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Q: My doctor says my elbow pain is due to tennis elbow. But I don’t play tennis. Could you explain how this has come about and what I can do about it?
A: “Tennis elbow” is a common term for a condition doctors call lateral epicondylitis. It’s caused by inflammation of the tendon that connects the extensor muscles of the wrist to the outside of the elbow.
Probably fewer than 10 percent of people get this by playing tennis. The usual causes are recreational activities such as gardening, job-related lifting, using a screwdriver or wrist overuse.
The medial epicondyle can also get inflamed. In this condition, called medial epicondylitis, the affected tendons connect the flexor muscles of the wrist to the inside of the elbow. It’s commonly called “golfer’s elbow” or “pitchers elbow.” Tightening and twisting the wrist from activities such as golfing or throwing a baseball can cause it.
Most people with medial or lateral epicondylitis feel pain when their doctor applies direct pressure to the inflamed area. He or she might ask you to push your wrist against resistance, which could also cause pain. You might also feel pain with handshaking, lifting a briefcase or heavy pot or similar activities.
If you’ve lived in Canada, you’ve heard of and probably used one of the greatest winter ‘do everything’ boots on the market; the Sorel’s. Or maybe just those felt lined Rubber Boots, rated for -35 and especially used in this transition season; wet, slush, even rain, but not too cold; typically found at Canadian Tire or Princess Auto (two great Canadian stores). Or do you snowmobile? you probably have some very large, -100 boots; that are not made for walking or even standing too long at the fire.
Sore feet? here’s your answer…an insulated (400 gm 3M Thinsulate) insole, that we can customize for your size and foot biomechanics.
2) Am I a candidate for telerehab? Review the above criteria, and if you are unsure, please call us. We will connect you with your therapist who will help determine if you are a suitable candidate for this service or in-clinic services.
3) How does it work? I will be using a combination of either Apple FaceTime, Zoom, Facebook Messenger video-call or Microsoft Teams. Upon virtual assessment, home pain management ergonomic assessment of your home and exercise prescription shall follow, along with physician/work letters, specialist referrals, etc.
4) What equipment do I need? You can use your mobile device or computer for your Easy Connect Virtual Physic sessions. Please make sure your device is charged, you have a secure internet connection and/or download the appropriate app to enable quick connection at the time of your call and enable camera access.
5) How do I book? I encourage you to use the email form (scroll down for New Patient form pdf) or
call 204- 9 4 3 8 4 1 1
text 204- 2 9 1 8 4 1 2
to setup an online session
6) How much does it cost? Assessment $89 Treatment $79 (save at least 45 minutes)
7) Is it covered by insurance?
As of April 16, we have confirmed that these services are covered by: Canada Life (Great West Life), Green Shield Manitoba Blue Cross, Sun Life Johnston Group, Chambers of Commerce Maximum Benefit, Manulife Johnson Inc., Industrial Alliance Blue Cross Federal Programs: CAF for existing claims to a max of 4 sessions
If you are a MPI or WCB client; please confirm with your adjuster if such services will be covered
8) How do I pay? Either by an interact email (online etransfer) or in some cases we can direct bill to your private insurance and/or company benefit program (with your written consent)
9) Can I receive virtual services if I am in another province or country? Only those Ergonomic Assessments not conducted as part of a physiotherapy treatment plan
10) I just want to talk to my physio with a few quick questions. Do I need to book an official session? Yes, your physiotherapist is operating under their professional licensure requirements and cannot provide medical advice unless done so under a mutually agreed, and signed consent contract. If you have specific medical questions for your therapist book an Easy Connect session.
11) How do I send my consent forms back to you? If you have the ability to print and sign the forms, please do. Then you can scan or take a photo of them and send them back to us via the secure email. Otherwise your Physio will obtain your verbal consent and review the consent to treatment forms with you. If direct billing is requested, specific insurance forms must be signed.
12) What if I have further questions or feedback? Please call us
204- 9 4 3 8 4 1 1
and we will be more than happy to answer your questions. Given this is a new service, we also welcome suggestions for improvement as well. Your feedback is important to us!
Did you know that more Canadians participate in golf than any other sport? 5.7 million Canadian golfers play over 60 million rounds of golf annually. Golf is especially popular with middle-aged and older Canadians. (PT Alberta)
In Canada, golf is generally considered an outdoor, spring or summer
activity, but the opening of indoor golf domes, smaller golf centers and
golf enthusiasts travelling to warmer climates to play has made it
possible for Canadians to enjoy golf year-round. While this means
Canadians can take advantage of the health benefits associated with golf
all year, more time on the course may also increase the risk for
injuries associated with the sport.
Golf is good for you?
Canadian physical activity guidelines recommend adults over 18 should
accumulate at least 150 minutes of moderate to vigorous aerobic
physical activity per week in bouts of at least 10 minutes.3
Many people assume golf is a leisure activity and that golfers do not
reach a high enough level of intensity to be counted toward their
weekly activity goals. However, although not as intense as some sports, a
golfer who walks a nine or 18 hole course expends enough energy to
classify golf in the moderate intensity group, meeting the physical
Walking 18 holes carrying or pushing your clubs takes around four
hours, requires 11,000 to 17,000 steps, covers 4-8 miles and expends 500
to 2,400 calories.4 If you add in a few hills, take more
strokes, cover more ground between shots or are a little less fit, the
numbers are more likely to be in the higher ranges. Using a cart
decreases the overall numbers by 50% but it’s still better than sitting
What are some of the benefits of golfing?
Evidence suggests that golfing can have beneficial effects on:4
Cardiovascular health: Golfing may be associated
with improvements in known risk factors associated with heart disease by
increasing physical activity levels, improving blood lipid and
insulin-glucose levels, reducing overall body fat, and improving aerobic
Respiratory health: Regular participation in golf may improve and maintain lung function in older adults.4
Musculoskeletal health: Older golfers may show
improvement in balance, muscle function and strength, and golfing may be
associated with better bone health in women.4
Mental health: Golf has been associated with positive impacts on overall mental wellness.4
What injuries may result from golfing?
Studies suggest that between 40% to 60% of golfers sustain a golf-related injury each year. Although approximately 25% of participants are aged 65 and over and may have pre-existing conditions that predispose them to injury, injuries are seen among golfers of all ages.
The most common golf-related injuries affect the low back, shoulders, elbows or wrists. Nearly all injuries relate to poor technique or faulty swing mechanics. Many of these injuries are caused by the unique twisting forces and the combination of movements that a golf swing applies to the body. Most fall into the category of overuse or repetitive strain injuries.
What can I do to prevent getting injured?
Tips to make your next round injury-free include:
Warm-up: Start with some general aerobic activity
such as walking for 10 minutes, then hit a few balls at the practice
range. On the practice tee start with your short irons, then the long
irons, the woods and finally your driver.6 Practice using
gentle swings and focus on good technique. Warming up in this sequence
lets your body get used to the combined movements of a golf swing before
you add the resistance of a heavier golf club. If you have the
opportunity, practice on natural turf. The natural golf swing involves
some degree of contact between the club and the ground so practicing on
artificial surfaces may increase stress to the wrists and elbows,
leading to injury.6
Stretch: There are mixed opinions as to whether
stretching should be included in warm-up routines to prevent injury.
However, stretching on a regular basis does help to increase your range
of motion and flexibility.7 Both are important to ensure you
have the physical ability to produce a full, easy swing and to ensure
you are not putting too much stress on your back while twisting. Be sure
to include stretches for your upper body and back as well as your
wrists, shoulders and low back. Remember that stretching should not be
painful. Focus on gradually increasing your range of movement and
holding each stretch for 10 to 20 seconds without bouncing.
Build up your golf endurance: When the sun is
shining, and the opportunity arises, you may just want to play those 18
holes whether you’re prepared or not. Acting on that impulse without
being prepared may increase your chance of getting injured. You will get
more out of golf season if you gradually build up your time spent on
the course. Consider starting on the driving range and then gradually
increasing your game from 9 to 18 holes.
Preparing for the next golf season or winter golf getaway
Rest: A four to six week break from golfing allows your body to recover from the last season and prepare for the next one. Canadian winters allow for a natural break from golf; however, if you travel to warm destinations during the winter months and make golfing part of those travels, you may want to schedule in a break from golf as part of your yearly travel plans.
Strengthening: A strengthening program for your core muscles and upper body will decrease your risk of injury and lead to better results on the golf course. Exercises should focus on the shoulders, wrists/forearms, back and core.6 If you are unsure how to start, contact a physiotherapist for some recommendations.
Aerobic fitness: Working on your general physical fitness in both the regular and offseason will improve your cardiovascular strength and fitness and allow you to transition between the off season and golf season with greater ease. Good exercises for aerobic fitness include walking, jogging, swimming and cycling; anything that gets your pulse rate up. This too will help you meet the activity recommendations set out by the Canadian Physical Activity Guidelines for Adults.
What do I do if I have a golf-related injury?
Whether you are a golf enthusiast or an occasional weekend player, getting back to the game safely is important.
Staying on top of injuries and preventing new problems from becoming chronic will help you to enjoy the game for years to come. If you are injured, investing in rest and physiotherapy treatment will help. Consulting a professional golf instructor in conjunction with physiotherapy may also help you to modify your swing, prevent injury and be able to participate for years to come. Being able to enjoy a pain-free game of golf without worrying about an injury is a goal that physiotherapists can help with.
The feet are an important link in the kinetic chain that we sometimes forget about. The foot is a dynamic structure that needs to be strong and stable while also being soft and malleable. Thanks to its design and muscular attachments, it can store and utilize elastic energy with each footstrike. The strength and stability of the arch, referred to as the “foot core,” are required for proper foot function.
Both local and global muscles control the shape and function of the arch. The local muscles are primarily stabilizers known as the intrinsic foot muscles and are smaller in cross-sectional area. The global muscles are primarily prime movers of the foot and are larger in cross-sectional area. With each footstep and running stride, the local foot stabilizers function to control the amount and speed of arch deformation. Dysfunction of these muscles can result in an unstable arch and abnormal foot movement. Excessive deformation of the foot has been linked to plantar fasciitis and other lower limb injuries.
Traditional foot strengthening exercises usually involve curling the toes to pull a towel toward you or picking up marbles with your toes. These types of exercises will target the local foot muscles but will also involve the global muscles. Ideally “foot core” training should only target the local foot stabilizer muscles.
Enter the short foot exercise.
The goal of the short foot exercise is to “shorten” the foot by contracting the intrinsic muscles to raise the medial longitudinal arch, or in science-speak, pulling the first metatarsophalangeal joint toward the calcaneus (heel bone). Care should be taken to ensure the foot is in neutral alignment and that the toes are not flexed or extended.Pain, and your shoes will dictate foot posture, or alignment. Check for arch support, heel cups, external support foams, plastics…those transitional, seasonal shoes can be dangerous!
The short foot exercise is best learned seated and can be progressed to bilateral standing, single-leg standing then to functional activities such as squats, deadlift, lunges and hops. It should also be noted that being completely barefoot would enhance sensory input detection from the plantar surface of the foot and help you develop the sense of creating the short foot posture.
Your Arch Strengthening Routine
This routine consists of some exercises that can be performed daily (e.g. short foot, toe splaying and big toe presses) and exercises that can be performed 2-3 times per week (e.g. leg swings and calf raise to big toe press).
Short Foot Exercise
Sit in a chair in your bare feet. Form a 90-degree angle at your knees and ankles. Without crunching your toes, try to shorten your foot by doming the arches in your feet. You can focus on one foot at a time or do both at once. Try not to curl or extend your toes and keep your foot neutral. It’s harder than you think! Practice this throughout the day. You can even practice while sitting at your desk. Once you become competent in performing the short foot sitting, attempt the exercise standing on two legs then on one leg.
Try moving your toes away from each other but be careful not to curl or extend them. Practice throughout the day. Remember your Grandmother pinching you with her toes? Some just have the primordial gene.
Big Toe Presses
Press your big toe into the floor while extending your other four toes. Hold each press for 8 seconds and perform 12-15 reps per foot. Then, try to remember to encorporate your ‘big toe push’ into every step; train for a new gait.
Dissimilar to dynamic leg swings that are commonly performed with a large amplitude, these legs swings are performed with a small amplitude to challenge your balance and hip and ankle stability. Stand on one leg in your bare feet and attempt to create the short foot posture. Swing the non-stance leg forward and backward 15 times. Without rest, swing the same leg left and right in front of your stance leg, also 15 times. Repeat this sequence without resting, then repeat on your opposite leg.
Calf Raise to Big Toe Press
Stand on the edge of a stair in your bare feet. Let your heels drop below the level of the stair. Then perform a traditional calf raise, but then proceed and press onto your big toe. This part is difficult for most. Feel free to hang on to something for balance. Perform 12-15 reps.
You might think that just because you’re still in college, you don’t have to worry about the physical stresses and strains that 8-plus-hour work days put on your body. But as a student, you put in a lot of hours studying and working, too. Besides getting regular exercise and trying to eat as healthfully as you can, you need to monitor your posture, especially at the computer and when you study. This is especially important for students enrolled in online graphic design programs or online IT programs as they will spend even more hours staring at the screen. Here are 50 tips and tricks for serious students. Think of it as your ultimate guide to ergonomics.
Make sure you adopt these good posture habits whether you’re sitting in the cafeteria or at your desk.
Fill in the space between your back and the back of the chair: When sitting in a chair, sit straight so that the space between your lower back and the chair is no longer existent.
Keep your tummy relaxed: Don’t contract all of your muscles when you sit down. You can rely on the chair to help you with your posture without tightening your tummy.
Keep your neck, back and heels aligned: If you draw an imaginary vertical line down your back, your neck and heels should hit in the same spot, too.
Keep your feet flat on the floor: Make sure you keep your feet flat on the floor when you’re sitting at your desk.
Sit down: Instead of sitting up, sit down, letting your chest relax down, but not over.
Tuck in your chin: When standing, keep your head straight but your chin tucked in to keep your neck stable but not overexerted.
Keep your knees at a 90-degree angle when sitting: Remember to keep everything aligned. Don’t tuck your knees in, which can make you start to hover and hunch over your keyboard.
Draw your shoulders back and relax: Draw your right shoulder, then your left shoulder back and then down, and then take a deep breath and relax. After working for several minutes, monitor the position of your shoulders, and make sure you’re not hunched over.
Align your hips with the base of your chair: Tuck your tummy in and sit so that your hips are touching the base of your chair back.
Evenly distribute your weight: You shouldn’t lean over to one side when you sit: you should distribute your body weight evenly between both hips.
Computer and Keyboard
When you’re researching, writing papers, or playing on Facebook, be aware of how your body should be aligned to prevent injury and strain.
Use a chair with a flat surface and straight back: This type of chair will support your back while you work at the computer.
Place your ankles underneath your knees: When you sit, make sure your ankles line up underneath your knees for proper posture and balance.
Your monitor should be at eye level: This is one of the most important tips to keep your posture in order. Adjust your chair and get the right desk so that the top of your monitor is at eye level.
Align your wrists with your forearms: Keep your wrists in line with your forearms instead of bending them up or down, which causes great stress on the muscles and tendons.
Bend your head slightly forward: Keep your head bent slightly forward and aligned so that you’re looking at your monitor straight on.
Use a document holder: To prevent twisting your neck and body, use a document holder next to your monitor if you’re making a transcription.
Keep your elbows close to the body: Experts recommend that elbows should be bent between 90 and 120 degrees.
Turn your whole body, not just your neck or mid-section: When you are sitting in a swivel chair, it’s best to turn your whole body instead of just straining your neck or mid-section.
Take advantage of armrests: Armrests will help you relax your shoulders and keep elbows close to the body.
Use a wrist rest: Use a wrist rest on your keyboard and on your mouse pad to make sure your wrists are supported and in line with your forearms.
Bring your keyboard down: It’s best to avoid reaching up to type, so use an adjuster that allows you to type at a more relaxed level.
Consider a slightly reclined position: A good ergonomic chair will allow you to lean back slightly, which relaxes your back muscles and decreases pressure on your lower back.
Believe it or not, sleeping in the correct position also benefits your health, can prevent injury and will help you maintain good posture habits when you’re awake, too. Check out this list for sleep-related ergonomics.
Keep your pillow under your head: It sounds obvious, but pillows are meant to support your head and neck, so don’t sleep without ample support under them.
Don’t sleep on your stomach: This rule is especially important if your mattress is weak, as sleeping on your stomach causes back strain.
Get up correctly: Don’t just roll out of bed. Avoid cricks and muscle cramps by first turning on your side and pulling up your knees, swinging your legs over the side of the bed. Push yourself up from the sitting position by pushing down on the bed.
Libraries, study centers and your dorm couch aren’t necessarily designed with ergonomics in mind, so you’ll have to make some adjustments. Here are tips for DIY ergonomics.
Bring a pillow or bolster: A small pillow, cushion or bolster will do wonders for your sitting or reclining position and will keep you comfortable for longer periods of time.
Watch the weight of your backpack or messenger bag: A purse or book bag that’s too heavy will cause great strain and even injury to your shoulder, neck, and/or back. Try switching the way you carry your bag every once in a while, and only carrying what you really need.
Don’t bring your laptop to bed: Balancing your laptop on your bed will cause you to hunch over and strain your neck, so leave it at your desk.
Choose the right ebook: If you’re lucky enough to use an ebook in college, choose the edition that has the best ergonomic improvements and that won’t cause eye strain.
Try out these exercises and stretches to give your body a break and work out some of the tension.
Shoulder blade squeeze: Lift your arms straight out in front of you, then swing them out towards your back as far as you can go, without over-straining yourself. Bring them forward again and repeat a few times.
Crunches: Anything that works out your core — including crunches — will help support your back.
Stretch everything: Take little breaks to stretch everything, including your facial muscles and fingers.
Work out your hands and palms: Fold your hands together, face your palms away from your body, and stretch your arms in front of you. Repeat up to eight times.
Knee Kiss: As you pull one leg at a time up to your chest (or lips), hold it with both hands and hold for five.
Superman: To do the Superman, lie face down on the floor, and lift your right arm and left leg off the floor. Hold for a few seconds, and then switch arms and legs.
Quadricep stretch: Scoot your chair back so that you can stretch out your legs in front of you, and hold for five.
Neck and shoulder stretch: Roll your shoulders back, and then drop your head so that your chin nearly rests on your chest. Move your head to the right, then to the left.
Identifying Risks and Injury
Here you will learn some potential risks for injury like carpal tunnel.
The scrolling wheel: Overusing the scrolling wheel on your mouse can actually lead to pain and discomfort, so choose to click instead.
Don’t cradle your phone with your neck: If you spend time on the phone while you work or study, hold it properly with your hand, and not by cradling it with your neck.
Monitor your B12 intake: Ergoblog reports that B-12 deficiencies, which can be common among college students who aren’t vigilant about their diet, can lead to tingling feelings in muscles and hands, which is similar to carpal tunnel symptoms.
Understand the difference between cumulative trauma and repetitive stress injuries: Visit a doctor so that he or she can help you correctly identify your injury and a rehab solution.
From using a footrest to taking frequent breaks, here are more ergonomics tips for students like yourself.
Take breaks: Ease eye strain and repeated muscle movement by getting up to walk around the room and stretch a couple of times every hour, at least.
Test your posture: You can test your standing posture by standing with your head, rear end, and shoulder blades pressed against a wall. You should have one hand’s thickness between your back and the wall.
Know how to lift your laundry: If you like to go weeks without doing laundry, don’t try to pick up the entire heavy load at once. Try lifting a few loads, and make sure you bend at the knees, not at the waist, and use your leg muscles to stand up.
Use a checklist: Use this checklist to make sure your workstation has all the right components for promoting good posture.
Check out our Ergonomic Services link about the onsite assessment and education services provided by yourPhysio.
Fasciae are connective tissue structures that pervade the entire body. In the 1950s, the American biochemist Ida Rolf examined fasciae for the first time. She believed that the connective tissue or fasciae played a greater role in muscle pain than muscles did. This resulted in rolfing, a manual body therapy that affects the network of fasciae in the human body. For a long time, it was unclear what really had an effect on the connective tissue and the role that it actually played. Today, we know that fasciae cover all our muscles as well as all our organs. Muscles are only able to transfer their complete force through them. Fasciae contain all nerve endings, receptors and lymphatic fluids and thereby cover our bodies like a network. Fasciae are flexible and can change.
Fascia is ‘connective tissue’, organized as an interconnected, multi-dimensional network. It wraps around every cell, tissue and organ. Think of it like a web that supports the bones, muscles, etc.; without it the body would fall apart. Fascia is formed by undulated collagen fibres and elastic fibres arranged in distinct layers, and within each layer the fibres are aligned in a different direction. Due to its undulated collagen fibres, fascia can be stretched and, thanks to its elastic and ‘smooth muscle’-like fibres, it can then return to its original resting state.
While part of the fascia is anchored to bone, part is also always free to slide. The free part of the fascia allows the muscular traction, or the myofascial vectors, to converge at a specific point. It is hypothesised, that the richly innervated fascia could be maintained in a resting state of tension due to the different muscular fibres that insert onto it. Due to this optimal resting state, or basal tension, of the fascia, the free nerve endings and receptors within the fascial tissue are primed to perceive any variation in tension and, therefore, any movement of the body,whenever it occurs.
So what happens when fascia gets tight, distorted or rigid? Well, that is where that tight feeling in your hamstrings comes from, creates those lumpy looking chunks in your rear end, and causes pain like plantar fasciitis. As you age, workout and sit still your fascia becomes a little more sticky and creates adhesions. These adhesions can restrict movement, create a tight feeling around the muscle like wearing jeans that are way too tight, and lead to injury if left untreated.
When we get injured or engage in repetitive actions that don’t have much variety in range of motion our body may over time develop excess fascia between muscle tissue like the image above as if a spider was weaving a web. This can create cross-linkages and fascial adhesions that begin to restrict our ‘usual movement’ which over time creates other lines of tension that are unnecessary on joints and muscles. This increases the likelihood for fascial restrictions which have the capacity of creating up to 2,000 pounds of pressure per square inch in a restricted area. This intense pressure can compromise our physiology and result in chronic pain and dysfunction.
Shockwave therpy is being increasingly used for treating fascial structures, alongside conventional treatments – with excellent results. Dr Stephan Swart and Dr Carlo Di Maio are two physicians who used shock wave therapy to treat fascia-related problems early on. Based on their ideas and experiences, in collaboration with STORZ MEDICAL the new PERI-ACTOR® transmitters were developed to facilitate and optimise fascial therapy.
Created for those alumni of Concourse Physiotherapy that want the latest articles, exercises and information regarding back pain, sciatica, degenerative disc disease, etc.
This information is gathered, and reviewed by the physiotherapist from a number of sources, such that you do not have to hunt through the internet, ‘self diagnose’ and just not know where to go next.
Please don’t hesitate to check back monthly for updates:
Was your back pain due to shoveling, raking, lifting, or golf, baseball, hockey? All of these require ‘rotational power’, and it’s those smaller, deep muscles of the spine that frequently do not get strengthened enough. Check out these exercise videos for great, ‘swing’ exercises!
Ready to take the ‘PLANK’ challenge? Learn more about your core, and how this relatively, simple exercise can benefit your health, click here for the article …try to plank each day for a month (let me know the result)
Are you a runner? no, well apply these principles to how you walk, do stairs or play; and now you’ve got the basics to prevent your back pain from happening again, check out this article.
Great video on ‘understanding your gluteal muscles’; for those that ‘sit-for-a-living’, this is an absolute must watch; click here
For pre-natal, peri-natal or post-natal…back pain is almost always a problem; you must learn to breathe diaphragmatically, engage the core, re-train those kegel’s and get your spouse to do these also; go here for 6 exercises
Another video for those that ‘swing’, golfers, tennis, baseball…some standing core exercises that incorporate your trunk rotators for greater strength and stability.
If you don’t have the space for a medicine ball, exercise bands or tubing works great when tied to something you know you cannot move; see the video