Author Archive

Temporomanibular Joint (TMJ)

When I was 18 years old (going back 16 years now) I noticed my right jaw clicking and clunking. 

When I mentioned this to my dentist, I was told it was normal. 

I didn’t know any better then to tell my dentist my left jaw didn’t click and clunk. I wondered, how could it be normal? 

Then my left side started to act up too.  

I played hockey (still do) which involved a whole lot of body checking and contact. 

I remember one morning waking up after sleeping at a friend’s house and putting my hands behind my neck and stretching. 

What happened next was “burning” in the right side of my neck and inability to move my neck in any direction.

I still played in the championship game that morning (turning my whole body in the corners so I could hits coming). 

What I now know after all my study and work as a physiotherapist is jaw clicking isn’t normal, and the “burner” I experienced in the right side of my neck way back when was a protective muscle spasm, resulting from an underlying hypermobile (moves too much) segment in my neck (likely related to hockey). 

When I started studying Kinesiology at the University of  Waterloo, I started experiencing intense right upper trapezius tightness and headaches so bad I would have to rest mid-day, just so I could make it to the end of the day still functioning.  

HEADACHE, NECK PAIN, JAW PAIN AND/OR CLICKING.. ALL RELATED

The trigeminal nerve (or Cranial Nerve 5 – one of the nerves that comes out of our heads), is responsible for our jaw muscles and sensations at the side of the face.

This nerve receives input from the upper three bones and nerves in our neck. So when there’s something not working at the top of the neck (or base of the skull) it affects the area from the nerve to the jaw. 

Headaches we feel at the front of the head can be the result of an irritated trigeminal. 

WHAT ABOUT CLICKING?

The jaw joint contains a disc (like a thick rubbery washer). Like most joints in the body, the jaw has a capsule (fibrous covering) and ligaments that hold it in position. 

These ligaments help keep the jaw bones gliding properly over the disc.

The jaw is highly vascularised (blood flow) and innervated (nerve supply). 

It therefore is susceptible to pain and inflammation. The click or clunk is considered to be the disc repositioning itself in the joint. 

HOW DOES THE JAW WORK?

With the mouth closed, the disc rests between the two bones that make up the jaw and the back ligaments are relaxed. 

When the mouth opens the jaw bone, mandibular slides forwards and rolls forwards.

At the end of jaw opening, the disc is pulled backwards by one of the two ligaments (stratum superior) which is elastic.

The lower ligament is not elastic (does not stretch) and helps to maintain the proper position of the disc with the jaw bones (condyles).

Muscles that help the jaw move include:

1. Lateral Pterygoid

2. Masseter (closes the jaw)

3. Medial Pterygoid

4. Temporalis (closes the jaw)

TMJ PATHOLOGY – WHAT WENT WRONG?

Tissues at the back of the joint and disc are not designed to withstand constant compression or tensile loading. 

Prolonged mouth opening (singing, dental work) may overstretch the tissues at the back of the jaw. 

Compression to the area may be the result of trauma to the chin (punch, car accident) that results in inflammation to the area. 

Stress that causes us to clench or tighten muscles in the jaw (from facilitation of the trigeminal nerve or muscle strain) can also create compressive forces. 

Pain will occur if the jaw bone is not resting properly and is compressing tissues.

If there’s pain with the jaw opening, it might be from tissues being over-stretched. 

The click or clunk is the disc repositioning itself in the joint (not moving properly). 

There may also be issues within the joint, such as small joint surfaces, wearing of the joint surfaces, hypermobility of the joint from loose ligaments, or changes in the disc itself. 

TREATMENT OPTIONS

Your dentist might prescribe a mouth guard that helps to reduce compressive stress to the joint if you’re a clencher at night.

If the issue is in the joint itself or the disc isn’t resting properly, the dentist may use splinting to help reposition the jaw and disc.

If tissues are inflamed, ice and anti-inflammatories might be in order.

Stiffness in the back part of the jaw will respond well with manual therapy and stretching exercises. 

If there is hypermobility of the joint from overstretched ligaments, you’ll have to be aware not to overstretch the jaw. It has been suggested in these cases

opening the jaw be limited to the point where the tip of your tongue can stay on the roof of your mouth. 

Personally, I always assess the neck area and treat it as appropriate. 

I also incorporate IMS, which can be used to release tension in the massater, temporalis, and lateraly Pterygoid muscles. 

I’ve had lots of success treating clients who come to me with jaw pain. 

Personally, I no longer get intense neck and trapezius muscle tension and jaw pain stapled with the brutal headaches I used to get. 

 IF YOU’RE MOTIVATED:

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter sites by hitting the link there. To book an appointment at Start Line, call the clinic at 250-746-7463.

 

I was talking with someone a few months ago after a hot yoga class. 

Somehow it came up in conversation she had seen my website and blog as she searched the web for information on carpal tunnel syndrome. 

She wanted to know if she should go ahead with surgery. 

She told me she has “tried everything.”

So my mind’s buzzing away. I wanted to ask (but I didn’t) ‘Have you tried IMS yet?’ 

Instead I asked: ‘So did you decide to do the surgery?”   

WHY IMS FOR CARPAL TUNNEL SYNDROME? 

Carpal tunnel syndrome (CTS) is a condition where the median nerve (large yellow band shown in picture below) gets pinched under the carpal (wrist bones) fascia (white band shown in picture) that crosses the wrists. 

This causes numbness in the thumb, index and middle fingers and sometime some weakness in the hand. 

THE MEDIAN NERVE

The median nerve can get pinched in a number of areas as it travels from the neck down to the hand. Some of the pinch happens as it travels out from the neck bones (nerves C5-T1) through the scalene muscles at the side of the neck under the collar bone, behind the pectoralis minor muscle, or through the fascia of the flexor digitorum (muscles in the forearm that bend the fingers).

HOW CAN IMS HELP?

IMS or intramuscular stimulation (www.istop.org) is a treatment technique that helps to release tense and shortened muscles. The theory behind IMS is there is an altered input of the nervous system into the muscle. 

This can cause the muscle to overreact to normal sensory stimuli and shorten or contract.  If the muscle is held in a shortened position, it can put extra strain on the nerve or pinch the nerve as it passes by the muscle. 

When a nerve is touched it can become inflamed and irritable. 

And, by the time you notice the tingling or numbness there usually has been compression or irritation to the nerve for awhile.

If there has been compression of the nerve because of tense and short muscles, releasing said muscles can help relieve the tension. 

CHECK YOUR POSTURE

Other treatments that might have to occur in conjunction with IMS are manual muscle release work to the neck area, stretching of the tight muscles in the neck, shoulders and arms, and mobilizations or manipulation to the neck or upper back areas to help improve joint mobility. 

A recent study (J Orthop Sports Phys Ther. 2009 Sep;39 (9):658-64) shows that people with CTS did have more forward head posture and loss of movement in the neck.

Some people need a night splint for their wrist to keep it in a certain position to stop the compression of the median nerve as it passes through the carpal tunnel (especially for those of us who like to sleep curled in a ball with our wrists bent forwards). 

If you have been diagnosed with CTS and have not had anyone examine your neck and shoulder areas, I would suggest doing this before going the surgical route.  

People do get relief of symptoms following surgery only because you’ve taken pressure off the part of the nerve that’s being pinched.

I’d personally want to know I tried everything before checking into the hospital.

 

IF YOU’RE MOTIVATED:

There are a ton of websites with information about CTS. Try http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001469/ or simply search for CTS in Wikipedia.

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter sites by hitting the links there. To book an appointment at Start Line, call the clinic at 250-746-7463.

 

I’m sure most of us remember the ‘80s and the leg warmers, head bands, cheesy workout videos, Olivia Newton-John’s Let’s Get Physical…

I’m sure for some of us, that workout insanity craze still resonates…

DEFINITION OF INSANITY

The best description of insanity in general is “doing the same thing over and over and expecting different results.” 

If I were going with this definition in my own personal life, I’ve been insane for the last 20 years. 

That’s how long I’ve been running for. Not continuously (I have taken some time off).  But, it’s not just about running. I was running with what’s termed by the medical community as ITBS (Iliotibial Band Syndrome) http://en.wikipedia.org/wiki/Iliotibial_band_syndrome 

My friend and fellow physiotherapist once commented that perhaps I should not run. 

This sounded crazy to me. Why should I not try to run?  I was managing my symptoms.  And, so what if I had this constant ache in my lower back and buttock/hip areas, with tightness down the side of my leg and occasional stabbing pain in the outer part of my knee? 

I was always able to settle it down and continue running. I worked on it so much, I was even able to celebrate turning the big 4-0 by crossing the finish line of a half ironman (with my knee pain reaching intense levels after 15 K into the 20 K run). 

I told you I was insane!

These types of exercise addictions are a common occurrence with clients who come into our clinic. They want treatment to settle symptoms so they can go and perform the aggravating activity. 

People might wonder why say anything at all; “This must make for great business for you,” but I actually like to see people improve, rather than just continually manage their symptoms.

I hate to be the messenger of bad news and tell people that perhaps they should not be doing an activity. Look at how reluctant I was to give up running and that wasn’t even my favourite activity.

Lately, I’ve been reading  Deepak Chopra’s Perfect Weight. 

Now I’m going to get into what exercises  we should and shouldn’t do, but which often tie into weight management as what really drives most people into exercise nutzo world? Weight management. 

Chopra talks about AYURVEDA which stands for the “science of life” and describes the relationship to man and nature.  

Once you determine your body type (VATA, PITTA, KAPHA), you’ll know what types of foods you should eat and what exercise is best for you.

DO YOU FEEL EXHAUSTED AFTER EXERCISE?

The philosophy of exercise under Ayurveda code is it’s supposed to rejuvenate and refresh the body, not stress and fatigue it. This is so the complete opposite of what so many people I know (myself included) have been doing. 

Many of us exercise to the extreme, inspiring to be just like our favourite professional athlete. 

Excessive exercise can actually have detrimental effects on our health.  

Ayurveda guidelines for exercise are:

1. Perform 50 per cent of your maximum tolerance for the activity. If you can run 10 K before fatiguing, then run 5 K. 

You don’t want to expel all of your energy, but rather create more energy.

2. Be consistently active on a daily basis (seven days/week). I often ask myself: What am I going to do for my physical health each day? 

3. Monitor your exertion level by using a perceived rate of exertion chart

http://www.topendsports.com/testing/rpe-scale.htm

or your breathing rate (you should be able to breath through your mouth).

4. The best times to exercise are considered to be in the Kapha phases (6 to10 a.m. or 6 to 10 p.m.). 

WHAT EXERCISES SHOULD YOU DO?

Vata body types are suggested to do light exercises (yoga, short hikes or biking). 

The Pittas of us are fine doing more vigorous activities (skiing, walking, running, hiking, mountain climbing or swimming), while the Kapha types can go even further (running, weight training, aerobics, or rowing). 

REMEMBER TO HAVE FUN

You should consider the enjoyment factor of exercise. You might be a Vata, but have a passion for hockey. After hockey you should be energized and rejuvenated.      Or you might actually like to run instead. 

If the exercise jazzes you, then do it (how about jazzercize? – sounds like an activity for a Kapha type) If you’re doing any said exercise begrudgingly then it’s not a great thing for your body.

Like eating broccoli (or wearing hot-pink legwarmers), there are some things our bodies just don’t agree with.

IF YOU’RE MOTIVATED:

I found a website where you can take a test to see what your Ayurveda body type is and if you’re in or out of balance.

http://www.holisticonline.com/ayurveda/ayv_home.htm

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter sites by hitting the links there. To book an appointment at Start Line, call the clinic at 250-746-7463.

There is no road to happiness, happiness is the way.

This is one of my favourite quotes by far. That one and this one by Gandhi:

Be the change you want to see in the world.

I just got back from a weekend conference called I CAN DO IT! which is put on by Hayhouse. 

Hayhouse is a publishing company that focuses on personal growth and development, with a very strong spiritual emphasis. 

So what does this have to do with physiotherapy you may ask? 

Personally, I believe it has everything to do with physiotherapy. We’re not just our bodies. 

We have a psyche, a spirit and a soul. At least that’s what I believe. We carry emotional, physical traumas with us and if we choose to ignore this emotional insult, we can begin to develop physical manifestations (pain in the body).

More and more research is supporting this notion of the power of the mind over our physical bodies. 

I took a lot from all of the conference speakers and I thought I would serve my readers a synapses of each topic.

First up was Dr. Wayne Dyer, who is one of my favourite authors and speakers. He spoke about the Seven Steps to Manifestating.  

1. Imagination

2. Living from the End (picture yourself already having what it is you desire)

3. Assuming the feeling of this desire

4. Attention

5. Understand the Subconscious Mind (which is much more powerful than the conscious mind)

6. Marinate on the feelings of having what you desire and what you have during the last five minutes before bed (helps with subconscious programming)

7. Natural: what you are desiring should feel natural to you

Watch for Wayne’s new book Wishes Fulfilled.

Other speakers included Geneen Roth, who spoke about her own struggle with weight and how she healed herself. 

What I liked from her talk was “The way we do anything is the way we do everything.”

Brian Weiss is a physiatrist who does regression therapy. That was quite the experience, while Doreen Virtue talked about our Angel guides. 

On the second day we heard Carolyn Myss. What a powerful presence this woman has. Her term “Psychic Free Radicals” really resonated with me. We know the physical free radicals we have in our bodies from the foods we eat (like sugar) “rust” our tissues.  I was able to get a sense of what Physic Injury or wounds can do to our Being. She asked the question “Have you ever been told what Spirituality is?” 

The message was essentially that it’s about Truth and Love. 

Brit Robert Holdon, had us laughing most of his lecture. His message was we get to choose happiness, which is about following your joy and doing what we love to do. Did you know the average Canadian rates their happiness at 7.6/10, and this really has not changed since the 1950s? If you’re not at a 10, ask yourself what it would take to be happier? What more do you want to be… to do… to give… to receive?

Think of happiness as your “gift” to others, the world, the universe. 

Happiness is about being authentic, Truth and Love. 

Cheryl Richardson really resonated with me. She summarized the two days, and the message travelled home with me from her was “Be big in the world.”

This involves being able to set your own boundaries (don’t say yes to things when you mean no). If you feel angry find a healthy way to express it and utilize the energy. The best personal example I have for this kind of scenario is when others knock me down at hockey, I can choose to do nothing (which makes me feel like a wimp and allows them to do it more), retaliate (which makes me look and feel like a goon, and makes the other team angrier with me and the level of physical play for the whole team escalates), or I can channel my energy into playing harder and generating more scoring opportunities. The last option usually works the best for me when I use it.

Finally, “Being Big in the World” is about being yourself and giving from a place of love without expectation of return (unconditionally). 

What I would like you to go away with after reading this, as I feel it can relate to your physical body, is if you have an injury that does not seem to heal despite the best efforts of your medical team, where you feel that you have “tried everything (including IMS), and there is no underlying significant pathology (and sometimes even if there is, because disease can be broken down to DIS EASE), try and take an honest look at your physic health. One of my clients told me today her “happiness” would be higher if she had more time for herself. 

BE HAPPY NOW! 

“Stop waiting for a better now,” Holdon tells us. 

Health is physical, mental/emotional, intellectual, and spiritual. These are like four legs of a table. When you have one or more that is shorter or less stable than the others, the table leans and isn’t as supportive.

IF YOU’RE MOTIVATED:

We’ve  got several of Dr. Dyer’s book/CD/DVD(s) at the clinic for our clients to borrow.

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter sites by hitting the links there. To book an appointment at Start Line, call the clinic at 250-746-7463.

IT REALLY WORKS

Are you the type of person who’s always looking for scientific evidence to support what you do?  

My post graduate education included a five-year co-operative Bachelors of Science in Kinesiology from the University of Waterloo. Then I did a second Bachelor of Health Science in Physiotherapy from McMaster University. 

My brain has been conditioned over these seven-eight years to look for the best scientific evidence to support my decisions as a health care worker. 

So when I studied Upledger Craniosacral Therapy, I had to examine the physiological principles behind this “alternative” therapy technique. I had to have rational, physical explanations of what I was doing, so I would not look or feel like a “quack” therapist.  

I have been asked about BOWEN THERAPY (http://www.bowtech.com/WebsiteProj/Pages/About/Welcome.aspx) on more than a few occasions.

People who had heard of the technique asked about me about it I guess because my last name is Bowen. 

I really hadn’t looked into Bowen therapy.

I haven’t studied it. I didn’t invent it.

But, guess what, now we offer it at our clinic.

We  have a Bowen therapy practitioner renting space here on Fridays.

Before Bowen practitioner Melanye Walker came on board, I of course, however, had to go and read up on it and look at it from a scientific and physiological perspective. 

Don’t get me wrong, I really do believe in the body as an energy system.

The left half of my brain just wants to try and make sense of it, rather than saying “I don’t know why it works, it just does.”

OUR BEAUTIFUL BODY

The body is bones (skeletal), tissues (ligaments, tendons), organs (skin), and muscles.

It is controlled by our nervous system (brain, spinal cord, and nerves).

We have the nerves to work our muscles when we need them to act. Sometimes this is automatic (reflexive response). We have a nervous system that is automatic. It controls our blood pressure, heart, lungs, and organ functions. This system has two components – sympathetic (driver – excitable part) and parasympathetic (brake – quiet, immune function, restful part). 

Neuropeptides are chemicals that help operate and control the body as well. 

Some of the neuropeptides we know about include melatonin which helps with sleep and relaxation, dopamine, endorphins, serotonin. 

Thanks to Candace Pert who wrote The Molecules of  Emotions (http://www.candacepert.com/)

we know more about the role of neuropeptides in our body function.  

All of these things work together. There is more and more evidence that even when we work on a muscle we are actually working on the nervous system. 

For the scientist reading this, this is termed “neuromuscular effect.” 

There is more and more evidence that manipulation (you know what most people call bone cracking) benefits are the result of the neuromuscular relaxation of the contracted muscle rather than the shifting of bones. 

When the muscle relaxes, the pain reduces and the bone joints move better again.

RELAXATION – REDUCING OUR BODY’S HYPERACTIVITY

From what I have read on Bowen therapy, it’s about relaxing an over-excited system. 

It’s a neuromuscular release when it works on the spindle of the muscle (the motor point of the muscle that is supplied by our nervous system).

Intramuscular Stimulation or IMS (www.istop.org) works on the same principles but, when practicing, we’re going directly into the muscle rather than working from the surface.  

Apparently the “moves” as they are termed also occur over tendons.

Acupressure works on the same principle of affecting the muscle spindle. 

Other areas affected by Bowen therapy include the joint proprioceptors (found in the ligaments and capsules surrounding the joint. These receptors are highly innervated (by nerves). 

Physiotherapist also use techniques that affect joint proprioceptors to get a muscle relaxation response. There’s also been mention of it affecting the superficial fascia.

To get the best result, you need to find the driver of the pain. 

Sometimes this takes a few sessions because injuries and compensation can be layered. 

You may release one area of tension only to find that it was compensating for something else. This is why it may take three to five sessions before you’re able to get to the main source of the pain.

No matter what form of therapy or treatment you use to relax the over-excited neuromuscular system (chiropractic, physiotherapy techniques, IMS, Bowen therapy, acupuncture, Craniosacral therapy), if you wind up your system again by performing the aggravating activity, you won’t get the full benefit of the treatment and the recovery is likely going to take longer. Don’t give up hope though, because I have seen people recover even when they did not give up their stressful lifestyles or aggravating activities. 

It did take longer, though.  

What I learned from a Strain Counter Strain Course (again another neuromuscular technique), was it takes about 48 hours for the muscle spindle, your motor point of the muscle to reset. I do tell clients this, so that they can get the maximum benefit out of the treatments. 

Personally, I decided to give up an aggravating activity (running) while working on my own hyperactive muscle system, and I have to say, I have no pain in the area that had bothered me for about 20 years. 

Time will tell if I can resume running and continue to be pain free. But before this happens, I’m working on my strength, muscle stability, and flexibility.

IS BOWEN THERAPY FOR YOU?

The clients who I have recommended try Bowen therapy have been those who have a very overactive or hypersensitive system.  

Their muscles are tense with minimal stimulation (light touch), and they cannot tolerate any hands on therapy or IMS.  

IF YOU’RE MOTIVATED:

One of Melanye’s clients has written a wonderful testimonial, ‘The therapy really works’ available at our clinic.

We’ve also got two copies of Melanye’s The Little Bowen Book by Louise Tremblay for clients to take on loan.

I will keep you posted on responses to treatment.

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter sites by hitting the links there. To book an appointment at Start Line, call the clinic at 250-746-7463.

Have you ever wondered why some people can bend like they’re plastic while others appear to be stretching with concrete blocks between their muscle fibres?

Have you ever wondered what holds the bones together? Have you ever wondered what tissues are made of?

If you’ve nodded to any of the above, or even if you haven’t, I still think you should read on. 

There are a number of factors that influence our flexibility – the shape of our joints, tensile strength of our ligaments and tendons and the length of our tendons and muscles. 

JOINTS

The joint is simply the name given to where two bones meet. The bones stay together in part because of how they are shaped. Some like to think the shoulder and hip joints are balls fitting into a socket. Others think the thumb joints are like two saddles sliding together. Or, the knees are like a hinge joint, where one is rounded and the other is cupped but not a full socket. 

There’s also the facet joints in our backs and the sacroiliac joints (SIJ), where your tailbone meets your pelvic bones. These are more planar. 

LIGAMENTS

Ligaments are tough tissues (I like to tell people they’re the duct tape of the body, and we all know how too often we use this tape as a quick repair). Our ligaments hold the joints tightly together. When you dislocate a joint (like your shoulder) or sprain your ankle, what’s hurting are the ligaments. 

Some people seem to have looser joints than others. It’s often because of the looseness in their ligaments. Next time your cooking your Thanksgiving/Christmas turkey, look for its hip ligaments when you’re pulling off its drumstick. 

I personally often wonder whether people with loose ligaments become gymnasts and dancers because their ligaments are loose, therefore they’re more flexible. Or maybe it’s the other way around. Maybe they get looser ligaments because they’re being stretched beyond the point of recovery. It’s the whole chicken and egg question of which comes first.

All I know is that I’m not a Gumby when it comes to flexibility and often struggle with any activity that requires a lot of flexibility. I guess I’m one of those concrete types.

COLLAGEN

Collagen fibres are what give our tissues (such as bones, ligaments, tendons, skin, blood vessels, organs) strength. 

Each tissue contains a different combination and concentration of collagen fibres. For example, in the bone, collagen fibres are orientated in parallel to give it strength. In the shoulder capsule (the sling that holds the ball into the socket, fibres are more meshed to allow for more flexibility). 

There are many types of collagen. 

Type I is the most common (found in 90 per cent of our tissues).  It’s also what makes up scar tissue. 

Type II is what is more commonly found in the cartilage (smooth covering over the bones). 

Type III is more granular and is what gets laid down during the first three weeks of healing. It’s not very strong and can easily be re-torn. 

Collagen is the glue that holds us together. 

WHAT IS FLEXIBILITY? 

It’s the ability of the tissues to stretch out. Our muscles are like elastic bands (made up of more elastic than collagen),while our ligaments and tendons are made up of higher concentrations of collagen fibres (less flexible). 

You can lengthen muscles by prolonged stretching (adds what are called sacromeres to the length of the muscle). We can also stretch out the ligaments. I like the analogy of pulling the duct tape apart (we know it’s not easy). It gradually gets longer and more pliable when you repeatedly pull on it. But if you pull too hard or in the wrong direction, it will tear apart. This is when injury occurs.

OVERSTRETCHING AND INJURY

The best example of an injury caused by overstretching comes from my own personal experience with studying GOJU Karate. 

In an effort to get me down into the splits, forcing my concrete laden legs apart, I was pushed beyond my flexibility point and felt a pop in my hip. My left hip joint hasn’t been the same since in terms of its stability. I’ve been more prone to groin strains on the left and more muscle tightness as my muscles try to compensate for the loss of ligaments or perhaps the labarum (cartilage ring around the joint that offers the ball more stability in the socket). 

A PHYSIOTHERAPIST’S PERSPECTIVE

While there isn’t really any good research evidence that indicates how, when, and why we should stretch, what I’ve seen clinically is that if our muscles and tissues are too tight, we are more prone to injury during sudden unexpected forceful strain that takes the tissue past its point of recovery (like trying the splits when you’re not a Gumby). 

I’ve also noticed clinically, the person who’s danced or done gymnastics and has a tremendous amount of flexibility but is lacking the muscle strength they once had to support their joints, have a great deal of joint pain. 

It’s much more challenging to treat the latter person than the first tight person. The first non-Gumby requires helping improve flexibility. The second person has to improve their strength. 

We can help the non-Gumby by releasing their tight tissues through IMS, manual therapy, massage and guided stretching. The second hyper mobile person (lots of flexibly) needs to stabilize and strengthen. 

We might be able to help relieve some muscle tension from trying to stabilize the joint, but the rest is up to the person. And if they don’t buy into doing an active exercise program, then quite often, we don’t see improvement. We just end up managing pain. 

Regardless of if you’re too loose or too tight, you will need to do some work to get better. You either need to add stretching into your life or strength and stabilization.  All too often people rely on the therapist to do all the work. Just remember you may only be in the clinic for 30-60 minutes each week, the rest of the time you are on your own…

 

IF YOU’RE MOTIVATED:

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter sites by hitting the links there. To book an appointment at Start Line, call the clinic at 250-746-7463.

Bikram Yoga (or hot yoga as most people call it) seems to be getting many Cowichan people fired up. 

More and more people coming into the clinic are asking if this is something they should try. Lots of other clients are telling me they’ve tried it and really liked it.

I’ve also had a few clients aggravate an injured area doing it too. So, what’s the scoop on hot yoga?

Being an ice hockey player and a triathlete, my muscles are prone to getting shortened and broken down and tight. 

Truth be told. I think I’m one of the world’s worst stretchers. When I stretch, it feels like I’m breaking down concrete in between muscles. The moment I stop stretching, it feels like I was right back to being as inflexible as ever. After having my ropy, banding muscles release with Intramuscular Stimulation, IMS (www.istop.org), I was able, however, to get more out of stretching. 

One of my goals for 2010 was to do yoga as a way to help me become a better stretcher. Take notice that I made it a goal not a resolution (I’m not fond of setting resolutions). In 2010 this didn’t happen, so I’m carrying it through to 2011. 

With a shoulder injury (my second one) that’s been keeping me from playing hockey with the two and a half teams I was playing for (my favourite sport by far), I had to find something else to do to keep me active. 

So I thought why not find out what Bikram’s all about. My physiotherapy colleague told me she did it and liked it too – more reason to give it a shot.

The story about how the Bikram series was created is also kind of cool.

Bikram Yoga was created by Bikram Choudhury over 40 years ago.

Choudhury started training at the age of four and was recognized as Yogi Raj, king of yoga, at 14.

He’s also been described as one of the most famous yogis of his generation and was sent to North America by his teacher, Bisnu Gosh, to teach true yoga to the world.

As a teen Choudhury injured his knee in a weightlifting accident.

After being told he might never walk again he created what’s now hot yoga.

The Bikram Yoga series is tailored for the western person to address the implications of a western living lifestyle, job stress, weight issues, fatigue, poor posture and breathing.

I attended a Bikram Yoga class at the Duncan location (www.bikramyogacowichanvalley.com) with Jennifer Houle this past Tuesday night. It’s a 90 minute (yes one hour and a half), in a warm room attempting to move my 43-yea- old (chronologically speaking) inflexible body into positions that I did not think were humanly possible. 

Not only was I limited by my shoulder injury, but just my general inflexibility. I did what I could listening to my body (for more on this, look back to my earlier No pain, no gain blog).  

What I loved about the Bikram series was the warm room. I’ve always really liked to be warm. It felt great to sweat. I was also pretty pleased how Jennifer was able to talk non-stop throughout the entire 90 minute session. She has a tremendous amount of energy about her. It was cool that I had a work out, but also felt more flexible. My injured shoulder hurt less and moved better. Overall, the functional use of the shoulder improved immediately. 

I even enjoyed getting to pet Jennifer’s little dog Olive!

Would I recommend Bikram Yoga to my client’s? The simple answer is YES! 

The injury would need to be at the stage of recovery appropriate for stretching. 

In early stages of healing, clients would really need to listen to what their body’s telling them. Pushing through the pain in the early stages of recovery can cause more damage, but pushing to the edge of pain can be beneficial. If the pain gets less as you work the area, it’s a good indication you’re doing the right thing. If the pain gets worse, back off somewhat. This is the only place my philosophy of healing and recovery differs from instructors. Sometimes things do hurt more before they get better. 

People are frequently more sore after a physiotherapy session with me. The decision to keep going or cut back depends on how much more sore they were, or how long the soreness lasted. Has the person’s function improved or is it less? Have we made improvements in other areas (strength and range of motion), and with the person’s tolerance?

Thanks go out to Jennifer at Bikram Yoga Cowichan Valley for a great first class. My goal is to attend twice a week while I’m not playing hockey through the winter and into the spring. 

I can’t make any guarantees for the summer as my kayak and bike are likely to be calling my name then.

IF YOU’RE MOTIVATED:

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter sites by hitting the links there. To book an appointment at Start Line, call the clinic at 250-746-7463.

A client who was recently referred to me by another client said he was told “Don’t expect her to treat the area you think she should be treating.”

Why would I treat any area other than the area that you are complaining hurts? 

Clients must think I’m absolutely bonkers when they tell me that they have lower back pain on the right and I start treating the left thigh or shoulder area. They might think I have lost my mind when they tell me they have pain at the back of the shoulder-neck area and I start working on the front of their shoulders. 

Rest assured, I’m not coo coo. Eventually, I will look for something to treat in the area that hurts, even if it’s just so you don’t think I’m out of my mind. 

What I’m really up to is looking for your bully – dun, dun, dun.

THE VICTIM VS. THE BULLY

The area of your body you’re feeling all the pain might just be the VICTIM of a problem somewhere else. The somewhere else is your BULLY.

When I was 16 years old, I sustained a left shoulder separation playing hockey. I was taken to the hospital, put into a sling that I was told to wear for two weeks. That was all I was told. I went back playing hockey after two weeks and separated it more. The second time did not hurt as much as the first time. No treatment was ever recommended. I could not sleep on the left side and still have muscles tighter on that side today. 

By the time I was 18 years old, I had right-sided neck and jaw pain. At age 19, I had a chiropractic adjustment for my lower back pain that ripped my mid-back area (because I was so tight in this area), and I started to develop chronic right-sided muscle tension and headaches. By the time I was 22, I have sciatica down my left leg with numbness, tingling and weakness. Knowing what I know now, it was likely a herniated disc. 

I lived with pain in my left lower back and sciatic symptoms I learned to manage over the years. I remained active, and the only real limitation I had was from iliotibial band pain down the sides of my legs that often limited how far I could run. 

 

TREATING MY VICTIMS

I didn’t really do a lot treatment-wise. A great session of craniosacral therapy, unwinding when I was about 31 relieved my left shoulder enough I was able to sleep on it. I did some massage therapy for my legs and lower back while training for a half ironman (which I completed in celebration of turning 40. I did have some ITB issues after 15 K of the run). I also had done a lot of IMS (www.istop.org) for the lower back, hips and legs (practice sessions with my colleagues but nothing that involved a thorough assessment).

It wasn’t until a recent massage session with Michelle Frazer, an incredible addition to the Start Line team, of a Healing Path Massage (http://www.ahprmt.com/), where she worked on my left shoulder area (specifically the lat) that I have had any lasting relief of my lower back pain. My hip flexors and quadriceps (front hip and thigh muscles) were also tight and likely contributing to my symptoms. She did a movement assessment first then did some release work. I have since done regular massage (every couple weeks) and an IMS session (monthly) to help with restoring all of my body’s proper motions. I am going to be starting yoga in the New Year as a way to introduce more stretching and flexibility into my body. I have yet to return to running which was what seemed to aggravate my lower back the most. 

For me, my lower back was the victim of a shoulder injury bully that happened several years prior to the onset of my lower back pain. There may be other factors to consider as well, but essentially, physiotherapists need to look at the whole body when treating clients.

So there! I told you so! I’m not really all that bonkers.

IF YOU’RE MOTIVATED:

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter sites by hitting the links there. To book an appointment at Start Line, call the clinic at 250-746-7463.

STRESS IS DEFINED AS

1. STRAIN

2. FORCE

3. MENTAL OR PHYSICAL TENSION

4. URGENCY

5. PRESSURE

We all feel stressed from time to time. For some of us, it’s about discovering whether we’re stressed, or stressed out. Stress is inevitable but there are ways to tackle feeling stressed out.

DID YOU KNOW

The body doesn’t know if an event is actually happening or if you are just thinking about it. Either way, your body will react the same way.

If you’d like to learn how stress affects your body and what you can do about it,  visit Start Line Physiotherapy’s website www.startlinephysiotherapy.com and go to the video presentations link.  Here you can watch Wendy Bowen, RPT and Michelle Frazer, RMT giving a presentation on stress.  This is an hour presentation.

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter sites by hitting the links there. We’re now on Twitter too! To book an appointment at Start Line, call the clinic at 250-746-7463.

PAIN BODY

In Eckhart Tolle’s book A New Earth, Awakening to Your Life’s Purpose we are introduced to the concept of the “Pain Body.”  My analogy of this is it’s our emotional gremlin inside us who seeks attention or reacts to what is happening in the world. It gets hungry, so it feeds off provoking reactions from others. My friend’s family calls this “poking the bear.”  In my family we would probably call our gremlin “cold pricklies” from the book TA for Tots. 

Our bodies are basically energy transducers. We take on energy and give off energy.  Sometimes it’s positive. Sometimes it’s negative. We are affected physically by the energy we are taking on and by our emotions. 

TAKE A STEP BACK

Have you ever tried to look at your emotions and how they are affecting what you are feeling in your body?  

Did you know lower back pain is connected to feelings of being safe and secure? The lower back is the first chakra area of your body. 

The next time you experience and see an increase in your back pain, look at how you are feeling about your job situation, career, or personal relationships. 

I had a client who experienced back pain for years but always managed it independently, until one day he experienced a significant flare in his symptoms. There had been no significant changes in his physical routine. The only new event in his life was the separation from his wife, who had left him to be with someone else, and he was feeling financial strain that often tags along with divorce. 

Another client with chronic lower back pain was experiencing verbal abuse from a partner. There was also the client who did not feel she had any support in her life and continually suffered pain in the spinal and leg areas. 

GET GROUNDED

It’s our legs that ground us to this world. It’s our spine that supports us. 

Our bodies are the physical connection to this world. It’s through our bodies we experience life. It’s by way of our bodies we sense our feelings. When you don’t listen to the initial signs that you are out of balance, body signals get louder.

If you continue not to listen you will breakdown. 

MAKING CONNECTIONS

You don’t have to believe there’s a connection between the pain you experience and your non-physical self, emotions or feelings. It’s something to consider, however, if you’re suffering from pain that won’t go away despite the best efforts of a number of health care professionals, your best efforts at an exercise program that we all recommend, and the strongest prescription drugs money can buy. 

If you can fathom a connection to your emotional and physical self and want more information on this, I suggest reading:

The Biology of Belief by Bruce Lipton and The Molecules of Emotions by Candace Pert (both authors are scientists)

Woman’s Wisdom, Woman’s Health by Dr. Christine Northrop, or The Anatomy of the Spirit by Carolyn Myss

IF YOU’RE MOTIVATED:

Wendy owns a copy of Tolle’s A New Earth. If you’re a client at Start Line Physiotherapy,you can borrow it from Wendy; just ask!

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook  or Twitter sites by hitting the links there. To book an appointment at Start Line, call the clinic at 250-746-7463.