Tag Archives: back pain

Back Pain, neck pain, Neck pain Treatment Mississauga, Neurological, Physiotherapy

Physio 101: Centralization vs Peripheralization

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Medical terminology can be a patient’s biggest nightmare. During a session, a lot of unfamiliar terms describing symptoms, conditions, muscles, and more can be used. Today, we will be discussing a process called centralization and peripheralization that is encountered a lot during physiotherapy. To elaborate, spinal and musculoskeletal pain and other symptoms can sometimes move, change location, or feel different with certain movements or exercises. The two important terms physiotherapists use to describe these changes are centralization and peripheralization.

Understanding these concepts helps you understand your treatment, reduce fear, and improve your rehabilitation outcomes.

What is centralization?

Centralization occurs when pain that was felt farther away from the spine (for example, in the leg or arm) moves closer to the spine or reduces in intensity with specific movements or positions.

Examples of centralization include:

  • Leg pain moving from the calf to the thigh
  • Arm pain reducing and becoming more localized to the neck
  • Radiating pain decreasing while central discomfort remains

Centralization is generally considered a positive sign in physiotherapy.

What is peripheralization?

Peripheralization is the opposite phenomenon. It occurs when pain:

  • Moves farther away from the spine
  • Becomes more widespread
  • Increases in intensity in the limb

For example:

  • Low back pain spreading further down the leg
  • Neck pain traveling into the arm or hand
  • Symptoms becoming sharper or more intense at areas farther from the spine

Peripheralization often indicates that a movement or load is not currently well tolerated.

Why do centralization and peripheralization occur?

Model of the spine
Model of the spine showing how the nerves (yellow) exit through spaces around the spine. These nerves give us sensation in our limbs so problems centrally can produce pain and symptoms peripherally

The spine, discs, joints, and nervous system are highly interconnected. Changes in symptoms reflect how these systems respond to movement and load.

Possible contributors include:

  • Mechanical loading of spinal structures
  • Sensitivity of neural tissues
  • Protective responses from the nervous system
  • Individual movement patterns and postures

Ultimately, these symptom changes provide valuable information for guiding treatment. Your physiotherapist can interpret these changes to determine whether the treatment is working well, or whether a different technique needs to be used.

Why is centralization important for physiotherapy?

A condition that displays centralization is commonly associated with:

  • Improved outcomes
  • Reduced nerve irritation
  • Better tolerance to movement

When symptoms centralize, physiotherapists often continue or build upon the movements that produce this response. So what happens to the patients that don’t show a centralization response? Unfortunately, while centralization is desireable to have, not all patients experience it. Thankfully, many people still recover fully without clear centralization patterns, it just may take more time.

Physiotherapy always considers the whole clinical picture, including function, pain levels, strength, and confidence with movement.

What does peripheralization mean for treatment?

Peripheralization does not mean lasting harm or damage is being done to the tissue. Instead, it signals that:

  • A movement may need modification
  • Load may need to be reduced
  • A different strategy may be more appropriate

Physiotherapists use this information to adjust treatment safely and effectively. A movement that causes peripheralization may become a part of treatment later on, but is currently not appropriate.

A summary of centralization vs peripheralization

An example of a repeated movement is back extension in a lying position. Over the course of the repeated movements, symptoms in the leg and back are being watched for change.

Physiotherapists assess symptom responses during:

  • Repeated movements
  • Postural changes
  • Functional tasks

This helps identify patterns of centralization vs peripherilization:

  • Movements that reduce symptoms
  • Movements that aggravate symptoms
  • Optimal starting points for rehabilitation

Treatment is then tailored to encourage positive responses while avoiding unnecessary symptom flare-ups.It’s important to understand that symptom location does not always reflect tissue damage where the pain is felt. Even though your pain might be in the ankle, your physiotherapist will be checking your back for the possibility of referred pain.

Looking for physiotherapy treatment?

Look for PhysioNow! We have 10 locations across the west GTA including Burlington, Oakville, Mississauga and Etobicoke. Our expert clinicians can help you recover from an injury, neck pain, back pain, and more. Don’t wait any longer, we can help you get back to your normal life. Book with PhysioNow today for your first assessment and treatment. We can be reached at P: 289-724-0448 Email: applewood@physionow.ca

Back Pain, Headaches: Neck Pain, Low back Pain, Motor Vehicle Accidents, neck pain, Physiotherapy

Physiotherapy After a Motor Vehicle Accident (MVA)

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A motor vehicle accident (MVA) can cause high degrees of neck and back pain, even if the impact seemed minor. Oftentimes, people will feel pain, stiffness, headaches, and/or reduced movement. Additionally, these symptoms may occur immediately, hours after, or even days or weeks after the accident. Thankfully, physiotherapy plays an important role in helping your body heal properly and prevent long-term complications.

In Ontario, most people fall into the Minor Injury Guidelines (MIG) after a car accident that entitles them to $3500 of medical treatment, including physiotherapy. This is usually sufficient to treat less severe injuries such as strains, sprains and whiplash disorders. After a car accident, the last thing you want to deal with is wordy forms and legal speak. Luckily, PhysioNow and our clinics are one of the preferred providers of MVA treatment from Intact, and our staff is ready to streamline the process for you. Find out more about our MVA treatments here!

Why is neck and back pain so common after an MVA?

Sudden forces during a collision can strain muscles, joints, and ligaments in the spine. Common injuries include:

  • Whiplash (neck injury)
  • Muscle strain and tightness
  • Joint stiffness
  • Nerve irritation
  • Poor posture due to pain and guarding

Without proper care, these issues can turn into ongoing or chronic pain.

How does physiotherapy treat MVAs?

At our clinic, we focus on pain relief, restoring movement, and helping you return to daily activities safely. Your physiotherapy treatment may include:

  • Pain and inflammation management
  • Hands-on manual therapy
  • Personalized exercise plans
  • Strengthening exercises for neck, back, and core muscles
  • Posture and movement correction
  • Education on safe activities, work, and daily movements

All treatment plans will be adapted to each patient, based on the symptoms, goals, and stage of recovery.

How does PhysioNow help with auto insurance claims?

On your first day, there will be many forms to read over and fill out. Don’t worry, our staff will be able to guide you through and answer any questions that you have!

We understand that dealing with auto insurance after an accident can be stressful. Our clinic helps by:

  • Accepting auto insurance (MVA) claims (not all private clinics will)
  • Direct billing when applicable
  • Communicating with your insurance company and other healthcare providers
  • Creating treatment plans that follow insurance guidelines
  • Guiding you through forms and what to expect

This allows you to focus on your recovery while we handle the paperwork.

Why is early physiotherapy so important?

Some people choose not to pursue physiotherapy right away. However, the longer you let a problem persist, usually the more disruptive it becomes. In some cases, waiting may prolong recovery times. Since you will have the coverage, we encourage people to get started with their rehabilitation as quickly as possible. The benefits of early physiotherapy includes:

  • Reduces pain and stiffness early
  • Prevents long-term complications
  • Improves movement and confidence
  • Speeds up return to work and daily life
  • Reduces reliance on pain medications

Start your MVA recovery with PhysioNow

If you’ve been in a motor vehicle accident and are experiencing neck or back pain, early physiotherapy can make a big difference. Our experienced physiotherapists are here to guide you through every step of recovery. PhysioNow has 10 locations across the west GTA including Burlington, Oakville, Mississauga, and Etobicoke. Please feel free to contact us by Phone: 289-724-0448, Email: applewood@physionow.ca, or through our online portal. Book with PhysioNow today to get started with your MVA assessment and treatment.

Back Pain, Ergonomics, Health and Wellness, Low back Pain, Physiotherapy

Physiotherapy Tips: How to Prevent Back Pain Shoveling this Winter  

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Why does shoveling cause many low back injuries each year?

While shoveling is a simple, everyday chore which Canadians need to endure each winter, it is also one which catches many people off guard. Unfortunately, shoveling can lead to many aches and pains, injuries to the shoulders, slips and falls, and last but not least, low back pain. As physiotherapists, we often see patients with injuries which can be prevented with some tips and improvement to their technique. 

Why does such a seemingly easy task cause so many injuries, you ask? Well, for those unfortunate enough to be placed on shoveling duty, they’ll be the first to tell you how physically demanding of a task it really is. Shoveling requires repetitive pushing, lifting, bending and twisting of the back while carrying heavy loads. Not to mention, the freezing temperature causes our muscles to stiffen up, causing them to be more prone to strains and can even lead to more severe injuries like disc herniations. Finally, icy conditions can cause even the best techniques to fail from a sudden slip.

What low back injuries can occur from shoveling?

Muscle strains

  • The most common and least severe injury
  • Caused by repetitive loading or overstraining of the muscles in our lower back

Disc-related injuries

Diagram of disc herniation in the lumbar spine
  • Disc bulges and disc herniations can also occur again due to repetitive forward bending, or all in one moment from a too heavy load
  • Disc herniations may then result in a pinched nerve, symptoms can include shooting pain, numbness or tingling down the leg on the affected side.

Fractures

  • Lastly, slips and falls can lead to bruises and especially severe ones can cause fractures of the spine
  • More common for older adults or those who have osteoporosis

Depending on the severity of the injury, it can take a few days, weeks or even months to recover in the order listed here. So instead of having to recover at all, why not prevent it in the first place?

Can we prevent shoveling-related back pain?

Shoveling is something that shouldn’t be taken lightly and unfortunately there are many people who are not able to complete the task safely due to the physical demands. 

Training to shovel snow may sound silly but 2-3x a week of regular exercise (both resistance and aerobic) can go a long way in not only preventing low back injuries, but also serious cardiovascular incidents such as heart attacks. Keep in mind, if you are new to exercising you should check in with your doctor first before engaging in strenuous physical activity.

  • Resistance/weight training- body weight, weighted, and/or banded exercises etc.
  • Aerobic/endurance training – walking, jogging/running, biking, sports, swimming etc.

Warm up before shoveling

Now, you must make sure to warm-up your spine and muscles before you begin shoveling. While it might seem like extra work, a few minutes of movement and stretching can prevent a whole world of trouble for your low back. When preparing for a dynamic activity, it is always best to warm up with dynamic stretches, 10 repetitions on each exercise usually does the trick. Below is an example of a quick warm up routine, but feel free to make your own!

  • Marching in place
  • Hip circles rotating inwards and outward to loosen the hips
  • Bending forwards to touch your toes, side bends, and arching backwards to warm up all aspects of your low back 
  • Body weight squats to warm up your legs
  • Forward and backward arm circles to warm up the shoulders 

Now that you’re all warmed up, let’s make sure we are shoveling with good technique!

Shoveling with good technique

Shoveling is very similar to lifting something off the ground. 

  • Avoid bending with your back and focus on hinging through your hips (keep a neutral spine)
  • Always keep the shovel close to the body when lifting
  • Push the snow away instead of lifting it when possible
  • If you do need to toss the snow, make sure your back is facing straight forwards and avoid twisting to the side
  • Shovel lighter loads of snow rather than heavier loads
  • Pace yourself and take small breaks throughout

Cooling down and recovery

Once you’re done working your muscles, it is important to do a cool down to prevent stiffness and assist recovery. A great way to do so is with static stretching (compared to dynamic stretching like in our warmups). Hold each stretch for 30s and repeat 2-3 times as needed (roughly 5 minutes in total). Again, here is an example routine you can complete once back inside your house.

Woman in child's pose yoga position to show example of a cool down stretch
  • Child’s Pose to stretch our back muscles: Start by being on our hands and knees (all fours position), then try to sit your hips back onto your calves while stretching your arms and hands forwards, and folding your torso down with your forehead resting on the floor
  • Seated figure-4 stretch for our glutes and hip muscles: Cross one leg over the other in a seated position and lean forward as tolerated.
  • Doorway stretch for our chest and shoulders:  Have both forearms and hands up against a doorway with elbows bent around shoulder height. Get into a split stance and lean forwards.

If all else fails…

Now that you know how to prevent injuries while shoveling this winter, stay warm and safe out there everyone! Some general muscle soreness in the body is normal but if there is any lingering pain after shoveling, your friendly physiotherapists here at PhysioNow are here to assess, treat, and teach you how to prevent any future injuries! Please feel free to reach out to us by Phone: 289-724-0448 or Email: applewood@physionow.ca. Find us at any of our 10 clinics located in the west GTA including Burlington, Oakville, Mississauga, and Etobicoke. Book with PhysioNow today!

Back Pain, Ergonomics, Low back Pain, Physiotherapy, Posture

Prevent Back Injuries: How to Lift Safely

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Back injuries are one of the most common workplace complaints, especially in jobs that involve lifting, moving, or carrying heavy objects. Prevention of back injuries and being proactive can help reduce workplace stress, missed hours, and healthcare costs. While the human spine is incredibly strong and flexible, improper lifting techniques combined with repetitive strain can lead to painful conditions. This includes muscle strains, herniated discs, or even chronic lower back pain.

Why do back injuries happen during lifting?

Back injuries typically occur when:

  • You lift with poor posture (rounded back or twisted spine)
  • The load is too heavy or awkwardly shaped
  • You make sudden or jerky movements
  • You repeatedly strain the same muscles without rest or proper technique

The injury can happen to the muscles, ligaments, discs and more. The key to preventing these injuries lies in ergonomic/posture awareness, strength training, and practicing safe lifting mechanics.

How can I prevent back injuries?

1. Plan out your lift

Before grabbing any heavy item, pause and assess the situation. Ask yourself:

  • How heavy is it?
  • Can I lift it safely on my own or should i get help?
  • Is there a clear path to move it?
  • Do I need help or equipment (e.g., trolley, dolly)?

Rushing increases the risk of poor posture and injury. Take a couple extra seconds to setup the lift and carry properly to save yourself a lot of pain and effort! Preventing back injuries is better than treating them!

2. Get into the proper position

Start with the right stance:

  • Feet shoulder-width apart for balance
  • One foot slightly ahead of the other
  • Stand as close to the object as possible
  • Keep your back straight and chest up
  • Avoid twisting your spine

This phase all occurs before the weight is even being picked up. A proper starting position is essential to starting the lift.

3. Start the lift with your legs, not your back

We’ve all heard this statement before, this is the golden rule for lifting.

As you now initiate the lift:

  • Bend at the knees and hips, not your waist
  • Keep the object close to your torso the entire time
  • Tighten your core muscles before lifting (bracing)
  • Push through your legs as you stand up

4. When transporting the load

If you have to move the load somewhere, don’t twist your back. Use your legs to turn or pivot. Ensure the weight stays close to your body, even as you’re putting it back down. Holding a heavy object away from your body increases strain on your spine and can lead to sudden injury.

Keep the load:

  • At waist level
  • Close to your center of gravity
  • Balanced between both hands

5. Know when to ask for help

Possibly the most important step, there’s no shame in asking for assistance. Team lifting is far safer than straining by yourself and will get things done quicker.

Use:

  • Mechanical aids (trolleys, carts, hoists)
  • Lifting straps or handles
  • A coworker to share the load

6. Take care of your body outside of work

Even the best lifting technique won’t help much if your muscles and joints can’t keep up. Physiotherapists recommend targeted exercises to support spinal health including both strength and flexibility. Strengthening your core, lower back, legs, and arms will ensure you have a stable base of support to start a lift from.

Some examples could include:

  • Planks (and side planks)
  • Glute bridges
  • Bird-dogs
  • Dead bugs
  • Squats

Looking to treat or prevent back injuries?

Look for PhysioNow! We offer comprehensive Physiotherapy treatment to support your lower or mid back pain, injury, or rehabilitation. With 10 locations across the GTA from Burlington, Oakville, Mississauga to Etobicoke, our clinics are ready to serve you! Find out why we’re one of the leading Physiotherapy clinics in the GTA. Book your first assessment and treatment with PhysioNow today! We accept both WSIB claims or private insurance claims!

Back Pain, Physiotherapy, Shoulder pain

Shoulder Blade Pain Annoying You? How to Fix It

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Shoulder blade pain can be a debilitating issue that affects your daily activities, sleep, and overall quality of life. You may feel like there’s a constant ache in between your shoulder blades and feel like you are unable to find a comfortable position to sit in. Understanding its causes, symptoms, and effective treatment options is essential for finding relief. This blog will address your shoulder blade pain and give you some effective strategies for resolving it.

Initial relief strategies

When experiencing shoulder blade pain, immediate relief is what you search for. Here are a couple of methods to try to manage your initial discomfort on your own:

  1. Heat therapy: Applying heat can relax tense muscles. Thus, a warm compress or heating pad can improve blood flow and soothe discomfort
  2. Gentle stretching and mobility exercises: Additionally, simple stretches can help relieve tension.
    Typically, effective stretches may include:
    • Neck tilt: Gently tilt your head to one side, holding for 15-30 seconds to stretch
      the neck and upper back
    • Child’s pose: This yoga position can stretch the shoulders and upper back while
      promoting relaxation
    • Leaning back over a foam roller or chair back: This position reverses the rounded shoulders posture that most of us spend a lot of time in, and can effectively relieve mid back pain
Stretching the neck along with the upper back regularly can help relieve or prevent shoulder blade pain.

Preventing shoulder blade pain

Preventing shoulder blade pain involves a combination of proper posture, regular exercise, ergonomic adjustments, and lifestyle choices. Here are several effective strategies to help you avoid and/or prevent shoulder blade pain:

  1. Maintain good posture
    • Sit and stand tall: Keep your shoulders back and down, aligning your ears over your shoulders. Furthermore, avoid slouching, especially when sitting for extended periods
    • Ergonomic workspace: Ensure your computer monitor is at eye level, and your chair provides adequate lumbar support. Also, use a chair that allows your feet to rest flat on the floor
  2. Take regular breaks
    • Movement breaks: Stand up, stretch, and walk around every hour if you have a desk job. Short breaks help reduce muscle tension
    • Stretching: Incorporate gentle stretching exercises into your routine to relieve tightness in the neck, shoulders, and upper back
  3. Exercise regularly
    • Resistance training: First, incorporate exercises that target the upper back and shoulders, like rows, lat pulldowns and shoulder presses
    • Flexibility training: Secondly, yoga or a daily mobility routine can improve overall flexibility and strengthen stabilizing muscles
  4. Be mindful of repetitive movements
    • Change it up: If your job or hobbies involve repetitive shoulder movements, take breaks and vary your activities to prevent overuse injuries
    • Proper technique: Use proper techniques for lifting and carrying to avoid straining the shoulder area. Additionally, ask for help or use a tool if you need to lift objects that are too heavy for you
  5. Invest in quality sleep
    • Sleep position: Use supportive pillows that keep your neck aligned with your spine. Also, avoid sleeping on your stomach, which can strain the neck and shoulders
    • Mattress: Ensure your mattress provides adequate support for your back. For example, if you are waking up with worse pain, there might be something you need to adjust in your nighttime routine

I still have shoulder blade pain, now what?

Sometimes, the pain can be stubborn and self-management is not resolving your problem to your satisfaction. In this case, you should consult a health care professional such as a Registered Physical Therapist/Physiotherapist. These professionals are trained to assess the movement and muscles of the human body and are experts at dealing with pain. Additionally, regular visits to either Physical Therapy or Massage Therapy may help with prevention of pain and maintenance of a healthy, active lifestyle.

The treatments may include:

  1. Manual therapy techniques: This includes hands on work like massage and soft tissue techniques, mobilizations, and more. The goal is to reduce pain and dysfunction in the body
  2. Modalities: For example, heat, therapeutic ultrasound, electrotherapy, and more. Your professional will decide what is appropriate for you to help your pain and help you get better quicker
  3. Therapeutic exercises: Whether it’s stretches, strengthening, or postural exercises, your professional will create a home program for you to self-manage your pain
  4. Acupuncture: The insertion of thin needles into certain parts of the body can stimulate many beneficial effects like pain relief, increased circulation, endorphin release and more

If you are experiencing pain, look for PhysioNow! We have many expert Physical Therapists, Massage Therapists and Manual Osteopaths to help resolve your pain. With 10 locations across the GTA including Burlington, Oakville, Mississauga, and Etobicoke, we make it convenient to find help! Book with PhysioNow today for your first assessment and treatment.

Images by FreePik

Model of the spine
General Category

Relieving Your Pinched Nerve: Physio 101

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A pinched nerve, also known as a radiculopathy, is caused by pressure on a nerve as it exits the spinal cord, potentially causing pain, discomfort, weakness, and/or changes in sensation.  Unfortunately, it can have quite detrimental effects on your daily life, hobbies, and ability to work. In this blog, we will discuss the causes, symptoms, and most importantly, how physiotherapy can help you recover from this condition.

Why does it happen?

Model of the spine

Model of the spine showing how the nerves (yellow) exit through spaces around the spinal column. The nerves may get pinched in these spaces.

A pinched nerve occurs when there is compression or pressure applied to a nerve, disrupting its normal function. This compression can happen in various areas of the body but is most common at the spine of the lower back or neck. Common causes include repetitive movements, sudden increases in activity (ex. heavy lifting), poor posture, herniated discs, and degenerative changes in the back such as stenosis or bony spurs.

It is separate from the diagnosis known as a peripheral neuropathy that involves damage to the nerve.  For example, a carpal tunnel syndrome. However, many of the symptoms between the two may overlap. In fact, a pinched nerve may turn into a neuropathy if left untreated for too long.

How do I know if I have a pinched nerve?

Primarily, nerve type pains have very specific symptoms. These usually include one, multiple, or all of the following:

  1. Pain: Sharp or dull pain that radiates along the nerve pathway. The pain is usually quite variable and may change quickly in intensity from one day to the next, or throughout the day.
  2. Sensation changes: This may be unusual sensations like pins and needles, losses of sensation, or even complete numbness in the affected areas.
  3. Muscle weakness:  Since our nerves are responsible for stimulating our muscles, you may experience reduced strength and control in the muscles connected to the affected nerve.
  4. Radiating pain: Discomfort that extends beyond the initial site of compression. In the neck, it may go down into the shoulder blade or down the arms into the fingertips. In the lower back, it may radiate down into the glutes or further down to the legs or feet.

Why does physiotherapy help?

Manual therapy is one of the treatment techniques used by physiotherapists to relieve pain and increase mobility

Physiotherapy is the first line of treatment for a pinched nerve. It is non-invasive and has shown to be an effective approach for managing pain and dysfunction from a pinched nerve. A skilled physiotherapist can create a tailored treatment plan to address the specific needs of each individual. A treatment plan may include some or all of the following:

  1. Manual Therapy: Hands-on techniques such as joint mobilization and soft tissue manipulation can help alleviate pressure on affected nerve. These techniques can help stiff areas, subsequently improving mobility and reducing pain.
  2. Exercise Prescription: Targeted exercises may include stretches or postures to help relieve pain and other symptoms. Once the pain has been controlled, strengthening the muscles near the area of the affected nerve will help minimize the risk of future reoccurrences.
  3. Posture Correction: Addressing poor posture is crucial in preventing and managing pinched nerves. Oftentimes, a certain position can be aggravating for the neck or back. A physiotherapist can assess which positions are helpful or harmful to you, and provide guidance on how to incorporate these changes into your daily life.
  4. Education: Understanding the factors contributing to pinched nerves is essential for long-term management. Your physiotherapists will help you understand the do’s and dont’s during your treatment, and the predicted timeline of your recovery.
  5. Modalities: Therapeutic modalities such as ultrasound, electrical stimulation, or heat and cold therapy may be helpful in reduce inflammation and reducing pain.

Need help? Look for PhysioNow!

Lumbar disc herniation resulting in a pinched nerve

Lumbar disc herniation resulting in a pinched nerve can be quite common, but may be treated with physiotherapy.

Pinched nerves may sound intimidating but with the right approach, they can be effectively managed. Physiotherapy offers personalized care to enhance mobility, alleviate pain, and improve overall quality of life. If you suspect a pinched nerve or have low back pain, PhysioNow is here to help! Consult with our expert team of physiotherapists with locations across the GTA. Book with PhysioNow today for your first assessment and treatment.

General Category

Could Your Back Pain Be Facet Joint Syndrome?

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What is a facet joint?

Image of 2 vertebrae showing the body, spinous processes, and transverse processes

Facet joints are located in the spine and are part of the vertebrae. The vertebra has two basic parts. Firstly, the body and secondly, the spinous process which is the bony part you can feel on your back that runs from the neck to just above the buttocks.

The joint from one inferior facet (transverse process) of the top vertebrae to superior facet of the bottom vertebrae is called the facet joint. As a result, they are called the connection joint from one vertebrae to another.

Facet joints are present on both sides of vertebrae. Facet joints increase in joint space when doing forward bending movements,  and compression while moving backward. Similarly, facet joints also help in twisting and rotation movements of the spine. Finally, they also prevent these movements from happening over their normal physiological limits.

What is facet joint syndrome or pain?

Facet joint pain can be due to a condition like osteoarthritis or due to other spinal conditions like spondylolisthesis or stenosis. Alternatively, other causes involve obesity-linked arthritis, aging, heavy and repetitive work duties or secondary to other trauma.

Facet joint pain can occur anywhere along the course of your spine the cervical, thoracic or lumbar areas. Usually, facet joint pain or syndromes present as pain on the back which is localized or radiating. In the lumbar spine, it could radiate down to your buttocks or leg. Additionally, if it’s in the neck, it could be localized or radiating down to the hands.

Overall, the symptoms vary depending on the severity and level of joint involvement.

Other symptoms:

  • Stiffness
  • Painful bending/ rotation
  • Depending of the area involved it has difficulty like sit to stand, standing up straight

How is it diagnosed?

Facet joint pain/ syndrome may be investigated by an x-ray/ MRI but this is not enough to confirm diagnosis. Instead, the gold standard for diagnosis is the use of a diagnostic injection of a joint block into the area. Then, it is considered positive if the patient experiences immediate relief of their pain and symptoms.

From a physiotherapy point of view, it can be diagnosed by using a special test called quadrant test to confirm involvement of facet joint.

In addition, physiotherapists perform other tests which involves looking for flexibility, range of motion, strength,  palpation of tender areas, and a sensory examination to check nerve root involvement.

Treatment:

From a medical perspective, facet joint pain can be treated by using anti-inflammatory injections or cortisone injections by healthcare provider.

For example, a physiotherapy treatment may involve:

  • Education
  • Manual therapy
  • Electrotherapy
  • Hot and cold therapy
  • Exercises mainly focusing on core and lower back strengthening 
  • Traction machine 

Core exercise that may be part of treatment for facet joint syndrome

Image by Freepik

Overall, the patient can be treated with a combination of the above treatment protocols. Importantly, treatment will be individualized based on your specific symptoms and presentation. You will be guided by the expertise of a physiotherapist throughout your journey.

In conclusion, if you are experiencing back pain or are experiencing any of the above symptoms, PhysioNow can you help you out. We have many experienced physiotherapists that can help you with your facet joint pain. Book with PhysioNow today for your first assessment and treatment!

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Motor Vehicle Accident: Injuries and Insurance

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Motor Vehicle Accidents / MVA and physiotherapy.

motor vehicle accident

Motor Vehicle Accident

Injuries sustained from a motor vehicle accident affect your normal function in life differently. It depends on the extent of the impact. Thus, it is very important to address any pertaining issues from the accident to your doctor. Additionally, to start rehabilitation at the earliest to decrease the impact of injury and its effects.

MVA injuries can be as minor as  sprains or strains or it can be extensive that might include concussion, fractures, neurological involvement, other musculoskeletal involvements, etc.

Once you are involved in an accident and you are discharged from your preliminary care, you would contact your auto insurance company for guidance on starting physiotherapy sessions.

 

Physiotherapy sessions for a motor vehicle accident:

Once you decide to attend a physiotherapy clinic, these are the few things to do and to expect  on your first visit.

  •  Book an appointment in a clinic which you decide to proceed with.
  • Once you arrive expect to fill a few Auto insurance forms and clinic specific forms to start your assessment at the clinic.
  • You would be seeing a physiotherapist who could be your primary care provider.
  • The therapist would do a detailed assessment on your situation and would also go over your treatment plan pertaining to your injury.
  • Your treatment session would be patient specific and progressive to get back to your normal functionality.

 

Facts about your treatment plan and coverage:

Once you are in a motor vehicle accident, you are mostly covered by the auto insurance company for treatment sessions.

Your treatment coverage depends on the category that you fall into.

  • Minor injury guideline/ MIG, where your injury falls into  the category of sprains and strains and would need a shorter duration of recovery and treatment sessions. Your treatment sessions could extent up to 4 months or as needed. Reassessments are done as needed to see your progress and to plan further with your sessions.
  • Out of Minor injury guideline, where your injury is more extensive or catastrophic. Where the duration of recovery is longer and so the treatment allotment is longer when compared to MIG.
  • Any multidisciplinary approach needed would be advised and would be recommended to your insurance company for further proceedings.

 

Commonly seen injuries after a motor vehicle accident:

motor vehicle accident

Motor Vehicle Accident Whiplash

  • Whiplash injury to the neck: which can include one or more of the symptoms ; pain, stiffness, swelling, muscle spasm, headaches, tingling /numbness into the hands, weakness, difficulty sleeping.
  • Low back Sprain/ strain or disc related symptoms which includes, pain, stiffness, tingling and numbness into the leg, disturbed sleep.
  • Shoulder, elbow, wrist, hip, knee, ankle sprain/ strain.
  • Seatbelt or airbag related pains in the chest area and abdominal area.
  • Fractures.
  • Concussion symptoms which might include dizziness, headaches, light and noise sensitivity, blurred vision, nausea, issues with concentration, imbalance, weakness, slurred speech, anxiety, depression, etc.
  • Vestibular symptoms with symptoms such as dizziness, nausea, vomiting, difficulty with positional changes, sense of imbalance, etc.

 

Treatment sessions:

 These are patient specific.

  • Electrical modalities such as IFC, TENS, Ultrasound, LASER, heat or cold packs for pain relief and decreasing muscle spasm, and to improve circulation to the area.
  • Manual therapy which includes soft tissue techniques, joint mobilization, joint traction. Muscle energy techniques to reduce pain, improve function in the joint.
  • Exercises for improving mobility, strength, and also function.
  • Braces and splints for immobilization as needed.
  • Post concussion therapy focusing on your symptoms and additionally presentation, which is provided by a physiotherapist trained in concussion therapy.
  • Vestibular rehabilitation services provided by a physiotherapist specifically trained in vestibular rehab.

Need some help?

Your assessment session would ideally be an hour and treatment sessions would be 45 min to an hour in our clinic.  Here at PhysioNow, we have many highly knowledgeable physiotherapists that can assist you with your injuries. If you think physiotherapy may help with an injury from an MVA, book with PhysioNow today for your first assessment and treatment!

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Scoliosis: Types, Symptoms and Treatments

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Scoliosis

Scoliosis

A side deviation or curvature in your spine is scoliosis. It could be in your neck, mid back and lower back. It can present in more than one area.

The most common area where it develops is mid-back. Cervical and lumber spine are very common  when it comes to two curvatures.

Type of scoliosis:

  • C-shape: This is most common type, there is only one-sided curve. The most common area for C shape to develop is in the thoracic spine and also lumber spine.  In this type, scoliosis side leg could be short compared to non-scoliotic side. Sometimes, there are  changes in the scapular level. Scoliotic side scapula will be lower than non-scoliotic side.
  • S- shape: In this type, two curvatures are present in the spine. One curvature is the primary scoliosis and the other curvature develops in compensation of the primary curvature. In this type, the scoliotic sided leg is short and the scapular level is higher than the non-scoliotic side. S-shape will bring other complications such as respiratory issues, cardiovascular issues, etc.

'S' Shaped curve and 'C' Shaped Curve

‘S’ Shaped curve and ‘C’ Shaped Curve

Causes of scoliosis:

Usually, the cause of scoliosis is unknown. However, following are a few possible causes mentioned:

  1. Poor Posture habits: People who have habits of not following ergonomics pattern of posture are at risk. One who has the habit of leaning and sitting mostly on their right or left, are also at risk.
  2. Carrying heavy stuff on back: People who have to deal with the delivery of heavy packets and lifting heavy objects are at risk.
  3. Family history: Sometimes, scoliosis runs in family. There are higher chances in these cases.
  4. Congenital limb length discrepancy: Congenital limb length discrepancy needs immediate correction otherwise; it will lead to scoliosis.
  5. Neurological disorder: Neurological disorders like cerebral palsy, multiple sclerosis, Down Syndrome which are progressive diseases have muscular imbalance.

 

Signs and symptoms:

  • Limb length discrepancy
  • Visible deviation of spine to one direction
  • Uneven shoulder and pelvis height
  • In anterior view, one sided rib is popping out.
  • Chronic neck and also lower back pain
  • Breathing difficulties in severe cases
  • Recurrent lung conditions like pneumonia, atelectasis, etc.
  • Pain and numbness
  • Fatigue due to muscle imbalance

 

Assessment of scoliosis:

Imaging: X-ray is the gold standard or MRI.

Physiotherapy Assessment:  assess in posterior view which means back view with open back.

  • Therapist will look for visible prominent border of scapula.
  • with bending forward the scapular border will be seen as well as deviation .
  • When leaning backward , a visible S shape or C shape will be seen.

 

Risk factors of scoliosis:

Scoliosis is bony disorientation which is irreversible. The best management is prevention. However, if it not managed well enough , it can lead to many complications.

  1. Lung disorders: Specially, thoracic spine scoliosis has a chance to affect the respiratory system as it disturbs the alignment of the rib cage. Deep breathing becomes limited or difficult and that is why the lower portion of the lungs get less air. As a result of this,  atelectasis develops in some areas of the lung.
  2. Limb length discrepancy: Lumber scoliosis has a major effect on pelvis alignment. As scoliosis is irreversible, it leads to permanent muscular imbalance. Thus, there is limb length discrepancy.
  3. Scapular winging: Thoracic scoliosis has drastic effect on scapular orientation.  The scapula takes part in shoulder movement. Indirectly, mid back, scapula and the shoulder joint are all affected because of spinal curvature.
  4. Herniated disc in spine: Lumber spine scoliosis has a higher chance to develop a herniated disc. Therefore, you may develop pain in the lower back and down the leg  into the thigh, knee or ankle. Please seek immediate attention in this case.

 

Management of scoliosis:

 Scoliosis is a irreversible bony deformity.

  1. Posture: Contact your physiotherapist for a better understanding for well maintained posture at work and home.  Correction in pelvis alignment will help in preventing it from getting worse.
  2. Deep breathing exercise: Deep breathing exercise will help in maintaining lung function. Additionally, with breathing exercises, chest mobility exercises will help in maintaining flexibility in the spine and avoid lung conditions like pneumonia, atelectasis, etc.
  3. Spinal mobility exercises: Contact your physiotherapist for proper exercises. Your Physiotherapist can better assess scoliosis and based on that provide spinal mobility exercises to stop it from getting worse.
  4. Orthotics: orthotics adjust leg length discrepancy from scoliosis.
  5. Education: Finally, a physician or physiotherapist can help you to better assess and understand this condition.

 

Need some help?

Your concerns are best managed by a health care professional. Here at PhysioNow, we have many highly knowledgeable physiotherapists that can assist you with your issue. If you think you may have scoliosis or are diagnosed with it, book with PhysioNow today for your first assessment and treatment!

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Sciatica? 10 warning signs

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What is Sciatica?

Sciatica is a pain in the back, neck, or buttock that radiates to the leg or arm. Sciatica is also quite common and affects almost 40% of adults. It travels through the sciatic nerve, which starts in your lower back and extends to run down your leg.  A proper diagnosis that confirms and best sciatica treatment is all that you need to lead a pain-free life.

Sciatica

Sciatica pain

10 signs which confirm the diagnosis

Before knowing about sciatica treatment, one needs to understand the nature of pain. The symptoms of sciatica are as follows: –
  1. Calf pain – pain that stretches down the lower leg and back of the knee.
  2. Lower back pain running down the leg.  A pull sensation from your lower back to buttocks and thigh, that further extends from calf to the foot.
  3. A pain in your butt or leg that worsens while prolonged sitting.
  4. Numbness in your leg or foot.
  5. Tingling sensation in your extremity (lower body).
  6. Persistent pain on one side of your butt.
  7. Muscle weakness in the distressful leg or foot.
  8. Shooting pain down the leg which makes it tough to stand up or extend the knee.
  9. Pain in one part of the leg while numbness in another part.
  10.  Lastly, a sensation of pins and needles only in the toes or feet

Early Symptoms Of Sciatica

 Apart from the 10 signs above, sciatica pain often starts in the back. However, occasionally, pain may start at the hip or knee; which may not look like sciatica. Although, you may feel isolated symptoms like feet numbness, knee pain, buttock pain, tingling, etc.

What contributes to Sciatica?

There are many factors that can lead to sciatic pain but the most common ones are listed below,
 • Strain and Occupational Stress: People in more physically demanding jobs as a result affect your nerve.
 • Obesity and genetic factors: The excess weight in the body put prolonged pressure on the backbone, leading to a slipped disc.
 • Accidents and Injuries: Unexpected physical damage from accidents can crack the vertebrae and irritate the nerve.
 • Gender: Studies have shown that men are more prone to slipped discs than women.
Treatment options available
Moreover, depending on the severity of the case, sciatica pain can be treated in the following ways:
 • First, medication and pain management: Pain can be controlled with various pain relief treatments including medication.
 • Second, surgery: In rare cases, the pain doesn’t subside for a prolonged period (6 weeks or more), and surgery can help relieve the pressure on the sciatic nerve endings caused by Sciatica.

 • Third, spine rehabilitation:

Sciatica

Effective exercises for Sciatica

There are multiple approaches to physical therapy in spine care and they can stabilize the spine and help patients with disability or restricted physical movement. This helps improve the mechanical functioning of the spine, manages pain, promotes regeneration of the affected tissue and disc, and with functional training, improves strength and flexibility.

 • Lastly, even in the case of surgery, follow-up rehabilitation helps sustain and improve the results.
If you are experiencing any such symptoms, our team of qualified physiotherapists at Physio Now will help you diagnose and guide you through your treatment. Book your appointment now!