Tag Archives: physiotherapy

Exercise, Health and Wellness, Physiotherapy, Vestibular Rehabilitation

Balance is for Everyone: How to Prevent Falls at Any Age

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When we hear the word “falls,” we often connect it with an older generation.  While it is true that with increasing age the risk of falls also rises, it is a risk that can affect a person from any age group. Starting from childhood to young adulthood, from an athletic to or weekend warrior population. 

At our clinic, we consider balance training an integral part of every treatment, whether it is geared towards performance improvement, prevention, or rehabilitation. No matter which age or activity level group you belong to, good balance is important to injury prevention, stability, and confidence in how you move. 

Why should I care about balance?

Your ability to maintain control while you are still or while you are in motion is called balance. There are two types of it:

  1. Static Balance 
  2. Dynamic Balance 
An example of a more advanced static, or held, balance position.

Static balance refers to times when your body is still, and trying to maintain a position. Common examples include yoga poses, standing on one leg, standing with your eyes closed and more.

Dynamic balance includes when your body is moving or being acted on by an external force. For example, you’re using dynamic balance when you’re walking, playing a sport, or riding a bus. They can range from easier tasks like walking on flat ground, to more difficult such as single leg squats on a bosu ball. A well-trained dynamic balance system is especially important during for preventing injuries during sports and daily life.

Which systems are in charge of balance?

There are many systems which gets involved and work closely together while maintaining balance. These include the following structures/systems:

  • Connection between your muscles and joints
  • Eyes (visual input)
  • Inner ear (vestibular system)
  • Nervous system (communicating with other parts of your body, processing all the sensory information, and proprioception, or your body’s ability to sense where it is in space)

Unfortunately, if there is any disturbance with one or more of them it can severely affect your balance. For example injuries to your joints, a traumatic brain injury such as a concussion, an ear infection, or other vestibular disorders can all affect your balance.

Who’s at risk (besides seniors)?

Concussions are serious injuries that affect many different system within the body. Very commonly, the visual and vestibular symptoms experience disruption post-concussion.

Although anyone can experience balance problems, you may be more vulnerable if you:

  • Recently had a sprain or surgery, especially in the lower limb
  • Have or have had in the past a traumatic brain injury (ex. concussion)
  • Play competitive sports which required fast direction changes for example baseball, soccer, rugby etc. 
  • Have a history of vertigo or dizziness 
  • Have decreased or altered sensation in your lower limbs (ex. common in people with diabetes
  • Have severe or uncompensated vision issues

How do I know if I my balance needs work?

  • You find yourself tripping often
  • You constantly reach towards and grasp walls or pieces of furniture
  • You are scared or avoid uneven surfaces, curbs, or stairs without extra support
  • You lose your balance or feel dizziness while standing with closed eyes or in the dark
  • You feel “off while unsteady while walking or turning

There are also a few types of objective tests we usually perform to check your balance. It’s always advisable to perform under the guidance of professional or under supervision.

  1. Single Leg Stance Test: In this, we make person to stand on one leg for 30 sec or as long as they are able to. They are observed for any difficulties with balance or safety.
  2. Tandem Walk: We make them walk heel-to-toe in a straight line and observe for difficulties with balance
  3. Eyes-Closed Balance: In this one, we will have the patient stand with their feet close together and with the eyes open. We measure the time they can stand and then we repeat and compare it to their time with closed eyes 

How can physiotherapy help improve my balance?

Your Physical Therapist can help you get started by assessing the cause of your balance issue. Whether it’s from a previous injury, a vestibular disorder, post-surgery or more, each will have a different type of treatment. Your physiotherapist will use the assessment to identify your specific impairments and create a personalized Fall Prevention Plan. It will also be targeted towards your goals, whether its to get back to your day to day activities, a specific sport, or just to feel more confident in yourself. They will use a combination of strengthening and coordination exercises, Vestibular Treatment if necessary, and offer education and lifestyle advice to prevent injuries in future,

Tips to reduce fall risk at home!

  • Practice standing on one leg with some stable surface around and add it in to your day-to-day activities like cooking or brushing your teeth
  • Focusing on strengthening the muscles of your lower extremity and core
  • Try to walk on different surfaces to get practice and sensory feedback
  • Wear well-fitted and properly cushioned shoes 
  • Try to keep your rooms clean and cluttered free
  • Try to use bright lights around the house and staircases to avoid falls

Looking for more help?

Look for PhysioNow today! If you are having any issue with your balance, connect with our team of experienced therapists. You will be surprised with the results of how small steps can quickly give you the confidence to move better! With 10 spacious clinics across the GTA from Burlington, Oakville, Mississauga to Etobicoke, we are ready to get you started. Book with PhysioNow today for your first assessment and treatment!

Exercise, Health and Wellness, Physiotherapy, Sports Injuries, Sports Physiotherapy

Do You Play Pickleball? How Physiotherapy Can Help You Stay Injury-Free

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Pickleball has exploded in popularity in the last couple of years across North America, with outdoor courts and racquet clubs popping up everywhere. The appeal is obvious as a fun, competitive or casual, social sport that can accommodate all ages and fitness levels. Whether you’re previous athlete or just trying for the first time, the greatest draw of pickleball is it’s accessibility. As Physiotherapists, we have also encountered a lot more pickleball-induced injuries recently. In this blog we’ll discuss the most common ones we see and a couple of tips to help you stay injury free this summer!

What are common pickleball injuries?

Tennis elbow, or lateral epicondylalgia, is one of the most common pickleball injuries that we see in the clinic

Pickleball is a sport with fast movements, quick changes in direction or starting and stopping, and repetitive plus powerful arm motions. As a result, the most common injuries tend to be:

  • Rotator cuff strains/sprains: Either an overuse or acute injury, overhead shots and smashes put a lot of strain through the shoulder joint and muscle
  • Knee strains/sprains: Overuse injuries can be like ITB syndrome, PFPS from muscular imbalances, or more acute injuries from sudden movements like a ligament or meniscal injury
  • Ankle ligament sprains: Common methods of injury include rolling/twisting your ankle, landing from a jump, or starting/stopping movement too quickly
  • Tennis/golfer’s elbow: This is an overuse injury of the muscles of the forearm, where a lot of the strain from holding and swinging the racket is directed
  • Achilles tendon problems: The strongest tendon in our body at the back of our heels, it is responsible for absorbing the stress of jumping, landing, changes in direction, running and more. Issues can be acute or from overloading the tendon

Staying injury-free with Physiotherapy

Physiotherapists are movement experts, and whether it is rehabilitation, injury prevention, or optimizing performance, we can help you with your game! Our recommendations for our pickleball athletes are as follows:

1. Ensure that your equipment and footwear is in good shape

Poorly maintained or fitting equipment can greatly increase your risk of injury. Ensure that your shoes fit well and provide enough grip to prevent slipping on the court.

2. Have a movement analysis done

Whether by a Physiotherapist or a coach, they can evaluate your technique and help you identify any issues. They can assess your movement patterns, running, jumping, swing, and how you hold your paddle For example, improper or over gripping can change the amount of stress on the forearm muscles and predispose them to injury.

3. Engage in a cross training routine

We highly recommend engaging in cross training, especially the more frequently you begin to play pickleball. Cross training helps to give the muscles primarily stressed by pickleball some rest, while still allowing you to work towards getting stronger, faster, and more cardiovascular fitness. While it may be tempting to play pickleball everyday, remember that your body needs a rest as well to repair itself. Cross training activities we recommend include resistance/weight training and another form of lower impact cardio like the elliptical, rowing, or swimming.

4. Regular body maintenance

Preventative care is key! Stopping an injury before it can even happen is our primary goal.

If you’re playing often, we recommend some focus on recovery whether its through Massage Therapy, Physiotherapy, or Manual Osteopathy. Not only does this help with injury prevention, but it can help you understand and engage in techniques like active recovery, soft tissue work or stretching and mobility work to reduce muscle inflammation and soreness.

5. Treating old injuries and impairments

It is important to address any pre-existing issues or injuries to ensure you’re in the best shape to play. For example, individuals who have had previous shoulder problems or lack mobility/strength in their shoulders are more likely to develop pain due to overuse in their forearm. As can be seen, a weakness in one area requires compensation with a different area of the body. Alternatively, If you are someone who struggles with mobility and has a hard time getting their arms overhead and behind your ears, you’re going to have a hard time hitting those overhead shots. Physiotherapy can help you work on these problems with a personalized treatment and training protocol.

Ready to level up your pickleball game?

Look for PhysioNow! We have many expert professionals (many of which love pickleball themselves!) that are ready to help you on your journey. Whether you’re looking for help with an injury, prevention, or looking for performance tips, we can help. Book with PhysioNow today for your first assessment and treatment. We have 10 locations across the GTA from Burlington, Oakville, Mississauga, to Etobicoke ready to serve your needs!

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Exercise, Health and Wellness, Physiotherapy, Sports Injuries, Sports Physiotherapy

Physiotherapy Tips to Stay Active & Injury-Free This Summer

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Summer is finally here and it’s the season where people start to get a lot more active. As physiotherapists, we love to see people getting back to their sports whether its hiking, biking, running marathons, playing sports, or more! However, as people get back into the swing of things, we unfortunately see a rise in injuries around this time as well. Usually, we see a lot of overuse injuries, or strains and sprains, as people push their bodies just the slightest bit too quickly. To help combat this trend, PhysioNow has prepared a list of the best physiotherapy tips to stay injury free!

1. Increase the intensity and frequency slowly

Training to avoid injuries is like taking the stairs, one step at a time

It’s hard not to jump right in, but easing into your new activities is the best way to avoid an injury. Your body needs time to build itself up to where it was before. For example, for a sport, schedule rest days in between and play 2-3x a week for the first couple weeks before increasing the frequency. If you’re a hiker, you may choose to do some shorter or less intense hikes first before tackling the more challenging ones. Overuse injuries can end your season early, so its crucial to take good care of your body!

2. Listen to your body

Even with the strategies above, we can sometimes push ourselves too much. Most of us know how it feels when our body is too tired, something doesn’t feel quite right, or there’s an annoying pain or discomfort somewhere. This is your body telling you to take some time off! While it can frustrating to sit out on the fun, just remember that taking care of any issues preemptively will save you time. Even if it seems small, addressing it now can stop it from turning into a bigger issue and prevent you from losing time doing what you love!

3. Hydration and rest

If you’re doing outdoor activities during the summer, don’t forget to bring your water bottle! Drink consistently to keep your energy levels high and your body in top shape. Dehydration will decrease your performance and puts you at higher risk for injuries, heat exhaustion, muscle cramping and more. Take breaks in the shaded areas when you feel your body starting to heat up, avoid heat-related issues at all costs!

4. Addressing old injuries

If you have a previous injury, then you should be extra careful when starting up more intense activities. For example, you may consider giving that area some extra strength and mobility training prior to starting your summer activities. You may also want to consider supportive gear such as taping or bracing (off the shelf or custom) to offload some pressure. Ultimately, you may need some extra help in which case that’s where the professionals come in! Physiotherapy will help you address your issue and give you guidance on how to still make the most of your summer.

5. Warm ups and cooldowns

Ensure that you give yourself sufficient time before each workout or activity to warm up and then cool down your body. This allows your body sufficient time to start the processes needed for intense exercise, and then winding them down. This prevents a big shock to the body by giving it space to increase circulation, get the energy systems working, and slowly increase body temperature for a warm up, and the opposite for a cool down. Generally, we recommend more dynamic movements for the warm up, and more stretching in the cooldown to alleviate muscle stiffness.

6. We love cross training

While you may love your sport or summer activity, doing it every single day places a lot of stress on the same muscles, ligaments and joints, as you perform the same movements repetitively. To combat this, high level athletes will engage in something called cross-training. This is when you incorporate a variety of different movements and workout routines to give parts of your body time to rest while the others work. The benefits of this are allowing you to still stay active, building up whole-body strength, improves fitness, and reduces injury risk. Cross-training can look like anything you want it to as long as you’re switching things up, you can mix up running, hiking, swimming, weight training, racquet sports, dancing, and so much more!

Looking to get active this summer?

Whether it’s your first time or you’re a fitness enthusiast, we hope to see you getting active! If you have a pre-existing issue, or encounter a new sports injury during the summer, look for PhysioNow. We have an expert health care team including Physiotherapists, Massage Therapists, Manual Osteopaths, Athletic Therapists and more! Our team is dedicated to your fitness journey from amateur to expert. With 10 locations across the GTA from Burlington, Oakville, Mississauga, to Etobicoke, our team is there for you. Book with PhysioNow today for your first assessment and treatment!

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Foot Pain, Foot Pain Treatment Mississauga, Physiotherapy

Bunions: Taking Care of your Feet

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Have you ever noticed a bump on the side of your big toe that gets bigger over time? This is a common foot condition known as hallux valgus, or more commonly, a bunion. While bunions may seem like a cosmetic issue, they can cause discomfort and pain, especially when walking or wearing shoes. If you’re dealing with this condition, don’t worry – Physiotherapy can help!

What is a bunion?

Hallux valgus is a deformity where the big toe (also called the hallux) points toward the second toe, causing the base of the toe to stick out. This creates a noticeable bump on the side of the foot, often referred to as a bunion.

Over time, the bump can become larger and more painful, making it difficult to wear shoes comfortably or walk without discomfort. Unfortunately, Hallux valgus is a progressive condition, meaning it can worsen if not managed properly.

What causes a bunion to form?

Excessive wear of shoes like flats, heels, or other pointy toed footwear increase the chance of a bunion forming

Hallux valgus is primarily caused by a combination of factors, such as:

  1. Genetics: If bunions run in your family, you’re more likely to develop them. Inherited foot structure, like flat feet or a certain shape of the bones, can make bunions more common
  2. Footwear: Wearing shoes that are too tight, narrow, or have high heels can contribute to the development of bunions. These shoes put extra pressure on the toes, causing them to shift out of alignment over time
  3. Joint instability: Conditions like arthritis or ligament weakness can cause the bones in the feet to shift, leading to the formation of bunions
  4. Injury or trauma: A previous injury to the foot can sometimes lead to hallux valgus, especially if it disrupts the alignment of the big toe. This is especially common with athletes whose sports may lead to a injury like turf toe.

What are the signs and symptoms to watch for?

The most obvious sign of hallux valgus is the bump on the side of the big toe. But there are other signs to look out for:

  • Pain: The bump can become painful, especially when pressure is applied, such as from shoes or while walking long distances
  • Swelling and redness: The area around the bunion may become swollen, red, or inflamed
  • Restricted movement: The big toe may become stiff or difficult to move due to the misalignment
  • Changes in foot shape: Over time, the foot may change shape, and the big toe may push toward the second toe, causing further discomfort

How can Physiotherapy help me?

If you’re dealing with bunions, physiotherapy can be an effective way to manage symptoms and prevent the condition from getting worse. Although physiotherapy can’t completely reverse hallux valgus, it can help with pain relief, improved foot function, and lead to a better quality of life.

Here’s how a physiotherapist can help:

1. Pain relief techniques

Your physiotherapist will use various techniques to reduce pain and swelling around the bunion, such as:

  • Massage: Gentle massage can help relax the muscles in your foot, reduce tension, and ease discomfort
  • Ice and heat therapy: Applying ice to the bunion can reduce swelling, while heat therapy can help loosen tight muscles and improve blood flow
  • Ultrasound therapy: In some cases, your physiotherapist may use ultrasound therapy to reduce inflammation and promote healing in the affected area

2. Stretching and strengthening exercises

Bunions can affect the muscles and joints in your feet, so your physiotherapist will provide exercises to help:

  • Stretching: Notably, stretching the toes and the soft tissues around the foot can help reduce stiffness and prevent the bunion from worsening. Stretching your calf muscles and Achilles tendon is also important for overall foot health
  • Strengthening: Also, strengthening the muscles of the foot and ankle helps to improve stability and support the toe joint. Stronger foot muscles can help redistribute pressure away from the bunion, reducing pain and slowing the progression of the condition

3. Foot alignment and joint mobilization

Your physiotherapist may use specific techniques, like joint mobilization, to gently improve the alignment of your big toe and reduce pressure on the bunion. Additionally, they will provide advice on how to align your foot properly while walking or standing

4. Footwear advice/orthotics 

One of the biggest contributors to bunions is poor footwear. Thankfully, a physiotherapist can help you choose the right shoes that give your toes enough space and avoid unnecessary pressure. In some cases, they may recommend orthotics—custom insoles designed to support your feet and help with proper alignment

5. Taping

Taping provides extra support to the foot’s arch and can help stabilize the foot when walking or running. This extra support can be beneficial if the bunion is causing instability or affecting the way you walk

Looking for more help?

Hallux valgus, or bunions, is a common condition that can cause discomfort and impact your quality of life. However, with the help of Physiotherapy, you can manage pain, improve foot function, and slow down the progression of the condition. If you’re experiencing pain or discomfort from bunions, don’t hesitate to consult with a physiotherapist at PhysioNow! They’ll guide you through a personalized treatment plan that can get you back on your feet and moving comfortably.

If you have any questions or want to schedule an appointment, look for PhysioNow! We’re here to help you take the next step toward healthier, pain-free feet.

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acupuncture, Health and Wellness, Modalities, Physiotherapy

Acupuncture and Healing: A Physiotherapy View

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Musculoskeletal injuries, ranging from sprains and strains to chronic conditions like tendonitis and back pain, are some of the most common reasons individuals seek medical care and/or physiotherapy treatment. Initially, they can be caused by a variety of factors, including trauma, overuse, poor posture, or aging. While conventional treatments such as physical therapy, medications, and surgery are often used to address these conditions, acupuncture has emerged as a complementary and alternative therapy. Fortunately, there is a growing body of evidence suggesting it may be effective in promoting healing, reducing pain, and improving function.

Acupuncture, a cornerstone of Traditional Chinese Medicine (TCM), involves the insertion of thin needles into specific points on the body to stimulate energy flow. By targeting specific points, practitioners aim to restore balance and promote natural healing. 

How does acupuncture work for musculoskeletal injuries?

Acupuncture can be used on many different body areas
  1. Pain management: One of the primary reasons individuals seek acupuncture for musculoskeletal injuries is its ability to reduce pain. Studies suggest that it stimulates the nervous system to release neurotransmitters, such as endorphins and serotonin, which are known to reduce the perception of pain. Ultimately, it can alleviate discomfort from injuries like sprains, strains, and even chronic conditions like arthritis or sciatica
  2. Promoting circulation and healing: Secondly, it has been shown to improve blood circulation to the affected areas of the body. By inserting needles into specific acupuncture points, blood flow can be increased, delivering more oxygen and nutrients to injured tissues. As a result, this helps tissue repair and may speed up the healing process for musculoskeletal injuries
  3. Reducing inflammation: Inflammation is a common response to injury and can contribute to pain and delayed healing. Acupuncture is believed to help regulate the body’s inflammatory response, reducing swelling and discomfort after an injury. In fact, some studies suggest that it may inhibit the production of pro-inflammatory substances and enhance the body’s anti-inflammatory response
  4. Relaxation of Muscles and Joints: Musculoskeletal injuries often lead to muscle tension or joint stiffness. Acupuncture can help relax tense muscles and restore normal joint function. Through insertion of needles into certain points, it can produce a relaxation response and improve range of motion. This is particularly beneficial for conditions like frozen shoulder, neck pain, and lower back pain
  5. Enhancing Healing at the Cellular Level: Emerging research indicates that acupuncture may stimulate the production of growth factors, which are essential for tissue repair and regeneration. These growth factors can support the healing of muscles, tendons, and ligaments that have been damaged due to injury. By promoting cell regeneration, it may help reduce recovery time and improve long-term outcomes.

Is this treatment supported by science?

While acupuncture has been practiced for thousands of years, modern research has begun to investigate its potential benefits in treating musculoskeletal injuries. Several studies have examined the effectiveness for specific conditions, such as:

  • Chronic low back pain: It has been found to provide significant relief for individuals suffering from chronic low back pain. Research published in the Annals of Internal Medicine showed that acupuncture was more effective than conventional treatments like physical therapy and pain medication in managing chronic low back pain
  • Knee osteoarthritis: Furthermore, it has been shown to be beneficial for knee osteoarthritis, a condition characterized by pain, stiffness, and reduced function due to joint degeneration. Studies indicate that acupuncture can help reduce pain and improve function in individuals with osteoarthritis, making it an attractive alternative to medications or invasive treatments
  • Tennis elbow: Another musculoskeletal injury that has responded well to acupuncture is tennis elbow (lateral epicondylitis), a condition characterized by pain and inflammation in the elbow. This treatment may reduce pain, decrease inflammation, and promote healing in affected tissues, offering an alternative to corticosteroid injections or surgery

Practical considerations and limitations

Although acupuncture can be highly effective for many individuals, it is important to consider that it may not be a one-size-fits-all solution. Results can vary depending on the severity of the injury, the individual’s overall health, and each individual’s unique response to treatment. In many cases, it is best used as a complementary treatment alongside conventional therapies like physical therapy, exercises, and proper nutrition.

Looking to try acupuncture?

Then look for PhysioNow! We have many experienced Physiotherapists that are registered to perform acupuncture. At our clinic, you can receive acupuncture alongside your regular Physiotherapy treatment to get the benefits from both! With 10 PhysioNow clinics across the GTA, we are happy to provide first-rate service to many neighbourhoods. Book with PhysioNow today for your first assessment and treatment!

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Foot Pain, orthotics, Physiotherapy

Metatarsalgia: I’m Having Burning Foot Pain!

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What is metatarsalgia?

Metatarsalgia is a general term used to describe pain and inflammation in the ball of the foot. Particularly, this is pain around the metatarsal heads—the bones just before your toes. While it’s not necessarily a condition in itself, it signals an underlying problem in foot structure, biomechanics, or lifestyle.

The pain feels like or is often described as:

  • A sharp, burning, or aching sensation in the front part of your foot
  • The feeling of walking on a pebble
  • Numbness or tingling in the toes

What causes this foot pain?

Metatarsalgia can develop from a variety of factors, including:

1. Overuse and high-impact activities

Runners, jumpers, and dancers often put repetitive stress on the forefoot. Ultimately, the large forces going through the area can affect the tissues leading to inflammation and pain

2. Improper footwear

Wearing high heels or tight shoes can shift your body weight forward onto the metatarsals or cause extra compression through those bones. As a result, consistently wearing these types of footwear can overload that area of the foot. Also, a lack of cushioning or arch support can be a common culprit in foot pain

3. Foot shape

Furthermore, people with high arches or other foot shapes like hammer toe, bunions, or a second toe longer than the big toe are more prone to metatarsalgia due to uneven weight distribution

4. Excess body weight

More weight means more pressure on the feet, causing increased strain over time

5. Aging

As we age, the fat pad that cushions the ball of the foot naturally thins, reducing shock absorption and increasing vulnerability

What are the symptoms of metatarsalgia?

Metatarsalgia may have some or all of the following complaints:

  • Pain location is the ball of the foot
  • The pain improves with rest and worsens with standing, walking, or running
  • Swelling or bruising around the ball of the foot
  • Feels like having a pebble in your shoe
  • Numbness or tingling in your toes

If these symptoms persist, it’s a good idea to consult a health care professional like a podiatrist (a doctor that specializes in foot care or a physiotherapist to have the issue evaluated and treated.

What is the treatment for it?

A professional can help identify contributors to the pain and provide a treatment that addresses the root cause.

Physical therapy management and care from a podiatrist is usually the first step in conservative care. These can include treatments such as:

1. Education

  • Activity modifications: Stopping high-impact exercise, alternatives include exercises in a pool, swimming, running or cycling
  • Footwear advice: Using supportive shoes to prevent reinjury
  • Advice on pain management: Ice, elevation, and NSAIDs for pain/swelling

2. Orthoses/orthotics

Orthotics
Orthotics may help correct foot posture that is contributing to foot pain
  • Metatarsal Pads: Rubber/silicone pads placed just behind the metatarsal heads can reduce pressure on the area. Subsequently, they can reduce irritation in the area
  • Forefoot cushions/metatarsal bars: Similarly to the pads, they help redistribute pressure in the foot
  • Insoles:
    • Accommodative: Redistribute pressure
    • Functional: Control abnormal foot mechanics that are causing

3. Stretching

The areas of focus include the calves, Achilles, and other muscles around the ankles or toes. Key exercises include:

  • Wall calf stretch
  • Step-down Achilles stretch
  • Seated ankle flexion/extension

Ultimately, the aim is to improves flexibility and mobility in the area and surrounding areas while reducing pain.

4. Strengthening

Different exercises may be used to builds foot strength, improve arch support, and increase muscle endurance. A common exercise used to improve intrinsic foot muscle (small muscles in the feet) strength is:

  • Toe towel scrunches: 3 sets of 15 reps/foot.

5. Modalities and pain relief techniques

Ice, ultrasound, interferential therapy may be used to help manage pain and swelling. In some cases: taping is a very helpful strategy that provides pain relief.

 Surgical Options

Unfortunately, conservative care does not achieve satisfactory results with everybody. Surgery is typically a last resort and considered only when conservative treatments fail. In this case, it might involve realigning bones or correcting deformities that are contributing to the midfoot pain.

Can metatarsalgia be prevented?

Prevention starts with foot awareness and smart lifestyle choices:

  • Wear well-fitting shoes with adequate support
  • Maintain a healthy weight to reduce foot pressure
  • Watch out for large increases in activity such as starting a new sport or increasing the amount you play.
  • Stretch and strengthen your foot muscles regularly
  • Replace athletic shoes often—don’t wait until they’re worn out

Looking for help with foot pain?

Look for PhysioNow! We are leading health care providers with service across the GTA from Burlington, Oakville, Mississauga to Etobicoke. Our experienced practitioners offer their expertise in many different areas including Physiotherapy, Massage Therapy, Manual Osteopathy, Athletic Therapy and more! Get help with your pain today! Contact us to book your first assessment and treatment with PhysioNow!

Fracture Rehabilitation, Fracture Treatment, Physiotherapy, Wrist pain

Scaphoid Fractures: A Physiotherapy Guide

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What is a scaphoid fracture?

A scaphoid fracture is one of the most common types of wrist fractures, particularly among young adults and athletes. The scaphoid bone is one of the eight small bones in the wrist, located in the middle of the joint closer to the thumb side. Functionally, it helps to connect the forearm bones (radius and ulna) to the hand bones (metacarpals). A fracture of the scaphoid typically occurs when an individual falls onto an outstretched hand (commonly shortened to FOOSH), causing the wrist to bend backward in an awkward position. The impact can break the bone, leading to pain, swelling, and difficulty moving the wrist. Unfortunately, due to its location and blood supply, scaphoid fractures can be tricky to diagnose and treat, and failure to do so properly may lead to long-term complications.

How do scaphoid fractures happen?

Activities that have a lot of high impact and weightbearing on the wrist are more susceptible to a fracture

The primary cause of a scaphoid fracture is trauma to the wrist, often from falling onto an outstretched hand. Some common scenarios include:

  • Sports injuries: Athletes in contact sports such as football, basketball, or acrobatic sports like gymnastics are particularly prone to wrist injuries
  • Motor vehicle accidents: Sudden impacts can cause severe trauma to the wrist, leading to fractures
  • Repetitive stress: In some cases, repeated stress or pressure on the wrist may contribute to stress fractures of the scaphoid bone

Additionally, certain risk factors can make someone more prone to a scaphoid fracture, including:

  • Age: Young adults, especially those between 18-30 years old, are more likely to experience this type of fracture
  • Bone density: People with low bone density or osteoporosis may be more susceptible
  • Activity level: Individuals involved in high-impact or contact sports have a higher risk of injury

What are the symptoms of a scaphoid fracture?

 A scaphoid fracture is often difficult to diagnose at first because symptoms may resemble those of other wrist injuries. Common symptoms include:

  • Pain in the wrist: The pain is usually felt on the thumb side of the wrist and may be more intense when the wrist is moved or when pressure is applied to the area
  • Swelling and bruising: Swelling is typically visible around the base of the thumb, and bruising may appear later
  • Reduced range of motion: It may be difficult to move the wrist or thumb without sharp pain
  • Tenderness: Pressing on the area near the base of the thumb is very sore

How can this type of fracture be diagnosed?

To diagnose a scaphoid fracture, doctors will typically perform a physical examination and review the patient’s medical history, including any recent falls or trauma. X-rays are the primary imaging tool used to diagnose a scaphoid fracture, but it’s important to note that fractures may not always be visible immediately after the injury. Sometimes, a second set of X-rays taken a week or two after the injury is required to detect any changes. Unfortunately, scaphoid fractures are unique, and some may never be detectable on x-rays, called occult scaphoid fractures. In these cases, the physical exam and symptoms can usually inform the diagnosis of a fracture.

How is a scaphoid fracture treated?

Treatment for a scaphoid fracture depends on the severity of the break and its location. Generally, treatment options include:

  1. Conservative treatment: Non-displaced fractures (where the bone fragments remain in alignment) are often treated with immobilization using a cast or a splint. This method is typically effective for stable fractures, and the cast is worn for about 6-12 weeks. Here, the wrist is kept in a position that limits movement to allow the bone to heal properly
  2. Surgical treatment: Displaced fractures (where the bone fragments are out of alignment) often require surgical intervention. Typically, surgery involves realigning the bones and using screws, pins, or plates to hold the fragments in place during healing. Also, surgery may be necessary if there’s a concern about the blood supply to the scaphoid bone, which can be disrupted by a fracture. This is an important complication to watch for as it can lead to a serious issue if untreated, called avascular necrosis (AVN)
  3. Rehabilitation: After the cast or surgical treatment, physical therapy is recommended to help restore the wrist’s strength and range of motion. For example, rehabilitation exercises can aid in reducing stiffness, improving flexibility and function of your wrist and hand

Initially, range of motion exercises after immobilization should focus on active-assisted ROM as the hand and wrist will be stiff. These exercises should focus on the wrist and thumb; however, the fingers, elbow and shoulder also need to be considered as they may be affected. If the full range is still restricted, manual therapy can be applied in the form of joint mobilizations to the radio-carpal joint, radio-ulnar and carpal joints. Furthermore,, other forms of manual therapy may also be helpful to reduce any residual swelling or pain such as soft tissue work or massage techniques.

What can go wrong with a fracture?

Although most scaphoid fractures heal successfully with proper treatment, complications can arise. For example, some potential complications include:

  • Nonunion: If the fracture does not heal properly, the bone may fail to unite, leading to chronic pain and dysfunction
  • Avascular necrosis (AVN): The scaphoid bone has a relatively poor blood supply, and fractures, especially those in the proximal part of the bone, can disrupt blood flow. Consequently, this can lead to the death of the bone tissue, which may result in permanent wrist damage
  • Osteoarthritis: Chronic wrist pain or deformity following a scaphoid fracture increases the risk of developing arthritis in the joint

How can I minimize the risk of a fracture?

While some scaphoid fractures are due to accidents or unavoidable trauma, there are steps you can take to reduce your risk:

  • Wear protective gear: When engaging in sports or high-risk activities, wearing wrist guards or other protective equipment can reduce the chances of injury
  • Strengthen the wrist: Regularly performing exercises that strengthen the muscles and ligaments around the wrist can provide more stability and help prevent injuries
  • Fall prevention: Practicing good techniques and safety measures to avoid falling, such as using proper footwear can be especially beneficial

Looking for help?

If you are dealing with a wrist pain, post-fracture issues, or any other type if injury, look for PhysioNow! We have many experienced Registered Physiotherapists ready to help you get better! With 10 different clinics across the GTA from Burlington, Oakville, Mississauga and Etobicoke, our offices are in prime locations to serve you. Contact us if you have any questions and book with us today for your first assessment and treatment.

Fracture, Fracture Rehabilitation, Fracture Treatment, Physiotherapy

Fibular Fracture: I Broke my Leg!

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What is a fibular fracture?

The fibula is one of two bones in the lower leg, the other being the tibia. Fractures of the tibia and fibula are common in those who have low bone density, specific diseases or anatomical features resulting in changes in bone structure. Also,the likelihood may also depend on the activity level, sports and types of training individuals do. 

Fibular fractures can happen anywhere along the shaft of the bone. Fortunately, due to the smaller size and degree of weight bearing of the fibula relative to the tibia, a fibular fracture is considered less severe. 

How do these fractures happen?

Usually, these fractures are caused by traumatic force to the bone.

  • High impact trauma: For example, these can be from a car crash, pedestrians being hit by a vehicle, falls from heights and more
  • Sports injuries: Especially, in contact sports like football or hockey. Alternatively, a sudden twist or rotational force can fracture the fibula even without a direct blow

What does a fibular fracture look like?

A fracture will result in a sharp, severe pain on the leg which worsens when you put weight on it

Symptoms of a fibular fracture may include:

  1. Pain and tenderness along the outside of the leg
  2. Swelling on the outside or sometimes the entire lower leg
  3. Visible deformity
  4. Inability or difficulty to bear weight on affected leg
  5. Numbness and coldness in feet 

When do I start Physiotherapy Treatment?

After being in a cast for several weeks and being cleared by the fracture clinic, you should see a Physiotherapist for Fracture Rehabilitation. Oftentimes, the knee and ankle become stiff, and the muscles weaken from disuse. Consequently, it is important to begin Physiotherapy Treatment as soon as you can. First, you will focus on regaining the range of motion, strength, and coordination in the lower leg. Simultaneously, you will work on restoring your normal walking pattern and functional abilities like weightbearing, balancing, squatting and stairs. Below is an example of a general rehabilitation program with Physiotherapy after a fibular fracture.

Phase 1: Protection (0-6 weeks)

  1. Patient will be in a cast for about 6 weeks and may be restricted in putting weight on the leg
  2. Encourage leg elevation
  3. Focus on ankle pumps, upper extremity and core strengthening

Phase 2: Early mobility and strengthening (6-8 weeks)

Exercises help increase the range of motion by pushing the ankle into dorsiflexion
  1. Focus on restoring range of motion in all the lower extremity joints
  2. Strong emphasis on ankle dorsiflexion range (bringing your ankle up)
  3. Focus on foot intrinsic muscle strengthening
  4. Start strengthening exercises for the musculature around the ankle, knee, and hip
  5. Gradual progression of weight bearing back to normal
  6. Gait retraining

Phase 3: Continue strengthening (8-12+ weeks)

Box jumps are a high impact exercise that challenges the entire lower body. Consequently, they require a strong foundation of strength before beginning.
  1. Advanced strengthening exercises including resistance training ex. weighted squats, lunges
  2. Start incorporating higher impact activities such as jogging
  3. Progress to plyometric (jumping) and exercises in multiple planes

It is important to note that not everybody will move through the phases of rehabilitation at the same pace. Thus, it is important to have supervision from a trained professional like a Physiotherapist. Ultimately, this will ensure that you are progressing appropriately and minimize your risk of reinjury.

Get started with PhysioNow!

If you are dealing with a fracture or any other types of leg pain, look for PhysioNow! We have many experienced clinicians including Physiotherapists, Massage Therapists, Manual Osteopaths, and Athletic Therapists to assist you in your recovery. We have 10 locations with free and accessible parking located across the GTA. Book with PhysioNow today for your first assessment and treatment!

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Hip Pain, Physiotherapy, Total Hip Replacement Surgery

Total Hip Arthroplasty: What you Need to Know!

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What is a total hip arthroplasty?

Total Hip Arthroplasty (THA), or a hip replacement surgery is a procedure that replaces damaged bone and cartilage in the hip joint. Instead, it replaces it with prosthetic components mainly using two techniques. The type of technique used will be discussed between you and your surgeon and is influenced by demographic and lifestyle factors.

1: Cemented: Used more in geriatric (older) populations or patients who have a more sedentary lifestyle 

2: Non-cemented: Indicated for younger populations, or patients having active lifestyles

Why do people get hip replacements?

On the left shows a healthy hip with an intact joint surface, the middle shows degeneration of the surfaces in the hip, the final image shows the outcome of the surgery where the hip surfaces are replaced.

Usually, the reason people get hip replacement is due to severe osteoarthritis (OA) that is causing high pain, loss of function, and disability. For example, when someone is having trouble walking and being independent with their daily activities due to issues with hip OA. Other reasons may include rheumatoid arthritis induced cartilage or bone damage, after a slip and fall on the hip (especially in older populations), and femoral neck fractures. However, some people may be ineligible for this surgery if they have peripheral vascular disease, history of blood clots, an ongoing infection, or septic arthritis.

Generally, hip replacements/THAs are safe procedures with great outcomes. Post-surgery, the most common complications to watch for include deep vein thrombosis which is a blood clot in the leg, or a post-surgical infection in the joint.

Physiotherapy Rehabilitation After Total Hip Arthroplasty

Total Hip Replacement Surgery

Total hip arthroplasties are highly effective surgical procedures designed to alleviate pain and restore function in patients with severe hip arthritis or hip joint damage. Initially, post-operative rehabilitation is crucial to ensure the continued success of the surgery and to optimize the patient’s recovery. Physiotherapy plays a vital role in this rehabilitation process, helping patients regain strength, mobility, and overall function. Read on to learn more about the phases of rehabilitation with Physiotherapy!

1. Immediate Post-Operative Phase

First, the immediate post-operative phase begins as soon as the patient wakes up from anesthesia. Then, physiotherapists start with gentle exercises to promote blood circulation and prevent complications such as deep vein thrombosis (DVT). Simple movements like ankle pumps, quadriceps sets (squeezing the big thigh muscle), and gluteal sets (squeezing the buttocks muscles) are encouraged. These exercises are designed to improve blood flow, reduce swelling, and initiate muscle activation without putting undue stress on the new hip joint.

Early mobilization is a critical component during this phase. Within 24 to 48 hours after surgery, patients are usually assisted to sit up and begin walking with the help of a walker or crutches. The goal is to start weight-bearing activities as tolerated, promoting healing and preventing stiffness.

2. Early Rehabilitation Phase

The early rehabilitation phase spans the first few weeks after surgery. During this period, physiotherapists focus on gradually increasing the intensity and range of exercises. Patients are taught specific hip-strengthening exercises such as leg raises, hip abductions, and gentle stretching. Additionally, simple balance and coordination exercises are also introduced to enhance stability and prevent falls.

Not only this, but pain management is a significant focus during this phase. Physiotherapists work closely with the medical team to ensure that pain is adequately controlled, allowing patients to participate actively in their rehabilitation. For example, ice therapy, electrical stimulation, and manual techniques may be used to manage pain and reduce inflammation.

3. Intermediate Rehabilitation Phase

The intermediate phase, typically from 4 to 12 weeks post-surgery, aims to build on the progress made in the early phase. Now, physiotherapy sessions become more intensive, incorporating resistance training and functional exercises. Furthermore, activities such as stationary biking, swimming, and gentle aerobics are introduced to improve cardiovascular fitness and endurance.

During this phase, the focus shifts towards improving gait and mobility. For example, patients practice walking without assistive devices, concentrating on proper walking mechanics and posture. Also, stair climbing and descending exercises are introduced to further enhance functional independence.

Strengthening exercises for the hip and surrounding muscles are progressively intensified. At the same time, core strengthening exercises are also incorporated to improve overall stability and support the hip joint.

4. Late Rehabilitation Phase

The late rehabilitation phase, typically beyond 12 weeks post-surgery, focuses on preparing the patient for a return to normal activities and, if possible, sports. Now, physiotherapy sessions aim to restore full strength, flexibility, and function. Advanced balance and proprioception exercises are introduced to ensure the patient can handle more complex movements and environments.

At this stage, patients may engage in low-impact sports such as golfing, cycling, and swimming. High-impact activities, such as running or jumping, are generally discouraged to protect the new hip joint from excessive wear and tear. However, each hip rehabilitation is different and should be discussed with your surgeon to understand your specific limitations.

Education on lifelong joint protection and healthy lifestyle choices is an essential part of this phase. Patients are taught strategies to prevent injury and maintain joint health, such as maintaining a healthy weight, avoiding high-impact activities, and incorporating regular exercise into their daily routine.

Getting a hip replacement soon?

If you are getting a total hip replacement soon and are looking for some advice and help, look for PhysioNow! Physiotherapy can help you maximize your strength and function prior to surgery to ensure that recovery is as smooth as possible. Then, after the surgery, we will work with you to return your hip back to its normal function with an individualized care plan. Our Physiotherapists are ready to get you started. Book with PhysioNow for your first assessment and treatment today!

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

Rheumatoid Arthritis and What You Should Know

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

What increases the risk of developing Rheumatoid Arthritis?

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

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

What are the signs and symptoms of Rheumatoid Arthritis?

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

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

During a relapse/flare up, symptoms include:

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

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

How is rheumatoid arthritis diagnosed?

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

Physiotherapy Management of Rheumatoid Arthritis

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

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

    2. Activity modification

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

    3. Therapeutic exercise

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

    4. Manual therapy

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

    Where can I find help?

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