Tag Archives: physiotherapy

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.

Arthritis, Health and Wellness, Medical Imaging, Physiotherapy, Sports Physiotherapy

Physiotherapy Myths: What We Want You to Know

In a world where we have a wealth of information available at our fingertips, it can be hard to know what is real and what is just gossip. This is true for many things in Physiotherapy as well, and a lot of what we do in clinic is educating our patients on what the science actually says. Today we’ll go over 5 common things we hear from our patients, and what the truth actually is! Hopefully, you can use this information to make more informed choices about your health.

Physiotherapy Myth 1: Physiotherapy is going to be really painful

The saying “no pain, no gain” is often associated with physiotherapy. In truth, physiotherapy is a constantly evolving field and techniques have changed. A lot of manual therapy techniques are great for relieving pain, and helping you move easier within a treatment session.

Now, there may be some techniques, movements, or exercises that can be uncomfortable, but a good therapist will always let you take the lead with what you can handle.

Physiotherapy Myth 2: I need imaging and a doctor’s note before my appointment

Many of us in Ontario are familiar with the long waiting times for an MRI or specialty appointment. Physiotherapy offers an immediate solution to help you manage and maybe even resolve your pain in the meantime.

In reality, Physiotherapy is often the most helpful touch point for a lot of pains and injuries. Beyond ones that need medical assistance such as fractures, your regular strains, sprains, spasms, nerve impingements may achieve a faster resolution by heading straight to a Physiotherapy clinic.

Physiotherapists are experts at treating based on symptoms, and can often puzzle out a diagnosis based on their testing. Instead of waiting weeks for an MRI, ultrasound, x-ray or doctor’s appointment, get started with a Physiotherapy session to jumpstart your recovery. Additionally, where a medical referral and imaging may be warranted, your Physiotherapist will help make that decision and can provide the doctor with a detailed report to make the process more efficient.

Physiotherapy Myth 3: I have arthritis, there’s nothing else I can do because it’s bone on bone

As physiotherapists, our goal is to change this mindset even for the people we don’t see in Physiotherapy. In reality, imaging on an x-ray or MRI have a very low correlation with actual symptoms, or what people feel. Someone on an x-ray may actually present with moderate or severe degeneration in a joint but feel no pain or discomfort at all.

Ultimately, most conditions can be improved and surgery delayed or completely avoided with Physiotherapy. It is normal for our bodies to experience wear and tear, but the issue gets compounded when we give up on moving it and exercising it. That leads to atrophy (weakening) of the muscles, forcing the joint to bear more pressure. Instead, the solution is to strengthen and mobilize everything to maintain and even improve your quality of life again. Even if you have been living with arthritic changes for a long time, it is never too late to get started!

Physiotherapy Myth 4: My physiotherapist can “fix” me

Manual therapy is a much loved and effective treatment technique, but it can’t be the only part of the plan. We don’t want people to rely on us forever, our jobs are to help you manage the pain then show you how to keep it away for good.

In previous years, Physiotherapy was treated more as a passive service where people would lie down on a bed, and receive treatment. As we mentioned before, research has caused a shift towards a more collaborative efffort between patient and practitioner. While hands-on treatments are still a big part of Physiotherapy, they alone will not be able to make long-term changes.

For this, we need active rehabilitation. These include the exercises, the lifestyle changes, the movement you are doing outside of the clinic that works hand in hand with what our physiotherapists do inside the clinic. This allows your body to make those tissue adaptations, building strength, endurance and flexibility that will keep your body happy into the future. Your physiotherapist can give you the tools you need to succeed, but they can’t do it without your help.

Physiotherapy Myth 5: I injured myself, I just need to rest until I get better

Relative rest is needed after an acute injury, but too long and the injury will not heal properly and can turn into a chronic issue. In fact, after a lot of surgeries the hospital starts Physiotherapy sessions as soon as possible. Of course, what Physiotherapy looks like will be different depending on which stage of healing your’re in.

Earlier on, we still follow the rules of RICE (rest, ice, compression, elevate) but we want to continue gentle range of motion and even muscle activation exercises. Afterwards, as soon as we are able to, we start building up capacity in the tissues by stretching and exercising them. We always respect pain and ensure we don’t over do it during each stage, but some discomfort is expected. If you don’t follow a progressive rehabilitation process, you may end up losing mobility, strength and set yourself up for a future injury.

Have another question about a topic not listed?

Look for PhysioNow! We have many expert clinicians ready to assist you and ease your worries. If you have an injury and are not sure how to proceed, a Physiotherapist can help you out! We have 10 locations across the west GTA including Burlington, Oakville, Mississauga, and Etobicoke. Book with PhysioNow today for your first assessment and treatment!

Back Pain, Low back Pain, Neurological, Physiotherapy, Sciatica

Disc Bulges, Herniations, Slipped Discs and More

Getting help from your back pain can feel very scary. Namely, words like x-rays, MRIs, surgery, disc bulges degeneration, and nerve impingement are extremely common when going to the doctor. It’s easy to get the wrong idea and feel like your issue can’t be solved, or is permanent. In Physiotherapy, we see people with imaging everyday, who have no clue what any of it means. In fact, it often makes them feel worse, and more scared to move. Today we want to clear up the misconceptions with disc bulges and what a realistic treatment program actually looks like.

What is a disc bulge/herniation?

What is a Herniated Disc?

Let’s start from the beginning, what actually is a bulge? In between each of our vertebrae from the neck all the way down to the lower back, there are squishy discs that act as shock absorbers. They have a thick outer lining and a soft inner center that lets them perform shock absorption while remaining flexible. A herniation or bulge is when the inner center gets displaced and puts pressure on the outer ring, changing the shape of the disc overall. There are different classifications based on how exactly the material has moved but in general, it is enough to know that it is just a displacement, the discs do not actually slip out. They are firmly attached the whole time still to the bones.

What can I do or not do with a disc bulge?

In reality, the biggest barrier to a disc bulge is fear. There are actually many people who have current disc bulges, but feel no symptoms at all. In other words, if we took random people off the street and MRI’d their backs, we would find a proportion of them with all kinds of “positive” imaging, but feel no pain or symptoms at all. Ultimately, this means that imaging has a very poor correlation with how people actually feel, so we have to be mindful of how much we rely on imaging.

Common myths include:

  1. My MRI shows a bulge, I’m permanently damaged
    • In reality many people are moving around, even playing sports, with disc bulges whether they know it or not. They become more likely to happen as we age, with normal wear and tear, but have no bearing on how we move.
  2. I can’t move until my back heals
    • Prolonged rest is the complete opposite of how we treat people. Gentle, progressive movement with an initial focus on pain management, then strengthening is the gold standard for treatment. A Physiotherapist is your guide to how to navigate your back pain safely, and what to expect during this.
  3. I can’t lift heavy things anymore
    • With proper treatment and Physiotherapy rehabilitation, many people return to any kind of high impact and intensity activities that you can think of. If you treat it like any other body part, a tear or injury is not the end, people recover from injuries all the time.

What are the signs and symptoms of a disc bulge?

Disc bulges can happen acutely, or develop over time. As some people can have a bulge with no pain, the severity and set of symptoms someone can experience vary greatly. The most common things are:

  • Back pain that might radiate down the leg: Most people will have pain in the back, but may actually feel a referred pain anywhere down the arm or the leg, potentially right to the fingertips or toes
  • Nerve pain: Sharp, electric, burning, stabbing paints that shoot down the arm or leg
  • Sensory changes: Tingling and numbness down the arm or leg
  • Muscle weakness: Fatigue or heaviness in a certain movement or limb
  • Pain with increased abdominal pressure: Often coughing, sneezing, or when bracing the core

Do I need surgery or physiotherapy?

Manual therapy is one of the potential treatment techniques used by physiotherapists to manage lower back pain

Surgery is the last resort for most individuals except in certain rare occasions. Most individuals are started on a conservative management program with Physiotherapy and recover well through that. We’ll start with how physiotherapy manages pain, and when that fails or in those special cases, where surgery plays a role. It is worth noting that the vast majority of individuals with back pain from disc bulges do NOT require surgery and recovery completely without it.

How does physio help?

  • Education: One of the most important things is understanding the do’s and dont’s, expected response to treatment, and addressing excessive fears and. Understanding how much you can do and what you can do to allow the disc to heal while optimizing your own movement
  • Pain management: Your physiotherapist can perform manual therapy techniques, stretches, mobilizations, and use modalities like electrotherapy to help you minimize pain
  • Load management: When deemed appropriate, your physiotherapist will help you return to lifting and daily tasks safely, then eventually physical activity and sports
  • Home exercise programs: This includes specialized exercises to reduce back pain, core strengthening, general full body strengthening, stretches and more

Who gets surgery?

Like previously stated, the vast majority of disc herniations even if they’re serious, can be resolved with 6-12 weeks of Physiotherapy. The individuals who would be considered for surgery are:

  • Cauda Equina syndrome: This is a medical emergency resulting in compression of the nerves at the end of the spinal cord. It presents as a loss of bowel/bladder control, saddle anesthesia (numbness in the area that would touch the saddle), significant leg weakness/pain that is progressing
  • Progressive neurological symptoms: This means that nerve damage is occurring, resulting in increasing muscle weakness
  • Life-limiting pain: If the pain is so severe that basic quality of life is affected after an attempt with conservative care has failed

Looking for more information on low back pain or disc bulges?

Then look for PhysioNow! Disc bulges are common occurences that are reversible, not permanent disabilities. With help from Physiotherapy you can return to your normal life. 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! Contact us at P: 289-724-0448 or Email: applewood@physionow.ca. We’d love to hear from you and answer all your questions.

Arthritis, Back Pain, Chronic Pain, Knee Pain, neck pain, Physiotherapy

Joint Pain and Weather: What’s the Connection?

Is joint pain connected to the weather? Many people are surprised when their knees ache before it rains, or when their back feels tight on cold mornings. At PhysioNow, we hear these concerns every single week, especially during seasonal transitions in Canada. Us Canadians know just how our weather can swing back and forth. While some people assume it’s “just age” or “just arthritis,” the truth is more complex: Weather changes can genuinely influence your joints, muscles, and nervous system. Importantly, this does not mean your joints are damaged. Rather, it means your body is reacting to subtle environmental changes, something completely normal and highly treatable with physiotherapy.

How does weather affect muscle and joint pain?

Your body is constantly adapting to changes around it. Namely, temperature, pressure, humidity, and even sunlight. Naturally, when these factors shift suddenly, your tissues response does too. This can lead to temporary stiffness, increased sensitivity, or a flare-up of older injuries. Arthritis.org has a great article on the best climates for arthritic joints.

1. Barometric pressure

Before rain or storms this pressure drops, causing the tissues around your joints to expand slightly. Even tiny changes in pressure can irritate inflamed or old injuries. This may result in:

  • Achy, throbbing pain
  • Increased stiffness
  • Sensitivity in arthritic joints
  • Old injuries feeling “reactivated”

2. Colder temperatures

Aditionally, cold temperatures also plays a role by decreasing blood flow, so muscles naturally contract to preserve heat. Tendons and ligaments become less flexible, making movements feel stiff or uncomfortable. As an example, you may feel:

  • Tight lower back
  • Stiff neck and shoulders
  • Knee and hip pain
  • Increased stiffness and less flexibility in joints and muscles
  • Susceptibility to injuries when exercising “cold”

3. Humidity/dampness

Humidity and damp weather can further aggravate the soft tissues, especially in individuals with chronic inflammation or scar tissue from past injuries. These tissues absorb moisture from the air, which can make them swell or feel heavy. This may lead to:

  • Heaviness or swelling in the joints
  • Increased dull aching
  • Reduced mobility
  • Pain in hands, knees, and spine

4. Rapid changes in temperature

Lastly, rapid weather changes can influence your nervous system. A sensitive nervous system may interpret small environmental changes as pain or discomfort, especially if you already live with chronic pain, fatigue, or stress. Some of the symptoms may include:

  • Pain flare-ups
  • Muscle tension
  • Fatigue
  • Restless sleep
  • Feeling more “inflamed” or sore than usual

Who is more likely to get joint pain from weather changes?

Arthritic joints are more likely to be sensitive to changes in the weather, especially if they are experiencing a flare up.

Not everyone reacts the same way to weather. Fortunately, some patients barely notice changes, while others feel it intensely. A lot of factors go into it, such as your joint condition, lifestyle, muscle strength, inflammation levels, and nervous system sensitivity. You’re more likely to feel weather-related pain if you have:

  • Osteoarthritis (knees, hips, hands, spine)
  • Previous fracture
  • Chronic pain (greater than 3 months)
  • Sedentary lifestyle (more stiffness)
  • Comorbid conditions such as fibromyalgia
  • Older sports injuries (strains, sprains etc)
  • Sleep issues or high stress

Your body is simply giving you signals, not warning signs of damage, but reminders that your joints need more support, movement, and strength. This is where some guided rehabilitation with a professional can help you recover.

What can physiotherapy do for my joint pain?

Physiotherapy is one of the most effective ways to manage and prevent weather-related joint pain. At PhysioNow, our therapists take a full-body approach: improving joint mobility, strengthening muscles, calming the nervous system, and teaching you how to manage flare-ups independently. Here are the main ways physiotherapy helps:

1. Joint mobilizations and soft tissue work

Gentle hands-on techniques restore smooth joint movements and can address muscle tension. This can lead to:

    • Less pressure inside joints
    • Improved lubrication
    • Reduced pain and tightness
    • Better range of motion

    2. Strengthening

    Strong muscles lead to healthy joints. Regular strength training has a whole host of benefits not only for reducing current pain but preventing future issues as well.

    3. Nervous system calming techniques

    As we discussed, weather affects the nervous system as much as the joints. Physiotherapists may include

      • Diaphragmatic breathing
      • Breath work coordinated with exercises
      • Mindfulness techniques
      • Education on pain control strategies
      • Massage techniques

      4. Posture and movement correction

      Poor posture or movement patterns puts extra stress on joints, making them more susceptible to weather-based changes. Your physiotherapist will observe and correct:

        • Sitting/desk work posture
        • Walking mechanics
        • Standing alignment
        • Sleeping positions
        • Lifting technique
        • Sports specific movements

        5. Personalized flare-up management plan

        Every patient receives an individualized plan for weather-sensitive days. It will address your specific concerns, circumstances, and goals. This may include your exercise routine, lifestyle advice, and other joint protection strategies.

        When should I seek help?

        You should book an assessment if:

        • Weather changes trigger your pain
        • Your joints feel stiff most mornings
        • You avoid activity on cold days
        • Pain affects sleep or your mood
        • You rely on painkillers frequently
        • Old injuries flare up every season

        Pain is not something you have to “just live with.” Fortunately, there is help. Look for PhysioNow in one of our 10 locations across the west GTA to get started with your recovery! We provide quality Physiotherapy services for Burlington, Oakville, Mississauga and Etobicoke. Whether it is a fracture, neck pain, back pain, and old sports injury, or you have no idea where the issue came from, we can help! Book with PhysioNow today for your first assessment and treatment!

        ACL REHAB, ACL Rehabilitation, ACL Tear, Knee Pain, Physiotherapy, Sports Injuries, Sports Physiotherapy

        Lindsey Vonn: Resilience and Rehabilitation

        The Winter and Summer Olympics are awaited eagerly by both viewers and athletes across the world. We get to witness amazing feats of athleticism and elite performance across all kinds of sports! For a competing athlete, the Olympics can be everything to them. It’s the ultimate goal, allowing them to push through pain, injuries and intense stress, all for the chance to prove themselves on the world stage. For one incredible Team USA athlete, their leadup into the Olympics was one of resilience and determination. This is the story of Lindsey Vonn.

        What is Lindsey Vonn’s story?

        Lindsey Vonn is one of the most decorated alpine skiiers in history, winning over 84 World Cup titles across different disciplines of alpine skiing. She has consistently been competing (and competing successfully!) at the highest level despite numerous and severe injuries including fractures and ligament tears. She made a decision to retire in 2018, citing her history of injuries. However, she decided to return to competitive skiing in 2024 after receiving a knee replacement surgery. She became the oldest downhill skiing World Cup winner in 2024, at the age of 41. This brings us close to the present day, the 2026 Winter Olympics.

        At the World Cup in Jan 2026, she crashed and had to be airlifted off the mountain. Later, it was revealed that she had ruptured her left knee’s ACL. Despite this, she communicated her intent to still compete in the Olympics 1 week later. Unfortunately, at the Olympics, she had another crash where she had to be airlifted off the mountain. Afterwards, she stated that she had suffered a complex tibia fracture requiring several rounds of surgery.

        How did Lindsey Vonn manage to compete with her injuries?

        A case like Lindsey Vonn’s is instrumental to showing the importance of sports rehabilitation. Throughout her career, she sustained multiple serious knee injuries, including anterior cruciate ligament (ACL) tears, medial collateral ligament (MCL) injuries, tibial plateau fractures, and meniscal damage. She underwent several reconstructive surgeries, particularly on her right knee.

        High-level alpine skiing places extreme forces on the knee joint. For example, cutting, rapid deceleration, torsional loads, and high-speed turns require not only strength, but joint stability and proprioception. Returning to competition after ligament reconstruction demands months of structured rehabilitation, often 9-12 months or longer. Her career illustrates that prior injury does not automatically end athletic performance, but it does require lots of dedication to a rehabilitative program.

        How did Lindsey Vonn’s pre-existing injuries affect her?

        Previous injuries pre-dispose athletes to further injuries, due to changes that happen through out the body. For Lyndsey Vonn, the rupture in her ACL tendon definitely affected the strength and stability around her knee. Some of these changes include:

        1. Strength asymmetries

        Muscles around the injury tend to get weaker. For example, quadriceps inhibition and hamstring weakness are common long-term consequences of knee injury. Even subtle asymmetries can affect force generation during high intensity sports and movements.

        2. Proprioception and neuromuscular control

        Tissue injury disrupts mechanoreceptors responsible for the sense of proprioception, or joint position awareness. This awareness gives your joints stability which is especially important during movements like pivoting and cutting.

        3. Load tolerance

        Cartilage and meniscus damage can reduce shock absorption capacity. Sufficient strength and coordination of muscles must be retrained to compensate

        4. Psychological readiness

        Fear of reinjury (kinesiophobia) is a well known barrier to return to sport, whether you’re a competitive or recreational athlete. Confidence in your body and its ability to resist injury is necessary to achieve your full potential.

        In Vonn’s case, repeated returns to elite skiing required not just healing, but continuous adaptation. Competing with a history of knee reconstruction often means meticulous strength programming, external bracing support, and careful monitoring of training volume.

        What does this mean for a recreational athlete?

        Even if you’re not at an elite level for sports, you should still rehabilitate each of your sports injuries. Not only will it reduce your risk for future injury, but it can help you achieve new levels of performance. Many recreational players experience similar injury patterns. For example, ACL tears, meniscal injuries, ankle sprains, rotator cuff tears, and stress fractures are common across many sports including soccer, basketball, skiing, running, and CrossFit.

        A common misconception is that once pain decreases, the injury has resolved. In reality, pain reduction often precedes full tissue healing and neuromuscular recovery. Returning to sport too early without restoring the necessary strength and control, can create a cycle of recurrent injury.

        If you have a pre-existing sports injury, consider:

        • Are both sides equally strong?
        • Can you perform single-leg movements with control?
        • Can you perform all the necessary movements of your sport?
        • Do you have the endurance to play a full game/session of your sport?
        • Do you have the same jumping/hitting power as before the injury?
        • Are you following a structured strengthening program?

        Sports physiotherapy addresses these gaps systematically.

        Need help with a sports injury?

        Then look for PhysioNow! Lindsey Vonn’s career is proof that sports injuries do not have to be the end. If you have suffered a recent or even a long time injury that’s affecting or stopping you from playing or participating, there is help. Our expert physiotherapists are avialable at 10 locations across the west GTA from Burlington, Oakville, Mississauga, Etobicoke, and offer Physiotherapy, Massage Therapy, Manual Osteopathy and more! Book with PhysioNow today for your first assessment and treatment!

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

        Physio 101: Centralization vs Peripheralization

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

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

        What is centralization?

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

        Examples of centralization include:

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

        Centralization is generally considered a positive sign in physiotherapy.

        What is peripheralization?

        Peripheralization is the opposite phenomenon. It occurs when pain:

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

        For example:

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

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

        Why do centralization and peripheralization occur?

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

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

        Possible contributors include:

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

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

        Why is centralization important for physiotherapy?

        A condition that displays centralization is commonly associated with:

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

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

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

        What does peripheralization mean for treatment?

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

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

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

        A summary of centralization vs peripheralization

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

        Physiotherapists assess symptom responses during:

        • Repeated movements
        • Postural changes
        • Functional tasks

        This helps identify patterns of centralization vs peripherilization:

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

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

        Looking for physiotherapy treatment?

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

        Health and Wellness, Medical Imaging, Physiotherapy

        Medical Imaging: Things Your Physiotherapist Wants You to Know

        Medical imaging is something many of us are familiar with in Canada. Whether you’ve had an x-ray, ultrasound, MRI, or CT, you may have had to undergo one or the other at some point in time. For many people, they think of it as the gold standard for understanding their pain or injury. In fact, i’s completely natural to want answers, but here’s something us physiotherapists wish more people knew:

        Medical image findings are poorly connected to pain, and you don’t need imaging to start recovering with physiotherapy treatment!

        What is the connection between medical imaging and pain?

        One of the most important things we can teach our patients to relieve lots of fear and anxiety is the fact that medical imaging results have a very poor correlation with people’s symptoms. Now what does this mean? Research studies have consistently shown that individuals that have no pain and have imaging done still have “abnormalities” such as:

        • Disc bulges/herniations
        • Degenerative disc disease
        • Varying levels of arthritis
        • Tendon tears
        • Mensical tears

        On the other side of this, people with pain and other symptoms may have imaging that comes back normal or inconclusive! Importantly, this does not mean that what you are feeling isn’t real, but that pain has many different sources that all interact to form the big picture. Overall, the main takeaway is to not overly rely on medical imaging, what’s more important is to listen to what your body is telling you.

        When is medical imaging useful or not useful?

        The American Academy of Family Physicians (AAFP) has published a recommendation of “Don’t do imaging for lower back pain in the first 6 weeks (unless red flags are present)”. They found no connection of imaging with better recovery, only an increase in health care costs.

        Now there is definitely a time and a place for medical imaging. It is a useful diagnostic tool and when used appropriately, provides a lot of information and guide our prognosis. For example, x-rays to confirm fractures after a fall. What we are trying to avoid is sending every patient with lower back pain for an x-ray or MRI that will likely have low diagnostic value, and has a much higher chance of getting better by starting physiotherapy treatment. Additionally, these excessive referrals can strain the health care system’s limited resources, resulting in those who actually would benefit from imaging having to wait for longer periods of time.

        Another time where we recommend medical imaging is during a course of physiotherapy treatment where we start to detect red flags (indicators of more severe medical conditions), or when the condition is not responding as expected. Here, the physiotherapist and members of the medical team can work collaboratively to determine the likely issue, and can expedite imaging or referrals to a specialist when warranted.

        How does physiotherapy treat without imaging?

        Remember that imaging is just one piece of the puzzle. There are many other clues that your physiotherapist can use to piece it together including:

        • Range of motion
        • Muscular strength
        • Quality of your movements
        • Coordination and balance
        • Special tests designed to assess specific conditions
        • Which movements or positions are hard to you

        With most conditions, there are a pattern of subjective and objective symptoms that your physiotherapist will be able to identify and match to the most likely conditions.

        Medical imaging wait times: The reality

        MRI waiting times are usually several months.

        Unfortunately, the reality of wait times for tests, for referrals, for surgeries, can be anywhere from days, to weeks, to months, to a year plus. At the higher end, this can leave people stranded in the system awaiting help, having to manage their pain and disability for months at a time. During this time, the condition may worsen, people become scared of moving, and this may delay recover times. This is why we recommend that people start physiotherapy as soon as possible, even while awaiting imaging. Many times, people will start to improve, and some completely, before the day of their test.

        As trained professionals, physiotherapists will be able to personalize the plan to your unique circumstances to ensure safety, comfort, and effectiveness of the treatment. Of course, there are some cases where medical imaging may still be required, but before that point you can still improve your strength, mobility, pain and function.

        Awareness is the key

        Our goal is to raise awareness about the trap of medical imaging. Words like degeneration, tear, and bulge, are very scary to read on a report and leave patients feeling disempowered and discouraged. The great news is that for most people, those words can be disregarded and improvement can still be found, you might just need a little help getting there!

        If you are waiting for medical imaging, confused by previous results, or looking for treatment for your pain, then look for PhysioNow! With a team of expert health professionals including Physiotherapists, Registered Massage Therapists, and Manual Osteopaths, you are in good hands. We have 10 locations across the west GTA including Burlington, Oakville, Mississauga, and Etobicoke. Please feel free to reach us by Phone: 289-724-0448 Email: applewood@physionow.ca. Book with PhysioNow today for your first assesssment and treatment!