You start having pain on the side of your hip, seemingly for no reason at all! Your symptoms may include pain over the greater trochanter, which is a bony protrusion on the outside of your hip. It can feel more painful when lying on that side, climbing stairs, rising from a seated to a standing position, or prolonged walking or running.
Let’s pause for a moment. What exactly does your “hip” even look like?
First, you have your femur (upper leg bone), which attaches to the pelvis through a ball and socket type of joint. This allows your leg to move in many different directions! The greater trochanter is the bony bulge at the top of the femur, on the outside. In other words, the bone you feel sticking out when you touch your hip joint. You can also see the location of a few bursa in the image below. Bursa are fluid filled sacs which help reduce friction in the body - this makes movement easier!
You also have many different muscles in this area which allow you to control the motion of these bones. Many of these muscles either attach to, or run over the greater trochanter. Two important muscles here are the gluteus medius and the gluteus maximus. The gluteus minimus attaches to the greater trochanter and is active when bringing your leg out to the side. It also works to control your pelvis when standing, walking, climbing stairs, or pretty much any other movement on your feet! Your gluteus maximus, however, passes over the greater trochanter but inserts nearby at the “IT” band (a tough band of tissue which runs down the side of your leg into your knee)
What is causing this hip pain? It could be Greater Trochanteric Pain Syndrome, which can result from irritation of a few different tissues. It can include injuries to the tendon of your buttock muscles which is sometimes called a “glute tendinopathy”. It can also include irritation of one of the bursa that are in this area, which is sometimes called “trochanteric bursitis”. In this case, if a bursa in the side of your hip gets irritated, it can cause pain with movement INSTEAD of making movement easier.
Because there are so many muscles, tendons, and bursa that either attach to, or run over the greater trochanter, when one gets irritated it can result in irritation of the others. The initial cause of this irritation can be from a hit to that area (ie. falling on your hip), long distance running, or weakness in your hip muscles.
Did you know?
This type of hip pain is most common in females, and recent studies have begun exploring associations between knee osteoarthritis that alters lower-limb biomechanics and Greater Trochanteric Pain Syndrome.
What can I do to help it feel better?
What exercises can I start with to help my hip pain get better?
These suggestions are just the first step to feeling better and decreasing symptoms. To return to your full activity level, you will need a progressive exercise program to help strengthen the muscles in your hip without making your symptoms worse. You may have to take a break from some activities that are making your pain worse, and slowly return back to them over time. A physiotherapist can help guide you through this recovery process.
Do you have some hip symptoms that haven’t gone away? Call us at 519-895-2020, or use our online booking tool on www.strivept.ca to book an appointment with one of our knowledgeable physiotherapists where they will perform an assessment and create a treatment plan for you.
Amanda McFadden, PT, BSc, MPT
Physiotherapist at Strive Physiotherapy & Performance
Low back pain is one of the more common complaints we deal with at Strive Physiotherapy & Performance. Often times, our clients will express concern about having sciatica, as they may have had it, thought they had it, or knew someone who had it in the past. Sciatica is sort of a complicated topic and often times, any back pain, or any leg pain is confused with sciatica.
This blog post aims to clear up a few things about sciatica. We will discuss:
What is Sciatica?
In short, sciatica is a neurological (nerve) problem that occurs when the sciatic nerve is entrapped or irritated. What exactly does a nerve do? In short, nerves send the signals that are responsible for telling our muscles to move, and for telling our brain how/what we feel.
Having sciatic nerve (“neurological”) symptoms means that you will be experiencing fairly intense pain in the buttock area, and down your leg. You may also experience 1 or more of the following:
The sciatic nerve is big, and it covers a lot of ground within our bodies. In fact, we have 2 sciatic nerves, one for the left low back and leg, one for the right low back and leg.
Our lumbar and sacral spines have 5 nerve roots each (labeled L1, L2, L3, L4, and L5; S1, S2, S3, S4, and S5). Each sciatic nerve comes from 5 different nerve roots within the lumbar and sacral spines. Our sciatic nerves branch from L4, L5, S1, S2, and S3 on each side.
The picture on the left is a front view and shows the left sciatic nerve coming off of the lower 5 nerve roots (L4-S3). It also shows a ‘piriformis’ muscle (remember that for later!). The picture on the right shows how the 5 nerve roots (L4-S3) come together to make the sciatic nerve (big green one!)
Although those 5 nerve roots come together to make 1 sciatic nerve, our bodies tend to keep track of each nerve root. We know that because we have ‘myotomes’ and ‘dermatomes’. A group of muscles that are supplied by a single nerve root is deemed a myotome. A dermatome is an area of skin that is mainly supplied by a single nerve root. Here are some examples:
This is important because sciatica pain typically follows a dermatomal pattern, and you can also have weakness in 1 or more of your myotomes (aside: you might also have decreased reflexes along a nerve root pattern!).
Most common sciatica symptoms:
Much like almost every injury, each sciatica case can present somewhat differently. That being said, the most common symptoms include:
What can cause sciatica?
Many different things can cause sciatica. Some of the more common causes include:
What else could it be?
Sciatica can sometimes be misdiagnosed, which is why it’s important to get a proper assessment. Other possibilities include:
The last one, piriformis syndrome, has many of the same symptoms as sciatica, so I’ll try to differentiate things a little bit.
Both sciatica and piriformis syndrome will present with a variety of symptoms including back/buttock/leg pain, numbness/tingling, and/or walking difficulties.
Here are some differentiating features:
What can I do about it?
First and foremost, it is important to have your pain and injury assessed by a healthcare provider you trust. Sciatica can come from a variety of sources, and it is important to try and determine the most likely source. This is because, depending on the source, the management can be completely opposite. For example, if you have sciatica due to a disc herniation pressing on the L5 nerve root, then you will likely prefer extension-type exercises. However, if you have sciatica from spinal stenosis, then you will likely prefer flexion-type exercises. Additionally, if you do the opposite exercises than what would be most preferable, you may actually make yourself worse!
If you think you may have sciatica, one exercise you can do to try and improve how well your nerve is moving is called a sciatic nerve floss. Here’s a good video of a sciatic nerve floss:
Remember to look up as you bend your foot, and look down as you straighten your foot. Timing is important, and doing it opposite (i.e. bending foot up while looking down), can make you more irritable. You should only complete this exercise if it feels relieving or if it feels like a “nothing” feeling. If it hurts, stop, and consult your physiotherapist.
How do I know if I’m getting better?
I will try to keep this section short and sweet. If you’re getting better, your pain will be lessening in intensity and frequency, and you should be finding it easier to move around (walk, get out of bed, etc).
One important thing to note is that, as you heal, your pain will likely centralize towards your back (i.e. move UP your leg). This is a good thing. The downside, however, is that it might make you feel more intense pain in your bum or back. That being said, as long as you have less (or no) pain further down your leg, that’s actually ok!
In conclusion, sciatica is a painful neurological (nerve) injury that usually affects only one side of your back and leg. There are many potential causes of sciatica, and many other things it could actually be, meaning it’s important to get a detailed assessment.
Do you think you have sciatica? Are you interested in decreasing your pain? At Strive Physiotherapy & Performance, we are committed to providing an in-depth, one-on-one assessment to ensure we can work together to find the best plan of action for each individual client. Call us at 519-895-2020, or use our online booking tool on www.strivept.ca to book an appointment with one of our knowledgeable physiotherapists, and they will be sure to help you understand your injury.
Physiotherapist at Strive Physiotherapy & Performance
Many people with elbow pain get diagnosed with tennis elbow or golfer’s elbow, and are left confused because they’ve never played either sport! Read on, and I’ll clear up the confusion, explain why some people get it, and a few things you can do to help it.
What is Tennis/Golfer’s Elbow?
First point of clarification: these injury names are layman’s terms for lateral epicondylitis (tennis elbow) and medial epicondylitis (golfer’s elbow). That didn’t really clarify anything, did it? Here’s a brief anatomy review:
Look at the above picture. Your humerus (upper arm bone), ulna (forearm bone), and radius (also a forearm bone), come together to make up the elbow joint. The lateral and medial epicondyles are bony protrusions on the distal part of your humerus.
As we learned in the post about the rotator cuff, when a word ends in ‘-itis’, it means inflammation. So, lateral epicondylitis (tennis elbow) is an inflammation of the lateral epicondyle bone, and medial epicondylitis (golfer’s elbow) is an inflammation of the medial epicondyle bone, right? Well…. Almost. Here’s a little more anatomy:
The picture on the left above shows the muscles on the back of your forearm. These muscles are called extensor muscles because they function to extend the wrist and fingers. The picture on the right above shows the muscles on the front of your forearm. These muscles are called flexor muscles because they function to flex the wrist and fingers.
As you can see in the pictures, most of the extensor muscles (left picture) combine into one tendon, and attach to the lateral epicondyle. This tendon is often called the common extensor tendon.
On the other side of the forearm, most of the flexor muscles (right picture) combine into one tendon and attach to the medial epicondyle. This tendon is often called the common flexor tendon.
So, lateral epicondylitis (tennis elbow) is an inflammation of the common extensor tendon (which attaches to the lateral epicondyle bone), and medial epicondylitis (golfer’s elbow) is an inflammation of the common flexor tendon (which attaches to the medial epicondyle bone), right?... RIGHT!
The injury typically occurs in the tendons, the injuries are just named for the bone in which they attach to.
So, here’s the short clarification: pain due to inflammation of the tendons on the outside of your elbow is called tennis elbow (lateral epicondylitis). Pain due to inflammation of the tendons on the inside of your elbow is called golfer’s elbow (medial epicondylitis).
But How Did I Get It? I’ve Never Played the Sport!
Tennis elbow is named this way because it’s common for those who play tennis (or other racket sports) to experience pain on the outside of their elbow. They get this pain by overusing their forearm extensor muscles (picture someone doing a backhand shot).
Golfer’s elbow is named this way because it’s common for those who play golf to experience pain on the inside of their elbow. They get this pain by overusing their forearm flexor muscles.
So, people usually get tennis or golfer’s elbow by overusing their forearm muscles, often with repetitive activity. This doesn’t have to be from tennis or golf, it can be from many different things. For example: lots of hammering, gripping or lifting heavy things, or even typing on a keyboard!
Typically, these injuries develop over time, and get gradually worse. Straining the muscles over and over again puts too much stress on the tendons, and they get inflamed. Constant pulling on the inflamed tendons can eventually cause microtears.
Commonly, people with these injuries feel pain with gripping/lifting objects, opening doors, or even shaking hands. Further, it usually hurts to do the activity that caused the problem in the first place!
So What Can I Do About It?
Like most injuries, it’s a great idea to try and prevent any occurrence in the first place. Resting from repetitive activity, even before the onset of pain, can help limit the development of tennis/golfer’s elbow. Further, maintaining a good overall fitness, and good forearm strength can be helpful. Periodically stretching these muscles can also be beneficial. The stretches are simple, and can be completed anywhere. The pictures below show how to stretch the muscles on the back of your forearm (extensors) and the front of your forearm (flexors). Hold the stretch (should not be painful!) for 30 seconds, and do 3 repetitions of each stretch 2-3 times a day.
If you unfortunately already have symptoms of tennis/golfer’s elbow, physiotherapy can be very helpful. Common strategies used at physiotherapy to help manage these conditions include:
Not sure if you have tennis elbow, or concerned about your elbow pain in general? Want to get out of pain, and back to function? The best thing to do is to see a physiotherapist and get your elbow assessed as soon as possible.
At Strive Physiotherapy & Performance, we are committed to providing an in-depth assessment to ensure we can work together to find the best plan of action for each individual client. Call us at 519-895-2020, or use our online booking tool on www.strivept.ca to book an appointment with one of our knowledgeable physiotherapists, and they will be sure to help you understand your injury.
Thanks for reading,
Physiotherapist at Strive Physiotherapy & Performance
Another question we, as physiotherapists, often get asked from friends, family members, and clients is: “what do you think about [insert other healthcare professional - i.e. chiropractors, massage therapists, etc.]?”
Much like the “It depends” blog post - the answer is, in a way, “it depends”.
Chiropractors, massage therapists, and even physiotherapists for that matter, are much the same as any other profession. Just like there are good restaurant servers and bad restaurant servers, there are good chiropractors and bad chiropractors, good physiotherapists and bad physiotherapists. Almost every profession, job, career, or product has a good version, and a bad version.
In this case, the word ‘bad’ is a generic word, and of course, entirely subjective. Bad doesn’t necessarily mean they have poor hands-on clinical skills, or that they don’t get 100% of their clients better. Bad - to me anyways - means complacent.
As mentioned, most professions have a good and bad, and therefore we can assume there is a spectrum of “talent” (again, ‘talent’ being used as a generic, subjective term). Since there is a spectrum, this means that it can be placed on a normal distribution bell curve, like this one:
We will use health care practitioners (i.e. chiropractors, physiotherapist) to quickly explain. Most healthcare practitioners fall in the middle, close to the average, and in many cases, are successful practitioners who get the majority of their clientele better. Some fall to the left side of the bell-curve, which in my opinion, are the ones you want to try and avoid. Now, like I said, hands-on skills may not be what places them towards the left of this curve. More likely, what places them near the left is complacency. They are comfortable with being average (or just below average). They are comfortable getting a decent proportion of their clients better. They are comfortable with the knowledge they currently have and the skills they currently use.
That being said, some fall to the right side of the bell-curve, which in my opinion, are the ones you want to try and seek out. These practitioners are always striving to better their practice (both soft (i.e. communication) and hard (i.e. hands-on) skills), as well as to better themselves. They self-reflect on what they could have done better, even in the successful cases. Most importantly, they are never complacent and comfortable with their current abilities, they are always striving to know more. Know the newest research, know a different hands-on technique, know what works, and how to alter it if it doesn’t.
That was the long answer. The short answer is this:
The purpose of this blog post was to:
Need the help of a physiotherapist striving to be at the right of the bell curve? Call us at 519-895-2020, or use our online booking tool on www.strivept.ca to book an appointment with one of our knowledgeable physiotherapists, and they will be sure to help you understand your injury.
Until next time,
Physiotherapist at Strive Physiotherapy and Performance
As learned in our previous blog posts on understanding surgeries (see: rotator cuff, knee scope), we used to work alongside surgeons. One of these surgeons completed A LOT of joint replacement surgeries - almost entirely on the knee and hip. Therefore, we’ve treated our fair share of post-operative clients - especially post-knee replacement! As an FYI, a total knee arthroplasty (TKA) is science speak for a total knee replacement (TKR), so they are used interchangeably!
So you’re going to have your knee replaced... The purpose of this blog post is to try and clarify the ins and outs of having a knee replacement surgery. Knowledge is power! Be prepared, and things will go smoothly!
Aside: We will use the same headings in this post as we did in the other ‘Must Know Knowledge’ posts. We’ll try to stick with the same format so that it’s easier to navigate. Some things might look similar, as some advice is “surgery” related, and less specific to the type of surgery.
How do I know if I even need a total knee arthroplasty (replacement)?
Typically, to qualify for a knee replacement, many, or all, of the following statements are true:
Do I have to do pre-operative physiotherapy?
In short, yes, you should. It helps in the following ways:
What else should I do before I get a total knee arthroplasty (replacement)?
How is a total knee arthroplasty (replacement) performed?
Every surgeon has their individual preferences, however, knee arthroplasty is typically performed as described here:
Note on the video: not every surgeon implants the drain
Psst. If you want to know more about knee anatomy, check out our post here: ACL. MCL, Meniscus - My Knee Injury Sounds Complicated
Before we get into the next part of this blog post, it is important to note that everything in this blog post is for information purposes only. This blog post is not intended to be strict medical advice. As previously mentioned, everyone is an individual, and therefore, individual variances do occur. It is important to consult your physiotherapist, surgeon, or doctor for the most applicable advice for you.
What does the typical rehabilitation process look like?
First, it’s important to reiterate that everyone is an individual, with individual circumstances, and therefore, the rehab process will be very individualized. That being said, in almost every case, it is safe to walk on your leg immediately after surgery, and you will typically spend 1-2 days in hospital post-operatively. In the hospital, you will learn how to walk with a walker, climb stairs safely, and be monitored for any post-surgical complications.
Once at home, you will often be allotted home physiotherapy appointments with a physiotherapist (for free), through the Community Care Access Centre (CCAC). That being said, the amount of appointments provided by the CCAC has been significantly reduced in the past couple years (down to 1-4 total appointments), which is not enough.
Due to the limitation in the number of CCAC-funded appointments, you will continue with further physiotherapy via one of two options: publically-funded (OHIP) physiotherapy, or privately funded (out of pocket/private benefits) physiotherapy. OHIP physiotherapy often has a limit to it as well, and many people require more than the “program of care” allows for. Therefore, it is important to consider the potential financial costs of ongoing physiotherapy when undergoing a total knee arthroplasty.
This next sentence is important: Complete rehabilitation after a total knee replacement will usually take 6-12 months. It’s likely that someone will tell you 3 months. 3 months of rehabilitation can get you back to work (depending on your job), or allow everyday life tasks to be more easily and comfortably completed. To get back to 100%, it will probably take longer. You may not be required to frequently attend physiotherapy appointments, but you should expect to be working on exercises, and self-management for up to 1 year postoperatively.
Overall, post-operative care looks something like this:
Here’s the unfortunate part: gaining the range of motion (over the first couple months postoperatively) in your brand new knee is usually not very fun.
That being said, speak openly and honestly with your physiotherapist to ensure the process is not completely unbearable, because that’s not helpful either.
How long does it take to heal after a total knee arthroplasty (replacement)?
In uncomplicated cases,
As with any surgery, here are some additional things to consider:
What exercises are safe to do right away after a total knee arthroplasty (replacement)?
In the hospital, or from the surgeon, you will likely be provided with a list of exercises to get started on. These usually include range of motion, and muscle activation exercises. These are a great place to start.
That being said, the primary goal in the early postoperative stage is to focus on gaining flexion range of motion (knee bend). Here’s one of the most common knee flexion exercises (called a heel slide):
A prescription of 10 repetitions with 5 second holds, 3 times a day is common when working on this ‘heel slide’ exercise.
Overall, you will progress in this order with rehab (roughly):
Lastly, it’s highly likely that you and your physiotherapist will work on other joints (such as the ankle and hip) together. You should be able to work on hip musculature (which greatly supports the knee) safely, so it is highly recommended. This should help to reduce any postoperative complications in your other joints, all while decreasing your pain, and improving your overall function!
How much function and how little pain can I expect at the end of my rehabilitation?
Alas, the loaded question. (We know we’ve started this section with that same sentence for each of the ‘Must Know Knowledge’ surgical blog posts… Sorry, but it’s always a loaded question).
Again, everyone is an individual, everyone heals differently, and therefore final pain and function are highly individualized. As mentioned earlier in this post, there are some indications of ongoing pain after a knee replacement. Further, if there are complications with surgery, it may alter the progress/end result of your recovery.
Here are some things we consider:
What are the potential complications associated with a total knee arthroplasty (surgery)?
All steps will be taken to limit complications postoperatively, however, it’s important to understand the possibilities. Complications include:
There’s a lot of information in this blog post. But there’s also a lot to know. Be informed, ask questions (even the hard ones), and look out for yourself.
Let us know if you thought this blog post was helpful, and we will try to post new ones outlining the helpful points for other types of surgeries!
Are you planning to undergo (or have already undergone) a total knee replacement? At Strive Physiotherapy and Performance, we are committed to providing an in-depth assessment to ensure we can work together to find the best plan of action for each individual client. Call us at 519-895-2020, or use our online booking tool on www.strivept.ca to book an appointment with one of our knowledgeable physiotherapists, and they will be sure to help you understand your injury.
Physiotherapist at Strive Physiotherapy & Performance
You start having a bit of hand pain or weird sensations in your fingers. You mention it to your friend and they start telling you about how you have a “tunnel in your carpal”?!?
I agree, sounds confusing. So let’s start with the basics of this condition, and clear things up.
What are carpals?
Carpals are the small bones in your hand/wrist (in the lower quarter of your palm). There are 8 carpal bones in each hand.
What is a carpal tunnel?
In addition to the carpal bones, you have ligaments, muscles, tendons, nerves, arteries, and veins throughout your entire wrist. The carpal tunnel portion is formed by your flexor retinaculum (a band of fibrous connective tissue) running over the top of your carpal bones on the inside part of your wrist. Inside this area are some wrist flexor tendons and the median nerve (and other tissues too). Everyone has this carpal tunnel!
Why do people complain about having a carpal tunnel?
When people you know are saying that they’ve had carpal tunnel before, they really mean they’ve had “Carpal Tunnel Syndrome”. This is a combination of symptoms which can include pain, tingling, pins and needles, numbness, and weakness in the hand. This is particularly evident with symptoms in the outside three fingers (and sometimes part of the 4th!), as seen in the image below.
What causes these symptoms?
These symptoms can be caused by increased pressure on the median nerve (inside the carpal tunnel) which can come from irritation and inflammation of the flexor tendons (there’s only so much space in there!). This can be from overuse of your wrist muscles, usually with repetitive flexion and extension movements (some factory workers). This irritation can become even worse with having to use heavy grip strength. Using vibrating tools (ie. a construction worker) can double the prevalence of carpal tunnel syndrome. It can also be worsened by prolonged end range positioning of your wrist. Interestingly, rates of carpal tunnel syndrome have not been indicated to be higher compared to the general population in individuals who use a computer for work, but pain relief may be achieved by those who do have carpal tunnel syndrome to create rest breaks from the computer and to set up their desk in an ergonomic way to avoid prolonged wrist extension.
Note: Pregnancy also can cause a carpal tunnel syndrome flare up as a result of hormonal changes and resulting swelling. Typically, carpal tunnel syndrome will resolve after delivery but the symptoms can be managed in the meantime while you are pregnant.
I think I have this!
It’s important to note that these hand symptoms can also be caused by injuries or compression to the median nerve higher up in the arm at the elbow, shoulder, or neck. There are also other causes of wrist/hand pain. It is important to see a physiotherapist to differentiate the cause of the symptoms in order to provide an appropriate treatment plan for the cause of the symptoms.
What can I do to help my carpal tunnel syndrome symptoms?
One of the most important things that you can do to improve the symptoms of carpal tunnel syndrome is to modify the activities that are aggravating it. By doing this, you can provide your wrist with “relative rest”. Please note : Complete rest (ie. having your arm in a sling so you don’t use it at all) will not get you better!
Even with modifying your work environment and tasks, you will likely find a benefit from using a wrist brace or splint at night. These are designed to keep your wrist in a neutral position and to prevent your wrist getting caught and twisted while you’re sleeping. This will allow for the aggravated median nerve and flexor tendons in your carpal tunnel to rest and recover in a neutral position overnight.
It is important to continue moving your wrist to optimize the recovery of the tendons that are irritated as well as the recovery of the median nerve. You can do this by bending your wrist slowly forward, and slowly back 5 times each direction, 10 times per day.
You can also improve the movement of the median nerve to aid it’s recovery by doing nerve glides. Start with your shoulder out to the side with your palm facing up, and curl your elbow and wrist in toward your head while moving your ear towards the opposite shoulder. Then, extend your elbow and wrist out to the side while bring your ear to the same shoulder. Repeat 10x very gently, not pushing into any symptoms, 3 times per day.
As always, depending on the occupation you have, your recreational activities, your symptoms, and your medical history, the advice and exercises that you receive from a physiotherapist will be specific to you.
Do you have some hand symptoms that haven’t gone away? Call us at 519-895-2020, or use our online booking tool on www.strivept.ca to book an appointment with one of our knowledgeable physiotherapists, and they will perform an assessment and create a treatment plan for you.
Physiotherapist at Strive Physiotherapy and Performance
Let’s face it. You’re getting older, your life’s passing you by, you’re sitting on the couch, and watching TV. All of the sudden, that Everest College Commercial comes on and reminds you that you need to get an education. So you get up, go to pick up the phone and…it hurts to walk over to the phone because of your knee pain. Then you remember your knees also hurt when you run. Bummer. All jokes aside, there’s a small chance that you’re interested in Everest College. Yet, there’s a greater chance that you’re frustrated with your knee pain.
So What Causes Knee Pain?
It could be a lot of different things, and this has a high potential for getting very scientific; so I’ll explain it in the simplest way possible. Improper patella (knee cap) tracking, is one of the fairly common reasons that your knees are sore. What do I mean by tracking? Think of it this way, your patella is held in position by various amounts of fascia (which is attached to muscles) pulling it in multiple directions. With improper tracking, your patella is not centered, and is in a position that could possibly rub against the bone, cartilage, etc, thus causing inflammation and knee pain. Your physiotherapist will often call this “patellofemoral pain syndrome” or “PFPS”.
There could be numerous reasons why your knee is tracking improperly, but judging by what I’ve seen in the trenches, the most uncommon reason is that your muscles on the outside of your leg are too strong, and pull your knee cap sideways. That is so 1980’s. The most common causes of this tracking problem (that I’ve seen) is bad Q-angle, poor hip and ankle mobility, and weak glutes (your butt muscles). Combine this with all the long distance running that people do, and you have a recipe for disaster that not even the Demon of Knee Pain could dream of creating.
This is the angle between the hip and knee. Check out the figure below:
Generally, you don’t want your knees caving in. Most women have a tremendous problem with this because they tend to have wider hips (for childbirth). This is the reason why I barely ever allow any of my female clients to do long distance running. Look at most female marathon runners. Natural selection has weeded out ones with wider hips, leaving the women with small Q-angles to win the races (pain-free).
Hip and ankle mobility?
This is basically the range of motion that your hips and knees have (often confused with flexibility). As you get older, the years of sitting at a desk add up, and you end up getting tight (pretty much everywhere), and start losing your mobility. This is why most children can put their feet over their heads, and the reason why your grandparents have trouble bending down to tie their shoes.
Let’s Get Rid of This Pain
First of all, I’m not a Physiotherapist, so use the methods below at your own discretion. Further, if you’re unsure about anything (your pain, why you hurt, exercises, etc. etc. etc.), then PLEASE go see a physiotherapist! With that being said, even if you don’t have knee pain, a lot of people could benefit from taking the advice I’m about to give.
First of all: if it hurts, stop doing it. Duh! A lot of people play Russian roulette with logic and end up losing. Does your knee really hurt after running that 5K? Then stop running until you’re better. Once you’re better, improve your running mechanics. This means getting a professional to teach you how to run properly, or at least doing a little bit of research.
Start foam rolling:
Invest only 10 minutes of foam rolling per day, and you will thank me and your foam roller.
Activate your glutes with the following exercise. Muscle activation simply means: warming up a specific muscle to “turn it on”. Most people recommend doing muscle activation after mobility work, but I’m a firm believer that activating the glutes (specifically) before mobility work will transfer over to an increased performance during the mobility work.
Mobilize your hips and ankles. Here’s some good videos how to do so:
Last (but not least), start building leg and glute strength properly. Use excellent form (don’t let your knees cave in), and use single leg exercises and their variations (reverse lunges, single leg deadlifts, etc). Progress slowly. When performing most single leg movements, make sure that your center of weight is on your heels (and not on your toes), and that you can feel the movement being executed (at some point in time) in your butt (and not your knees or back). Good rehab is usually just good (and proper) training. Not sure if you’re performing an exercise properly? Ask a physiotherapist or a good trainer at the gym. Don’t be afraid to ask. Usually, the ones who know what they’re doing are also the ones who will happily help you out. Don’t forget to thank them.
Concluding this madness…
Obviously, there is no one single method to rehab an injury, but your first step should always be to get someone to look at it (I would recommend a good physiotherapist over a Doctor). Or, if you want to try the self experimentation route, my tips above are a great starting point. Just remember that nothing will ever compare with getting one-on-one consultation with a well established movement specialist, such as a physiotherapist. “Why you making it complicated? It’s easy” (Everest College Guy).
Good luck with your knees!
We want to thank Jason for providing the excellent guest post! He makes some great points! Need one of those good physiotherapists Jason was talking about? In pain, and would like a one-on-one physiotherapy assessment? At Strive Physiotherapy and Performance, we are committed to providing an in-depth assessment to ensure we can work together to find the best plan of action for each individual client. Call us at 519-895-2020, or use our online booking tool on www.strivept.ca to book an appointment with one of our knowledgeable physiotherapists, and they will be sure to help you understand your injury.
Physiotherapist at Strive Physiotherapy and Performance
About the Author:
Jason Maxwell is a rocket scientist turned fitness professional. He specializes in helping guys build muscle, lose fat, and get stronger. Visit www.jmaxfitness.com for more information.
Pain is the most common reason someone sees a physiotherapist. How pain impacts a person’s identity, their relationships and their outlook on life, are typical factors for an individual to seek counselling support. Consequently pain is one of healthcare’s greatest challenges. We’re literally spending billions of healthcare dollars on pain management without a true solution to the problem.
Why isn’t there a solution?
This is because pain is individualized. You could have 5 people with the same injury and they will all present differently, with different amounts of pain. Their bodies will all react differently to the same approach. Conversely, their brains will react differently too. For some, pain may be seen as a challenge that needs to be tackled and overcome, for others it may be perceived as a threat that is robbing them of their personhood; both mindsets can be detrimental to recovery. Whether it be stress and frustration adhering to the slower pace an injury demands or overcoming anxiety and fear as the result of an injury, these are just two examples in a multitude of ways people comprehend pain. Interestingly, most people believe pain is experienced the same way by everyone, like we’re cars made on the same factory line. There is a belief that we all heal the same way and that the same therapeutic approach works for everyone; a one size fits all. If this were the case, North Americans wouldn’t be spending approximately $600 billion dollars per year toward the care and management of chronic pain. For practitioners and the healthcare system as a whole, this is where the challenge lies.
New research over the past 5 to 10 years has shown that pain depends on many factors. One small factor is your actual injury. Your actual injury may cause pain, but did you know that within 15 seconds of experiencing pain your brain changes the way it thinks about an injured area? So, if you hurt yourself reaching for a cup of coffee, your brain will think differently about how to reach for a cup of coffee while you’re experiencing pain. If you don’t recover from your injury, this new pathway can create adaptations in your brain that modifies your body and movement compared to how you moved before you experienced your pain.
Check out this amazing video from one of the world’s leading pain researchers.
Now, let’s take it a step further. Research also indicates that your experience of pain is greatly influenced by your current and past experiences with pain, your ability to cope and manage with emotional responses to stress, your work-life balance, your support system and much more. This is called the biopsychosocial model of pain. Considering all these factors, can we really attach all of our focus on our tissues as the main or only source of our pain? The more we learn the more we can confidently say “No.” In fact, through medical imaging, researchers have found that people can have disc bulges, meniscal tears, osteoarthritis, and many other diagnostic findings without the experience of pain. There have been multiple reports that show people without pain having the exact same MRI findings as someone with pain.
Check out the findings comparing MRIs for people with and without low back pain.
Can this go both ways?
If we can be pain-free regardless of a muscular, tissue or skeletal change in our body, can we experience pain when there is no longer a tangible change in our physical structure? Totally! There are many people that experience pain for years following an injury, but their injury has been fully healed. So how do they still experience pain? Current science indicates that all the other factors discussed above may continue to influence pain for years following an injury and lead to a life with chronic pain.
You may want to ask yourself the following: Have I returned to sleeping well following my injury? Am I avoiding certain movements? Is the pain I’m experiencing hurting a relationship at work or at home? Does my pain lead to feelings of fear or anxiety in certain situations?
Check out this video about how pain can be impacted by our daily lives.
What does that mean?
It means we believe you can get better. It means that we don’t take a “one size fits all” approach to your pain but rather an integrated look at what could benefit you. It means with the right approach we can calm things down and build them back up. It means we can retrain your brain to overcome pain and return to previous levels.
Are you looking to find out more? At Calming Tree Counselling and Strive Physiotherapy & Performance, we’re committed to providing a multi-disciplinary and in-depth assessment to ensure we can work together to find the best plan of action for each individual client. Check us out at www.calmingtreecounselling.ca and www.strivept.ca.
Have a great day,
Physiotherapist at Strive Physiotherapy & Performance
MSW, RSW at Calming Tree Counselling
About the Authors:
Melissa Reid is a Registered Social Worker with a Master’s degree in Social Work. Ms. Reid received her undergraduate degree from the University of Waterloo after which she pursued a certificate in child abuse studies, and finally a Master’s in Social Work from Wilfrid Laurier University, Waterloo, Ontario. Ms. Reid has also participated in numerous educational conferences on trauma, grief and bereavement.
Mike graduated from the University of Waterloo in 2006 with an Honours Bachelor of Science in Kinesiology. Immediately upon graduation, he was accepted into McMaster University's Physiotherapy program where he graduated with a Masters of Science in Physiotherapy in 2008. Prior to becoming a physiotherapist, Mike served in the reserves for 9 years as a member of the Artillery in the Canadian Armed Forces.
According to Stats Canada, up to 20% of Canadians aged 65 and older have had a fall in the previous year. As you get older, many things about your body change. Typically, your eyesight declines, your muscular strength and endurance decreases, and your balance starts getting worse. Sometimes, these changes can contribute to a fall, which may or may not lead to another fall… which CAN cause significant injuries such as a fractured hip . Even worse, this can lead to a FEAR of falling and a subsequent decrease in activity level… which can, unfortunately, increase your risk of falling again! Does this sound like you, OR someone you know?
While I admit that there are many changes as you age that you can’t control, there are just as many changes that you CAN control. Working to improve your function as you age can increase your confidence at preventing falls.
Here are five tips to reduce your fall risk:
1. Strength training
This can start with something as simple as a sit to stand exercise. This is a great exercise that works similar muscles to a squat, including your quadriceps, and gluteal (bum) muscles. Start by doing 10 repetitions in a row, and take a break if you need to. Breathe throughout the exercise (don’t hold your breath!). You can use a chair with arms or a chair next to a counter if you need some extra balance support with this exercise.
2. Balance training
If you don’t use it, you lose it! Many of my clients stare at me like I’m crazy when I ask them to stand on one leg during their assessment. These same clients, after a few weeks of practicing their balance at home, can stand on one leg with relative ease. Many people will report that they “just have bad balance”. The great thing about balance is that you can easily improve with practice! Start by standing next to a counter with both hands resting lightly on the counter and lift one leg up. Progress by lifting 1 hand up off of the counter, and then your 2nd hand off of the counter. Try to balance for as long as you can! Work on it for 1-2 minutes at a time, taking breaks and touching your hands/ feet back down whenever needed.
Note: These example exercise training suggestions are targeted towards older adults who do not use a gait aid and are living at home (if you DO use a gait aid (ie. cane or a walker) or have a level of function that will not allow for the above exercises, or have pain during these exercises, you may require some modifications). Safety is the number one focus when starting any new exercise program, so use a spotter if needed when starting out with these exercises.
3. Get your eyes checked!
Make sure your eyeglass prescriptions are accurate, and that you WEAR your eyeglasses (they don’t help you see when they’re on your nightstand!). Your “balance system” uses many cues from the body, including your vision. If your vision has declined, there is poorer information for your brain and body to use to keep its balance.
4. Clean up your home environment!
Remove clutter from stairs or in walking areas. Consider the placement of tripping hazards, such as scatter mats. Ensuring good lighting (especially at night time) can also help create safe navigation in your home.
5. Add some helpful equipment (if needed)!
Install handrails on all indoor and outdoor stairs/steps and grab bars in the bathroom. Increasing your points of contact will improve your balance and decrease the chance that you will fall, whether on the stairs or in the bathroom. There are many assistive devices to make living at home easier and safer, depending on your function level. Using a gait aid, like a cane or a walker, may also be appropriate for some older adults that are having difficulty with their balance when standing and walking.
These are some very simple ways to start to decreasing an older adult’s fall risk. The best way to minimize an older adult’s fall risk is for a physiotherapist to assess their capabilities and limitations, in order to provide an individualized program for each person. One older adult can have a much different activity level or health history compared to another older adult of the same age.
Are you concerned about your risk of falling? Call us at 519-895-2020, or use our online booking tool on www.strivept.ca to book an appointment with one of our knowledgeable physiotherapists, and they will be sure to assess your level of function to determine the best treatment plan.
Physiotherapist at Strive Physiotherapy & Performance
As the technological world of laptops, cell phones, and tablets forces us to focus our attention downwards and inwards, many of us begin to feel achiness, pain, or stiffness in our necks, upper backs, or shoulders. Often, we adopt a common cell phone posture (see below), which can increase our risk of neck, back, or shoulder pain.
As you can see in the above picture, our preferred cell phone posture leads to increased neck flexion, increased upper back kyphosis (forward curve), and forward/rounded shoulders. When this causes pain, it has been dubbed “tech-neck” or “text-neck”.
Alternatively, we could adopt an improved posture:
The improved posture above encourages an upright torso, with a neutral spine and retracted (pulled down and back) shoulder blades.
For some, even obtaining the more upright, improved posture can be difficult. As a physiotherapist, I often hear that it’s too hard for people to keep their torso upright, with their shoulders down and back. In my opinion, most people feel this way because the upright posture is so different from what they’re used to. Further, the increased amount of time they spend in the poor posture causes their shoulder and scapula (shoulder blade) muscles to be on a constant stretch. The constant stretch leads to inhibition of these muscles, and apparent weakness. Therefore, people find it difficult to obtain an improved, upright posture because their muscles don’t have the capacity to maintain that position.
So How Do I Improve My Capacity To Obtain That Position?
Great question. A good place to start is to simply try and obtain that (improved) position as often as you remember. Set an alarm on your phone, add a post-it note to your computer, tell others to have you ‘sit up tall’ or ‘stand up tall’ - just be in the improved position more than you are now. Slowly it will feel less difficult.
Secondly, improve your capacity through exercise. This is the fun part! 17 muscles attach to the shoulder blade, cool right!?. Strengthening some of these scapular muscles can lead to improvements in your ability to maintain a good posture, as well as improvements in your pain and stiffness!
NOW FOR THE SCIENCE!!! This paper outlines the recommended exercises for each muscle [Aside: to the physiotherapists reading this-go read that paper]. Many of these recommendations are based on electromyographic (EMG) evidence. EMG is how we measure muscle activity. The higher the EMG measured in a muscle with a certain exercise, the higher the muscle activity with that exercise. So in theory, the higher the muscle activity, the higher the chances of good strength building!
So What Muscles Should I Build?
Another great question. I would recommend starting with your posterior rotator cuff muscles (infraspinatus and teres minor), the middle trapezius, and the lower trapezius. These muscles are responsible for drawing your shoulders/shoulder blades down and back and for controlling arm/shoulder movement (especially overhead!). Improving the activation/strength in these muscles will allow you to obtain the improved posture more easily! Spending more time in the improved posture will help your pain!
Here’s a table of the recommended exercises for activating each of those muscles (from the research paper mentioned above!):
Start by doing 2 sets of 10 repetitions of each exercise 1-2 times a day. If that’s too hard, do fewer reps. If that’s too easy, do more reps. Find the numbers that make you tired, but not painful! If anything is painful or too difficult, consult a physiotherapist!
If your cell phone, laptop, or tablet is bringing you down, bring yourself back up! Consciously think about your posture, activate some muscles, and take care of yourself!
Do you suffer from TechNeck? Is obtaining a good posture difficult for you? Want to get out of pain, and back to function? At Strive Physiotherapy and Performance, we are committed to providing in-depth, one-on-one assessments and treatments to ensure a quick and comfortable recovery. Call us at 519-895-2020, or use our online booking tool on www.strivept.ca to book an appointment with one of our knowledgeable physiotherapists today!
Physiotherapist at Strive Physiotherapy and Performance
Strive Physiotherapy & Performance
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