Low back pain…make your glutes your best friend !

Low back pain is amongst the most common injuries seen in Physiotherapy.

Some of the causes can be directly located in your spine (disc, vertebrae, nerve, etc) but lets not forget that the spine movements are also influenced by your pelvis/hips.

When actions of the spine are not accompanied by correct movement in the rest of the body, the spine and its surrounding muscles have to take up the slack and may become overworked and injured.

The glutes (maximus, medius and minimus) are the primary controller of movements in our hips and thighs and also play an important role in the stabilisation of the pelvis and support of the low back.

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The Glute Medius and Minimus are in charge of the stabilization while the Glute Max is our powerhouse.

If you have lower back pain or your back feels tight frequently, then you are probably overusing your movers while your stabilizers are taking a break. It’s time to wake them up!


But wait…am i really using my stabilizers during a squat…?

Did you know your body can actually switch on the wrong muscles because the correct ones are weak or inactive?  This is most common in our glutes and can be the reason for lower back pain, muscle spasms, and even nerve pain.

If your glutes are weak or inactive they cannot hold your pelvis in the right position or help maintain correct alignment.

How to start your glute awakening:

The basic process requires you to re-establish and strengthen neural signalling pathways that will correctly route the signals from your brain to the target muscle, and cause it to activate or ‘fire’ as it is supposed to.

This means that in the following exercises you must perform quality repetitions over quantity. This can and will take a surprising amount of concentration – but take the time to set up and focus your mind before each repetition.

Who doesn’t like brain teasers !

Release

Make sure your glutes have the optimal environment to be activated.  Your hips and pelvis should be in a neutral position and the surrounding muscles should the relaxed to avoid excessive tension.

Start by releasing your hamstring, hip flexors and buttock.

You can use a foam roller or a trigger point ball lying on the ground or against the wall.

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Palpate, feel and visualize :

In the first stage of reactivating your glutes, you’ll be focusing on trying to feel the glute muscles working and actually getting them to fire correctly. This is also known as your mind-muscle connection.

From a standing position, place fingers on each side of your butt cheeks and attempt to contract the glutes by imaging squeezing your butt cheeks together (this may sound funny but picture yourself holding a fart or holding a pencil slotted between your butt cheeks !)

You should be able to feel a glute contraction without tucking your pelvis or locking your quadriceps/hamstrings into a straight leg.

Once you get more practiced with this exercise, try to increase your level of control to be able to activate one side of your glutes at a time.

Isolate :

Tried to recruit your glutes in a bridge position without contracting your hamstrings.

You should be able to recruit your core to stabilize the pelvis, squeeze your glutes, without any pelvic tilt, and then push through your heels to lift your buttock without gripping your legs (hamstring compensation).

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Integrate:

Now that you are able to activate, feel that your glutes are being recruited without any surrounding muscle, you are able to integrate them in your favorite glute exercises : bridge, squat, leg lift etc.

This can be very challenging, so don’t hesitate to book with one of our physiotherapist to guide you through the proper process of glute activation without cheating.

 Stay tuned for a full glute strength program. Work on activation first then build strength in the right place.

 

Exercises for Pre and Post Pregnancy Issues and Meet the Expert.

Following our educational piece on Women's Health and Peri Natal Care we have been asked about common exercises and where to reach out to for further help. So here are some common exercises for some of the previously mentioned issues. But please, if your issues are more complex consult before trying these.

 

Pelvic Floor Strengthening

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Strengthening Core with Diastasis

 

Core Strengthening

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Meet the Expert

Jacquie Williams

Physiotherapist - Walnut Grove

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Jacquie graduated from UBC with a Master’s degree in Physical Therapy. Providing evidence based techniques in manual therapy, exercise prescription, and education, Jacquie believes it is important to empower clients with the tools and knowledge for the most effective treatment of any injury.

Jacquie has work in private clinics throughout the Lower Mainland. She treats all orthopedic conditions with a strong focus on manual therapy techniques. Jacquie also specializes in Women’s Health Physiotherapy. This includes peri-natal care, pelvic floor dysfunction and incontinence, and pelvis organ prolapse. Jacquie is a Registered Yoga Teacher and a Level 1 Hypopressives instructor.

For questions or appointments with Jacquie call 604 881 2002 or go to our website at www.physiofocus.ca.

 

Women's Health and Peri-Natal Care. The Role of Physiotherapy.

 

Women’s Health Physiotherapy is a specialized area of treatment that aims to address issues caused by pregnancy and child delivery. During pregnancy and delivery the body undergoes huge changes and this causes muscles, ligaments and connective tissue to stretch and deactivate, creating a difficult situation for women to create stability around there spine and pelvic girdle and difficulty maintaining normal pelvic functions. 

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Several common problems occur:

  • Diastasis rectus abdominus - where the abdominals separate  in the midline. 
  • Deep Abdominal and Pelvic Floor Dysfunction - this results in low back, pelvis and pubic symphysis pain. 
  • Urinary Incontinence or Prolapse - often as a result of sports associated with mild impact such as running or jumping. This is generally a result of your pelvic floor and muscles supporting your pelvic floor being stretched or torn. 
  • peri-natal or postnatal related musculoskeletal changes/impairments - physiotherapy manual therapy techniques are used to treat a variety of muscle, joint, ligament and postural issues associated with changes during pregnancy and child delivery. 
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The human body is amazing at functioning with the changing forces on it at pregnancy progresses and coping with the stress of childbirth. There are however several situations where help is needed to restore normal function and help women return to a pain-free active lifestyle.

If you need help with any of the above issues call the clinic in Walnut Grove at 604 881 2002 and ask for our Womens Health Physiotherapists Jacquie Williams. If you want to know more about Jacquie visit our Website at www.physiofocus.ca

Exercises to Help with Vertigo and Meet our Vertigo Specialist Rosanne Molnar

We have had lots of questions following our last article on Vertigo. Mainly more ideas for exercises and asking who is the best person in our team to see for this condition. 

The common exercises used to treat Benign Paroxysmal Positional Vertigo (BPPV) are:

  • Epley Maneuver
  • Gaze Stabilization
  • Brandt Daroff
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If you are having any of these issues our Walnut Grove Physiotherapist Rosanne Molnar is a specialist in this area. Meet Rosanne.

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Rosanne Molnar graduated in 2009 from the University of Alberta with a Master of Science
in Physical Therapy after completing a Bachelor’s degree in Kinesiology in 2005 from the
University of the Fraser Valley. She has continued her education with courses that include
level I and level II (lower extremity) of her manual therapy qualifications with the
Canadian Orthopedic Division Diploma of Advanced Orthopedic Manual and Manipulative
Physiotherapy, Vestibular Therapy (BPPV) and Graded Motor Imagery. Rosanne is an avid
leaner who is constantly updating her skills.
She has experience treating clients following motor vehicle accidents (ICBC), work related
injuries (WSBC) as well as most orthopedic conditions (strains, sprains, post-fracture).
With a straight forward and positive approach, Rosanne uses a variety of treatments which
include soft tissue release, mobilizations and exercise to help you return to your optimal health.

To speak to Rosanne or book an appointment please call 604 881 2002 or go to our website at www.physiofocus.ca

Vertigo. Why do I think I'm Spinning and How Physiotherapy Can Help.

Vertigo is a a condition commonly characterized by dizziness or the sensation of objects spinning around you. 

By far the most common type of vertigo is Benign Paroxysmal Positional Vertigo (BPPV) which is a problem with the inner ear. In this condition intense short periods of dizziness are associated with changes to the position of the head. This is due to calcium deposits, that are dislodged from the inner ear, blocking the flow of fluid through the semicircular canals in the inner ear. The normal flow of fluid in the canals is responsible for balance, and when this flow is disrupted, dizziness and the sensation of the room spinning happens. 

 

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Although movement of the head causes dizziness, physiotherapist have techniques where the fast and specific movement of the head is used to quickly move the fluid through the canals and unblock the calcium deposits. 

There are several techniques used but the most common are:

  • Elpey Maneuver
  • Dix Hallpike Maneuver
  • Brandt Daroff
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It is important to consult with a physiotherapist with advanced training on dealing with vertigo or vestibular issues. Specialized testing of balance issues is important to rule out other causes of vertigo and get a treatment that is tailored to the patient. Physiofocus Walnut Grove is fortunate to have Physiotherapist Rosanne Molnar on our team who has a specialization in this area. 

Check out www.physiofocus.ca or call 604 881 2002 for more information on Rosanne and how you can book to get rid of your issues with vertigo or any other aches and pain you may have. 

Have a great day.

Do you have Bad Posture?.... Feel Better with these Exercises

Postural pain is extremely common but most people don't know how to go about treating there pain.

Postural dysfunction or “Poor” posture is defined as when our spine is positioned in unnatural positions, in which the curves, or lack of,  are emphasised. Therefore the joints, muscles and vertebrae being in stressful positions. Poor posture longterm results in a build up of pressure on these tissues, causing pain and lack of function.

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Common causes of postural pain

  • Lack of education or awareness of correct posture
  • Sedentary lifestyle
  • Occupational demands
  • Joint stiffness
  • Decreased fitness
  • Muscle weakness
  • Muscle tightness
  • Poor core stability
  • Poor ergonomic work-stations

Physiotherapy uses the following techniques to treat postural pain

  • Assessment of postural deficincies
  • Postural education and training
  • Manual therapy 
  • muscle release/ massage
  • Postural taping
  • Joint mobilisation
  • Exercises to treat muscle weakness and lengthen tight muscles

Here are some exercises for neck and thoracic spine postural pain. 

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If you need more specific help with these exercises or need hands on treatment to help alleviate your postural pain and get you on track please call us at Physiofocus, 604 881 2002, or book online at www.physiofocus.ca

Enjoy your day

Heel Pain....Do you have Plantar Fasciitis?

Plantar fasciitis is pain that occurs underneath the heel at the point where your plantar fascia connects onto your heel bone

The plantar fascia is a tough fascial tissue that runs under your foot and has several functions in the foot during walking and running such as load distribution and maintaining stability. 

People will commonly describe:

  • Pain under the heel of the foot usually described as “sharp and achy”
  • Difficulty walking long distances or running
  • Worse pain in the morning when taking the first few steps out of bed or after a long period of rest

Plantar fasciitis occurs in approximately 10% of people who run regularly. Those at most risk are:

  • People between the ages of 40 and 60,
  • Those with “flat feet”
  • Obesity
  • People who spend a prolonged time standing on hard surfaces
  • people with joint tightness issues in their feet

Exercise is one of the primary forms of treatment along with hands on physiotherapy for lengthen the plantar fascia and maintain normal movement on the feet. Here are some ideas on how to treat plantar fasciitis with exercise. If you need more help treating this problem please go to www.physiofocus to book an appointment.

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Do you have Osteoarthritis in your knees but not ready for a Knee Replacement?? Have you heard of Hyaluronic Acid??

Knees contain synovial fluid, which is responsible for

  • absorbing shock
  • lubricating the knee joint
  • anti inflammatory effect

Changes in synovial fluid and  joint degeneration can lead to Osteoarthritis in the knee joint.

Hyaluronic acid (synvisc, cingal, viscosupplements) is a major component of synovial fluid and can provide relief from OA knees with a single use injection. Combine this with physiotherapy, exercise prescription and lifestyle changes and osteoarthritis can be well managed. 

We can help....

Dr Rose Martel (sports medicine) is the person to ask.......

http://physiofocussquamish.com/physiotherapists/

 

 

 

 

Great Article on Return to Sport after ACL Repair in Young People

http://trustmephysiotherapy.com/return-sport-following-acl-reconstruction-young-athletes/

October 28, 2016

Return to Sport Following ACL Reconstruction in Young Athletes

Again a great blog by Mick Hughes about ACL rehabilitation! 
This time, he explains the research on the return to sport decision in young athletes under 20 years old.
Should we really wait for 2 years for our young athletes to return to sports?

Mick Hughes is the head Physiotherapist of the Collingwood Magpies Netball team and shares his time between Collingwood and The Melbourne Sports Medicine Centre.

He is a keen blogger and posts regularly on sports physio and strength and conditioning topics. You can check out his website, which you can find some of his previous blogs.
And he is very active on social media and can be found at Facebook , Twitter: @mickwhughes and Instagram: @mickhughesphysio.

 

I wrote a blog recently called When can I return to sport after ACL surgery?.
It summarised two recent articles by Grindem et al (2016) and Krytsis et al (2016) that both clearly showed a reduction in ACL re-injury risk in elite adult athletes who waited at least 9 months, and passed a battery of strength and functional tests prior to being cleared to return to sport (RTS). To reiterate the above literature; waiting at least 9 months, being within 10% of the uninjured limb on a number of different strength and hop tasks, performing an agility T-test under 11 seconds and performing sport-specific conditioning at training, significantly reduced the athlete’s risk of re-injuring their ACL upon RTS.

This blog however will be a little different as I wanted to explore some worrying trends in the literature that suggest we should be more conservative with our RTS planning in our younger athletes who have had ACL reconstructive surgery – specifically those athletes under the age of 20.

I recently attended the annual Sports Medicine Australia (SMA) Conference here in Melbourne and was lucky enough to sit down and listen to some world experts in the field of sports medicine and sports physiotherapy. Two people in particular, Tim Hewett and Kate Webster, really grabbed my attention with their research and insight into the world of ACL injury.

And unfortunately that world is very bleak…

 

I’ll cut straight to the chase.

One study they discussed showed that 30% of young people (mean age 17) who RTS following ACL reconstruction will sustain a 2nd ACL injury within 2 years (1). Of this 30%, females were 5x more likely to do so than males.

And before you say, “C’mon Mick, don’t jump at shadows. This is just one study”.

This research wasn’t alone…

In a further review of the literature I started to find a depressing trend:

  • 25% of subjects (n= 16, mean age 16 years) sustained a 2nd ACL injury within 12 months upon RTS following ACL surgery; with 14 (87%) being female and 12 (75%) sustaining a 2nd injury to the contra-lateral knee. The authors conclusion was that, in this cohort of young athletes, those that RTS were 15x more likely to sustain a 2nd ACL injury within 12 months (2).
  • 29% of patients under 20 years of age (32/110) sustained a 2nd ACL injury within 3 years (3). To put this in perspective, only 8% (35/451) of the subjects aged over 20 years of age in this study sustained a 2nd ACL injury within the 3 year follow up period.
  • 23% of subjects (13/56, mean age 16 years) sustained a 2nd ACL injury within 12 months following RTS (4).

With such a concerning trend of 2nd ACL injuries within the first 2-3 years following a RTS, it has lead some researchers, including Tim Hewett (Nagelli & Hewett, 2016) (6), to pose the question:

“Should we be waiting 2 years to allow our younger athletes (<20 years of age) to return to sport?”.

Nagelli & Hewett wrote their paper based on the current ACL literature and make some very valid points. If we are to look purely at biological and physiological healing, the research is telling us that it can take up to 2 years to achieve baseline knee health (ie. full maturation of the ACL graft, resolution of bone bruises), restoration of knee joint position sense (proprioception/balance), restoration of neuromuscular control and restoration of knee strength following ACL reconstruction.

 

Although Nagelli & Hewett make a very good argument to delay sport for 2 years, we are all going to have a very difficult time explaining to a 17 year old, their coach and their parents that we need to wait 2 years before we allow them to RTS. This would be an even more difficult discussion, especially if the young athlete is at a critical stage of their early sporting career and the opportunity for a professional sporting contract is on the horizon.

But what I feel often goes missing in the literature on 2nd ACL injuries are the 3 things that are critical to a successful RTS following ACL reconstruction:

1) Was the patient compliant to the ENTIRE rehab plan as set out by their physio, exercise physiologist or strength and conditioning coach?

2) Did the rehabilitation plan include a period of supervised jumping, landing, pivoting, unanticipated change of direction, unanticipated landing and sports specific conditioning?

3) Was the athlete cleared to RTS with strength tests and functional hop tests prior to stepping back on the field/court? And were these tests also passed in a fatigued state?

My gut instinct tells me that these 3 things are not frequently ticked off prior to the patient returning to sport, and I have no doubt that the absence of these 3 criteria plays a significantly role in the high rates of 2nd ACL injuries that we see in the literature.

And there was some preliminary research presented that supports my gut…

Jay Ebert and colleagues from Hollywood Functional Rehabilitation Clinic (Perth, WA) presented some nice (unpublished) data on post-op ACL rehabilitation in a community setting of non-elite athletes. They reported that of the 111 ACL reconstructed patients in their study, 9% DID NOT attend ANY supervised physiotherapy within 12 months, 45% did not attended supervised exercise after 3 months, and only 30% of patients actually performed jumping, landing and agility training as part of their rehab.

Furthermore, they also looked at the quality of rehab and it’s influence on functional outcome measures (the same quads/hamstring strength and hop tests that Grindem et al & Krytsis et al used).

They found that of the 55% of patients who conducted at least 6 months of supervised rehabilitation/physiotherapy, they were all able to achieve 90% or greater limb symmetry on strength and hop tests at the 12 month follow-up mark. Furthermore those that completed supervised training longer than 6 months and/or completed high level training drills such as jumping and landing, were all close to achieving full limb symmetry between operated and non-operated limbs. This lead the authors to conclude that the higher quality of the rehabilitation, resulted in superior post-operative functional outcomes.

 

 

Conclusion

I think 2 years may be an ultra-conservative RTS timeframe for young athletes, but the evidence for biological healing is very hard to ignore. What us health professionals really need to be explaining to our young patients who wish to return to sports that involve hard landing, cutting and pivoting, are the following key points:

  • Up to 30% of people under the age of 20 will go on to sustain a 2nd ACL injury within 2 years upon to RTS. We can’t shy away from the statistics, and we need to try as best as we can not to allow the patient sitting in front of us to become another statistic of 2nd ACL injury!!
  • Surgery is only 50% of the rehabilitation plan. Surgery only restores mechanical/anatomical stability of the knee. It does not restore functional deficits of the knee; some of which may have been present prior to the primary injury (ie. dynamic knee valgus, poor trunk control, abnormal quad to hamstrings ratio).
  • The better the quality rehabilitation (ie. one that includes regular jump, landing, agility training), the more likely the patient will achieve post-operative limb symmetry on strength, hop and agility tests. As a result, the patient will have a significantly reduced chance of 2nd ACL injury.
  • The decision to allow unrestricted training and RTS should be based on an orthopedic assessment, time (at least 9 months post-op) AND a battery of strength and functional tests. The tests must include quads and hamstrings strength tests, hop tests and agility tests and the athlete must achieve at least 90% symmetry between limbs on all tests prior to RTS clearance. In my very humble opinion, we should be aiming to get close to 100% on all tests in both fresh and fatigued states.
  • With the very high rates of contra-lateral injuries, as much as possible, rehabilitation drills need to be performed unilaterally.
  • For better functional outcomes in non-professional athletes, a supervised physiotherapy/strength and conditioning/sports-specific training plan needs to be conducted for at least 12 months prior to returning to sport.
  • Once back playing sport, the patient should be conducting at least 2x per week ACL injury prevention drills (ie. PEP, FIFA 11, KNEE) for the remainder of their sporting career to reduce the risk of 2nd ACL injury.

I hope you have enjoyed this summary of recent evidence. As always, please share this blog with colleagues, other health professionals, patients, coaches, parents, family and friends. The more people are on board with this evidence, I firmly believe that we will start to see declining ACL injury rates, 2nd ACL injury rates and an overall improvement in individual and team performances on the field.

The Bosu Ball is Dead to Me......Snowboarders now have a Balance Rehab Tool

We got one of these in the clinic for our snowboard patients. Perfect for rehab for ligament injuries in the lower body in order to retrain proprioception, or balance perception. Is also good for general snowboard specific strengthening. 15 minutes jumping around on this thing and you are completely gased out. I couldnt look at bosu ball or wobble board anymore.....this is too much fun.