Chair:
Your chair should be easy to adjust from a seated position and should be on casters which allow you to swivel and move around the desk without much effort. The height of the chair should allow your knees to be level with your hips and your feet to rest flat on the floor or on a footrest. Armrests are helpful, especially if you have neck pain. Chairs with backrests should provide lumbar support. Ideally you should set the backrest height and angle such that the lumbar support rests against the small of the back. Some people even choose to sit on a large exercise ball because it causes the back to make frequent, fine adjustments and prevents stiffness. This can be tiring for those who are not used to it so always consult your physiotherapist first before you attempt to replace your chair with a ball.

Keyboard, Mouse & Monitor:
Most patients have computers placed too far in front from them (ie. placed too deep on the counter/desk). They end up slouching, reaching forward excessively and straining their neck. Ideally your desk should allow your elbows to be bent at an angle between 70˚ to 135˚. The forearms should be supported on the desk and the wrists should be straight. As you type, the fingers and hand should be moving instead of the wrist and forearm. The monitor should be placed centrally in your field of view. Repetitive strain problems may develop if you are chronically turning your neck to one side in order to look at a monitor. The top of the computer screen should be at or below eye level.

Work Tasks:
Take a look at all your work tasks and try to rotate through them in a day so that you avoid doing the same task for more than two to three hours at one time. This will minimize the risk of developing repetitive strain injury. For example, if your tasks include making phone calls, typing and stapling, try not to spend more than two to three hours at a time doing each before switching to a different task. Change your working position frequently to avoid stiffness. Try to take a three to five-minute break from your workstation every hour.

Work/Life Balance:
It is common for work to be a major stressor for people. We may associate stress in the neck and upper back with work, and feel less tension when we are away from the work environment. Fitting regular exercise into your life is a healthy way to help manage stress. Regular yoga, dance, running and swmiming are just a few examples. You will reap the benefits by having a stronger, healthier body as well as a more balanced lifestyle.

Final Note About Gadgets:
In a world of laptops, Blackberries and iPads, convenience doesn’t always translate into something which is good for our backs. Small laptops and devices fit nicely on our laps or in our palms but they may cause us to slouch and spend hours surfing the internet in a poor posture. Remember to put the device on a desk instead of on your lap if you are planning to spend longer than 30 minutes.

Consult your Cross Roads physiotherapist or an ergonomics specialist at work if you have further questions about your work station set-up.

If you are struggling with swelling in your limbs which is not resolving post-surgery, you may have lymphedema. Treatment is available. Seek a consultation with Cross Roads registered massage therapist, Dawn Sparks, who is a Vodder-trained and certified manual lymphatic drainage therapist.

Exercise After Breast Surgery

The pelvis is made up of three bones which join together and form a ring.  Three joints are part of this pelvic ring: the symphysis pubis joint at the front (marked green in the diagram below) and two sacroiliac joints at the back (the areas marked red in the diagram below).

In pregnancy, the hormones relaxin and progesterone help the body to prepare for birth by causing ligaments to soften and relax. Joints become more flexible, including the joints of the pelvis.  As the baby grows with advancing pregnancy, increased demand is put on the body’s muscles, ligaments and joints.  Everything must work harder to maintain good posture.  Sometimes this increased stress leads to injury and pain.  Women with PGP may also have asymmetry in their pelvic joints whereby one joint is more stiff or more mobile than the others.

Below is an informative guide with general advice on how to manage pelvic girdle pain in pregnancy from the Association of Chartered Physiotherapists in Women’s Health in the United Kingdom.  In addition, if you are experiencing persistent sharp pains in the low back or in the groin in your pregnancy or in your post-partum recovery, you should consider consulting a physiotherapist for an assessment.  The therapist will help restore balance in your pelvic joints, teach you safe exercises which will provide better support to your joints, and educate you on delivery positions which are less stressful for your joints.

Guidance for Mothers-To-Be and New Mothers: Pregnancy-Related Pelvic Girdle Pain

Physical Activitiy and Arthritis

We encourage our patients with low back pain to review the following practical guide. It is based on the latest evidence in back pain research and was written by respected leaders in the fields of orthopedic medicine (Professors Stanley Bigos and Gordon Waddell), physiotherapy (Professor Jennifer Klaber Moffett) and psychology (Professor Chris Main). It provides facts about low back pain and practical tips for self-management. It is published by TSO in the United Kingdom and is made available below in an electronic version for personal use only.

The Back Book

The following is an excellent resource for our patients suffering from whiplash injury written by respected Physiotherapist and Professor Gwendolen Jull at the University of Queensland, Australia. The guide is based on research and published by the Motor Accident Insurance Commission (MAIC) of Australia. It is made available here electronically for personal use only. We hope it will help our patients with whiplash injury understand the recovery process and learn practical tips on how to manage their symptoms at home and at work.

Whiplash Injury Recovery: A Self-Management Guide

A recent study by Canadian researchers proves what kinesiologists and physiotherapists have known for some time; exercise therapy helps patients with shoulder impingement syndrome recover pain-free movement.[1]

Researchers discovered, however, that the effects of exercises quickly diminished after 24 hours suggesting that single training sessions in the beginning are simply not enough.  In order to have a permanent effect the exercises must be practice many times over.

It is estimate that near 50% of all patients seeking medical help for shoulder pain have some sort of impingement syndrome. The muscle most commonly implicated is the supraspinatus followed closely by the infraspinatus and subscapularis muscles. Impingements can happen under several of the boney structures of the shoulder.

Very commonly patients with this syndrome also have very weak shoulder stabilizers. This causes the scapula to sit improperly on the upper rib cage and leads to postural imbalances resulting in the entrapment of the muscle tendons under the shoulders various boney structures. Improper shoulder stabilization is termed scapular dyskinesis (see picture to the right) and is often a cause of scapular winging.

This mal-alignment of the scapula can lead to pain when lifting the arm overhead or lowering from an overhead position and in common reaching tasks. If it becomes chronic patients may also experience pain while at rest. In many cases the mal-alignment of the scapula can be in response to a direct-blow or injury, whereby the stabilizer muscles of the shoulder lose their stability role, but it can also and often does precede injuries.

The impingement or constant wearing of the tendons of the muscles of the rotator cuff can eventually lead to tears and further shoulder damage causing excessive inflammation and more of the pain cycle. Left unchecked this will eventually require surgery, and a very involved rehabilitation process. The obvious implication is preventing this occurrence is of utmost importance in those who are already experiencing consistent shoulder pain, or those with pain upon movment; particularly with arm movements overhead and with reaching and lifting tasks.

This can be accomplished with an appropriate thorough assessment by your physiotherapist or kinesiologist, followed with a clearly outlined and progressed shoulder stability training routine.

Training is maximized when your therapist involves visual, manual and verbal feedback on specific shoulder and arm movements to properly entrain the correct movement sequence for shoulder stability, and as the study below confirms regularity with your training schedule is imperative to return the shoulder to proper function. Therefore a well designed home-routine that patients can carry out independently should be a part of every shoulder training regimen.

If you are experiencing regular shoulder pain, or pain with arm movements overhead and in common reaching tasks, schedule an appointment to see your registered physiotherapist at Cross Roads Physiotherapy and Massage Therapy today at (604) 568-1337.

References:

1. Roy JR, Bradford HR, McFadyen J, Lirette R (2009). Impact of movement training on upper limb motor strategies in persons with shoulder impingement syndrome.  Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology. 1(1), 1-8.

It is the action of these three groups of muscles that, when coordinated together, stabilize our spine and pelvis providing pain-free and fluid movement. 

 The Diaphragm

Upon inhalation our diaphragm drops down and out, compressing our abdominal contents and increasing intra-abdominal pressure. By increasing the intra-abdominal pressure, the act of breathing through movement helps to create stabilization for the spine and pelvis. For this reason it is just as important to co-ordinate our breathing with any lifting activity as it is to lift with proper biomechanics or posture.

The Abdominal Wall Corset

The abdominal wall corset consists of our transverses abdominus and the internal and external oblique muscles. Our transverses abdominus attaches to a fascial layer of connective tissue which further attaches to our spine. The fascial sheath is known as the thoraco-lumbar fascia which, when tensed upon contraction of our abdominal wall corset, provides further stability to our spine by counteracting  compressive and shearing forces.

The Pelvic Floor

The pelvic floor, often referred to as our pelvic diaphragm, consists of a group of muscles that when contracted push up against our abdominal contents in reverse to the action of our diaphragm which pushes down.

This not only supports our internal organs such as our bladder and bowels, but also further creates an increase in intra-abdominal pressure which increases the stability of our spine.

 Core Stability in Practice 

An integrative model for optimizing core-stability training is achieved through coordinating breathing with abdominal wall contraction and pelvic floor contraction:

Our core never acts independently of any other movement. That is, whenever we move from one position to another or in order to lift or carry something, our core region automatically tenses to brace our spine. This ‘tensing’ is a good thing and is unconscious, which means that prior to even moving our limbs the musculature that protects our spine is called into action. This holds true even in those with chronic back. Recent studies have demonstrated that the difference with those who have back pain and those who do not is a micro-second delay. This delay is enough to cause pain and harm to structures that protect our back. The primary aim of core-stability training in the initial stages is to regain the proper timing and reduce the delay, thereby reducing pain and damage to the structures that hold our back in tact.

With increasing load and complex movements, degeneration to the spine can accelerate to the point where the body then chronically tenses other “non-core” muscles to limit the potentially dangerous movement. This tensing results in the body becoming too stiff to move through our full range. A properly trained core therefore allows the body to maintain optimal mobility as well.

The optimal use of our core musculature is also needed to transfer force and power from the ground across the body in any movement. Core stability is essential for maintaining a strong upright posture and for movements that require extra efforts such as lifting and carrying objects. Without core stability our back is vulnerable to these extra forces causing a potential increase in degeneration to structures holding our low back together. 

A lack of core stability can result in chronic low back pain, poor posture and fatigue.

A proper core-stability routine integrates all three of these muscle groups and functions to ensure that our spine and pelvis are truly capable of protecting itself against external forces.

In Vancouver call (604) 568-1337 to book an appointment with a Kinesiologist at Cross Roads Physiotherapy and Massage Therapy for your Core assessment and training needs .

Some chronic health conditions, including breast cancer, pelvic pain and urinary incontinence, are important concerns for women. These conditions can significantly affect a woman’s physical and mental well-being, participation in daily activities, and even her identity as a woman.

Benefits For Specific Conditions Affecting Women
Physiotherapy can offer valuable benefits in chronic health conditions that are predominantly seen in women. Physical training can help women cope with the effects of breast cancer and its treatment. Also, specific therapeutic exercises can noticeably improve pelvic pain and urinary incontinence, whether the symptoms occur secondary to labour and delivery or occur earlier or later in life. Your physiotherapist will assess your problem, discuss your concerns, and develop a treatment plan that can help you return to an active life.

Breast Cancer
Fatigue, a common side effect of chemotherapy and radiation, can linger even after treatment is finished. An exercise prescription from your physiotherapist can reduce fatigue and improve physical functioning, cardiorespiratory fitness and well-being, even during treatment.(1,2) Specific physiotherapy techniques can also reduce post-mastectomy pain and swelling (lymphedema) and improve lost range of motion and strength that may occur in the arm on the side of the surgery.(3) Your physiotherapist can assess your overall fitness, identify specific problems resulting from surgery and/or radiation, and design an individual program that can support you during treatment and recovery, and help you cope with chronic symptoms that persist after medical recovery.

Chronic Pelvic Pain
Pelvic pain is chronic if it lasts at least six months. Living with chronic pelvic pain is draining, and can interfere with sexual intercourse, good sleep, hygiene and daily functioning. Although no specific cause can be identified in many women, pelvic muscle or nerve inflammation, pelvic muscle spasm, or postural problems affecting pelvic muscles and joints may be implicated.(4) Your physiotherapist can assess your pain and develop an appropriate treatment program. Specific therapeutic exercises can stretch painfully contracted muscles, strengthen weakened muscles, and address postural problems that may be contributing to your pain.(5) Physiotherapy can produce a substantial and lasting reduction in pelvic pain and let you focus on enjoying your life again.(3)

Incontinence
Urinary incontinence (the involuntary leakage of urine) is common in women, affecting up to 30% of women by 65 years of age.(6) It should not, however, be dismissed as a normal sign of aging or long term effect of labour and delivery. In addition to reducing well-being and activity levels, urinary incontinence can cause secondary health problems, such as urinary tract infections and skin ulceration(7), and may lead to reduced fitness, quality of life and depression. Bladder and pelvic floor muscle training are proven treatments for improving symptoms of urinary incontinence, recommended by the International Continence Society as the first line treatment for this condition. Clinical studies have found that targeted exercise therapy can resolve or improve most types of incontinence.(6,7) Age is no barrier in this condition, as women over 75 years of age can also benefit from physiotherapy.(8) If you are experiencing urinary incontinence, talk to your physiotherapist about exercise therapy to eliminate or reduce your symptoms.

For a consultation regarding your women’s health concerns and physiotherapy, contact your Cross Roads therapist today.

References
1. McNeely ML, Campbell KL, Rowe BH, Klassen TP, Mackey JR, Courneya KS. Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis. CMAJ 2006;175:34–41.
2. Markes M, Brockow T, Resch, KL. Exercise for women receiving adjuvant therapy for breast cancer. Cochrane Database Syst Rev2006 Oct 18;(4):CD005001.
3. Gomide LB, Matheus JP, Candido dos Reis FJ. Morbidity after breast cancer treatment and physiotherapeutic performance. Int J Clin Pract 2007;61:972–82.
4. Montenegro ML, Vasconcelos EC, Candido Dos Reis FJ, Nogueira AA, Poli-Neto OB. Physical therapy in the management of women with chronic pelvic pain. Int J Clin Pract , 2008;62:263–9.
5. Hall J, Cleland JA, Palmer JA. The effects of manual physical therapy and therapeutic exercise on peripartum posterior pelvic pain: two case reports. J Man Manip Ther 2005;13:94–102.
6. Shamliyan TA, Kane RL, Wyman J, Wilt TJ. Systematic review: randomized, controlled trials of nonsurgical treatments for urinary incontinence in women. Ann Intern Med 2008;148: 459–73.
7. Dumoulin C, Hay-Smith J. Pelvic floor muscle training versus no treatment for urinary incontinence in women. A Cochrane systematic review. European J Phys Rehabil Med 2008;44:47–63.
8. Perrin L, Dauphinée SW, Corcos J, Hanley JA, Kuchel GA. Pelvic floor muscle training with biofeedback and bladder training in elderly women. A feasibility study. J Wound Ostomy Continence Nurs 2005;32:186–99.

For Infant to Adolescent!

Some Benefits of Pediatric Massage:

For Infants:

• Improved weight gain
• Improved respiratory function
• Decreased hospitalization
• Improved parent/infant interaction
• Improved sleep patterns
• Improved long-range behavioural & developmental testing scores

For Children with Special Healthcare Needs:

• Improved muscle tone
• Improved joint mobility
• Improved respiratory function
• Improved sleep patterns
• Improved gastrointestinal function
• Decrease in stress and anxiety (for the parent or caregiver as well!)

Specific conditions helped through Massage Therapy:

• Asthma
• ADHD
  
• Atopic Dermatitis
  
• Autism Related Conditions
  
• Cancer
  
• Cerebral Palsy
  
• Cystic Fibrosis
  
• Depression and Anxiety Disorders
  
• Diabetes
  
• Down Syndrome
  
• Eating Disorders
  
• Fibromyalgia
  
• HIV
  
• Leukemia
  
• Post Traumatic Stress Disorder
  
• Sports-Injuries
  
• Whiplash & MVA Related Conditions
  

Call Cross Roads today to set up a consultation for you and your child.

For more information on the benefits of Pediatric (including Infant) Massage please check out www.liddlekidz.com.