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Arthritis, Hand Pain Treatment, Health and Wellness, Hip Pain, Physiotherapy, Shoulder pain, Wrist pain

Rheumatoid Arthritis and What You Should Know

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Rheumatoid arthritis (RA) is an inflammatory disorder that can affect multiple joints, usually on both sides simultaneously. In other words, if it affects your wrists, it would likely be both, not just one. RA is an autoimmune disorder. Essentially, a flare up is when your immune system starts to attack your own body’s tissues. Ultimately, it has systemic (body-wide) effects and can damage your skin, lungs, heart and blood vessels in some cases.  RA mainly damages the lining of your joints causing large amounts of pain and swelling that can eventually result in joint line erosion and deformities. In most cases, the damage is permanent and leads to a decreased quality of life and increased disability.

What increases the risk of developing Rheumatoid Arthritis?

The ultimate cause of rheumatoid arthritis is unknown, but what we do know is certain things increase the risk of development. This includes:

  • Family history
  • Smoking
  • Obesity
  • Environmental or external factors (exposure to pollutants, stress, infection etc)
  • Sex: Women develop RA more often than men

What are the signs and symptoms of Rheumatoid Arthritis?

The symptoms depend on the current stage the condition is in, and it cycles between two stages:

  1. Relapsing: Also known as a flare up, symptoms appear and are more intense
  2. Remitting: Symptoms including pain will decrease or are absent, but structural deformities will persist  

During a relapse/flare up, symptoms include:

  • Pain in the joints, usually 4 or more joints at a time
  • Warmth and redness around the affected joints
  • Swelling 
  • Tender to the touch 
  • Morning stiffness
  • Fever
  • Fatigue

In the early stage of RA, the small joints of the body like the fingers or toes are more affected. As the disease progresses, the larger joints become involved like the wrists, knees, ankles, elbows and hips.

How is rheumatoid arthritis diagnosed?

Primarily, RA is identified through a combination of a physical exam, analysis of your health history, x-rays and other imaging tests, and blood work looking for markers that may indicate the presence of the disease.

Physiotherapy Management of Rheumatoid Arthritis

  1. Education about the condition and the key role of interprofessional and collaborative care in the management of RA:
    Managing your Rheumatoid Arthritis requires coordination of care from a variety of health care professionals.

    Your Physiotherapist can help you understand the condition, identify early signs and advise you on how to proceed or where to seek help. For example, they may help connect you to a medical doctor and a rheumatologist (professional that specializes in the care of inflammatory conditions) for specific management of RA. Additionally, these specialty clinics may provide additional resources for the management of the condition. 

    2. Activity modification

    During a flare up, strenuous activity should be avoided and rest becomes the priority. This may include things like lifting, climbing stairs, and even walking can put excessive pressure on the joints. To help, your Physiotherapist may give you strategies to help you manage fatigue, conserve your energy, and prescribe you with a gait aid or other adaptive devices. For example, using a walker or cane to offload the lower body, or installing railings or raised toilet seats.

    3. Therapeutic exercise

    During periods of remission, therapeutic exercises will be used to maintain normal muscle strength and prevent deterioration. The duration, severity, and types of exercise will be determined after a thorough assessment. Your Physiotherapist will uniquely adapt the exercises to an appropriate level for your condition. Overall, these exercises could include range of motion and stretching, aerobic conditioning, and strengthening.

    4. Manual therapy

    Manual therapies like soft tissue release, gentle joint mobilizations, and other massage techniques are useful for relieving pain and swelling and improving flexibility. It is also beneficial for promoting a general feeling of well being and increasing mood, which is often affected in this condition. Thus, it is an important part of the management of RA.

    Where can I find help?

    If you are experiencing difficulties with RA or any kind of joint pain, look for PhysioNow! We have many expert Registered Massage Therapists and Physiotherapists that can help you with your recovery today. With 10 clinics across the GTA from Burlington, Oakville, Mississauga, and Etobicoke, our highly accessible locations are ready to serve you! Book with PhysioNow today for your first assessment and treatment!

    Knee Pain, Sports Injuries, Sports Physiotherapy

    Hamstring Injuries Caused by Deadlifting: Prevention and Recovery

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    Deadlifting is a highly effective exercise for building strength, especially in the posterior chain (glutes, lower back, and hamstrings). However, improper technique or a lack of foundational strength can lead to injuries, especially in the hamstring. If you are an avid lifter or just looking to get started with deadlifting, here is a quick guide on preventing and recovering from hamstring strains related to deadlifting.

    What do the hamstrings do in a deadlift?

    The hamstrings are a group of three muscles located at the back of your thigh: the biceps femoris, semitendinosus, and semimembranosus. These muscles are primarily responsible for bending the knee and extending the hip. During a deadlift, your hamstrings play a key role in two ways:

    1. Hip extension: As you stand up with the barbell, your hamstrings work alongside your glutes to extend your hips (bringing them forwards).
    2. Knee flexion: While not as heavily involved as in hip extension, the hamstrings also help stabilize the knee during the lift, especially in the bottom position of the deadlift.

    Because deadlifting places significant load on these muscles, improper technique or weak hamstrings can increase the risk of injury.

    How do the hamstrings become injured during a deadlift?

    1. Poor form

    Firstly, one of the most common reasons for hamstring injuries during deadlifting is improper form. Usually, deadlifting requires precise movement mechanics to avoid unnecessary strain on the muscles. If you are unsure about your form, you can always ask for help from a fitness or exercise professional such as a licensed personal trainer, athletic therapist, sports physiotherapist and more. For example, a few common form issues that can lead to hamstring injuries include:

    • Rounding of the lower back
    • Overextending at the top of the lift
    • Incorrect hip positioning over top of the bar

    2. Weak hamstrings or muscular imbalances

    Secondly, weak hamstrings can be a contributing factor to injuries. The hamstrings may not be able to handle the load, especially when lifting heavier weights. Alternatively, if other muscles in the lower body are weaker or have been injured, the hamstrings may compensate for them by taking on excessive load.

    3. Sudden increase in load or frequency

    Additionally, jumping into heavy deadlifts without gradually increasing the load can overstress the hamstrings. Consequently, progressive overload and sufficient rest, both key principles of exercise training, are essential for proper muscle growth and injury prevention.

    4. Lack of mobility or a warm-up

    Finally, a lack of proper warm-up can leave the hamstrings (and other muscles) stiff and more prone to injury. Neglecting mobility work or stretching can lead to tightness or stiffness, limiting your range of motion and increasing the risk of overstretching the hamstrings during the lift. For example, during deadlifts some people lack sufficient hamstring flexibility to perform the lift with proper form. As a result, when they go to bend forward in the lift, it is already stretched maximally or past its safe limit, putting it in a vulnerable position.

    How to Prevent Hamstring Injuries When Deadlifting

    1. Master proper form

    Initially, ensuring you have proper technique is the number one way to prevent injuries, including hamstring strains. For example, key tips for deadlifting with proper form include:

    • Start with your feet shoulder-width apart and the barbell close to your shins
    • Maintain a neutral spine (no rounding of the back) throughout the lift
    • Keep your core tight and engage your glutes and hamstrings as you lift
    • Use your hips, not your back, to initiate the movement, and make sure your back remains straight as you stand
    • Focus on hinging at the hips rather than bending at the waist
    Proper form in a deadlift includes keeping the bar close to your body, and maintaining a neutral spine as seen above

    2. Strengthen your hamstrings

    Additionally, incorporating other exercises that strengthen the hamstrings can help prevent injury. Some of the most effective exercises for hamstring strength include:

    • Romanian deadlifts: These focus on the hip hinge and engage the hamstrings
    • Leg curls: Using machines or resistance bands to isolate and strengthen the hamstrings
    • Glute-ham raises: A great bodyweight or weighted exercise to target the hamstrings and glutes

    Ultimately, building hamstring strength and addressing muscle imbalances can help your body handle all loads more safely.

    3. Gradually increase weight, take rest days

    To avoid overstretching or overloading the hamstrings, progressively increase the weight you’re lifting over time. Also, avoid training the same muscle group 2 days in a row, especially if you’re lifting heavier. Even experienced lifters can suffer from overtraining, everybody needs rest days! Instead, think about doing some cardio or training a different body part while the hamstrings recover.

    5. Incorporate mobility work

    Hamstring flexibility and mobility are crucial for preventing strain. Regular stretching, yoga, or foam rolling can help maintain or improve the flexibility of not just the hamstrings but the hips, knees and ankles as well. If you take care of your body properly, you’ll reduce the risk of injury during deadlifts.

    I need help with a hamstring injury, what do I do?

    If you have experienced a hamstring injury while deadlifting, first follow the R.I.C.E. protocol (rest, ice, compression, elevation) immediately after the injury. Some strains may heal on their own, but it is always recommended that you engage in a rehabilitation program afterwards to ensure you recover full mobility and strength.

    For more serious strains, or if your function is impaired after, such as difficulty walking or putting weight on it, you should consider Physiotherapy. Your Physiotherapist will work with you to help you safely recover from your injury and then return to your normal activities and sports. If you are looking for help with a hamstring injury or any other sports injury, look for PhysioNow with clinics across the GTA. Book with PhysioNow today for your first assessment and treatment.

    Exercise, Health and Wellness, Knee Pain, Sports Injuries

    Prevent Injuries to your Knee: Quads Strength is the Key!

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    Strengthening the quadriceps is crucial for minimizing the risk of knee injuries. Notably, the quadriceps (the group of muscles on the front of your thigh) play a key role in stabilizing and supporting the knee joint. As a result, regular training and maintenance of this muscle group is crucial for knee health. The following are 6 reasons why you should train your quads strength!

    1. Stabilizes the knee joint

    The quadriceps are the primary muscles that help extend your knee (straighten your leg). They work in tandem with the hamstrings (muscles on the back of the thigh) to provide balance and stability to the knee joint. Proper quadriceps strength helps to control and create motion of the knee, especially during activities like walking, running, jumping, or climbing stairs. If weak, the body may be forced to compensate with other muscles like the calves, glutes or hamstrings which may lead to overuse/strain injuries.

    2. Absorbs shock and reduces load on the knee

    Strong quadriceps muscles help absorb impact and control the load placed on the knee joint, especially during weight-bearing activities. For example, when you perform high-impact movements (like running or jumping), the quadriceps cushion some of the forces that otherwise would be transferred directly to the knee. This reduces wear and tear on joint surfaces and cartilage and helps manage conditions like osteoarthritis, patellafemoral pain syndrome, or bursitis.

    3. Helps maintain proper knee alignment

    The quadriceps contributes to maintaining the alignment of the knee, particularly in preventing the knee from collapsing inward (known as valgus) or being pushed outward (known as varus). These misalignments can put excessive stress on the knee joint and ligaments, increasing the likelihood of injuries such as meniscal tears, ACL or MCL tears/sprains, or patellofemoral pain syndrome.

    4. Protects the knee ligaments

    The quadriceps play an important role in protecting the knee ligaments, particularly the anterior cruciate ligament (ACL). Weak quads can lead to poor control of knee motion, increasing the strain on the ACL and potentially causing tears, especially during cutting, pivoting, or landing from a jump. In other words, strengthening the quadriceps can improve dynamic knee stability. Consequently, allowing you to better control the forces that act on the knee during athletic movements.

    5. Improves functional movements

    Strong quadriceps improve your ability to perform daily functional movements, such as stairs, squatting, bending, and standing up from a chair. Weak quads make these movements more challenging and can lead to compensation patterns that strain the knee or other body parts. Especially as we age, ensuring we build enough strength for our daily activities is the key to maintaining a good quality of life.

    Quads strength influences our ability to go up and down the stairs, especially quickly

    6. Prevents chronic conditions

    Chronic weakness in the quadriceps can lead to altered gait patterns, which may increase stress on the knee joint over time. This abnormal stress can contribute to the development of degenerative conditions such as knee arthritis or chondrosis that wears away joint and cartilage surfaces in the knee joint. Overall, strengthening the quadriceps helps to alleviate some of that excess stress and reduce the progression of arthritis.

    Looking for help?

    As can be seen, quads strength is vital for knee health. Whether you’re an athlete or someone or just enjoying activity recreationally, quadriceps strength can make a significant difference in knee performance and injury prevention. If you want to get stronger or having problems with your knees, PhysioNow has many experienced Physical Therapists to help you out. Book with PhysioNow today for your first assessment and treatment!

    ACL Injury to knee
    ACL REHAB, Knee Pain, Sports Injuries, Sports Physiotherapy

    Torn Meniscus: What to do Next

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    What is a torn meniscus?

    Torn meniscus types Different types of meniscal tears, depending on location and orientation

    The meniscus is a C shaped fibrocartilage in our knee joints, located between the tibia and femur. Importantly, they work as shock absorbers for the knee joint. Our knees are weightbearing joints and as a result, must withstand a lot of force. On each side of our body, we have one meniscus on the inside (medial), and one on the outside (lateral). Unfortunately, the medial meniscus tear is more common torn. Especially, in individuals who play contact sports and high impact sports.

    How does a torn meniscus happen?

    Usually, meniscal tears are traumatic, you can pinpoint the moment in time that the injury occurred. However, in rarer cases they can be insidious and feel like they happen without your knowledge. One of the main methods of injury are sports, a forceful direct impact or a sudden twist while foot is planted on the ground. Additionally, the incidence rate of meniscus injuries increases with age.

    What are the risk factors?

    • Overuse
    • Osteoarthritis (OA)
    • Obesity
    • Age
    • ACL injury
    • Previous knee injuries, especially if they were traumatic

    Signs and Symptoms:

    It is important to note that meniscal tears often happen in conjunction with other knee injuries such as ligament strains/sprains. As a result, the symptoms often overlap with other each other.

    • Decreased and painful range of motion
    • Knee feels like it will give out
    • Popping sensation at the time of injury
    • Joint swelling
    • Crepitus
    • Locking in knee
    • Pain around knee joint
    • Stiffness
    • Antalgic gait ex. limping
    • Pain increases with weightbearing activity like walking, stairs and squats

    Diagnosis:

    After taking a detailed history about the pain and injury history, your health care practitioner will conduct a physical examination for your knees.  They will check your range of motion, strength, integrity of the joints, check your sensation, balance, and more. Then, they might send you for further investigations like x-rays, ultrasound or MRI if they think it is warranted.

    Physiotherapy Treatment for a Torn Meniscus

    Torn meniscus physiotherapy

    Oftentimes, people think that meniscal injuries will heal over time on their own. In reality, the recovery process purely depends on the type and severity of the injury and symptoms being experienced. It is always recommended to be seen by a health care professional and undergo physical therapy to rehabilitate your knee after an injury. Ultimately, this will ensure your knee gets the proper care it needs and nothing severe will be missed.

    1. RICE Protocol

    • Rest: First, let the injured knee rest by putting less weight/pressure on it
    • Ice: Additionally, use an icepack around your knees several times a day for 15-20 mins
    • Compression: Importantly, will help to reduce the swelling around knee joint.
    • Elevation: Lastly, rest your leg using a pillow or something similar to keep it elevated and minimize swelling

    2. Protective Equipment:

    Braces and crutches may be used depending on the severity of symptoms. Ultimately, they will help protect the joint and prevent the injury from worsening.3. Modalities:

    3. Modalities

    Modalities such as electrotherapy (IFC, TENS), ultrasound, and laser therapy may help decrease inflammation, manage pain, and help with the healing process.

    4. Exercise Therapy:

    As quickly as possible, we want to restore as close to normal range of motion in the knee. Then, strengthening of those muscles will make the knee stronger to resist future injuries.

    • Low impact exercises for cardiovascular training ex. biking
    • Isometrics exercises
    • Range of motion exercise
    • Stretching
    • Strengthening exercise of the joint muscles and areas around such as the hips, back and pelvic muscles:
    • Functional activity (ex. stairs, squatting, job specific tasks)
    • Balance and coordination training

    5. Surgical procedure

    Finally, in some severe cases, physiotherapy may not be enough to fully rehabilitate your knee, especially if the joint is being blocked by the tear. Thus, a consult with an orthopedic surgeon may be necessary to determine future treatment options for your knee. The meniscus may be able to be repaired, or you may require a partial/complete meniscectomy (removal of a part of the full meniscus).

    If you are experiencing a knee pain or torn meniscus that is limiting you, look for PhysioNow! We have many experienced Physiotherapists across the GTA from Burlington to Etobicoke that can help you feel better. Book with PhysioNow today for your first assessment and treatment.

    ACL Rehabilitation, ACL Tear, Custom Knee Brace, Exercise, General Category, Knee Pain

    ACL Rehabilitation

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    ACL injuries are very common.  Most people know at least one other person who has gone through some kind of ACL injury.  But what exactly is the ACL?  Furthermore, what is ACL Rehabilitation?

    ACL Rehabilitation is a term used to describe the physiotherapy treatment that takes place after an ACL injury.  It is an important part of the recovery so that individuals can get back to their work and sport

    ACL Rehabilitation – What is the relevant Anatomy

    The term ACL stands for Anterior Cruciate Ligament.  Ligaments are soft tissues that connect 2 bones together.  Ligaments provide stability to the joint.  The ACL is found in the knee joint.  It is one of the most important ligaments in the knee.

    ACL Rehabilitation – Where is the ACL located?

    The ACL is one of two ligaments found deep inside the knee joint.  The other ligament is called the PCL, or Posterior Cruciate Ligament.  These ligaments cross each other inside the joint, forming an “X”.  Together, they help keep the thigh bone (femur) connected to the shin bone (tibia).  The ACL stops the shin bone from sliding out in front of the thigh bone.  The PCL stops the shin bone from sliding back on the thigh bone.

    ACL anatomy

    ACL Rehabilitation – What is the function of the ACL?

    The ACL is more commonly injured than the PCL.  This is likely because the PCL is wider and stronger than the ACL.  However, the ACL is more important to the overall function of the knee.  Injury to the ACL means that there is too much forward movement of the shin bone.  This has huge impacts on the stability of the knee, especially when doing any weight-bearing activities.

    What are some of the signs and symptoms of an ACL injury?

    • A loud ‘pop’ or a ‘popping’ sensation in the knee
    • Severe knee pain and unable to put weight through the knee
    • Immediate swelling of the knee
    • Loss of range of motion
    • A feeling of instability or ‘giving way’ with weight bearing

    How does the ACL get injured?

    Another important part of ACL Rehabilitation is understanding how the injury happened.  This information helps explain why the injury happened and may help prevent a re-injury.  Specifically, the ACL can be injured in many ways.  Some examples of mechanisms of injury include:

    • Quickly changing direction while running
    • Suddenly slowing down or stopping
    • Incorrectly landing from a jump
    • Twisting the knee with the foot planted on the ground
    • Direct blow to the knee

    What are some of the risk factors for ACL injury?

    For ACL Rehabilitation to be successful, there has to be an understanding of risk factors.

    • Firstly, female gender seems to be a risk factor
      • Women have a higher incidence of ACL injuries according to the research
      • There are a variety of factors, including differences in anatomy, muscle strength and hormones
    • Additionally, certain sports have more risk for ACL injury
      • Sports that involve a lot of sudden direction changes and collisions are more likely to result in ACL injuries
      • Examples include soccer, football, basketball and downhill skiing
    • Lastly, poor strength through the hips and lower legs is an overall risk for ACL injury

    ACL injuries – Are they all the same?

    ACL injuries can vary from person to person depending on the extent of the injury.  The term for an injury to a ligament is called a sprain.  Sprains are graded based on how severely the ligament is damaged.

    ACL Tear

    Grade 1 – there is mild damage to the ligament

        • The ligament is slightly stretched
        • The knee joint is still stable
        • There is no requirement for surgery.

    Grade 2 – there is a partial tear in the ligament

        • The ligament is stretched to the point where it becomes loose.
        • There is still some stability in the knee joint.
        • There is usually no requirement for surgery

    Grade 3 – there is a complete tear or rupture in the ligament

        • The ligament has been split into two pieces
        • The knee joint is unstable
        • Due to the level of damage, there is usually requirement for surgery

    Additionally, other structures may be injured at the same time as the ACL.  Specifically, a lot of patients who injure their ACL, also injure their Medial Collateral Ligament (MCL) and/or medial meniscus.  This combination increases the overall severity of the injury.

    Unfortunately, ACL injuries can also lead to the early development of osteoarthritis in the knee.  The arthritis can vary in severity depending on the person but can contribute to long term pain for some people.

    How do we diagnose ACL injuries?

    A doctor or Registered Physiotherapist can assess the knee after the injury.  They may perform some physical tests that may confirm an ACL injury.  However, these tests are not always 100% accurate.  Additionally, with a very acute injury, it is difficult to complete the tests properly due to intense pain and swelling.

    As a result, imaging is usually required  to confirm an ACL injury.  Understanding the severity of the injury is important because it will determine if surgery will be required.

    Magnetic Resonance Imaging or MRI is the most commonly used imaging test to diagnose an ACL tear.  An MRI uses radio waves and a strong magnetic field to create images of the tissues in the body.  An MRI will be able to show the extent of an ACL injury and any other tissues that may have been damaged.  However, there is usually a lot of swelling soon after the injury happens.  As a result, an MRI is usually not done immediately afterwards.

    ACL Rehabilitation – What are the treatment options?

    Physiotherapy

      • For grade 1 or 2 sprains, the treatment is usually conservative.
      • This means that the doctor would refer the patient to physiotherapy to regain range of motion and strength.
      • The physiotherapist will assess the patient and work on restoring their function
      • The physiotherapy treatment may involve:
        • Electrical modalities to reduce inflammation
        • Hands on treatment to release muscle tension, promote circulation and improve flexibility
        • Exercises to help regain range of motion and recover strength and function through the knee
        • The physiotherapist may also recommend a custom knee brace to help protect the knee from instability
        • Education regarding home management and using any necessary gait aids or braces if required
      • The time required for recovery varies from patient to patient, but generally ranges from 8-12 weeks

    Surgical repair

      • For sprains that are severe, the family doctor will refer the patient to an orthopedic surgeon.
      • The surgeon will assess the patient and determine if they need surgery for their injury
      • Circumstances where surgery may be recommended include:
        • The patient is an athlete and their sport involves a lot of jumping, cutting or pivoting movements
        • There is injury to more than one structure in the knee
        • The knee buckles regularly with everyday activities

     How does surgery affect ACL Rehabilitation?

          • Once the surgery is finished, there will be a recovery process
          • Firstly, to keep the knee from bending, the patient will be placed in a brace
          • Additionally, to be able to move around safely, the patient will be given crutches
          • The surgeon will refer the patient for ACL Rehabilitation
          • The surgery repairs the torn ligament, but the knee will not be able function normally at first
          • Physiotherapy is needed to recover the knee movement, strength and stability.
          • The recovery time after the surgery can range anywhere between 6-9 months. This can be up to 12 months if the patient is returning to high impact sports.
          • For more information about ACL surgeries, please click here.
    • However, there are some patients who can choose not to have the surgery if they can regain function through physiotherapy and if their lifestyle doesn’t place too much stress on the ACL.
    • For example, surgery may not be needed for people who are:
        • Relatively inactive
        • Engage in moderate exercise and/or recreational activities
        • Play sports that put less stress on the knees

    Whichever treatment pathway the patient requires for their ACL injury, physiotherapists play a huge role in their recovery.  It is important to seek out treatment as soon as possible to prevent chronic problems from developing.  Furthermore, starting your treatment sooner than later, helps you get back to your life.

    Call PhysioNow today to book your appointment!

    Patellofemoral Pain Syndrome
    Applewood Physionow, Applewood Sports & Physiotherapy Ltd, Custom orthotics, Erin Mills Physionow, Erin Mills PhysioNow, Erin Mills Physiotherapy Ltd., Etobicoke Physiotherapy, General Category, Knee Pain, Long Branch PhysioNow Ltd., Long Branch Physiotherapy, Lorne Park PhysioNow, Lorne Park Sports & Physiotherapy Ltd., PhysioNow, Physiotherapy, Physiotherapy Etobicoke, Registered Physiotherapist Mississauga, Registered Physiotherapy Mississauga, Sports Injuries, Sports Physiotherapy, Sports Taping

    Patellofemoral pain syndrome

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    Patellofemoral Pain Syndrome

    Patellofemoral pain syndrome happens when your knee cap does not track properly.  The knee joint consist of two joints.  The tibiofemoral joint which is between the two long bones in your leg and the second one is the patellofemoral joint.  This  is between the femoral condyle (end of thigh bone) and the knee cap. The cartilage on the back of the knee cap glides on the cartilage on the front of the condyles of the femur. The knee cap usually sits in a snug groove at the end of the thigh bone.

    Knee movements are controlled by a number of muscles connected to the knee cap. Your  thigh muscle helps to stabilize the knee cap and enables it to move smoothly in the groove.  When this is pulled out of the groove, you can develop Patellofemoral pain syndrome.

    Causes of Patellofemoral pain syndrome or Anterior knee pain

    Patellofemoral pain syndrome, is one of the most  common causes of pain in the knee. Pain is usually felt under the knee cap.  This is where it glides on the femur/thigh bone. If you have patellofemoral pain syndrome, it hurts when you bend and straighten your knee . There are a number of factors which can cause the pain.

    Common Causes of Patellofemoral pain syndrome

    • Weakness in the hip and thigh muscles-Weakness in the thigh muscles can cause increased load which may lead to pain. Pain in your knees will further limit the activity of your muscles and over time can cause further weakness. Weakness of the inner thigh muscle  will affect the movement of the knee cap as you do your normal activities. Weakness in your hip muscles also can affect activities like climbing stairs and walking.
    • Excessive loading or rapid increase in the load for muscles around the knee-Depending on your usual activities, your knee will have a level of activity that is tolerated by your joint. Rapid increases in loading of activity may lead to a highly irritable or sensitive joint. This can cause Patellofemoral pain syndrome.
    •  Posture or position of hip, knee and feet-Flat feet or excessive turning in of feet can change movement mechanics further up the leg and cause excessive strain in your knee cap.
    • Tight muscles around the knee-Tightness in the muscles can reduce the movement of your knee and affect  how your joint works . This will lead to excessive loading during activities. The common muscles that become tight are your hamstrings, Quadriceps, Iliotibial band and calf.
    • Previous injury or dislocation of knee cap
    • Desk top work, where a lot of sitting can cause pressure on the kneecap.
    • Irritation of fat pad around the knee
    • Tendinitis of quadriceps tendon
    • Bursitis around the knee
    • Osteoarthritis

    When poor biomechanics are repeated with each step of your walking and running it may lead to a highly sensitive joint and Patellofemoral pain syndrome.

    Symptoms

    • The onset of  knee cap pain is normally gradual rather than traumatic.
    • Pain at the front, back and sides of the knee with or without swelling.
    •  Bending and straightening of knee can cause pain.
    • Pain after prolonged sitting or when you keep the knee bent for longer periods of time.
    • Clicking or grinding when you bend or straighten your knee.
    • Pain when you go up and down the stairs, up hill /down hill, squatting, running or jumping.
    • Poor knee control or stiffness

    Physiotherapy Treatment

    Patellofemoral Pain Syndrome treatment

    • Physiotherapy is the most effective treatment for short- and long-term management of Patellofemoral pain syndrome. Your Physiotherapist will fully assess you on your first visit to identify your functional limitation. They will also help to set goals and identify contributing factors for the pain.   They will  provide a customized rehabilitation program.
    • In the initial phase of rehabilitation, treatment is directed towards reducing the pain, swelling and muscle inhibition. To do this PhysioNow will  use electrotherapy modalities, acupuncture, rest, taping, gentle motion or joint mobilization and muscle setting exercises.
    • Once the pain and swelling reduces, treatment is focused towards modifying the  factors that have been identified as a cause for the problem.
    • Rehabilitation typically emphasizes increasing strength and pain free movements.  It also will address postural correction, improving the  stability of the pelvis, balance and functional abilities.
    • Stretching exercises to address the tight muscles and strengthening the weak muscles will improve your load tolerance.
    • Successful rehabilitation requires adherence to your exercise program .
    • You will also need to reduce the aggravating movements and slowly build the endurance and strength for those activities over time.
    • Prior to discharge you will be given a safe progression of exercises and functional activities.
    • For long term management, your foot and knee control will be assessed by your Physiotherapist.
    • As a result, you may require  custom foot orthotics to correct your foot position.
    • This will  help to improve foot and knee control.
    • Others might need a hip stabilization program and your Physiotherapist will be happy to discuss with you the long term rehabilitation plans if this is needed.Custom orthotics for Patellofemoral Pain syndrome

    How long it will take to get better?

    We expect to see improvements with Physiotherapy over a 3 to 6-month period.   Further improvements continue beyond this period. Adherence to your specific exercise program is important in maintaining the improvement. Most people will get back to their normal function with rehabilitation in the short term. Many patients can continue in their chosen activity during rehabilitation.  Some modification of activity may be all that is needed.

    If you play sports, you will need to do sports specific exercises to ensure a safe return to sports. It is good to wear proper supporting footwear to help keep your feet in a good position.  This will  improve alignment of your knees.

    How to book an appointment with a Physiotherapist at PhysioNow?

    We have four Physiotherapy clinics of which three are located in Mississauga and one is in Etobicoke. You can call 289-724-0448 to book into any of these clinics  for an appointment with a Physiotherapist.

    Most of the time we can arrange your initial visit on the same day in a location which is nearest to you. Your initial appointment will be a one to one 40-60 minute session with a Physiotherapist which includes treatment as well on the first day.

    Your follow up appointments  will typically take  40 minutes.  Normally, we would recommend 2 to 3 sessions per  week depending on the factors identified on initial assessment, treatment plan and your goals.  If you have limited funding available, we will be happy to work with you to develop a home exercise program.

    Please call today to get started on your treatment for Patellofemoral Pain Syndrome at PhysioNow!

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    Heat therapy

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    Heat and Cold therapy

    How it works

    When we apply Heat therapy, it improves circulation and blood flow to  that area due to increased temperature. Heat therapy can relax and soothe muscles and heal damaged tissue.

    Heat therapy

    Types

    • Dry Heat therapy includes sources like heating pads, dry heating packs, and even saunas. This heat is easy to apply.
    • Moist Heat therapy includes sources like steamed towels, moist heating packs, Theratherm heating pads that take moisture from the air, or hot baths. Moist heat may be slightly more effective as well as require less application time for the same results.

    Contraindications

    • diabetes
    • dermatitis
    • vascular diseases
    • deep vein thrombosis
    • multiple sclerosis (MS)

     Heat is useful for relieving:

    • osteoarthritis
    • strains and sprains
    • tendonitis, or chronic irritation and stiffness in the tendons
    • warming up stiff muscles or tissue before activity
    • relieving pain or spasms relating to neck or back injury, including the lower back

    Cold therapy

    How it works

    Cold therapy is also known as cryotherapy. It works by Louis- hunting reaction theory. When we apply Ice to an injured site, it reduces the blood flow by vasoconstriction. After some time, it causes vasodilatation and increases the blood flow to the area. This process goes on continuously. This reduces inflammation and swelling that causes pain, especially around a joint or a tendon. It can temporarily reduce nerve activity, which can also relieve pain.

    Types of Cold Therapy

    There are a number of different ways to apply cold therapy to an affected area. Treatment options include:

    • ice packs or frozen gel packs
    • coolant sprays
    • ice massage
    • ice baths

    Cold treatment can help in cases of:

    • osteoarthritis
    • a recent injury
    • gout
    • strains
    • tendinitis, or irritation in the tendons following activity

    Contraindications

    • people with sensory disorders
    • uncontrolled diabetes
    • You should not use cold therapy on stiff muscles or joints.
    • Cold therapy should not be used if you have poor circulation.

    Here’s a general guide that helps you to decide which to use heat or ice : https://www.healthline.com/health/chronic-pain/treating-pain-with-heat-and-cold#cold-therapy

    In General,  use ice for the first few days after an injury.  Beyond that, heat usually does the trick.  There is some evidence that suggests that using ice beyond the first few days can actually slow down injury healing.  It pushes away the healing agents that help you to get better.

    If you have been injured and need advice or treatment, please call PhysioNow today.  We are always happy to help!

    Applewood Physionow, Applewood Sports & Physiotherapy Ltd, Custom Knee Bracing, Custom orthotics, Erin Mills PhysioNow, Erin Mills Physiotherapy Ltd., Exercise, General Category, Knee Pain, Lorne Park PhysioNow, Lorne Park Sports & Physiotherapy Ltd., Manual Therapy, PhysioNow, Physiotherapy, Registered Physiotherapy Mississauga, Sports Injuries, Sports Physiotherapy

    Baker’s Cyst

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    Baker's cyst

    A Baker’s Cyst, also known as a popliteal cyst, is a fluid-filled swelling that causes a lump at the back of the knee. This leads to tightness and restricted movement. The Baker’s Cyst can be painful when you bend or straighten your knee.

    ? Causes of a Baker’s Cyst

    Synovial fluid is a clear liquid that normally circulates through the spaces in your knee joint. Sometimes the knee produces too much of this fluid. The increasing pressure forces the fluid to the back of the knee via a one-way valve. This creates a bulge. This  swelling of the knee causes a Baker’s Cyst to form.

    The most common causes of a Baker’s Cyst are:

    • damage to the knee’s cartilage (meniscus)
    • arthritis of the knee
    • rheumatoid arthritis
    • other knee conditions that cause joint inflammation

    ? Symptoms of a Baker’s Cyst

    Some patients may have no pain and may not even notice the cyst is there. However, the signs and symptoms of a Baker’s cyst can include:

    • Swelling or lump behind the knee (the main sign) – this is more evident when standing and comparing one knee to the other. It may feel like a water-filled balloon.
    • Knee pain.
    • Calf pain.
    • Accumulation of fluid around the knee.
    • The knee joint may click or buckle.
    • The knee joint may lock.

      • ? Diagnosis of a Baker’s Cyst

      • Your doctor will examine your knee and feel the swelling. If the cyst is small, they may compare the affected knee to the healthy one and check your range of motion.
      • Your doctor may recommend non-invasive imaging tests if the cyst rapidly increases in size or causes severe pain or fever. These tests include an MRI or ultrasound. An MRI will enable your doctor to see the cyst clearly and to determine if you have any damage to the cartilage.
      • These tests will determine if some other form of growth, such as a tumor, is causing the swelling.
      • Although the cyst won’t show up on an X-ray, your doctor may use one to check for other problems, such as inflammation or arthritis.

      Web MD has additional info on this condition.

      ? Treatment

      A Baker’s Cyst doesn’t need treatment. It will go away on its own. However, if the swelling becomes large and causes severe pain, your doctor may recommend one of the following treatments.

      • Fluid draining

        Your doctor will insert a needle into the knee joint and may use an ultrasound to help guide the needle to the correct place. They’ll then draw the fluid from the joint.

      • Medication

        Your doctor may recommend a corticosteroid medication, such as cortisone. Your doctor will inject this drug into the joint, and the medication will flow back into the cyst. Though it may help relieve the pain, it doesn’t always prevent a Baker’s Cyst from recurring.

      • Physiotherapy

        Regular, gentle exercises may help increase your range of motion and strengthen the muscles around your knee.

      If you think you or someone you know may have a Baker’s Cyst, please call PhysioNow today!  We would be happy to help! We have highly trained Registered Physiotherapists ready to see you Now!

    Custom Knee Bracing, General Category, Physiotherapy, Sports Injuries, Sports Physiotherapy

    Knee Arthroscopy

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    Knee Arthroscopy

    knee arthroscopy

    Custom Knee Bracing


    Knee arthroscopy done by orthopedic surgeons “clean up” or repair the cartilage or meniscus in the knee. Typically, knee meniscus injuries will happen one of two times. A large bucket handle tear is one that creates a three cornered flap. This is much like if you catch the sleeve of your coat on a nail. This flap can be stable or unstable. After the initial swelling and pain heals, a stable flap rests in place and does not interfere with your daily activities and use of your knee. An unstable tear will flip up much like the handle of a bucket. If this is occurs, often your knee will lock and you will have very limited movement in your knee. The second type of meniscal damage is wear and tear, or degeneration. This will consist of tiny tears, called microtears, which create a fraying of the cartilage.
    All of the different types of meniscal damage can be treated by knee arthroscopy surgery. There are two small incisions used for this surgery. In one, the surgeon will place a scope, or a small camera. The other incision is used for a tool which will trim or shave the meniscus depending on the damage that has occurred. This procedure is typically a day surgery and you should be able to walk immediately after it is over. Some people prefer to use crutches or a cane, but if all heals well, you should be able to stop using these after a day or two.
    Regardless of the injury, researchers are now suggesting that a course of physiotherapy focusing on strengthening and balance, or proprioception, is critical before knee arthroscopy surgery. Studies are indicating such a physiotherapy treatment program can reduce pain and increase function to the same degree as surgery in most cases. This can in some cases eliminate the need for surgery altogether. It also can eliminate the risk of infection and reduce the chances of future osteoarthritis.
    Lastly, sometimes, custom knee bracing can be effective to offload the side of the knee that has a meniscus injury.
    If you have knee pain, see a physiotherapist today. They can help!
    knee arthroscopy

    knee arthroscopy

    Custom Knee Bracing, Exercise, General Category, Physiotherapy, Sports Injuries, Sports Physiotherapy

    Knee Pain- Teenagers

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    Athlete Stretching

    Athlete Stretching-  Knee Pain

    As we start into the fall and winter sports seasons, many people have asked about knee pain in their early teenaged or pre teen children. This pain is at the front of the knee and is not usually due to falls or sudden injuries.

    The most common cause is something called Patellofemoral Pain Syndrome. This is swelling and pain in the joint between the knee cap and the thigh bone. Often it will start at the beginning of a new activity or if the amount of training is suddenly increased. However, knee pain can also happen after a growth spurt or for no reason at all. The cause of the knee pain is the kneecap is not tracking properly. In a healthy knee, there is a groove in the thigh bone,  that the knee cap travels up and down as we straighten or bend the knee. If there is muscle tightness or weakness, the kneecap will be pulled out of the middle of the groove and the back of the knee cap gets painful. This knee pain is more noticeable on stairs, squatting or with activity because there is more pressure on the sore area.
    Proper stretching is key to relieving Knee Pain . Although generally a forgotten part of fitness, it is very important that joints are flexible in order to stay healthy. If you are not sure which muscle needs to be stretched or strengthened, book an assessment with a physiotherapist.
    Physiotherapists are trained to determine which exercises are best for you. Physiotherapy will include a full assessment of your knee and the muscles surrounding it. Treatment will focus on addressing the tight muscles and joints as well as education on prevention. Proper care at the start of any injury is key to preventing a longer term chronic injury. The goal is to keep you in the game and allow you to continue with your normal activities of daily living.

    Physiotherapists-Sports Injuries

    Knee Pain