It’s common to think that pain not only has a physical aspect, but that it’s also “in our head.” We often believe that we can modulate pain according to our state of mind or our will. But what does this really involve?
The brain, an extraordinary computer, with just a few flaws
In fact, it’s both true and false. The brain is an incredible machine that has the power to send commands for action and for feeling to the entire body. Its function is to control and to protect. It controls your muscles, allowing you to walk, move, smile and talk. These actions made are possible because the brain receives information from the outside (the immediate environment) which it analyzes and integrates in order to respond to it.
We have five senses: smell, hearing, taste, sight and touch. When the body is injured, an emergency system, which we call inflammation, takes over. The brain then orders the management of the emergency by sending chemical mediators to control the inflammation and thus to promote healing. A normal process of protection.
The brain doesn’t really know the difference between physical and psychological pain. For example, stress leads to more rapid breathing, sustained muscle contractions (e.g. trapezius muscles), certain facial expressions and a higher heart rate. This puts the body in a situation similar to a physical injury. The brain then sends comparable signals, without really identifying the original trigger.
The social environment, something not to be neglected
If we return to the concept that our brain collects information from our environment in order to respond to it, the contexts and situations in which we live can greatly influence the creation and/or aggravation of pain.
Take, for example, a person on medical leave from work whose relationship with his/her employer is very tense or who has a significant fear of being injured again when returning to work. The brain perceives this to be a dangerous situation, thus triggering or intensifying the body’s protective reactions. In order to manage the threat, the brain will send chemical mediators similar to those it sent during the original physical injury.
Let’s take the opposite example now of a person who has a “healthy” relationship with pain, for example, someone who gets injured while playing a sport he likes. When he feels an increase in pain following a new activity or exercise, he perceives this as a sign of making progress and he may even experience “pleasure” as a result. Not knowing the difference, the brain will send chemicals (endorphins, adrenaline) to relieve the kind of pain caused by strenuous activities, such as sports.
It’s all about perception
Studies show the importance of the psychosocial environment in the presentation of pain. It’s not enough to just heal a wound, the person, and the experiences that come with that person, have to be treated. This can make all the difference when it comes to recovery and avoiding chronic pain.
Never underestimate your mental health at the expense of your physical health, the two go hand in hand! You have to talk about it, you have to act so that your brain reacts appropriately and in your favor.
You have several bikes and want to be fitted for each one? You had a fitting for one of them, but would like to transfer the measurements to a second one? Be aware that different types of bicycles vary considerably in fit.
For bicycles with more similar geometries, such as road bikes and gravel bikes, the fitting will be done by considering the goals and expectations of the cyclist. The length of the outings, the type of terrain, and the level of performance sought for each bicycle are some examples that will determine the chosen fit. It is therefore possible that the measures for both bikes are similar and require only a few specific adjustments.
Road bike VS mountain bike
However, when we are comparing a road bike to a mountain bike, there are more variables to be considered. In fact, these bicycles have several different characteristics. First, the geometries of mountain bikes differ greatly from those of road bikes, because the playing fields are very different. In addition, mountain bikes are equipped with one or two suspensions of varying length. This equipment changes the position of the cyclist since it can be more or less compressed, depending on the force applied. The positioning will therefore be different depending on the type of mountain bike used by the cyclist. A good climber will not have the same position as another one practicing only descent.
Moreover, since the terrain in the mountains is very variable, it is difficult to position the cyclist for all situations. The fit will therefore aim to optimize the positions most often taken during rides.
Thus, the clinical reasoning of the physiotherapist, depending on the needs of the cyclist, will influence the adjustments on the bicycle. For these reasons, measurements on the road bike will probably not be transferable to the mountain bike.
To improve your comfort and performance with a bike fit, make an appointment with Émile or Carolanne, our physiotherapists trained by BikePT Bronze at our clinic in the Sherbrooke Jacques-Cartier neighborhood.
Are you a seasoned or novice triathlete? Do you experience pain, discomfort or numbness during your bike rides? Did you know that your positioning could have a big influence on your comfort, as well as performance levels?
In fact, the positioning on a triathlete’s bicycle facilitates the transition from bicycle to race (T2), increasing comfort for the cycling portion and optimizing the efforts exerted by the legs. The adopted position differs from that of the road bike mainly through the addition of aerodynamic bars and a more advanced positioning on the bike. Your physiotherapist will take these into account when making adjustments for your evaluation.
What’s the assessment?
The assessment and positioning will nonetheless follow the same steps as for a road bike, the functional and specific biomechanical assessment of the cyclist, positioning on the bike and personalized exercises according to known limitations. Everything will also be adapted to your current physical conditions and past injuries. Depending on shoulder, core, and leg flexibility, the positioning will be adapted to meet the cyclist’s unique needs and goals.
Because the biking portion comes after swimming, the shoulders have already been under considerable stress.As such, the arms must support the cyclist’s comfort and breathing, while aiming to streamline the profile and reduce wind resistance.
Don’t hesitate to consult our physiotherapists Émile and Carolanne, who offer cycling positioning evaluations at our Sherbrooke clinic in the Jacques-Cartier sector, before you start your season!
Simply put, bruxism is excessive, repetitive teeth grinding or jaw clenching. This excess pressure can cause pain in muscles and teeth. It can even lead to a tooth shattering. The jaw joint also suffers from this severe pressure, leading to premature wear of the articular surfaces. It is possible to engage in awake (or diurnal) bruxism or sleep (nocturnal) bruxism, with or without perceptible noise.
Moreover, this condition can lead to a limited range of jaw opening mobility, which limits food options and can cause headaches. These signs and symptoms generally appear upon waking up or after a meal.
The Most Frequent Causes
Asymmetrical occlusion, or imperfect contact among the dental surfaces, is one of the main causes. The jaw is always in search of “perfect” occlusion. Poor occlusion can result from the dental morphology, a needed repair, or a missing tooth, which reduces the contact surface for chewing. This inconsistency can also cause uneven muscle strength, which may lead to bruxism.
Stress is a possible cause of bruxism. One manifestation of stress is the presence of para-functional habits (tics) involving the mouth, such as nail-biting, jaw-clenching, and excessive gum-chewing. All of these actions subject the jaw to asymmetrical force, which leads to exaggerated, inappropriate demands on the muscles.
Poor neck posture can be the source of inappropriate muscle tension. Neck posture affects head position, changing the contact point between the skull and the mandible (jawbone). This can, in turn, cause a change in articular pressure, impairing masticatory strength. As a result, the active muscles (primarily the masseter, temporal, and pterygoid muscles) are not optimally aligned and work asymmetrically.
Treatment and Prevention Options
If you suffer from bruxism, the first professionals you should consult are your physical therapist and your dentist.
Getting an oral health check-up to optimize your occlusion will be an important first step. If you wear dentures, your denturist will be have a role to play in your rehab process. In some cases, particularly if you have sleep bruxism, a biteplate may be an option.
Your posture, muscle tension, and the joint integrity of your jaw will need to be evaluated. With that information, we will be able to analyze the issue and choose from a variety of treatment approaches:
- Internal and external manual therapy techniques: massage and joint mobilization;
- Analgesic methods including ultrasound;
- Posture and pain management recommendations;
- Lifestyle recommendations: para-functional habits, eating (chewing, mouth opening);
- Specific exercises;
- Acupuncture (with needles) in physical therapy is useful in some cases
- Orofascial and cranial approach
Bruxism is a multifactorial condition. That is why effective communication between health care professionals is such a high priority. Don’t hesitate to ask questions of your physical therapist or your dentist.
Transcranial direct current stimulation (tDCS) is a non-invasive method that stimulates the brain with electrodes placed on the scalp. An low-intensity electrical current circulates from one electrode to another, which allows the excitability of brain cells to be changed and persistent pain to be reduced.
During treatments, healthcare professionals use carbon electrodes which are inserted into sponges that are moistened with a saline solution. The electrodes are then deposited on the scalp and held in place with straps. The cathode is placed in the motor cortex (right or left, from the opposite side of the patient’s main pain) and the cathode on the forehead, on the opposite side. Approximately 50% of the current emitted by the device (2 mA) reaches the brain tissue. The rest of the current dissipates at the level of the skin and bones of the skull. The current enables cortical excitability to be adjusted in certain regions of the brain in order to stimulate the mechanisms of pain deceleration.
The increase or decrease in excitability can vary according to the protocol and installation of electrodes: the anode allows for an increase and the cathode, a decrease.
Who should use tDCS?
These treatments aim to reduce chronic pain, including:
- Nociceptive pain (ex.: persistant musculoskeletal injuries)
- Neuropathic pain (ex.: post-AVC pain, radiculopathy)
- Mixed pains (ex.: lombosciatalgia)
- Functional pain (ex.: fibromyalgia)
In practical terms: quite a few!
A tDCS session in physiotherapy lasts about 45 minutes, including the installation of electrodes, 20 minutes of stimulation, and 15 minutes of therapeutic exercises. Everything is repeated for 5 consecutive days. The increase in cortical excitability produced by the stimulation can last longer than the duration of the stimulation. It is therefore essential to take advantage of the post-stimulation effect to complete therapeutic exercises. Relief from pain is generally perceived after 2 or 3 sessions, and its effect tends to increase after 5 sessions, and in the weeks following the treatments.
You do not need a medical prescription to have access to tDCS treatments. Contact can be made with your family doctor or referral (specialist) to inform them and follow up on the treatment via courrier.
Patients must first be evaluated by a physiotherapist in order to learn if tDCS applies to their condition. Some contraindications exist, such as:
- Previous surgery on the head
- The presence of a brain tumor
- The present of neurological or neuropsychiatric disorders
- The presence of metal plates on the skull (excluding fillings)
- Wearing stimulators or electronic implants (ex.: pacemaker)
- Suffering from epilepsy or having suffered recent or severe cranial trauma
Potential adverse effects of tDCS treatment:
- tDCS generally does not cause adverse effects; when these do occur, they remain minimal (light headaches and fatigue) and short-term
- The tDCS treatment is not painful
tDCS could be for you if:
- You have persistant pain
- You would like to find something to complement medication to treat your pain
- You would like to improve pain management in order to optimize your physical capabilities
For more information, don’t hesitate to reach out to one of our physiotherapists: Amélie Boucher, Catherine Apinis, and Guillaume Léonard would be happy to discuss this treatment option with you.
First, let’s get our definitions straight!
What exactly is a “trigger point”? Simply put, a trigger point is defined as a hyperirritable spot found along a taut band of muscle. The trigger point may cause pain following compression, stretching, or excessive or lengthy stimulation. Each muscle has areas that are predisposed to trigger points; it is even possible to find several of them in the same muscle. A trigger point may be active or latent. In other words, it may or may not reproduce the patient’s pain upon consultation. Aside from the localized sensitivity, active trigger points can produce referred pain in specific, but distant, areas of the body. This radiating pain can be experienced as either pain or weakness.
In addition, it is possible to experience discomfort or pain exclusively within the muscle’s radiation area. However, it is essential to treat the pain at its source: the muscle associated with that radiating pain.
Here are the areas commonly linked to a trigger point in a nearby muscle.
|Area where the pain is experienced||Associated muscular trigger point|
|Teeth||Mastication muscles in the jaw, including the masseter and temporalis|
|Temple and eye||Trapezius muscle|
|Line from the shoulder down toward the elbow and back of the hand||Rotator cuff muscles: supraspinatus and infraspinatus|
|Hip and sacrum||Piriformis muscle|
|Behind, back of thigh, calf||Gluteal muscles|
|Bottom of foot and heel||Calf muscles: soleus|
What can cause or sustain this type of condition?
The development mechanism behind trigger points is still poorly understood. However, the creation of these areas of tension is often linked to a lack of oxygen in the muscle tissues following excessive demand (such as a repeated muscle contraction or a posture held at length), resulting in muscular fatigue or pain. A direct impact or a muscle strain could also lead to this type of pathology, both during the inflammatory phase and during tissue remodeling in the presence of scar tissue adhesions.
This means that trigger points can develop in any number of everyday situations: an intense workout, sub-optimal posture at work, an awkward movement, or even the wrong sleeping position.
What treatments are possible?
The primary goal is to reduce muscle tension and promote better circulation locally.
Here are a few treatment options used in physical therapy:
- Massage, rubbing, friction;
- Dry needling;
- TENS (electrical nerve stimulation);
- Advice (posture, lifting);
- Modification of duties at work.
What can we do in terms of prevention?
- It’s all a matter of balance between strength, endurance, and muscle flexibility. Proper balance between each muscle and its opposing muscle (for example, the biceps and triceps) is important as well.
- Don’t forget to warm up prior to physical activity and to cool down after your workout.
- Modifying your duties at work and your sleeping position can be essential elements of prevention.
- Getting prompt treatment for trigger points also helps prevent compensation and allows you to avoid developing secondary pain.
Karate is a Japanese martial art. Depending on the style of karate practiced, the karateka (karate practitioner) will learn different techniques for warming up, physical training, strikes, self-defense, fighting and Katas (execution of techniques/movements against a fictitious opponent).
In karate, which muscle groups are most used and how can we train them?
All the muscles in our body are used, but more specifically the muscles of the legs (calves, quadriceps, hamstrings and glutes) and abdominal and dorsal regions. Indeed, the motions and techniques are initiated in the legs and the strength exerted from the ground is transmitted to the whole body. Good core stability will also help the karateka improve his/her stability and balance during different techniques.
Since karate requires power, speed, endurance and balance, muscle/physical training will be geared toward these components to enable the karateka to increase his/her efficiency. Acquiring these elements will also enable the karateka to improve his/her posture and facilitate all the physical tasks performed daily (e.g., transporting/lifting loads, static endurance)
What are the most common injuries when practicing karate and how are they treated?
Depending on the style of karate practiced (with or without limited contact during fighting), injuries may vary. The most common injuries occur in the wrist/hand/fingers as a result of multiple strikes (sprain and fracture), the ankle (sprain) and the knee (sprain, pulled muscle). Because of the blows that are dealt, bruised muscles and even a concussion may also be seen.
SPRAIN : pulled ligament. The severity of the injury depends on the grade of the lesion and proportionally influences the prognosis for recovery.
Signs and symptoms:
- Restricted mobility with or without a limp in the case of a sprained ankle or knee
- Diminished balance (stability)
- Managing pain and inflammation: Ice, elevation, compression bandage, rest, electrotherapy and crutches are a few relevant treatments
- Restoring joint range and flexibility: manual therapy and mobility exercises and stretching
- Increasing muscle strength and proprioception: strengthening and stability exercises
- Gradual return to activities and sports: Training tips and progress.
CONCUSSION : traumatic brain injury caused by an external force, resulting in injuries such as an impaired state of consciousness and cognitive, behavioral and physical disabilities.
Signs and symptoms:
- Fatigue/sleep disturbance
- Dizziness/vertigo, feeling slow
- Concentration or memory disorders
- Blurred vision, sensitivity to light or noises and emotional lability.
When an injury occurs, it becomes a good idea to talk to your physical therapist quickly in order to have a detailed assessment of the problem, to determine a treatment plan and to seek appropriate advice for the situation to facilitate your recovery and your return to the sport.
- Initial rest period lasting at least 48 hours:
- Limiting intellectual activities that require concentration
- Fostering a calm environment
- Not participating in physical activities
- Not consuming alcohol/drugs
- Limiting driving
- Protocol for a gradual resumption of intellectual activities
- Resumption of home activities over a short period of time (15 to 20 min)
- Gradual resumption of structured activities on a part-time basis (school/work/hobbies)
- Gradual resumption of structured activities on a full-time basis (with adjustment if necessary)
- Protocol for a gradual resumption of physical activities and sports (wait 24 hours between each stage), all as tolerated.
- Very light activities without increased symptoms (15 to 20 min)
- Light individual aerobic activities (20 to 30 min)
- Individual exercises specific to the activity/sport
- More demanding exercises/training (if no daily symptoms)
- Unrestricted training (medical authorization needed for contact sports)
- Return to competition
Did you know that one of our physical therapists, Jayson René, is a karateka himself? If you have further questions about this sport or about karate-specific physical training or to make an appointment with him, feel free to contact us directly at the clinic.
What is balance?
In short, the word balance can be defined as follows: “Symmetry of forces and energies that compensate each other to maintain a stable state. It is a state of rest obtained by the equality of opposing forces and weights, allowing one to control one’s position and movements so as not to fall.”
More specifically, our body has the following with which it maintains our balance:
Each muscle (agonist) has an opposing muscle (antagonist) that is responsible for performing the opposite action (for example, the biceps bend the elbow, while the triceps unbends the elbow). An imbalance of forces between an agonist and its antagonist can lead to long-term compensation, such as bad posture! The criteria that our muscles must fulfil to keep us balanced are:
- Force sufficient to perform a movement X, such as lifting a load, getting up from a chair or climbing a staircase.
- Endurance to support our body in a position X for a long time without compensating.
- Symmetry with its opposite muscle, to avoid an alteration of the posture. An adequate rest position minimizes the impact on the joints involved.
Thus, the role of our muscles is primarily to move us, but also to provide active support to our body through endurance and co-contraction with their opposing muscles.
Our ligaments are designed to stabilise our joints while our muscles work, whether during a movement or in a static position. They play the role of passive stabiliser. They have several receptors that measure the amount of stretch in a joint. These receivers allow them to warn our muscles in case of over-stretching so that they contract to restore the situation and maintain balance. An overload of tension on our ligaments can induce a tear of varying degrees, commonly called sprain.
Joint surfaces also have receptors, but are more sensitive to pressure. They evaluate the amount of pressure and its symmetry. As a complement to the ligaments, these receptors give complete information on the resultant forces submitted to the joint and allow our muscles to react. Uneven and / or excessive forces on a joint surface may cause irritation, leading possibly to inflammation and pain. This can result in ankylosis, premature degeneration, or even osteoarthritis over the long-term.
Our eyes and our brain
Finally, all this information is analyzed by our brain. This will then confirm whether we are in a state of imbalance and send the necessary commands to our muscles, via the nerves, to restore balance. In addition, our brain will process information from our eyes. It will take into account the horizontal level, as well as the rotation of our head (visual tracking, glancing). Finally, it will study the data transmitted by the inner ear (small crystals) that will confirm whether the movement is completed or not.
Balance is a much more complex concept than its initial definition. When one of the systems in the chain is damaged, impaired or incomplete, it will influence the speed and efficiency of the other systems to maintain our balance. An abnormality in any of these steps will result in the risk of injury, loss or impairment of our posture. However, bear in mind that all these elements can be exercised at any age to improve our balance.
A consultation with your physiotherapist will shed light on the source of the problem and give you the tools to recover.
Soon you will undergo total radical prostatectomy surgery, which involves removal of the entire prostate. In the vast majority of cases, men undergo this surgery due to the development of a malignant tumor of the prostate (cancer). The surgeon removes the prostate and with it the elements of the smooth sphincter it contains, the urethra that passes through and the seminal vesicles. Continuity of the urinary system is restored by suturing the bladder to the urethra. When you wake up, you will be wearing a urinary catheter. It is put there so the bladder can rest and to allow the suture between the bladder and the urethra to heal well. The nurse will usually remove this catheter 10 days after surgery.
When the nurse removes the urinary catheter, it is NORMAL that you will have some urine leaks initially, especially when changing position or through effort (coughing, blowing your nose, getting up from a chair…). It is therefore a good idea to prepare yourself with urinary pads when you go for your appointment to remove the catheter, and also for the next few days. These leaks are temporary and will reverse themselves within 6 weeks about 80% of the time. 90% of patients will be completely continent 4 months after surgery.
Any intervention at prostate level modifies sexuality. You will have discussed this beforehand with your surgeon. Where possible, without taking risks with the cancer, the surgeon will preserve the vessels and nerves that come into contact with the prostate and then feed and control the erectile bodies. Many patients retain their abilities and can have quality sexual relations. It can take between 3 or 4 months and 1 year before the satisfactory return of sexual function.
How can physiotherapy help you?
Pelvic-perineal physiotherapy treatment in patients who undergo prostatectomy generally reduces the intensity of leakage on removal of the urinary catheter, reduces the duration and intensity of leakage during the recovery period, and allows a faster return to an active life, including sexual relations. In addition, prompt post-op care is important: patients seen less than 3 months later are more likely to regain continence than those who wait before starting treatment.
Prior to surgery, the goal of the first physiotherapy session will, in addition to checking the risk factors for any possible pelvic dysfunction present, is to teach you to develop the voluntary musculature (striated sphincter) in order to replace the automatic musculature (smooth sphincter) as much as possible.
Following surgery, you will need to continue your exercises. At 6 weeks and then 4 months after your operation it is advisable to see the physiotherapist to ensure optimal function of your pelvic muscles. If problems persist, more regular monitoring could be considered.
Patience and perseverance will be your allies in the coming months.Remember that in the vast majority of cases, you will notice a gradual improvement during the first year, and the vast majority of patients regain excellent urinary continence and can return to their occupations, just as they were before!
Document inspiré de : Enseignement pré-opératoire pour l’opéré de prostatectomie radicale totale, clinique pelvi-périnéologie du CHUS, Sherbrooke.
Rajkowska-Labon E et coll (2014) Clinical study: Efficacy of physiotherapy for urinary incontinence following prostate cancer surgery, BioMed Research International, Article ID 785263, 9 pages http://dx.doi.org/10.1155/2014/785263
Bend down…but watch your back!
How many times have you heard about bending your knees when you lift? It’s true that bending your knees is important, especially when it involves lifting something – no matter how light. But why? A lack of support from the legs during this movement will overload your back, affecting the vertebrae, muscles, and adjacent nerves, including the sciatic nerve. Often, people repeat these movements a lot.
Thigh muscles (glutes, quads and hamstrings) are known to be strong and powerful. As such, they’re ideal for lifting loads over many repetitions. The stabilizing muscles of your back, on the other hand, should be used for endurance. They let you maintain a steady posture and aren’t designed for movement, let alone lifting! Everything’s a matter of physics: by not bending the knees, our body’s center of gravity shifts. The force of gravity is added to the weight of the load being lifted, greatly increasing stress on the spine.
Trades that involve a lot of load handling are more at risk. However, there are strategies to help you avoid sudden, excessive or asymmetric movements.
Neck, head, and shoulder aches…sitting has now become the professional standard.
Sitting in front of the computer has become ubiquitous in the era of technology. Indeed, statistics show that a growing number of workstations almost exclusively involve sitting in front of a screen. Although it seems harmless, prolonged sitting comes with its share of discomfort and injury. As such, it’s essential to set up one’s workstation appropriately. Proper screen height and orientation promotes a neutral position of the head and neck. Support is also needed for the forearms to avoid overload, which can cause muscular tensions to the shoulders, shoulder blades and neck. The back must also be supported, to maintain an ideal resting position.
Ask your physiotherapist about work-related pains. He or she will refer you to an occupational therapist (as needed) to evaluate and properly adjust your position.
Standing all day on a hard surface: sore feet! And there’s more…
Many jobs require standing for several hours on a hard surface (like concrete or asphalt). This sometimes involves extra preparation, like steel cap boots. Indeed, this position affects the feet first, where discomfort and pain can be felt. Beyond the feet, standing also involves the knees and menisci, hips and back. These bearing joints (which support our weight) help us move. Standing in a static position with little movement can be exhausting and lead to compensation, since it requires prolonged muscle contraction.
To unburden these joints, it’s important to maintain good posture in your legs and torso. Healthy stabilizing muscles (link to video exercises) will help: their contraction is weak, but sustainable. Vary the work positions according to your needs to avoid overload. Finally, make sure you have good shoes.
Twisting your back? Yes, but it’s going faster!
To save time, we sometimes work in torsion movements. However, torsional/rotational mobility is quite restricted compared to bending (leaning). The muscles that initiate rotation are small and have low stamina. During torsion movements, an asymmetric (left/right) force is created in the spine. The load is thus heavier on one side than the other. At the same time, the space where the nerve passes between each vertebra is reduced.
Considering these factors, it’s easy to see how a trivial twist can result in serious injury!
That’s why it’s recommended to work in front of you whenever possible. This means turning the body completely to face our work, whether we’re carrying a load or not.