Author: Peak Health Calgary

Written by Jordan Knapman, Physiotherapist 

 

Vestibular therapy, or vertigo treatment by a physiotherapist, is one of those topics that you likely don’t come across unless you or someone you know has been impacted by vertigo or severe dizziness. One of the most common misconceptions about vertigo is that it is something you ‘just need to live with’.

This is not the case at all! As a physiotherapist in Peak Health who is trained in vestibular rehabilitation, I can set that myth straight and say there is lots we can do to help you or your family member. Whether you are facing chronic dizziness, experience intermittent vertigo symptoms, or are unsure if what you have is even classified as dizziness, we are here to help. If you’ve been experiencing dizziness, or know of someone who has, you’ve come to the right place!

What is Vestibular Physiotherapy?

Vestibular Physiotherapy is a type of rehabilitation geared specifically for dizziness and balance. We have three senses that contribute to our balance and equilibrium, one of which is the vestibular system. This is a small organ in the inner ear that detects how fast we move our head position and in what direction. 

Often, when we have a problem with this organ we can have a sensation of spinning, which is referred to as vertigo. Since information coming from the vestibular system is combined with information coming from our vision and foot sensation, a Vestibular Physiotherapist will often look at all 3 systems to determine the best course of action.

Can a Physiotherapist Use Tests to Diagnose My Dizziness?

No matter the cause of dizziness or vertigo, the tests that are needed will often bring on symptoms. Most commonly, the Dix-Hallpike Test is used to test for a common type of dizziness. In this test, the Physiotherapist will lie down a person on the treatment table quickly, while looking for a specific type of eye movement while you wear special goggles with infrared cameras. 

Other tests may include balance with eyes closed on a foam pad, fast head movements, or even holding your breath! Unfortunately, these tests will often bring on similar symptoms to what you’ve been experiencing, as the Physiotherapist will need to determine what is responsible for your issue. This feeling is most often very short-lived and should dissipate quickly.

However, the most important test is your story as some problems cannot be tested for. A skilled Physiotherapist with training in Vestibular Rehab will spend time in careful discussion with you about what your symptoms feel like, how long they last, when they happen, and how they affect you. All of this allows the Physiotherapist to determine the most likely cause of your symptoms and determine the next steps to confirm their thoughts.

Does Vestibular Therapy Get Worse Before It Gets Better?

This is sometimes possible! Certainly, during treatment for one cause of vertigo, called BPPV, it is very common to feel worse both during and immediately after treatment. This subsides quite quickly, and most feel much better soon after. For other, more complicated causes of vertigo, it is possible to feel slightly worse during the first week of home exercises. 

Thankfully, not everyone experiences this and we know that it does not mean things are moving in the wrong direction! Your Physiotherapist would help in making this determination and adapt your treatment plan if necessary.

How Long Does It Take For Vestibular Therapy To Work?

As with any type of rehabilitation, this largely depends on the underlying cause of your symptoms. For the aforementioned BPPV, the most common cause of vertigo symptoms, may resolve in as few as 1-3 treatments. 

For most other vestibular causes rehabilitation may take an average of 6-12 weeks, depending on how long symptoms have been ongoing. Regardless of how long the dizziness has been occurring, Vestibular Physiotherapy can often make a difference (even if it takes a bit longer!).

So… Does Vestibular Therapy Actually Work?

Vestibular Rehabilitation can be very successful! For many vestibular conditions, Clinical Practice Guidelines mention that this therapy “provides a clear and substantial benefit” and has a “strong recommendation” when used appropriately. 

That said, while an improvement in symptoms is expected in the majority of cases, not everyone will achieve a complete resolution of symptoms for every cause of dizziness. Your physiotherapist will help to determine a management strategy in the case of a long-term condition to deem if vestibular therapy is right for you.

Final Words

At Peak, we believe that through a thorough, in-depth assessment we can get you feeling confident with a plan to help you feel your best. Living with dizziness or balance issues should not be your normal, so let us help you feel your best again! Click here to book in for a vestibular assessment today.

 

References

Bhattacharyya N, Gubbels SP, Schwartz SR et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngol Head Neck Surg. 2017;156:S1-S47.

Hall CD, Herdman SJ, Whitney SL et al. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline From the Academy of Neurologic Physical Therapy of the American Physical Therapy Association. J Neurol Phys Ther. 2022;46:118-177.

Written by Dr. Claire Wells, Chiropractor

 

Maybe you’re an experienced runner who’s been dealing with the same recurring “niggle” during long runs for years. Or maybe you’re thinking about doing your first 10k but you’re not sure if your body is ready to take on the training. Or maybe you feel great when running, but you want to see if there is anything you could improve on! A gait analysis, or a running assessment, is often a great place to start when you are stuck on an injury that keeps resurfacing, you’ve hit a plateau with your running, or you are new to the sport and you want to get off on the right foot. 

Gait Analysis 101

A running assessment is not simply watching you run! It involves a thorough assessment of your entire body, in addition to a gait analysis performed via video analysis. This is because as practitioners, we know that running is a full-body sport and we can’t ignore deficits or findings in other areas of the body when we are looking at a runner. The basic breakdown of a gait analysis involves 2 primary sections:

1. Screen for Deficits in Range of Motion, Strength, and Stability.

Based on the mechanics and demands of the sport, there are certain requirements of the body. If we don’t meet these requirements, we are more likely to create adaptations that could lead to injury, or make you less efficient when running. You need to have a solid foundation before you add speed and movement into the mix! From the amount of movement in your big toe to the amount of rib expansion you have, we are looking at it all. There is a misconception that you need to be on a track to pick out running abnormalities when really having a patient stand on one leg can tell us a lot about what we may see when we add the running movement into the picture. 

2. Screen for Deficits in the Essential Qualities for Running.

When you add speed and movement to the basics, this is when we are able to see how you are able to piece it together on the pavement. Gait analysis with slow-motion video allows us to identify what you’re doing well, and what could be better in your running technique. 

We can identify potential injury risk factors, or reasons why you might be experiencing pain as well as break down biomechanical factors and compensations that are snowballing into less than favorable results. Having a proper gait analysis performed by a trained physiotherapist or chiropractor will give you the confidence to know the practitioner is assessing you head to toe, finding anything that may be contributing to your presentation.

Gait Analysis, Running, and Tapping Into Your FULL Potential

Your chiro or physio can also triage your needs based on your goals and obstacles. We are excellent at diagnoses, manual therapy and exercise prescription, but you may have more specific needs that would be more effectively addressed by different professionals or additional resources. We can help point you in the right direction depending on what we find during your gait analysis. For example, you may need or want:

• A strength and conditioning specialist
• Run Coaching
• A dietician or nutritionist
• Sport psychology
• Lab testing with an exercise physiologist in Calgary
• Massage therapy
• A visit to your medical doctor for blood work
• Diagnostic imaging
• Resources such as book recommendations 

Who Should Get a Gait Analysis?

Running assessments are for anyone who runs!  Whether you are brand new to running, are wanting to get into new distances for racing, or have been running at a high level for most of your life, you will get something out of it. Here are some examples of when a running assessment might be especially valuable:

• You Are New to Running or Want To Get Into It.

This is sometimes the best time for a gait analysis, as we can stop bad habits before they arise, and get you on a tailored strengthening program to best support running injury prevention. 

• You Have a History of Running Injuries or Any Overuse Injury.

The biggest risk factor for an injury is a prior injury. If our brain asks our body to do a task, it’s going to find a way to do it. When we have an injury or pain, our body will adapt so it can still achieve the movement goal while reducing the threat to the compromised area. Often we maintain these adaptations long-term, and this can set us up for new issues. Getting assessed can help to see if you’ve created compensations for your movement deficiencies. 

• You Have a Current Injury That Is Causing You Pain or Preventing You From Running As Often, Far, or Intense As You Want To.

Let’s figure out why! The location of your pain is often NOT the location of the problem. This is especially true when pain has a gradual onset or if you seem to get the same pain that comes and goes repeatedly over a long period of time.

• You Are Looking To Improve Performance.

Because the things we check in a running assessment are factors that contribute to running economy and tissue health, identifying deficiencies (and of course, then working to improve them!) can positively impact your performance in training and racing.    

What Does a Running Assessment Look Like?

This will vary based on the clinic you go to and the practitioner that you see, not to mention the individual being assessed. But the essential components of a running assessment include the following:

1. Mobility and Strength Assessment

• Ranges of motion of the spine, shoulders, and lower extremities 
• Strength of the core and lower extremities
• Stability testing of the core and single leg   
• Breathings mechanics 
• Movement pattern competency 

2. Gait Analysis on the Treadmill

• Slow motion and real-time video analysis of your run from multiple angles 
• Real-time practitioner-led cueing for trial-and-error type corrections and recommendations based on findings  

3. A Summary of Findings

• At the end of your assessment, you will receive a plan of care outlining all of the findings, patterns, and relevant information as we often go over A LOT in these sessions! 
• This summary of findings will also include outcome measures to monitor and progress throughout your treatment plan and running journey 

4. An Action Plan for the next steps. This might include:

• Recommendations for manual therapy, if you are experiencing pain or lacking range of motion.
• An exercise prescription to resolve any deficits identified in the assessment. 
• An individualized warm-up and/or cool-down protocol. 
• A timeline for when to follow up for treatment and/or new exercises.
• A referral to an additional service provider, if needed. 

Final thoughts

These appointments are also great to just connect with a practitioner who understands your sport and can relate to what you’re doing. It’s helpful to have a professional in your corner who not only shares your enthusiasm for running but also has your back when it comes to supporting your goals. 

Our Running Assessment practitioners at Peak have combined experience in track, road running, and trail running, and we can’t wait to help you! Whether you are a novice runner, a long-distance runner, a track athlete, or someone who is curious if you could ever become a ‘runner’, we have someone who is ready to help you. To book your running assessment today, click HERE.

Written by Gina Rolf, Physiotherapist

 

As a peak health physiotherapist who works with kids, I am frequently asked about two common conditions in babies: torticollis and plagiocephaly. While they may sound like tongue twisters, these conditions can have significant impacts on a child’s development. In this blog post, we will explore these conditions, including their causes, effects, and treatments.

What Is The Difference Between Torticollis and Plagiocephaly?

First, let’s define what these terms mean. Torticollis is a condition in which an infant’s neck is tilted to one side, resulting in difficulty turning the head in the opposite direction. Plagiocephaly, on the other hand, is a condition in which an infant’s head becomes flattened on one side, due to various factors such as a preference for sleeping or turning to that side.

Is Torticollis Associated With Plagiocephaly?

So, are these two conditions related? The answer is yes. In fact, torticollis is a common cause of plagiocephaly. When an infant’s neck is constantly tilted to one side, the weight of their head can cause flattening on that side, leading to plagiocephaly.

Does Physical Therapy Help Torticollis and Plagiocephaly?

The answer to this one is also yes! Physical therapy is often recommended as the first line of treatment for both torticollis and plagiocephaly. 

In the case of torticollis, physical therapy can help to stretch and strengthen the muscles in the neck, allowing for a better range of motion and improved head control. During an appointment, your physiotherapist will review the specific stretches prescribed for your child, as well as ensure all developmental milestones are being met and not being adversely influenced by the torticollis.  

For plagiocephaly, physical therapy can help to improve the baby’s overall alignment, reduce the asymmetry in the head shape, and promote the use of both sides of the body. In some cases, treating in conjunction with a remolding orthosis (more commonly known as a helmet) may be recommended to help direct the growth of your baby’s head. If this is the case, your pediatric physiotherapist will help facilitate this process with other clinics in the city. 

At What Age Is Plagiocephaly Permanent?

It’s important to note that physical therapy is not a one-size-fits-all solution. Each baby’s treatment plan will be tailored to their specific needs, based on the severity of their condition and their age. The good news is that plagiocephaly is not usually permanent, especially if it is caught early and treated appropriately. In fact, most cases of plagiocephaly will resolve with a combination of physical therapy and repositioning techniques before the baby turns one year old.

What Happens If Torticollis is Left Untreated?

Unfortunately, untreated torticollis can lead to a host of other problems, including delayed motor development, difficulty with visual tracking, and even facial asymmetry. That’s why it’s so important to seek treatment as soon as possible if you suspect your child has torticollis.

What Happens If You Don’t Correct Plagiocephaly?

While plagiocephaly is not usually permanent, leaving it untreated can lead to long-term problems, such as facial asymmetry, jaw misalignment, and even developmental delays. Again, seeking treatment as soon as possible is key to ensuring the best possible outcomes for your child.

Key Takeaways

In conclusion, while torticollis and plagiocephaly can be concerning for parents, it is rarely permanent. With the right treatment, such as the stretches and exercises learned during physical therapy, most infants and young children can overcome these conditions and go on to develop normally with an improved quality of life.

So, if you suspect your child has torticollis or plagiocephaly, don’t hesitate to reach out to me or anyone from our team at Peak Health Kids. Together, we can help your child achieve their full potential! Click HERE to learn more. 

Written by Chiropractor Dr. Nathan Boone

 

Maybe you remember what happened: a twist, a step, a fall. Maybe you don’t! Either way, the discomfort in your knee has morphed from a nuisance into an unrelenting and gnawing pain, present during even the simplest day-to-day tasks.

Knee pain, unfortunately, appears to be a universal consequence of having knees (of which most of us have two!). In fact, a recent review reported that nearly 25% of adults are likely to report an episode of non-traumatic knee pain in a given year. 

Infuriatingly, many episodes of knee pain appear to have no specific source, and patients report symptoms of generalized or “moving” pain in the front of their knee that may be aggravated during activities such as squatting, sitting, running, or climbing stairs. 

Persistent pain that interferes with activities you love can be a physically and mentally draining experience, leaving you with questions like: What is causing it? How long will it be here? And most importantly: What can I do about it?

PFPS: Patellofemoral Pain Syndrome 

In the absence of a clear mechanical or structural issue, health care professionals often provide an intentionally vague diagnosis of Patellofemoral Pain Syndrome (PFPS), sometimes referred to as Runners Knee. PFPS describes this nonspecific experience of pain in the area in front of the knee that can range from annoying to debilitating and may prevent or impair participation in activities from running to working out, to just sitting and watching a movie. 

For those experiencing PFPS, there is good news and bad news. The good news is that it can be dealt with. Remember that many people develop knee pain, but most don’t currently have it – this is a testament to its ability to improve! The bad news is that for many people, PFPS is a persistent and recurrent issue that may take time to deal with. 

Due to the vague nature of PFPS, we lack a clear picture of all the factors that may be involved; however recent research has dramatically improved our understanding of the condition, what causes it, and how we can manage it!

What Causes Knee Pain?

The most common question patients ask is: why does my knee hurt? Unfortunately, the answer to this question is a bit foggy – but researchers have some good ideas. The leading theory suggests that the pain stems from irritation of the cartilage on the underside of the patella (kneecap). 

Abnormal, excessive, or repetitive stresses may lead to softening or deterioration of the top layer of this cartilage exposing the more sensitive surfaces beneath. Although our bodies typically thrive under stress, these persistent forces on the patella don’t allow for the necessary recovery time needed to get stronger, leading to a degeneration process that ultimately results in pain. 

Am I At Risk for PFPS or Knee Pain?

“My sister runs every day and doesn’t get knee pain, why does MY knee hurt?” Although these answers are highly individualistic, and you should consult your health care professional regarding your specific situation, there does appear to be some consistent observations amongst PFPS sufferers. 

Consistently, those who have, or develop, PFPS demonstrate abnormal biomechanics during lower limb activities as well as deficits in lower limb strength. In other words: they move differently. As the knee joint is a simple hinge connecting the ankle to the hip, it is at the mercy of what goes on above and below it. Poor control and strength of the hip and knee, especially during single-leg activities (like climbing stairs), place the knee in a disadvantaged position which may result in those increased patella forces mentioned earlier! 

How To Manage Your Knee Pain

So, what does this mean and what can be done? Any time you experience continued pain or discomfort, visiting your local chiropractor or physiotherapist is always a good idea to get an accurate diagnosis of your knee pain to ensure you are implementing the correct management strategies. Other potential causes of knee pain must first be ruled out before we can call it PFPS! Your professional should work with you to identify the activities that aggravate or relieve your pain, as well as determine any potentially predisposing strength or movement impairments. 

Although our understanding of the development of PFPS is sometimes cloudy, the evidence supporting exercise as a treatment tool is crystal clear.

Strengthening programs targeting the muscles of both the thigh (quadriceps) AND the hip (glutes) appear to have the largest benefit for PFPS patients in the short and long term. 

Because weakness and poor movement control are culprits in the development and progression of PFPS, the strategic application of strengthening activities should come as no surprise. Ensuring you have an exercise plan that is right for you is the first step. 

Although exercise is the most effective single method of managing PFPS, manual therapy techniques including soft tissue massage, joint mobilizations, taping, and even orthotics may be included in treatment plans to help relieve pain and improve function in the short term. 

How Long Does it Take to Make Knee Pain Go Away?

Timelines for managing PFPS can range from weeks to months. Many factors may play a role in the duration of PFPS, including duration of symptoms, strength levels, types of activities, genetics, and prior injuries to name a few. Developing frustration with slow progress and persistent symptoms is common, so demonstrating patience is key when beginning the journey of managing your knee pain. 

As our understanding of PFPS improves, so will our management techniques. For now, one thing is clear: early intervention of relative rest, exercise, and targeted manual treatments are the best tools we have; but a healthy dose of optimism goes a long way as well. 

Final Thoughts

If you are experiencing knee pain and are in search of what direction you should go, book your discovery call today to find out what next steps may be appropriate for you. Our team is always just a phone call away to get you on the right path! 

Peak Health & Performance can help you recover from a wide range of common conditions including:

• Impaired range of motion
• Chronic injuries
• Motor vehicle accident injuries
• Neck pain
• Knee injuries
• Joint pain
• Shoulder pain
• Rotator cuff issues