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Tennis Elbow more common in those who do not play racquet sports…Downtown Winnipeg computer users get Laser or ShockWave therapy today!

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.

The treatment is similar for both conditions.

LLLT Low Level Laser Therapy is widely used for any inflammatory condition. Given the minimal depth to the affected bone-tendon area, there is little to impede the efficacy of laser treatment.

trigg-back

rSWT Radial ShockWave Therapy was developed little over 10 years ago by the Swiss company that treats kidney and gallstones. It is the latest treatment for those myofascial trigger points; those areas of chronic, nagging pain, whether it be from overuse or poor postural habits, we all have them.

rSWT neck

You could wear a wrist splint or forearm brace to prevent overuse of the muscles of the forearm.

You can also try a non-steroidal anti-inflammatory drug (NSAID such as ibuprofen or aspirin) and ice packs to help relieve symptoms. Your doctor may recommend physical therapy, especially if you need to return to a job or activity that caused the problem.

Sometimes doctors recommend one or two steroid shots over the affected epicondyle. But there is some risk of tissue loss around the elbow with repeated shots.

The symptoms of “tennis” or “golfer’s” elbow normally get better within a few months with conservative therapy. Once the symptoms disappear, you should begin gradual stretching and strengthening of the tendon and muscle attachments. We will develop an exercise program for you specific to your chosen activity or sport mechanics.

We will also look at your biomechanics. How you move, and perform your work is called ergonomics. Even the simplest changes can have great affects on chronic pain.

Call or email today, I can probably assess your elbow the next business day.

204-9438411 or yrphysio@gmail.com

 

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Redeem this iPhone Pass in Passbook or Google Wallet for next day physiotherapy service in Winnipeg

yourPhysio Pass

Walking via the indoor walkway, through Winnipeg Square, under the Portage & Main Concourse, into TD Centre (201 Portage), keep going through the Exchange District Parkade, up to ground level Albert Street…and you’ve stayed warm, indoors to my door!

Download this iPhone Pass to your Passbook app or to Google Wallet;

please bring it to your first, assessment appointment and

maintain it in your app for 2015;

we’ll make it yourPhysio ‘health spending account’… for next day service options, direct billing, guaranteed appointment times, lunch hour appointments and there is no waiting room.

you can even ‘air drop’ it to friends to share your experience and service at Concourse Physiotherapy, always much appreciated.

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Glucosamine, Chondroitin supplements for Joint Pain in Downtown Winnipeg

If you work in Downtown Winnipeg, you experience the ‘hardness’ of your daily commute. It is a ‘concrete jungle’, and the impact on your feet, knees, hips and back can be felt on a daily basis.

We all know someone who takes ‘vitamins’, or some kind of ‘supplement’ with the latest health benefit.

I get asked almost everyday about ‘glucosamine supplements’ for arthritis, joint pain, etc. Those ‘horse pills almost choked me’ exclaimed one patient, ‘how much do I need to take to even notice a difference in my knee pain?’, ‘where can I get those pills that supposedly help my joints?…are common questions in Downtown Winnipeg.

In a 2010 British Medical Journal, one of the most reputable of all scientific journals; an article published this conclusion:

“Compared with placebo, glucosamine, chondroitin, and their combination do not reduce joint pain or have an impact on narrowing of joint space. Health authorities and health insurers should not cover the costs of these preparations, and new prescriptions to patients who have not received treatment should be discouraged.”

So is it fair to conclude that it’s not worth taking glucosamine, and/or chondroitin supplements?

Maybe.

May I present the evidence to people to let them make an informed decision. I have seen patients describe dramatic reductions in pain after taking G&C. If the supplement helps your symptoms it may be worth continuing it, especially if stopping taking it causes an increase in pain. I’ve also seen many report no change and complain about the ongoing cost. 1 or 2 have reported occasional side effects, although these supplements are generally considered fairly safe to take.

Other studies have shown more promising results, with Bruyere et al. (2008) concluding G&C may reduce the need for total joint replacement. It’s worth noting however, that in terms of quality of evidence, a systematic review of multiple research papers is usually considered better evidence than an isolated study. A recent analysis by Lee et al 2010 did show that G&C may slow progression of osteoarthritis (as measured by X-ray change) although it required taking it daily over 2-3 years.

But Sawitzke et al. 2010 found “no clinically important difference in pain or function” when compared to placebo. The Cochrane Review (2009) – Glucosamine Therapy for Treating Osteoarthritis had somewhat mixed results but concluded it may reduce pain and improve function.

Prices of G&C vary a great deal. Most clients speak of Costco having ‘bulk’ prices, while Walmart still has the edge on discount pricing for ‘reasonable amounts’. But physicians I have questioned here in Winnipeg, some at our best sportsmedicine centres, still recommend greater than 1600 mgs per day, over greater than an initial 6 week period to judge the supps usage.

Personally, I have recommended our local Winnipeg stores, like Guerrilla Jacks and Sunrise Health; as there is still nothing like more opinions and education about your health.

So the question you need to ask yourself is, am I willing to spend that much on a treatment that might help or may make no difference to my pain or the progression of arthritis?

Words of caution: If you are planning to take supplements to treat arthritis or other conditions discuss this with your GP or Pharmacist.

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Seasonal Back Pain during Golf? Physiotherapy Winnipeg yourPhysio.com

Again? that seasonal back pain is back…and consecutive golf games are impossible, not to mention your regular league match at any of the golf courses in Winnipeg. One likely culprit; your hip flexors! Yeah, those muscles that lift your knee towards your chest are connected to your back, specifically your lower lumbar spine and pelvis.

During the downswing, the obliques and hip flexors are highly activated, creating a crunch-like position as your hips extend and your pelvis tilts (your belt buckle stays level, pointing forwards) while your chest remains over the ball.

The hip flexors are an important part of your core, working to maintain posture, generate power, stabilize the body, and to decelerate the lower body for efficient energy transfer coming into impact.

Maintaining the quality and function of your hip flexors is very important for maintaining posture through the downswing and impact, especially with the longer clubs, where the greater length of the club’s shaft increases the forces that must be absorbed by the body.

Your hip flexors attach from your spine to your legs.  When they are weak, they are not able to withstand the high forces of the longer clubs and are unable to hold your spine angle.  This results in early extension (loss of spine angle) as the hip flexors lengthen under high loads, resulting in a loss of spinal posture before impact.

 

The Foam Roller Hip Flexor Exercise is a great self-massage exercise that will give your hip flexor muscles (in the front of your hips) a deep and effective sports massage, thus improving the health and quality of your muscle tissue and helping you to perform better.  It will also alleviate soreness and make your muscles feel better.

The foam roller is available at most yoga studios or medical supply stores in Winnipeg; you may even get it covered by insurance! The movement over the roller overloads the muscle tissues through compression, causing your nerves to relax, signalling muscle spasms to shut off, pumping blood and and getting your lymphatic system flowing, to help muscle recovery and regeneration.  You’ll work out those knots (muscle adhesions) in your muscles caused either by inactivity, by the repetitive strain of the golf swing, or by walking a tough golf course.  This will enable you to stretch the muscles back out to their original length, making them more pliable and functional.

Be careful! if the back pain is acute, do not attempt this exercise without first talking to yourPhysio; exercises can be modified and tailored to your injury, and reduce your pain.

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Canada’s Growing Demand for Ergonomics in Kitchens…for Aging in Winnipeg Place, for the disabled and the post Surgical

As the first Boomers move into their later 60’s, their growing demand for services, for activity and for health has spurred the demand for ergonomics in kitchen design.

Aging in place is a term used to describe a person living in the residence of their choice, for as long as they are able, as they age. This includes being able to have any services (or other support) they might need over time as their needs change.

To be clear: the act of aging in place takes place during a period of time in an elderly person’s life where they can have the things that they need in their daily life, while maintaining their quality of life.

The reason this distinction is important is because many people think aging in place will fix the problems they have in their lives. The only problems that can be fixed while aging in place are the ones that a person has planned for (i.e. finances, health, personal or health care, etc.).

The kitchen has always been a place for family and socializing. Making changes for aging in place in the kitchen space can greatly increase its usability and the safety of those that live there. With home modification, people will no longer have to spend less time in the kitchen as they age.

In a growing trend observed by the brand Smeg, European consumers are opting for compact appliances to give their kitchens a homogenous look and more efficient arrangement of appliances. Will this trend make it to Canada? to the USA?

One of the most popular trends in kitchen design is the demand for ergonomics with more and more consumers choosing a linear look for the placement of their appliances. Smeg, a leading Italian home appliance manufacturer, has observed this trend with a significant growth in the sales of its compact appliance range.

Smeg is the only brand to offer its appliances in two design styles – the classic stainless steel look and the linear look in stainless steel with glass. Both design styles are made in standard sizes and have matching aesthetics to ensure the kitchen gets a clean and homogenous look.

All standard compact appliances are 600mm wide and 450mm high and designed to be easily installed in a bank at midway level (chest or eye level) or under the bench. Smeg’s current range includes convection ovens with microwave, combination/steam convection ovens, dedicated steam ovens, microwave ovens with grill function and built-in coffee machines.

Appliances play a major role in a person’s ability to use and work in the kitchen safely and efficiently. Appliances that do not incorporate universal design, or that are placed improperly, can inhibit this. Select appliances that display information clearly, have convenient functions and are easy to use. Many appliance makers are incorporating universal design principles in their designs, which allow consumers to get a variety of more functional appliances. You should also consider investing in energy saving appliances, which will help you save money. Currently, the most popular placement of any appliance or storage cabinet is at the midway level since it ensures easy and safe access to a range of appliances without the need to bend or stoop.

As in lifting or reaching mechanics, the placement of load or where you interact with that load is of key importance.

Beware of your biomechanics. Know your Ergonomics.

Know yourPhysio Winnipeg!

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Consider your back, shoulders, hips when buying your next mattress Winnipeg…some tips from yourPhysio

Many people complain of back pain soon after they get out of the bed. Whether it be a combination of tight muscles, stiff joints or general aches, this is a common complaint at any age in Winnipeg.
Although, many fail to sense the link between the back pain and the bedding that they use, research has shown the influence the bedding can have on causing as well as relieving the stress from a persons back. When we go in search for bedding, we can see lot of varieties which are made in many different ways. Adding to this variety is our personal preference. The mattress should also match the framework of the bed. With all these considerations, the value we give to our health is probably low down in the list or not in the list at all.
The link between the bedding and back pain is associated with the malalignment of our body structures away from its natural alignment. When the spine is kept straight, which is the optimal shape to minimize stress towards the lower back, we can see that the ear, shoulder tip and the hip joint are in a straight line. Even when a person sleeps, this would be the optimal positioning for better stress distribution. In overly soft mattresses as well as in old mattresses, we can see certain body parts sinking more into the mattress than other parts of the body. This will upset the alignment and would either direct more stress towards the back or would not facilitate already stressed back muscles as well as the spine. Therefore, in order to avoid such back pains linked to your bedding, you can do the following:
1. If appropriate, the old rule was to place a piece of plywood to make the mattress more firm
2. Do shopping and choose a mattress which is soft as well as firm; many of the new ‘pillow-tops does this for you
3. Can sleep on the floor or on a firm surface with a soft covering to relieve pressure to the bony points.
4. Make use of a water or air filled mattress which could sooth the existing pain as well as relieve the stress in the whole body.
5. Do gentle exercises or stretching before getting out of the bed. Contact yourPhysio for appropriate exercise plans
6. Do not place extra pillows under your head, some may used behind the back, between or under your legs.
7. Position your bed at a adequate level to ease the work related to getting out of the bed.
When considering the link between bedding and the back pain, simple measures would go a long way in relieving this chronic problem. Therefore, the money that you spend for a perfect mattress would definitely be worthwhile when considering the suffering, the loss of productivity as well as the time you spend on your bed.

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Post-Operation? Surgery? into Rehab yet Winnipeg? need yourPhysio asap…

Joints just say no. Muscles grow weak.

 

We all know the body’s ability to do the mind’s bidding often falters later in life. But the effects of age on function can be especially unforgiving when you’re hospitalized. Knee replacements, hip replacement, arthritis, rotator cuff, spinal fusions, laminectomies, osteotomies…all common surgical procedures happening in Winnipeg everyday.

 

Lying in a hospital bed day after day can quickly undermine one’s mobility. Even though most of the hospital data comes from the USA; our nurses, doctors, hospital staff are experiencing the same trends in healthcare as the Boomers come into their 60s.

 

Hospitals get it. Care plans are developed for patients that prescribe exercise when appropriate. Doctors put in orders for physical therapists to help patients walk and otherwise preserve their mobility.

 

Nurses and assistants often are expected to help patients move, even if it’s just from bed to chair for their dinner.

 

But that doesn’t mean it always happens. When hospital units become swamped with particularly sick patients, preserving mobility can easily slip down the priority list, hospital administrators say.

 

“There’s the ideal world, and then the practical world,” said Liz Ericson-Macke, a nurse, social worker and case-management supervisor with the Franklin County Senior Options Program.

 

“Sometimes just getting people up and walking them may not happen as much as we would like it to.”

 

Michele Weber acknowledges that. While working on her doctorate, the clinical nurse specialist at Ohio State University’s Wexner Medical Center evaluated how well nurses stuck to the mobility guideline for intensive- and critical-care patients.

 

It took persuading, but physicians bought into the guideline that took effect in 2009. They issued a blanket order giving registered nurses greater power to decide when exercise and physical therapy were appropriate during stays in the ICU, which average 5.5 days. A physician’s order is still required for physical therapy, however.

 

In late 2010 and early 2011, Weber examined the care provided to 207 patients — 41 percent of whom were older than 60 — to see whether the guideline was being followed.

 

“We were following protocol 30 to 40 percent of the time,” she said.

 

There were several barriers to improving compliance, including factors beyond the nurses’ control. Some patients refused to exercise. Many hospital rooms are small, with constrained layouts that didn’t lend themselves to the right kind of chair.

 

In some cases, nurses didn’t have the right supportive devices — walkers, canes, gait belts — close at hand. Some equipment didn’t have battery backup so that IVs could remain hooked up to patients when they were up and about.

 

And inadequate staffing levels sometimes hurt compliance.

 

Today, audits show compliance is better, typically between 50 and 60 percent, Weber said. The hospital added the mobility guideline to the orientation process for new critical-care nurses, provided better equipment and balanced staffing.

 

Mount Carmel Health System declined to share similar compliance data. A spokesman for OhioHealth said the hospital system doesn’t have such data.

 

Efforts to get patients moving might seem at odds with another hospital priority: fall prevention. But Weber said there were no adverse outcomes during the OSU research project.

 

The benefits of getting a patient moving early have become more widely recognized, said Dr. Larry Swanner, vice president of medical affairs at Mount Carmel West.

 

“In the past several years, we have increased our focus on physical therapy,” he said.

 

For patients who have had hips or knees replaced, early exercise leads to quicker recovery times. For surgical patients, walking encourages deep breaths and coughing, which reduces the risk of pneumonia.

 

Meanwhile, patients who have undergone abdominal surgery might find that walking stimulates the return of their intestinal function.

 

If a physician orders physical therapy in the morning, it should take place that same day, Swanner said. If it’s ordered late in the afternoon, it should happen the next morning.

 

OhioHealth has been assessing many protocols, including for mobility, through a process-improvement group focused on geriatrics, said Michele Stokes, director of senior health services at the Gerlach Center for Senior Health.

 

“We really have a lot of opportunity across the system to be aware and do more for our elderly patients,” she said.

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MPI says 20,000 motor vehicle accidents in December, is this you? Winnipeg? Whiplash?

In my opinion, our Winnipeg streets have never been so bad in my lifetime; streets like Portage, Main, Pembina, Henderson have become obstacle courses of ruts and ice.
Today, another 10,000 accidents reported by MPI in the last two weeks! Cmon Winnipeg, we are the resilient drivers of Canada, we’ve probably seen it all! Little more time and space and you too can avoid that next injury claim

I can offer you this advice to make your injury claim as ‘painless’ as possible; whether it be whiplash, other neck pain, spinal injury, low back pain, knee sprain, shoulder strain, etc.

Always obtain a ‘personal injury or health’ claim number as this is a basic part of your ‘personal injury protection plan’ given by Manitoba public insurance if you are involved in a motor vehicle accident. The pain of the accident may not be there initially, but hours or days later.

In Manitoba, you do not have to see your doctor first before obtaining treatment from a physiotherapist. The physio shall assess your injury and determine if additional testing, medication or xrays are required.

MPI will send you an individual package of information regarding the complete process to cover all costs of your personal injury. Physiotherapy fees are billed directly to MPI, such that there are no ‘out of pocket’ expenses.

Education will be a key component of your treatment program; risk management, ergonomics, exercises, that involve home and work environment should be considered.

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Shovelling in Winnipeg’s Extremes; know your Biomechanics, your limitations and your Physio

A great bulletin from the Heart and Stroke Foundation; Snow shovelling may be dangerous for some hearts

Snow shovelling may be dangerous for some hearts. Reports have linked snow shovelling in extreme cold weather to an increased risk of hospitalization or death due to heart attacks. The Heart and Stroke Foundation advises taking extra precautions when snow shovelling during extreme cold alerts, particularly for individuals with a pre-existing heart condition or who are at high risk of heart disease.

Research shows that physical activity helps protect against heart disease, stroke and many other health conditions. It is also an important part of cardiac rehabilitation programs and an important way for heart patients to keep their cardiovascular system strong and resilient.

Extreme weather conditions, such as very high temperatures and humidity in the summer, smog, and cold winter days, can make physical activity more strenuous. Both strenuous exercise and extreme weather independently increase blood pressure, push the heart rate up, and increase blood concentration of fibrinogen, a protein involved in blood clotting. All of these factors contribute to increased heart attack risk.

The Foundation recommends approaching physical activity in extreme weather with caution if you have been diagnosed with heart or blood vessel disease (including stroke, previous heart surgery, and uncontrolled high blood pressure) or if you are at increased risk of a cardiac event because of high cholesterol levels, an inactive lifestyle being overweight, or obese or other risk factors. Speak to your doctor about what is acceptable for your health.

The risks become even greater when vigorous exercise and extreme weather are combined, such as when shovelling snow in sub-zero weather conditions. Studies show that in most people who have died shovelling snow or carrying out some other form of vigorous physical activity in extreme weather conditions, the plaque inside their blood vessels ruptured and travelled to the heart causing a heart attack. The rupture may be caused by increases in blood pressure or changes in vascular tone associated with physical exertion. Plaque is a sticky, yellow substance made up of fatty substances such as cholesterol, calcium, and waste products from your cells.

Here are some tips from the Heart and Stroke Foundation.

Take the time to do a few minutes of warm-up activity like walking to increase your heart rate slowly and prepare you for the activity

Build in frequent breaks from extreme weather activities so your body doesn’t become too strained

Ask for help from family, friends or neighbours if you need to do an urgent task, such as clearing snow, in bad weather;

Wear appropriate clothing and keep water nearby to replace fluids lost through perspiration

Plan ahead. Watch your local weather forecast for smog, humidity, heat and extreme cold alerts and plan for enough time or get help with major tasks like snow shovelling, on those days.

Stop your activity if you experience sudden shortness of breath, discomfort in the chest, lightheadedness, nausea, dizziness, or severe headache and immediately seek medical attention

Snow shovelling in very cold weather has specific risks. Here are some additional tips to help you stay safe during this particular activity:

Don’t continue shovelling just to get the driveway cleared in a hurry. If you’re tired, quit;

Don’t shovel or do any other vigorous activity directly after eating a meal. Your body is working hard enough just to digest the meal; adding vigorous activity on top of that could put too much strain on your heart;

Don’t stoop to pick up the snow; bend at the knees to avoid back problems.

Find out if your community offers programs or assistance for snow shovelling or snow removal (particularly for older adults or those with existing heart conditions)

Play safe Winnipeg; your your biomechanics, your limits and your Physio…

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It’s heavy snow Winnipeg, learn about rotator cuff injuries, the winter cold and shovelling

It’s snowing this morning in Winnipeg; the first heavy blast of winter this season. Car accidents, falls and shovelling injuries are inevitable. Beware of your posture, the load, your balance and fitness level before you ‘shovel for hours’. The shoulder, and its supporting rotator cuff group of muscles are highly susceptible to those strains n sprains of high repetition and little prep.

Rotator cuff injuries are common in all sports and can be career enders for athletes likes quarterbacks and pitchers. But even if you’re just throwing snowballs with the kids or working out to stay fit, it’s important to keep the shoulder joint healthy. Here, physiotherapist Chris Bisignano, answers some of the important questions.

Q1: What exactly is the rotator cuff?

“The rotator cuff is a group of muscles, that act almost like a dynamic ligament. It is comprised of four muscles: the supraspinatus, which is the most commonly injured, the infraspinatus, the teres minor, and the subscapularis. The rotator cuff’s functions are to assist with arm movements and provide stability to the glenohumeral [shoulder] joint.”

Q2: Why does the rotator cuff get hurt so often, and what are the common issues?

Most of the exercises we do actually do not specifically target the RC enough to make a difference to its actual strength.

“Up to 67% of the population will have a shoulder problem at some point in their lifetime, and the rotator cuff is most often the source of the pain. The primary reason for rotator cuff pain is that pinching sensation or ‘impingement syndrome,’ which may be the result of rotator cuff tendon inflammation caused by an activity or trauma. Over time, this can lead to a rotator cuff tear. To make matters worse, evidence suggests that most individuals are likely to experience rotator cuff degeneration by age 40 and rotator cuff tearing by age 60. Thus, in many cases, a seemingly normal exercise session or home-repair project may incite shoulder pain.”

Q3: What kinds of moves should I avoid if I want to stay injury free?

Repetitive reaches with even a simple load can isolate alot of force upon the RC. Movements above shoulder become risky when a joint is not supported well, or even unstable because of weakness.

“Many of the more common gym exercises—such as upright rows and lateral deltoid raises—may lead to rotator cuff injuries. Modifying these exercises to keep the end position of the arms or elbows below shoulder height may help prevent injury.”

Q4: How can I tell if I have a rotator cuff injury?

“Many people already have a rotator cuff injury and aren’t aware of it. Unfortunately, evidence suggests that these individuals will eventually develop symptoms. Early on, if you have pain when reaching overhead—pain located at the tip of the shoulder or the outside of the arm, where the lateral deltoid is located—that suggests a rotator cuff injury. Weakness when reaching the arm out to the side is also suggestive of a tear.”

Q5: How can I prevent a rotator cuff injury?

“Three key measures can be taken to reduce the chances of experiencing a rotator cuff injury.

“First, strengthen the external rotators; specifically by tubing or dumbbell exercises that need to be learned from a professional; these will help restore and maintain shoulder stability and may prevent impingement.

“Second, avoid sleeping on your side with your arm positioned overhead.

“Finally, try to achieve muscle balance—that’s key. Many weight-training routines are inherently biased, creating muscle imbalances that may lead to a rotator cuff injury. Try to perform an equal number of ‘pull’ versus ‘push’ exercises. Moreover, try to replace a few sets of shoulder exercises—such as lateral deltoid raises or shoulder presses—with exercises that strengthen both the deltoids and the rotator cuff, such as prone ‘Y’ or ‘T’ exercises.”

Visit yourPhysio or ask your healthcare provider for specific RC education and exercises.