We are very excited to announce that starting in the New Year, chiropractic intern Taylor Huehn will be joining the team!
After her 4 year B.Kin degree from WLU, she is now 3.5 years into her 4 year Doctor of Chiropractic program at CMCC. As such, Taylor is now certified to provide direct care to patients under Dr. Delanghe’s guidance as she finishes the final 6 months of her training.
You can read more about her background and book with her online HERE.
How will she help at the clinic?
Other than a number of tasks behind the scenes including research and various learning objectives, Taylor will be helping as follows:
Same day appointments
No existing patients will be required to see her. However, if there is a day where you need to get in and Dr. Delanghe is unable to accommodate, rather than wait you will have the option to get in the day you call with Taylor.
Free initial assessments
As part of her training, Taylor will be providing free initial visits to all patients new to the clinic.
These visits will consist of a 1 hour, highly in-depth history and physical exam followed by a communication of a diagnosis, plan of management and initial treatment. In addition to this, all of these visits will be completed with consultation with Dr. Delanghe.
It is important to note that there will be no requirements for additional visits if you do not wish to pursue more treatment.
Subsequent visits will be the same price as seeing Dr. Delanghe. As such, Dr. Delanghe will be either directly or indirectly overseeing all treatments. He will also offer any help in completing procedures if needed.
Yes, your insurance will still cover it!
As part of her training, Taylor will be observing Dr. Delanghe during certain treatments at the clinic. As the patient, you are always welcome to decline having her in your treatment room with no questions asked.
That’s it for now! We also have some exciting things in the New Year planned including things for new mothers and those who suffer from osteoarthritis.
If you have any questions, feel free to let us know, and make sure to welcome Taylor if you see her around the clinic!
Ankle sprains, AKA rolled ankles, have got to be one of the most common injuries out there. They can happen in the most innocuous situations, like stepping on an uneven surface, or during sports that require cutting and landing. The words “walk it off” are synonymous with ankle sprains. Get up. It’s nothing serious. Back to business.
I get the sense that most people that sustain an ankle sprain do not seek any guidance from a physiotherapist. It might swell up nicely for a day or two, but then you limp around and manage to get on with your life. What you might not appreciate though, is that ankle sprains have a high recurrence rate due to the residual effects of the initial injury. Things like ligament laxity and damage to the neural and musculotendinous tissue around the ankle can inhibit complete recovery. This can present as weakness, poor balance, and slower muscle response to load. You might not notice these deficits when you are walking around, but they do make you susceptible to re-injuring the area. This is why I always advocate for getting any old rolled ankle assessed by a physiotherapist.
Want to know what kind of exercises are appropriate for you? Or have you sprained your ankle before and feel things are not quite right? You can book an appointment with me here!
In both kinesiology and physiotherapy school, we were taught anatomy. The sheer volume of knowledge was overwhelming. Where does each muscle attach? What nerve controls which muscle? It felt like we were learning everything there was to know about the body. That was incredibly naive of me, as research has plowed on and has shown just how complex our movement systems are.
This post will take a closer look at the infraspinatus, one of your four rotator cuff (RC) muscles. Located just under the boney ridge of your shoulder blade, it is commonly injured, especially in overhead athletes (throwers, climbers, etc).
When I learned about the infraspinatus, we were told that it was a muscle that externally rotates, or turns your arm outward (see below for a picture showing that position) and that it is controlled by your suprascapular nerve. But within the last 20 years or so, researchers have found that the infraspinatus has three distinct regions, each innervated by its own mini branch of the suprascapular nerve; the superior, middle, and inferior infraspinatus subregions.
Why does this matter? Well, turns out that the subdivisions serve slightly different purposes, kind of like how your municipality functions within the province. The province of Ontario has an overarching goals, but Waterloo Region will function in a different way than say the GTA. They also will take on more or less burden depending on the task at hand (regional containment of COVID19 being a prime and timely example). This goes for the subregions too – some sections might turn on more or less depending on the degree of arm elevation, your plane of movement, and resistance.
If that’s the case, then is there a way to make rehab more specific by targeting movements that bias one subregion over another?
I was hoping the answer would be yes, but the research isn’t there yet. It seems as though there are still some discrepancies in the research about which subregion does what. Furthermore, the role of the inferior infraspinatus has yet to be determined.
I have summed up 4 key takeaways below in terms of the roles of the subregions:
All three subregions of infraspinatus are more active the higher your arm is in front of you (eg: they will work harder if you are reaching into a high cupboard, and will work less if reaching for something at waist height).
The superior infraspinatus has a shared insertion on the top of the arm bone with your supraspinatus (another RC muscle that will have its own blog post next). It is thought that both muscles contribute to shoulder stabilization, and that redundancy allows for people to have tears and still be strong.
The middle infraspinatus is more of a pure external rotator.
There is minimal evidence for the role of the inferior infraspinatus.
What does this mean for rehab?
When you are dealing with a fresh injury, start with exercises where your arm is low and closer to your body, like farmer’s carries. Any load on your arms will turn on your rotator cuff, and this is the least provoking position to be in.
You can start with isometrics (exercises where you are not moving your arm through range) if you cannot even move the shoulder without pain.
You don’t have to rotate your shoulder to get your infraspinatus. You can just do an arm raise and it will work all three subregions. The higher your arm, the more the infraspinatus will be working.
Generally, strengthening external rotation follows the same principle. The movement of rotating your arm outward will be more challenging the further away your upper arm is from your body (overhead vs tucked into your side).
Check out the video below for 4 different exercises that target the infraspinatus, ranging from lower muscle activation to the most, using the principles I outlined above. Some of these exercises are based on articles published by researchers at the Digital Industrial Ergonomics and Shoulder Evaluation Laboratory at the University of Waterloo (local shout out!).
The next write up will target the supraspinatus – yet another notorious RC muscle that also has 2 subregions despite being super slender. As I eluded to above, superior infraspinatus shares an insertion with supraspinatus, and we will talk about why that is so important for shoulder stability and how you could approach rehabilitation for a torn supraspinatus. Stay tuned!
Sayaka is an evidence based physiotherapist in Waterloo. Click here