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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.

Given that fascia adapts to muscle stretch, it is unable to transmit force like a tendon or an aponeurosis (thicker, connective tissue that binds and protects; such as that covering the carpal tunnel of the wrist). Please view this beautiful, but anatomical video displaying our fascial types. Subcutaneous connective tissue forms a very elastic, sliding membrane essential for thermal regulation, metabolic exchanges and the protection of vessels and nerves, whereas the deep fascia envelops the muscles, and surrounds the muscle’s aponeurosis up to where it inserts onto bone.

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.

An in-person or virtual assessment should be completed before starting any exercise program; 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

If you do not have therapy bands or tubing, come in for some instruction, specific to your condition or sport activity; you can purchase this offer online

You must remember to stretch those hip flexors. You know I gave you that as ‘homework’; that ‘dynamic lunge’ exercise is a must; here is your review

An in-person or virtual assessment should be completed before starting any exercise program;

these are created for those alumni of Concourse Physiotherapy that want the latest articles, exercises and information regarding neck pain, whiplash, headaches, 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:

Neck pain still hindering your activities? Check out this article on specific biomechanics and postures that can make a difference at work, rest and play!

Diaphragmatic breathing is opposite that of ‘chest breathing’, and is really your first core exercise. If you breathe with chest expansion/shoulder shrugs, you are engaging the accessory muscles of upper respiration and will always aggravate chronic neck pain. Learn about breathing during activity and exercise here!

‘Eccentric’ training; a must for any gym routine. Your neck and upper back stabilize and hold your head in place, for function and structural health. Check out this article to understand eccentric muscle work and always include a SLOW RETURN in your exercises to maximize muscle work!

Because head and neck posture combine to form the dreaded ‘forward head posture’, please check your posture with each task; proper ergonomics slows you down initially, but practice makes perfect; postural exercise

Did you know the accessory muscles for breathing are those ones that feel constantly tense, the ones at the base of the neck, towards the shoulder blades…the picture above points to the ‘upper Trapezius’ muscle; the most common trigger points of the neck. If you hold your ‘tension and stress’ there, you must learn to breathe, no, really! check this article

Smartphones, and their apps, have changed the way we communicate and access information forever. Your neck and upper back take the brunt of this constant rounded, slumped posture; here’s a few stretches to prevent ‘text neck pain’

rSWT Shockwave therapy for those chronic, neck-shoulder pains

Many patients have asked about foam rollers and how to use them, especially for daily release and tension headaches. If you have one, fantastic; here is a great video focusing on the neck-upper back

If you don’t have a foam roller yet, I’m still offering the best deal on the internet…no really, and it’s covered by your company benefit plan or private insurance, just call me or hit the upper right CONTACT button for an appointment; check this out here

yourPhysio is treating an increase in patients with neck and upper back pain. Computer use, tablets, smartphones or previously, just reading in bed bad habit were likely the causal factors. But now researchers are focused on communication via text, and the pain related to poor posture during prolonged smartphone use, according to a recent report in the international Journal, The Spine.

Our patients endure all of the above causal factors, but the demographics of smartphone use, particularly young patients who shouldn’t yet have back and neck issues, are reporting disk hernias and alignment problems, the study authors write in The Spine Journal.

In an X-ray, the neck typically curves backward, and what we’re seeing is that the curve is being reversed as people look down at their phones for hours each day, said study coauthor Dr. Todd Lanman, a spinal neurosurgeon at Cedars-Sinai Medical Centre in Los Angeles.

The real concern is that we don’t know what this means down the road for kids today who use phones all day. Lanman and co-author Dr. Jason Cuellar, an orthopedic spine surgeon at Cedars-Sinai, write that people often look down when using their smartphones, particularly when texting, as compared to browsing online or watching videos. Remember that ‘reading in bed’ comment? Now it’s using our phones or tablets that affect our spine, wrists and eyes!

It’s the way you hold your neck

Previous studies have also found that people hold their necks at around 45 degrees, and it becomes even worse as they sit, versus standing, the study team writes. The impact on the spine increases at higher flexed postures, they add.

While in a neutral position looking forward, the head weighs 4.5 to 5.5 kilograms. At a 15-degree flex, it feels like 12 kilograms. The stress on the spine increases by degree, and at 60 degrees, it’s 27 kilograms.

Lanman and Cuellar suggest simple lifestyle changes to relieve the stress from the text neck posture. They recommend holding cellphones in front of the face, or near eye level, while texting. They also suggest using two hands and two thumbs to create a more symmetrical and comfortable position for the spine.

Beyond smartphone use, the spinal surgeons recommend that people who work at computers or on tablets use an elevated monitor stand so it sits at a natural horizontal eye level. But with Windows software, it is more effective, and ergonomic, to have the most common ‘cursor use area’ at eye level. Now, this may change with the software or program being used; but change is good for postural awareness.

With laptops, I recommend a similar adaptation by using a separate keyboard and mouse so the laptop can be at eye level and still create a good ergonomic position while typing.

It is difficult to recommend a proper posture for smartphone users. If we raise the phone at eye level to avoid the look-down posture, it will add new concerns for the shoulder due to the elevated arm posture, now we create those dreaded rotator cuff issues. And even, frozen shoulder or adhesive capsulitis.

Take a break from texting

A more practical recommendation would be frequent rest breaks or some physical exercise that can strengthen the neck and shoulder muscles. Ask yourPhysio for a custom exercise plan for your specific work tasks.

Selfie? to self examine…no, get a friend to take a picture of you texting or using your computer. Check your posture. Bring it to yourPhysio for an Initial Assessment and we’ll correct your posture and give you the exercises you need to avoid pain.

Radial Shockwave Therapy (rSWT) for muscle, joint, ligament and myofascial pain, brings the technology for disintegrating kidney stones in to the Physiotherapy clinic for chronic pain, musculoskeletal problems.

It is great for:

• Chronic Neck and Low Back trigger points
• Calcific, shoulder Rotator Cuff Tendinitis
• TMJ, chronic jaw pain
• Achilles tendinitis
• Plantar fasciitis, heel-arch pain
• Tennis or Anglers’ elbow pain, and golfers elbow
• Patellar, knee tendinitis
• Quadriceps, thigh tendinitis
• Iliotibial band, friction syndrome
• Trochanteric, hip pain
• Other tendon problems

All of these conditions are otherwise hard to treat if they don’t get better with physiotherapy and before shockwave therapy existed the next step would often be surgery.

It has a success rate of about 70-80%, so it does not work for everyone, but does help most people even when other treatments have failed. It is a great way to keep yourself away from an operation.

How does Radial Shockwave therapy work?

Radial Shockwave therapy is a non invasive way of restarting the natural healing process allowing your body to repair itself. The common factor in all of these conditions is the chronic inflammatory process, which is a vicious cycle of pain and damage that is often seen in association with over use injuries. Shockwave therapy can convert this chronic inflammatory process into an acute inflammatory process much like a fresh injury, from which the body can usual heal itself.

Institutional Shockwave units for kidney stones are huge, costly and have the power to disintegrate tissue at larger distances. This musculoskeletal unit is almost portable, affordable and works only millimeters below the skin.

How much does it cost, and will my insurance cover it?

Shockwave therapy is covered as ‘physiotherapy treatment’ being a modality used by a trained, medical professional. In Europe, a similar unit is used in dermatology and aesthetics to affect myofascial distortions; specifically those that cause ‘cellulite’. Watch for our introduction of this service under your Health Savings Account.

What happens during shock wave therapy treatment?

During Shockwave therapy, a high-intensity sound waves are sent into the tissues of the body. This leads to all sorts of beneficial effects such as new blood vessel growth, reversal of chronic inflammation, stimulation of new tissue growth and breaking down calcium deposits. For you it’s about 5 minutes of quite noisy, and a little bit uncomfortable treatment to the sore area. Some people feel some benefit right after the session, but then it may be sore for the next day or two.

Benefits of shock wave therapy treatment

• Clinical studies report success rate above 75%
• Much cheaper than surgery
• Shock wave therapy brings new technology
• No anesthesia required, no drugs, no injections
• Just 3-5 sessions of 5 minute treatments

How long does it take to work?

You are likely to feel reduced pain within minutes of starting the first treatment. You will be sore after each treatment, but it is important NOT to take anti inflammatories. The treatment works by stimulation of a ‘pro-inflammatory state’; heat may even be recommended with normal activity. Most patients experience considerable benefit by 3 months from the first treatment, but studies show improvements continue up to one year from treatment.

Are all shockwave treatments the same?

No! There are a variety of types of shockwave machines and ways to deliver the therapy. Concourse Physiotherapy uses the latest Storz Radial Shockwave Therapy unit (as pictured); which has a wealth of research for orthopedic injuries.

The type of hand piece determines how much energy can be given, and the newer ceramic hand pieces deliver more energy with less discomfort. The variable applicator head allows the new Storz machine to be much more comfortable and delivers more of the all important energy for less discomfort.

Sciatica? Do you have lower back pain referred down the buttocks, or even the leg and foot; with numbness, tingling, abnormal sensation in those same areas?

It is very common, especially in Downtown Winnipeg, where nearly everyone ‘sits-for-a-living’. Research says ‘flossing’ may not help our teeth, but flossing or dynamically stretching the nervous tissue is another way to prevent, and lessen this back pain. No stretch should create pain, get assessed by your Physio before trying these exercises.

Almost everyone has seen that ‘camel or cat back’ exercise; on all fours, rolling the back upwards, and downwards, we move the nervous tissue associated with sciatic pain.

Reaching, with back extension exercises will help strengthen the muscle supports around the spine.

Give yourself more reasons to stand, and if you include a ‘sit-stand workstation’, know your ergonomics!

Don’t hesitate to ask…

If sitting is the ‘new disease’, then remember your ‘standing core’! Your ‘core’ includes any musculature about your central skeleton that may balance your trunk (not a booty remark).

You must include more standing postures in your work day to avoid back pain and other health concerns. Get more from your company benefits or private insurance Winnipeg, know your ergonomics at work, home and play!

Now apply some of those ‘abdominal’ exercises you did on your back;

the Standing ‘knee-cross crunch’

a great standing exercise for balance and hip-pelvic stability; incorporate some kegels for extra control.

the Standing ‘sidebend-reach’

lower to the side slowly, to maintain control; include some diaphragmatic breathing to stimulate all the intercostal muscles.

the Lateral ‘elbow-knee, side crunch’

again incorporating balance, with hip-knee-ankle stability; this exercise will challenge you. No? do it with your eyes closed then.

the Medicine ball or Tubing ‘cross-body chop’

either exercise prop can assist your directional effort in this exercise. Golfers, try not to focus on your ‘hold’ as you may regret the ‘tension’ effects.

the Tubing or Med ball ‘trunk rotation’

move, and resist, slowly; swing through for those tennis players, golfers look down the tubing and finish with the wrists. You could even work in your ‘address position’, batting stance or fore- or backhand pose Winnipeg!

Finally, give yourself some space, create  your own ‘weighted pillow’ and get into some plyometrics! Down to the floor, up to the sky or against that concrete wall in the basement; a great way to include functional, sport force into your movement. Throw n catch against a mini-trampoline for extra challenge or get a partner!

Get ready Winnipeg for these functional, standing core exercises and get more from your company benefit plan or private insurance with Physiotherapy Winnipeg today! Check out our clinical facility at 201 Portage today (ask security for directions or call ahead.

As benefit dollars remain tight, we’re all looking for ways to DIY…whether it be online diagnosis, nutrition or exercise plans. Lately, in Downtown Winnipeg; ‘everyone’s asking about foam rollers’ and how to use them.

Foam rollers, therapy balls, self massage toys are all a form of self-myofascial release. All muscles have a ’tissue wrap’, the fascia; and it too can become bound, thick and lumpy. This can create painful, trigger points. A common example for runners; the dreaded Iliotibial Band, from hip to knee, with connections to both our quadriceps and hamstring muscles. It can influence pelvic biomechanics and contribute to back pain.

Foam rollers can be used to ‘roll out’ or lengthen, and relax our tight muscles. You can even break those lumps or adhesions in the tissue, causing minor swelling, but increased blood flow which will help feed, and relax your achey muscles

Technique is important. Many clients have just ‘jumped on’ the roll bandwagon and created more pain or injury. We’ve used a spinal orientation to improve trunk and shoulder mobility for golfers. Body rotations in baseball, tennis, hockey, bowling…could all benefit from this routine.

Foam rollers come in various sizes, surfaces and can even be travel friendly for those on vacation or work travel. Check out our foam roller offer. Learn how to proceed safely at home, your foam roller can become a nightly ritual in front of the television.