further aggravate the site of injury. For minor injuries, applying heat for 15 to 20 minutes at a time may be sufficient to relieve tension. However, longer periods of heat application such as 30 minutes to an hour may be required for major chronic injuries. Hot baths, steamed towels, or moist heating packs can be used as different heat options.

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

How to Prevent Elbow Injuries in Young Throwers

Recent research has shown that nearly 40% of 7 to 18 year old baseball players endure elbow and shoulder pain during their baseball season. Nearly half of these injured players report their ongoing participation despite having pain. A recent epidemiological study of ulnar collateral ligament (UCL) injuries in athletes 17 to 20 years old reported the number of UCL reconstructions has increased dramatically for this age group. Early education and detection of elbow injuries in throwing sports may help reduce the number of overuse injuries from developing.

Symptoms

“Little league elbow,” or known as medial epicondyle apophysitis, is most commonly found in young throwers. Sports such as baseball, softball, tennis, or golf, can result in this overuse injury to the growth plate on the inside of the elbow. Repeated stress to the growth plates may cause inflammation and lead to pain or swelling. Serious injury may even result in separation of the growth plate from the rest of the bone. Players may also experience a reduced range of motion and a decreased ability to throw hard or far. A child experiencing any symptoms involving their arm should cease activity and see a pediatric specialist or their family physician. X-rays may be required to determine the extent of damage.

Prevention

Prevention begins with identifying causative factors early in the season and adhering to strict guidelines such as the pitch count for young players and the duration of participation in a given year. Total body conditioning that involves strengthening the hip, back, and legs may help reduce the strain on the athlete’s arms. See below for exercises on how to stretch and strengthen the forearm.

Playing in a variety of sports rather than engaging in one particular sport, known as early sports specialization, may promote athletic dexterity and minimize risk of overuse injury.

Treatment

Partial UCL ruptures can be successfully treated with nonsurgical treatment. However, with or without surgery, players must cease any throwing activity prior to undergoing an organized throwing rehabilitation protocol to reduce the risk of further progressing the injury. Promoting mental health is also important in the young athlete’s recovery period. Preventing the athlete from participating in their sport may result in significant psychosocial trauma. Therefore, special attention to the athlete and feelings of sadness or depression should be addressed with coping strategies.
Watch the video below on how to perform “nerve flossing” for chronic neck, shoulder, elbow pain or stiffness:

Watch the video below on how to warm up properly before games or training to prevent injuries and perform better:


References:
https://www.breakthroughpt.com/wp-content/uploads/2018/05/Reducing-Elbow-Injuries_jospt.2018.0607.pdf

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

Building a Stronger Core to Prevent Low Back Pain

Up to 80% of individuals will experience some lower back pain at least once in their lifetime. Lower back pain (LBP) results in high costs and places a burden on society. These costs include diagnostic, treatment, and indirect costs associated with work disability. A number of conditions can lead to low back pain such as infections, tumours, fractures or dislocations of the spine. However, lifting heavy loads is generally thought to be a key predictor of LBP. An important element in prevention of LBP is to correctly stabilize the trunk during lifting by pre-activating the abdominal wall muscles. By doing so, the spine will increase in stiffness to reduce the effect of undesired spinal perturbations. Exercises aimed at bracing the abdominal muscles may reduce the risk of LBP.

There are two ways of stabilizing the abdominal muscles: an abdominal hollow or abdominal brace. An abdominal hollow begins by drawing in the lower abdomen (transversus abdominus) while maintaining relaxation of the other surrounding abdominal muscles such as the obliques. At the same time, small muscles of the lower back (close to the spine) such as the multifidus are contracted while the larger back muscles are relaxed. With contraction of the lower abdomen and small back muscles, intra-abdominal pressure is increased and the fascia surrounding the spine increases in tension. Combined, these contribute to provide intersegmental stability.

An abdominal brace is performed by activating all of the abdominal and lower back muscles, rather than specific muscle recruitment. By tensing the entire trunk without drawing the muscles in or pushing them out, global activation of the ab and back muscles may provide increased stability in all directions in various movement patterns.

Both the abdominal hollow and brace can help increase the stiffness of the spine to minimize lower back pain. The use of either one will depend on the desired movement pattern and the goals of the individuals in stabilizing their core. Strengthening the core muscles is also essential in reducing the amount of loading on the lower back muscles. Watch these videos below:

Back Pain, Lower Back Treatment “Building Core Strength”:

Back, Sacro-Iliac-Joint Pain & Dysfunction: Core Stability Foam Roller:

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

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

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

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:

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

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”

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