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Clinic Fee Updates

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January 1, 2015 Fee Changes

Due to the continued increase in the costs of operating the clinic it is necessary to adjust our fee schedule as follows:

Physio Assessment $ 63.00

Physio Follow-up: $ 57.00

Personal Training Private: $ 57.00

Physio MSP: $ 20.00

Physio ICBC: $ 28.00

Orthotics Services: $325.00

Pain Truth Test

berold Facts and Myths, Injury Prevention, Pain, Physiotherapy Comments Off on Pain Truth Test

Answer to the best of your knowledge. If you score less than 20, please consider giving us a call or book online @ to discuss your options.  T   F   X 
1. Pain always means that there is something injured or damaged in the body      
2. The brain produces pain only if there is actual injury to the body      
3. Persistent pain always means that the injured tissues have not yet healed.      
4. Ignoring pain and quickly getting back to full activity is a good method of dealing with persistent pain      
5. Pain is an alarm system that warns the body of actual or perceived danger      
6. All pain is "in the head"      
7. All pain is real      
8. Thoughts and fears can increase blood pressure, breathing and heart rate      
9. Thoughts and fears can cause or increase muscle tension and spasms      
10. Thoughts and fears can cause or increase swelling / inflammation      
11. Just thoughts and fears can actually cause or increase pain      
12. The far majority of disc degenerative changes see on x-ray are normal and are not associated with pain      
13. The far majority of disc bulges seen on MRIs are normal and are not associated with pain      
14. Increase in nerve hypersensitivity may explain why sometimes pain persists even after injured tissues have healed      
15. Emotional stresses such as depression, anxiety or anger can increase nerve hypersensitivity and contribute to persistent pain      
16. The spinal cord and the brain can magnify pain as long as the brain believes the body is in danger      
17. Reliance on passive treatments such as pills, massage, tingly machines, and adjustments may be OK in the short term, but not in the long term      
18. Understanding and truly accepting that pain does not always mean harm is the best way of very gradually returning to normal life activities      
19. It is impossible to recover from persistent pain without a daily active exercise/movement program      
20. To reverse pain from hypersensitive nerves, our body needs ample oxygen, water, fresh fruits & vegetables, sleep, vitamin D (sun), joy and pleasure      

visit – for the answers

Valid Until September 31st, 2014 – Mention This Blog Post and Receive 10% Off Of Your Pain Assessment Appointment.

For more information please give us a call or book online @ - Please Allow Images

Better Posture

berold Physiotherapy Comments Off on Better Posture

Devote 10 minutes a day to better posture

Time spent hunched over gadgets can affect your back and cause pain

IT is estimated that more than 80 per cent of the population will suffer from back pain during their lifetime.
With the increase of high tech gadgets in today’s world, it is no surprise to see that number rise dramatically. The poor posture we demonstrate while we text and use our laptops plays a key role. Common muscles that become overactive or short include the upper trapezius, latissimus dorsi, thoracic spine and pectoral muscles. When these muscles become tight, they alter our posture, leading to typical symptoms such as rounded shoulders and scapular winging.

To correct these muscle imbalances, we need a four-step approach.

  • Step 1: Inhibit overactive or short muscles
    Muscle/Area: Thoracic spine
    Lie on the floor with a foam roll behind your upper back. Interlock your hands behind your head to prevent it from tilting back. Raise your hips off the floor; hold tender area for 30 seconds.
    Muscle/Area: Latissimus dorsi
    Lie on your side with the arm on the floor extended overhead and thumb pointing up. Place a foam roll under your armpit. Slowly move back and forth; hold tender area for 30 seconds. Repeat on opposite side.


  • Step 2: Lengthen overactive or short muscles
    Muscle/Area: Back of neck stretch
    Stand with your feet straight and shoulder-width apart, knees slightly flexed. Place your arm behind your body and lower shoulder.
    Tuck your chin and lower your ear to your shoulder using the opposite hand until a stretch is felt in the back of your neck. Rotate your chin down toward opposite chest muscles. Hold for 30 seconds. Repeat on opposite side.
    Muscle/Area: Pectorals
    Stand with your forearm in a vertical position on a stable object, your elbow and shoulder bent at a 90-degree angle. Place your feet in a stagger stance position. Your back leg is the same side as the chest muscle being stretched.
    Slowly shift your weight forward until a stretch is felt in front of your shoulder and chest. Hold for 30 seconds. Repeat on opposite side.
    Muscle/Area: Latissimus dorsi
    Kneel with one arm on the front of a chair or stability ball, your thumb pointed up, with your other hand on the ground. Lower your hips toward your heels until a stretch is felt alongside your torso and into the lower back. Hold for 30 seconds. Repeat on opposite side.


  • Step 3: Strengthen the right muscles
    After we have inhibited (relaxed) and lengthened our overactive muscles, we need to activate or strengthen our weak muscles.
    Muscle/Area: Lower and middle traps, rhomboids
    Lie with your belly on a stability ball, legs and feet extended. Draw-in your belly button and hold a dumbbell in each hand.Squeeze your butt muscles and lift your chest off the ball. Do not arch your back or jut your neck forward. Extend your arms in front of your body.
    Lift your arms in front of your body at a 45-degree angle, thumbs up (scaption). Hold for two seconds.
    Move your arms straight out to the side, thumbs up. Hold for two seconds.
    Move your arms to the side of your body, thumbs up (cobra). Do not shrug your shoulders. Hold for two seconds. Return to the start position. Repeat for 10-15 reps.


  • Step 4: Integrate
    We need to connect the muscles that we have activated or strengthened to our whole body, making it a functional movement. This last step is key in putting it all together so we can be strong in everyday movements.
    Muscle/Area: Lower traps (and balance!)
    Stand on one leg, your base leg slightly bent, and your other leg slightly in front with the toe pointing up. Draw-in your belly button. Hold a dumbbell in each hand, your arms at the side of your body. Raise both arms up at 45-degree angle (like a Y), your palms facing in to shoulder level. Do not shrug your shoulders or arch your back.
    Hold. Return your arms to the side of your body. Repeat for 10-15 reps.

Bijan Jiany is a certified strength and conditioning specialist, functional movement systems expert, performance enhancement specialist, corrective exercise specialist, and author of Reach For It! Master the Essential Sports Skills for Youth. He owns Coach Bijan Conditioning, located in West Vancouver. For more information, call his office at 604-512-1306 or visit his website,

Top 20 Myths About Pain

berold Injury Prevention, Myths, Pain, Physiotherapy, Rehabilitation Comments Off on Top 20 Myths About Pain

Top 20 Myths About Pain

By Dan Woywitka (

Myth #1: Women and Men Feel and Perceive Pain The Same

It is most common to see women pointing to childbirth as a measure by proof and intensity of their greater capacity for pain. Funny thing is, the science seems to support this.
Clearly women and men tolerate and experience pain in different manners. Women tend to use more coping mechanisms for pain. Seeking treatment more expeditiously, all the while recovering from pain at a great rate than men.
Experts agree that pain is so highly subjective to our experiences, that it is clearly very difficult to compare one person’s pain to another’s.

Myth #2: Rest Is The Best For Back Pain

It is very important to understand that whilst short term rest is often prescribed, it is still preferable to keep your body active. Experts agree that prolonged or total bed rest will only bring you more back pain through improper healing as muscles contract in response to an injury, continuing the cycle of pain. Laying down only makes them tighten more.
Just like a buildup of potential energy, this will cause you even more pain when you do eventually move again. So whilst you must clearly avoid certain exercise during acute or chronic episodes of pain, consult with your physiotherapist or chiropractor to develop a safe stretching and strengthening program to heal and protect your back as it is important to maintain your normal level of daily activity and continue exercising .
If you simply are not active, your body quickly becomes atrophied/de-conditioned, stiff or worse, frozen. (see: Frozen Shoulder Syndrome)

Myth #3: Shedding Pounds Will Not Affect Your Pain

Should one be overweight, it is important to understand that more weight equals more pressure on important joins in the body such as your knees, and affects your back quite measurably
“Dropping a few extra pounds can really help improve joint pain in the knees and hips,” says Patience White, MD, vice president of public health at the Arthritis Foundation. “Even 10 pounds can make a huge difference.”
Losing weight also can help back pain caused by muscle fatigue. Again, consult with your physiotherapy provider to understand how your muscles are out of balance and what needs to be treated to achieve balance.

Myth #4: Painful Flares Cannot Be Curbed By Exercise

Pain makes it harder to exercise. Harder, but not impossible, and certainly not inadvisable. Remaining active is on the top of the list for things to help you get better and feel better. Exercise will help you lose weight, maintain better sleep cycles, assist with digestion, boost your mood and help your brain and heart.
All of these will assist with reducing pain. Exercise clearly strengthen muscles, restores coordination and balance, and eases joint stiffness. Exercises such as swimming, walking and stretching, are excellent, low impact places to start. Your physiotherapy provider knows best about when and how fast to progress back as close to 100% as possible.

Myth #5: No Source? No Pain! Your Imagination At Work

“Just because you can’t find the exact origin of one’s pain doesn’t mean it’s not felt,” says John D, MD., a Washington, D.C. pain specialist. There is no true test for pain intensity, imaging is unable to display a representation of pain, and there is no instrument to assist with direct pain localization (taking into account things like, your finger, or a needle). Pleasantly, this does not mean pain is non-treatable.

Myth #6: Don’t Sweat The Small Pain

It is common believe that pain is something one must bear and be burdened with for the rest of their life. When pain, just by extension of functionality is something that should never be ignored. Pain is the body’s way of telling you that you are in danger and you need to pay attention or be damaged.
Should your pain recede during the use of over-the-counter pain medications, see your doctor if the pain persists for more than a week, worsens with time, or interferes with daily routine and activities.

Myth #7: Pain Is Unaffected By Attitude

If there is one way to increase pain, sour your spirits, and feel depressed: It is to dwell on that pain. “Those who focus on their pain tend to do poorly compared with those who have a proactive attitude and try to find ways to cope with their pain,” says Mr. Roger C, MD, associate professor of medicine at Oregon Health and Science University. Pain can certainly lead to, or be accompanied by depression and anxiety, making that pain worse. Speak with your Doctor, physiotherapy Provider, or Personal Therapist today to help ease your mind/body and get back to healing.

Myth #8: “No Pain, No Gain”

Remember everyone, we have said it before and we will say it again. Pain is the brain and body’s way of telling you how important it is you pay attention to what is happening before you damage yourself.
So, whilst it is understandable to push yourself to the point of “feeling the burn” during an exercise, it is very important to understand when you really should stop. If something hurts the wrong way and you do not notice, then those “extra reps” are creating damage, not benefit. Pain is reminding you that something is not correct. You should never feel pain when exercising. If you do, stop and take a break. To stay safe, learn what your limits are, and stay within them as you maintain or increase your routine.

Myth #9: Pain Just Comes With Age

The average ache here and pain there is a part of almost everyone’s life. It’s rather alike to wrinkles and gray hair. However chronic pain, with its ability to decrease quality of life and increase suffering and depression, is a real bugger, however it does not have to be. Most people should be able to lead relatively pain-free lives as they age. If you are bothered by chronic pain, your doctor, physiotherapy provider or pain specialist can help you find relief, no matter how old you are.

Myth #10: Pain Killers Cause Addiction

It is well understood and documented how most pain killers, opiates, and the like affect the human body and the patient as a whole. So if one truly takes their medication as directed, prescription pain medications rarely cause addiction. However, as with many drugs, your body can become physically dependent on pain medication. This does not imply that you are addicted, simply that if you stop using the mediation, you may have withdrawal symptoms should the use of that particular drug stop abruptly. This is an expected response when a prescription pain drug is used for more than a few days.
Your doctor or pharmacist can help you stop safely and more comfortably.

Myth #11: Pain Is A Head Game

Pain is a complex problem, involving both the mind and the body.
For instance, it could be said that back pain has no known cause in a fair number of cases, yet stressful life events will worsen its impact. This does not mean it is not real. Pain is an invisible problem that others can’t see, but that doesn’t mean it’s all in your head. A highly trained specialist or physiotherapy provider can greatly assist you in rooting out the real cause of your pain. For Example: Improper or misaligned walking gaits can and do cause back pain and more.

Myth #12: Only Sissies Go To Doctors: Complaining About Pain Makes You Weak.

There is no weakness in seeking treatment. It is understandable how those with chronic issues feel helpless and trapped by their pain, do not wish to burden others with their problems. The aged adult is far more likely to just push through the pain and its accompaniments, than their kids or grandkids are. We have all partaken in sports or activities which have required us to endure the occasional minor injury or headache, and that is one that. However, simply enduring pain of the chronic nature will impair function and impact quality of life. This is not a guessing game, it’s a fact. Fatigue from loss of sleep, anxiousness, trouble focusing or working, relationship impairment: Depression.

The fact is, you do not need to suffer, relief may be just around the corner.
You owe it to yourself to visit your physiotherapist or doctor to discuss how your pain can be treated effectively, the way it should be, and can be.

Myth #13: There is always an underlying cause when it comes to chronic pain

It is not always possible to link chronic pain to an injury or physical condition. Yes that minor car accident  a while back may have been a catalyst for your back pain. Perhaps too many hours on an improperly setup bicycle or running along the tarmac has caused you knee pain.
Or maybe not.
Pain can be a lone traveler, developing for no identifiable reason. Yet it’s indisputable the pain is very real.  It can be more difficult to relieve pain without a direct cause to treat, however you can still effectively manage it. This brings us to our next myth.

Myth #14: Something you did at one time caused your back pain

Jerking your body, lifting something heavy or improperly, slipping, falling are all potential culprits.
The lesser known disk degeneration from small micro-tears that go unnoticed over time could be the real cause of your back pain. The small jelly-like donuts sandwiched between the vertebrae of your spine are made up mostly of collagen and water and help your spine move. A “slipped” or herniated disk will cause inflammation and pain as it bulges out and presses on a nearby nerve root. Should a disk rupture, fluid is leaked, placing pressure on sensitive nerve endings in the lower back. 

Myth #15: Back-Extensions And Sit-Ups To Strengthen Your Core

For some of you it may come as a big surprise that traditional core exercises like crunches, back extensions and sit-ups are among the worst exercises as they can do more damage than good.
These exercises exacerbate an existing problem or cause a new one to occur as they are putting tremendous pressure on your disks. Ideal exercises for your core involve keeping your spine in a neutral position. Brace your abdominals as you would before a cough or clearing your throat, this will give you the best foundation to help keep your spine stable in everyday life. Try to not stick out your abdominal muscles or suck them in.

Myth #16: You Should Bend Your Knees When You Lift Something Heavy

“Proper lifting mechanics require you to actually lift with the hips, not with the knees, otherwise you will just end up with knee arthritis,” says Stuart McGill, University of Waterloo  professor of spine biomechanics and chair of the department of kinesiology.
If engaged in heavy lifting, endeavor as best as possible to disperse the weight throughout all of the muscles in your body, remembering to brace your abdominals as if you were going to clear your throat or cough, lift from the hips and keep the object close to you. When picking up a small item, bend from your hips, keeping your back straight using one leg out behind you for balance.

Myth #17: Increasing Flexibility Will Protect Your Back

“Statistically, those who have more range of motion in their back have a greater risk of back disorders in the future, so having a flexible back is not protective, in fact, it’s the opposite,” says Stuart McGill, University of Waterloo  professor of spine biomechanics and chair of the department of kinesiology.
The structure of the spine and skeletal muscles are designed to provide stability whereas leg and arm muscles are more movement oriented.

Myth #18: A Back Belt Is A Prudent Measure When Lifting Something Heavy

Those Belts you sometimes see airline baggage handlers, warehouses workers and weight lifters, do not reduce back injuries. According to the U.S. National Institute of Occupational Safety and Health (NIOSH) there is no supportive scientific evidence that supports claims of back belts lessening load on the spine or reduction of injuries. Fact: they may actually cause more harm than do good due to providing a false sense of support and security.

Myth #19: People Who Have Seen Several Physicians and Have Not Made Strides In Dealing With Their Chronic Pain Will Just Have To Live With It

There are few exceptions to the fact that there is no need for anybody to live with unbearable pain.
Available to you, are a wide variety of options for treatment, however it is necessary to locate the correct doctor or physiotherapy practitioner. Just as a cardiologist would be sought out for heart disease, or an ophthalmologist for vision issues, there are highly trained pain management specialists who deal solely in chronic pain. They are careful listeners who perform exacting physical examinations and treatments and who will not hesitate to combine care with other specialized medical consultants in developing a comprehensive treatment and longevity plan.

Myth #20: Pain Is Unaffected By The Elements

Sometimes common knowledge, but worth a mention anyways.
Should your joint pain change with the weather, it is definitely not your imagination at work.
Despite studies demonstrating mixed results, barometric pressure fluctuations cause some of those with arthritis to have increased join pain. Experts believe the barometric pressure change also affects pressure in the joints.

Frozen Shoulder Syndrome

berold Physiotherapy Comments Off on Frozen Shoulder Syndrome - Please Allow Images
North Shore Orthopoedic - Allow/Download Image to viewSevere shoulder pain characterized by capsular contraction, formation of adhesions & movement loss.
The shoulder is comprised of:

• Humerus,
• Clavicle &
• Scapula

Usually frozen shoulder occurs due to pain & secondary immobility, “don’t use it, you lose it.”

1. Pain may be due to shoulder injury, sub-acromial bursitis, impingement, etc.,
2. Surgery: immobilization following surgery.
3. Anatomical: bursitis is secondary to positional or structural-like phenomenon,
i.e. simply due to its’ anatomical location
4. Neurogenic: the nerve supply, if impeded, interrupts neuromuscular function,
producing muscle weakening / associated pain
5. Other: falling, lifting, repeated micro-trauma, age-related cuff degeneration &
6. Idiopathic: no apparent cause. The shoulder suddenly, without warning,
becomes painful & the capsule surrounding the shoulder tautens

North Shore Orthopoedic - Allow/Download Image to view• Pain: gradual or sudden onset of shoulder pain.
• Night: pain 2ndary to sleeping on the affected shoulder.
• Swelling: swollen tendons & increased upper arm circumference
• Palpation: painful to palpate the tissues surrounding the humerus & scapula
• Alignment: the scapula is misaligned with accompanying humeral head forward
tilting & a reversal of scapula-humeral rhythm
• Active R.O.M.: movement in all planes of motion is incredibly stiff & painful.
• Passive R.O.M.: movement initiated by the clinician is virtually impossible
• Strength: weakness proportional to pain severity, though injury may not have
precipitated thesymptoms
• Occupational: cannot work due to pain
1. Mechanical: Overhead movement “pinches” the tendon & bursa against the
over-hanging acromion causing
1.1 If the scapula is tightly bound against the rib cage, reversal of the scapula-humeral
rhythm occurs & the shoulder
muscles strain moving the scapula
2. Anatomical: Structural abnormalities result in a narrower sub-acromial space,
eg. A-C joint arthritis & spurs under the
acromion narrow the sub acromial space
3. Computer Posture: computer-related position predisposes the shoulder to
misalignment, muscle imbalance & loss of
antagonist muscle programming
4. Muscle Imbalance: characterized by interruption of the length / tension ratio
4.1 Training Errors: over-training in 1 plane of motion, inadequate recovery time,
overhead training with too much load
4.2 Overuse Position: Day-to-day computer-related positioning poses difficulties due
to occupational-induced muscle imbalance & weakness.
5. Other: falls, lifting, repeated micro-trauma, age-related cuff degenerationNorth Shore Orthopoedic - Allow/Download Image to view
6. Idiopathic: some frozen shoulders occur spontaneously without
clear rationale
7. Demographics: women age 45+ more frequently suffer “frozen” shoulder syndrome.
The writer hypothesizes this may be secondary to strangling of the micro-circulation due to the brassiere.
Frozen shoulder injuries always take longer because the tendon is not the “working” component of the unit & effective circulation is directed to the muscle belly.1. Physician’s Exam: indications for NSAID’s & investigative testingNorth Shore Orthopoedic - Allow/Download Image to view
2. P.R.I.C.E.:
b. Rest: relative rest, pain-free R.O.M. & avoid overhead motions
c. Ice: ice for 15 minutes every 2 – 3 hours to reduce inflammation
d. Elevate / Exercise: strategic exercise to restore passive & then active R.O.M.
e. Compression: N/A
f. Elevate / Exercise: following appropriate rest, strategic exercise to restore
passive &then active, pain-free R.O.M.
3.Physiotherapy: ultrasound & laser enhances micro-circulation, acupuncture
4. Manual therapy: re-aligns the scapula & restores scapula-humeral rhythm
5. Targeted Stretching:Timing is critical because pre-mature stretching
exacerbates pain.
5.1 Lengthening the muscles surrounding the shoulder joint, enhances
scapulo-humeral rhythm, increases the subacromial
restores length / tension ratios & prevents adhesive capsulitis
6. Exercises: avoid cyclical pain patterns as this encourages “guarding.”
6.1 Improve muscle control: Shoulder stability exercises involve precise
re-training of scapular movement, practiced
with minimal resistance
6.2 Re-program Scapula control: scapular depression & retraction
6.3 Rotator Cuff Muscle Balance: require minimal weight to correct imbalances
• Assisted R.O.M.: creep the hand up the wall, door-frame pulley
• Free-Active: strengthen scapular & rotator cuff muscles with minimal weight
• Isometrics: neutral & 30 degrees of amplitude
• Isotonic: free weights & pulleys
• Dynamic: theraband resisted rotation
7.Functional: incorporate speed & load specific for functional recovery.
Eg. proprioception exercises, wall push ups
8.Posture: head & shoulder alignment optimizes muscle length tension relationships, reducing impingement
This is directed by pain, not the time since pain began. You must have:

• Full & pain-free shoulder R.O.M

• Restored length / tension ratios, full strength & coordinated scapula control

• Optimizing the sub-acromial space to prevent impingement & potential “freezing.”

• Correct warm-up & shoulder stretching techniques

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