Running Injuries

With the fall clock running down, many of us weekend warriors are being chased down by the injury bugs. Following a long, hot season of pounding the trails, it’s not uncommon for some aches to show to up. For both the avid year-round runners and the warm-weather aficionados, the mileage starts to add up. With the mileage comes various ailments to our hips, knees and ankles. This can be contributed to poor training habits, technical errors or the body just hates us. Regardless of the reason, the point of the fact is there is a broad spectrum as to why the body breaks down. Looking at it anatomically — and biomechanically — from a physiotherapist’s standpoint, two of the most common areas where a runner’s body can break down are the hips and the feet. This article will focus on the hips. The hip can be a cause of a variety of common injuries encountered by runners. These include patella-femoral syndrome, aka runner’s knee, IT band pain, or the dreaded plantar fasciitis. Weakness or imbalance in the muscles of the hip, or tightness of the hips, can change how the joints below your hips move. For the runners that have been told their knee and/or feet pain is due to flat feet, or over-pronation, it could very well be due to one of the above-mentioned reasons related to the hip. The hip is an important part of running as it is designed to take the bulk of the impact when we land, it is also responsible for generating the energy that moves us forward. Because humans are inherently designed to compensate for faulty systems in our bodies, we have become very good at using different body parts and movements to achieve the same goals. In running, when the hips aren’t doing their job, the muscles and joints below can take up the slack. Overtime, these systems can be overworked and this is when we can start getting achey joints, and chronic muscle and tendon injuries. With a physiotherapist, the initial assessment includes: comparison of both walking and running patterns (viewed from in front, behind, and from the side); strength assessment; lower extremity alignment; and education regarding the findings. A plan can then be put together that best fits with the runner’s goals, including activities aside from running. There is not a single solution, but let us work with you to find your stride.

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Cervicogenic Dizziness

Vestibular Rehabilitation (Dizziness and Vertigo)

Cervicogenic Dizziness

Dizziness is not necessarily vertigo!

Have you ever experienced dizziness and the Doctor tells you it is vertigo? Yet you are not responding to the vertigo treatment? There is a chance that the symptoms are not from a classic BPPV (benign positional paroxysmal vertigo) because there are many other reasons why you could feel dizzy.

There are other vestibular sources that can provide dizziness and to understand where it is from, you need to know more about the vestibular system.

Anatomy

In your body there are 3 systems to keep you in balance:

Eyes/vision
Vestibular system
Proprioceptive system

These 3 systems work together, so if one of them is lacking you might suffer from dizziness as a symptom. For example, if you have glasses and a stiff neck because of anxiety, your vestibular system has to work harder to compensate for the two others. If the 3 systems are not coordinated it might result in vestibular problem.

Cervicogenic dizziness is a diagnosis of exclusion. This means that when the medical and vestibular problems are ruled out you can consider this diagnosis.

The main characteristics of this problem are feeling imbalance and having neck dysfunction or pain.

Symptoms

Many people are surprised to know that their symptoms could come from their neck. Cervicogenic dizziness can provide symptoms such as faintness, disorientation, imbalance and perception of spinning (inside vertigo). Along with those symptoms you will have a lack of cervical spine range of motion (ROM) and probably pain. The dizziness can last from minutes to hours, compared to BPPV (seconds).

Causes

Studies put forward explanations to those symptoms and the first possible cause they agree on for cervicogenic dizziness would be a physical injury and/or psychological issues. For example, a physical injury could be falling, a whiplash or a head concussion. The psychological issues could be depression/anxiety, employment difficulties, fear of space etc. It is good to mention that you can find in some people cervicogenic dizziness combined with any other vestibular problem. For instance, people with BPPV could still feel dizzy even after getting rid of their vertigo.

To conclude, cervicogenic dizziness is all about the input (information) brought to the vestibular nuclei. With 6x more receptors in the neck versus the rest of the body, the information from the cervical spine to the head (here vestibular system and vision) is really important to feel balanced.

Now, how can we treat cervicogenic dizziness?

Some studies say that manual therapy has good result with this kind of problem. Usually when the neck ROM is restored and pain has gone, the dizziness symptoms will go away too. That combined with vestibular exercises can provide the patient with long term improvement. It is important to have a good assessment of the problem in physiotherapy to make sure the right diagnosis is identified. Some physical therapists are qualified in differentiating between the many vestibular problems. A neck assessment should be done in addition of the temporomandibular joint and cranial area if necessary.

Sources:

Yaseen, K. and al., The Journal of Physical Therapy Science, Vol. 30, No. 1, 2018
Reiley, A. and al., Archives of Physiotherapy (2017) 7:12
Wrisley, D. and al., Journal of Orthopaedic and Sports Physical Therapy, Vol. 30, No. 12, December 2000

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Headache & Migraine: Physiotherapy Management

Neck

Headache & Migraine: Physiotherapy Management

Is that pain in your head really a pain in the neck? Do you suffer from persistent headaches when sitting at your desk at work? Or does your headache come on when there is added stress in your life? Maybe when you get a migraine you’re in bed for the next 2 days?

These are all common descriptions physiotherapists hear when they treat someone who suffers from headaches or migraines. They are an incredibly common problem – up to 47% of the global population suffer with headache, and an estimated 10-15% suffer with 1-year prevalence of migraine according to the World Health Organization. They also create significant socio-economic burden due to the volume of time taken off work.

Some of the most common forms of headache include cervicogenic headache, tension-type headache, and of course, migraine. Cervicogenic headaches are ones that originate from the cervical spine (neck), whilst tension-type headaches are related to muscle tension in the forehead, face and neck. Migraines are a neuro-vascular cause of headache and relates to altered activity of the brainstem and nerve tissue. They usually have unique characteristics of sensitivity to light and sound, nausea or vomiting.

Your physiotherapist will be able to diagnose your specific type of headache according to key characteristics such as;

quality and area of pain
severity of pain
chronicity (length of time you’ve suffered headaches) and length of each episode
regularity of episodes
the presence or absence of light/sound sensitivity.

Evidence strongly supports physiotherapy intervention for all three forms of headache. In the past there has been some controversy and debate when it comes to intervention for migraine, but recent research suggests the joints, muscles and nerve tissue in the neck may have a significant role to play when it comes to migraines – indicating physiotherapy management as an option.

Medical management of migraine includes non-steroidal anti-inflammatories, corticosteroids or the migraine-specific group of medication known as the triptans. Some patients report excellent results, however, quite a few report no improvement with medication, and some even report worsening symptoms!

Another intervention that has been experimented with in recent years is botox injections into the muscles of the forehead and neck in chronic migraine sufferers, paralyzing the muscles – however research shows only “small to modest” benefit and this must be repeated every 12 weeks.

In most cases, physiotherapy alone offers an effective solution for tension headaches.

Correct diagnosis– On your first visit, we can establish a correct diagnosis to direct the most effective care to your headache. Establishing the correct diagnosis early is imperative as several injuries have similar symptoms yet have different treatment protocols. Early treatment will be focused on reducing pain and regaining normal neck range of motion.
Improving neck joint mobility– Using manual therapy techniques to improve upper neck joint mobility and muscle flexibility will aid your symptoms
Improving your posture– Your headaches and migraines can be improved by improving your posture. Poor posture can lead to strain on your back and neck muscles possibly leading to headaches and migraine.
Pillow assessment– A cervical pillow assessment can help ensure that you have the proper pillow to obtain an optimal neck position during sleeping.
Workstation /work desk set up– Sitting incorrectly at your desk, having the computer screen at an incorrect height could be some of the leading causes of headaches and migraines
Strengthening program– The physiotherapist will then prescribe an exercise program to improve the strength and coordination of your deep neck stabilizers and upper back muscles, which are important for preventing re-injury.

If you are someone who suffers from headache or migraine then come and see a physiotherapist for a thorough and careful assessment followed by outlining an appropriate treatment regime to manage and resolve the condition.

Sun City Physiotherapy Locations

Full recovery after an ankle sprain.

Foot and Ankle

Full recovery after an ankle sprain.

It was a crisp autumn day when Sue decided to go for a hike. All of a sudden she caught her foot on the unstable ground and rolled her ankle. Her ankle was sore, swollen, tender to the touch and she felt unstable while walking on it. Eventually, after a couple weeks of rest, ice, elevation and gentle movement she was again able to resume most of her usual activities of daily living. She thought she would rest over the winter and be ready to get back to hiking in the spring.

Fast forward to spring. The snow is melting, the birds are chirping and Sue is getting ready to once again get back to hiking and soccer. This time though, she observes some odd changes. Sue notices that her ankle still feels weak and she is worried about slipping when she goes out for her long hikes. She decides not to play soccer in the spring out the fear that running on the field with opponents may result in rolling her ankle again. She even feels unstable while standing on one foot and very stiff in her ankle when having to kneel or squat.

Sue is a classic example of someone who has recovered well from the acute symptoms of an ankle sprain but has not done the proper rehabilitation to recover fully from the injury. Ongoing symptoms of stiffness, weakness and poor balance are common. If someone has been limping or using crutches for a period of time after the initial injury, general weakness in that leg is also quite common. Due to the residual ankle weakness and reduced balance, there may be an increased risk of rolling the ankle again with return to sports and activities.

A physiotherapist can help get you on track for a full recovery. During an initial assessment, a physiotherapist will ask you questions about your specific injury and assess your mobility, strength and balance. Based on the findings of the assessment and your specific goals, your physiotherapist can come up with a personalized home exercise program for you. Manual therapy, which involves hands on techniques, is also used to treat stiffness and reduced range of motion. Following a physiotherapy treatment program most people are able to safely and confidently return to their regular sports and activities.

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A recipe for jaw pain

TMJ / Jaw

The fact of the matter is jaw pain can be down right miserable. Talking and eating are two of our most important functions in daily life and the jaw plays a large role in both. If wrapping your teeth around a big juicy Okanagan apple has lost its sweet satisfying crunch and been replaced by pain, then seek some help.
Many structures in and around the jaw can contribute to pain. The teeth and their attachment to the jaw and skull are obvious contributors that your dentist is well equipped in managing. Infection or dysfunction within the ears, sinuses, salivary glands or lymph nodes are problems best addressed by your family doctor. However, other structures such as the jaw joint (temporomandibular joint) and associated ligaments and tendons are common contributors to jaw pain that are often left untreated. Dysfunction in the neck can also refer pain and/or dysfunction to the jaw. Another, often overlooked contributor to jaw pain, is the effects of our mental health. It is well documented that stress, anxiety, exhaustion or depression will not only effect our head and neck postures but also how the nervous system reacts to messages sent from dysfunctional tissues, such as those in and around the jaw. A sensitized nervous system can increase one’s experience of pain.
Pain is complex but treatment doesn’t have to be. An assessment by your family doctor, dentist or physiotherapist with special interest in temporomandibular dysfunction will ensure you are referred to the correct health professional for managing your problem. If the problem relates to dysfunction of the jaw joint, the first step is to address any habits outside of normal jaw function, such as teeth grinding, pen chewing or jaw clenching. A restriction in joint mobility is common, affecting your mouths ability to fully open, in which case, the sleeve (capsule) of the joint is susceptible to strain and inflammation. Clicks and pops are very common but are rarely related to the cause of your pain.
Try this – gently place your finger tips about 3cm above your temples, then clench your teeth on and off. You will feel the temporalis muscle tightening under your fingers. Now gently place your fingers 5cm directly below your temples on the sides of your jaw and clench your teeth. You will feel the masseter muscles tightening. You have just located two of the most important muscles for eating. Both the temporalis and masseter muscles and their tendons are common contributors to jaw pain that respond well to hands-on soft tissue treatment techniques. In addition, many people can relate to how these muscles might be clenched a bit tighter in times of stress and anxiety, thereby contributing to the muscles overload.
The important message is that many structures, behaviours and feelings contribute to the experience of jaw pain and effective management is best achieved through identifying all factors involved.

Running Injuries

Sun City Physiotherapy Locations

Phone: 250-861-8056

Phone: 250-762-6313

Phone: 250-766-2544

Phone: 778-699-2006

Cervicogenic Dizziness

Dizziness is not necessarily vertigo!

Sun City Physiotherapy Locations

Phone: 250-861-8056

Phone: 250-762-6313

Phone: 250-766-2544

Phone: 778-699-2006

Headache & Migraine: Physiotherapy Management

Sun City Physiotherapy Locations

Phone: 250-861-8056

Phone: 250-762-6313

Phone: 250-766-2544

Phone: 778-699-2006

Full recovery after an ankle sprain.

Sun City Physiotherapy Locations

Phone: 250-861-8056

Phone: 250-762-6313

Phone: 250-766-2544

Phone: 778-699-2006