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 4^th decade of life and progresses steadily, with up to HALF of our muscle mass typically being lost by the time we reach our 80^th 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.

Don’t Let Medical Imaging Get You Down!

In today’s day and age, medical imaging technology is better than ever before.  We have x-rays, ultrasounds, CT scans, MRIs, bone scans, and the list goes on.  Indeed, technology now allows us to visualize internal changes within our joints and soft tissues.  We can detect if the rotator cuff tendons in your shoulder have been torn, if the discs in your back are bulging, and if osteoarthritis has developed in your joints.  So, with all of this available, why are medical professionals often hesitant to refer you for imaging?

Part of it is time and money.  Most of us already know that medical imaging is costly to our health care system.  Additionally, wait times for imaging can be painfully long.  Consequently, to save healthcare dollars and avoid bogging down the system with any unnecessary referrals, physicians are tasked with only referring those who truly need imaging.  But there is more to it than saving money and keeping wait times down.  In some cases, imaging is just not needed nor helpful.

Now, make no mistake, medical imaging is invaluable in cases where we need to rule out serious injury or disease, such as fracture, dislocation, severe third degree tears, and malignancy.  Your medical team relies on this information to make decisions such as whether you need something like casting or surgery, additional tests, or referral to a specialist.  However, in the absence of anything serious, medical imaging is often not necessary and may actually be detrimental in some cases as imaging results may not be clinically relevant.

The fact is, there is poor correlation between imaging findings and clinical presentation.  This means that how bad something looks on imaging does not always dictate how much pain or restriction the patient will experience.  A patient with severe osteoarthritic joint changes on x-ray may have minimal pain and stiffness while a patient with minor changes may be significantly impaired.  Additionally, a lot of asymptomatic people have positive findings on imaging.  For instance, a 2014 study published in the American Journal of Neuroradiology demonstrated that when individuals with NO back pain were put through a CT scan or MRI, a startling percentage were shown to have disc degeneration and disc bulging.  In 20 year olds, the number was 1 in 3.  By 50 years of age, 80% had disc degeneration and 60% had disc bulging – and again, these were people with NO back pain.

This phenomenon is not limited to the back.  In the shoulder, MRI studies have shown that in those 60 years and older with NO shoulder pain, 50% had rotator cuff tears that they were not aware of.  This occurs in other areas of the body as well. 

So, if degenerative changes and tears can be present without pain or dysfunction, then these findings must be interpreted with caution.  Their presence may just be an incidental finding and they do not necessarily dictate why you are having pain nor your prognosis.

Additionally, if the results of medical imaging are not likely to change your medical management, it’s sometimes better not to know.  Studies have shown that once someone has been given a label of abnormal findings (which may in fact be irrelevant), they are more likely to suffer longer duration of pain, more disability, and a poorer sense of wellbeing.  This makes sense.  We hear someone tell us that we have “disc bulging”, “degeneration”, “osteoarthritis”, and so on.  Hearing this can be very scary and can be accompanied by feelings of finality and hopelessness.  These feelings can make us less likely to stay active and seek treatment, which is usually to our further detriment.

If you have had medical imaging that demonstrated findings such as osteoarthritis, tears, or disc bulges, my best advice is to see a Physiotherapist.  These findings may or may not be clinically relevant, but in any case, we can show you what you can do to improve your strength and mobility to help you lead your best life.

Teresa Waser

RX Physiotherapy