Suffering From Vertigo?


There are several reasons for vertigo, and all of them suck, but positional vertigo is a common type of dizziness that can be treated with a simple maneuver.
Benign paroxysmal positional vertigo (BPPV) is the medical term for positional vertigo. BPPV is caused when tiny stones in the inner ear are dislodged from the sticky cushion where they usually sit, and travel into the semicircular canals, which determine our perception of three-dimensional space. When these stones are trapped in the semicircular canal, it gives your brain the wrong message about your body position, and creates a false sense of motion.
If the stone is dislodged on the left side, when you turn your head to the left you would experience extreme vertigo that lasts several seconds to one minute, then settles until the next time your head turns to the left.
In 1979, Dr. John Epley discovered a maneuvre that could treat most cases of BPPV without medication, and is essentially placing the head and body in certain positions to get the stone out of the semicircular canal and back onto its sticky pad in the inner ear. The Epley maneuvre is a series of head and body movements that try to reposition the stone out of the semicircular canal and back onto its sticky pad in the inner ear. Once back in place, the stone will no longer cause the symptoms of vertigo. Some patients can be trained to perform the maneuver at home.
It is important that other causes of vertigo are ruled out before trying the Epley maneuvre, such as inner ear infections, migraine, neck issues, and multiple sclerosis. Once BPPV has been determined to be the cause of vertigo, then it is often very treatable with postural correction and the Epley maneuvre.

At Elevation Physiotherapy, we can help with vertigo from BPPV or neck issues. Let us help you get better, faster.

How To Do A Proper Plank

There has been plenty of conversation lately around doing plank exercises after age 50—is it safe?  What is the effect of estrogen depletion of skeletal muscles? Can doing planks to strengthen the core actually cause a prolapse of the pelvic organs?

The answer is a resounding NO—planks can continue to be a great strengthening exercise, but there is more to it than that.

  1. Like any other exercise you would ever do, your form really matters.  Don’t start planking at a level that is beyond where you are. Start on your knees or a modified version and progress onto your toes as your strength improves.
  2. Make sure that you are engaging your pelvic floor muscles while you are holding your plank—meaning that you have to know that you are engaging them properly, and remember to breathe as well
  3. You have not become fragile when you reach age 50, or beyond for that matter! Decreasing levels of estrogen in your body has been shown to reduce the strength in our skeletal muscle.  Let’s not forget that general inactivity, at any age, will also decrease strength in our skeletal muscle. There is also evidence to show that we can still build muscle when we age, and everybody should do this!
  4. When you stop challenging your body physically, you WILL get weaker over time.  That is the same for all muscles.  Many people have weak pelvic floor muscles because they don’t work them specifically unless they have developed a problem! So if you are starting to plank (at any age), you should have a pelvic health physiotherapist assess you if:
    1. You leak urine while holding a plank
    1. You feel a heaviness or pressure in your pelvic floor after planking
    1. You can’t hold good form
    1. You are experiencing back or hip pain to do a plank

HOW TO DO A PROPER PLANK:

  • Keep your body in a straight line, whether you are on your knees or your toes
  • Tuck your pelvis under
  • Stack your elbows under your shoulders
  • Think about pushing away the floor with your elbows
  • Squeeze your glutes hard!
  • Keep your hips level: don’t let them sag or rise up
  • Remember to breathe

Could Low Impact Sports like Cycling and Swimming Put your Bones at Risk?

A new study in the British Medical Journal looked at the bone density of elite cyclist and runners, and found that the cyclists had thinner bones than the runners, even though many of the cyclists also lifted weights.  The sports we do make our skeletons adapt in different ways over time.

Exercise is necessary for bone health—studies have long shown that children who are consistently active develop thicker, stronger bones than those who are sedentary.  Many scientists agree that activities that involve sprinting or jumping will make the body increase the number of bone cells to prepare the bones to tolerate those forces. Even middle-aged or older people can maintain strong bones if they maintain activities that put more force through the skeleton.

Researchers are still not sure what activities build the bones enough—some studies show that running generates enough force to remodel bone, and other research says that it does not.  It’s the same with weight training. Several studies have raised concern that non-weight bearing exercise like cycling and swimming may actually be helping the bone to get thinner because they put so little pressure through them.

A Norwegian study looked at the bone density of 21 elite runners and 19 road cyclists in their 20’s.  Despite the fact that the cyclists trained much more than the runners and many more of them did weight training, they had noticeably different bones.  All of the cyclists had thinner bones than the runners, and more than half of them met the criteria for low bone mineral density.

This research can’t tell us why the cyclists’ bones might be thinner—both eating too little and sweating too much have been shown to cause bone loss.  This research points to serious cyclists needing to combine other activities that are weight-bearing through the bones.

Physiotherapists are experts on optimal cross-training for athletes to prevent overtraining certain muscles or building imbalances from those sports or activities that use the same muscles over and over.  If you’re a serious athlete, check in with your Physio to find individualized activities and exercise to complement your own sport

Exercises for Lower Back Pain Are NOT Created Equal!

Elevation Physiotherapy & Wellness :: Exercises for Lower Back Pain Are NOT Created Equal!

Research has shown that people suffering from lower back pain should focus on just two things:  keep moving, and be careful with sitting posture and avoid slouching.  There has been more recent research studying if specific directional exercises are more valuable to get rid of pain, or if general stretching and strengthening around the spine is more effective.

A directional preference is described as when repeated lower back movements in one specific direction (eg. arching the back) demonstrates quick improvements in pain and range of motion that remain better as a result.  This phenomenon doesn’t always happen, but when people’s back pain responds so nicely to repeated movements into one direction, they often progress faster than those who do not demonstrate any directional preference. Long et al (2004) developed a brilliant study where they identified those people who showed a directional preference to a lower back movement, and asked would happen if the person did not continue with exercise in their direction of preference?

 Three hundred twelve people with lower back pain had an assessment to determine who demonstrated a directional preference with lower back movements.  Those who did (n=230) were placed into one of three directional subgroups:  flexion (rounding), extension (arching) or lateral (sideways) preference. Each subgroup was then randomized into a matched (n=80), opposite (n=70), or non-directional exercise program (n=80).   All 3 groups were given education on posture and keeping active as able. For example, if one person showed a directional preference for lumbar extension (arching back) during their assessment, they were then randomly allocated to continue with exercises into lumbar extension (matched preference), or lumbar flexion exercises (opposite), or a third control group of generalized strengthening and stretching exercises of the lower back, hips and thighs (commonly prescribed multi-directional mid-range exercises).

Elevation Physiotherapy & Wellness :: Lower Back Pain Testing

After two weeks, 95% of the people doing the exercises in their preferred matched direction were improved or completely better and no one was worse. Yes, you read that right—95%!!!

This was over four times better than the group performing the opposite movement to their direction of preference (23% better or resolved and 15% reported being worse). The control general exercise group had 45% report they were improved and  15% were worse, but interestingly, 55% of these control group did not feel they were improved despite performing commonly prescribed exercises and general movement.  This study strongly demonstrates how individualized directional exercises can be very powerful to improve or resolve back pain quickly.  One does not have to suffer for weeks or longer to help the source of the problem.  A proper mechanical assessment can determine the proper course of action to help get better, faster… and stay that way!

Reference:

Long, A. et al.. Does it matter which exercise? A randomized control trial of exercise for low back pain.2004, Spine 29(23): 2593-2602

Why Would You Strengthen Your Hips When It’s Your Knees That Hurt?

Elevation Physiotherapy & Wellness :: Why Strengthen Your Hips When It's Your Knees that Hurt?

Pain at the front of your knee is often called patellofemoral syndrome, and can be a nagging ache or a sharp pain that you might feel after exercising or even sitting too long.  Over time, your knee might start to hurt during exercise or throughout your day, and may cause you to limit your activities. 

Recent research showed that in people with patellofemoral syndrome, strengthening the thigh muscles can be helpful, but it is even more helpful to strengthen hip muscles.  One study followed 33 women who did consistent knee or hip strengthening exercises over four weeks:  the group that strengthened their hip muscles reported 43% less pain than the group who did knee/ thigh strengthening exercises—they reported only 3% decrease in their knee pain. 

Pain relief and function were similar for both groups by 8 weeks.

Why?

The power for you to move your body around is supposed to come from your hip muscles, specifically the “outer” butt muscles.  Often people are fairly weak through these muscles and your brain makes your thigh muscles take over and do more of the work than they should.  It is thought that getting or keeping the hip muscles strong helps to improve the mechanics of the whole leg and therefore reduces stress on the knee itself.

Strengthening your hip muscles can help decrease knee pain faster, but it is also thought that keeping those muscles strong can actually prevent knee pain from beginning. Examples of targeted hip strength exercises are clamshells, lateral walking with a resistance loop around your legs, and even squats—these exercises need to be done properly and should not be painful. It is always best to see your Physiotherapist who can determine specifically what is causing knee pain, and can then design a program individualized to help you.

Snow Shoveling … Canada’s “Other” Winter Sport!

Elevation Physiotherapy & Wellness :: Snow Shoveling Tips for Canada's "Other" Winter Sport!

With winter comes snow, and with snow comes shoveling.  Snow shoveling can be the cause of muscle and ligament injuries, as well as back pain.  It should be treated the same way as any sport—warm-up and cool down with some basic stretches and movements to increase your heart rate.

7 Steps to Easier Shoveling

  1. Start Slowly – shoveling can increase your heart rate and blood pressure, so warm up and cool down with stretches.
  2. Clear Off Snow as Soon as Possible – fresh snow is lighter than packed snow, so the job is easier.
  3. Push Snow Out of the Way – when possible, push snow off to the side rather than lifting and throwing the load.
  4. Don’t Overload the Shovel – fill the shovel half full and step forward when loading the shovel.
  5. Don’t Stoop and Lock Knees When Shoveling – that position increases the pressure on your low back, so bend your knees and keep your back straight.
  6. Take Breaks – if it’s a heavy job, rest awhile and return later to finish
  7. Stop to Stand Upright – make sure you regularly stand up straight and even stretch backward during shoveling to give your spine a break; repeat a few times in a row.

Choosing a Shovel

“Ergonomic” shovels have a bent shaft that allow you to keep your back much straighter, as you can get a good grip on the shaft without having to reach down too far.  Often these shovels have an aluminum shaft, making it lighter and helping to minimize the stress that shoveling imposes on your back.  Also look for a small, lightweight, plastic blade to help reduce the amount of weight that you are moving.  When shopping for such ergonomic snow shovels, pick them up first and go through the motions of shoveling to see if they’re the right length for you.

Proper Lifting

When lifting even a light load, be sure to keep your feet wide apart and put your front foot close to the shovel.  To lift, shift your weight to the rear foot and keep the load close to your body; turn your feet in the direction toward which you are throwing the snow rather than twisting your body. After you’re done, try to keep moving for a short time afterward—allow your muscles and your lower back to stay limber.

The Shoe Story (for Runners)

Ten years ago, research showed that there was no evidence to show that modern running shoes prevented injuries, and such shoes should be considered “unproven technology with the potential to cause harm.”  Then in 2009,the rise in barefoot or “minimalist” running created the thinking that more traditional runners were not as good, as the minimalist shoe would make a runner adopt a more natural gait pattern.

As years go on, there is still no evidence to speak about how running shoes prevent injury—and that goes for traditional shoes, minimalist shoes, the super-cushioned maximalist shoes,or even that you should simply choose a shoe based on comfort.

The false argument that exists for the newer maximalist model states that since there is no evidence around more traditional shoes, then the newer version must be better. Also, the thinking that a more natural foot motion is best, as represented by the minimalist model, is also not backed up by evidence.  Plenty of people who properly train in these shoes report injuries.

Some researchers have argued that the best way to choose a shoe is comfort, and that your own legs have a unique“preferred movement path” that will minimize injury. There are plenty of studies that show how different types of shoes, or no shoes at all,affect the way your joints move and the forces that impact them – but no one can say if those changes actually affect injury rates.

What research actually does show is some of the best ways to avoid injury are to be cautious about how to increase the training load, and maybe to make small adjustments in running form to avoid problems such as excessive braking with muscles on the front of the thigh. 

Someone newer to running might want to try on several different shoes at their local running store to find what feels best. Running shoes should not have a “breaking in” period, so if they aren’t comfortable right out of the gate, then try a different make or model that feels good to run right away. Check with your physiotherapist for specific exercises or gait analysis to help you build up some miles safely and stay injury-free!

How to Keep Your Fitness Goals Rockin’ this Winter

Elevation Physiotherapy & Wellness :: How to Keep Your Fitness Goals Rockin' This Winter

Winter is here, and although it’s not bad yet, we know what is in store for the upcoming months.  It’s dark, it’s cold, it’s icy— all conspiring to suck any motivation to keep up your fitness goals right out of your body!

But here’s the thing. We know it’s coming, so now is the time for a few easy preparations to keep your workouts loaded through the next few months.

  1. Keep your gym/yoga studio/dojo close to your home or work.  If you have to travel more than a few kilometers out of your way, you won’t go.  At least not regularly like you should.  Make your workouts easily accessible to go first thing in the morning before work, at lunch, or right after work before you go home and settle in for the night. Or train at home. It only takes a few basic piece of equipment to get in a solid workout in your own space. Some resistance bands, dumbbells or kettle bells, maybe an exercise ball or suspension system, and you’re gold.
  2. If you’reworking out outside, dress appropriately. Layers are the key. You will still sweat if it’s -20° and you’re running outdoors. No cotton, including socks, as that will hold the moisture close to your body.  Clothes that wick the moisture away from you is best, and won’t restrict your movement.
  3. A warm-up is actually important.  Even if you’re inside at the gym, you’ve probably just arrived from outside and changed into shorts and a t-shirt. When it’s cold out, blood flow to muscles decrease and joints can get stiff. Even a short warm- up will better prepare your body for the work you’re about to do.  Some dynamic stretches, a few bridges and body-weight squats, 5 minutes on a treadmill and you’re good to go!
  4. Use the winter months to try something new.  Why not try out the kickboxing studio you pass each day on your way to work?  You’re more likely to do “inside” workouts during the winter months, and why not mix it up with something you haven’t tried before? 

The bottom line:  keep yourself moving!  The pull to hibernate can be strong, but think of the next few months as an opportunity to keep yourself fit so you can hit the ground running (literally!) in the spring.

Are Our Brains Making Us Sit Too Much?

Elevation Physiotherapy & Wellness :: Are Our Brains Making Us Sit Too Much?

 

A recent study in the journal Neuropsycologia finds that our brains tend to be wired towards being lazy.  People know that they should exercise and even may plan to work out, but electrical signals in the brain may be motivating them to be sedentary.  Relatively few people exercise regularly, even though most know that it is important for our health.  Earlier research shows that many people sincerely wish to be active, but few people actually follow through.

Scientists wondered if there was something going on in the brain that lessened the motivation to exercise, so they recruited 29 healthy and fairly sedentary young men and women who said they wished to be more active.  Each volunteer was fit with a helmet that had multiple electrodes that read and recorded the brain’s electrical activity.

Each person was given a computer test where they had an avatar they controlled by pushing a keyboard key, and they were instructed to move their avatar as fast as they could toward either the active images and away from the sedentary ones, and then vice versa.

If people respond more quickly to one kind of image, moving their avatars to it faster than they move them away from other types of images, then it is thought that they are drawn to that subject. The people in this study were almost uniformly quicker to move toward the active images than the sedentary ones–they all consciously preferred the figures that were in motion.

But at an unconscious level, their brains did not seem to agree. The electrical tests of brain activity showed each person had to use much more brain resources to move toward physically active images than toward sedentary ones. Brain activity there was much slighter when people moved toward couches and hammocks, suggesting that our brains are naturally attracted to being sedentary.

The results were explained in that our ancestors needed to conserve energy, so they had fewer calories to replace when food was not easily available—it was a survival strategy.

Of course, this study was small and looked only at electrical activity in the brain, but the authors feel that it would be helpful for some people who are reluctant to exercise to know that they are not alone.  It is also very important to note that we can consciously choose to move, despite what our brains might think.

4 Reasons to Try Yoga When You Are Recovering From Pain

Elevation Physiotherapy & Wellness :: Four Reasons to Try Yoga When You Are Recovering from Pain

As a Physiotherapist, I see people who have pain.  Together we work on strategies to help that pain and get to the root of the problem, and often for a period of time I will ask people to limit certain activities, but the big picture is to get someone back to full function and have no limitations.  Once people are on the road to recovery, then often yoga can be beneficial as part of the solution! Here are 4 reasons to start yoga when you’re recovering from an injury:

 

  1. Here’s the thing: all yoga is not the same.  It is important to look at your specific movement and breathing patterns, and develop a yoga series that is unique and helpful for you and your pain.  Start small and slowly by focusing on one joint and one movement at a time, as that is easier for the nervous system to learn and progress occurs more quickly. As you progress, you may increase the number of joints involved, number of reps and speed. You may also transition from sitting or lying down movements to more standing movements to build stability and strength.
  2. There is a sense of safety: When the nervous system is responding to stress, your breath can be shallow, muscles tighten, the digestive system and sleep get thrown off. Pain and anxiety can exacerbate the stress response. Yoga can help to down-train the nervous system and encourage further healing of the issue with breath, movement and calm.
  3. It helps you listen to your body. As you get to know the cues your body is giving you, you can learn a better connection with your body and can help take control of your own self-care.
  4. Any movement is therapy when done with ease. Yoga can help you become more aware of how you move. You can work on easy vs. tight breathing, and ease of movement vs. force.  Awareness is the key to shifting the movement and breathing habits that can contribute to symptoms. With awareness, symptoms can change.

 

How do I start? At Elevation Physiotherapy, we work closely with a trained yoga instructor to develop a program that can be a part of your own injury recoverySpeak with your Physiotherapist to see if yoga sessions could be helpful for you.  If you are still working with your Physiotherapist, it is possible that your yoga session(s) could be covered under your Physiotherapy benefits.