Understanding the Pelvic Floor: Why You Should Care About Your Pelvic Health

/in /by

First off, what is your pelvic floor?

 

The pelvic floor is made up of two layers of muscles at the base of your pelvis. These muscles attach to your pubic bone in the front, the tailbone in the back, and the sitz bones on the sides. Imagine a hammock that supports all the organs in your pelvis. In a well-functioning pelvic floor, these muscles contract and relax in a coordinated way to allow for normal bodily functions. For example, they relax when we go to the bathroom and contract when we cough or sneeze.

Source: https://www.kenhub.com/en/library/anatomy/muscles-of-the-pelvic-floor

 

What happens when the pelvic floor isn’t functioning properly?

Sometimes, the muscles of our pelvic floor lose the ability to contract strongly, relax fully, or contract and relax in a coordinated way leading to pelvic floor dysfunction. Like any muscle in the body, we want both mobility and strength in our pelvic floor muscles. 

Pelvic floor dysfunction might look like:

  • bladder or bowel leaks
  • peeing often (frequency) 
  • having a strong or uncontrollable urge to pee (urgency)
  • constipation
  • pain with penetration (speculum, tampon, or penetrative intercourse)
  • sexual dysfunction 
  • pelvic, tailbone, or low back pain

There can be many causes for pelvic floor issues including:

  • pelvic or abdominal surgeries
  • pregnancy and childbirth 
  • chronic coughing
  • chronic constipation 
  • menopause or other hormonal changes
  • posture
  • lifestyle choices and toileting habits 
  • genetics and certain medical conditions

How can a physiotherapist help?

Some physiotherapists have special training in assessing and treating conditions that affect the pelvic floor. In a pelvic health assessment, a physiotherapist will perform a detailed evaluation and identify what factors are relevant to you and your symptoms. They will then develop an individualized treatment plan with you to help address your concerns and achieve your goals. Kegels aren’t the answer to everyone’s problem! Sometimes the answer lies outside of the pelvis and a physiotherapist can help to identify what is most relevant to your case.

Our pelvic health physiotherapists are trained to help with pelvic floor dysfunction, so book an appointment to discuss any concerns relating to your pelvic floor!

Written by: Natalie Constantin

How to Avoid the ‘Bluebird Blues’: Spring Skiing Injury Prevention

/in /by

Every now and then the stars align and British Columbians are blessed with a late season dump of snow which allows us to enjoy Spring skiing. Is there anything better than bluebird day with fresh tracks to be made? However, caution must be taken as spring conditions pose their own risks. The warmer and longer days of Spring skiing can lead to an increased risk of injury due to many factors described below.

1. Changing Snow Conditions
One of the biggest challenges with spring skiing is the unpredictable nature of the snow, especially here in British Columbia. The snow quality can change dramatically throughout the day, from icy and firm in the early morning to slushy and soft by the afternoon.

An icy and crusty surface can lead to a variety of musculoskeletal injuries, especially when skiers try to maintain high speeds or tackle challenging terrain in these conditions. The risk of falls increase, and your knees, shoulders, and wrists often bear the brunt of the force. By afternoon the snow is often soft and moist, leading to excess demand on your muscles, especially the quadriceps (anyone who has gone from mid station to Creekside in April can relate).

Typically, spring skiing means a change in snow condition multiple times on the same day, or even a change in the condition on the same run i.e. Skiing from the top of the mountain down to the village. Hard packed and icy conditions transitioning into sticky, slushy conditions sometimes happen quickly and without much notice resulting in sudden twists, crashes and subsequent bodily sprain and/or strain.

If you are skiing in the backcountry, be mindful of the potential for avalanches. The large variability in temperatures paired with melting snow and weak layers of snowpack are a recipe for disaster. As snow conditions can vary quickly, always check the avalanche forecast and carry the necessary safety equipment.

2. Equipment selection and maintenance
As the end of the season approaches it is easy to forget about equipment maintenance. Make sure your skis/board are waxed and tuned properly to handle different snow conditions.

Standard ski waxes for spring are warm weather specific, like a yellow colour wax for your board or ski bases to ensure bases are hydrophobic and are better able to glide over soft, wet snow. True alpine traditionalists often opt for black/molybdenum wax which provides an additive to repel dirt, reduce static friction and improve glide. Be sure to wax your bases at least every other day on the slopes for best results.

Spring skiing means a higher likelihood of brighter days. Ensure the proper lens selection for your goggles to avoid excessive glare. Typical suggestions are goggles or glasses with a lower Visible Light Transmission (VLT) less than 25% and typically Platinum, Black or Red lenses are best when the sun is blazing down on those bluebird days.

3. Exposed Rocks and Hazards
Spring conditions bring warm weather and with it melting snow. Areas once covered with fluffy snow, now expose jagged rocks and exposed tree stumps. Be mindful of off-piste terrain early in the morning, as it is likely to be challenging with an overnight freeze thaw, with ice moguls, ice chunks, making steep descents with exposed rock a few notches more difficult and unpleasant.

Injury Prevention and the role of Physiotherapy
More daylight hours paired with warmer temperatures can lead to long days on the mountain. As your body fatigues, so does your form. This increases the likelihood of muscle strains and ligament sprains. It is important to listen to your body and recognize signs of muscular fatigue. These include, but are not limited to, weakness, soreness, and muscle cramping.

Stay hydrated and make sure you have an adequate warm up and stretch (dynamic stretching preferred) before heading out. This is especially important after your mid-day lunch break when the muscles have had a chance to cool down and become stiff.

At the end of the day if you are nervous about the long ski out, there is no shame in enjoying the view while downloading via the gondola!

Physiotherapy can help address muscle imbalance as we continue to ski/ride late into the spring as conditions allow. If you feel discomfort or pain it is advisable to address it right away. After a day on the slopes, post care is paramount. Stretching and tissue release (eg. foam rolling or massage stick are great ways to maintain flexibility and hasten recovery).

In the off season, strengthening exercises are highly recommended to get ready for the following season. A strength program should consist of squats, wall sits, Romanian Deadlifts, and various progressive core loading exercises tailored to your specific needs. Check out the video below for examples of these exercises.

Written by: Jonathan Tom-Yew

Core Strengthening: Beyond the Six-Pack

/in , /by

Core Strengthening: Beyond the Six-Pack

Everyone has heard of their core, but do we really know what it is? Most people associate their core with having a six-pack of abs. But did you know that the core extends far beyond the abdominal muscles you can see? A strong core is essential not just for aesthetics but for overall function, injury prevention, and optimal performance in daily life and sport.

What Exactly Is the Core If Not Chiseled Abs?
The core is a complex system of muscles that work together to provide stability, balance, and power. These muscles are located in your pelvis, hips, lower back, and abdomen. They can be further broken down into two categories: deep “stabilizers” and superficial “movers”. One of the movers is the Rectus Abdominis, the “six-pack” muscle that helps with forward flexion of the trunk. Although these muscles are important, today’s focus is on the “deep stabilizers”, also known as the “deep core muscles”.

The Deep Core Consists Of:
1. Diaphragm— yes, your breathing muscle! Breathing plays a huge role in stabilizing the core.
2. Pelvic Floor — These muscles support the pelvic organs and contribute to core stability.
3. Transverse Abdominis (TVA) — A deep abdominal muscle that acts like a corset, providing core stability.
4. Multifidus— Small but mighty muscles along the spine that assist with stability.

Why Should We Care About Deep Core Strength?
You may be wondering, why focus on the deep core if it won’t give you a six-pack? The deep core plays a crucial role in treating pain, preventing injury, increasing performance, and making everyday function easier.

Low Back Pain and the Importance of the Deep Core
Trunk strength and endurance tend to decrease in patients with low back pain. In chronic cases—where pain persists for more than three months—the timing of deep core muscle activation can be affected. If these muscles are not turning on or firing at the right time, it can lead to instability and prolonged discomfort. Strengthening the deep core helps retrain these muscles, providing better spinal support and reducing pain. A strong core also distributes forces evenly, reducing strain on the spine and joints.

Injury Prevention
A weak core can lead to poor movement mechanics, increasing the risk of injury in both daily activities and sports. A stable core reduces the likelihood of lower back pain and other injuries by keeping the spine supported.

Performance Improvement
Athletes rely on core strength for power, balance, and efficiency in movement. Whether you are running, lifting, cycling, or playing sports, a strong core enhances performance by improving movement control and force transfer.

Everyday Function
From bending down to pick up something to tying your shoes to carrying groceries or sitting at a desk, your core is engaged in almost every movement you make. A stable core helps maintain good posture, reducing strain and fatigue throughout the day.

Who Can Benefit from Core Strengthening?
The short answer: everyone! Whether you’re an office worker who sits for long hours, a weekend warrior hitting the trails, or a high-performance athlete, a well-conditioned core is essential for movement efficiency and long-term health.

How to Strengthen Your Deep Core
Effective core training involves more than just crunches. A well-rounded program should include stabilizing exercises, anti-rotation, and anti-extension movements. Some examples include:

1. Dead Bugs:

  • Start by lying down on your back on an exercise mat.
  • Lift both legs up into a table top position (knees and hips bent at 90 degrees).
  • Raise your arms so they are both pointing straight towards the ceiling.
  • Maintaining a neutral spine, extend your right leg forwards whilst simultaneously raising your left arm overhead in a controlled manner.
  • Return your arm and leg to the starting position, then switch to repeat the movement on the opposite side.

2. Heel Slides:

  • Start by lying down on your back with both knees bent.
  • Slowly slide one heel out by straightening the knee.
  • Slide your heel back to its starting position with and repeat the movement on the opposite side
  • For an added challenge, do the same exercise starting in a bridge position:

3. Bird Dogs:

  • Start on your hands and knees, with your hands under your shoulders and your knees under your hips.
  • Reach one leg up and out so it’s in line with your back, and reach the opposite arm straight out in front.
  • The arm and leg travel out together, then back to the starting position.
  • Switch sides.

4. Diaphragmatic breathing (breathing deep into your belly):

  • Lie on your back on a flat surface or in bed, with your knees bent.
  • Place one hand on your upper chest and the other just below your rib cage. This will allow you to feel your diaphragm move as you breathe.
  • Breathe in slowly through your nose so that your stomach moves out, causing your hand to rise. The hand on your chest should remain as still as possible.
  • Tighten your stomach muscles, so that your stomach moves in, causing your hand to lower as you exhale through pursed lips

5. Pallof Presses:

  • Set up the cable machine or resistance band so that it sits at chest height.
  • Stand sideways to the machine or band and grip the attachment with both hands at chest height, then take a few steps out to the side and backwards so that the band or cable is providing resistance.
  • With a neutral spine, extend both arms to press the cable or band forwards until the arms are fully extended.
  • Revert the movement by slowly bringing the pulley back towards your chest.

How Do I Know If I Am Activating My Deep Core?
If you’re unsure whether you’re activating your deep core correctly, a physiotherapist can help assess your technique and guide you through proper engagement. With expert guidance, you can gradually build core stability and progress your exercises to help prevent injury and improve movement efficiency.

Written by: Evelina Michniak

Unlocking Relief: How Physiotherapy Can Alleviate Neuropathic Pain and Restore Your Quality of Life

/in /by

Neuropathic pain is a type of pain that happens when there is dysfunction to the nerves themselves. Unlike the usual pain that occurs when tissues like muscles or joints are injured, neuropathic pain is caused by problems with the nervous system. Nerves send signals to the brain to tell us when something is wrong, but when the body undergoes some form of trauma, the nervous system begins to send excessive signals throughout the body which then leads to increased body sensitivity and discomfort. This type of pain often feels different from regular pain and can be described as sharp, burning, tingling, or even like an electric shock, and it might be constant or come in waves. People with neuropathic pain may also experience hypersensitivity to touch or a feeling of numbness in the affected area. Common causes include conditions like diabetes (which can cause diabetic neuropathy), herniated discs, shingles, osteoarthritis, and nerve compression from being in prolonged positions (such as being hunched over or sitting for too long).

As an example, when someone is feeling a burning or tingling sensation going down to their toes while bending over, it could suggest that they are experiencing neuropathic pain that is originating from their lumbar spine (lower back). More specifically, the nerves that provide muscular function and sensation to the feet and toes are located in the lumbar spine may become irritated and possibly compressed in some way or another. Of course, this is not normal and should be assessed by a physiotherapist to determine an appropriate treatment plan to help treat this neuropathic pain.

 

How Physiotherapists Can Help

 

When you see a physiotherapist for neuropathic pain, we begin by determining how the pain is affecting your daily life, your movement, and your posture. We’ll ask you about the type, intensity, and location of the pain, and the use specific assessment tools and tests to better understand how your nervous system is behaving. This then helps us determine which treatment strategies may work best for you. Here are some common treatment options that a physiotherapist may provide for neuropathic pain:

  1. Intramuscular Stimulation (IMS) and Dry Needling: This technique involves inserting a very fine needle to stimulate specific muscles (next to the spine or into the shoulder, hip and leg areas) or sometimes directly into a sensitive muscle area called a trigger point. This process has been shown to help relieve muscle tightness surrounding specific nerves and to improve blood flow in the area. IMS has also been found to be helpful as it can create a reset (or desensitization) to the nervous system, thus leading to reduced pain in our body.
  2. Manual Therapy: involves hands-on techniques such as soft tissue and joint mobilization, which can help relieve muscle tension, improve movement in the area, and reduce pain. This can also improve blood flow to the affected areas, which may help reduce inflammation and promote healing. In some cases, gentle spinal mobilizations or stretching techniques can also help relieve nerve compression that contribute to neuropathic pain.
  3. Exercise Therapy: when appropriate, guided movements can help reduce nervous system hypersensitivity. Once the nerve tissue irritability is under control, adding gentle and controlled movements can reduce muscle tightness, improve posture, and decrease nerve irritation. Some examples include:
  4. Nerve gliding exercises: specific movements that gently slides a nerve within the surrounding muscles, promoting better movement and less pain.
  5. Core exercises: help improve strength, flexibility, and postural stability which is optimal for nerve tissue function. This can also promote better circulation to the nerves which is essential for healing.

Written by: Chelsea Chua

Strength Matters: How Diabetes and Muscle Loss Are Linked

/in , /by

Diabetes, especially type 2 diabetes (T2DM), is a widespread health challenge that affects millions of people around the world. It’s not just about blood sugar levels; it can also lead to a concerning condition called sarcopenia, which is the gradual loss of muscle mass and strength as we age. Let’s explore the connection between diabetes and sarcopenia, why it matters, and what you can do to keep your muscles and health strong.

The Diabetes-Sarcopenia Connection

Sarcopenia isn’t just an unfortunate part of aging; it can also make managing diabetes more difficult. Here’s how it works: T2DM can speed up muscle loss, and weakened muscles can lead to poorer blood sugar control. This creates a vicious cycle where less muscle mass can lead to  less physical activity, which in turn can worsen diabetes management.

Research shows that older adults with T2DM experience muscle loss more rapidly than those without the condition.

Why Muscle Matters

Muscles play a crucial role in how our bodies use glucose, the sugar that fuels us. Healthy muscles help absorb glucose from the blood, which is especially important for people with diabetes. Unfortunately, when muscle function declines, so does the body’s ability to manage blood sugar, leading to higher levels of insulin resistance.

Key Factors Contributing to Sarcopenia

Several factors can contribute to the development of sarcopenia, particularly in people with diabetes:

  1. Aging: Muscle loss typically begins around age 30 and can increase significantly by age 80, especially in those with T2DM.
  2. Energy Intake: As we age, our calorie intake and requirements decrease leading to increased fat accumulation and further muscle loss.
  3. Physical Activity: A sedentary lifestyle greatly contributes to muscle decline. Regular exercise is essential, especially for those with diabetes, to help maintain muscle mass and improve insulin sensitivity.
  4. Diet: Nutritional factors, like vitamin D and protein intake, are vital for muscle health. Vitamin D is essential for proper metabolic function and muscle health, and inadequate protein can accelerate muscle loss.
  5. Hormonal Changes: Hormones such as estrogen and testosterone play important roles in maintaining muscle mass. Changes in these hormone levels can negatively impact muscle health.
  6. Smoking: Smoking can lead to decreased muscle strength and further metabolic issues, making it harder to manage diabetes.

Taking Action: Managing Sarcopenia and Diabetes

Fortunately, there are effective strategies to tackle sarcopenia alongside diabetes. Here are some key approaches:

  1. Dietary Management
  • Focus on a balanced diet rich in protein (aim for 1.0 to 1.5 grams per kilogram of body weight) to help maintain muscle mass.
  • Incorporate foods with anti-inflammatory properties, like those high in omega-3 fatty acids, to support overall health.
  1. Physical Exercise
  • Engage in Progressive Resistance Training (PRT), which is essential for building and maintaining muscle. Aim for at least 150 minutes of moderate aerobic activity each week, combined with 2-3 sessions of strength training.
  • Regular exercise can significantly improve muscle mass and enhance blood sugar control.
  1. Professional Support
  • Physiotherapists can create personalized exercise programs to improve mobility and strength. A physiotherapist will ensure the exercises prescribed are both effective and safe and address any mobility or injury concerns.
  • Kinesiologists focus on developing fitness plans that emphasize resistance training to counteract muscle loss. Kinesiologists are experts in guiding you through proper exercise technique and will help in injury prevention.
  • Dietitians help create meal plans that ensure you’re getting the right nutrients to support muscle and overall health.
  • General Practitioners monitor diabetes progression and manage any necessary medications.
  • Psychologists can assist with mental well-being and motivation to stick to health plans.
  1. Collaborative Care Approach

Working with a team of healthcare professionals ensures all aspects of your health are addressed, from physical fitness to nutritional needs. This holistic approach can empower you to take control of your health and improve your quality of life.

Conclusion

Managing diabetes and preventing sarcopenia is crucial for maintaining health as we age. By focusing on nutrition, regular exercise, and seeking support from healthcare professionals, you can enhance your muscle strength and overall well-being.

If you’re looking for guidance on managing your diabetes or muscle health, don’t hesitate to reach out to us at Treloar Physiotherapy Clinic. Our team is here to support you on your health journey!

Written by Jordan Yum

Fall into Balance: Transform Your Routines with Clinical Pilates!

/in , /by

September marks the shift from summer to fall. Coinciding with the seasonal change is a tendency to ‘fall’ back into the more regular routines of school, work, sport and exercise.

Come October these new routines tend to be settling into place.

Whether it is the return to the familiar or commencement of the new, it is not uncommon for some aches and pains to accompany these now regular activities.

All activities consist of ‘patterns’ of repetitive postures and movements. The significance on how these influence our complaints often go unnoticed until they impact us negatively. Even then it may not be obvious.

Many of our repetitive postural and movement patterns tend to overload certain areas of the body while at the same time underutilize other regions. This naturally leads to something called an imbalance of function which often plays a significant role in both our inactive and active lifestyle-related complaints.

Correcting these faulty patterns can reduce the risk of chronic overuse type injuries, as well as reduce the risk of acute ones.

This is where Clinical Pilates can be very beneficial. The emphasis on the quality of movement versus the amount of resistance or load is ideal to re-train or reinforce desired patterns.

Some benefits of addressing imbalances and improving our patterns include:

  • improvement of pain/ discomfort
  • injury prevention
  • enhanced performance

We are all humans doing modern human things on a daily basis, many of which include combined bodily movements requiring various direction, speed and control. As a result of ongoing repetition, our body continues to repeat these same movements, thus leading to patterns of imbalance with associated bodily correction (compensation).

But we are also all unique individuals with different presentations and needs. There is no ‘one size fits all’ approach to any type of physical training or rehabilitation, including Clinical Pilates.

An assessment with a Clinical Pilates Physiotherapist can help identify and guide your specific needs, which is especially important if you are managing any discomfort or injury. Some areas they can help you with include:

1. Postural/Movement Analysis

A Clinical Pilates therapist can analyze your lower body mechanics using the reformer to identify issues like overactive hip flexors or weak glutes contributing to knee pain. Targeted Pilates exercises on and off the reformer can strengthen these areas and improve alignment for better function.

2. Exercise/Training Strategies

For runners dealing with knee pain, a Clinical Pilates therapist can evaluate running mechanics on the reformer to identify contributing factors. Specific Pilates exercises can be integrated to strengthen supporting muscles and enhance running performance.

3. Ergonomics/Workstation Set-Up

If you’re experiencing neck and back discomfort from prolonged computer use, a Clinical Pilates therapist can assess your posture and recommend adjustments to your workstation. Utilizing the reformer, they can prescribe Pilates exercises that strengthen postural muscles and improve overall alignment, reducing strain.

In summary, creating positive changes to our day-to-day routines are beneficial. As our ability to move becomes more natural and free of any restrictions and any faulty compensatory patterns, the better we continue to live a pain-free life while engaging in all our daily activities.

Written by Jonathan Poon

Dance Pain-Free: Physiotherapy Tips to Conquer Snapping Hip Syndrome

/in , , /by

What is Dance Physiotherapy?

Dance Physiotherapy combines manual therapy & clinical pilates techniques to help artistic athletes – dancers, gymnasts, skaters (and more!) reach their goals. Dance physio is ideal for artistic athletes of any level who are recovering from injury, preparing for pointe work, looking to prevent injury, improve mobility or overall performance.

Dance physiotherapy can help with a variety of conditions including:

  • Knee injuries – for example jumper’s knee & bursitis
  • Back injuries – including spondylolisthesis
  • Foot injuries – for example plantar fasciitis, bunions and achilles tendinopathy
  • Hip pain & injuries – including snapping hip syndrome
  • Chronic or acute ankle sprains
  • Overuse injuries
  • Joint Hypermobility

In this blog post we will be discussing snapping hip syndrome which unfortunately, is very common in dancers, particularly when extending the leg or coming into a grand battement.

What is the snapping or clicking sound? One of the most common sounds is a deep “clunk” when extending the leg. The most likely cause of this is spinal instability and/or over-recruitment and chronic thickening of your psoas muscle (your hip flexor) 

How do I get rid of the noise/ snapping sensation? By working on mobility, stability and then gradually loading the hip. Below are some great exercises to start with!

1. Aikido or “Frog” Mobilization

Come into Aikido or frog stretch position – knees wide on the mat, bottoms of the feet together, arms or forearms resting on the mat. 

Rest in this position for 10-15 seconds, allowing for a gentle stretch in the inner thighs and opening of the front of the hip. 

From here, bring your pelvis into a forward tilt (think about rotating the top of your hip bones towards the mat), and hold for a further 10-15 seconds. Engage your deep core in this position to get an even deeper stretch through the front of the hip! 

Alternate between these positions 4-5 times.

Note: There should not be any discomfort or pain in the hips during this mobilization. If you are feeling any pinching or discomfort decrease how far apart your knees are or consult your physiotherapist before continuing. 

One of the common contributors to snapping hip syndrome is when the outer, or lateral glute muscles have increased tension in them – this can occur when glute med grips to maintain turnout in standing – rather than the deep external rotators. 

 

  2. External Rotation in Table Top

Equipment needed: pillow or small ball 

Lie on the mat, back flat and deep core engaged. Slowly bring both legs up to tabletop position (knees bent at 90 degrees) with the small pillow or ball between your thighs. 

Maintaining inner thigh activation by squeezing the pillow or ball, slowly extend one knee in parallel. Then, from the deep hip socket, externally rotate your extended leg (coming into turn-out). Hold for 2-3 seconds and then come back to parallel and then back to your tabletop position. Continue to maintain the squeeze of the pillow/ball during this entire process. 

Repeat this up to 10 times on each side.

Tip: to ensure the core & deep external rotators are working, check that hip flexors are relaxed throughout this entire exercise.

 

3. Plié Variation targeting deep external rotators

Begin standing tall, in first position. Start with a demi plié and then, maintaining your turn-out (external rotation), slide one leg along the floor (in fondu – one side continues to be in plié, the other knee extends). The foot on the extended leg should come onto the ground. Then, while maintaining your weight over your standing leg (in plié), bend your extended leg while you slide it back to first position. 

During this movement you should be able to feel your inner thighs (extended leg) and deep external rotators (standing leg).

Tip: Place one hand over the outer glutes on your standing leg – these muscles shouldn’t be gripping or over-activating as the turnout should be coming from your deep external rotators.

Note: This exercise can be completed in centre or standing at the bar (or at a counter at home!)

 

Thanks for reading! Consult your physiotherapist if you experience pain or are interested in a personalized targeted program to address your specific goals!

 

Written by Talia Berson (Physiotherapist, Clinic Pilates Instructor).

 

Is Back Pain Holding You Back? Discover a Path to Recovery and Strength through Clinical Pilates

/in , , /by
Read more