~ Lisa Lepage, Phsyiotherapist

References
https://www.physio-pedia.com/Breast_Cancer
https://cancer.ca/en/cancer-information/cancer-types/breast/statistics
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3457869/
https://www.hopkinsmedicine.org/health/conditions-and-diseases/breast-cancer/breast-cancer-lymphedema-after-treatment

​

“An ounce of prevention is worth a pound of cure.” (Benjamin Franklin, 1736)
 
80% of human beings will experience low back pain during their lifetime. And 80% of that eighty percent will have reoccurring back pain throughout their life. It is the leading cause of absenteeism in the work place and it affects our ability to show up in our lives in the way we wish.

As a person who had her first episode of back pain at age 16, I can attest to the fear and anxiety it can cause as well as how it can prevent me from doing the activities I love. So as a sufferer of recurring low back pain and a physiotherapist, here are my top strategies to prevent low back pain.

Humans, by nature,  appear to be more reactive than proactive. Should we choose the latter over the former, we stand to be happier and healthier.

Health is the new wealth so read on and join me in a proactive revolution against back pain!

1. Optimize your posture.

We are designed to have three curves in our spine: two ingoing curves- one in the low back and one in the neck; and a slightly outgoing curve in the midback. When these curves are maintained throughout the better part of a day, we reduce the chance of irritating our spine.

How do we do this Lisa?

I am so glad you asked! My personal favorite way that maintains all three curves is a lumbar roll to support the ingoing curve in our low back which then corrects the curves above. Furthermore, with such a support in place, we are free to concentrate at whatever task at hand, such as

• work,
  
• driving,
  
• reading,
  
• eating,
  
• our favorite program or hobby.
  

​Your muscles get a break too and you will prevent them from getting tired unnecessarily.

2. Microbreaks to move or stretch in the opposite direction.

​Most of us humans in the 21st century are spending a lot of time sitting. So all the more reason to use a lumbar roll!

But this is also a great reason to stretch backwards!

The good news is the investment of time is literally 10 seconds every 1-2 hours during your day. Because sitting and bending forward stress our discs, we need to give them a break and do the opposite arching backwards.

The bonus of this movement is that it stimulates our facet joints at back of our spine, allowing the joints to become lubricated and get adequate nutrition. You know what that means?? You got it! Your joints will be happy and you will prevent the onset of stiffness. ​

3. Use your big muscle groups to lift.

Lifting is not harmful if done properly. Bending at our knees and hips to lower ourselves to pick up heavier objects, reduces the stress on your spine. Doing the golfer’s pick up for light objects is great at protecting your spine also.

4. Breathe deeply!

Do you hold your breath sometimes when you lift or open a heavy door?

​When we breathe, expanding our rib cage and bellies, our brain recruits our core musculature which supports our spine. When our spine receives adequate support, we reduce the risk of injury.

BONUS TIP

5. Stay active!

Even a 15-30 minute moderate paced walk engages our core muscles, especially when we swing our arms.

A 10-15 minute yoga session will help keep your muscles flexible and your joints stimulated.

2-3 sets of 10-15 squats every other day will strengthen your legs and core. Start small and keep it simple and joyful!

​ 
There are no guarantees in life but when I make use of these tips, I feel so much better and I don’t miss out on my life!

Hope you find this helpful and if ever you become a statistic there’s help and hope! Donald Physio can help just give us a call!

~ Lisa Lepage, Physiotherapist

​It's in the name! Donald Physiotherapy is a physiotherapy clinic. The focus in on orthopedics, but the services are actually quite diverse!

Donald Physiotherapy can assist with:

• Muscle and joint injuries
• Concussions
• Vestibular Rehabilitation - for Balance and Dizziness
• TMJ - jaw pain
• Pelvic Floor Physiotherapy for men and women
• Arthritis and Osteoporosis Education and Treatment

But, what else should you know about Physiotherapy?

What is Physiotherapy?
Physiotherapy is multifaceted treatment used to restore, maintain and optimize a person’s function, mobility and overall well being. 
Different types of treatment are used to accomplish these goals including:

• ​hands on treatment,
• exercise prescription and programming,
• different modalities such as acupuncture,
• dry needling,
• electrical current,
• and of course education.

​What Kind of Training do Physiotherapists Have?

• In Saskatchewan, in order to apply to the School of Physical Therapy through the College of Medicine, you have to have completed an undergraduate degree. Once a student is accepted, the program is two and a half years in duration. This includes both in class learning and clinical placements. 
• Once having completed the program successfully, the therapist has to then take a credentialing exam with both written and practical components. 
• Once licensed, a physiotherapist may choose to specialize in a given which requires additional specialized training. The post graduate courses vary in length dependent on the specialty.  A therapist can choose to specialize in
  • ​orthopaedics,
  • vestibular therapy,
  • pelvic floor physiotherapy,
  • acupuncture,
  • dry needling,
  • neurology,
  • paediatrics, or
  • cardiorespiratory therapy to name a few. 
• Physiotherapists are highly skilled health professionals who provide safe, quality, client-centred physiotherapy through a commitment to service availability, accessibility and excellence. The profession is shaped by scientific evidence and the education and competencies of the physiotherapists delivering the services. Physiotherapy is grounded in the belief that, to be effective, its services must respond to the changing needs of populations and our health system.

( https://opa.on)

Did You Know, Physiotherapist are Primary Health Care Providers​?

What is primary health care? Oh I am so glad you asked! 

• Primary health care is the everyday care we need to protect, maintain or restore our health. For most people, it's the first point of contact with the health care system and the most frequently used health service. (About Primary Health Care in Saskatchewan | Primary Health Care in Saskatchewan | Government of Saskatchewan)
• Physiotherapists are regulated health professionals whose practice includes health promotion and disease prevention. Physiotherapists working in primary health care teams maximize mobility in response to the needs of patients across the lifespan. Physiotherapists help ensure continuity of care for patients and their families across the care continuum. (https://physiotherapy.ca/)
• Physiotherapists are able to screen for various conditions and refer for further assessment and treatment as appropriate to other health care providers such as, doctors, occupational therapy, psychology etc.

​
​BONUS Point - Did you Know Physiotherapy is Direct Access?

What is Direct Access - as mentioned above, a Primary Health Care Provider can be the first point of contact within the health care system - and this can include Physiotherapy! 

It means, a Doctor's referral is not required to seek the assistance of a physiotherapist!


So, whether there is a nagging injury or you want to learn more about your health, and ways to help with overall prevention and quality of life, Physiotherapy is an important piece in the health puzzle!


~ Lisa Lepage, Physiotherapist 

The  world stressors are at an all-time high. A global pandemic. Intense political climate in the world community. Drastic changes to our normal living habits. Changes to our childrens’ school and extracurricular activities.

Heightened anxiety, irritability, worry and/or concern is inevitable.  The effects of stress are far reaching. There has been no escape from it these last few months.

You are not alone. Yet it may feel very much like you are. So much is beyond your personal locus of control.

• So what can you do?
  
• What is in your control?
  
  

The reality of life is, pandemic or no pandemic, all you truly have control of is your thoughts and behaviors.

​So how are you really doing? 

Perhaps the answer to this question varies day to day. Fluctuations in our wellbeing to some degree, are considered to be “normal” or typical. However, sometimes your current state of wellbeing can be difficult to pinpoint. You can also be unconsciously self-deceptive about your wellbeing out of habit like when someone asks:

“how are you?”
​
how often are you truly honest? How often do you quickly respond without reflection “good!”?
Well I am excited to share with you a tool that helps you do a mini self check. 

​

The Mental Health Continuum Model was developed by the Mental Health Commission of Canada to help employers understand mental illness in the workplace. 

This model illustrates the spectrum of symptoms people exhibit when dealing with mental health issues. The mental health continuum is a range having mental health and mental illness at the two extreme ends. Depending on the internal and external faculties of a person at any time, a person can be at one point of the continuum and shift position as his situation improves or deteriorates.

The continuum goes from:

• healthy, adaptive coping (green),
• through mild and reversible distress or functional impairment (yellow),
• to more severe, persistent injury or impairment (orange),
• through to clinical illnesses and disorders requiring more concentrated medical care (red).
• It also provides a list of action strategies one might use to cope in health-adaptive ways depending which zone we find ourselves in. 

What Can You Do?

You may find it helpful to identify your present state of health and problem solve without reinventing the wheel.

Use the Model as seen in the picture, to place yourself on the scale. Ask yourself,
            “Am I feeling focused today?” or
            “Can I break problems into manageable chunks?”
​
If you are finding you are swaying away from the Green Zone, what are your strategies to help? Are they:

• Deep breathing
• Meditation
• Yoga
• Or maybe you don’t have a strategy yet…and that’s ok.

What’s Next?

I hope you keep this in mind and in “your back pocket” as a tool to check in with yourself because we only truly have control over ourselves. Let’s take charge of our wellness in these uncertain times!

Do you need to talk with someone about things?

I am here - I am Certified in Mental Health First Aid, developed by the Mental Health Commission of Canada, and would be happy to help with any questions you may have.

~ Lisa Lepage, Physiotherapist, Certified Mental Health First Aid

A follow up to Part One of Pain: A Normal Human Experience.  At the end of our last blog post, Sally wanted to go for a walk. Her physiotherapist had recommended 2-3 km max, however she was feeling good and completed 5km.  But then the pain started again...

When the physiotherapist meets with her the day after her walk, he clarifies that she didn’t trip or roll her ankle again. He notices she is walking without limping. Her ankle movement is painful but equal to her other side. There is no change in colour, temperature or skin changes. He retests her ligaments and they are somewhat aggravated but no laxity is detected. After a thorough understanding of Sally’s activity in the last 24 hours and a normal objective exam, the physiotherapist is able to confidently reassure Sally that her increase in pain is related to increased activity and that she has not reinjured the ankle. He explains that it is normal to have soreness when resuming normal activity. The fact her pain gradually decreased in the hours following her walk and had fully resolved by the next morning speaks to pain related to increased activity beyond the tissue tolerance. Furthermore, there are no signs of damage, such loss of ROM, gross swelling, redness or increased temperature. She is also able to fully weight bear through that foot and ankle.

Fast forward to six months later, Sally decides she would like to start running. She has completed her treatment with her physiotherapist and is feeling 100%. She hasn’t had ankle pain in four months. She goes for her first run and is able to run for 15 minutes before guess what?? Her ankle starts to hurt. She asks herself, why is this happening? Should she be fearful, abandon running completely and resolve that because she sprained her ankle she will never run again? Or is this a normal physiological response to a new activity?

She decides to walk the rest of the way home. The pain subsides. She notices she is not limping and she is able to go up and downstairs without incident. She is leaning toward the conclusion that perhaps she is just not used to running and nor is her ankle. She decides to try running the day after tomorrow. She was able to run 17 minutes before that pain came on and it wasn’t as intense as Day 1. She decides to follow-up with her physiotherapist.

After thoroughly understanding Sally’s recent activity and performing a detailed physical examination including a running technique assessment, her physiotherapist concludes Sally has a good running technique and her foot and ankle exam is normal. He reassures her that she is safe to run and together they design a plan to meet her goal of a 10 km fun run to raise money for the local children’s hospital in two months. Sally is so excited she doesn’t have to abandon her bucket list goal of running a 10 k. She understands now that it can be normal to have a temporary increase in symptoms with new and/or increasing activity. She also knows what signs to look for that would indicate she needed to seek attention from her physiotherapist or physician.

~ Lisa Lepage, Physiotherapist

Did you know that it is normal for humans to experience pain for different reasons over the course of our lives? The purpose of the acute pain experience from a primitive evolutionary perspective, is to signal our attention that we might stop a certain activity, movement or behaviour in order to increase our chances of survival. Acute pain is of sudden onset and of short duration. It is often a signal of  tissue damage, such as a burn or sprained ankle. It may resolve quickly or last several weeks. This type of pain is protective in nature and motivates us to get help, avoid further aggravation, and other recovery seeking, health promoting behaviours. 

Chronic pain on the other hand, is pain that lasts longer than 6 months, and continues long after the area of injury has healed. Chronic pain is more complex and requires a multifaceted approach to manage effectively. This is not the typical pain humans experience. Chronic pain management requires a specific yet individualized approach, often involving several health disciplines ranging  from physicians, physiotherapists, psychologists, occupational therapists, kinesiologists and others who have a special knowledge base and training in the area of chronic pain.

The normal or typical pain humans experience addressed here is the acute kind. Pain that is intermittent in nature, in a specific location, made worse or better with certain movements is benign in nature. Benign meaning the pain is not life-threatening or sinister. For the purposes of this discussion, let’s use a low grade lateral ankle sprain as an example. 

While stepping off the curb, Sally planted unknowingly on a rock causing her to roll over on her ankle. She experienced immediate pain on the outside of her ankle and foot and could barely put weight on it. This was followed by:

• swelling and change in colour in the form of bruising
• Her pain was constant for the first few days, but with rest and time, her pain became intermittent (would go away completely if she was non-weight bearing).
• Her swelling decreased significantly after 7 days and she was able to fully weight bear by day 10.  
• By day 5, her pain no longer disrupted her sleep and she rarely needed to take advil.

On day 11, she consulted her physiotherapist and was given the green light to return to her outside walks which brings her joy. She looks forward to this exercise each day. Normally, Sally walks 5 km per day at a fairly brisk pace.  She hasn’t walked this far for over 10 days nor has she walked at her typical pace. But Sally is feeling really good and she is excited to get back to her happy routine, plus her physiotherapist told her she could. The physiotherapist  suggested she only do 2-3 km to start. But the sun is shining and Sally’s foot and ankle feels almost 100%. So she decides to go for it and walks her 5 km route. Well that evening, Sally is experiencing pain, almost like what it felt like when she first injured it. She notices a bit of swelling. She decides to rest that evening, but is very anxious and worried she has reinjured it. Luckily, she has an appointment to see her physiotherapist the next day.

Do you think she has reinjured it?

~ Lisa Lepage, Physiotherapist

Rectus diastasis (RD), is the separation of normally joined abdominal muscles at the middle fascia called the linea alba. This commonly occurs with pregnancy and the risk increases with multiple births and repeated pregnancy. The narrow band of connective tissue (linea alba) widens as the uterus increases in size and thins in response to hormones (progesterone, estrogen and relaxin) that cause our soft tissue to loosen and stretch in preparation for delivery. This together with the mechanical strain of the enlarging uterus results in a high proportion of women experiencing RD.  Studies have demonstrated the incidence of RD to be up to 100% during pregnancy. In other words - we will all experience RD at some point.

Due to hormonal changes and a growing uterus, the abdominal muscles become over-stretched and weak, compromising posture, trunk stability, respiration, trunk motion, and vaginal delivery. Pre-pregnancy fitness levels can decrease risk and severity of RD. It is safe to exercise during pregnancy to strengthen the abdominals and optimize the recruitment and function of the core (diaphragm, abdominals, and pelvic floor musculature). Different strategies are often required to recruit and strengthen properly. This is best done with the help of a physiotherapist trained in this area.

While there is a high incidence of RD in pregnant and post partum women, this phenomenon varies in severity. We clinically quantify this with finger width. We will have the patient lying on their back while palpating the centre line of the abdomen, observing and feeling for any existing gap between the right and left abdominals. The right and left abdominals are join together at the linea alba. Any gap greater than 2 cm is considered to be RD.  It is most often widest at the umbilicus and narrower at the top where the linea alba meets the sternum and the bottom where it meets the pelvis. Surgical correction is rarely indicated except for cosmetic reasons or in severe widening. It is important to note that this is different than a hernia where one is at risk for strangulation of the intestines; there is no such risk of this with RD.

Due to the importance of our abdominals for trunk movement and control, breathing, support of the abdominal organs, posture, and bowel and bladder function, weakness in this area is often accompanied by low back pain, and impaired function of our ability to void and evacuate the bowels. The remedy is exercise!

In most women, RD will naturally resolve over time. Women who participate in regular exercise prior to pregnancy are more likely to have smaller RD than women who do not exercise and therefore will require little to no intervention. Resolution of RD can be anywhere take up to one year post delivery or longer. RD can still be detected in women many years after their last delivery.

While this condition requires more research, exercise has been shown to help resolve the condition. Certain abdominal exercises coupled with diaphragmatic breathing (belly breathing) have been shown to be effective. I cannot emphasize enough the importance of proper breathing. Diaphragmatic breathing often needs to be retrained in pregnant and post-partum women due to postural changes and adaptations that occur to accommodate the growing uterus. We are often unaware our breathing mechanics have changed at all after pregnancy. Therefore, breathing in addition to assessing the abdominals and pelvic floor is required to provide the best set of exercises for this condition.

Ideally, all of us moms should seek the care of a post-partum/pelvic floor trained physiotherapist to help regain their fitness and optimize the function of their core during and after pregnancy. They can develop an exercise program tailored to your individual needs and help you not only tolerate the physical demands of being a mom, but also help you get back to doing the activities you love, improving your quality of life and sense of well being.

~ Lisa, Physiotherapist


REFERENCES
https://www.physiotherapy-treatment.com/diastasis-recti.html

Chiarello  et al, The Effects of an Exercise Program on Diastasis Recti Abdominis in Pregnant Women,
Journal of Women's Health Physical Therapy: April 2005 - Volume 29 - Issue 1 - p 11-16

https://radiopaedia.org/articles/diastasis-recti

https://www.physio-pedia.com/Diastasis_recti_abdominis
​
Giridharan, G.Vaishnavi. (2019). Effectiveness of Exercise in Treating Rectus Abdominis Diastasis. Biomedicine. 38(4).

Many of us have been socialized to believe that aging goes hand in hand with illness, frailty and loss of function. But does it have to be this way? Is it just that our bodies get wrinkly and withered and there’s nothing we can do? Or is it that we lose fitness and we believe that is what will happen because that is what happened to grandma and grandpa, and mom and dad and so it happens…a self-fulfilling prophecy if you will.

How many times have you heard someone say “I’m too old to…” or how many times have you had this thought yourself? And if we are honest with ourselves does your inability to…perhaps play with your grandchildren on the floor or my inability to skateboard for example, have anything to do with your age or my age as I approach 50? For me personally, is it more a consequence that I’ve never learned this skill(true), I’m afraid of falling(true), and I am out of shape(perhaps also true)? If I had the desire to learn a new skill physical or otherwise, I should be able to learn it on some level regardless of my age. I may require a skilled coach and invest some time at the gym building some muscles and improving my balance, but I should be able to learn to skateboard should I have the desire. After all, I’m not aspiring to be Tony Hawke, but skateboarding down the road alongside my boys would be a great achievement in my eyes.

The scientific definition of aging is “the sum of all the mechanisms that alter the functions of a living thing, prevents it from maintaining physiological balance and eventually leads to the death of said organism. In the human body and most other living things, the process is complex, gradual and depends on many biological factors. This natural process can be amplified by external factors throughout a lifetime (pollution, food, smoking…)”(Cavallasca,2017) What a negative view of aging! Why is there no mention of increased wisdom, strength of character, and improved confidence that is often noted to go along with growing older….hmmmm.

Aging occurs more or less quickly based on a number of factors. Our bodies become less efficient and effective at DNA repair, our telomeres shorten, impact of our environment, protein malfunction, mitochondrial dysfunction, oxidative stress, cell senescence, and stem cell exhaustion.( Cavallasca,2017)Now that is a lot of contributory science that is beyond the scope of my current knowledge base and indeed of this blog! But another important factor is indeed whether he have pessimistic beliefs about aging or positive beliefs about aging. (Fan, May 2007) Among many scientific papers on the subject, the Irish Longitudinal Study on Ageing, having over 8500 participants, found that negative beliefs about ageing were associated with both declining mental and physical function. (TILDA publication papers)

How many examples of people do you know who are aging well?
Have you heard about Harriette Thompson who completed her 15th marathon at age 91 and she ran her first marathon at age 76! Or,how about Jacinto Bonilla—a 73-year-old Brooklynite, who participates in CrossFit, which he started 6 years ago. How about 88 year old Germany native, Johanna Quaas, who is the oldest active gymnast in the world. Quaas was born in 1925. In 2012, she earned her name into The Guinness Book of World Records as the oldest gymnast in the world. The grandmother and mother of three, has been married to Gerhard Quaas, a gymnastics coach, for more than 50 years. Then there’s Nola Ochs, who at age 95 earned her college degree. Ochs became the oldest person on record to graduate from college when she received her diploma from Fort Hays State University alongside her granddaughter. She began pursuing a degree at age 65 (when FHSU was still known as Kansas State College) after her husband passed away. Thirty years later, through a combination of online and in-person classes, Ochs reached her goal and crossed the stage to receive her college diploma. What about Fred Mack, who celebrated his 100th birthday by skydiving for the second time! Mack’s first skydiving experience occurred at the age of 95. (Coxwell,2014)

These are just a few of many “aged” individuals to say the least! While their level of tenacity and joie de vivre isn’t what typically comes to most of our minds when we think of being in our elder years, why isn’t it?? Wouldn’t we rather be having fun living to our fullest potential  than sitting around and watching the world pass us by?

So what do you wish to be doing? What have you always dreamed of, or wanted to do or try? What is stopping you? If your fitness levels or your perceptions are holding you back, we can help! The aging body responds to exercise in the same way our younger bodies do. You can become more flexible, stronger, bigger muscles, better balance and confidence, better posture etc. You need only desire, an open mind and elbow grease! Let’s age well together!

~ Lisa, Physiotherapist
 
 
REFERENCES
https://tilda.tcd.ie/publications/papers/

Beliefs about aging and later life health and well-being among the elderly in Taiwan, T.D. Fan, May 2007, University of Texas Libraries.

Age is Only a Number; Amazing Accomplishments by 70, 80 and 90 Year Olds, June 25, 2014 by Kathleen Coxwell
 
Aging 101: Biological causes of aging, By Julie Cavallasca,10 January 2017
 

I have been a practising physiotherapist for nearly 20 years. I have had the privilege of bearing witness to people’s suffering and have the honour to be a source of help. While the impetus for my patients to access my care is most often due to physical ailment, early in my career I began to recognize there were inevitable emotional consequences to their physical pain. After practising longer, I began to notice that in some cases, the root of their physical suffering was often from an emotional injury. I never learned this in university. While it was not part of my formal education, it made it no less true.


Thankfully, in my 20 career, I have been fortunate enough to work with and learn from some of the best psychologists in this province. For the better part of my career, I worked as part of a multidisciplinary team that treated the “whole” person. I have also had opportunities in the last five years, to take courses in mental health. I have to say it was amazing to watch the lives of many of my patients transform. Those who embraced our team’s approach became happier and healthier human beings. Not all patients I worked with experienced the same success however. In fact, some were outright resistant to becoming well. Despite mine and the team’s efforts, no matter how kind and compassionate we were, no matter how tactfully we offered feedback, no matter how hard we worked  to establish connection, they simply were not willing to have an open mind to consider the possibilities available to them.


Incidentally, the present global pandemic is imposing involuntary restrictions and changes to our way of living. We may be tempted to resist these changes, resist this phenomenon so much outside of locus of control. It is affecting all of us, regardless of socioeconomic status, ethnicity, religious or cultural background, regardless of age, and regardless of health status. We have essentially been put on pause. This pause has resulted in many losing their source of income, losing their daily routine and potentially losing their human connections. A few days ago, I crossed paths with a friend who is a sergeant with our local police force. This person shared how since our government imposed social restrictions on our community the incidence of violence and suicide has increased substantially. While this is affecting us all, the consequences of social isolation is undoubtedly more harsh for those of our community with less resilience, fewer coping strategies and unhealthy family and social dynamics.


So much about this health crisis leaves us feeling powerless. In fact, the devastating potential of this virus on our world is downright scary. This reality combined with the fact that our brains are wired to focus on the negative (an evolutionary survival mechanism), is a recipe for a mental health crisis for anyone. That is, if we let it. (Amen, 2020)


Allow yourself for a minute to consider the possibility that in the midst of this crisis there is opportunity here. The opportunity of time which allows reflection, healing, transformation, that we might emerge from this better, stronger and happier than we have ever been. Perhaps this is a gift wrapped in ugly paper. But inside is a never before known chance at true happiness. It is a looking glass that is all revealing. This looking glass tells us what is good and life giving and what no longer serves our peace and happiness.


We have already seen much positive healing impact on our environment-clear water in the canals of Venice with return of water fowl and fish; blue skies and singing birds in cities once clouded in smog and the holes in the ozone layer are getting smaller.


I have learned both in my training and in my clinical experience, the only thing we truly have control over is our thoughts and our behaviours. So how can we think and act so as to diminish the stress we are experiencing in crisis?

1. Practise gratitude every day. Better yet, every night before you go to sleep, write down 3 things for which you are grateful. This increases the production of dopamine (a feel good neurotransmitter) in our brains and activates our reward centers in our brains. This works to rewire our brain to become effortlessly grateful. (Doidge, 2007)
2. Develop a healthy daily routine. This should include a set wake up and sleep time, healthy regular nutrition, adequate water intake(our brains are 80% water, so try to aim for 8-10 glasses/day), physical activity, something fun and some time to tidy up your living space. (Amen, 2020)
3. Exercise! Anything that increases your heart rate will increase blood flow to your brain, improving its function and increasing the release of feel good neurotransmitters. Start with just 10-15 minutes per day.
4. Try meditating. Start with 5 minutes per day. Meditation activates the calming centers of our of brains and studies show these centers actually increase in size, allowing us to better manage stress. There are free apps you can download for guided meditation and walking meditation if you the thought of being still overwhelms you.
5. Keep life simple and be kind and compassionate to yourself. These are unprecedented times! We are learning a lot, what works, what doesn’t work. This requires lots of energy. Have realistic expectations and choose one or two things to focus on.
6. Buddy up! Stay connected regularly with someone you trust and who accepts you as you are. Use the virtual apps(Facetime, Zoom,Facebook etc) to have coffee together. We are social beings and need human connection. The longest human study done on happiness is an 80 year longitudinal study conducted out of Harvard. The conclusion of the study was that the only predictive factor on health and happiness was the QUALITY of our human relationships.  (Stossel, May 2013)
7. Focus on that over which you have control, your thoughts and behaviours. You may find it helpful to make a list of these, let the rest go. This may mean limiting your exposure to news and social media.

Any questions, or want to chat - don't hesitate to reach out.

~ Lisa Lepage, Physiotherapist


References
Amen, Daniel G., The End of Mental Illness (Carol Stream, IL Tyndale,2020)

Doidge, N., The Brain the Changes Itself (Penguin Group,2007)

Stossel, Scott (May 2013). "What Makes Us Happy, Revisited: A new look at the famous Harvard study of what makes people thrive". The Atlantic. Archived from the original on 7 June 2017.

​Image credit - Saskatchewan Health Authority, April 2020.
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