Exercise vs Pregnancy - The purpose of staying active during pregnancy

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Latest Canadian research on physical activity throughout pregnancy has been able to update the

previous recommendations and guidelines that were previously established 15 years ago. As of the new

researches, prenatal physical activity should be considered a front line therapy for reducing the risk of

pregnancy complications and enhancing maternal physical and mental health.

The new Canadian guideline includes six recommendations; including pregnant women should

get at least 150 minutes of moderate-intensity exercise each week.

Canadian Guideline recommendations:

1. All women without contraindication should be physically active throughout pregnancy

2. Pregnant women should accumulate at least 150 minutes of moderate-intensity physical

activity each week

3. Physical activity should be accumulated over a minimum of three days per week.

However, being active everyday is encouraged

4. Pregnant women should incorporate a variety of aerobic exercise and resistance

training activities to achieve greater benefits.

5. Pelvic floor muscle training (e.g. Kegel exercises) may be performed on a daily basis to

reduce the risk of urinary incontinence.

6. Pregnant women who experience light-headedness, experience nausea, or feel unwell

when they exercise flat on their back should modify their exercise position to avoid the

supine position.

Evidence has found that aerobic and resistance activities are safe for the baby and are not

associated with miss carriage, foetal complication, small baby and preterm birth. It is not only

safe during pregnancy, but is also beneficial in preventing childbirth complications and providing

significant postpartum health benefits.

Prenatal physical activity has potential lifelong health benefits for both, the mother and the child.

It also helps to reduce major complications of pregnancy by 40%, and on long-term

consequences, it helps to reduce cardio vascular disease and hypertension.

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A smart jump into an active lifestyle is recommended for women who were fairly sedentary prior

to being pregnant. Starting with small and attainable objectives like 50min exercise/week can be a

good starting point for those who were inactive.

The most important is to listen to your body and to not push it too much. Specific prenatal workout exists.

Educated trainers can help pregnant women and teach them how to adapt exercises and

modify their training so they can train properly with a changing body.

Modifications to consider while training during your pregnancy:

  • Minimize or avoid high impact exercises (ex : jumping )

  • Avoid exercise that involves physical contact or danger of falling (ex: downhill skiing or

horseback riding)

  • Avoid scuba diving, exercising at a high altitude and in excessive heat

  • Modified Abdominal and CORE exercises

  • Involving the entire CORE unit instead of insulating one group of muscle. It will focus on

the body function and will help it to be ready to give birth.

Keep in mind! You are training for this intense physical activity which involves labour and

birth as your optimal goal. Good biomechanics of the pelvis also helps to facilitate labour and to minimize

complications. Ask your chiropractor what are the specific technics for pregnant women that help

to optimize the pelvis function.

Your sport focused and family chiropractor,

Dr. Valerie Brabant chiropractor, DC

Physiofocus Squamish

Climbing – Finger injury

Squamish is well known to have some of the most beautiful and accessible rock climbing in the world, therefore attracts the best climbing population. Training for competitive or recreational climbing involves dedication and discipline. Focussing on a balance lifestyle and training is recommended to perform in any kind of sports, including climbing. Too much of the climbing community participates as weekend warriors and don’t perform proper warm up before getting on the crag. In the list of the overuse climbing injuries, 40% of the injuries occur to the fingers. The flexor tendon pulley injury, well known as the climber’s finger, is being the most common injury of the upper extremity in the climbing population. It can range from microscopic to partial tears, and in the worst-case scenario, to complete rupture. 

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The pulley system is a series of annular and cruciate fibrous band. Most common injuries are at A2 and A4 pulley.

Pulley ruptures occur most commonly following falls with the hand in the crimp grip position. This position brings the tendon near a maximal contraction to resist body weight and creates the injury. Typically, patients will hear a loud pop in presence of a complete rupture, with a feeling of giving away of the proximal interphalangeal (PIP) joint. Severe pain is normally present at the base of the proximal phalanx and will be aggravated by the finger flexion against resistance. It can also be followed, several hours later, by swelling. Pain only present on the proximal phalange and palm area are indicative of flexor tenosynovitis, compared to a bowstringing injury where the flexor tendon appears to resist bending may be an indicator of a multiple pulley rupture.

Also, pulley rupture mostly occurs when there is already micro-damage accumulation. Allowing full recovery after more minor injuries may help reduce the incidence of pulley rupture. On the other hand, repetitive gripping and pulling without stretching, and failure to exercise the antagonist’s muscles, which are the extensor digitorum muscles, can lead to relative overdevelopment, contracture and reset of the functional length of these muscles.

Healing progression: 

Tendons and ligaments need time and progressive loading to heal compared to muscles. A gradual return to climbing is permitted when 80% of the prior strength and pain free motion is present. It usually takes a minimum of 6 weeks to reach that goal. A lower grade annular pulley injury typically heals in about 2-3 months, and after 4-6 months it can bear normal loads. 

The use of Non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of musculoskeletal injury has shown negative impact in recent studies. It reduces tenocyte and fibroblast proliferation as collagen formation, and therefore negatively affects tendons and ligaments healing. 

Factors modifying the load: 

  • Biomechanical: previous injuries and misalignment can relate to abnormal forces and abnormal motions. Make sure your grip technique, as your CORE and body position are efficient when you train or you climb.

  • Training: ongoing use of high absolute load magnitudes, rates and accelerations may reduce the body ability of adaptation to heal and even lead to micro-damage accumulation.

  • Muscle: When a muscle is dysfunctional (weakened, fatigued or altered in their activation patterns) its ability to attenuate loads becomes compromised.

  • Playing surface: some wall and holds require a higher load on the fingers and hands. After an injury, be smart on the progression and surface you are training or climbing on. 

Training/climbing tips: 

  • Restricted taping can be applied during training or climbing to limit hyperextension of the finger. It helps to take tension off the injured pulley. 

  • After a finger injury, isometric training on a fingerboard can be started once ROM exercises are painfree. A return to climbing can be initiated when the climber is able to avoid grip positions that produce pain.

  • Build up load on your tendon. Gradually use holds that involve more loading in your training as to build up weight resistance on your fingers. Full crimp and half crimp grips use up to 3 times more loading on the tendons and sheaths than an open hand. 

  • Take some rest days, depending of your body adaptation and training intensity. 

  • WARM UP! To do a proper warm up helps to lubricate the pulleys and to activate the muscles. 

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Here’s the key: Train smart and properly. 

There is a ton of climbing guides, trainers, coaches and health care providers that can help you achieve your goals. 

Dr Valerie Brabant, Chiropractor, Dc

PhysioFocus Squamish

Management of headache disorders

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Headache disorders are some of the most common disorders of the nervous system. The World Health Organization has estimated that prevalence among adults of current headache disorders (at least one within the last year) is about 50%. It can range from a light headache to a 10/10 pain. Headaches can have a major impact our daily living. They are classified by the International Classification of Headache Disorders (ICHD) and include 2 broad categories: Primary, when they are not the result of any other underlying disease or condition and Secondary, when there is a further underlying cause. 

Primary headaches:

Common primary headaches are migraine and tension-type headaches. Patients with migraines can feel different type of symptoms pattern. Most of the time, the presentation of the migraine has one side distribution. It can be pulsatile and accompanied by nausea and/or vomiting. The person may also have warning signs as aura or light and sound sensitivity. On the other hand, tension type headaches are typically related to muscle tension and are present with both side head pain characterized by a pressing or tightening sensation (e.g. band-like).

Secondary Headaches:

They are attributed to underlying clinical problems in the head or neck that may also be episodic or chronic. Cervicogenic headaches are common type of secondary headache encountered by chiropractors and can be attributed to a source of pain that originates in the neck. Reduced cervical range of motion, neck tenderness and trigger points that refer pain from the neck to the head can also be noticed. Secondary headaches could also be related to dehydration, medication side effect, sinus infection, concussion or other health conditions. 

From so many type of headache existing, it is important for the chiropractor to conduct a thorough assessment and to do a proper examination and diagnosis of the patient’s condition. Some person can present more than one type of headache and multiple associated symptoms. If so, each headache should be diagnosed separately and managed appropriately. 

The research literature shows that chiropractic care may be concurrent with pharmacological treatment or may provide an alternative to it. Spinal manipulation (defined as high velocity low amplitude thrusts delivered to the spine) is recommended for the management of patients with migraine or cervicogenic headaches. The selection, frequency, dosage and duration of treatment(s) will depend on the nature of the headaches. Treatment frequency may vary from 1-2x per week and following appointments can go up to 8 weeks. In addition, multimodal multidisciplinary interventions including massage, physiotherapy may benefit patients with migraine as joint mobilization or deep neck flexor exercises may improve symptoms of cervicogenic headaches.

In conclusion, chiropractors are expert of the spine, muscles and nervous system and use specific techniques to treat a specific person. It is not all patients that benefit from the same therapy in exactly the same manner. Most people will find relief from a combination of exercises, manual therapy and education of the origin of their problem. Also, a good way to keep track of headaches is by maintaining a diary. It helps to track the frequency, duration, intensity and evolution of the headaches. 

Other benefits of chiropractic care: 

- Improve movement in your neck, shoulders, back and torso

- Better posture

- Relief from headaches, neck and back pain

- Prevention of work-related muscle and joint injuries

- Enhanced athletic performance and manage sport injuries

- Improve flexibility

- Relief of pregnancy-related backache

- Correction of gait and foot problems


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From Squamish being the outdoor capital of Canada, it can be possible that one of your friend or even you have done, or will eventually do a concussion. So lets have a look to what it is, what are the results of it and what can we do to help it.

What is a concussion:  A concussion is often defined as representing the immediate and transient symptoms of traumatic brain injury. It can be from a direct as an indirect impact (whiplash) and can potentially produce a tear in the nuchal ligament. No matter what type of concussion, it is important to treat it.

Signs & Symptoms: They appear within the first 24 to 48h. Then, after a big mountain bike crash or a good whiplash falling from kite boarding, helmet or no helmet, the person concern must take precaution within the next days and must be aware of late symptom appearance. Cognitive and physical rest is required for the first 48h.

A concussion can result of many different type of symptoms such as physiological, cervical and occulo-vestibular symptoms.  Symptoms like cervical restriction, headache, dizziness, change of vision, fatigue, anxiety, and change in emotional behaviour, concentration and/or memory disorder can be noticed.

The brain itself can result of an increased energy demand and glucose consumption, an activation of the inflammatory process and a high level of cell Calcium. Even cell apoptosis as an axonal disruption can occur.  

When to go to the emergency? : If there is several vomiting episodes, suspected skull fracture, amnesia and alteration of consciousness state, symptoms in the extremities, increasing neck pain and headache, convulsion or double vision, it is important to go to the emergency and to have a proper medical follow-up.

Management: 80-90% of the concussions will heal within 7-10 days for adults and 4 weeks for children. Latest studies show that each concussion should be taking individually and that healing and activity should be following symptom tolerance. A graded exercise program at a level that does not exacerbate symptoms should be performed and no medication should be taken to take off symptoms (though, if necessary, Tylenol can be recommended for cervical pain).

Indeed, prolonged rest can have negative effects as doing too much to quickly. To completely rest until being symptom free is not appropriate. On the other hand, every time someone increases symptoms too much makes the healing process to last longer.When symptoms persists and recovery falls outside the expected window (ie, 10 days) it is recommended to be managed in a multidisciplinary manner by healthcare providers with experience in sport-related concussion, like chiropractors and physiotherapists.

What if I go back to my sport right away after a concussion?

Once a concussion has occurred the person becomes as much as 4 to 6 times more likely to sustain a second concussion. Suffering a second concussion while still having symptoms from a previous concussion can be lethal. We call it the second impact syndrome. It is a condition in which the brain swells rapidly and catastrophically after a person suffers a second concussion before symptoms from an earlier one have subsided.

In conclusion, your brain is important and taking the proper time for it to heal is smart. Go to your healthcare provider that has experience in sport-related concussion and if needed, medical specialist exist (neuro-optometrist, neuro-physchologist…)

Don’t forget:

  • We must always prioritize the return to school or to work before to sport

  • There is no miracle treatment.

  • Synonymous with concussion, dysfunction of the cervical spine may involve many type of symptoms and chiropractors are specialist in that field.

  • Studies show that manual therapy have a benefit effect in reducing post-traumatic headache

  • Progressive return to school, work and to sport is required

Have fun on the mountains.        

Your sport focused and family chiropractor,

Dr. Valerie Brabant Chiropractor, DC.

Physiofocus Squamish

For appointments call 604.848.6281 or book online at www.physiofocus.ca

Menicus Tears, what can physiotherapy do for you

Meniscus tears are among the most common knee injuries. Athletes, particularly those who play contact sports, are at risk for meniscus tears, most often related to trauma. However, anyone at any age can tear a meniscus.

 In the older adult, the tear may be due to a natural age-related degeneration of the meniscus or a rough arthritic femoral bone surface tearing into the softer meniscus. In this case, surgery may be required to attend to both the meniscal repair and to repair the damaged joint surface.

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Your knee meniscus is a fibrocartilage that separates thigh bone (femur) from your shin bone (tibia). It is commonly referred to as your "cartilage". Each knee joint has a medial meniscus and a lateral meniscus.

Our meniscus acts like a wedge to assist with the rotational stability created by the anterior cruciate ligament. The meniscus also acts as a shock absorber.

If you tear your meniscus, You might feel a "pop" during the traumatic event. Not all meniscus tear provoque an audible sound. You may also experience swelling, pain, limited range of motion, catching or locking sensation.

Depending on the location of the tear, your meniscus might heal differently due to the blood supply. The outside of the cartilage has more blood supply, therefore can heal better naturally. On the other hand, the inside of the meniscus gets the nutrition mostly from the synovial fluid and doesn’t heal naturally.

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Depending on the type of meniscus tear, the location of the tear, age and function of the injured person, you can imagine that not all meniscus tears require surgery.

With an orthopedic opinion and assessment with related imaging (MRI), the Md will be able to direct you toward a conservative or surgical approach.

Physiotherapy can help you control the symptoms and guide you toward the full rehabilitation of your knee. Researchers have discovered that if you strengthen your leg muscles, your bone stresses will reduce as your muscle strength improves and your knee becomes more dynamically stable.

RICE (Rest, Ice, Compression, Elevation), manual therapy, soft tissue release, individualized exercise program are all great methods to help you go through your rehab with the guidance of your physiotherapist.

Difference between Physiotherapy, Chiropractic and Osteopathy

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Physiotherapists, chiropractors and osteopaths all take a slightly different approach to treatment, so it can be difficult to know which one might be right for you.

A good physio, osteopath or chiropractor can all fix injuries. There are probably more crossovers than differences in how each therapist treats. Each different therapist will approach things from a slightly different perspective but we all have the same aim; to decrease pain and fix an injury, using a drug free and non invasive approach to improve physical health and wellbeing.

While we all have a different tool box of interventions, each different discipline aims to diagnose and treat problems related to muscles, joints, bones and nerves. We all have different hands on techniques to – among other things – mobilise joints, decrease muscle tension, get nerves moving better and make sure the body is moving how it was designed to move. Our hands on interventions are backed up with different exercises to control movement, get better balance between different muscles and prevent injuries from coming back in the longer term. We will all try to find the problem rather than just treat the symptom.



Physiotherapists specialise in the diagnosis, management and prevention of movement disorders.

The aim of physiotherapy is to rehabilitate and improve a person’s ability to move and function

They look at the interaction between your muscular, skeletal and nervous systems to see what could be contributing to your issue. Then they look at what aspects of your sporting, work or recreational life may also be contributing.

Physiotherapists can use hands on techniques for mobilisation of joints or massage for release of tight muscle or connective tissue. They also use an individualised exercise program to maintain the improvements/gains reached throughout treatment.


Chiropractors will generally treat pain and altered body alighment related problems using manipulation of the joints (adjustments), either of the spine or the limbs. Manipulation is a fast manual technique that takes the joints being treated to the end of their available range of motion.

Chiropractors can also use soft tissues techniques, stretching, strengthening and rehab techniques

But the main difference between the two is that a chiropractor traditionally uses manipulation of the spine and limbs, whereas a physiotherapists will more commonly use mobilisation techniques and rehabilitation exercises.


Osteopaths use techniques to influence joints, muscles, nerves, circulation, connective tissue and internal organ’s function, so osteopaths try to have an all-encompassing “big picture” approach to diagnosis and management.

Osteopaths focus on the health of the entire body, rather than just the injured or affected part. They look at how your skeleton, joints, muscles, nerves, circulatory system, connective tissue and internal organs function as a whole body unit.

They also use manual techniques, mobilisation and manipulation of the joint, as well as soft tissue release and exercises.

Crânio-sacral techniques are also used in osteopathy.

Regardless which therapist you end up choosing, remember that you have to feel comfortable with the treatment and go with what works for you.

The beauty of a multidisciplinary clinic like Physiofocus, is that your therapist can ask advice and discuss with other therapists onsite and guide you and refer you as needed during your rehab process.

Stand-up desk, miracle solution ?

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As you may heard already, sitting is now considered the new smoking, increasing the risk of heart disease, diabetes, obesity, etc.

Health guidelines suggest we should spend 150 minutes a week in moderate exercise, but many of us sit down for more than half the working day. With email nowadays, you don’t even have to get off your chair to speak to anyone!

“As for a stand-up desk, the research so far is inconclusive. The benefits may be more myth than reality. A systematic review by Cochrane researchers found that sit-stand desks reduced sitting by between 30 minutes and two hours a day. While this sounds impressive, the researchers say the studies mostly did not deliver the up-to-four-hours of standing that experts recommend. Standing desks were also not found to have much benefit in weight reduction – if an average-sized man and woman spent half of their eight-hour working day standing, they would spend an additional 20 kilocalories and 12 kilocalories each. This, point out the researchers, is not enough to prevent obesity or type 2 diabetes. Prolonged standing may also be difficult for people with low back pain.”

So, while the benefits of standing desks may be overstated, the risks of sitting are not. There's no doubt that sitting too much is very bad for your health. However, that certainly does not mean you should stand all day instead.

Studies have found strong associations between lower back pain and standing occupations, such as bank tellers and production line employees. Standing still for long periods is also thought to negatively affect your leg muscles, tendons and other connective tissue, and may even cause varicose veins

Sit/Stand ratio:

The research is still in its early stages, but a ratio of 1:1 or 2:1 sitting versus standing time appears to be optimal for comfort and energy levels, without affecting productivity. It is also recommended not to sit more than 1 hour.

For 1:1 ratio: Sit for 60 min and stand for 60 min

For 2:1 ratio: Sit for 60 min and stand for 30 min

Other ratio are also acceptable but you should never stand more than 2 hours in a row. See the table below for examples:

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Work station adjustment:

Ensure your desk and screen are well adjusted to prevent risk of injuries. They are still many ways to cheat even with the best equipment.

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Other tips to help maximise your set-up:

-Usage of an anti-fatigue mat can improve blood flow and reduce overall discomfort of the lower limb by encouraging slight movement of your leg muscles during the day.

-Make sure your keyboard and mouse are positioned properly. The wrist should be straight (aligned with the elbow) and slightly extended while using the equipment.

-Using arm support can help minimise neck and shoulder issues while taking pressure off the wrist while using the mouse.

-Make sure to take breaks, if you can’t remember yourself as you get too absorbed by your work, you can install a reminder/alarm on your computer to help you out. A break every 20 min to rest your eyes and walk around is optimal, but every hour is still acceptable.

If you don’t have the luxury to have a stand-up desk at work, remember you can take walking breaks throughout the day and use the stairs, whatever desk you have.

How to prevent shoveling injuries?

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When it snows, it also means it’s time to shovel...

Shoveling snow repeatedly with altered biomechanics and poor posture can cause many unfortunate injuries. In addition to weak techniques, the weight and imbalance of snow, using a long lever arm (shovel), will most commonly target the low back and shoulder area.

The physical exertion required to carry and move heavy snow isn’t a piece a cake either. Research has found that risk of heart attack is higher in the few days after heavy snowfalls.

Another big mistake people make is rolling out of bed and heading outdoors immediately to clear the snow after being inactive during many hours while sleeping.

Shoveling should be considered as an exercise and according to the previous articles on our blog, we now know how important it is to warm-up and wake up  your muscles as a preparation to a physical activity.

Few key pointers to remember while shoveling:

Body position and muscle awareness:

By keeping your knees slightly bent, hinged at the hips and legs in a wider stance, you will take some of the tension off of the low back and favorise the use of bigger muscles like the glutes, human’s best friend!

While being in a partial squat position, don’t forget to contract your core muscles by keeping your abdomen flat and tensed (as if someone was to give you a punch in the stomach).


Shovel position:

By using a wide grip on the shovel and keeping the it close to your body, you will decrease the lever arm and make it easier for your muscles to do the work.

Don’t cheat:

Pivoting with your hips instead of twisting with your back is a safer way to handle the snow while shoveling.

Also, hold your shoulders back (see scapular stability article) and your neck tucked in.

Use your lower body to lift the snow instead of your low back,  while keeping your body aligned in the direction you are shoveling the snow.

If you can plow the snow instead of lifting it, your body will definitely thank you later!

Take breaks:

As we mentioned earlier, shoveling should be considered as a workout, so don’t hesitate to take breaks, have a sip of water when you feel the fatigue is setting in.

The snow is part of our beautiful background in the Sea-to-Sky, might as well treat it as our workout buddy instead of the mean one that injures us and stops us from enjoying outdoors activities ;)

Temporomandibular Joint exercises

Following the previous article on TMJ dysfunction, here are a few examples of exercises you can do at home to help your symptoms.

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Working on your posture is key to release some muscular tension coming from the neck and shoulders. Also see the previous blog on scapular stability.

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You can also controlled active jaw movement, meaning that the focus is to avoid the jaw from shifting or clicking. All movements should be painfree.

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Following some painfree active jaw movement, you can also do the same exercises with a slight resistance using your hand.

For more question or guidance, don’t hesitate to contact our clinic to see our experienced physiotherapist.

Temporomandibular Joint (TMJ) Dysfunction

The TMJ is the ball and socket joint that connects the Mandible (jaw bone) and the Temporal bone (one of the bones of your skull). It’s the small joint located in front of your ear. There is a cartilage cushion in between the ball and socket, referred to as the Disc. The disc is supported by special Ligaments, which keep the disc in place. Movement problems of the disc can be responsible for creating many symptoms in the TMJ, such as clicking, crepitations, locking, muscle spasm, and pain. There are several muscles which support and control movements of the TMJ.

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You may or may not experience jaw pain or tenderness with TMJ dysfunction. The most common symptoms include:

  • jaw clicking

  • jaw popping 

  • grinding 

  • limited jaw opening, or jaw deviation while opening (which you can observe in a mirror)

  • an inability to fully clench your jaw.

TMD sufferers are often teeth grinders or clenchers.  TMD can cause jaw headaches, ear pain, dizziness and upper neck pain. Some TMJ patients report pain or inability to eat, talk or sing. Tinnitus or ear ringing can be associated with TMJ dysfunction. (Vierola et al 2012)

TMJ Disorder/Dysfunction, or TMJD/TMD, is seen more commonly in women than men. There is a 3:1 incidence in females to males, and can include one or both jaw joints. In most instances, the dysfunction is a result of an imbalance or change in the normal function of the bones, ligaments, muscles, disc, or nerve components of the TMJ complex.

What Causes Temporomandibular Disorder?

TMJ dysfunction is considered a multifaceted musculoskeletal disorder. 

The most common causes of TMD include:

  • Masticatory muscle dysfunction, 

  • Derangement/displacement of TMJ articular disc

  • Bruxism: nocturnal grinding of teeth leads to increased pressure in TMJ and asymmetrical movement.

  • Occlusal Problems: Poor bite, Asymmetrical or Retrognathic (underbite, overbite) .

Contributory factors include:

  • Mandibular malalignment secondary to occlusal appliance or orthodontic treatment.

  • Removal of wisdom teeth,

  • Prolonged mouth opening eg dental procedure, 

  • Poor cervical posture, 

  • Myofascial pain, 

  • Neuropsychological factors,

  • Stress, and 

  • Whiplash and other less common causes include: trauma (e.g., blow to the chin), infection, polyarthritic conditions, tumors, and anatomical abnormalities.

The TMJ specific muscles involved in myofascial pain dysfunction are the Temporalis and Masseter. The temporalis is a fan-shaped muscle that fills the temporal space, and inserts onto the mandible. Its function is to raise the mandible to close your jaw. The masseter is a thick and strong muscle attached at your cheekbone and runs to the angle of the mandible. Its function is to also raise the mandible to close your jaw. 

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Treatment of myofascial pain disorder is focused on desensitizing muscles through hands-on mobilization, restoration of normal functional movement pattern through exercise, and providing education regarding prognosis and self applied maintenance. Treatment may also include other muscle re-education techniques such as Intramuscular Stimulation (IMS). We look at other mechanical influences such as neck disorder and posture, to assist in maximizing treatment management. At times, we often work with your oral practitioner (dentist, orthodontist, oral surgeon), and other practitioners who deal with behavioural modification, to optimize results.

Scapular Stability, your shoulder core

When we think of the core, we usually refer to our abdominal muscles, but did you know the shoulder has its own core ??

To improve function, strength, posture and balance, we need all our muscle to do their job and at the right time. It all starts with the center, the stability muscles, which is considered the core.

The scapulothoracic joint relies on the coordinated dance of 17 muscles, as well as its mobility at three other joints — the acromioclavicular, sternoclavicular, and glenohumeral joints — to provide stability for the rest of the arm and shoulder.

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The shoulder requires both mobility and stability in order to support and stabilize the rest of the upper extremity.

Think of the scapulae as the foundation of your house. Your house is only as sturdy as its foundation. Similar to a house, upper body strength relies heavily on the stability provided by the scapular muscles, which ground the upper extremities and allow for greater distal strength.

Any weaknesses can provoque a change is the muscle balance, the larger muscles will start to overwork and compensate for the smaller ones that are not doing their job.

Poor biomechanics and weakness of the shoulder "core" can also lead to overuse of the smaller muscles of the extremities (tennis/golfer's elbow, De Quervain tenosynovitis, etc).

A well balanced exercise program is key to avoid injuries in the upper body. In order to know where to start with your exercises, your physiotherapist can give you a specific selection adapted to your needs. 

In the following blog, we will show you an example of scapular stability exercise program as a basic to start with. Stand by for more !

All you need to know about the current air quality in BC

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Currently, there are air quality advisories for BC, Alberta and parts of Saskatchewan due to the BC wildfires. Follow the necessary precautions to take care of what matters most and avoid illness or injury.

What are the risks?

Poor air quality can lead to allergy-like symptoms including:

  • Headaches and fatigue

  • Eye, nose and throat irritation

  • Wheezing and heightened effects of asthma, particularly for children and the elderly

Photo by 9nong/iStock / Getty Images

Photo by 9nong/iStock / Getty Images

The risk of respiratory and cardiovascular issues increases over time with continued exposure. Some people may experience more severe symptoms, like shortness of breath, dizziness coughing, or chest pain. If it's an emergency, immediately dial 9‑1‑1. If you'd like advice, call HealthLink/HealthLine at 8‑1‑1 or talk to your doctor.


What should you do?

  1. Stay indoors as much as possible. Avoid exercising outside; instead, head to a mall or gym.

  2. Drive with the windows up. Use air conditioning if you have it and set it to recirculate.

  3. Entertain children inside. Limit the amount of time children spend playing outdoors; young lungs are sensitive.

  4. Check air advisories often. Don’t rely solely on what it looks like outside.

  5. Be vigilant with breathing-related medications. If you have asthma or a lung-related illness, stay on top of your medications. See your doctor if you need to discuss dosage.

  6. Invest in an air purifier. A good air purifier will reduce particle levels inside your home.

  7. Above all, make your health and safety a priority.

Here’s a few interesting comments from Medical professional through Global and CBC news:

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Dr. Bonnie Henry says there is a lot of “confusion” surrounding the impacts of the smoke, and wants to assure people there won’t be any major issues down the road.

“Despite the fact it has been going on for several weeks, we really do see this as a short-term exposure compared to the day in, day out exposures that others have,” said Henry. “So for the vast majority of people when the skies clear, these symptoms of irritation and shortness of breath are going to go away and most of us will be absolutely fine.”

Henry says the smoky air makes it harder to get oxygen into the blood, and normally-healthy people can have symptoms including eye irritation, sore throats, running nose, cough and wheezy breathing. There will be some people who will feel long-term effects from the smoke if it irritates underlying conditions.

Infants, pregnant women and those with underlying health conditions are being told it is recommended they stay inside.

According to the app “Sh**t! I Smoke,” the air quality in Vancouver today is equivalent to smoking 9.5 cigarettes a day. But Henry says the smoke produced by a wildfire is different than cigarette smoke or smoke produced in cities known for heavy air pollution.

“Wildfire smoke is different from other air pollution. So we have seen comparisons to cities like Beijing and Delhi. But air pollution is caused by vehicle exhaust and industrial emissions and has other components to it that are also harmful to human health,” said Henry. “While wildfire smoke does certainly has health effects, it is not the same as ongoing exposure to long term pollution like we do in some of these cities.”

Health officials are discouraging strenuous activity outdoors for everyone — be they athletes or not — while the air quality advisory remains in place.

"Heavier breathing will allow more air pollution to enter the lungs," said Hedieh Hafizi a clinical exercise physiologist at Copeman Healthcare.

"Inhaling carbon monoxide decreases the body's oxygen supply and can cause respiratory irritation such as shortness of breath, and it can also aggravate any preexisting medical conditions," Hafizi said.




To Stretch or no to Stretch...?

I was once told to stretch before my activity, and then i heard it is a must to stretch after. I used to think i was good for me, but now heard it might not... but really what should i do ?!?

And why do i even stretch ? Because it feels good, because it’s part of our pre-workout routine, because a muscle is stiff and we think stretching will fix it. But most of what we know about stretching are based on wishful thinking and outdated science. We’re stretching for all the wrong reasons.

Who never heard of the old school technique of static stretching before a soccer game? Static stretching being where you sit, lie or stand and hold stretches for 20-30 seconds each. It was always part of our phys-ed class and the teacher was telling us the importance of stretching the muscle to prevent injuries…the time has change people!

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There is a lot of research now to show that this type of static stretching prior to exercise does not reduce your injury risk, including several big systematic reviews (a high level of scientific evidence) that all show that static stretching as part of warm up does not reduce your risk of injury.

Static Stretching has also been shown to reduce peak power and force output in the muscle stretched. What this means is that after static stretching, your muscle is not able to produce quite as much force (strength) as it could prior to stretching. Stretching robs your power !!

Studies show a 2% to 7% reduced strength and short lasting after a stretching session, 15-30 min. It is important to know the fact so let’s not panic, stretching before an activity will not significantly reduce your power nor will it make a difference on your next day activity.

So does it mean i should never stretch before an activity ? Well… NO!

The current best practice recommendation for warm up prior to exercise is NOT  to perform static stretches, but instead perform dynamic warm up designed to prepare your body for the exercise to come.  This should include things like large amplitude, controlled dynamic movements (such as leg swings), activities to gradually increase blood flow to the areas needed for exercise and activation/preparatory movements relevant to the activity.

Static stretching is only one type of intervention, so it doesn’t mean all stretches are bad. You can do PNF(Proprioceptive Neuromuscular Facilitation), where we use muscle contraction and relaxation to affect muscle lengthening, joint mobilization, ballistic stretches, and self myofascial release (foam roller, spiky ball etc).

The nervous system controls our flexibility much more than we thought.  Part of the limits of our flexibility is how much our nerves “put the brakes on” to protect our tissues from damage by excessive length or tension. Neurodynamic testing can be done to evaluate if the nerve is the structure actually blocking your flexibility.

Once again, your physiotherapist is well trained to guide you through the proper warm-up/stretching/technique to use according to your own condition.

Proper Deadlift Technique

The deadlift is one of the exercises i see the most mistakes performed regarding form and technique.

The deadlift, if performed correctly, will target many important and large muscle groups, not only in your lower body but also in your upper body.

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It will work your strength, core, balance, coordination and posture which makes it an easy exercise to incorporate many muscle groups, who doesn’t want to save some time at the gym !

“Doing the deadlift with good form teaches you to activate the stabilizing muscles around your spine,” says study author Lars Berglund, Ph.D. “It also strengthens your glutes, which are often weak in people with back pain.”

But if done incorrectly even with a slight variation of the proper form you can quickly injure yourself, and often it can lead to long term, painful injuries.

Even when you use a relatively light weight, doing poor reps shift some of the stress to your delicate spine. Little by little, rep by rep, your spine breaks down until you potentially end up with serious back pain, according to Stuart McGill, Ph.D., professor of spine biomechanics at the University of Waterloo in Ontario and the author of Ultimate Back Fitness and Performance.

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One interesting fact about deadlifts is that the exercise you perform in the gym is actually a real movement that we use in our daily living, like lifting objects. So while you’re doing your routine at the gym, you are actually practicing how to use a common daily movement to prevent injuries.

In the same category, the squat is another beneficial exercise, while performed correctly, will help you protect you back and other structures from injuries caused simply by a picking up your shoe…

So now that we know a bit more about deadlifts, there is a test you can self-perform before starting your program at the gym to evaluate if your form is fit for this exercise.

Push your hips back, bend at your waist, and touch your toes. The catch: your back has to remain flat throughout. If you can’t touch your toes—or if you had to round your back to touch your toes—you lack the hip mobility to properly deadlift. You can either ask a friend to take a video, do the test in front of a mirror or ask your beloved physiotherapist to have a look !

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If you passed you are ready to do a deadlift! But wait ! It’s always a better idea to progress your way into it to prevent any injuries and making sure you keep the right form even with heavier weights.

You can start with a body weight deadlift, progress with a kettlebell and then a weight bar, from light to heavier weights. Starting to lift only  a few inches from the ground and progress your way up is another trick to make the smooth transition.

As you do your deadlift, just keep in mind to keep your feet flat on the floor, bend at the knees, hinge at the hip by keeping your low back straight.

Grab the bar with hands shoulder-width apart, keep your shoulders retracted and your neck tucked in. And BREATHE !!!!


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Stay tuned for different variations of deadlift you can do at the gym.

Cuboid Syndrome

Feeling pain on the outside edge of your foot (lateral foot pain) is usually the first thing people with cuboid syndrome notice. It’s a relatively common condition, but not always recognized since it can come on slowly over time.

Trauma to the foot, be it a sudden injury or gradually repetitive forces may damage the supporting soft tissues causing the cuboid bone to move out of its usual position.  It can then act like a block, limiting the movement of the surrounding bones in the foot.


This may happen suddenly due to an injury such as an ankle sprain, or develop gradually over time from repetitive tension through the bone and surrounding structures.

The 3 main causes of the cuboid syndrome is from a injury (sprain most likely inversion), repetitive strain (overuse, running, jumping) or altered foot biomechanics (foot pronation or flat feet).

The symptoms related to a cuboid syndrome can be lateral foot pain, swelling around the cuboid area, decreased ankle mobility and increased pain in weight bearing.

It is strongly recommended to seek help from your physiotherapist as the cuboid syndrome will not appear on a xray, unless there is an actual fracture of the cuboid bone.

Your physiotherapist will assess the condition and evaluate what is causing the cuboid the shift out of alignment. The assessment will not only include the foot and lower leg but the whole lower quadrant (Low back, hip and knee) because as you know, it’s all connected !!

The peroneus longus muscle runs down the outer side of the lower leg attaching on to the outer side of the foot.  Tension placed through this muscle from repetitive activities usually locks the cuboid in the altered position causing sustained pain.

If you remember the previous article on the glutes, you will remember that the glute muscles help to stabilize your pelvis to avoid your knees to shift medially and cause your foot to pronate. By losing your  arch support, you keep the cuboid blocked in the injured position.

Your therapist will be able to mobilize the cuboid in the right alignment with manual therapy techniques, release the soft tissue in the lower leg and foot (peroneus longus mostly), tape the foot to support the cuboid in the corrected position, show individualized exercises to your condition.

If the exercises and other techniques are not sufficient to old your foot arch, orthotics can be needed to support the structures. Come and see Katie, physiotherapist at the clinic for custom orthotic fitting!

RICE (Rest, Ice, Compression and Elevation) is always a good start at home to help the inflammation process when you notice the pain.

The cuboid syndrome is fairly easy to treat if it’s recognized early!

Keep your eyes open on the blog for an example of exercise program to follow if you think you are experiencing pain from a cuboid syndrome.

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.


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 !


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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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.