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Why Virtual Services?

It has been nearly a year since the world stood still here in Saskatchewan. Prior to the pandemic we had the technology to provide virtual services, but it was still considered best practice to see people in-person for all services. This changed rapidly March 18, 2020. In practicing virtual services since this time for the vast majority of the time, we wanted to highlight some of the answers to “Why Virtual Services?”

No need to worry about exposure

The most obvious reason for those that are more conservative is your reduced exposure. You can have your service provided from the safety of your home. There is no need to worry about who all has been in the building.

Childcare Barriers are Reduced

Our biggest struggle is following the recommendation that people should come independently to appointments. We LOVE helping mommas, kiddos, and babies. Not being able to share our toys and baby containing options for families has been a big challenge for us. Having virtual options for services allows us to still see those with busy families; while reducing your costs and eliminating childcare costs!

No Drive Time

YES! We are able to see anyone in Saskatchewan that is a resident of Saskatchewan (for physiotherapy), and greater expansion across Canada (counselling and nutrition services). This allows us to significantly reduce the time away from work or family and increase the efficiency of appointments.

We Still Get a Lot Done!

There are very few appointment types that can’t be done virtually! Especially when it comes to the first appointment. This is where we are gathering information on what happened and how everything is feeling. Getting some movement and visual observation can go a long way. If it isn’t an appropriate issue, injury, or area to be seen virtually, it is our responsibility to ensure that you know and we continue with alternative options – which we hold ourselves highly accountable for.

Remember, the most important piece to improvement is not what we DO, it’s what YOU do!

We see people for anywhere from one appointment every few weeks, to once a week. We impact change from our knowledge and applying to your homework to do between appointments.

“I have been treating people virtually since March 2020 and I am really loving the option for people. It has allowed me to get to know my clients even better, as well as work within the restrictions with a variety of health limitations for my clients.” ~Haylie

If you want to learn more about our virtual services check out our other publications!

Virtual Services

Tele-Wha? Telehealth Services

 

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Headaches – From the Neck Up

We have talked before about headaches from a massage perspective previously. However, there are many reasons for headaches that may be cause to see a physiotherapist as well. Check out this case study for headaches from the neck!

Case Study NP

What does it feel like?

NP comes into the clinic, he is a 35 year old father of 3 and works a desk job for the past 5 years. Before that he was working on-site in construction, often looking overhead. In the past 2 years since his third child was born he is noticing he is getting more frequent headaches. Often his headache is is on the right side behind his eye and in the temple. As NP gets talking he realizes that he also has some dull pain in the shoulder and arm; but this pain is occasional compared to the headaches. He finds that when he is working at his desk by the end of the day the headache is nearly unbearable. By the time he gets home he has difficulty playing with his kids, and it’s starting to impact his ability to work around the house and cabin.

He doesn’t recall a specific injury to his neck, but NP does have a cabin and boat at the lake and loves trying new water sports. Just before his third child came friends came to the lake and decided to take the tube out where he was flipped multiple times.

This all-too-familiar story can have multiple ways that it could have begun – a whip lash injury, strain of the neck or shoulders, etc. Let’s focus on this case study and some of the possible reasons WHY this happens, what we can do about it, and how you can start your road to recovery TODAY! 

What Causes Headaches?

The neck is actually a highly complex unit. We have multiple bones in the neck (seven to be exact!), nerves that travel from the neck up into the scalp and down into the arms, plus all the ligaments, tendons and muscles. The body is an amazing thing when you think of all the moving parts. Generally speaking we are able to maintain a pain-free lifestyle; however sometimes we need a little help.

One of the reasons that we can develop headaches is because of neck dysfunction. In this instance NP is experiencing referral from the upper cervical spine (C1-3). This is why he has pain near his eye. Increased stress and posture issues can also significantly impact headaches.

If you have headaches, a physiotherapy assessment could benefit you!

What does an assessment look like?

NP came for an appointment at the beginning of the day because it worked better with his schedule. He was worried that not being severely symptomatic would be a problem for the assessment. He was relieved when he heard that the therapist would be able to evaluate the neck regardless of the amount of current pain.

The assessment took a look at his overall neck range of motion. NP was surprised to discover that he had more difficulty tipping his right ear to his right shoulder, and shoulder checking over the right. When the therapist had him lay down to evaluate the neck movement and muscle tension he was significantly more tender on the right side at the base of the skull.

During the assessment the therapist identified some specific muscle weakness and tension that would need to be addressed.

NP was surprised that during the appointment the therapist was able to recreate his headache symptoms and shoulder pain. He wanted to make sure that he could get back to his normal home-life routines. NP booked his next 4 appointments weekly and was sent home with exercises and stretches to get him started.

Over the next four weeks NP attended his appointments for some manual therapy from the physiotherapist and updates to his home program. He was pleased that by week 3 his headaches seemed to be significantly better.

NP resolved his headaches within 6 weeks, and returned for a flare-up 4 months later. The flare-up lasted 2.5 weeks and after resolving has not returned since he is able to manage any issues with his home program.

How long until I am better?

The recovery period usually varies from client to client, depending on the severity and frequency of signs and symptoms. Other factors include:

  • How long the headaches have been going on, how severe they are
  • What areas are contributing (neck mobility, muscle tension, etc)
  • Commitment to the home exercise program

Straightforward cases we tend to see client’s 1x/1-2 weeks for a total of 4 to 6 sessions. These sessions include manual therapy to help restore joint and muscle mobility as well as exercises for their home program.

Don’t delay! Schedule your assessment today to get started your journey to recovery!

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Ankle Sprains: A Case Study

With icy sidewalks and streets, falls during the winter can become more prominent. One injury that can occur is ankle sprains.  Have you ever sprained your ankle before? Wondering if you should seek physiotherapy? Lets look at a case history of one example of an ankle sprain and what physiotherapy may involve…

Ankle Sprain: Case Study

A 35 year old woman attends the clinic after she was walking her dogs outdoors when they lunged suddenly, causing her to slip on some ice. She fell, rolling her right ankle to the side and was able to get back up and weight bear through her injured ankle, although limping back home. Her ankle was pretty sore with some noticeable swelling so she went to see her family physician the following day. X-rays were taken of the ankle and she was advised she did not have a fracture, but rather sprained her ankle. She was recommended to rest the ankle for the next 3 days and to limit her weight bearing as tolerated using a lace up brace. She was also prescribed anti-inflammatories and referred to physiotherapy.

Dance Ankles and Feet

For the assessment she was weight bearing with a lace up ankle brace. The ankle was noted as still sore but improving.

Some mild swelling over the lateral ankle and some tenderness to touch over the ankle ligaments were noted. With in-clinic testing it was determined she was dealing with a moderate ankle sprain. She was prescribed some basic neuroproprioceptive and gentle strengthening exercises. These early phase exercises set the base foundation for return to regular activity and sports and she was eager to get back to her regular routine with her dogs.

The client was seen for 6 further follow ups over the next 3 months.  During this time she was provided with some manual therapy techniques to the ankle. She was also given a progressive home exercise program which included progressive strengthening, balance and proprioceptive training. The client noted full resolution of symptoms at the conclusion of her treatment and return to her activities which included walking her dogs and her dance class.

Often people find that their ankle will feel “good enough” part way through rehabilitation but ensuring that all systems are truly “go” will help prevent a recurring injury from incomplete rehab programming.

What is the current evidence for acute lateral ankle sprains and the role of physical therapy?

If required a short period of immobilization may be used, however exercise and a functional support (either bracing or taping) is recommended over immobilization. Clinical practice guidelines support the inclusion of an active exercise rehab program following an acute lateral ankle sprain as soon as possible to help prevent recurrent lateral ankle sprains. 1

It is commonly misunderstood that someone must wait a certain period of time before attending physiotherapy, however, keep in mind that physiotherapists can assess injuries right from the moment of impact; just like when an athlete becomes injured. Coming for an appointment early in healing can give you the right tools to start with immediately. Alternatively, the body is capable of healing and change even after extended periods of time so it is also never too late to start.

If you have unfortunately sustained an ankle injury, we at Warman Physiotherapy and Wellness have trained physiotherapists who can offer a progressive rehabilitation program to help you on the road to recovery and return you to your activities/sport!

 

References:

  1. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. BJSM. Volume 52, Issue 15. August 2018. Gwendolyn Vuurberg, et. al.
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My Broken Pelvis: Part 2 – Pubic Symphysis

Lightning Crotch. Ouch! Our pubic symphysis is the point where the two halves of our pelvis meet in front – the bone at the top and front of the groin. For those that have had pubic symphysis dysfunction (PSD) or “lightning crotch” you well know that this can go from slightly irritating pain to WHAT IS GOING ON HERE! B(#%P! pretty quickly.

Commonly associated with pregnancy, we well know that individuals suffering with PSD can get to a point of despair and resignation that this pain will become a new normal; often because that is what we are being told about pain during pregnancy! “This is just part of becoming a woman” is a term I have heard yet again this past week from a client. I urge us to think of pain in pregnancy (any pain, but in this instance PSD), as something that although is common is not normal.

We wouldn’t tell someone who has just started running that has developed knee pain that “this is just part of becoming a runner – it will go away when you stop

 

There is research now that shows that pain in pregnancy can often be addressed with physiotherapy (1,2) – from PSD to back pain, and that staying active during pregnancy (3) has many benefits (which is hard to do when you are painful!). When there is pain, there is usually something we can do about it!

 

Case Study

An active mother of 28 comes into the clinic complaining of groin pain – it’s sharp, shooting, sometimes take your breath away pain that is getting progressively worse as her pregnancy continues on. She is only 26 weeks gestation and has been struggling with pain since about 16 weeks and finally decided to come to an appointment after talking with a friend about it. She is having difficulty rolling in bed (she tries squeezing her knees together because that is what she read on a few blogs on google) which has helped a little but not much, standing on one leg, and she sometimes notices popping and clicking with movement that really hurts as well. She tried kicking an empty laundry basket out to the side the other day and found that extremely painful as well.

Although there are many reasons for PSD, we will go through some of the things that may be found during a physiotherapy assessment of this type of pain

Assessment

Upon evaluation the client was clearly limping while they were walking, more on the right than the left leg, they had pain with standing on the right leg more than the left leg, and had difficulty bringing their knee toward their chest on both sides in standing. Generally speaking these individuals will have some restriction of movement on one side (same side as pain or the opposite – everyone is different!), significant muscle tightness of the inner thigh, and poor coordination of the gluteals. We also often see a change in posture – the individual may be hinging backwards (rib cage back over the pelvis), but there is a huge variation in the changes seen here depending on the underlying cause.

What can I do NOW?

In many instances our protective mechanisms related to pain may end up being one of the additional driving factors of our pain – your groin hurts, and when you hurt you tend to ‘protect’ the area (curling in) and the muscles around the area will tighten. Increased tension often doesn’t help serve us to feel better or less painful, but may drive a continued pain cycle! Squeezing the knees together to roll like in this instance, may help initially, but overall results in increased tension and often stops being helpful over a short period of time. Relaxing the muscles – particularly the inner thigh – and activating the gluts can go a long way to improving PSD pain. As always, an individual assessment is best, but when you are rolling over, try pushing yourself over with a bent knee (leg straight to the side you want to roll to), and spending some time in a ‘butterfly’ position.

At Warman Physio we have experienced physiotherapists that will use a variety of hands-on treatment while you are in-clinic, as well as home programming and exercises so that you can continue to help yourself to feel better between appointments!

PSD can be a draining, exhausting, and very painful experience for some people, and merely annoying, irritating, and minorly problematic for others. Let us help you, help yourself!

 

Haylie has been practicing pelvic health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. She officially added to her practice pediatric pelvic floor therapy in 2017. Haylie has been advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms ultimately brought her to open her family-friendly clinic since opening in 2014. She now adds to this education and treatment provision her knowledge and experience in pediatric pelvic health providing workshops and presentations in addition to assessment and treatment. At Warman Physio clients are encouraged to bring their infants and children to treatment. Haylie was recognized as YWCA Women of Distinction for Health & Wellness in 2017, the ABEX Young Entrepreneur Award Recipient in 2018, and has been nominated for the 2019 SABEX and WMBEXA Awards.

 References:

  1. E Vermani et al (2009). Pelvic Girdle Pain and Low Back Pain in Pregnancy: A Review. World Institute of Pain. Volume 10, Issue 1 (60-71)
  2. E Richards, G van Kessel, R Virgara, & P Harris (2012). Does antenatal physical therapy for pregnant women with low back pain or pelvic pain improve functional outcomes? A systematic review. Nordic Federation of Societies of Obstetrics and Gynecology. (ahead of print)
  3. MF Mottola et al (2019). 2019 Canadian guideline for physical activity throughout pregnancy. British Journal of Sports Medicine. Volume 52, Issue 21
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My Broken Pelvis: Part 1 SIJ

SIJ pain – sacroiliac joint – that lower than low back pain that is off to the side but not quite your butt… This pain is commonly aggravated by rolling in bed, standing on one leg (getting dressed!), walking, and getting into/out of a vehicle… Check out the case study and information we have on Pelvic Girdle Pain (SIJ version)

Pelvic Girdle Pain

A 35 year old individual began experiencing pain in the low back off to the left side. Their pain was worse with rolling in bed, standing on one leg to get dressed and is now to the point that they need to sit to get dressed, having pain and difficulty with stairs, the pain gets worse the longer they walk, and they always feel it just in the one spot at the back to start and then it radiates around the hip and into the groin as it gets worse.

Although there are many reasons why someone may have pain with rolling, stairs, and walking, let’s go through some of the possible reasons WHY this happens, what we can do about it, and how you can start your road to recovery TODAY! 

What causes pelvic girdle pain?
When we are thinking of pelvic girdle pain we are specifically thinking of the pubic symphysis (right in the front of the pelvis), the SIJ (the joints between the pelvis and sacrum at the back), and the hips.

For this particular case study we are thinking of the SIJ at the back of the pelvis on one side being more problematic than the other. Why does this happen? For some people pain may stem from an area moving more than the other side, and for others it will be from moving less. In some instances we will have pain due to extra muscle tension across the joint (the gluts), or not enough support, stability, and strength by the muscles… why you have pain will boil down to the change in movement, and the change in tension and how your brain interprets that difference.

Often SIJ dysfunction and pain can arise without a particular cause or injury, and sometimes starts after an injury or particular instance of “ow! That hurts!”

If you have pelvic girdle pain, a physical therapy assessment could benefit you!
What you may expect from this appointment is a postural assessment to look at your alignment, flexibility of the lower extremity muscles, mobility of the spine, pelvis, and hips, and evaluation of how you walk and move. You physiotherapist will often do some manual techniques to evaluate joint mobility and muscle tension throughout the hips and pelvis as well.

In many instances by the end of the assessment there is a clear driving factor to the pain that can begin being addressed by home programming. This will put you in charge of feeling better, and not relying solely on having to come to the clinic to improve. Your therapist may provide you with a variety of homework items including stretching/re-education of muscles that are providing too much tension, strengthening of muscles that aren’t providing enough support, and exercises to help you move with more symmetry to restore balance.

A common question we are asked is how long until I’m better?

The recovery period usually varies from client to client, depending on the severity and frequency of signs and symptoms, the duration of symptoms, the activity level the client is needing to maintain, and the ability to be able to practice their home exercise program. Typically, with a straightforward case we tend to see client’s 1x every 1 to 2 weeks for a total of 4 to 6 sessions. These sessions include manual therapy/hands on treatment, as well as progressing exercises for your home program to help you help yourself.

Need to know what can help RIGHT NOW?!

Without an assessment we are unable to determine what will specifically help you with your specific pain (it could be that you don’t have an SIJ problem after all!) Since some SIJ dysfunction may come from muscle imbalance, resting in a “butterfly” position (modified cobblers pose as pictured above), and working on activating the glute muscles (your butt!) may prove helpful. However, if something is painful and doesn’t seem to be improving (quickly!) find ways to move that are pain-free (or less painful), and schedule an appointment to have it checked out so we can target the underlying cause and give you tips!

Do I have to stop working out?

Probably not. Some things may need to be modified or swapped initially, but if you are a regular exerciser and have goals you are wanting to achieve, then it is our job to help you reach them, pain-free!

Don’t delay! Schedule your assessment today to get started your journey to recovery!

 

Haylie has been practicing pelvic health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. She officially added to her practice pediatric pelvic floor therapy in 2017. Haylie has been advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms ultimately brought her to open her family-friendly clinic since opening in 2014. She now adds to this education and treatment provision her knowledge and experience in pediatric pelvic health providing workshops and presentations in addition to assessment and treatment. At Warman Physio clients are encouraged to bring their infants and children to treatment. Haylie was recognized as YWCA Women of Distinction for Health & Wellness in 2017, the ABEX Young Entrepreneur Award Recipient in 2018, and has been nominated for the 2019 SABEX and WMBEXA Awards.
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