When HOW matters more than WHAT:  TIIPPSS – A Framework for Changing Symptoms

Perhaps you are a CrossFit athlete who leaks during double unders,

or a mother who feels bulging in her perineum when she lifts her toddler,

or a runner who becomes symptomatic during longer runs,

or an athlete experiencing back pain during Olympic lifts,

or a senior suffering knee pain when going down the stairs.

or perhaps you are a healthcare or fitness professional working with individuals who are limited by such symptoms.

What can you do?

In all of these situations, there exists a good possibility that we can change the individual’s symptoms with a task or activity by changing HOW they do it.  As my friend and mentor, Antony Lo (aka The Physio Detective) would put it, we can do this by getting them to #dosomethingdifferent.  But WHAT?  How do we find the difference that will make the difference?  How do we know where to begin? And if that doesn’t work, what else we can try?

Travelling around and teaching alongside Antony, it occurred to me that these questions were coming up pretty frequently.  Additionally, I would sometimes hear from healthcare & fitness pros who were trying to #dosomethingdifferent with a client but had gotten stuck – out of ideas and unsure to do next.  What I heard was that we needed a framework.  And out of that, TIIPPSS was born.

TIIPPSS is a handy acronym that I came up with to help us consider all the categories for potential variation that we may try as a means to change someone’s symptoms and/or performance with a given task. 

Let’s break it down…

T – Tension

I – Impact

I – Irritability

P – Posture/Positions

P – Pressure

S – Strategy

S – Sensitivity

Ideally, we want to optimize the TIIPPS and then consider FC (Fatigue and Capacity).  More on FC later…

So what do we mean by these?  Let’s elaborate a little…

Tension

This is all about having the right #tensiontotask – not too much, not too little.

Are we overcooking the tension in the pelvic floor musculature?  If so, what if we cued the person to relax or “soften” the pelvic floor during the activity?  Or to imagine the pelvic floor as a trampoline that yields as it’s loaded with impact?

Or if we are undercooking, what happens if we dial up the tension in the pelvic floor (whatever that means to the person)?

What about full body tension?  Are we tensioning ALL the things?!  Think of the athlete who is tensing every muscle in their body as they try to squeeze out one more double under.  What would that level of tension potentially do to the dynamic responsiveness of our pelvic floor?  To the intraabdominal pressure?  To the demands on the pelvic floor and our continence mechanism?  To our athletic performance overall?  What if we let that go?  Try to relax that tension – letting the cheeks jiggle as we run or jump (yes, all the cheeks!)?

What is the potential impact of emotion on tension?  For instance, fear of falling when running downhill?  Or fear of leaking when skipping? Or fear of injury?  How could we potentially change fear or emotional state to alter tension?  Perhaps distraction? Visualization?  A positive memory? Foot in the door technique?  Changing context, environment or equipment?  Music? Our tone of voice and the confidence (or lack thereof) that we display as their care provider?

What about from a pain standpoint – can we potentially alter pain by modulating tension?

Aside from #allthetension, what if we have focal tension in one area of the body?  And if so, what if we tried to take that tension and dispersed it around the whole body, as if to #spreadtheload?  As if taking a glob of paint in the area of focus and then spreading it out to paint over the whole of our body?

Impact

Modulating impact can change symptoms.

Close your eyes and listen to the footfalls – whether running, skipping, jumping or in the catch of an Oly lift.  What is the impact like – an elephant or a ninja or somewhere in between?  Can we make that impact softer?  Can we reduce vertical excursion?

What about other impacts such as the Oly lifter who sustains vertical loading onto the torso when catching the barbell in a squat clean?  Or the equestrian who is symptomatic when landing in the saddle as the horse is cantering or landing a jump?  Or the softball athlete who’s bat connects to the ball? There are various impacts to consider depending on the athlete and the activity.

Irritability

Bladder and gastrointestinal irritability can really impact pelvic floor symptoms.  Dietary factors such as the consumption of bladder irritants can exacerbate urinary leaking and urgency and, anecdotally, POP symptoms as well.

If you tick off your bladder with a pre-workout drink, energy drink or diet soda (those three are aka bladder irritant soups), coffee, sparking water or any of the other common bladder irritants, the muscular bladder will contract more frequently and forcefully, making it harder to stay dry.  Other bladder irritants can include spicy foods, acidic foods such as citrus, artificial flavours/colours/sweetners, caffeine and, potentially, dairy.  Even dehydration can result in bladder irritability as our more concentrated urine can act as a bladder irritant.

Ignored food sensitivities and anything leading to gastrointestinal irritability can mean the pelvic floor has a harder time managing gas and fecal continence.

There is also some indication that other dietary factors such as the amount of sugar and processed food in one’s diet can have a potential influence on inflammation.

Hormonal influences can also impact the irritability of our symptoms.  Whether this is something amenable to change or not, understanding the influence of these factors on the irritability of our symptoms can be empowering.

Posture/Positions

In my mind, “posture” refers to relatively static alignment – as in sitting or standing, or trunk posture while running or walking on a level surface where there tends to be fairly minimal deviation in alignment, whereas “positions” refers more to dynamic movements where one moves through a series of significantly different positions such as during a snatch or clean and jerk.

What if we change the alignment of ribs over hips?  The inclination of the torso?  Could a slight forward lean from ankles to provide bony support for bladder? Perhaps.

While we subscribe to the notion that there is no ONE “right” or “perfect” posture, changes in our alignment, either statically or dynamically, can change symptoms. 

Additionally, I think that while we tend to do a decent job of moving people towards postures and positions that fit with what are traditionally seen as the “right” postures, there tends to be hesitation or resistance in moving people away from these “good” postures, even though doing so may be a way out of symptoms.

Of course, biomechanics matter and the rules of physics apply, particularly at higher load and intensity.

Additionally, while these changes in posture/position may be helpful long term, they may also be something that we employ temporarily. #fornownotforever

Pressure

Intraabdominal pressure (and how we manage IAP) can influence symptoms.

What if we modulate breathing to change IAP?

What if we exhale through the movement?

What if we breath hold?  What if we breath hold on a smaller volume of air?

Are we taking shallow breaths under a shield of tension?  What if we took larger breaths?

What is the impact of wearing a weightlifting belt or not?

How can we modulate the distribution of pressure with muscular activation of various components of our inner core and trunk?  How can our alignment influence pressure and it’s distribution?  How can tension influence pressure?  As you may be beginning to see, these categories overlap and interact with one another – they are categorized not as separate entities but rather to categorize our thinking and our potential approach to changing their experience (whether that means changing pain, symptoms such as leaking or POP symptoms, or changing athletic performance).

Strategy

Strategy really refers to the HOW of the movement – the technique and all the variables of the task that we can play with.

For instance, I can change running technique by changing cadence (which will also change impact and vertical excursion among many other things!)

Strategy can also include HOW heavy, HOW fast, and other variables of the task that can be altered.

In the example of running, strategy may also refer to pace, terrain, incline, footwear, arm swing, thoracic rotation, etc…

Sensitivity

Both pain and sensation are outputs of the central nervous system.

Consider that right up until I mention it, you are likely unaware of the sensation of your clothing resting on your body.  Or consider how you may initially feel a tampon or well-fitting pessary that you just inserted but then later forget that it’s even there.  Or consider how someone with a mild grade 1 prolapse may have debilitating symptoms while another with more significant structural descent, say even a grade 3, may not be bothered at all.  Consider how poorly medical imaging findings correlate with clinical presentation (symptoms and function).  Perhaps you can recall a time that you noticed that you were bleeding or bruised without recollection of pain, perhaps unable to even recall when the injury occurred.

The fact is, your central nervous system (brain & spinal cord) is constantly receiving messages from your body and environment.  The tissues are always talking.  So how does it decide WHAT you need to pay attention to, and how much attention you should pay?  This is sensitivity – and it can be ramped up or ramped down.

Context, history & past experience, emotional state, beliefs, sleep deprivation, stress & anxiety, and many other players on the field will together determine the outcome of the game – what symptoms you experience and to what extent.

What if we can alter the symptoms of pelvic organ prolapse by addressing the individual’s beliefs about their POP?  What if rather than being told not to lift anything greater than 10lb for fear of their ladybits falling out, they were counselled in appropriate loading within a context of progressive overload to harness adaptation and improved function?  What if rather than focussing on DANGER and FEAR, we bolstered feelings of safety, connection, empowerment and strength?  Similar to Lorimer Moseley and David Butler’s application of DIMS and SIMS for pain, could we not apply this same approach to symptoms of POP as well?  So many exciting questions that we can discuss with respect to sensitivity, but what I’d like you to take away from this is that sensitivity can impact an individual’s symptoms in a real way and we can impact that sensitivity.

So with all the TIIPPSS that we can change, how do we know if it’s a change worth keeping?  How do we know if any of these are useful to the person in question?  We test them.  #testretest

As a result, not just anything different is required, but rather, the difference for that person in the given situation at this given moment in time.  We keep the difference that makes a difference – improvement in the parameter that we are wanting to improve (pain, symptoms, performance).

Now remember when I said we’d come back to FC…here we are.

We want to aim to optimize the TIIPPSS, which in reality is likely an ongoing process in some cases, but we also need to consider the Fatigue and Capacity.

Fatigue

In any situation, fatigue can play a role.  In the short term, such as during a run, a workout or a day in our lives, the more fatigued we are or the more fatigued the weakest player is (which may in some cases be the pelvic floor), the more likely we are to become symptomatic.

As a result, someone may be fine to do 200 double unders staying dry and happy at the start of their session whereas as the end of a gruelling workout, they may not. 

We can consider fatigue in determining rest & recovery needs, as well as programming decisions for those who are symptomatic, in order to optimally match tolerance with demands.  This also gives us a place to further discuss sleep, in addition to energy balance – knowing that RED-S is a risk factor for pelvic floor dysfunction, and that frequency of SUI and urge incontinence has been found to be significantly higher in eating disordered athletes compared with healthy athletes.

Capacity

Whereas fatigue is a consideration over a shorter time frame, capacity refers to changes in tolerance over a longer term. 

Sometimes we optimize all the TIIPPSS and we get to a certain level of symptom-free performance, and then we may just need to build capacity – building strength and endurance over the long term with progressive overload that is matched to the individual’s current tolerance and in keeping with the individual’s goals.  Load and volume management matter in the short and long term!

So there you have it – optimize the TIIPPSS, consider the impact of Fatigue and then build Capacity.                                                                        

I hope this post has given you food for thought in all the ways that you can help yourself or others change symptoms.  This is an ever-evolving framework so I welcome your feedback – both good and bad – as well as any questions or comments that you may have.

In addition, I would like to add that TIIPPSS FC is no substitute for a good assessment – if you are experiencing pelvic floor symptoms such as leaking urine, gas or feces, pressure/heaviness/bulging, or pelvic pain, see a pelvic floor physiotherapist – ideally one who also looks at your movement and helps you with the HOW as well.  And if you are having issues with pain elsewhere in your body or looking for performance improvements, a qualified physiotherapist can help!

 

As physiotherapists, I think the vast majority of us enter into the profession due to a strong desire to help people. That was certainly the case for me. In fact, the main reason why I decided to go into physiotherapy rather than medicine was the allure of human connection – to have more time with my patients, a greater opportunity to connect with them, to educate and empower them, and to help restore function and performance in multiple facets of life. I couldn’t imagine a better job. 

Fast forward several years, and I found myself working in a busy private orthopaedic clinic. I still loved my job and embraced the privilege of working with my patients every day. But there were days when at the end of my shift, I would reflect back and wonder if there was more that I could do. 

Specifically, I observed that a lot of my older patients were having difficulty maintaining their strength and function as the years went by. In some cases, they felt afraid or reluctant to get active and unsure of what to do, particularly those who had diagnoses such as osteoarthritis, osteoporosis, joint replacements, metabolic syndrome or other chronic diseases. Additionally, there was a lack of safe, appropriate and effective exercise programming for older adults in our community. As a result, these older adults would often remain or become more sedentary. Unfortunately, as we can imagine, this only accelerates the decline over time. Bone density and muscle mass drop, strength and mobility deteriorate, balance suffers, fall risk climbs, and a multitude of psychosocial factors can be negatively impacted. Sadly, this is often just chalked up to “aging”, as if there is nothing we can do. Fortunately, that is far from the truth.

Strength Training as a Solution

Recent years have brought about some practice-changing research which has demonstrated that high intensity strength training is both safe and extremely effective in older adults, including osteoporotic patients. For instance, the 2017 LIFTMOR trial demonstrated that in osteoporotic patients, bone responds very well to progressive strength training (back squat, deadlift and overhead press) and impact loading (jumping chin-ups with drop landings). Additionally, they recorded improvements in functional performance and even thoracic kyphosis. Groups around the world are also demonstrating successful models of delivering just this type of intervention. Some examples include The Bone Clinic in Australia, Stave Off in Ontario, Greysteel Strength and Conditioning in Detroit, and a growing number of Masters programs in CrossFit gyms across North America.

The Longevity Program

The desire to do more for my patients led me to develop a program called Longevity, which was launched in CrossFit Leduc in the Fall of 2016. Held twice per week, this hour-long group training session for adults over 50, is coached by myself and the head coach and owner of CrossFit Leduc, Brad Bendfeld. We begin with a group warm-up, then work on resistance training and, finally, a WOD (“workout of the day”), which typically involves some interval training. Participants undergo an intake assessment prior to entry to the program, and all workouts are modified as needed to be safe and appropriate for each individual, while still delivering a challenge.

Our participants laugh, smile and encourage each other as both a sheen of sweat and a sense of accomplishment appear. I see that, in most cases, the decline in their function is not only slowed, but reversed. They are getting stronger, fitter, moving better than they have in years and they are having so much fun doing it. But there is more to it than getting stronger and building denser bones. We all want that, but what really makes me happy is when I hear a patient say that she can now play with her grandkids because getting on and off of the floor isn’t so hard anymore, she can now pick up her grandchild, go up the stairs much more easily, and so on. 

We have a number of participants in their 70s, some with joint replacements, many with osteoarthritis and osteoporosis, and they are all making gains. We have participants who are now deadlifting 200lb with impeccable form and blowing their own expectations out of the water. The goal is not to deadlift 200lb – although those who can are incredibly proud of their progress to achieve that! The goal is to maximize function and to build resilience, with the overarching goal of maximizing and preserving quality of life. Isn’t that what physiotherapists strive to do?  It certainly is what drew me to the field many years ago.

A New Career Path

What started out as a solution to fill a need in our community, ended up changing my career path. In falling in love with Longevity, I decided to leave my position as Clinical Lead at that busy private clinic. I now continue to program and coach Longevity on an ongoing basis but, additionally, I opened RX Physiotherapy, my own practice within CrossFit Leduc. In this setting, a new model of care has become a reality, one where strength training is integrated into treatment in a capacity that is not typically seen in traditional clinics, and where the lines between rehabilitation, preventative care, and physical performance are appropriately blurred.

In our field, I feel there is so much potential to continue to do more for our patients in this capacity. Let’s strive to deliver care that goes beyond traditional confines. Let’s explore partnerships with those in the strength and conditioning world – we can be tremendous allies, rather than competitors, and we have so much to learn from one another. Let’s challenge our beliefs regarding exercise and rehabilitation in the older adult and embrace appropriate loading in this population. Honestly, I cannot convey how rewarding this can be.

Reference:

Watson, SL, Weeks, BK, Weis, LJ, Harding, AT, Horan, SA, Beck, BR. High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. Journal of Bone and Mineral Research (2017) 1–10.

 

Have you ever noticed a baby move their feet?  I remember marvelling at my little ones’ feet – how they could curl, splay and extend their little toes.  This always reminded me of the intricacy of foot anatomy.  Each foot contains 26 bones, 33 joints and more than 100 muscles, tendons and ligaments.  I think this is one of the reasons why this is one of my favourite areas to assess and treat.  Call me a nerd, but I love anatomy.  It is fascinating how the body is created, the purpose behind the design, how each part connects to and affects the function of the other parts, and how truly amazing our bodies are.  Within our anatomy is a truth that I have always paid attention to: form equals function.  Basically, nothing in our design is random and if we want to know how something is supposed to function, we need to look to it’s form – it’s design.  In no other area of the body is that truer than in the foot.

With 33 joints, our foot holds a tremendous amount of possibility for movement.  Why would we have so many joints and muscles in our feet if they weren’t meant to move?  Our feet are our connection to the ground.  We balance on them, walk on them, propel ourselves across the ground, or launch into the air with them.  The foot can absorb shock when you step onto it and then in the next moment turn into a rigid lever to push off with.  The biomechanics of the foot are fascinating.  But here is where I think we have gotten things wrong.

That little baby that could splay her toes – what do we do before she can even walk?  We put her in shoes – often stiff, rigid shoes that, while ridiculously cute, are also typically unnecessary and restrictive.  We continue on throughout our lives – wearing shoes that do not allow our feet to move as nature intended.  And when our feet don’t move, what do you think happens to all of those muscles that control our foot movement?  We know that motion is lotion and our joints like to be moved, so what happens when we do not allow them to move as they should?  You know the answer – if you don’t use it, you lose it. 

Now here’s a test.  Take off your socks and shoes.  Put your foot flat on the ground.  Keeping the ball (front) of your foot on the ground, can you lift all of your toes well off the ground?  Can you them curl them all underneath?  Can you splay or spread your toes away from one another?  Keeping you heel and the knuckle of your big toe on the ground, can you lift your arch without curling your toes?  If you cannot do these things, I would argue that you have lost full functioning of your feet.

If this is you, no need to despair.  Because the only thing more fascinating than our anatomy is our capacity to adapt.  In other words, just because you have lost it, that doesn’t mean you can’t get it back.  Now that being said, there are cases where this is not so.  For those with nerve damage in their feet, such as diabetic neuropathy, these muscles may not be able to come back.  Additionally, for those with significant arthropathy affecting their feet, this may not be the case.  But for the vast majority of us, we can benefit from getting in touch with our feet again.

So how do you do that?  One easy way to start is with some simple foot exercises.  Spend a few minutes each day working on these movements: curl your toes, splay them, lift your toes off the ground while keeping the ball of your foot down, lift your arch, draw out the alphabet in the air with just your foot and ankle.  Remember that none of these should hurt and be cautious to not do too much at once, especially at the beginning.  If you have issues or pain in one or both of your feet, consider seeing a physiotherapist – we can help!

Teresa Waser is a physiotherapist and owner of RX Physiotherapy.  She has a Master of Science in Physical Therapy from the University of Alberta, in addition to several years of continuing education and experience treating patients of all ages.  Outside of the clinic, she coaches running and CrossFit and is passionate about helping others live life to the fullest.  You can find more about Teresa and how she can help you at rxphysiotherapy.com

This week’s installment of Strength in Knowledge is Part 3 of a 3-part series on foam rolling.  Part 1 discussed the theory behind foam rolling.  Part 2 covered how to safely foam roll.  This final installment will highlight a few popular foam rolling techniques.

Disclaimer: Please ensure that you have read Part 2 of the 3-part series on foam rolling prior to trying these techniques.  Part 2 was featured in The Leduc Rep and can also be found online at rxphysiotherapy.com/blog 

Additionally, if you are unsure if foam rolling is right for you, if you have osteoporosis, difficulty getting on and off of the floor independently, or have sustained a recent injury, please consult with a healthcare professional before trying these.

Quadriceps (Front of Thighs)

Roll the front of your thighs from the crease of your hip down to (but NOT over) your kneecaps.  You can do both legs at once, or for more pressure, you can cross over at the ankle and just roll one at a time (as shown).  Remember to keep breathing and sink into the foam roller as you roll slowly back and forth for 1-2 minutes.

 

 

Glute med and min (Upper side of Buttock)

Roll the side of your buttock (glute med and min) from just above the hip bone to the top of the pelvic bone.  Take care NOT to roll over the hip bone (located at the widest part of your hips) to avoid rolling over the trochanteric bursa that resides there. 

Lat dorsi and posterior shoulder (the back border of your armpit)

Roll the muscles that make up the back border of your armpit (the lats and posterior shoulder muscles) which can wreck havoc on the shoulder girdle.  You can do this with your elbow bent or straight – whichever is more comfortable.

These are just a few of the techniques that utilize a foam roller.  There are several more, in addition to many other self myofascial release options using other myofascial tools such as spiky balls, Yoga Tune Up balls, Pilates balls, hand held rollers and more.  Patient instruction in these techniques, when appropriate, is one of the many services provided to empower our patients at RX Physiotherapy.  Get in touch if you want to learn more!

Teresa Waser is a physiotherapist and owner of RX Physiotherapy.  She has a Master of Science in Physical Therapy from the University of Alberta, in addition to several years of continuing education and experience treating patients of all ages.  Outside of the clinic, she coaches running and CrossFit and is passionate about helping others live life to the fullest.  You can find more about Teresa and how she can help you at rxphysiotherapy.com

 

This week’s installment of Strength in Knowledge is Part 2 of a 3-part series on foam rolling.  Part 1 discussed the theory behind foam rolling.  This week, we will discuss how to safely foam roll.  The final installment will highlight a few of the most popular foam rolling techniques.

Foam rolling has been called the “poor man’s massage therapist” as it’s free, aside from the initial cost of a foam roller – which will set you back around $20-30.  You just need to know what you’re doing.

With foam rolling, we want to use long sweeping strokes, making sure to maintain normal breathing and keep your muscles relaxed.  Make sure not to roll too fast and try to allow the foam roller to sink into your tissues.  If you find areas of your muscles that are tighter than the surrounding area, you can spend some time focussing there, trying to coax the muscle tension to take a hike.  Typically, as a guideline, I suggest rolling for 1-2 minutes per muscle group, once daily, focussing on quality rolling and listening to your body. 

Foam rolling is typically uncomfortable – just as a deep tissue massage would be.  However, it should not be outright painful.  If you find that you cannot maintain normal breathing and keep the muscles relaxed while rolling, then you need to reduce the amount of pressure you are using.  There are a number of ways to do this – increasing the surface area of your body that is in contact with the roller, offloading how much weight you are putting into the roller, and using a handheld roller rather than a foam roller are just a few of the ways this can be done.  Additionally, I often suggest working on areas around the tight, tender region with the intent of “feeding slack” to the tight region, prior to directly working on that area.

Foam rolling is relatively safe, assuming common sense is employed.  However, there are some key safety considerations.  First, don’t roll over bony bits or joints – just stick to the muscle bellies.  Second, never do this is you have recently injured the area, particularly in the first 48-72 hours.  If you have strained or torn the tissue, you don’t want to possibly cause further damage.  To be on the safe side, if you have injured an area, wait until after your healthcare professional gives you the go-ahead before starting or resuming foam rolling in the injured region. 

Keep in mind that after foam rolling you should feel better and, although the tissue may be a bit tender to touch, you should not be in more pain.  Additionally, it should not cause bruising.  If you are in more pain afterwards or notice any bruising later on, this could indicate that either you were too aggressive with your rolling or you were working on a tissue that you shouldn’t have been (i.e. injured or really unhealthy tissue).  Finally, foam rolling should never cause any feelings of tingling, numbness or electric, shooting pain.  If you feel any of these, stop rolling on the area you are working on.  As rule, we want to avoid any deep pressure over nerves and avoid rolling over any irritated nerves.

If you feel uncertain as to whether foam rolling is right for you, or want to learn specific techniques that would be best for you, please feel free to reach out to me! 

Teresa Waser is a physiotherapist and owner of RX Physiotherapy.  She has a Master of Science in Physical Therapy from the University of Alberta, in addition to several years of continuing education and experience treating patients of all ages.  Outside of the clinic, she coaches running and CrossFit and is passionate about helping others live life to the fullest.  You can find more about Teresa and how she can help you at rxphysiotherapy.com

This week’s installment of Strength in Knowledge is Part 1 of a 3-part series on foam rolling.  This week we will discuss the theory behind this practice.  Next, we will discuss how to safely foam roll.  The third article will highlight a few of the most popular foam rolling techniques.

Perhaps you have been in the gym and have seen someone on the ground, rolling around on a big foam roller, typically grimacing.  Or perhaps your physiotherapist has already introduced you to this technique.  Alternatively, if you have been living under a rock for the past several years, you may have never even heard of foam rolling before.  If that’s the case, no problem – better late to the party than to never show up at all.

Foam rolling has been around for well over a decade and, nowadays, foam rollers are a ubiquitous feature commonly found in fitness facilities, physiotherapy clinics and homes all over.  So, what’s all the hype about?  And why would you ever want to do such a thing?!

Foam rolling is one form of self myofascial release – a manual therapy technique that you perform on your own body, in the hopes of positively impacting your fascial system, neuromuscular system (your nerves and muscles) as well as the local circulatory system (the blood flow to the tissues). 

Research in the area of self myofascial release is not extensive.  Not all studies are of high quality and there are some conflicting results.  More work is needed, but a 2015 systematic review (Cheatham et al.), which pooled the results of the high-quality studies that had been performed to date, concluded that self myofascial release, using a foam roller or handheld roller, appears to be effective for enhancing range of motion (mobility) and pre and post exercise muscle performance.

Basically, foam rolling is believed to reduce muscle tension, improve range of motion, and improve local blood flow.  Additionally, some studies have demonstrated that post-exercise foam rolling can reduce the intensity and duration of delayed-onset muscle soreness following exercise (the stiffness and soreness that you may feel in your muscles after a workout).  Furthermore, it provides an opportunity for you to map out areas of restriction in your body.  Clinically, we often see that changes in our range of motion and increased muscle tension precede painful symptoms and this can allow us to address these changes before they become real problems.  For instance, if the tissues at the back of the shoulder start getting really tight, this can affect how the shoulder is moving and can eventually lead to shoulder pain.  If we are foam rolling and we identify and treat this tightness early, we may be able to avoid this leading to a painful shoulder.  In the event the shoulder has already become painful, depending on the issues present, application of appropriate techniques can aid in recovery, ideally in conjunction with suitable therapeutic exercises.

The next installment of this series on foam rolling will cover how to do so safely.  Stay tuned!

Teresa Waser is a physiotherapist and owner of RX Physiotherapy.  She has a Master of Science in Physical Therapy from the University of Alberta, in addition to several years of continuing education and experience treating patients of all ages.  Outside of the clinic, she coaches running and CrossFit and is passionate about helping others live life to the fullest.  You can find more about Teresa and how she can help you at rxphysiotherapy.com

You may have heard the saying “age is just a number.”  I’m quite sure that these words are actually etched into my soul.  They stand in the face of a world that often says, “You’re too old for that.”  On the contrary, I believe that age does not dictate what you are capable of and no matter how old you are, you can start today.  This defiance of ageism has been sewn into the fabric of my existence by the threads of all the older adults that I have worked with.  They have shown me how capable they are when we do not shackle them with underestimations but instead support them with educated guidance and exercise that is safe, appropriately scaled for their abilities, and challenging.  They have shown me the courage to start, the will to grow stronger, and the power to take back their lives.

So, I shout from the mountain top that age is just a number.  But you know what?  That is not the whole story because age does carry with it some important considerations.  As most of us know, as we get older, both the quality and density of our bones decline, often leading to osteopenia, osteoporosis and, in some cases, fragility fractures.  This weakening of our bones occurs quite rapidly in women with the hormonal changes of menopause, but can also occur in men.  I think, in part due to marketing strategies from dairy companies, there tends to be some awareness regarding the loss of bone health in older adults, but there is another loss that often occurs as we get older – a loss that is arguably more significant.

What I’m referring to is sarcopenia, which is the age-associated loss of muscle tissue and function, that occurs as we grow older.  Studies suggest that sarcopenia begins as early as the 4th decade of life and progresses steadily, with up to HALF of our muscle mass typically being lost by the time we reach our 80th birthday.  Just as the loss of bone health can vary between older adults, so too can the loss of muscle.  There are a lot of different things can contribute to the progression of sarcopenia.  Some of these include poor nutrition (particularly poor protein intake), the presence of chronic illness, chronic inflammation, insulin resistance, hormonal factors, inactivity and sedentary lifestyle. 

So why do we care if we lose muscle as we get older?  Well, this loss of muscle is a major factor in the typical decline in older adults’ functional abilities.  The weaker we become, the less we can do – including all the activities that are necessary for independent living.  We also know that sarcopenia results in a higher likelihood of falls, disability, hospitalization, and death.  Trust me, it matters – both in lifespan and, arguably more importantly, quality of life.

Fortunately, we can all raise arms in the fight against age-related loss of bone health, muscle mass and strength.  The call to action is a call to get active and stay active, while eating well.  The best activity is one that you enjoy and will continue to do.  That being said, the best exercise for improving strength and bone health in older adults is strength training – preferably under the guidance of a professional such as a physiotherapist who is experienced in working with this age group.

Teresa Waser is a physiotherapist and owner of RX Physiotherapy, in Leduc, AB. She has a Master of Science in Physical Therapy from the University of Alberta, in addition to several years of continuing education and experience treating patients of all ages. Outside of the clinic, she coaches running and CrossFit, including a program at CrossFit Leduc known as “Longevity”, which is specifically designed for adults over 50.

If I close my eyes, I can remember it like it was yesterday – the sweet smell of babies who seemed to be forever in my arms and the heaviness of exhaustion that so often settles on the shoulders of mothers.  I remember days when my hair went unwashed, the rings under my eyes stayed dark, and my house remained a mess as my time was consumed caring for my children – at one point three under the age of three.  Everyone had told me to cherish these days and I did – feeding, diapering, bathing, singing, teaching, cuddling, and loving.  Most days, I would just gaze at them after they had fallen asleep in my arms – trying to memorize how they looked, knowing that every day they were changing and growing.  And then other days I would drive to Starbucks knowing the kids would all fall asleep in the van, just so I could have a latte in silence while they slept.  And some days, tears would escape down my cheeks because at times it was just hard.

The fact is, being a mom is hard.  Yes, it is amazing, wonderful and transformative – all of that and more, but it can also be challenging and intense.  The loss of normalcy, changes in our relationships with partners and friends, and the overwhelming expectations that come with being a mother in today’s world can lead to heightened emotional strain – and that’s before we even factor in lack of sleep and often poor, inconsistent nutrition.  Plus, “momming” is HARD physical work: lugging around babies and/or toddlers, diaper bags and carseats; pulling heavy strollers in and out of vehicles; and the list goes on.  From a physical and emotional standpoint, I would hazard a guess that most mothers feel depleted.  If you are one of these mothers, I want you to know that feeling of running on empty is pretty normal.  So, what is a mom to do?

This dilemma was definitely present for me.  I knew that getting active would be of great benefit, but as a mother with small children, I felt a crush of guilt that kept me from spending any time on myself.  Fortunately, over time, I slowly came to understand the truth behind this familiar quote: you cannot pour from an empty cup.  With this realization, I began to get active again – initially in exercise classes where I could bring my little ones along.  Over time, I got stronger and fitter, but more importantly, I actually became a better mom.

With exercise, my body became more resilient and capable of being the fun, active mom that I wanted to be.  Carrying kids and their gear, running with and after them, and playing with them on the playground all became so much easier.  Exercise also provided an outlet for stress relief, making me happier and, to my husband’s benefit, less irritable!  And although not perfect, I have become more confident and comfortable in my body, which I’m grateful for as my three daughters watch my every move.  I’m keenly aware that my relationship with my own body will influence their relationships with theirs.

As parents, we can be tremendous role models for our children, teaching them to love and respect their bodies by doing so with our own.  We can illustrate how to lead a healthy lifestyle.  We can show them that being active can be not only a normal part of life but also an very enjoyable one.

Nowadays, the fullness of my cup fluctuates with the ebb and flow of life, but I make it a priority to find time to exercise.  Doing so is not always easy, but it’s worth it because it brings out the best mom in me.  My kids deserve that and so do I.  And so do you and yours. ♥

If you are a mom and want to get active but need some guidance or have had some issues and are unsure of how to get active safely, please feel free to reach out to me!  I would love to help you in your journey.

 

Teresa Waser is a physiotherapist and owner of RX Physiotherapy, in Leduc, Alberta. She has a Master of Science in Physical Therapy from the University of Alberta, in addition to several years of continuing education and experience treating patients of all ages. Outside of the clinic, she coaches running and CrossFit and is passionate about helping others live life to the fullest.

Tears filled her eyes and spilled onto her cheeks as she smiled and hugged me.  This had been a big moment and we both knew it.  Just a moment before, I had snapped a picture of my patient pressing a 15lb barbell overhead with two 3lb plates on either end.  In total, she had just pressed 21lb – a new personal record for her and something she had once thought impossible.  But this was something much more than that.  This was more than pressing a barbell overhead.  This was a woman who was taking her life back and beginning to redefine her self perception.

               Needless to say, like many cancer patients, this woman had been through a rough couple of years.  Cancer had challenged her very being – in her fight to survive, it had stolen her energy, changed her body and shaken her confidence.  Fortunately, she was winning.  Surgery and chemotherapy had been successful and she was now in remission.  From the oncologist’s standpoint, she was good to go – but fatigue and weakness left her unable to return to work and tackle life’s challenges like she used to.  Additionally, the chemotherapy drugs had caused peripheral neuropathy, leaving her with pain, tingling and hypersensitivity in her feet. 

               Her experience is not uncommon amongst cancer patients.  As it should be, the focus initially is on beating cancer – on surviving.  However, in the aftermath, patients are often left in this frustrating and disheartening zone where they are no longer considered active cancer patients but they are not able to resume their normal work and leisure activities due to the effects of both the cancer itself and the medications and interventions that were used to save their lives.  Fatigue, weakness, deconditioning, “chemo-fog” or “chemo-brain” may all be present to some extent and, in some individuals, the fatigue can be staggering.  Additionally, removal of lymph nodes can lead to lymphedema which involves swelling of the limb(s) in which the lymph nodes were dissected or removed.  Cording, radiation fibrosis and scar tissue from surgeries can also be present – limiting mobility of the soft tissue and joints in the area.

               All of these issues can take away from their ability to live life to the fullest.  Thankfully, help exists.  A few years ago, I was fortunate enough to undergo specific training in cancer rehabilitation.  In my studies and my clinical experience, I have learned how incredibly successful physiotherapy and exercise therapy can be for these patients.  Research shows that exercise not only improves fatigue, strength, function, and quality of life, but also improves survivorship – meaning that not only will rehabilitation help improve cancer patients’ ability to take their lives back, but it also has the potential to add years to their lives!  Additionally, there are hands-on techniques that can improve cording and help restore joint mobility in these patients.  We work with them to regain their strength and endurance.  In doing so, we also bear witness to an incredible period of transformation, both inside and out.  These types of experiences are what make me feel so blessed to be a physiotherapist.  I honestly can’t imagine anything better.

               I took the picture of my amazing patient because she needed to see it.  She was getting stronger, moving better and her physical capacity was significantly improved, but in her mind, she was still weak, beaten down by her fight with the horrific disease we call cancer.  She needed to see how strong and capable she was becoming.  She has not finished her journey but she is well on her way to taking her life back – both inside and out. 

If you or a loved one could benefit from cancer rehabilitation, there are places that can help.  Some options are the Cross Cancer Institute, Cancer Rehab Clinic at the University of Alberta, and Wellspring Edmonton.  Here in Leduc, RX Physiotherapy, also offers cancer rehabilitation.

Teresa Waser is a physiotherapist and owner of RX Physiotherapy.  She has a Master of Science in Physical Therapy from the University of Alberta, in addition to several years of continuing education and experience treating patients of all ages.  Outside of the clinic, she coaches running and CrossFit and is passionate about helping others live life to the fullest.  You can find more about Teresa and how she can help you at rxphysiotherapy.com

In Love with Longevity

Teresa Waser, MScPT, BSc, CAFCI, CFL1 Trainer


Every Tuesday and Thursday morning at a gym in Leduc, my favourite hour begins.  A group of women come together to work out.  The session starts with a group warm-up, then they work on strength training – honing their technique under close supervision and building strength under the barbell.  Finally, they finish it off with a WOD (“workout of the day”), typically involving some interval training.  We laugh, smile and encourage each other as both a sheen of sweat and a sense of accomplishment appear.  These are my Longevity ladies and let me tell you, they are amazing.

Longevity began in the fall of 2016, with the realization that there was a need in the community for safe, appropriate and effective exercise programming for older adults.  In the clinic, I saw that a lot of my older patients were having difficulty maintaining their strength and function as the years went on.  Conditions such as osteoarthritis and osteoporosis often left them feeling as if their bodies were no longer their own – afraid to get active, unsure of what to do and, as a result, becoming or remaining more sedentary.  Unfortunately, this only exacerbates the decline.  We hurt, so we move less.  And when we move less, we get weaker which makes it harder to move and then we get more pain.  Bones deteriorate, balance suffers and falls occur.  Sadly, this is often just chalked up to “aging”, as if there is nothing we can do.  Fortunately, that is far from the truth.

Recent research, including the ground-breaking work performed by The Bone Clinic in Australia, has demonstrated that strength training is both safe and extremely effective in older adults, including osteoporotic patients.  They have demonstrated that bone responds best to progressive strength training.   Although walking, swimming and aquacize are all wonderful activities, they do not provide the stimulus needed to adequately improve bone mineral density.  Additionally, they pale in comparison to the strength gains that can be achieved in the older adult with appropriate, supervised strength training.

But there is more to it than getting stronger and building denser bones.  We all want that, but what really makes me happy is when I hear my patient say she can now play with her grandkids because getting on and off of the floor isn’t so hard anymore, she can now pick up her grandchild, go up the stairs much more easily, and so on.  I see my Longevity ladies and I see the decline in their function is not only slowed down, but reversed.  They are getting stronger, fitter, moving better and they are having so much fun doing it.  We have a number of participants in their 70s, some with joint replacements, many with osteoarthritis and osteoporosis, and they are all making gains.    

The body does not stop listening to us as we get older, we tend to stop talking.  Whatever your starting point, today can be the beginning.  Let’s start the conversation.

Longevity is a registered program held out of CrossFit Leduc for adults over the age of 50.  The program is led by Physiotherapist, Teresa Waser and CrossFit Leduc Coach/Owner, Brad Bendfeld.  Teresa also provides physiotherapy and personal training at her new clinic, RX Physiotherapy.  More information can be found at rxphysiotherapy.com and crossfitleduc.com.