Tag Archives: physiotherapy

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!

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

        Physiotherapy After a Motor Vehicle Accident (MVA)

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

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

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

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

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

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

        How does physiotherapy treat MVAs?

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

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

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

        How does PhysioNow help with auto insurance claims?

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

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

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

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

        Why is early physiotherapy so important?

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

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

        Start your MVA recovery with PhysioNow

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

        Acute Ankle Sprains, Ankle pain, Physiotherapy, Sports Injuries, Sports Physiotherapy

        Ankle Mobility Matters: A Hidden Reason Behind Back, Hip and Knee Pain

        Ankle mobility, or rather the lack of it, is often overlooked. Many people assume ankle problems only matter if they’ve had a sprain or fracture. In reality, limited ankle mobility can affect your entire body, from your knees and hips to your lower back. At physiotherapy clinics, it is very common to see patients with knee pain, hip pain, or back pain where the root cause is actually poor ankle movement. Understanding ankle mobility and how it ties into the whole body can help you proactively prevent pain and reduce your injury risk.

        What is ankle mobility?

        Ankle mobility refers to how well your ankle joint moves. Normally, the ankle joint moves into dorsiflexion (bringing the foot closer to the ankle), plantarflexion (pointing the foot away from the ankle), inversion (sole of the foot towards the middle), eversion (sole of the foot away from the middle), and a combination of these movements. There are relative “normals” for each movement recorded in degrees, but ultimately, there are lots of individual variations of normal. Usually, we talk about restricted ankle mobility in something being different for that specific person, such as between their left and right sides. Healthy ankle mobility is essential for:

        • Walking
        • Running
        • Squatting
        • Going up and down stairs
        • Maintaining balance
        • Absorbing shock during movement

        Why is ankle mobility so important?

        In our daily movements, ankle mobility is key. As seen above, a deep squat requires a lot of dorsiflexion mobility.

        To sum it up, when ankle motion is restricted, your body is forced to compensate elsewhere. For example, the ankle is one of the first joints that contacts the ground while moving around. If it does not have the mobility to perform its job as a shock absorber properly, them the joints above it must work harder. As a result, they will experience a greater proportion of stress. For another example, somebody without sufficient dorsiflexion in their ankle has a very hard time going down stairs. Instead, a lot of pressure goes into the knee as it has to bend much more to compensate for the ankle. Try it yourself at home! Can you go down the stairs without bending your ankle? Instead, you might find this happening when ankle mobility is limited:

        • The knee collapses inward or twists
        • The hip rotates excessively
        • The lower back moves more than it should
        • Balance becomes less stable
        • Muscles fatigue faster

        Over time, these compensations increase stress on other joints and tissues, leading to pain and injury.

        Common causes of ankle restrictions

        Following the use it or lose it principle, immobilization is one of the biggest causes of ankle restrictions. After getting it off, it is essential to start moving immediately to regain range of motion.

        Ankle stiffness can develop for many reasons, even without recent injury. For example, many people don’t realize their ankle never fully recovered after an old sprain. It might have recovered 90% of the way so that they don’t notice it day to day, but over the course of years the effects from that can build. Common causes include:

        • Previous ankle sprains (even years ago)
        • Immobilization in a boot or cast
        • Tight calf muscles
        • Muscle contractures
        • Scar tissue
        • Prolonged sitting
        • Wearing unsupportive footwear
        • Reduced activity levels
        • Arthritis
        • Poor movement habits

        Signs that you may have limited ankle mobility

        You may have ankle mobility issues if you notice:

        • Heels lifting off the ground during squats
        • Knee pain doing stairs or lunges
        • Feeling stiff in the ankles, especially in the morning
        • Poor balance on one leg
        • Recurrent ankle sprains
        • Feel like you have “tight calves” despite stretching a lot
        • Pain during walking or running
        • Feeling unstable on uneven surfaces
        • Back or hip pain with no clear cause or changes in range of motion

        How do I improve my ankle mobility?

        Physiotherapist helping their patient regain dorsiflexion range of motion

        Physiotherapy is a great way to learn your areas of weakness or vulnerabilities and get help addressing them. Specifically for the ankle, you can focus on restoring ankle mobility and correcting compensation throughout the body. At PhysioNow, treatment typically includes:

        1. Comprehensive assessment: Your physiotherapist assesses range of motion, muscle length and tension, biomechanics, gait patterns, balance and coordination, muscular strength and more. This helps identify the extent of your ankle stiffness and how its affecting the rest of your body.
        2. Manual therapy: Hands on techniques can reduce stiffness, improve flexibility, break down scar tissue, reduce pain, and more. The specific techniques used will be decided based on the results of the assessment
        3. Home exercise plan: Targeted exercises focusing on your areas of need and goals will be given. These may includes stretching, mobility, functional, strength, balance, speed, coordination, power exercises and more! Your physiotherapist will work with you personally to decide.
        4. Movement retraining: If you have been compensating for a long time, you will have to unlearn your old compensatory habits. For example, you may have to readjust to proper mechanics for squatting, walking, running, sports movements and more.

        Looking for help with an ankle?

        Look for PhysioNow! We can help with sports injuries, ankle, back, knee, hip pain, and so much more. We have 10 beautiful locations across the west GTA including Burlington, Oakville, Mississauga, and Etobicoke. Our experienced clinicians can answer any questions you have and get you back to feeling and doing great. Find us at P: 289-724-0448 or E-mail: applewood@physionow.ca. Book with PhysioNow today for your first assessment and treatment!

        Back Pain, Headaches: Neck Pain, Health and Wellness, Low back Pain, mindfulness, neck pain, Physiotherapy, Sleep

        Physiotherapy for Better Sleep: Treatment to Help You Rest

        Better sleep, a goal that many of strive for day after day. Unfortunately, the struggle to get a good night’s sleep may be known to many of us. Tossing and turning, waking up with a stiff neck or sore back, or feeling exhausted even after a full night in bed, sound familiar? At PhysioNow, we often see patients who come for back pain or neck pain, but once we treat the underlying physical tension, they start sleeping better too. Ultimately, that’s because your body and sleep quality are closely linked. Physiotherapy helps your body relax, realign, and recover, so you can fall asleep easily and wake up feeling truly rested. 

        Why does sleep matter?

        We all know sleep is important, but are you aware of what actually goes on in your body when you’re catching z’s? Good sleep is when your body performs its most powerful repair work. To name a few, your muscles rebuild and recover from daily stress or exercise, tissues and joints heal from inflammation or injury, the nervous system calms down and resets and even more!

        When your sleep is disturbed, this natural recovery process is interrupted. Over time, you may notice:

        • Morning stiffness
        • Fatigue
        • Slower healing
        • Reduced focus
        • Reduced mental function

        If your pain or posture issues are keeping you awake, it’s a sign your body isn’t getting the deep rest it needs. This can lead to a chain effect of other negative symptoms in the body. Overall, we all know how it feels to be sleep deprived and not feel great, so lets see how we can fix it!

        How does physiotherapy give you better sleep?

        Improving sleep quality can be the main focus or even a side effect of physiotherapy treatment. Many of the treatment techniques used will either directly or indirectly affect your sleep. We may not think about it often, but there is certainly a science behind sleep! Here are different ways that physiotherapy can affect give you better sleep:

        1. Easing pain and tension that disrupt sleep

        For example, many people struggle with a difficult time falling asleep or waking up due to discomfort in the night and being able to go back to sleep. Physiotherapists use techniques such as manual therapy, gentle joint mobilizations, soft tissue release, and modalities to reduce discomfort. Once your pain decreases, your body automatically relaxes, making it easier to fall asleep and stay asleep through the night. 

        2. Correcting postures and sleep positions

        Your posture during the day affects your comfort at night. As a result, your physiotherapists will assess your spinal alignment, pillow height, and mattress type. We can guide you on ideal sleeping postures to fit your individual circumstances. Some of these tips may include tips like side sleeping with a pillow between your knees or back sleeping with one under your knees to reduce strain. 

        3. Managing stress and nervous system overload

        Physiotherapy helps regulate your nervous system through mindfulness breathing exercises, gentle stretches, and relaxation. Deep breathing activates your body’s “rest and digest” mode, lowering heart rate and easing muscle tension. There is also evidence for the healing power of touch, and the benefits of massage on easing stress.

        4. Improving mobility and reducing restless nights

        When joints or muscles are stiff, your body keeps adjusting during the night. A personalized mobility and strengthening program can help you move freely and rest comfortably. 

        5. Supporting recovery from injury or surgery

        After injury or surgery, pain and immobility often lead to poor sleep. Physiotherapy assists recovery, restores function, and reduces the need for pain medication that can disrupt deep sleep.

        Easy physiotherapy tips for a better night’s sleep

        • Stretch before bed: Get your body into a relaxing routine by stretching gently for 5–10 minutes.
        • Breathe deeply: Try slow belly breathing before bed. You may combine this with the stretches or when lying down to calm the mind
        • Adjust your pillow: Make sure your pillow is supportive. It should keep your spine in a neutral position when lying on it
        • Stay active during the day: Movement improves circulation and exercise is know to improve sleep quality
        • Watch screen time: Blue light delays sleep hormones
        • Address discomfort early: Don’t wait until pain becomes chronic

        Looking for help with better sleep?

        Look for PhysioNow! At PhysioNow, our experienced physiotherapists focus on your complete well-being, not just symptom relief. We take time to understand how your posture, work habits, and daily activities affect your body and sleep. With this information, we can make you a personalized plan to address your concerns.

        We offer personalized one-on-one care, education on posture, sleep ergonomics, and relaxation,e exercise plans for flexibility and strength, breathing and mindfulness guidance and more. Come find us at 1 of our 10 locations across the west GTA, including Burlington, Oakville, Mississauga and Etobicoke. Book with PhysioNow today for your first assessment and treatment!

        P: 289-724-0448 E-mail: applewood@physionow.ca

        acupuncture, Neurological, Physiotherapy

        Bell’s Palsy: Causes, Symptoms, and How Physiotherapy Helps

        What Is Bell’s Palsy?

        Bell’s palsy is the most common form of facial paralysis worldwide. While the sudden onset of facial weakness can be alarming, the condition is usually temporary and, with appropriate care, highly treatable. Bell’s palsy is an acute, often temporary paralysis of the facial nerve, also known as the 7th cranial nerve. This nerve controls the muscles responsible for facial expression, including smiling, blinking, and closing the eyes.

        When the facial nerve becomes inflamed or compressed, it can result in:

        • Pain or discomfort on one side of the face
        • Sudden facial weakness or paralysis
        • Difficulty performing everyday facial movements

        Bell’s palsy can affect people of all ages, although it is uncommon in children under 15 and adults over 60. While Bell’s palsy is not considered permanent, a small number of people may experience lingering symptoms. For most individuals, recovery begins within 2 weeks to 6 months.

        What causes Bell’s Palsy?

        The exact cause of Bell’s palsy is not fully understood. However, strong evidence suggests it is related to viral reactivation, leading to inflammation within the narrow bony canal through which the facial nerve travels.

        Possible viral triggers

        • Herpes simplex virus (HSV-1)
        • Varicella-zoster virus (shingles)
        • Epstein–Barr virus
        • Influenza viruses

        This viral reactivation causes swelling that disrupts the nerve’s ability to function normally.

        Possible other risk factors

        You may be at higher risk of developing Bell’s palsy if you have:

        • Diabetes
        • Pregnancy (particularly in the third trimester or postpartum period)
        • A recent viral illness
        • Autoimmune conditions
        • High stress levels
        • Hypertension
        • A family history of Bell’s palsy
        • Guillain-Barré syndrome

        What are the signs and symptoms?

        Symptoms typically appear suddenly, often overnight, and on one side of the face.

        Facial muscle symptoms

        • Drooping on one side of the face
        • Inability to fully close the eye
        • Difficulty smiling or raising the eyebrow
        • Drooling
        • Impaired blinking

        Sensory symptoms

        • A feeling of numbness or altered facial sensation
        • Pain behind the ear or along the jaw

        Other symptoms

        • Increased sensitivity to sound
        • Reduced tear or saliva production
        • Excessive tearing or dry eye
        • Altered taste on the front portion of the tongue

        How is Bell’s Palsy diagnosed?

        Bell’s palsy is usually diagnosed through a clinical examination and medical history. Since some of the other causes of facial paralysis are quite serious, it is important that you see a doctor immediately. Your healthcare provider will first rule out other causes of facial paralysis, such as:

        • Stroke
        • Lyme disease
        • Ramsay Hunt syndrome
        • Tumours

        Additional testing may be required if symptoms are atypical or slow to improve, including:

        • MRI or CT scans
        • Blood tests if infection is suspected

        What can you expect?

        Most people experience significant improvement within three weeks, with approximately 70–85% making a full recovery within 3–6 months.

        Factors that may indicate a slower recovery include:

        • Complete paralysis with no early movement
        • Diabetes
        • Older age
        • Painful onset
        • Delayed initial improvement

        What is the role of physiotherapy in Bell’s Palsy treatment?

        Physiotherapy plays an important role in recovery, particularly if facial weakness persists beyond the initial weeks.

        Physiotherapy can help to:

        • Improve facial symmetry
        • Restore coordinated facial movement
        • Reduce compensatory habits
        • Prevent long-term complications such as synkinesis (involuntary movements, e.g., the eye closing when smiling)
        • Improve confidence and overall facial function

        When should physiotherapy start?

        Physiotherapy may be recommended:

        • Immediately: For education, eye protection, and gentle guidance
        • Within 2–3 weeks: If facial weakness continues or recovery is delayed

        Early education is essential to avoid habits that may interfere with optimal recovery.

        What physiotherapy treatment techniques are used for Bell’s Palsy recovery?

        Facial neuromuscular retraining (NMR)

        This is the most evidence-supported physiotherapy approach for Bell’s palsy.

        It focuses on:

        • Correct activation of facial muscles
        • Small, precise, and controlled movements
        • Avoiding overuse or forceful exercises
        • Re-learning coordinated facial patterns (e.g., smiling without eye involvement)

        Guided facial exercises

        Exercises are tailored to your stage of recovery and may include:

        • Eyebrow raises
        • Forehead wrinkling
        • Gentle closed-lip smiles
        • Nose scrunching
        • Controlled blinking

        These exercises are typically performed slowly using mirror feedback to ensure correct movement. The Facial Palsy Org UK has a great resource with pictures and videos demonstrating some of these techniques.

        Massage, soft tissue therapy, and needling

        Picture demonstrating type of needle that may be used in acupuncture on the face
        Very fine needles are used in acupuncture around the face

        Manual techniques and acupuncture may be used to:

        • Reduce muscle tightness or overactivity
        • Improve circulation
        • Prepare muscles for retraining
        • Reduce facial discomfort

        Mirror therapy

        Using a mirror helps improve awareness, movement control, and reduces unwanted compensatory patterns.

        Eye protection strategies

        If the eye cannot close fully, physiotherapists may recommend:

        • Blink-training exercises
        • Lubricating eye drops
        • Taping the eye closed at night
        • Techniques to prevent dryness and irritation

        Looking for more help?

        Look for PhysioNow! We have expertly trained clinicians across the west GTA ready to help! Look for us at 1 of our 10 locations including Burlington, Oakville, Mississauga and Etobicoke for Bell’s Palsy Treatment. Feel free to contact us by Phone at 289-724-0448 or by Email at applewood@physionow.ca for any inquiries or booking requests. Book with PhysioNow today to receive your first assessment and treatment!