The Contact Continuum: Considerations, Targets, and Structure

/in , /by

The 2025 Women’s Rugby World Cup Final was played just a month ago in front of record-breaking crowds, and Canada’s dominance through the tournament reflects the rise in contact sport participation in Canada². As good as it feels to break a tackle or slip past a hard check, we know it doesn’t always go according to script. Whether it’s an ankle knock, a shoulder issue, or even a concussion, we’re here to make sure you have a concrete plan to get back on your feet efficiently and safely.

Contact Considerations

It goes without saying – contact is complicated! Regardless of the sport, entering contact is technical and requires a careful combination of learned skill and physical force¹⋅³. When breakdowns in these areas occur, injury risk can increase—which might mean you’re checking in with our team sooner than you may have expected. 

A physiotherapy initial assessment will gather information regarding your injury and will test different structures depending on the nature of your injury. This helps us understand the severity of your injury and determines where the recovery starting line is. Remember, this is a team effort! An effective recovery plan is a collaborative effort between the therapist and you – there are no cookie-cutter rehab programs here.

I’m Out of Pain – Now What?

Stepping back on the training pitch can feel daunting, but this is where a structured rehab approach really shines. There’s a fine balance to keep: too aggressive and we risk re-injury, but being too cautious can lead to unnecessary delays. Your physiotherapist will work with you to determine your specific training targets depending on your injury and sport demands to make sure you get back to training safely, efficiently, and confidently, which could look like the example below.

Sample  Return to Contact Progression

In-clinic Testing

– Indicated by the type of injury, your physiotherapist may test for limb strength asymmetries, muscular/cardiovascular endurance, reaction time, and/or sport-specific balance.

Non-contact training

– Individual or team training focused on technical skills at an increased intensity without contact. Typically completed without protective equipment to encourage a focus on technical quality without the “autopilot” contact focus to build confidence on-feet.

Contact Exposure – Pads

– Team training where contact is initiated by you against a tackle bag or foam cushion. Specifically non-person contact to build confidence and dose intensity appropriately. This session may also include you receiving contact from these tackle bags, but not directly from other players.

Contact Exposure – People

– Team training with individual drills where you give and receive contact to/from other players in controlled drills. This is typically submaximal at a “training intensity”.

Contact Exposure – Match Simulation

– Team training at full match intensity with full contact in short durations. This typically starts with controlled drills and should progress to unstructured or unplanned reactionary match situations.

Match Play

– A reduced-minutes return to match exposure.

Return To Play Monitoring

Stepping back into the matchday squad is an exhilarating feeling, but this doesn’t mean you’re being thrown back without support. Your physiotherapist will continue to modify your Return To Play structure as needed in collaboration with your coaching staff and yourself to make sure the last pieces of the rehab puzzle go according to plan. There should be a smooth handoff from your rehab team back to your performance team, and you can continue check-ins with your physiotherapist through this process as needed.

Taken a knock and looking to get back on your feet? Come by for a chat and let’s get started!

Written by: Ben Dyck

 

References:

  1. Martin, E., Beckham, G. Force production during the sustained phase of Rugby scrums: a systematic literature review. BMC Sports Sci Med Rehabil 12, 33 (2020). https://doi.org/10.1186/s13102-020-00174-z
  2. Sport Participation Among Children and Youth. Canadian Fitness and Lifestyle Research Institute. (2024, June 25). https://cflri.ca/publication/sport-participation-among-children-and-youth/ 
  3. Trewartha, G, Preatoni, E, England, ME & Stokes, KA 2015, ‘Injury and biomechanical perspectives on the rugby scrum: a review of the literature’, British Journal of Sports Medicine, vol. 49, no. 7, pp. 425-433. https://doi.org/10.1136/bjsports-2013-092972 
  4. Image 1: Adrian Dennis AFP
  5. Image 2: Networld Sports

Menopause and Frozen Shoulder: How the Two Might be Connected, and How Acupuncture and Cupping Can Treat Both

/in , /by

Frozen Shoulder: A Symptom of Menopause?

Frozen Shoulder (FS), or adhesive capsulitis, is a condition that causes pain, stiffness, and limited mobility in the shoulder joint. It can be a result of a combination of hormonal changes, injury, and prolonged shoulder immobilization, leading the connective tissues surrounding the shoulder to become thickened and inflamed. This can lead to scar tissue formation and further restriction of movement.

FS primarily affects adults, especially those between 40 and 60 years old, and it occurs more often in women than men. This has led researchers to believe there may be a hormonal link at play. The Traditional Chinese Medicine (TCM) term for “frozen shoulder” translates into English as “shoulder at the age of 50 years”.

Frozen shoulder typically progresses through three stages:

  1. The freezing stage: marked by increasing pain and reduced mobility.
  2. The frozen stage: where stiffness is most severe.
  3. The thawing stage: during which movement gradually improves.

Frozen shoulder can develop over months and may last up to two years if untreated.

Benefits of Acupuncture and Cupping for Frozen Shoulder

In TCM, there is an understanding that different people can have the same symptoms, but have different underlying conditions that are causing pain and other symptoms. The specific presentation of symptoms can help an acupuncturist determine the underlying root causes of the condition and treat them accordingly.

Acupuncture and cupping aims to restore your body’s energy balance, known as Qi, which flows through meridians or pathways. When Qi is blocked or unbalanced, you may experience pain and dysfunction, like in the case of FS.

Acupuncture and cupping helps to treat FS by stimulating the body’s natural healing processes by needling into specific acupuncture points. The benefits include:

  • Increased Blood Flow: improving circulation around the shoulder joint, ensuring that oxygen and nutrient-rich blood reaches the affected tissues. This increased blood flow promotes healing, reduces stiffness, and accelerates recovery. Improved circulation can also reduce swelling.
  • Reduced Inflammation: Reduction in inflammation decreases pressure on surrounding tissues, easing pain and allowing for greater mobility.
  • Relaxation of Tight Muscles: Relaxation of muscles reduces the tension contributing to pain and stiffness while promoting a more balanced flow of energy throughout the body. Improved energy flow can enhance the body’s overall healing process. By relaxing muscles and increasing joint lubrication, acupuncture promotes a greater range of motion.
  • Promotes Holistic Healing: Acupuncture not only targets physical symptoms but also supports overall well-being by addressing stress, anxiety, and fatigue associated with chronic pain.
  • Cupping: Involves placing specialized glass cups on the skin to create suction. This vacuum effect lifts the skin and underlying fascia, increasing circulation and loosening tight tissue. For FS, cupping is typically applied around the joint and shoulder blade.

The number of sessions required varies, but most people see noticeable improvements after 4 to 6 sessions. For chronic or severe cases, a longer course of 8 to 12 treatments may be needed. 

In some cases, individuals with complex conditions may require maintenance sessions beyond the initial course of treatment. These ongoing treatments help sustain progress, prevent symptom recurrence, and further enhance shoulder flexibility and function.

The ability to customize the treatment plan ensures that each patient receives care tailored to their unique needs, maximizing the benefits of acupuncture.

The Menopause and Frozen Shoulder “Double Hit”

There is no current evidence that directly links menopause and frozen shoulder. But it’s likely that changing hormones during menopause can put folks at risk.

Menopause is the stage of life in which people who have periods no longer have one. This occurs due to declining levels of the hormones estrogen and progesterone. Estrogen is also good for the joints, as it protects the cartilage, stimulates bone growth, and helps regulate inflammation. Low levels of estrogen cause many of the symptoms of menopause, like hot flashes and insomnia.

For many, the onset of FS during perimenopause or menopause feels like a double burden. Not only are they dealing with menopausal symptoms, but the sudden, sharp pain and reduced mobility in their shoulders make day-to-day activities even harder.

Acupuncture is exceptional at both treating hormone imbalances and reducing pain. Other symptoms of menopause that acupuncture can help with, include:

  • Night sweats
  • Mood changes
  • Anxiety
  • Fatigue
  • Low back pain

Early intervention through acupuncture and physiotherapy can help maintain shoulder function and prevent the condition from progressing.

 

Written By: Yvonne Sui

Oncology Physiotherapy: Our Approach to Your Healing Journey

/in , /by

I’ve been working with people affected by cancer for about 10 years. My first client was going through breast cancer treatment and had been advised to exercise, but pain in her Achilles tendon was holding her back. Supporting her led me to dive deeper into understanding how chemotherapy and other cancer treatments affect tendons and tissues throughout the body. She shared her experience with others in her recovery community, and from there my oncology-focused practice began to grow.

Over the years, I’ve worked most often with people recovering from breast cancer, helping with pain and reduced mobility following surgery or radiation. This commonly affects the shoulder, arm (including cording), neck, upper back, and ribcage.

As a Fellow of the Canadian Academy of Manual and Musculoskeletal Physiotherapy (FCAMPT), I bring advanced training in hands-on techniques to restore mobility and reduce pain. Manual therapy can be very effective, but research — and my clinical experience — consistently shows that exercise is one of the most powerful tools in cancer recovery. Exercise helps manage side effects such as fatigue, mood changes and nausea, and supports return to daily activities, recreation and work. Excitingly, emerging evidence suggests exercise may also improve long-term survival.

I’m now focusing my practice fully on oncology physiotherapy, supporting people with all types of cancer. My approach is calm, empathetic, and collaborative; it is always tailored to your unique needs and goals. Together we’ll develop a treatment plan that may include:

  • Exercise prescription — ranging from breathing and gentle mobility, to strength and conditioning, to progressive return-to-sport or work programs.
  • Education and guidance — to support safe return to activity, optimize recovery and health, and build strategies to manage pain and other symptoms.
  • Manual therapy — when needed, to improve movement, reduce pain, and complement exercise.

Every cancer journey is different, but physiotherapy has so much to offer in helping you recover, regain confidence, and get back to the things that matter most to you.

Written By: Kate Kennedy

Ankle Sprain from Summer Sports? Here’s Everything You Need to Know to Get Back Out There

/in , /by

 

Ankle sprains or “rolling an ankle” is one of the most common injuries and is often underestimated. Whether it happened during sport, a misstep off a curb, or a slip on an uneven surface, how you manage your sprain in the early stages can significantly impact your recovery.

What Is an Ankle Sprain?
An ankle sprain occurs when the ligaments (tough bands of tissue that stabilize your ankle joint) are forced beyond their normal range of motion resulting in a stretch or tear, usually from rolling or twisting the ankle. Ankle sprains primarily affect the outside of the ankle, often including the anterior talofibular ligament (ATFL), the calcaneal fibular ligament (CFL), and in some instances the posterior talofibular ligament (PTFL).

The Three Different Grades of Ankle Sprains:

  • Grade 1 (Mild): Slight stretch with microscopic tearing, minimal swelling and tenderness, no loss of joint stability. Sport is usually resumed within a couple of weeks.
  • Grade 2 (Moderate): Partial ligament tear, more swelling/bruising/and pain, little to no loss of joint stability. Treatment is required (the sooner the better) and it is typically at least 3 to 6 weeks before activity resumes.  A protective brace or taping is often needed to aid recovery.
  • Grade 3 (Severe): Complete tear of ligaments, significant swelling, instability. Full recovery may take several months. There is usually permanent laxity or looseness of the ligaments. A brace should be used to assist with stability, healing, and resumption of full activity.
  • In some cases, often those with higher impact like landing from a jump, an avulsion fracture can occur. This means that a small piece of bone is broken off where the ligament attaches. A physiotherapist or doctor can help rule out if you need x-rays for a potential fracture.

How Physiotherapy Helps:

  • Diagnose and determine the severity/grade of the injury
  • Swelling and pain management in early stages
  • Targeted exercises to restore range of motion, strength, and balance
  • Manual therapy to improve joint mobility
  • Return-to-sport plans and injury prevention education

When Can You Return to Activity?
Every sprain is different, but returning too soon can increases your risk of re-sprain. A physio-guided rehab plan ensures you’re not just pain-free, but functionally ready.

Sprained Your Ankle Recently?
Immediately after injury let P.E.A.C.E. guide your approach:

P-Protection: in the first 1-3 days avoid movements or activities that increase pain.
E-Elevation: elevate the injured leg higher than the heart as often as possible to help reduce swelling.
A-Avoid anti-inflammatories: avoid taking anti-inflammatory medications or icing the injury as it will reduce tissue healing.
C-Compression: use elastic bandage (ex: tensor) or taping to reduce swelling.
E-Education: a guided active approach is helpful for recovery.

Don’t wait for it to “just get better.” Book an assessment today and let’s get you back on your feet!

Written By: Danielle Carter

 

References:
Dubois B, Esculier J. Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine 2020;54:72-73.
Hubbard TJ, Hicks-Little CA. Ankle ligament healing after an acute ankle sprain: an evidence-based approach. J Athl Train. 2008 Sep-Oct;43(5):523-9.
Martin RL, Davenport TE, Fraser JJ, Sawdon-Bea J, Carcia CR, Carroll LA, Kivlan BR, Carreira D. Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021. J Orthop Sports Phys Ther. 2021
Apr;51(4):CPG1-CPG80.

 

Move Better and Hit Harder on the Court: An Exercise Program to Prepare You for Tennis Season

/in , /by

Summer is right around the corner, and with the French Open concluded and Wimbledon here, I am sure we are all rushing out the door to lace up those tennis shoes.

Players like Alcaraz and Coco have certainly shown us why working on our physical strength can make such a big impact on the court.

Whether you are looking to compete in local tournaments or get together for a casual doubles match with your friends, here are 5 exercises for the lower body, upper body and core that I would consider!

Lower body 

  1. Squats: Great for building lower body strength, do these if you don’t want to have knee pain. 
  2. 3-way lunges (forward/side/back): With tennis being such a dynamic sport, there is a strong requirement to be able to lunge in all directions. 
  3. Single-leg hinges: Great for strength, balance and stability while targeting your glutes, hamstrings and core. These are all the important muscles for movements such as sprinting. Do this exercise if you don’t want to lose points from drop shots.
  4. Monster walks: Great for lateral movement on the baseline during groundstrokes or when you do your split stance at the net to get that volley winner. 
  5. Calf raises- double leg or single leg: Important for explosive movements such as jumping, running and quick directional changes. Do these and your Achilles will thank you. 

Upper body 

  1. ½ kneeling single-arm dumbbell shoulder press: Enhance your core stability and power: more aces, more free points. You’re welcome.
  2. Supine dumbbell pec flies: Whether you like to hit the ball flat or with top spin, strong pectoral muscles will help with the power of your groundstrokes and serve.
  3. Pull-ups or lat pulldowns: Strengthen your back and improve your posture so you don’t use the sun as another excuse for missing that easy overhead smash.
  4. Rows: Strong scaps, healthy shoulder, enough said.
  5. Forearm stretch and strengthening: Do these unless you like tennis elbows? 

Core

  1. Bird dogs: Improve core stability, balance and coordination. Lower back pain? No thanks 
  2. Side planks: Improve your rotational power and stability. KEY to generating power in your forehand and backhand. 
  3. Forearm plank: Upper back, shoulder and core stability. This is your 3 in 1, talk about efficiency. 
  4. Palloff press in split stance: Core stability to unleash your forehand and backhand.
  5. Dead Bugs: Coordination and core stability, never wiff a ball again! 

Check out this video to see examples of each exercise:

All jokes aside, these are not the only exercises to help your tennis game. But these foundational movements will certainly help with injury prevention, so you can keep playing the game you love!

Written By: Victor Choy

Step into Summer: How Clinical Pilates Can Help You Hit the Trails Stronger

/in , , /by

 

With the days getting warmer and summer adventures calling, many of us are itching to lace up our boots and hit the trails. Hiking is a fantastic way to enjoy nature, build cardiovascular fitness, and reset mentally. But before you dive into steep climbs and uneven terrain, it’s important to make sure your body is ready for the challenge, especially if you’ve been dealing with stiffness, aches, or old injuries. If you’re feeling a little out of step after a busy spring, you’re not alone.

Whether you’re easing into day hikes or training for a multi-day trek, working with a physiotherapist trained in Clinical Pilates can help you move more efficiently, manage lingering discomfort, and reduce your risk of injury. Most importantly, it can help you feel stronger and more confident on the trails.

Why Prepare Your Body For Hiking?

Hiking challenges more than just your lungs. Long climbs, rocky terrain, descents, and carrying a pack can put stress on your knees, hips, ankles, and back. Many hikers experience lower back discomfort, or fatigue in the stabilizing muscles that support posture and movement. Taking the time to prepare your body before you ramp up mileage or elevation can help prevent common injuries like knee pain and ankle sprains. It also means you’ll move more confidently and enjoy your hikes without nagging discomfort.

How Clinical Pilates Can Help You Move Better on the Trails

Every hiker has a unique body and movement history, which means their needs and challenges on the trail are equally unique. Whether you’re recovering from an injury or feeling stiff after months at a desk, a tailored approach is key. Clinical Pilates offers a personalized way to address your specific biomechanics and goals.

Working with a physiotherapist trained in Clinical Pilates means you’re receiving guidance based on thorough assessment and clinical reasoning. Physiotherapists are trained to identify joint restrictions, movement inefficiencies, and muscle imbalances that could limit performance or lead to injury. With this understanding, they will design a program focused on improving strength, mobility, and control where you need it most.

Some key areas that Clinical Pilates might target include:

  • Strengthening your hips, knees and ankles to tackle hills and uneven terrain
  • Enhancing core control for hiking endurance
  • Improving balance and proprioception to reduce the risk of slips and falls
  • Restoring mobility and movement efficiency to help you stay light on your feet
  • Addressing old injuries that still affect loading patterns, confidence, or stability

The goal is to help you move with greater ease and control, focusing on the areas that will support you most on the trail, so that you can hike longer, stronger, and with more confidence!

Get Trail-Ready This Summer!

Whether you’re managing old injuries or simply want to feel stronger and more stable, now is the perfect time to get your body trail-ready. Clinical Pilates can help you hike longer, with less discomfort and more ease. By focusing on your body’s unique needs, you’ll be better prepared to enjoy everything the season has to offer – one step at a time.

Written By: Alexia Lee

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