Aging results in many different effects on our bodies.  Of these, one of the most undesirable is often changes in body composition and physical appearance. On average, men and women add 10 lbs of bodyweight every decade during the midlife years.  In addition to this we can lose more than 5 pounds of lean body mass (mostly muscle) every decade due to disuse.  Therefore, 10 lbs per decade increase in bodyweight represents a 15 lbs problem in body composition.

Each decade = 5 lbs less muscle, 15 lbs more fat.

Muscles burn calories at a high rate.  With the decrease in muscle mass as we age, our resting metabolic rate decreases which means we burn less calories.  It’s the same as going from an 8 cylinder engine in your car to a four cylinder engine – it burns less fuel. Our bodies need to do something with this excess fuel (calories) so it stores it as fat instead.

This explains why dieting is often not successful.  Dieting aims to reduce the number of calories we intake.  However, in this case the problem is not the number of calories we are taking in.  The problem is that the calories we have taken in, cannot be used and then get stored as fat instead.  Dieting can actually make the problem worse because dieting can further reduce muscle tissue and in turn, further reduce the resting metabolic rate.

If losing muscle is such a big problem, then what is the solution?  Enter – strength training. Several studies have shown that strength training can increase muscle mass at essentially any age. Strength training exercise can add muscle, lose fat, increase resting metabolic rate, and increase daily energy expenditure. 

As an added bonus strength training has been shown to increase bone density, decreasing the risk of osteoporosis.  Another benefit is enhanced glucose metabolism which may decrease the risk of adult onset diabetes.  It can increase gastrointestinal transit speed, thereby, decreasing the risk of colon cancer.   Strength training has also been proven to reduce low back pain and arthritic pain.  It has been shown to help reduce resting blood pressure and blood cholesterol levels. Finally, strength training has been proven to have positive psychological effects such as reducing depression in older adults.  There is no medication that can produce all these benefits!

If you need help with starting to strength train, let us know.  We can help you choose safe methods of strengthening and how to properly progress over time.
 
 

Today I was pondering what to write on.  As most of you know, I have many interests, from Women's Health, Strength and Conditioning, Acupuncture, Dry Needling, Persistent Pain Science....the list could go on.  I am also a mother, a wife, a business owner with my husband, Trevor (and trust me, people ask me how that goes!!)  So today as I was trying to plan my day, realizing the mountain of things I am seeing that I could be doing, should be doing, and figure out what needed to be done, the idea of a blog came to me.  And it came to me because a dear friend sent me an email with the words in it "You ARE enough. You ARE kind. And you've got this."

You see, on a daily basis, I see clients for various ailments and they can be effecting their quality of life - their time with their spouse, their children, their ability to do the things they love.  And today, as I'm trying to figure what to do and when to do it, I realized, these lovely clients I have the privilege of getting to help, they are taking time for themselves - or doing Self Care.  It's become a very notable word at the moment - almost trendy at times to discuss, but the reality is I have seen now, how important it truly is to take time for yourself.  Despite my clients being there, and being present for their treatment and education, I do frequently get asked, how can I take care of myself?

Recently I had the opportunity to take some time and explore the West Coast.  I headed out to Nanaimo, BC, and up to the Tofino area.  There I explored the Wild Pacific Trail, read a book, slept for 8 hours, and missed my family.  But it was a time to step back and enjoy the world around me instead of rushing through it.

Realizing this was a special circumstance, this trip to BC, it is not always how self care has to or can happen.  It can be the smallest things including:

• a cup of coffee in the morning before everyone is awake
• a short walk
• 5 mins in your office at work or home, to breath
• being in bed 30 mins earlier than normal
• reading a book
• going on a field trip with your child's class (I truly found this amazing!)
• driving in the vehicle by yourself
• being kind to yourself
• ​come up with the PRIORITY of the day rather than trying to find BALANCE
  

The list could truly go on, but I thought, after reading my email from my, I was inspired to speak to it. 

Who is this dear friend you may ask...it's Amanda of Grounded Goodness, and she knows just what to say when to say it.

I have only scratched the surface of this topic...there is so much more that could be said. But, let's have just a brief snippet sit and take it in.

Have an enjoyable weekend, and looking forward to chat with you soon.

~ Michelle, PT
​

Balance is a difficult concept to define. Some people seem to have a natural sense of their own body in space, others are chronically tripping over thin air and running into furniture. There are several different systems in the body that must work together cooperatively to maintain normal balance. These chiefly include the vestibular system, the visual system, the brain/brain stem, and the muscles and joints of our body. Each of these play a different role in the coordination of balance.

Vestibular system:
The vestibular system itself has multiple components that contribute to the sense of our position in space and the movement of the head in relation to the body. These include the semicircular canals and the organs that reside within our inner ear. The semicircular canals include three different structures that are oriented in three different planes, anteriorly, horizontally, and posteriorly. These are paired between the left and right side in such a way that both sides will provide the same information to the brain no matter the position that the head is in.

Next to the semicircular canals are the utricle and saccule. These sensory organs also help to provide information on the position of our head in space, but are more interested in acceleration both vertically and horizontally. Inside these organs are small crystals or otoliths that are embedded in the cellular membranes. Since these otoliths are a bit denser than the surrounding tissues and fluids, they are acted on by gravity more powerfully. When our head moves quickly or changes speed in general, these pressures in the utricle and saccule create electrical signals for the brain to interpret and coordinate. 

Visual system :
We rely on our vision a great deal when it comes to orienting ourselves in space and with our environment. The eyes provide a wealth of information about where we are, how we are moving, and allows us to keep track of all of the elements in an ever-changing environment. The visual system has a very close relationship to the vestibular system and the brain/brain stem. In fact, there are a series of reflexes that exist within the brain that allow our eyes to hold steady in difficult circumstances, such as reading in a bouncing car, or being able to follow objects even as we change the orientation of our head such as watching a plane fly overhead. These reflexes rely on the ability of the brain and vestibular system to agree very closely on the position of the head and the necessary eye movement to keep everything in focus.

If there are any discrepancies in this communication it can lead to a feeling of slowness, eye fatigue, and accompanying dizziness and disequilibrium. There is a constant rechecking going on that makes sure that what the eyes are seeing and the vestibular system are reporting match up. What this means is that any compromise to vision or even changes in lighting can affect this communication and relationship.

Muscle and Joints:
The muscular system and proprioception are another key component of balance. The feet act as our contact point to the environment when we are standing or walking. The feet themselves are quite sensitive and good at measuring both pressure and force in a fine-tuned manner. I like to think of it as the steering wheel on the highway, it never holds perfectly still even when the road is straight and the constant adjustments and small twitches are what keeps everything in place in a dynamic fashion.

The information from the feet and ankles is sent to the brain to provide a sense of how our body is oriented. When walking on an incline or a decline this can get more complicated, with more muscle activity and more information being sent to the brain. If this information conflicts with the information from the vestibular or visual systems there can be confusion in the processing in the brain and a lack of ability to adapt to the environment (such as missing a step or stumbling/staggering).
All of these fine-tuned movements and measurements happening in the body allow for a number of places where things can break down. Sometimes, this system alone can lead to balance difficulties as inaccurate information from the feet, ankles, joints, and muscles can lead the brain to make poor decisions based on faulty information. Even in people who are experiencing primarily vestibular dysfunction it is often necessary to train the muscles of the lower extremities to develop control, strength, and power. The strength and power are often overlooked, particularly in an older population, but it is vital that the muscles of the foot and ankle be able to make the adjustments needed to maintain balance.

What can happen in some situations is that the brain will recognize an adjustment needs to be made, perhaps in a more challenging environment, but the ankles and feet are not powerful enough to make the necessary correction. This can lead to stumble, stagger, or fall, depending on the situation. Beyond the feet and legs themselves there is also the consideration of the core musculature that holds our spine and hips stable while moving or statically positioned. These muscles and the general control of this area from a proprioceptive perspective can greatly affect the control of our bodies and provide other strategies for maintaining balance outside of the ankle. While the ankle is the first line of defence for the average challenge to our balance, the hips and lower back can create changes in the center of gravity.

In an ideal situation, a small challenge to our balance would rely largely on the ankles and their respective muscles to adjust. However, if the challenge is large or fast, the hips can shift to absorb some of the force and to significantly alter the center of gravity. If the movement of the hips themselves is not enough, leaning the trunk/torso by utilizing the core musculature can also be implemented to regain or maintain equilibrium.

All of this is happening in a fraction of a second and is typically coordinated by the brain without much conscious effort. That being said, it is possible to train these responses and these systems. Much like any skill, progressive practice and repetition with guidance from a skilled practitioner can typically provide improvement in strategies and functional outcomes.

~Trent, PT

​
References 

• Vestibular Rehabilitation: 4th Edition. Herdman, Susan. Clendaniel, Richard. ISBN 9780803640818. F.A. Davis. July 2014. 
• Current concepts and future approaches to vestibular rehabilitation. Tjernstrom, F., Zur, O., Jahn, K. J Neurol 2016. DOI 10.1007/s00415-015-7914-1. 
• Effects of balance training on balance performance in healthy older adults: a systematic review and meta-analysis. Lesinski M., et al. Sports Med 2015. DOI 10.1007/s40279-015-0375-y.

What is mental health?

“Mental health is defined (by the World Health Organization (WHO)) as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community. (1)
 
Have you ever had too many appliances in use at once and flipped a breaker?  Or perhaps you’ve opened too many windows at the same time on your laptop, only to have your system crash in the middle of an important assignment. Well, in regards to the breaker issue, you’d likely unplug all unnecessary appliances, flip the power switch back on and problem solved. As for the computer overload, you’ll probably end up closing all unnecessary windows and some programs and hit reboot. And chances are, you’ll learn from your experience and it won’t happen again...well not too soon anyway.  
 
When I think of understanding mental health these are analogies that I have found helpful to relate to. Although by comparison these are fairly simplistic analogies, since “It has been estimated that we have anywhere from 25,000 to 50,000 thoughts a day,” and “when programmed to simulate human brain activity, it took “one of the most powerful computers in the world” 40 minutes to crunch the data equivalent to just one second of brain activity.” (3)
 
So, like the overloaded electrical or computer systems, perhaps you can relate to feeling pulled in so many directions, that you suddenly felt you couldn’t keep up and found yourself experiencing difficulty coping? Anyone who knows what it feels like to suffer a great loss has likely been through a period when it feels almost impossible to journey through to the other side? Life’s stressors will always be there, and they can accumulate, a bit like “repetitive strain for the brain.”
 
When you stop and think about it, as we age and mature and experience life’s challenges, we are constantly collecting and processing vast amounts of data and assuming more numerous and complex roles with expectations for performance mounting and time always appearing to be in limited supply.  And now with the age of “high speed” technology rapidly escalating, the words “down time” seem to be becoming almost obsolete.
 
So how much is too much - your mental health limits?

• the breaking point is as varied as the number of people there are in the world, and
  
• the types of mental illness are equally as varied, because
  
• there is no one cause for mental illness, it is “A complex interplay of genetic, biological, personality and environmental factors…” (2)

 
However, though everyone is unique, what we do share in common is that we need to stop and take notice that our mental health or that of the people close to us is sending warning signs that deserve immediate attention.
 
What are some of the warning signs?

• you find yourself so worried about the future that you can’t be happy in the present
  
• you’re struggling to find the joy in things that you used to enjoy
  
• maybe you’ve started to retreat from family and friends, becoming isolated because you feel overwhelmed
  
• perhaps it takes only the smallest things to get you irritated and you find yourself struggling to control your emotions more often
  
• all the thoughts in your head are suddenly difficult to keep up with and you’re struggling with focus and with remembering
  
• you’re listening but not really hearing and find you’re having trouble carrying on a conversation

 
If you can identify with any of these warning signs on a consistent basis, It’s likely your brain and your body are signalling you that your mental health is requiring attention.  Awareness is key, knowledge is power.
 
What do you do if you or someone you know has reached or is on the way to reaching their limit?
When your system starts giving you signs that you’ve reached or are about to reach your breaking point, “Mental illnesses can be treated effectively.” (2) With increasing awareness and many resources now available to address this issue you need not struggle alone.

• See your family physician or health care provider- they can help advise in regards to the best course of action to initiate your recovery process and ongoing management
  
• Seek a referral to a counsellor- they are trained professionals whose main goal is your mental health wellness and they possess a wealth of knowledge and an endless amount of resources to help you
  
• Talk to your spiritual advisor, a trusted family member or a close friend, a compassionate ear is often the first step in a successful recovery
  
• Maintain a healthy diet, remembering that what you put into your body is fuel for your brain
  
• Take advantage of the benefits of regular physical activity, provided your doctor has cleared you for any contraindicating physical health issues, remembering that realistic goals are best
  
• Get the appropriate rest you need, in order to regenerate and restore your mind - unplugging from technology on a regular basis’ and keeping the bedroom for sleep are some helpful tips
  
• Increase your awareness of your own mental health, becoming mindful of what goes into your mind, how much you hold on to, and what may be necessary to let go of
  
• The practice of mindfulness and other relaxation or meditation techniques are helpful tools that have recently been proven to be very effective  

 
Who is affected by mental health - are you at risk?

• In any given year, 1 in 5 people in Canada will personally experience a mental health issue (2)
  
• Mental illness affects people of all ages, education, income levels, and cultures. (2)
  
• By age 40, about 50% of the population will have or have had a mental illness (2)

 
So chances are high that we or someone close to us will be affected by a mental health crisis or illness at some point in our life.
 
How can we reduce the likelihood of getting to this point before recognizing it and seeking help? 
Take ownership – empower yourself, and empower others.  In my personal experience, dealing with big life changes has never been easy, but up to this point I’d like to think I’ve managed ok.  But as I’ve gotten older, accepting these changes has become even more difficult, even though I realize that they are a necessary part of life.  Hopefully it won’t take you a multiple succession of changes and maxing out on coping strategies before you realize that it’s ok for a caregiver to take a break and receive care. There is no shame in asking for help, as shame invokes fear and fear in turn defeats growth. Instead, realize that even the tiniest of steps forward can make all the difference and aim for continued progress with obtainable goals, not perfection. No one is perfect. Be courageous.  We can all think of something we want to change but are we willing to be that changing factor, putting fear aside and becoming a catalyst for others to follow suit. Surround yourself with positive influences that are willing to walk beside you on your mental health recovery journey, who are willing to help you draw out your full potential once again. Then pay it forward and walk beside someone you know as they journey through as well.  Though our issues may differ we are all in this together. There is strength in numbers.

Where will I stand going forward?                                                                                        
Plan to attend Cameco’s Step up for Mental Health initiative, where exercise, awareness and community support meet to make a difference May 11, 2019. https://www.stepupformentalhealth.ca/step-up-program/what-is-step-up

Sign up for a mental health first aid training course and empower yourself by increasing your own knowledge about mental health. https://saskatoon.cmha.ca/programs-services/mental-health-first-aid-training/

~ Elizabeth, PT


References:
(1) https://www.who.int/features/factfiles/mental_health/en/
(2) https://cmha.ca/about-cmha/fast-facts-about-mental-illness
(3) https://www.psychologytoday.com/us/articles/200107/depression-doing-the-thinking
 
 
 
 
 
 
 
 
 

One of the more common things that people come into the clinic for is shoulder pain.  There are many issues that may occur with a shoulder that may cause pain, and this may include problems with the rotator cuff. 
What is the rotator cuff? It is a group of muscles that helps to hold the shoulder in its socket. They also work to lift the arm and rotate it inwards and outwards. The four muscles of the rotator cuff include the subscapularis, supraspinatus, infraspinatus and teres minor. There are other muscles that surround these four and influence how efficiently they work. And if these muscles do not work efficiently, they and the rotator cuff muscles can develop tendinopathy (thickening and tears).  
​
Tendinopathy can occur due to the following (1):

• Impingement of the shoulder muscles – when the muscles rub on each other or surrounding structures due to postural position or other bony changes such as shoulder or acromioclavicular (AC) joint arthritis
• Partial or full thickness tears due to chronic degeneration of tendons
• Partial or full thickness tears due to trauma, such as falling on an outstretched hand or trying to catch yourself on the way down 

What does rotator cuff tendinopathy feel like? Your shoulder can be sore, uncoordinated, and weak. You may have difficulty and/or pain with reaching overhead or behind you (especially if you have to reach quickly!), pain in your shoulder at night, and pain as you try to raise your arm up. There is a very high chance that you have a rotator cuff tear if you have two of the signs above and you are over the age of 60 years (1).  

So what can do you if you suspect that you have a rotator cuff tendon issue or tear? There are several factors that may lend to a more favourable recovery from a rotator cuff tendinopathy. Depending on your mechanism of injury, severity and location of a tear, age and level of function, you may be a candidate for surgery. But physical therapy has also been shown to be effective in the management of rotator cuff tendinopathy (1). Through consideration of each person’s level of function, daily activities and interests, a home exercise program that is best for that person an the issues that they are having can be recommended. Manual (hands on) therapy to help improve shoulder and muscular mobility (this can include massage therapy) is also helpful. Education on anatomy, the way the body moves and how it heals, and different movements to do or avoid is also very helpful with managing this kind of shoulder pain. 

Personally, as someone who has enjoyed playing a number of sports and still likes to do so, getting ahead of shoulder pain and potential tendinopathy is important for me, especially since I know that chronic degeneration can lead to tears. I try to keep my shoulders in shape for volleyball, carrying kids and, daily activities in the home and yard, and running with the dog. Some of my go-to exercises include yoga (weight bearing through the hands and shoulders), free weight exercises like rows and overhead press, and rotational resistance band exercises. I began doing these things after minor aches and pains began to affect some of the activities that I enjoy the most. I intend to continue to be active and keep my shoulders healthy, and I am passionate about helping my patients do the same. Please feel free to contact me or one of my colleagues if you have any questions about what you can do to prevent or manage your shoulder pain!

~ Kristyn, PT 

References:
1. Factor D, Dale B. Current Concepts of Rotator Cuff Tendinopathy. Int J Sports Phys Ther. 2014 Apr; 9(2): 274–288.
 
 
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