In the last decade in an attempt to make office work more healthy there has been mass proliferation of standing while working on the computer (see our blog on how to set up your office workstation here).  Granville Physio's very own therapist, Jim Bowie, not only has a degree in Physiotherapy but also studied biomechanics extensively at SFU and worked as an ergonomist at Humantech the world's largest ergonomics consultant firm.  His suggestions for standing at work is to try to alternate between sitting and standing multiple times per day.  Jim says "ideally as humans we would be switching positions several times per hour but that's not really all that practical so I'd recommend 2-3 hours out of an 8 hour shift in 3-4 standing spells.  Unfortunately for students it's even harder to spread out those spells as they're often forced to sit on the way to school, while at lecture, and also while studying.  They're also more constrained for space and budget."

Enter the Anthrodesk's sliding standing desk converter.  It's a cost competitive $99 CDN solution that doesn't take up too much space on the desk.  Anthrodesk was kind enough to give us a unit so we could see if it was something we would recommend.  We had multiple users at Granville Physio take it apart and set it back up and the comments were consistently that it is easy to assemble (it requires no tools).  Additionally, it is light enough to easily pick up which is a benefit in places like a dorm room where if you need desk space you can lift up the desk converter and place it on your bed. 

Most importantly we need to talk about how it functions.  Once set up, we found that while the hinges for height adjustments are easy to access and use, it takes effort to move the platform upwards and requires removal of your device from the platform before adjusting.  While the desk converter provides ample adjustment for the keyboard level height, the monitor level height is more  constrained.   

As you can see in the photos below for the first individual at 5'2" there is about 4 more inches of height adjustment available for optimal monitor height off of a tablet.  She is able to have the desk converter at a good height for both her elbows and neck.  In the second picture you can see this 5'11" individual has the keyboard tray in a good position but the tablet height is still several inches below the ideal height.

 Having said that this is still light years ahead of the cardboard box method in terms of durability and providing extra space for items to be stored below and at the same height as the keyboard.  See below for the free but completely unergonomic method and the only slightly better $35 CDN option.

​Our final verdict was this is a great solution for the price.  This will work for those people on a budget with confined space.  So any parents looking for something for their kids in senior high or university this is a great idea.  Head over to: www.anthrodesk.ca/manual-desk-converter-black.html to purchase yours today.

Stand with your feet together and extend your arms in front of you at shoulder level, palms down. Take a step forward with your left foot, then kick your right leg up as high as you can, keeping it as straight as possible and trying to kick your hand with your toes. Continue, alternating sides for 20 steps. ​

Jog for 2 to 5 minutes. Follow up your jog with....

As Fido is demonstrating above, everyone enjoys a good stretch. Typically, we feel more relaxed and our movements feel less restrained. In order to reap the benefits of stretching, you need to do it correctly. Here's what you need to know about stretching the right way and at the right time so you can enjoy all the outdoor activities Vancouver has to offer!

For almost all cases you want to hold your static stretches for 15-30 seconds.  That's because during this time frame you're causing change in the contractile portion of the muscle.  This is not going to cause the same permanent change that longer holds would in the non-contractile muscle component, ligaments, and joint capsules but it also won't cause any instability in the joint or overly stress the joint surfaces.  Additionally, research shows that if you're changing the non-contractile component you increase your chance for injury immediately following stretching. ​

To know if you need to do longer holds all you have to do is ask yourself if after doing dynamic warmups before activity and static stretches after you still feel tightness or restriction.  Alternatively if during your normal daily routine you may also feel tightness or restrictions doing simple movements like putting your coat or socks on.  At Granville Physio we'll be able to assess which joints have restrictions and what stretches would benefit you the most!

Although some dynamic movement may be required for certain stretches, bouncing into and out of stretches can cause injury and should be avoided! ​

With the exception of stretches that restore joint mechanics or alignment you should only do dynamic stretches before activity.  Ideally, you've worked on the mechanic and alignment issues at other times and don't need to work on them before activity.   Numerous studies show that as little as 90 seconds of dynamic stretching prior to an activity enhances performance and reduces risk of injury.  Dynamic stretching has a significantly smaller impact on flexibility when compared to static stretching though. 

Here is a link to our blog on how to perform a dynamic stretch routine: Lower Body & Upper Body coming soon!

Did you know just from moving your wrist back and forth the ulnar nerve moves on average 14mm at the point of your funny bone?  Sometimes tight nerves are responsible for pain, numbness, tingling, and tightness that doesn't go away with stretching.  This is where you could use guidance from one of Granville Physio's experts to make sure all your nerves move correctly. ​
We now know that the nervous system controls our flexibility much more than we thought.  Part of the limits of our flexibility is how much our nerves “put the brakes on” to protect our tissues from damage by excessive length or tension.  This is part of our “danger” mechanism.  There are receptors in our muscle spindles (muscle cells) and golgi tendon organs (stretch receptors in our tendons) that provide feedback to the nervous system and constantly drive a certain amount of tension that resists excessive length in the muscles.  Remember your muscles do not do anything by themselves – they need the brain and the nerves to tell them what to do.  When people are under general anesthetic (and their neural drive is turned right down) – suddenly they have excellent flexibility! Stretching is now thought to inhibit that neural drive, or modulate the “danger” response. 

References:
​Small, et al. (2008). A systematic review into the efficacy of static stretching as part of a warm-up for the prevention of exercise-related injury.Research in Sports Medicine, 16(3), 213-231.
 
Lauersen, et al. (2014). The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. British Journal of Sports Medicine, 48(11), 871-877
 
Konrad & Tilp, (2014). Increased range of motion after static stretching is not due to changes in muscle and tendon structures. Clinical Biomechanics, 29(6), 636-642
 
Schroeder et al., (2015) Is self myofascial release an effective pre-exercise and recovery strategy? A literature review.  Curr Sport Med Rep 14,  200-208
 
McHugh & Cosgrave, (2010). To stretch or not to stretch: the role of stretching in injury prevention and performance. Scandinavian Journal of Medicine & Science in Sports, 20(2), 169-181.
 
Amako M, Oda T, Masuoka K, et al. (2003) Effect of static stretching on prevention of injuries for military recruits. Mil Med. ;168:442-446


Bacurau RF, Monteiro GA, Ugrinowitsch C, Tricoli V, Cabral LF, Aoki MS (2009) Acute effect of a ballistic and a static stretching exercise bout on flexibility and maximal strength. J Strength Cond Res 23:304–308
Bandy WD, Irion JM, Briggler M (1998) The effect of static stretch and dynamic range of motion training on the flexibility of the hamstring muscles. J Orthop Sports Phys Ther 27:295–300
Beedle BB, Mann CL (2007) A comparison of two warm-ups on joint range of motion. J Strength Cond Res 21:776–779
Behm DG, Chaouachi A. A review of the acute effects of static and dynamic stretching on performance. Eur J Appl Physiol 2011: 111: 2633–2651.
Behm DG, Bambury A, Cahill F, Power K. Effect of acute static stretching on force, balance, reaction time, and movement time. Med Sci Sports Exerc 2004: 36: 1397–1402.
Christensen BK, Nordstrom BJ (2008) The effects of proprioceptive neuromuscular facilitation and dynamic stretching techniques on vertical jump performance. J Strength Cond Res 22:1826–1831
Covert CA, Alexander MP, Petronis JJ, Davis DS (2010) Comparison of ballistic and static stretching on hamstring muscle length using an equal stretching dose. J Strength Cond Res 24(11): 3008–3014
Gelen E (2010) Acute effects of different warm-up methods on sprint, slalom dribbling, and penalty kick performance in soccer players. J Strength Cond Res 24:950–956
Jaggers JR, Swank AM, Frost KL, Lee CD (2008) The acute effects of dynamic and ballistic stretching on vertical jump height, force, and power. J Strength Cond Res 22:1844–1849
McHugh MP, Cosgrave CH. To stretch or not to stretch: the role of stretching in injury prevention and performance. Scand J Med Sci Sports 2010: 20: 169–181.
O’Sullivan K, Murray E, Sainsbury D (2009) The effect of warm-up, static stretching and dynamic stretching on hamstring flexibility in previously injured subjects. BMC Musculoskelet Disord 10:37–42
Papadopoulos G, Siatras T, Kellis S (2005) The effect of static and dynamic stretching exercises on the maximal isokinetic strength of the knee extensors and flexors. Isokinetics Exerc Sci 13:285–291
McMillian DJ, Moore JH, Hatler BS, Taylor DC (2006) Dynamic vs. static-stretching warm up: the effect on power and agility performance. J Strength Cond Res 20:492–499
Samuel MN, Holcomb WR, Guadagnoli MA, Rubley MD, Wallmann H (2008) Acute effects of static and ballistic stretching on measures of strength and power. J Strength Cond Res 22:1422–1428
Sekir U, Arabaci R, Akova B, Kadagan SM (2009) Acute effects of static and dynamic stretching on leg flexor and extensor isokinetic strength in elite women athletes. Scand J Med Sci Sports
Simic L., Sarabon N., Markovic G. Does pre-exercise static stretching inhibit maximal muscular performance? A meta-analytical review Scand J Med Sci Sports 2013: 23: 131–148
Torres EM, Kraemer WJ, Vingren JL, Volek JS, Hatfield DL, Spiering BA, Ho JY, Fragala MS, Thomas GA, Anderson JM, Hakkinen K, Maresh CM (2008) Effects of stretching on upper body muscular performance. J Strength Cond Res 22:1279–1285
Unick J, Kieffer HS, Cheesman W, Feeney A (2005) The acute effects of static and ballistic stretching on vertical jump performance in trained women. J Strength Cond Res 19:206–212

Lean Protein
Collagen is the most abundant protein in the human body and plays an important role in knitting damaged/torn tissue back together. This is especially important when healing cuts or incisions. Generally, it is recommended that people consume 0.8 grams of protein per kilogram of body weight but these numbers should increase after injury as demands for protein will be significantly higher. You should aim to get 1.5 to 2.0 grams of protein per kilogram of body mass.

Excellent lean protein sources include eggs, fish, turkey, legumes and beans.

Fiber
A common condition post-surgery is constipation. This is due to side effects of pain medications, anesthesia, dehydration, changes to diet, stress and reduced physical activity. To maintain healthy eliminations, it is recommended to drink plenty of water and consume foods that are high in fiber.
​
Prunes are a rich source of both soluble and insoluble fiber which softens and adds bulk to stool.
Other foods include beans and legumes, apples, pears, bran flakes, oatmeal and flaxseed meal. 

Fermented Foods
It is standard protocol to be given antibiotics as a preventative measure before or during and sometimes after surgery. Antibiotics kill both pathogenic and beneficial bacteria in our digestive system. The problem with this is that since 75-80% of natural immunity resides in our digestive system, this actually reduces our natural protective barrier.
​
There are foods rich in probiotics and digestive enzymes you can eat to help keep your immune system integrity strong. Some of these include:

• Yogurt
• Kefir (both dairy and water)
• Apple cider vinegar or other traditionally fermented vinegars
• Naturally fermented vegetables; sauerkraut, kimchee
• Fermented beverages; beet kvass, kombucha
• Fermented bean and legumes
• Naturally fermented chutneys and salsas
  
• Additionally, companies such as AOR provide well researched solutions to combat bad intestinal bacteria (fighting bacteria with bacteria) and good bacteria in the form of probiotics. 

Deeply Coloured Fruits
The body is under constant oxidative stress but the stress of surgery or an injury, in addition to the drugs used during and after the procedure, further increases the stress placed on the body through free-radical production. Your body will naturally utilize antioxidants to combat these harmful molecules but the demands will be much higher post-injury or surgery.

Antioxidant intake can be substantially increased by eating deeply coloured fruits such as strawberries, raspberries, blueberries, cherries, and pomegranates. These fruits contain anthocyanidins, which are compounds that enhance the effects of Vitamin C, as well as improve the integrity of your capillaries and stabilize collagen.

Vegetables & Orange-Coloured Fruits
Vitamin A is needed by the body for the repair and maintenance of soft tissue, mucus membranes, and skin and is thus, important when dealing with an injury.

Sweet potatoes, carrots, darky leafy greens like kale are excellent sources of beta carotene, or pro-vitamin A, which the body converts into Vitamin A as needed. Orange-coloured fruits such as cantaloupe, mango, and dried apricots are also exceptional sources of beta carotene.

Bell Peppers & Citrus Fruit
Vitamin C is a water-soluble vitamin that helps to cross-link collagen. As mentioned previously, collagen is a crucial protein to proper wound healing, especially if you have had an incision during surgical procedures. Stress also depletes Vitamin C stores so increasing your intake is highly recommended after surgery (up to 900 mg per day).

Excellent sources of Vitamin C are bell peppers (340 mg per medium pepper), papaya, broccoli, strawberries, citrus fruit, kiwis, and broccoli.

Cruciferous Vegetables
There is always the risk of infection after surgery and the best protection is to build up your immune system. Phytonutrients are natural compounds found in plant foods such as vegetables, fruit, whole grain product and legumes. There are many different phytonutrients and they have been shown to possess antioxidant properties, act as antibacterial or antiviral agents, and have positive effects on the immune system.

Foods rich in phytonutrients include dark green leafy vegetables (such as spinach, kale, bok choy), cabbage, brussel sprouts, and cauliflower.

Nuts & Seeds
Zinc is necessary for proper immune system function. The body requires zinc to develop, mature and activate cells that are integral to the process of immunity. Furthermore, zinc is essential for wound healing as it is integral to protein synthesis and cell growth.

Sesame seeds, squash and pumpkin are excellent sources of zinc. Oysters have the highest concentration of zinc and red meats have some incredibly high concentrations as well. 

Inflammation & Eating
In a healthy body, inflammation is a normal and effective response that promotes healing. However, sometimes inflammation persists on a daily basis even when you are not injured or ill. This is when inflammation can become a problem. Many major diseases such as cancer, heart disease, diabetes, arthritis, depression, and Alzheimer’s, have been linked to chronic inflammation.

Studies have shown that certain foods and beverages have anti-inflammatory effects such as tomatoes, olive oil, green leafy vegetables, nuts, fatty fish and fruits. Conversely, there are some foods that can promote the inflammation response and should be limited as much as possible. These include refined carbohydrates (such as white bread and pastries), fried foods, soda and other sweetened beverages, red meats, processed meats, margarine, shortening and lard.

While dizziness remains one of the most commonly diagnosed issues by physicians in North America for aging populations, it is not a normal part of aging. Commonly referred to as "dizziness," issues with balance, vertigo, or spinning can actually arise from issues in the inner ear or the visual system. Dizziness or a lack of balance, can lead to issues that drastically affect quality of life. It can affect your ability to go to work, it can cause falls, or even make basic functional activities such as walking or getting out of bed seem difficult. 

Here is a video to help explain how the inner ear works: http://www.granvillephysio.ca/other-conditions.html

What is Benign Positional Paroxysmal Vertigo (BPPV)? 

BPPV is the most common cause of vertigo in the aging population. It causes dizziness or spinning with rapid positional changes such as moving/turning the head or getting up and down. BPPV gives you the feeling that the room or environment is spinning around you. 

BPPV is caused by problems in the structures of the inner ear. The inner ear has canals containing fluid that end in a structure called the cupula. When you move your head, fluid flows freely in your cupula and helps you determine where you are in space. BPPV is when small sand-like particles from the vestibule in your inner ear become detached and tell the fluid that you are in a different place than you actually are. It can cause vertigo immediately or shortly after head movement.

What is Vestibular Rehabilitation?

During Vestibular Rehabilitation the cause of dizziness/vertigo is determined by assessing eye movements, balance, posture, aggravating movements, or visual system influences. Information such as medical conditions, medications, and prior history are taken into account for their involvement in exacerbating the condition.

What kind of treatment can I expect during Vestibular Rehabilitation?

You will be given a customized treatment plan consisting of manual techniques within the clinic, at-home exercises, or home-care principles. During the assessment, symptoms may be exacerbated but your treating therapist will guide you through the process. 

If you are suffering from vertigo, spinning or dizziness and you are unsure of the cause, don't wait to get assessed. You will be surprised that such delicate structures of the inner ear can have such a profound effect on your quality of life.  Book today with Graville Physio's Inner Ear specialist Brendon Ip.

​"Sitting is the new smoking."

It's a drastic statement, but it has caught much attention and popularity in recent years, as study after study has shown the drastically negative impact that sitting has on our overall health (read a few by clicking here or here). While simply sitting for less time may seem like the easy answer, unfortunately for a lot of us, sitting at a desk comprises a large portion of our work week.

In fact, we are willing to bet that you are sitting at a desk - whether your work station or at home - right now as you read this. If you are, freeze! Don't move! Take a moment to investigate your positioning right now, simple things like how far away from the computer you are, or where your mouse and keyboard are in relation to you. While sitting may not always be avoidable, we have five easy adjustments that you can make, to help reduce the negative impact your desk habits may be having on your health. 

How many of our five key workplace habits do you think you are guilty of?  Read on below to find out, and to see what our physiotherapists recommend to help alleviate these problems.

In our previous article explaining the causes and symptoms of Achilles tendinopathy (click here if you haven't seen it yet!), we did not address treatment options for individuals suffering from particularly stubborn or severe cases of Achilles tendinopathy. If traditional treatment options or previous physiotherapy sessions have not helped to treat your injury, we believe we can help you here at Granville Physio.

​We are excited to be able to offer our patients Shockwave Therapy, a newer treatment option that has shown incredible results in the treatment of Achilles tendinopathy, amongst other conditions. Intrigued? Read on below to learn how Shockwave therapy works, and what makes it so effective in treating Achilles tendinopathy. If you would like to book an appointment for Shockwave therapy, click here for access to our online booking system!

​We've discussed before the symptoms of Achilles tendinopathy, and what potential factors may be contributing to your injury (click here if you missed that article, or would like to read it again). However, sometimes simply treating the calf is not sufficient. For conditions caused by deep-rooted dysfunction, a treatment option called IMS (intramuscular stimulation) is a fantastic alternative that yields immense relief. 

Whether you're hiking the mountains of Vancouver or going for a walk in Richmond it would be tough to do it without your Achilles.  The Achilles is the thickest tendon in the human body, it attaches the calf muscles to the calcaneus (heel bone), and is responsible for plantar flexion at the ankle (pointing your toes). 

​As we perform activities that use our Achilles tendon, small "micro-tears" occur within the tendon band. This process is completely normal, and occurs in our body when most movements are performed. Our body is constantly repairing the microtrauma that results in our tissues when we move, and in a healthy body these tiny injuries are healed at approximately the same rate that they occur.

However, if this cycle of microtrauma and repair in the Achilles tendon becomes unbalanced, Achilles tendinopathy may result. Over time, these microtraumas accumulate in the tendon, until major injury and dysfunction force a halt to normal movements and activities. Achilles tendinopathy is described as pain, swelling, stiffness, and weakness in the Achilles tendon, and is exacerbated by any movements involving the Achilles tendon (as described above).
  

A number of factors can contribute to the damage leading up to Achilles tendinopathy, such as:

• Overuse of the Achilles (the most common cause, and often seen in runners, dancers, or athletes that do a lot of jumping)
• Wearing inappropriate footwear
• Exercising and/or training with poor technique and alignment
• Increasing intensity of exercise
• Issues with one of or all three arches
• Inappropriate use of toe muscles for propulsion or stabilization
• Poor flexibility

If you are experiencing any sort of stiffness or pain in the Achilles region, it is very important to have your injury assessed and treated accordingly, as ignoring the signs of Achilles tendinopathy can result in a complete rupture of the Achilles tendon. However, here at Granville Physio we have a variety of successful treatment options for Achilles tendinopathy, such as shockwave therapy and IMS treatment. Click here to book in with one of our physiotherapists today, and treat your injury before a tendon rupture occurs!


Below, you can also find four of our favourite exercises for the stretching and maintenance of a healthy Achilles tendon. We recommend performing these exercises regularly, especially when heavy exercise is performed or tightness in the Achilles is experienced. As always, if you have any questions, we are happy to assist you. 

Poor posture and alignment places unnecessary stress on our bodies, and while most people are aware of what "good posture" looks like, it can often be very difficult to overcome our bad habits and adopt a correct position. We've compiled a quick list of our favourite exercises for correcting posture. The best part? They are quick, easy, and can be done anywhere from your home to the workplace. Try incorporating these exercises into your daily routine, and you'll be amazed at the postural improvement you see! 
​

We love it because... It targets extension (bending backwards) in the area of the mid-back that people tend to keep mostly flexed (especially when sitting)! 

We love it because... It relaxes the spine, increasing mobility and strength in the vertebral joints.

We love it because... It lengthens shortened pecs, which can put strain on the back muscles and cause the shoulders to pinch the rotator cuff tendons. Lengthening the pecs makes it easier to hold the shoulders back in a correct posture, and feels great too! 

We love it because... Many people have an anterior pelvic tilt, and this exercise will lengthen the hip flexors and allow for a more extended, upright posture. 

We love it because... It opens the front of the chest, encouraging the shoulders to press back into correct postural placement. Granville Physio's Damien Wild recommends saving this exercise for last, as a tool to fine-tune your postural improvement! 

If you are struggling to perform any of the above exercises, or would like more exercises/advice for your posture or any pains you've been experiencing, our physiotherapists at Granville Physio are here to help. Click here to book in with James, Damien or Jim today!