Latest from Fifth Ave Physio

New Year & New Health Goals

Published: January 15th, 2018 by

Many of us find ourselves reflective as we turn the calendar to January of a New Year.  Who hasn’t started off the year with lofty ideas of big changes?  Sometimes it’s our overall health, sport and movement, sleep, relationships, work or trying to find a better balance in general. It is well established in the literature that which common sense has told us for a long time – movement helps all aspects of our health. Everything from mood and mental health to sleep, pain, strength, energy and cognition just to name a few. Movement helps keep us functional in our lives and allows us to do the things we need and want to do.

With this in mind, what are your hopes for yourself for this New Year? Perhaps it’s staying strong and improving your balance in order to maintain your independence in your home. For others it might be sticking with that gym membership and showing up for yourself to exercise. Maybe you have an old nagging pain that you haven’t quite figured out how to manage or fix? Or there’s a new sport or activity that you want to try and finally have some space to give it a go! Perhaps you’re after that PB that escaped you in your last race?

The notion of setting a goal sounds simple enough yet it’s challenging to succeed and often falls by the wayside when life gets in the way.  Have you tried setting small goals that can add to up to one large lofty goal? What about setting a SMART goal (1). A SMART goal is defined as:


  • Specific and Simple
  • Measurable and Meaningful
  • Achievable and Action Oriented
  • Realistic
  • Time Oriented


I would also add in Flexible, Meaningful and Sabotage Proof because life is a dynamic system and we tend to put action toward the things that matter most to us.  An example of a small SMART goal that could help work toward a larger goal of better overall health and well-being is:

“I really want to be more independent with my persistent low back pain management. Five mornings per week I will start with 5 minutes of rolling my back/hip musculature/legs and shoulders with a massage ball, then spend 10 minutes doing 5 reps of bridging, plank, bird-dog and clamshells. My backup time will be right after I finish dinner in case the kids wake up early and I miss my morning window. I will know that I’m succeeding when I have 4 weeks marked off in my calendar. Then I can revisit my SMART goal and modify or add. “

If you would like to improve your confidence with overall movement, a SMART goal could be:

“I am not in the habit of being especially active and I’m not comfortable starting off at a gym with all those experienced folks who all seem to know what they are doing. My intention is to keep track of my steps on my phone pedometer. On weekdays when I’m at work, I have 20 minutes free at lunch time where I can walk outside or in the Plus 15. I need my lunch after busy morning meetings, so I’ll eat my lunch then lace up my shoes and walk for 20 minutes with my friend Jim. I will keep track of my steps as I know that some days I’ll feel more energetic than others. If I have to occasionally work into lunch to meet a deadline, I can get off the bus early and walk the 20 minutes home at the end of my day. I can track my steps on my phone and I’ll know I’m successful when I reach my goal of 10,000 steps per day. By teaming up with my friend, I know that between the two of us we’ll help keep each other on track.”

SMART goals can be built upon and used as stepping stones. If you are trying to reach a certain time cut off or put the heat on that person who seemed to slip by you in the last 5 km of your races, here is an idea:

“I’m in the habit of doing my usual workouts throughout the week to keep up my training for the Calgary Marathon. Last year, there was one competitor that seemed to have another gear that she kicked into for the last part of the race and I just couldn’t stick with her. I’ve heard that doing some strength training can help with breathing regulation and endurance to power through that last stage of the race. I wonder if that might help? I have enough rest built into my training schedule, so on Tuesday nights when I take the kids to gymnastics from 7-8:30pm, I’m going to take my resistance bands. I know there is a quiet corner where I can put down my mat and build up my strength using the battery of exercises my Physiotherapist gave me last year. I’ll start with 10 reps of 10 seconds of those 6 exercises and keep track of my success in the spreadsheet I have in my journal so there is a monthly tally of sessions and increasing reps. On weeks when I’m travelling for work or something throws me off track, I will do my strength workout right after dinner. I’ll know I’m succeeding when the Tuesday workouts happen every week, my reps increase overall and I find that extra gear in my races. It would be super rewarding to stick with that other competitor next time we race against each other!”

We all need a little help and coaching sometimes with bringing focus to our health goals. Fifth Ave Physiotherapists are Movement Specialists, Internationally Certified in Manual and Manipulative Physiotherapy with  CAMPT Certification and happy to help you create your 2018 SMART goal.

  1. Doran, G. T. (1981). “There’s a S.M.A.R.T. way to write management’s goals and objectives”. Management Review. AMA FORUM. 70(11): 35–36.


Have You Ever Experienced Vertigo?

Published: November 2nd, 2017 by

Have you ever had that feeling when you lay down or roll over in bed where the room is spinning like crazy (without having had too much to drink!) Or, do you have a lightheaded feeling when you get out of bed? Have you noticed when you’re walking in a store that looking side to side makes you feel nauseous or unwell?

Most of us have experienced at least one of these symptoms. In fact, 35% of people over the age of 40 have experienced some form of vestibular dysfunction. A remarkable 80% of people over 65 have experienced significant dizziness, of which 50% can be attributed to a condition called Benign Positional Paroxysmal Vertigo (BPPV).

Dizziness and vertigo are not the same thing. Vertigo is a type of dizziness with the illusion of the environment moving. This is similar to the sensation you get if you’ve had too much to drink and you lay down. Dizziness is a term used to describe a variety of sensations including unsteadiness, lightheadedness, swaying or disorientation. Dizziness can be caused by a variety of factors including medications, cardiovascular causes (blood pressure, blood flow), neurological causes (infection to the brain, multiple sclerosis), psychological causes (anxiety) or a dysfunction to the vestibular system. The vestibular system is the coordination of your vision, the sensation you get from your muscles, ligaments and joints, and balance centre in your inner ear.

Remember when we asked earlier if you’d felt like the room was spinning when you laid down or rolled over in bed? That sensation is better known as vertigo. The most common cause of these symptoms comes from your inner ear. In the inner ear, there’s a little series of semicircular canals that have fluid in them. These are connected to a couple of small sacs (the otoliths) which contain calcium carbonate crystals. Movement of our head in space causes movement of the fluid and crystals, and this message is sent to the brain to be interpreted in relation to what our vision is telling us and what our muscles, ligaments and joints are telling us.

Occasionally, the calcium carbonate crystals migrate from the small sacs (otoliths) into the semicircular canals. When this happens, there’s a big change in the input from the inner ear relative to the other balance systems, which results in the illusion that the environment is moving. It’s an awful feeling!

While this condition can leave you feeling anxious and unwell, the good news is that it’s commonly completely treatable. Physiotherapists (and usually Physiotherapists more specifically trained in Vestibular Therapy) will perform a few tests to determine how the situation should be treated. They can apply a treatment technique known as the Epley Maneuver which repositions the calcium carbonate crystals, and in 98% of cases, clients have significant reduction of vertigo symptoms. It is important to note that this is specifically related to the condition known as Benign Positional Paroxysmal Vertigo (BPPV). This treatment will not be effective for other causes of dizziness.

Dizziness can come from many other causes as well, as we mentioned earlier. Your healthcare professional should evaluate for other possible contributing factors. The main portion of determining the cause of your dizziness can be gleaned from your history. A Vestibular Therapist will likely ask many questions asking you to describe your dizziness, when it occurs, how long it lasts, if there are any other associated symptoms (nausea, vomiting, tingling into your extremities or face) and about any history of trauma. Previous concussions can be a major contributing factor to dizziness, so any history that might be consistent with a concussion is relevant. A full medication list is important for your Therapist to have since dizziness can be a common side effect of many different medications. Finally, they might ask questions about any history of mental health issues. This can be because persistent dizziness can cause anxiety (which comes with its own problems), and because mental health conditions can cause dizziness.

Your health care professional will also likely be doing some clinical tests. This might include tests of your blood pressure, tests to measure your coordination, tests that look at the strength in your extremities (especially around your hips, knees and ankles) and around your spine (both your neck and your trunk muscles). They may look at how good your vision is and how your vision contributes to your balance. A scan of your nervous system is also important, so testing reflexes and sensation will likely also be done. Finally, there are specific tests to evaluate the coordination of the three systems of balance; the vestibular system, vision and your ligaments, muscles and joints.

It’s important to remember that dizziness is not normal. If your healthcare professional can’t come to a definitive diagnosis about the cause of your symptoms, then further assessment can (and generally should) be done. A referral to more specialized practitioners can be beneficial as well. This might include seeing a Neurologist or an ENT (Ear, Nose and Throat Specialist). These specialists might send you for more advanced medical testing to look at the health and effectiveness of the vestibular or nervous system.

If you choose to see a medical professional about dizziness, there are some things you should be prepared for. As I mentioned earlier, a detailed history is very important in determining the possible cause or contributing factors to your symptoms, so be prepared to answer questions about the what, when, where and how’s of your condition. Medication history is very important, so having a list of current medications, as well as previous medications you may have taken (specifically antibiotics) is very helpful. Any medical assessment generally tries to look for the cause of your symptoms, which involves stressing your body. It’s unfortunately quite common for the assessment to leave you feeling a bit uncomfortable, so It’s very helpful to have someone with you at your assessment to look after you, especially if you need to drive home.

Physiotherapists are qualified to assess the complex combination of systems that can contribute to vertigo and dizziness. Visit our Physiotherapists to find a solution if you struggle with this potentially disabling condition.

Written By:

Mark Metcalk BSc. (Kin), MSc. (PT) FCAMPT 

Orthopaedic Division Instructor 

Independent Medical Consultant

Why Does My Shoulder Hurt When I Don’t Remember Injuring It?

Published: September 21st, 2017 by

Why Does My Shoulder Hurt When I Don’t Remember Injuring It?

The shoulder is a complex joint and has many different anatomical components that could be the source of pain.  At a recent shoulder course, the lecturer listed off at least 48 different diagnoses for shoulder pain. One of the most common diagnoses that can cause ongoing shoulder pain with no apparent mechanism of injury is tendinopathy.  

What is the difference between Tendinopathy and Tendinitis?

Most of us have heard the word tendinitis but not tendinopathy. Any type of pain around a tendon used to be called a tendinitis. The issue with this terminology is that it implies that all tendon injuries have an inflammatory component. Research does not support this. Studies show that overuse tendons tend to degenerate or have changes and degradation of the collagen fibers, but have minimal inflammation. These changes can cause pain, weakness and sometimes tearing. Why does the terminology matter? Treatment for an actual tendinitis where the tendon is hot, swollen and is due to a recent injury most likely would be rest and anti-inflammatories. Treatment for a tendinopathy is very different as there is no need to target inflammation. Research recommends functional rehabilitation that includes specific eccentric strengthening exercises as well as targeting the causes or aggravating load to the tendon.

How does a Tendon injury occur?

A tendon is the part of the muscle that attaches to the bone. It is designed to withstand high repetitive loading. When too heavy or constant, repetitive loading is placed on a tendon, it can cause too much strain or stress on the tendon and create microtears. If the rate of healing is less than the injury rate, as is the case with constant or repetitive overloading, the tendon will go into disrepair and collagen degeneration will occur. This is called a tendinopathy. The most common areas in the shoulder this occurs in are the supraspinatus, infraspinatus, long head of biceps or subscapularis tendons. This overloading can be caused by multiple reasons, including overtraining in a sport or exercise, or repeating the same movement repetitively at a job or household chore.

Symptoms of a Tendon injury in your shoulder

-Pain can come on suddenly, appearing seemingly like there was no cause for the injury

-Pain is usually worse with the use of your arm but may be better at rest

-Pain may be worse as the day goes on and you may be more stiff and sore in the morning when you wake up

-Crunching or noises with shoulder movements may also be present


Early intervention and correct diagnosis is the key to recovery. A qualified Physiotherapist can do specific testing to sort out if your shoulder pain is a tendinopathy or one of the other 47 diagnoses. If it is a tendinopathy, they can assess what stage of repair that tendon is in and make appropriate treatment recommendations.   

Tendon injuries can be very frustrating as they can appear to come on suddenly even though the tendon has most likely been overloaded over a period of time. They can take weeks to months to recover depending on how much collagen degeneration has occurred. If the tendon persists to be overloaded or used in the wrong way too early in its process of recovery, further damage can be done to the tendon, lengthening the recovery time.    

To keep from injuring the tendon further you may need to learn how to change how you are performing your work or aggravating activities. You may need to learn how to correct muscle imbalances around your shoulder blade, neck and shoulder. If it is a specific sport that is causing the damage, getting help improving your technique may be beneficial. Closely monitoring your exercise or work loads can also help. Doing a proper warm up, not starting with too heavy of a load or doing something for a long period without proper breaks can go a long way in preventing these types of injury.  

Getting your shoulder pain assessed early on, being patient with your tendon injuries and receiving proper physiotherapy treatments can lead to a quicker recovery!

Submitted by: Renee Poloprutsky

BScpt, FCAMPT, IMS Certified

Brett M. Andres, MD and George A. C. Murrell, MD, Dphil Clin Orthop Relat Res. 2008 Jul; 466(7): 1539–1554. Published online 2008 Apr 30. doi:  10.1007/s11999-008-0260-1

Treatment of Tendinopathy: What Works, What Does Not, and What is on the Horizon

Dry Needling: What You Need To Know

Published: August 25th, 2017 by

Dry Needling is becoming a commonplace modality used by many healthcare practitioners such as Physiotherapists, but what exactly is it and how does it work? Fifth Ave has you covered – listed below are the answers to some frequently asked questions about Dry Needling: Q: What’s The Difference Between Dry Needling and Acupuncture? A: This is the most frequently asked question that we get at Fifth Ave Physio. They both use needles, right…? Right, but then that’s where the similarity ends. Acupuncture is a traditional Chinese medicinal practice that uses fine filament needles inserted along meridians (thought to be pathways of energy flow throughout the body) to establish an equilibrium within the system. With Acupuncture, the needles are often left in place for a longer duration of time (about 15-30 minutes), and there’s often very little sensation felt with these needles. Dry Needling on the other hand, uses a slightly thicker gauge needle inserted directly into palpable focal regions of tension within the muscle tissue – motor points (which are often referred to as “knots” or “trigger points”) with the intent of relaxing or resetting the muscle to its normal resting condition. This resetting of the muscle provides relief of both the local pain and/or tension as well as the referral pain that may be created by some trigger points. In most cases, the needle is not left in; however, if the muscle is particularly tight or resistant to releasing, the needle may be left for a few minutes and may be combined with electrical stimulation. Unlike Acupuncture, there is often a strong sensation of an involuntary muscle twitch which is often described as “odd” and occasionally “achy” or “uncomfortable”. In summary, the main differences between Acupuncture and Dry Needling include the foundational theory, the goal of the technique and the application of the needle – the location, duration, sensation and effect.

Q: What’s The Difference Between Dry Needling and IMS (Intra-Muscular Stimulation)?

A: There are several models for the application of Dry Needling which differ slightly in the theory and methodology of using the needling technique; however, they are largely the same. Dry Needling is a generic term for the use of a needle to release a motor point in the muscle, while IMS (Intramuscular Stimulation) and FDN (Functional Dry Needling) are essentially brand names that depict the Practitioner’s specific training background.

Q: Why Is It Called ‘Dry’ Needling?

A: Dry Needling implies that there are no injections involved in the technique. The needle is blunt without a lumen (no hole to inject fluid), so it is simply the stimulus of the metal needle within the muscle tissue that is sufficient to create the desired result.

Q: How Does Dry Needling Work?

A: The introduction of the metal needle into the motor point of the muscle causes an involuntary twitch response. This muscle contraction has been shown to quickly remove the pain producing chemicals such as hydrogen ions from the muscle. This allows the muscle to reset and normalize its contract-relax cycle, whereas it had previously been stuck in the contract phase. The sudden contraction of the muscle has also been theorized to restore normal blood flow to the region, which provides nutrients and substrates required for normal muscle function. A muscle that is deprived of these nutrients is unable to relax properly, thereby limiting its functional use and resulting in the accumulation of chemicals that cause muscle soreness and fatigue.

Q: Who Can Do Dry Needling?

A: Due to the high level of knowledge and skill involved, Dry Needling is considered a restricted activity by the College of Physical Therapists of Alberta (CPTA). Only a Health Care Practitioner who has been trained and examined in the use of Dry Needling is permitted to use this technique. The CPTA website provides information regarding whether your Therapist is permitted to perform this restricted activity.

Q: What Conditions Can Be Treated With Dry Needling? How Do I Know If It Is Right For Me?

A: Dry Needling is used to treat a wide variety of musculoskeletal conditions, including ankle sprains, whiplash, TMJ dysfunction, lower back pain, and carpal tunnel. Just about every injury or pain state creates dysfunction within the surrounding muscle tissue, which can be effectively treated with this technique. For example, an ankle sprain may result in tight muscles along the shin or in the calf, which can lead to excessive pain and discomfort in the ankle. In this situation, dry needling can be used to relax and off-load these muscles in order to provide optimal conditions for the healing ligaments and tendons.

Q: Why Am I Sore After The Dry Needling Treatment?

A: The process of resetting the muscle causes a cascade of events to occur in the muscle cell. The soreness following Dry Needling is attributed to the release of hydrogen ions, a component of lactic acid. These ions are trapped within the tight/contracted bands of muscle. When the muscle is released by the needle, these ions are released into the bloodstream as they get flushed out of the muscle. This creates a sensation quite similar to post-exercise muscle soreness (fatigue, achiness, heaviness), which can last 24 – 48 hours following treatment. The muscle is not injured or damaged with the insertion of the needle. The tip of the needle is actually blunt, intended to separate the cells as it enters the muscle rather than cut through the cells the way traditional needles do. On occasion, bruising may occur, but this is due to the needle coming in contact with a blood vessel and does not indicate injury to the muscle.

All Fifth Ave, Physiotherapists are fully trained and highly skilled in the application of Dry Needling. If you think you’re a candidate for this type of treatment, come see us today for an assessment, or contact us at [email protected] for more information!

Postpartum Goals: Get Your Strength and Mobility Back

Published: August 17th, 2017 by

Pregnancy is one of the biggest changes a woman’s body will every go through.  It is remarkable that a woman’s body is able to grow and accommodate a human being; muscles expand, organs shift, and blood volume doubles to create space for the tiny human. This change happens over 40 weeks, but, unfortunately, many women end up living with the after-effects for years!

Once you have had a baby, you are considered postpartum: even if you are a grandmother, you are still considered postpartum. This is not a negative label, but a record of what your body has done; however, this becomes a problem if you are not able to get your body back to its original capabilities.  We often see women who have not been able to reach their goals or exercise at the same level of intensity as they were before their children – even 10 years later!


Have You Ever Been Shocked?

Published: July 13th, 2017 by

Shockwave Therapy has been used in Canada for more than 2 decades. It is a common treatment offered to patients who have a tendinopathy. You may know of the condition as a tendinitis. But this term is not scientifically correct because research shows that there is actually little or no inflammation present in these conditions.

What you need to know about tendinopathies:

  1. A tendinopathy is a broad term that includes a painful tendon and the surrounding area in response to overuse.
  2. Tendons are tough fibres that connect muscle to bone. Tendon injuries usually occur in three areas:
  • musculotendinous junction (where the tendon joins the muscle)
  • mid-tendon (non-insertional tendinopathy)
  • tendon insertion (where it attaches into bone)

Most tendon injuries occur near joints like the shoulder ankle, knee, and elbow.  A tendon injury may seem to happen for no apparent reason, but usually it is a result of a repetitive overload.

So, what is actually going on in your tendon that has forced you to stop playing your favourite sport?


What do all those LETTERS mean?

Published: May 9th, 2017 by

When you look at your Physiotherapist’s business card, do you ever wonder what do all those initials mean?

May is National Physiotherapy month, and what better time to clarify what all the letters behind our names mean. Seeing the collection of letters may cause you to feel many things: intimidated, that you are good hands or maybe you are just plain confused and have no idea what they mean. Like many professions, we like to speak in our own “special” language that means a lot to us but can be confusing to you.

Let’s decode many of the common acronyms and abbreviations, so you are aware of the designations your Physiotherapist may have and what difference it may make to you.  


See a Physiotherapist for a movement screen – even when you don’t have an injury.

Published: April 11th, 2017 by

Establish a baseline so you can play to your strengths and work on your weaknesses. What if I told you that your Physiotherapist or Massage Therapist is actually an excellent resource to do check-ups on your body, even if you’re injury free? That way we can check out even those minor aches and pains to help prevent them from getting worse. We all know that we go to the dentist to prevent cavities and we get our car serviced – why wouldn’t we do the same thing with our body? Here are some excuses I hear all the time:


Why is Massage so beneficial?

Published: March 17th, 2017 by

There are so many benefits to Massage. If we view Massage as a treatment rather than an indulgence, would we value it more and therefore, view it in a different light?

I know… we all have a visual of a Massage room. Some see it as a relaxing place. Others, a table in a closed space with a strong Therapist waiting to treat us. These visuals are somewhat true, but even so, there are tremendous benefits to be achieved through regular Massage Therapy. Whether you need a moment of relaxation, reduced muscle tension or relief from chronic pain, Massage can enhance your overall sense of emotional and physical well-being as well as your quality of life!


What is your office chair telling you about workplace ergonomics?

Published: February 13th, 2017 by

Your office chair is fundamental to your workplace. It is a piece of equipment that gets a lot of attention when we talk about ergonomics. So what is ergonomics? The principle of ergonomics has been around for a long time. In the effort to decrease physical and emotional stress humans have done tasks in different ways. To make work easier and more efficient, shovels were made lighter, cockpit controls were made more logical and machines were made to be driven by electricity. When we discuss ergonomics in the workplace we commonly refer to posture and sitting in front of the computer.