|Cryotherapy Purchase and Rental Program
Cold therapy is widely recognizeld as an early intervention and effective treatment strategy to combat pain and swelling. By using cold therapy you are taking an important step in speeding up the recovery process, getting you back to the pain-free life you deserve. Ask us about our rental program.
Frozen Shoulder Syndrome
|Severe shoulder pain characterized by capsular contraction, formation of adhesions & movement loss.
The shoulder is comprised of:
|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.,
|Frozen Shoulder Signs and Symptoms|
|• 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
• Occupational: cannot work due to pain
|Frozen Shoulder – Biomechanics and Pathology|
|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 degeneration
6. Idiopathic: some frozen shoulders occur spontaneously without
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 Treatment|
|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 testing
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
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
|Returning To Activity From A Frozen Shoulder|
|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
|Stay Tuned For Our Next Newsletter!
Dry Needling Explained
Dry Needling, By: Reza Ghannadan, MPT, BSc (Kin), Physiotherapist
Every physiotherapist has an “Ah-ha” moment in their career. This is the moment when they have an insight or realization that will change the way they assess and treat patients.
I recently had this “Ah-ha” moment after completing my first two Functional Dry Needling courses through Kinetacore this past January, 2014. Functional Dry Needling is an effective technique and has altered the way I assess and treat my patients. So, you may be wondering what Functional Dry Needling is.
What is Dry Needling?
Dry Needling, also known as Intramuscular Stimulation (IMS), is an effective technique used by physiotherapists to treat pain arising from muscles and/or nerves. Dry needling involves inserting a needle, without medication or injection, into an area of the muscle known as a trigger point.
A trigger point is an irritable, hard “knot” within a muscle that is painful when palpated and can produce significant pain over a large area. Trigger points are very common and can often make everyday tasks difficult. Often, these trigger points may be too deep to be effectively treated by other treatment techniques.
How does Dry Needling work?
Dry needling works by advancing the needle into the trigger point, which causes the muscle to grab onto the needle in an attempt to repel the needle. This is called a localized twitch response. This localized twitch response is necessary in order to deactivate the trigger point and relax the muscle. This can result in significant pain relief, decrease muscle tension, increase the range of motion, and promote a return to activity.
What can I expect to feel with Dry Needling?
Many people may not feel the needle insert into the skin. However, once a localized twitch response is elicited, the discomfort can vary drastically. Many people describe the feeling as a muscle cramp once a localized twitch response is elicited. People will soon learn to recognize and even welcome the sensation, as deactivating the trigger point reduce decrease pain, restore muscle length and improve function.
What conditions can Dry Needling treat?
A broad range of musculoskeletal injuries can be treated effectively with dry needling. These include, but are not limited to, the following:
• Shin splints
• Plantar Fasciitis
• Low back pain
• Sciatica and piriformis syndrome
• Knee pain and Patellofemoral pain syndrome
• Neck pain and whiplash symptoms
• Tennis and Golfer’s elbow
• Shoulder pain
• Repetitive overuse injuries
• Chronic pain
Who will benefit from Dry Needling?
Prior to treatment, your physiotherapist will first perform a thorough assessment to determine if you may benefit from Dry Needling. If you are a good candidate, sessions will vary from 1-2 times/week. Your physiotherapist may also incorporate other forms of therapy, such as manual therapy or exercise, as part of your treatment. The total number of treatment sessions will vary depending on a number of factors, including the cause and duration of the symptoms, your general health, and you and your practitioner’s satisfaction with the outcome.
How is Dry Needling different from Acupuncture?
Dry needling is different from Traditional Chinese Acupuncture. Both methods do involve inserting a needle into the tissue. However, there are significant differences in the evaluation, application and overall goal of the treatment. Traditional Chinese Acupuncture involves inserting needles along a meridian based on Eastern Medicine principles in order to re-establish chi, or life energy, back in the body. Dry needling involves an examination of the neuromuscular system and insertion of a needle directly into hyperirritable spots within the muscle in order to de-activate it, and thus, decrease pain and restore function.
Is there research evidence supporting Dry Needling?
Yes. A recent, high quality review of several studies found dry needling can be effective in providing immediate pain relief after treatment and at 4 weeks post treatment in patients with upper body muscle pain1. There has not been enough research evidence to determine its effectiveness on lower body conditions. However, your physiotherapist can still help treat many lower body injuries with dry needling. Please consult with your physiotherapist.
Dry Needling is a powerful and effective treatment adjunct used to treat many musculoskeletal conditions. Your physiotherapist will perform a thorough assessment to determine if you will benefit from Dry Needling.
If you think you would benefit from Functional Dry Needling or if you have more questions about it, please book an appointment with Reza by calling 604-987-5291.
About me: Reza Ghannadan is a Physiotherapist and is certified in Functional Dry Needling through Kinetacore.
1. Kietrys, D. M., Palombora, K. M., Azzaretto, E., Hubler, R., Schaller, B., Schlussel, J. M., & Tucker, M. (2013). Effectiveness of dry needling for upper-quarter myofascial pain : a systematic review and meta-analysis. Journal of Orthopaedic Sports and Physical Therapy, 43(9), 620-634.
Common Running Injuries
By: Reza Ghannadan, MPT, BSc (Kin), Physiotherapist
I recently volunteered at the Mountain Equipment Co-op (MEC) Vancouver Race Series 5k/10k in Stanley Park. Myself and a massage therapist were onsite to provide post-race treatment for runners.
What surprised me was how many runners required post-race treatment for common running injuries, to manage their pain and other symptoms. Several runners had never been to a physiotherapist before and were not aware as to the cause of their pain or how to manage it. This is where physiotherapy can help as demonstrated by the fact that the majority of runners achieved significant pain relief of their common running injury within a 5-7 minute treatment session.
Below is a list of common running injuries physiotherapy can address:
1. Iliotibial Band Friction Syndrome (AKA outer thigh pain)
2. Patello-Femoral Pain Syndrome (AKA central knee pain)
3. Hamstring strain
4. Shin splints (AKA inner or outer shin pain)
5. Plantar Fasciitis
6. Achilles Tendinitis
In order to manage your common running injury, your physiotherapist will initially perform a thorough assessment in order to identify the structure(s) at fault. Then, an individualized treatment plan will be developed to address your specific needs.
Muscle imbalances are usually a key feature in the above injuries. Your physiotherapist may “release” or stretch tight muscles and strengthen weaker muscles in order to correct these imbalances. For example, in Patello-Femoral Pain Syndrome, your physiotherapist may release your tight quadriceps and iliotibial band (outer thigh), and strengthen the gluteal muscles. This will help correct muscle imbalances and promote return-to-activity. Your physiotherapist may also incorporate other modalities to promote recovery, such as dry needling/acupuncture, taping, electrotherapy, and education regarding activities/positions to temporarily avoid.
Personally, I have successfully helped manage the above common running injuries in a variety of populations, whether sedentary, active and athletic. What I have learned is that every patient is different and thus requires an individualized treatment plan to achieve their fitness goals. Healing timelines will vary depending on how acute or chronic the injury is, your age, your activity levels, and your compliance with the treatment plan.
Bottom Line: Common running injuries are very common and the majority of runners may not be aware how to manage them. A physiotherapy assessment can help identify the cause of your pain and your physiotherapist will develop a treatment plan to manage your injury and keep you active.
If you are experiencing any of the above injuries, physiotherapy can help. Please contact us at 604-987-5291.