Tag Archives: physiotherapy

Physiotherapy, Rotator Cuff tear, Shoulder Injuries, Shoulder pain, Surgery

Rotator Cuff and Shoulder Injuries: Do I Need Surgery?

Shoulder injuries from rotator cuff tears are something we commonly see in the clinic. Whether it’s from playing a sport, an overuse injury from work or daily life, or just lifting something too heavy, rotator cuff injuries can happen for a wide variety of reasons.

Unfortunately, there is a lot of fear around shoulder injuries, especially after getting an ultrasound done and seeing words like “tear,” “degeneration,” and “tendinosis.” Understandably, the question then becomes, will I need surgery? Thankfully, surgery is only reserved for very specific and severe cases of shoulder injury. In the vast majority of cases, conservative management with Physiotherapy is the gold standard of treatment.

What is a rotator cuff injury?

The rotator cuff is made of 4 muscles and their tendons around the shoulder joint. Sometimes, they are called the SITS muscles, an acronym for supraspinatus, infraspinatus, teres minor, and subscapularis. Each muscle has a slightly different function, but altogether their job is to hold the arm bone inside the shoulder socket while the arm moves.

A rotator cuff injury usually falls into 2 issues.

  1. Tendinopathy: A general term to describe a pathology and degeneration with the tendon.
  2. Tears: The tear can be partial thickness (incomplete) or full thickness (complete). Partial means part of the tendon is still intact, full means the tendon has been completely severed and is a more serious condition.

These 2 conditions are also not mutually exclusive. Long term tendinopathy leads to a higher chance of a tear happening, as the tendon health becomes compromised. Similarly, a tear that does not undergo proper rehab may not heal to 100% and lead to tendinopathy.

What are the symptoms of a rotator cuff injury?

Generally, you may have a rotator cuff injury if you have:

  • Pain when reaching overhead
  • Difficulty sleeping on your side
  • Pain is worse at night
  • Difficulty putting clothes on, especially a bra or a jacket
  • Difficulty lifting or carrying
  • Clicking or popping in the shoulder

How long does a rotator cuff injury take to heal?

Generally, anywhere from 6-12 weeks of rehab is needed, depending on the nature if the injury. More severe or chronic conditions may land closer to the 12 weeks time period, while smaller acute tears may recover in 6 weeks. Your shoulder will likely pass through several stages of rehab. Keep in mind these may overlap.

  1. Pain control and restoring range of motion
  2. Strengthening and scapular mechanics
  3. Strengthening and weight training
  4. Sport-specific training

Surgery or physiotherapy, how do I know?

Research has shown that for partial tears and chronic tendon degeneration, conservative care with physical therapy is the first choice. With the help of a Physiotherapist, many patients can return to their daily activities and sports. Treatments may include targeted strengthening exercises, mobility exercises, manual therapy, and more!

Surgery may be indicated in a highly traumatic injury causing complete or large tears to multiple tendons. Additionally, a huge loss in function and range of motion ofthe shoulder suggests a higher severity. Finally, in cases where physiotherapy has been tried for several months with no real improvements, surgery may be indicated.

Either way, physiotherapy will play an important role whether a surgery is happening or not. It is a necessary part of the rehab, pre-surgical, and post-op protocol if needed. Surgery is always the last resort due to the risks involved. If your shoulder can heal without it, you should take that chance!

Looking for help with shoulder pain?

Look for PhysioNow! We have expert physiotherapists knowledgeable in rotator cuff pain ready to assist you. Whether you are worried about surgery, prepping for one, or trying to avoid one, we can help! We have 10 locations across the West GTA including Burlington, Oakville, Mississauga, and Etobicoke. Don’t let your shoulder pain keep you from your daily life or sports. Book with PhysioNow today for your first assessment and treatment!

Arthritis, Custom Knee Brace, Custom Knee Bracing, Hip Pain, Knee Pain, Physiotherapy, Surgery, Total Hip replacement, Total Hip Replacement Surgery, Total Knee Replacement

Hip and Knee OA: Can Physiotherapy Prevent Surgery?

Getting that x-ray back with a diagnosis of osteoarthritis (OA) of the knee or hip can be alarming. Maybe you’ve also started to notice some persistent pain, and daily movements like stairs are starting to become harder. Rest assured, surgery is not the immediate next step. Physiotherapy treatment and conservative management is the first line treatment for hip and knee OA.

Understanding hip and knee OA

Simply put, OA involves natural wear and tear in the joints over time. The cartilage and joint surfaces change over time and show signs of degeneration. Thankfully, we now know that these structural changes are not the whole story. Even though an x-ray may show these signs, it does not automatically mean there is an issue. More importantly, you can have signs of OA without feeling pain or discomfort at all and there is something you can do about it. Ultimately, the strength of the muscles and tissues around your joint is what matters the most to how you move and function.

How does physiotherapy treat OA?

Single leg glute bridges are great strength builders, working the core, glutes, and lower body all at the same time.

More and more we are understanding that regular strength training is the key to building resilience around the joint. Here’s how physio can help:

  1. Strengthen: Even though the joint changes may be there, the load support comes from the surrounding musculature. This means strengthening the quads, hamstrings, calves, hips, and core. These muscles can replace the shock absorption for the joint, offloading stress from it
  2. Mobility: Motion is lotion, joints need this stimulation to stay healthy. Movement helps produce the joint fluid that lubricates the joint and gives it nutrients. A regular mobility program can improve lost range of motion and reduce morning stiffness.
  3. Education and activity modifications: OA is not a condition that goes away completely, it’s something that you will have to manage. Your Physiotherapist will help you figure out what activities in your life may have to be temporarily sidelined to avoid overuse, and when it is safe to go back to it again
  4. Gait aids and braces: We want you to be as independent and stay in touch with all your favourite activities as much as possible. Sometimes, this may involve doing things with a bit of help. Whether it’s going for a walk outside, or playing tennis, an aid like a walker, cane, or custom brace may help.

How does physiotherapy prevent or delay surgery?

Physiotherapy can either delay, or completely prevent the need for a total joint replacement. The earlier you start with rehabilitation and strengthening, the better it is. Major health organizations like the Osteoarthritis Research Society International (OARSI) recommended structured physical therapy and exercise plans as gold standard treatments for OA.

People who participate and complete these programs can delay their surgery for years, or even are able to forgo it completely. Worst case, if surgery is still necessary, research has shown that patients who engage in training beforehand have quicker recovery and better outcomes post-surgery.

What can I expect in a Physiotherapy session if I have hip or knee OA?

If you’re new to Physiotherapy, no worries! We’re here to help you and answer every question you may have. Here’s a general outline of what to expect at your first session.

  1. Comprehensive assessment: Your physio will ask you questions about your current symptoms, function, and goals. They will gather any relevant information about your medical history, previous injuries, and more. Afterwards, they will conduct a physical evaluation of your range of motion, strength, balance, and function.
  2. Creating a treatment plan: After the assessment, your physio will use this information to create a personalised plan for you. Based on your areas of weakness and goals for the future, a week by week plan will be presented to you.
  3. Treatment: Treatment will happen on the very first day. This part will be very individualised based on your unique factors. This part may consist of manual therapy, electrotherapy, cryo or heat therapy, and exercises. Here, your physio will also teach you your home exercise plan including cardiovascular training, strength and mobility work, and more!
  4. Outline for the future: Finally, there will be time for questions and your physio will educate you on what to expect in the future. They will tell you how often you will need to come in, and what the expectations for progression are.

Looking for help with a hip or knee OA?

Your hip or knee is something we can work on, it doesn’t have to be what stops your life. If you’re looking to improve your quality of life, get stronger, and delay a surgery, look for PhysioNow! We have expert clinicians at 10 locations across the West GTA to help. Look for us in Burlington, Oakville, Mississauga and Etobicoke. Book with PhysioNow today for your first assessment and treatment!

Ergonomics, neck pain, Pediatric physiotherapy, Physiotherapy, Posture

Pediatric Physiotherapy: Tech Neck and Posture

Leaning over a desk doing homework or studying puts a lot of pressure on the muscles and joints at the back of the neck.

Maybe you’ve noticed that your child spends a lot of time hunched over their homework or leaning forwards at their computer. You may have noticed them rubbing their neck or complaining about soreness. This is a very common phenomenon in both adults and children, and has been becoming known more and more as “tech neck”.

This refers to the slouched and forward head posture many people take when looking at their laptops, phones, or reading something in front of them. In this blog, we’ll go over how this pain happens, some postural tips, and postural muscles exercise to help keep your child pain free!

Is tech neck bad?

Girl doing homework with a head bent forwards position, illustrating the types of posture commonly seen and ones that can lead to pain developing

While the posture by itself isn’t bad, we all slouch sometimes, persistent slouching can lead to neck stiffness, upper back pain, and even tension headaches.

The tech neck posture tends to overuse the muscles of the upper neck. As the back and lower neck fall forwards, to keep things in view they must often crank their neck up, stressing the upper neck muscles greatly. On the other hand, the other muscles become overstretched, or overly tight and weakened leading to an imbalance in the body.

Over time, they may find that they’re no longer able to sit in an upright posture as the muscles fatigue too quickly.

The ideal ergonomic setup for your child’s desk

While our muscle strength plays a big part, so too does the working setup. The key tips include:

  1. Chair: When sitting, their feet should be flat on the floor or if unable, on a foot stool
  2. Screen: The first line of text should be in line with your child’s eye line. If they use a tablet or laptop, consider getting them a desktop monitor to connect to or lifting it with a stand.
  3. Back support: Ensure that your child has a proper comfortable chair that promotes natural curves in the lower back. They should not be doing their homework slouched into the couch or bent over the dining room table
  4. Movement breaks: Every 30 minutes ideally, they should take 1-2 minute stretch break to prevent stiffness
  5. Other modifications: Consider other tools likes standing desks, an ergonomic mouse, wrist rests, and more. These may be more relevant to older children who have to spend a lot more time completing assignments on computers.

3 postural exercises to combat slouching

We’ve prepared 3 easy to do exercises at home to help break up your child’s computer and desk time. Specifically, they require no specialized equipment and help to release built up muscle tension.

  1. Doorway stretch: Using a door frame, place the hand on the wall and gently lean forwards until you feel a stretch in the chest/pec muscles.
  2. Chin tucks: Sitting or standing, bring the head directly backwards almost like making a double chin motion, or a turtle retreating into its shell.
  3. Thoracic extension over the back of the chair: Use your hands to support your neck. Use the back of the chair as a support to bend over and extend the spine.

Persistent pain or tech neck? Try pediatric physiotherapy!

Pediatric physiotherapy is specialized towards treating the younger population. Oftentimes, children’s needs are different from an adults and sometimes their body’s respond in different ways as well. In a pediatric physiotherapy assessment, you are encouraged to be a part of your child’s session, as it is important for everyone to be informed. A pediatric physiotherapy will assess how your child moves, their strength, balance, and flexibility, and come up with a personalised plan to resolve their issue!

If neck and back pain are the primary issues, a session will include a postural assessment, education on ergonomics and setup, manual therapy to help relieve tight muscles and stiff joints, and an exercise plan to strengthen and stretch as needed.

Does your child have neck pain or is worried about their posture?

Look for PhysioNow! We have expert pediatric physiotherapists ready to help you and your child. There are 10 locations across the West GTA including Burlington, Oakville, Mississauga and Etobicoke. Also, we offer extended evening hours and Saturday times to best fit into your schedule. Don’t let the pain develop into something worse, get it treated today! Book with PhysioNow for your child’s first assessment and treatment!

Acupuncture
acupuncture, Chronic Pain, Dry Needling, General Category, Physiotherapy

Needling with Physiotherapy: How it Relieves Pain

Acupuncture

Each day, more and more Physiotherapists are using acupuncture and needling techniques alongside the usual treatments to create the best outcomes for their patients. Maybe you are struggling with some persistent pain and the usual techniques don’t seem to be working, acupuncture or dry needling might be worth a shot!

For some people, the idea of using needles to treat pain sounds counterintuitive. How can such small needles help pain? In this blog, we’ll discuss the science behind needling techniques and how Physiotherapists use it in their practice. If you’re worried, we’ll walk you through the process to help you decide whether it’s right for you.

First, the difference between acupuncture and dry needling?

You may have heard both these terms being used around a Physiotherapy clinic. Both are very similar and use the exact same needles, just with slightly different mindsets and goals.

Acupuncture comes from ancient Traditional Chinese Medicine philosophies. It is based around restoring the the Qi, or energy flow throughout the body. On the other hand, dry needling targets muscle trigger points to help release tight muscles. Some Physiotherapists may even practice both and use them depending on what their treatment goals are.

How does needling help pain?

Research has shown that needling has very good evidence for its benefits in pain. For those interested in more detailed evidence, the website called Evidence Based Acupuncture creates research summaries for different conditions. Without going too far into the details, acupuncture needles trigger a complex cascade of tissue responses including altering blood flow, endorphins, neurotransmitter release, and the nervous system itself. All of these factors can come together to create an analgesic, relaxation effect.

How do Physiotherapists use needling?

Acupuncture and needling by itself is not a full treatment. However, Physiotherapists have found that it can boost the effectiveness of other parts of treatment. For example, for someone who’s condition is limited by pain, needling can create an opportunity for them to participate in more aspects of their life and exercises by giving them pain control. During this window, exercises for strengthening and increasing mobility may be performed where it may have been too uncomfortable beforehand. Used alone, acupuncture can create short-term relief, but when combined with the other evidence based Physiotherapy techniques, that’s where the real benefits lie.

Is acupuncture and needling safe?

Understandably, some people are squeamish around needles. The good news is, acupuncture and needling techniques are considered safe with only minor side effects. Your Physiotherapist will ensure that you fully understand the benefits, risks, and procedures on the day of your appointment. They will create a specific acupuncture and physiotherapy plan with you based on your goals, current status, and type of injury or pain that you are dealing with. A quick summary of potential side effects of acupuncture are below:

  • Pain is not always present. As the needles are inserted there may be slight ache or pinch, but some people don’t feel any pain
  • Mild post-treatment soreness, bruising, or bleeding is possible. This should resolve within 1-2 days.
  • Temporary fatigue afterwards might be present for the same 1-2 days.

These other side effects are possible, but more rare including:

  • Fainting or dizziness due to an anxiety or blood pressure response to the needles
  • Emotional release including a sudden rush of tearfulness or strong emotion

Finally, the very rare but more severe side effects include:

  • Infection
  • Nerve damage/irritation
  • Pneumothorax (collapsed lung) from the needle piercing the lung tissue

These severe side effects are linked to poor practitioner technique.

Looking for help with managing pain?

Look for PhysioNow! Regardless of how long you’ve had your pain or injury, there is treatment for it. Don’t let your pain take control of your life, find relief with acupuncture and needling with Physiotherapy treatment. Each session comes with a comprehensive assessment, guaranteed 1 on 1 time with a Registered Physiotherapist, and a personalised treatment plan.

PhysioNow has expert clinicians at 10 locations across the West GTA including Burlington, Oakville, Mississauga, and Etobicoke. Book with PhysioNow today for your first assessment and treatment. Or to find out more information contact us by Phone: 289-724-0528 or Email: applewood@physionow.ca

Hip Bursitis, Hip Pain, Physiotherapy, Sports Injuries, Sports Physiotherapy

Hip Pain: How to Resolve Your Gluteal Tendinopathy

Have you been experiencing pain on the outside of your hip recently? Or maybe you notice a sharp twinge every time you climb the stairs, step out of the car, or try to lie on your side at night?

If this sounds familiar, you aren’t alone. Outer hip pain is incredibly common, and very often, the main culprit is a condition called gluteal tendinopathy. Oftentimes, this can be accompanied by a bursitis and is generally classified as Greater Trochanteric Pain Syndrome (GTPS). Either way, the condition and pain is very treatable with Physiotherapy and we’ll go over how today.

What is a tendinopathy?

First, tendons are the tough, fibrous cords that connect your muscles to your bones. Then, tendinopathy is an umbrella term for a condition tendon that has become stressed and irritated, usually due to overuse

For a long time, people called this “tendinitis,” assuming it was just temporary inflammation. Today, research shows that tendinopathy is less about active inflammation and more about tendon overload. When a tendon experiences more stress or load than it is adapted for, its collagen fibers become disorganized, leading to localized stiffness, weakness, and pain.

How does gluteal tendinopathy happen?

Your gluteal tendons (specifically gluteus medius and gluteus minimus) attach to the bony bump on the side of your hip, known as the greater trochanter. These muscles work hard every day to keep your pelvis level when you walk, run, or stand on one leg. In other words, they are huge stabilizers of the hip and essential for daily function and sports.

Gluteal tendinopathy usually happens due to a combination of:

  • Increase in activity: For example, starting a new workout routine or increasing your daily walking/jogging mileage too quickly
  • Compressive positions: Positions that pull the tendon tight over the hip bone can irritate an already sensitive tendon. This includes things like sitting with your legs crossed or standing while resting all your weight shifted onto one hip hanging on your hip
  • Compensation for other weak areas: If the surrounding hip or core muscles aren’t taking their share of the work, the gluteal tendons take on extra strain.

What are the common signs and symptoms?

Gluteal tendinopathy presents with a fairly distinct pattern. Patients usually report:

  • Pain on the outside of the hip: A localized ache or tenderness directly over the bony bump on the side of your hip, which sometimes radiates down the outer thigh toward the knee. Most people can point directly towards the source of their pain
  • Nighttime pain: Difficulty sleeping on the affected side due to pressure, or pain when sleeping on the opposite side because the top leg falls across the body, stretching the tendon
  • Pain during single leg activities: Discomfort when walking, going up or down stairs, standing on one leg ex. getting dressed or running
  • Worse after prolonged rest: A stiff or sensitive hip when stepping out of bed in the morning or standing up after sitting for a long period

How does physiotherapy treat this condition?

Mindsets around healing have changed a lot in the past decades, no longer is resting considered a good thing. Obviously, there needs to be a modification to activity to avoid overuse, but doing absolutely nothing will only make the tendon issue worse. The most important thing to know about tendinopathy is that tendons need load to heal. Complete rest might make the pain quiet down temporarily, but as soon as you return to your normal activities, the unstrengthened tendon will likely flare up again in a relentless cycle.

Physiotherapy focuses on progressively rebuilding your tendon’s capacity so you can get back to living pain-free.

1. Activity management and modifications

First, we help you identify and temporarily adjust activities that compress or overload the tendon:

  • Place a thick pillow between your knees when sleeping on your side
  • Avoid crossing your legs when sitting
  • Stand evenly on both feet rather than resting your weight on one hip
  • Participate in activities only up to a 3-4/10 of pain, then take a rest

2. Targeted exercises

Exercise is the gold standard treatment for tendinopathy, and research now shoes that we need to push the tendon quite heavily to create the adaptations that are needed for healing. Recovery typically moves through phases, depending on the individual tolerance level and initial severity of the condition.

  • Isometrics: Holding muscle contractions without moving the joint. These are used for pain relief and to start with early muscle activation
  • Strength training: Controlled strengthening exercises like sidelying leg lifts, bridges, and step-ups that gradually build tendon strength without excessive compression.
  • Functional and heavy Loading: Restoring full strength and power through functional movements like squats, lunges, Bulgarian’s and more. Heavy slow resistance is considered the gold standard for tendon loading and should be strived for in all rehab programs.

3. Manual techniques

In the early stages, manual techniques can help to calm the pain down. Tight hip muscles can increase the compression force over the tendons or bursa, worsening the condition. Restrictions in joint mobility may be contributing to overuse at the hip. Your physiotherapist will perform a full assessment to determine the techniques that are appropriate for you.

Need help with hip pain or a gluteal tendinopathy?

Look for PhysioNow! We have expert clinicians at 10 locations across the West GTA, including Burlington, Oakville, Mississauga, and Etobicoke. Don’t let your hip pain stop you from enjoying the rest of your summer. Book with PhysioNow today for your first assessment and treatment!

Knee Pain, Pediatric physiotherapy, Physiotherapy, Sports Injuries, Sports Physiotherapy

Osgood Schlatter’s: My Kid Has Knee Pain!

Is your kid complaining about a persistent knee pain under their knee? Does it bother them the most after physical activity, especially basketball, volleyball, soccer player or other sport? If so, they might be dealing with a condition called Osgood Schlatter’s Disease. Dont’ worry, it sounds scary but it’s very common and manageable with Physiotherapy!

What is Osgood Schlatter’s?

To put it in simple terms, Osgoode Schlatter’s is the inflammation of a part of the tibia (shin bone), right where the tendon attaches. Repetitive and high force contraction of the tendon puts pressure on the growth plate, causing irritation over time. Eventually, it can even cause a prominent bony bump to form where the tendon attaches.

It is most frequent in young athletes, especially boys, from around 10-15 years of age, but can certainly happen in girls as well. It is more likely to happen after growth spurts and with highly active individuals. The more intense the sport is, with running, jumping and sprinting, the more likely they are to develop this condition.

What are the signs and symptoms for it?

  • Pain at the front of the knee, tender to the touch
  • May have swelling at the front of the knee
  • Worse with activity
  • Worst with running, jumping, kneeling, squatting
  • Enlarged prominence may be present at front of knee

What is the treatment for Osgood-Schlatter?

Thankfully, research shows that most Osgood-Schlatter cases are self-limiting, which means that it will resolve itself over time. However, this time can be quite long (months) and painful, especially if not managed correctly. In some cases, daily activities such as stairs can be quite sore, and they may have to take an extended break from their sport if their symptoms are severe.

As a result, Physiotherapy is highly recommended so that your child can experience the smoothest process for recovery and the fewest limitations to their daily life and physical activities. The goal of physiotherapy is to help you understand the condition, how to avoid flaring it up, strengthen the muscles, and correct movement patterns that can exacerbate the condition. Next, we’ll go through the common Physiotherapy treatments in more detail:

Pain Control

Obviously, one of the most important things to you and your child is how to manage the pain. Immediate treatment for pain can include use of heat, ice and NSAIDs. Based on your symptoms, your Physiotherapist will recommend a plan of action including relative rest and activity modifications. They will try to have you participate in as much as possible without making your condition worse. You may still be able to play some sports, but have to take more rests or not play as hard. Manual therapy and massage techniques may be used to help alleviate pain.

Exercise Plan

Poor flexibility can be a predisposing factor to this issue. Tight quadriceps can increase the tension of the tendon on the bony area, worsening the irritation. Your Physiotherapist can teach you specific stretches to target the affected areas. Additionally, strengthening the hips, knee, and core are all beneficial. Weakness in one area can produce compensations in others, increasing the risk of overuse and injury over time. Your Physiotherapist will help you put together a comprehensive program to address your individual weaknesses and how to progress exercises safely.

Teaching proper movement patterns

Improper form such as in a squat, or taking off and landing from a jump can put extra stress on an area. Doing a biomechanical assessment can be helpful to catch any predisposing factors and ultimately, lessen the load on the knee. Your Physiotherapist will look at the common moves in your sport, and give you specific drills and cues to help you adapt.

Looking for help with knee pain?

Look for PhysioNow! We have 10 clinics across the West GTA including Burlington, Mississauga, Oakville, and Etobicoke. We have late evening hours and Saturday hours available to help you and your children find the times that they need. Don’t let your pain continue to worsen, get help today! Book with PhysioNow for your first assessment and treatment!

Exercise, Hip Pain, Knee Pain, Physiotherapy, Running

Runner’s Knee: How to Keep Yourself in Running Shape

It’s a dull, aching pain around your kneecap that you can’t quite touch. Runner’s knee, or clinically known as patellofemoral pain syndrome (PFPS), is a very common cause of knee pain. The good news is, it us very treatable especially if you catch it early. In this blog, we’ll break down what runner’s knee is, how it happens, and tips to avoid it whether you’re gearing up for a marathon of just getting into running.

What is runner’s knee?

Runner’s knee isn’t as specific of a diagnosis as say, a hamstring strain. It is an umbrella term for pain where the patella (kneecap) and the femur (thigh bone) meet and form a joint. Normally, our patella sits in a little groove on the femur, and slides up and down like a track. However, different forces can act on the patella, like a muscular imbalance or improper form, that causes it be pulled off track. This creates extra friction in the area which can lead to irritation, inflammation, and pain.

What are the symptoms of it?

  • Dull pain in the knee, usually for the first couple minutes of exercise or after exercise
  • Increased pain when walking downhill or down stairs
  • Pain after sitting with the knee bent for long periods of time
  • Grinding, popping, clicking in the knee

How does it happen?

Your knee alignment while you’re running or exercising can be a major factor in developing runner’s knee. A professional like a Physiotherapist will assess your whole body to determine the cause of the knee pain.

Usually, 1 of 2 things happens or a combination of both.

  1. Too much, too soon. You’ve recently increased your running mileage or intensity, and your body is not yet used to the new workload. The tissues in your body get overloaded, leading to injury and pain.
  2. Biomechanical imbalances. This causes tracking issues at the knee cap. Commonly, the hip stabilizer muscles are not activating well, causing the knee to fall inwards (aka valgus) when you put weight on the leg. In other cases, the foot collapses inward (aka flat feet or overpronation), creating a similar result. In either case, the patella is being pulled out of alignment which with repetition, can develop into a runner’s knee.

Tips for prevention of runner’s knee

Smart training habits can keep you out of trouble. First, follow a 5-10% rule when ramping up. As you increase your mileage, you should not increase by more than 5-10% from the previous week’s mileage. A gradual progression gives your body time to adapt, decreasing the risk of overuse injuries.

Secondly, make sure your footwear is in tip top shape. Recommendations include keeping a rotating set of 3 shoes to prevent wearing out too quickly, and to switch them out every 500-800 km. Over time, the shock absorption capabilities of your shoes will decrease, so keeping them fresh also helps to keep your joints healthy.

Third, a running assessment can be helpful if you notice irregularities in your gait. A trained professional like a Physiotherapist can watch your run pattern to see if it’s contributing to your pain. For example, factors that can be adjusted include position of the foot during heel strike, step length, correction of valgus or pronation, trunk position and more. Longer steps tend to put more force on the knee cap, and a Physiotherapist can help you make the required changes.

Finally, build in some cross training days. Don’t skip out on your strength training, strong muscles are resilient muscles. Additionally, don’t be afraid to give your joints a break while keeping your cardio up by hopping onto a bike for some sprints, or a treadmill for some incline walking. Cross training helps to give your commonly used running muscles a break while still being able to make progress in your training.

How is runner’s knee treated?

In a flared up runner’s knee, you will need to take some time off. If you jump on one leg and feel a sharp pain that you would rate a 4/10 or above, it’s your body’s sign to take a rest. Continuing to push through will only succeed in worsening the pain. Follow the principles of RICE (rest, ice, compression, elevation).

A Physiotherapist will help you assess the root cause of your knee pain, remember it can come from different sources even though the pain is happening at the knee. They will also give you rehabilitation exercises to start retraining your knee, and the associated muscles at the hip or ankle that are contributing to the issue. For example, teaching you glute activation and strengthening exercises, and how to keep the knee in good alignment while performing single leg activities. Other interventions will include manual therapies on the joint, soft tissue releases for tight muscles, and a personalized home plan including your rehab exercises and a back to run plan.

Need help with a knee pain or a runner’s knee?

Look for PhysioNow! We have expert clinicians ready to help you get back on track. We have 10 locations across the West GTA including Burlington, Oakville, Mississauga and Etobicoke. Whether it’s a new or old pain, rest assured you can find help here. Book with PhysioNow today for your first assessment and treatment of knee pain!

Neurological, Pediatric physiotherapy, Physiotherapy

Pediatric Physiotherapy: How It Can Help You and Your Family

Pediatric Physiotherapy is a specialization that focuses on infants, and children. It is widely recognized that the bodies and brains of our children are vastly different than an adults. From the way they learn, heal, and constantly are developing, we need to treat them differently as well. While the average sports injuries, strains, sprains, fractures and more are all still present in this age group, there are also unique conditions that are managed by pediatric physiotherapists. In this blog, we will discuss the more specialized situations that are unique to a pediatric population, and how Pediatric Physiotherapy is uniquely configured to address it.

Why do children need pediatric physiotherapy?

When a baby is born most of their physical function is controlled by a bunch of reflex systems that are more dominated from their spinal cord level, called “spinal reflexes’’, and not from their brain. Babies Brains are not developed during the time of birth. Hence, these reflexes are temporarily present to protect them. As the child grows these reflexes integrate and their brain starts developing more refined movements which are then controlled by the mature brain.

While a baby is growing it’s very important to help them get through this phase so their brain develops normally and they are functional to the best of their capacity. Some children take longer to get into this and some may not be able to get the full potential due to various medical reasons.

What is special about pediatric physiotherapy?

Pediatric Physiotherapy will teach guardians how to be involved in their little one’s care. Exercises may look and feel like play for kids, which is important for keeping them engaged. Each exercise will be designed to target a specific motor development skill or goal

Pediatric physiotherapy is a very unique way of helping small infants and children. To specify, it facilitates gross motor development and provide support to guardians through a family-centered approach to treatment. “A Family Centered Approach” means where a child and family are an important part of the team. They are present at each session, actively participate and help facilitate treatment goals and plans of care based on their individual needs and requirements.

What happens in a session?

A trained Physiotherapist is able to determine what motor skills are missing in normal growth by conducting a thorough pediatric assessment. Afterwards, based on their findings, they will create a program that will help the child to achieve this milestone.

For example, baby’s should develop the ability to sit with support around 6 months, and unsupported by 9 months old. However, keep in mind these are just general rules of thumb and individual variation is to be expected.

Milestones are considered a very important landmark in a child’s development. This is a time sensitive phase where a set time determines when a child should develop certain skills. For example, a healthy baby is able to sit with support by 6 months and is able to hold and transfer objects from one hand to another by 9 months. Sometimes this might change and it could take longer and your physiotherapist can determine whether it’s normal or not normal by having a close look at their movement patterns. Remember, child development is not just about learning how to move, rather it’s also about observing if they are able to hear and listen to sounds. If they have a hearing problem it has to be addressed quickly as listening and hearing helps them to talk, and plays a major role in helping them learning motor skills.

As babies grow, they may have certain problems even if they have grown fully and normally. At times they regress back suddenly and are not able to do things they were doing before. There are various reasons why this happens, but the main cause is due to sudden brain damage. In children the most common cause for this is having a intense fever due to seizures or any kind of infection. This high body temperature due to infections and seizures causes their developing brain to regress back. Hence its very important to be careful when a child develops a fever.

What kind of conditions can be treated in Pediatric Physiotherapy?

Some of the common conditions that require a pediatric physiotherapist consultation and treatment plan are as below:

  1. Down syndrome: Genetic condition, low muscle tone leading to delayed development 
  2. General delayed milestone: Normal development but slower than a normal child would be
  3. Neonatal abstinence syndrome: A child born with drug and substance withdrawal due to maternal use during pregnancy
  4. Cerebral palsy: There are different types, impaired motor development due to high muscle tone
  5. After Botox therapy: Botox is injected to the muscle group to decrease the muscle tone and help walking, especially in children with cerebral palsy
  6. Autism Spectrum Disorder: issues with sensory processing and tippy toe walking
  7. Hip dysplasia: Issues with hip clicking that can cause a lot of pain during activity

Looking for more information?

If you are concerned with your child with any of the above, if your newborn was in an ICU for a very long time, or if your baby was born very early (prematurely), please give a call for a short consultation. We are here to help and answer all your questions. Currently, Pediatric Physiotherapy services are offered with Bimala Odari at the PhysioNow Oakville North and Credit-View Bristol locations. We offer private treatment rooms and specialized equipment for each pediatric appointment.


Please reach out to us at Physio Now at our central line 289-724-0448, or email oakvillenorth@physionow.ca creditview@physionow.ca for more information.

Blog post written by Bimala Odari (BPT, MPT) (Pediatric), Registered Physiotherapist 

Ankle pain, Physiotherapy, Sports Injuries, Sports Physiotherapy

2026 World Cup Injuries: Understanding Neymar’s Calf Strain

With the World Cup starting imminently, soccer fans are waiting to see their idols perform. One of the big stories going into the tournament is Brazil’s star forward, Neymar, experiencing an injury that could affect not only his performance, but even his participation in the upcoming games. This injury was a grade 2 calf strain, a pretty common injury all things considered. Today we’ll go over what the injury is, what recovery is like, and how to prevent similar injuries from happening to yourself.

What is a calf strain?

Everytime we push off with our toes, we are using the calf muscles

Your calf is made up of 2 muscles called the gastrocnemius and the soleus. Together, they allow you to do an action called plantarflexion or pointing the toes downward. This action is essential for everything we do from walking to jogging to jumping. Connected to the Achilles, these 2 muscles are powerhouses that help us to generate power and accept high intensity forces during movement.

Muscle strains are graded from 1-3 to help us classify the severity:

  • Grade 1: Mild, minimal pain and swelling, no loss of function, ~2 week recovery
  • Grade 2: Moderate, significant pain and swelling, decrease in strength and function ex. limping, unable to heel raise, ~8 week recovery
  • Grade 3: Complete tear/rupture, severe pain and swelling, complete loss of function, likely to require surgery 3-6 month + recovery

Neymar’s grade 2 strain means that approximately 50% of the fibers have been torn in the muscle, requiring time for the body to repair itself.

Why can’t he go back into play immediately?

It is always difficult to determine when an athlete is ready to go back into play after an injury. We’ve seen many times where a newly returned athlete gets injured in their opening match, flaring up their old injury or even making it more severe.

We can’t speed up the time it takes muscle to heal. It initially has to form scar tissue, which is less flexible and not as strong as healthy tissue. Only after sufficient time and stimulation (ex. rehab exercises) does the tissue remodel itself into stronger tissue. As a result, you can see why forcing a return too early makes someone very vulnerable to a reinjury.

How is a calf strain treated?

If you have pulled a calf muscle recently, or any muscle strain really, the rehab will follow a general pattern.

1. Protect and RICE – 0-48 hours

Initially, the goal is to manage swelling and protect the area from worsening. You may have heard the term RICE before for rest, ice, compression, and elevation. During this time you may be using a brace, or a gait aid like crutches to offload the tissue. During this phase, we only want gentle pain free movements to keep circulation flowing.

2. Rebuilding 48 hours – 8 weeks

You don’t have to wait for the pain to go away quickly before starting your rehab. This phase lasts a while and is where you progressively build up your muscle strength again. A rehab professional like a Physiotherapist is essential to determining your current abilities and how fast your rehab can proceed. Everyone goes through this phase at different speeds depending on their personal goals, fitness levels, and general health.

During this phase, you will start mobility and strengthening exercises such 4 way band exercises for all the muscles around the ankle. Then, you’ll progress your ability to put weight on the foot, starting harder exercises like calf raises, squats, lunges, and cardio like walking and jogging. The exercises will be tailored to your specific situation and circumstances.

3. Back to sport 8 weeks+

While it can be frustrating to wait this long, your body needs to build up its strength, endurance and resilience before this stage. Quick movements such as sprints, jumps, hops, and cuts require a lot from the muscle, and this is the stage most people are likely to re-injure themselves if they don’t do it properly.

You will start plyometrics exercises during this stage which may include exercises like box jumps, pogo hops, skipping, running, sprints, shuttle runs and more. In this stage, the exercises will be tailored to your specific sport and the movements that are required to perform.

How do I protect my calves from a future strain?

A dynamic warmup before a game can include drills to get the blood flowing and warm up the nervous system

You don’t have to wait for a pain or injury to happen, you can work proactively to prevent one! We call this prehabilitation (or prehab for short) where we can undergo training to reduce the risk of injury. For example, if you are thinking of starting a sport or increasing the amount you are currently playing one, it is advised to go slowly and do some strengthening alongside it. Plyometrics and strength training are great for healthy calves too!

Additionally, a proper warmup and mobility training is essential for the body to perform. Limitations in other joints are going in cold can increase the chance of a strain happening. We recommend doing a dynamic mobility routine before you play, and taking care of your muscles afterwards with some active recovery and foam rolling.

Experiencing a calf strain or other ankle pain?

Look for PhysioNow! We have expert clinicians ready to help you with your sports injury and guide you safely back to play. We have 10 locations across the West GTA including Burlington, Oakville, Mississauga and Etobicoke. We offer free parking, direct billing, and extended weekend and Saturday hours for your convenience. Don’t miss out on the rest of the summer, get started with PhysioNow today. Book your first assessment and treatment here! Or contact us at 289-724-0448 or applewood@physionow.ca for more information.

Hip Pain, Physiotherapy, Surgery, Total Hip replacement, Total Hip Replacement Surgery

Physiotherapy Research: 5 Ways Hip Replacements Have Improved

If you’re awaiting a total hip replacement (THR), you probably have a lot of questions. Surgeries are nerve-wracking events, but the more you learn about a THR, the more at ease you will feel. Research and developments in the medical surgery field have made THRs easier than ever. If you’ve heard about previous surgeries you may have heard some scary things, spending long times in a bed or unable to move your leg in certain ways. Now, thanks to improved techniques and knowledge, movement and rehab start on day 1!

What happens during a THR?

The left shows a normal hip joint, the middle a hip joint with degeneration of the joint surfaces (osteoarthritis), and the right a hip after replacement

Before we dive into how the procedure has improved, let’s first go over how the surgery is performed. To summarize it, the surgery’s goal is to replace the worn out surfaces of the hip’s ball and socket joint. The surgeon will clear out some of the damaged tissues and replace it with an artificial joint and surface, usually made of specialized plastic and metal. This synthetic cartilage allows the joint to move smoothly again.

How has the surgery changed over time?

We will split this section into 5 parts to examine different aspects of the surgery itself and surgery procedures that have evolved. Each of them contributes in its own way an accelerated healing process and better health outcomes.

1. Prehab vs traditional post-op rehab

Previously, treatment didn’t start until after the surgery had already been done, as it was thought that there was nothing that could be done besides surgery.

Now, we know that physiotherapy and pre-rehabilitation are essential leading up to and actually delaying surgery. Delaying is important as hip surgeries have to be revised eventually, we will get to this more in our next point. Physiotherapy starts weeks before the surgery to build up your strength and optimize your brain and muscle connection. This has been shown to ease the recovery process and return strength faster.

2. Lifespan of a hip replacement

Previously, patients were told to save the surgery for as long as possible, as the parts would wear out in 10-15 years. This revision surgery is not as effective as the primary surgery at reducing pain and increasing function and also will not last as long, leading to more revisions. This left people needing earlier replacements, such as their 50s, waiting with a lot of pain and disability.

Now, due to improvements in material engineering there has been a huge increase in durability. The Lancet estimated that hip replacements can now last around 25 years in a majority of patients.

3. The relaxing of hip precautions

Previously, patients were given very rigid rules to follow with their hips for 6-12 weeks after surgery to reduce the chance of dislocation. These included things like don’t cross your legs, don’t lift your leg past 90 degrees, don’t turn your toe inwards, sleep with a pillow between your legs and so on.

Now, research has shown that these precautions were overly restrictive and didn’t impact the risk of dislocation at all. In fact, it had a negative effect by creating a environment of anxiety around the hip, slowing down recovery. Some restrictions may still be recommended by your surgeon and depending on the technique used. In general, the rule of thumb is to listen to your body and move naturally.

4. Same day discharge

Hip joint replacement
You may be using a cane or walker to help support the hip after the surgery.

Before, recovery times after a surgery included a couple day stay in the hospital before being allowed to walk.

Now, you are up on your feet within just a couple of hours after waking up from surgery. Total hip replacements are now considered an outpatient surgery, which means that you go home on the very same day that you had the procedure. Patients are told how to prepare their homes to make the transition easier, but resting in your own bed can’t be beat! What this also means is that Physiotherapy post-op rehab will take place outpatient now as well, and you are recommended to start ASAP.

5. Change in surgical techniques

Before, the traditional approach was to make an incision through the back of the hip. Unfortunately, this required the cutting through of some important stabilizing muscles like the glutes. This led to longer recovery times for these muscles and also the distinctive walking pattern where their hip will jut out every time they step on it, or the body leans over heavily.

Now, there are other techniques such as the anterior approach which allows the muscles to be spared. The surgeon does not have to cut through any muscles, they can just work around them. This results in a faster return to normal walking patterns, no precautions, and usually less pain as well.

Waiting for a surgery or have hip pain?

Look for PhysioNow! We have expert clinicians ready to assist you at any point during the process. Whether you are trying to prevent surgery, have a new hip pain, awaiting surgery, or are trying to schedule your post-op care, we can do it all! We have 10 clinics across the West GTA including Burlington, Oakville, Mississauga, and Etobicoke. We have free parking with accessible spots available, offer direct billing, and extended evening and Saturday hours for your convenience. Get your hip pain looked at today, book with PhysioNow today for your first assessment and treatment! Or contact us at P: 289-724-0448 or E-mail: applewood@physionow.ca for more information.