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Frozen Shoulder Syndrome

berold Physiotherapy Comments Off on Frozen Shoulder Syndrome
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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 &
arthritis
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
inflammation.
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.:
a.Protect:
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
space,
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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Dry Needling Explained

berold Acupuncture, Dry Needling, News and Events, Physiotherapy, Rehabilitation Comments Off on Dry Needling Explained

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.

Dry-Needling

Dry-Needling

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
   •    Headaches
   •    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.

Take-Home Message

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.

Reference:
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

berold Fitness, Injury Prevention, Physiotherapy, Rehabilitation Comments Off on Common Running Injuries

Common Running Injuries

By: Reza Ghannadan, MPT, BSc (Kin), Physiotherapist

Common Running Injuries

Common Running Injuries

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.

About me: Reza Ghannadan, MPT, BSc (Kin), Physiotherapist – certified in Functional Dry Needling through Kinetacore.
Common Running Injuries


Happy New Year 2014

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Happy new year from everyone at NSOSC!
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John McCordic


Merry Christmas – December 2013 Newsletter

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John McCordic, B.Sc. (P.T.) MCPA
John McCordic, B.Sc. (P.T.) MCPAA leader in Physical Therapy for over 30 years, John leads a highly qualified team of allied professionals. He has earned degrees in both Kineisiology and Physical Therapy. With his comprehensive understanding of human biomechanics, anatomical structural weaknesses and the applied analysis of muscular imbalances John will assess acute and chronic injury either at his clinic or outside. He realizes that optimal preventative intervention must consider both the internal systems of the body as well as the external influences acting upon the body. John may potentially identify methods via which functional biomechanics may be reversed in order to submit injured tissue to optimal healing conditions and then re-construct your physical positioning or movement pattern. Therefore his strategy is to concurrently re-position, observe and re-program adjustments into your habitual activity patterns. John is qualified to practice medical acupuncture and IMS.
Andrew Bell, B.Sc.(HK) – M.Sc.(P.T.)
Andrew Bell, B.Sc.(HK) - M.Sc.(P.T.)Andrew graduated from Ottawa University with a B.Sc. Human Kinetics, gaining fundamental knowledge in the disciplines of biomechanics, exercise physiology & psychomotor behavior. Andrew continued studying at Queen’s University, graduating with an M.Sc(PT). To optimize physical function, Andrew will biomechanically assess your problem & develop a customized pro-active treatment plan. His treatment strategy comprises a blend of hands-on manual therapy, neuromuscular principles, modalities including acupuncture/I.M.S., therapeutic exercise & early intervention cryotherapy.
Christine Elsey, Ph. D.
Candace McCurdy, B.Sc(P.T)Christine has taught Hatha Yoga for over 30 years. She developed her own unique approach using a blend of various alternative therapeutic and educational movement techniques. She has taught all levels including children, adults and seniors. In the clinic she conducts therapeutic YOGA, in direct consultation with the physiotherapist. As well, she works 1:1 sessions, utilizing a gentle hands-on approach manually guiding students into position to facilitate improvement of their posture and postural awareness. Furthermore, Christine undertook certification in a discipline called “Bones For Life”, that both counteracts and addresses the growing issue of bone loss and the continual necessity of bone maintenance amongst an aging population.
Rose Landry, B.C.R.P.A.
“Achieve a Well-Balanced Functioning Body.”
Rose offers an integrated philosophy of personalized training, recruiting a variety of exercise systems, including classical-style weight training, functional exercise principles, corrective movement techniques and ball oriented movements. Her training process facilitates strength, speed, flexibility, agility and balance, each tailored to aligning the spine by strengthening the “core” musculature, re-educating the body and targeted towards healing. Rose also designs fitness programs for seniors, by offering dedicated services for people over 50.
Optimizing Physical Function
Philosophy:
To identify movement disorders & intervene to restore correct movement patterns or
develop alternate movement strategies.
The North Shore Orthopaedic & Sports Clinic is a full service facility featuring
specialized equipment, technology & professional staff. The clinic will provide:1. Thorough Assessment: We listen to your needs and apply a thorough clinical &     biomechanical assessment to IDENTIFY:

• causes of pain
• causes of articular dysfunction
• causes of muscle length / tension ratio imbalances
• causes of muscular weakness static & dynamic
• causes of neuromuscular “programming” dysfunction
• causes of “weak link” segmental dysfunction

2. Analysis: We develop the hierarchy of priorities to facilitate correction of your
biomechanical dysfunction.

3. Treatment: We adhere to the priorities outlined in the analysis and always develop
an individualized problem-specific treatment strategy.

• We always commence with hands-on manual therapy and progress to individual,
unique strategies which permit your return to activity.• Progression is clinical-based and progresses to functional and activity-based protocols.• We advocate preventive care to improve on treatment gains to prevent reoccurrence.• Apply our experience to your concern & achieve optimum results.

 

Rehab Continuum
Andrew Bell, B.Sc.(HK) - M.Sc.(P.T.)
On the “Rehab Continuum of Treatment” there are potentially many intervening practitioners whom all offer a different expertise & some carryover. Optimally, the interaction between each practitioner is collaborative in order to optimally assist you to return to maximal physical function. The advancement along the “rehab continuum” is education directed, biomechanical, muscular myogenics and neuromuscular based. The collaborative approach involves a hybid of disciplines, including the following

     • Physiotherapy biomechanical assessment
• Osteopathic treatment principals
• Kineisiology
• Acupuncture / IMS

Orthotics
Complimentary Gait Analysis
Technology is available at North Shore Orthopaedic & Sports Clinic to accurately measure the pressure distribution along the bottom of your feet while you walk.Andrew Bell, B.Sc.(HK) - M.Sc.(P.T.)This dynamic pressure analysis directly translates into a digitized report. If the report indicates a foot problem, theclinic will provide the prescribed custom fit orthotics.

FEATURES
• Light weight
• Comfortable
• Fit into your existing footwearAs the leader in this field we are committed to the research, analysis, and the application of technology available today. Appropriate orthotic evaluation often permits viable solutions for lower extremity syndromes previously unresponsive to treatment.

SATISFACTION GUARANTEED 30 DAY MONEY BACK
 
Redcord – Neurac ™
Inactivity, fatigue & pain deactivates muscle groupings, causing compensatory movement patterns. This contributes to pain, dysfunctional biomechanics & tissue breakdown. Norwegian-based Redcord uses a unique neuromuscular Assess & Treat system called Neurac™ (neuromuscular activation) to optimally facilitate restoration of normal movement.Redcord is a suspension system utilizing ropes & slings (Slings Exercise Therapy – S-E-T) to:Assessment: we help identify your cause of pain

• Identify “weak-links”
• Identify alterations in muscle stability, neuromuscular patterning & muscle interactions

Treat: we therapeutically treat the “weak-link” & effects of pain inhibition to:
• Restore controlled, pain-free movement patterns
• Re-program weak muscles
• Establish normalized muscle firing patterns
• Re-build muscle strength & balance
• Maintain normal function & prevent relapse.

Redcord treatment has demonstrated significant results for high level athletes and patients suffering pain syndromes.

Andrew Bell, B.Sc.(HK) - M.Sc.(P.T.)
  Merry Christmas Everyone!
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