Fibromyalgia is a chronic condition. It is often associated with widespread symptoms including fatigue, pain and sleep disturbances.
Causes and Risk Factors
It is unclear as to what causes fibromyalgia. However, there are some causes which might be increasing your risk of getting fibromyalgia:
Genetics-
You could be ay a higher risk for fibromyalgia if it runs in your family
Stress-
Emotional or physical stresses have been known to aggravate or cause this condition
Age-
Women have been found to be at a higher risk
Symptoms of Fibromyalgia:
The symptoms may vary from individual to individual but, following are some of the commonest symptoms-
Fatigue-
One of the commonest symptom is fatigue
Pain-
Pain that lasts > 3 months and widespread pain at several sites in the body
Sleep disturbances-
You could have sleep disturbances or non restorative sleep (sleeping for long but not feeling rested)
Reduced exercise tolerance and morning stiffness.
Other symptoms include trouble with concentration/memory. It is also called ‘fibro fog’ or ‘brain fog’. Headaches and depression are also common. It is common to have fluctuations in the symptoms. You may experience pain that may range from a mild discomfort/ache to an unbearable pain.
Although it may mimic more like an arthritis/ bone related pain, it actually comes from the soft tissues. Fibromyalgia can start at any age. However, mostly it is by early to middle adulthood that people start feeling it.
Diagnosis:
Your doctor will take a detailed history to understand all of your symptoms. There is no definitive test to diagnose this condition. However, the doctors may prescribe you to do other tests like blood work or X-rays to rule out other conditions that show similar symptoms.
How do you treat it?
Drugs-
The treatment is usually focused on relieving the symptoms. For instance, your doctor may prescribe muscle relaxants, pain killers, anti-depressants or sleep medications,
Acupuncture-
To help relieve pain
Fibromyalgia. Acupuncture
Cognitive Behavior Therapy-
Cognitive Behavior Therapy can help to reduce stress. Can be individual or group therapy.
Nutrition-
A healthy balanced diet is good because it helps to keep your body healthy and keep the energy levels high.
Massage therapy-
Helps in relaxing the muscles and relieve pain
Activity pacing-
There may be good and bad days in this condition. Thus, it is important to make sure you prioritize your activities for the day. This is helpful in order to reduce excessive fatigue.
Physiotherapy-
Physiotherapy can help to firstly, reduce your pain. Secondly, they can give guidance on modifying activities and finally, prescribe exercises. In addition, aerobic fitness and strengthening exercises help in this condition.
Physiotherapy for fibromyalgia
How can we help?
Our physiotherapists will take a detailed history followed by a thorough evaluation of all your symptoms and problem areas. Then, they will formulate and discuss a treatment plan for you. Also, we have massage therapists and therapists who do acupuncture. Thus, if you are having fibromyalgia or know anyone who needs help with the same, contact us today at PhysioNow!
Did you know that current research suggests 80% individuals will experience back pain at some time in their lives? There are several causes that can lead to back pain-degenerative changes, herniated discs, poor posture, pulled/torn muscle /ligament around the spine, kidney stones or many other pathological causes. Of all these various causes, there is one thing that can be controlled and taken care of by you-POSTURE!
WHAT EXACTLY IS A POOR POSTURE?
Any position that places our spine in unnatural curves (most often a C shape) instead of the normal S shape curve is a poor posture (see picture below). S shaped curve allows for equal weight distribution as well as flexibility of the spine. Poor posture is known to affect not just the spine but also the surrounding ligaments and muscles. Prolonged poor postures lead to a lot of pressure on these surrounding tissues thus increasing the damage and pain.
Good-Posture-vs-Poor-Posture
FACTORS CONTRIBUTING TO POOR POSTURE:
Improper workstation design :
Could be a wrong chair, monitor height or distance of yourself and the monitor. Lack of enough breaks specially in a desk job also contribute to poor posture in the long run.
Repetitive movements/postures as a part of work/occupation:
Bending repeatedly and working.
Lifestyle:
Current technology has made people to bend down and look into their electronic devices for several hours every day. High heels, sitting with the wallet in the back pocket and heavy bags/purses also lead to malalignment of the spine.
Muscle imbalance:
Due to certain sports that we play or our basic posture leading to weakness in some groups and tightness in others thus affecting the curve.
Poor core stability and strength
Age:
As age advances, it leads to lesser flexibility and strength. If we keep thinking that doing exercises will cause more discomfort than what we currently have, the muscles become weaker and weaker and without enough muscle strength, the spine cannot stand erect
Habit:
The habit of poor posture is very difficult to change like sitting slouched on a couch for several hours or just slouch sitting or standing in day to day activities. Sure, everyone loves to sit in a relaxed position but, if you do not make the effort of trying to change it, it will keep creating more and more problems for the body.
EFFECTS OF BAD POSTURE:
Since childhood we have been asked to sit straight or stand tall and not slouch. Mostly everyone did that as a compulsion and rather grudgingly. However, it has many important reasons instead of it just being better for our appearance!
Back pain:
That is the most obvious one! Poor posture leads to stretching of the muscles of the back and the surrounding structures thus making them weak which in turn reduces the support it gives to the spine – taking us back to poor posture! As it becomes more of a chronic habit, you then have to take care of your posture and make your muscles stronger as well.
Neck pain, headaches and jaw pain:
Sometimes when there is no trauma or injury to your jaw and it starts clicking, popping, paining or going into spasm. There is a possibility it might be coming due to malalignment of the neck. A forward head posture has been known to cause jaw pain and headaches.
Hip, knee and foot pain:
Yes, the body is a closely connected structure. Any malalignment or change at one point like the foot or knee does affect the spine and leads to pain and vice versa.
Gastrointestinal system problems:
A slouched position/poor posture may compress the internal organs of the abdomen. It also affects the movement of the intestines thus leading to numerous gastrointestinal troubles like acid reflux or constipation. Over time it can also affect the metabolism and the way food is processed in the body.
Psychosocial impact:
In general, a person with a good upright posture seems more approachable and confident compared to the one who is slouching. This in turn leads to less motivation or mood issues in social situations. It has also been known to cause more fatigue and sleep problems as the body has to work harder and spend more energy to maintain itself when it is clearly not aligned well.
WHAT CAN YOU DO TO FIX A BAD POSTURE?
Avoid prolonged sustained positions. Make sure you take frequent breaks, if possible, try getting up from your chair after every 30-45 minutes .
Get into the habit of sitting well- always sit with your buttocks touching the back of the chair. This, in turn, will promote an erect posture and your back will get enough support
While you are standing try to distribute your weight evenly on both legs and do not lean on one side.
Use a backpack instead of a one sided bag if it is heavy so there is equal weight distribution on the shoulders. While sitting remove the wallet from the back pocket
Do a chin tuck- if you have a poking chin and rounded shoulders, straighten your upper back and do a chin tuck and repeat it 10 times. You should also stretch your chest muscles if you have rounded shoulders
If you have to use the phone for a long time, try holding it with your hand. You can also use a hands-free device instead of cradling it with your shoulder
HOW DOES PHYSIOTHERAPY HELP TO SOLVE POSTURE RELATED PROBLEMS?
Physiotherapists can help you by assessing exactly where your problem begins and then helping you to understand and modify habits that lead to bad posture. There are also various other treatments like manual therapy, taping and exercises that are aimed at stretching the tight muscles and strengthening the weaker muscles around the spine. They can also advice you regarding your work station modifications, if required.
PhysioNow
If you or anyone you know has posture related aches and pains or wants to get an assessment done to find out more about how you can improve your posture, call us today for an appointment!
The Pelvic Floor. Perhaps you have heard this referenced
before but did not have a definitive idea of what it was. Is it just a region
in the body? A single muscle? Let us explore this very important topic.
The Pelvic floor
is a group of extremely important muscles located on the inside of the pelvis
with a hammock like orientation. They attach to the tailbone (coccyx) at the
back, the pubic bone in the front and span side to side.
Functions:
These muscles are involved in several complex functions but
are often overlooked in their contribution due to their “out of sight, out of
mind” presence. These functions include:
1. Bowel and Bladder Function and Support
Assists in control of the bladder and bowel (helping to prevent incontinence) in males and females. In females, the pelvic floor supports the uterus and other organs located in the pelvic cavity. This helps to prevent prolapse. Prolapse is the lowering down of a pelvic organ from its normal position.
Contribution to our Core Muscles?
The pelvic floor acts as the base of our core together with the deep back muscles and diaphragm. Core muscles help to provide strength and stability of the spine.
Involvement in Sexual Function
The pelvic floor plays a role in sensation during sexual intercourse. As a result, dysfunction of these muscles may lead to painful intercourse. In addition, it can lead to decreased sensation, and reduced erectile function amongst other symptoms.
Involvement in pregnancy and delivery
The strength of the pelvic floor muscles is very important during pregnancy. They help to support the extra weight of pregnancy. This can reduce certain symptoms of discomfort. They can also help to decrease the incidence of incontinence (bladder leakage), and prolapse. Additionally, they play a large role during delivery in guiding the baby’s head down the birth canal.
Symptoms of Dysfunction?
When the pelvic floor is working in harmony, it plays a big role in a variety of our functions. What happens when something is not quite balanced in the pelvic floor? Symptoms may arise. For example, they can be as a result of one of two scenarios: weakness in the pelvic floor or increased tension in the pelvic floor.
What about Kegels?
It is common to assume that any pelvic floor concerns are automatically as a result of weakness. Many people think that kegels should immediately be practiced. However, kegels are NOT always the answer! If the primary problem in the pelvic floor is tension, kegels can in fact do more harm than good. The Mysterious Pelvic Floor issues can be solved with a little Pelvic Physiotherapy!
So, what are some of the symptoms associated with pelvic floor dysfunction?
Urinary issues, such as the urge to urinate, incontinence (bladder leakage), urinary frequency and painful urination.
Bowel concerns such as constipation and incontinence
Lower back pain
Pain in the pelvic region, genitals, or rectum.
Discomfort during sexual intercourse for women.
Pressure in the pelvic region or rectum.
Muscle spasms in the pelvis.
What are some of the Risk Factors for issues with The Mysterious Pelvic Floor ?
A history of back pain
Previous trauma to the pelvic region such as a fall or pelvic radiotherapy
Ongoing constipation (i.e. for example, regularly straining to empty your bowels)
A chronic cough or sneeze (e.g. due to asthma, smoking or hayfever)
Being overweight, or having a body mass index above 25, and
Heavy lifting on a regular basis – either at work or at the gym most commonly
During pregnancy and post-partum, some factors may arise
Women who are going through, or have been through, menopause
Women who have had gynaecological surgery (e.g. hysterectomy)
Men who have had prostate surgery
Elite athletes such as gymnasts, runners or trampolinists.
What is a Pelvic Physiotherapist and How Can We Help?
What is a Pelvic Physiotherapist and How Can We Help?
A Pelvic Physiotherapist has advanced training . They assess and treat the pelvic floor through a combination of external and internal examinations. This treatment is for both males and females. Internal examination allows the Physiotherapist, to evaluate the pelvic floor directly. As a result, this will help to identify contributing factors to your concern.
Typically, tension or weakness are underlying imbalances in the pelvic floor. The Mysterious Pelvic Floor issues are usually treatable!
Although this is an area less known for its muscle contribution, the parallel of a shoulder injury should be drawn here, for example. In order to help treat a shoulder problem, a Physiotherapist would still have to evaluate all the muscles around it. We would check to see where the problem lies. Once found, these same muscles would be treated directly.
This is the same principle to keep in mind when trying to understand pelvic floor problems and treatment.
Treatment of The Mysterious Pelvic Floor?
Once a full examination has been completed, the Pelvic Physiotherapist discusses the results with you. Together, they will develop a treatment plan with you. Pelvic Physiotherapy treatments vary, however, some of the methods often used can include:
Postural training
Release and mobilizations , (often the low back, hips, etc. are involved).
Connective tissue release. Connective tissue is the thin layer found above our muscles. Sometimes, it can cause tension pulls and compression in areas. As a result, this causes pain and poor function.
Dilator work
Internal techniques to release areas of tension. We teach contraction exercises AND relaxation techniques. These are often overlooked
Exercises: These are positional to alleviate pain and pressure. They strengthen, stretch, and activate muscles. As a result, they help to build endurance, and improve coordination.
Breathing techniques
In cases where internal assessment or treatment may be painful, external treatment can be started first. This can often reduce the tension causing the internal discomfort. Improvements can be made to achieve your ultimate goals.
It is also important to note that Physiotherapists are primary health care providers. Therefore, you can see a Physiotherapist without a doctor’s referral. However, if your Physiotherapist feels that you may benefit from further testing, we will reach out to your doctor of choice.
Summary of The Mysterious Pelvic Floor
The Mysterious Pelvic Floor doesn’t need to be so mysterious!
Two of the most common phrases that I hear patient’s mention during or after a pelvic physiotherapy assessment are:
“I didn’t even know that this type of Physiotherapy existed” and
“I wish I knew about this sooner”
These phrases are often derived from patients who have a pelvic concern. In most cases, it has significantly affected their function. It has resulted from the belief that nothing could be done, besides “living with it.”
My hope is that Pelvic Physiotherapy becomes well known! My hope is that you seek treatment as often as our rotator cuff friends. Afterall, they both involve muscles that can be easily treated. Take care of your pelvic floor, it is literally of foundational importance!
If you or someone you know suffers from Pelvic Floor issues, PhysioNow can help! We have specially trained Pelvic Floor Physiotherapists available at all of our clinics to help. Call today to get started on your treatment!
Acute Ankle sprains are common injuries in people of all ages. They can happen in many different circumstances. However, they always involve some type of fall or twisting movement to the ankle. For example:
Going downstairs and missing the last step resulting in twisting the ankle
Landing on the ankle in a twisted position after coming down from a lay-up in basketball or in a Sports Injury
Slipping on an icy street while walking
In all of these situations, the ankle gets a sudden movement and/or trauma that causes it to twist more than its normal range of movement allows.
Acute Ankle Sprains
What structure gets injured with an acute ankle sprain?
The structures that are injured with acute ankle sprains are the ligaments around the ankle joint. Ligaments are soft tissue structures that connect two bones together. Their function is to prevent the bones from moving too far away from each other. Ligaments help maintain normal movement between the bones.
With ankle sprains, the ligaments get over-stretched beyond what they can tolerate which causes tears in their fibres. The ligaments that are involved in acute ankle sprains are present on the outside (lateral), inside (medial), and top of the ankle.
Are there different types of acute ankle sprains?
There are three main types of ankle sprains:
Inversion
Eversion
High Ankle Sprain
The terms relate to the direction of ankle movement that caused the injury to occur.
INVERSION ANKLE SPRAIN
An inversion sprain occurs when the ankle is forcefully turned inwards.
This type of acute ankle sprain is the most commonly occurring of the three because the ligaments on the outside of the ankle are generally weaker than the rest.
Another name for an inversion ankle sprain is lateral ankle sprain
A lateral ankle sprain injures the ligaments on the outside of the ankle.
EVERSION ANKLE SPRAIN
An eversion sprain occurs when the ankle is forcefully turned outwards.
This type of force injures the ligaments on the inside of the ankle.
The ligaments on the inside of the ankle are called the deltoid ligament
An eversion ankle sprain is also called a medial ankle sprain
HIGH ANKLE SPRAIN
A high ankle sprain is the rarest of the three types and it occurs when there is excessive twisting of the shin.
The ligaments that are injured with this type of injury are located above the ankle.
The location of the ligaments is why this injury is called a ‘high’ ankle sprain.
Are some people more at risk for Acute Ankle Sprains than others?
There are certain risk factors that may make ankle sprains more likely to happen. However, the research is a little inconclusive on why this is so. Some of these possible factors include:
Poor muscle strength/fitness
Increased weight
Decreased muscle-reaction time
Previous history of ankle sprains resulting in poor balance
Can there be different severities of Acute Ankle Sprains?
The severity of the ankle sprain depends on how much the ligament was overstretched in the process of the injury. Sprains are classified by different grades to explain the severity:
Grade I: mild stretching or tear of the ligament, with little or no instability at the joint
Grade II: incomplete tear of the ligament, with some instability in the joint
A Grade III: ligament is completely torn or ruptured and there is no stability in the ankle
Ligaments affected in Ankle Sprains
What should you do if you think you have sprained your ankle?
In all three types of Acute Ankle Sprains, it is important that you see a health care provider. The health care provider, whether it is a doctor or a Registered Physiotherapist, will first rule out the possibility of fracture. There is always the possibility of a fracture with Acute Ankle Sprains. The ligaments attach onto a bony area and if the twist is severe enough, it can pull off a chunk of the bone. When this happens, it can cause a fracture. Signs and symptoms of a potential fracture include:
Lots of swelling
Increased bruising
Increased tenderness over specific areas of the ankle
Difficulty or inability to put weight through the injured ankle
When the signs and symptoms are suspicious of a fracture, then an X-ray must be completed. If there is no evidence of fracture, then your doctor may send you for an ultrasound. In the end, they should refer you for Physiotherapy treatment. So ask your doctor to send you to Physiotherapy if they don’t think to recommend it themselves.
What will happen during my first Physiotherapy appointment?
During the Physiotherapy assessment, your Registered Physiotherapist will assess everything to do with your Acute Ankle injury, including:
Pain intensity and location
Swelling
Sensation
Range of motion
Ankle stability
Strength
Balance
This will provide some baseline information for your Physiotherapist.
How can Registered Physiotherapy help treat Acute Ankle Sprains?
The treatment for acute ankle sprains depends on the type of sprain as well as the severity of the injury.
Immobilization
Because of their affect on ankle stability, a Grade II or III injury will require some immobilization. This is usually done through a removable walking cast.
The purpose of the immobilization is to protect your injured ligaments from movement and external stressors, so that they can heal.
The period of immobilization will depend on the injury and your health care provider will provide specific instructions.
A grade I sprain will not require any immobilization because the stability of the ankle is still intact. However, your Physiotherapist will recommend activity modification to help with the healing process.
Physiotherapy Treatment in the acute phase?
In the initial phase of the treatment, the Physiotherapist may focus on pain relieving modalities
Electrical modalities like IFC and Ultrasound can help relieve pain and swelling
The Physiotherapist will also prescribe gentle mobility exercises to help improve or maintain movement through the ankle
The length of the acute phase depends on the severity of the sprain
Ankle Rotations for movement Recovery
Treatment in the later stages of Acute Ankle Sprains
Once the ligament healing is underway and the patient feels a little better with their pain, the treatment will get more progressive
It will focus on regaining mobility, strength and function through the ankle
Your Physiotherapist will prescribe exercises that are going to help regain the lost range of motion and strength.
Over several weeks, the exercises will be progressed as you improve.
Another important aspect of treating an ankle sprain is including balance re-training in the program.
Balance is very much affected after an ankle sprain and it is something that must be improved with specific exercises. This is very important no matter whether you are returning to Sports or just everyday living! Balance Retraining is key to Falls Prevention!
We use our balance ability on a regular basis with walking on uneven surfaces or when trying to recover from a stumble. Therefore, it is important to improve balance ability to prevent any possible re-injury of the ankle.
If you have had an acute ankle sprain before, and DID NOT attend Physiotherapy, it is likely that you are at increased risk of reinjuring your ankle or falling again!
Physiotherapy Mobilizations
Do I need to get Physiotherapy treatment after Acute Ankle Sprains?
There are some people who have sprained their ankle multiple times and never sought out treatment for the injury. They usually give themselves some time for the pain to get better and then go about their usual activities.
This type of management is not usually recommended because multiple ankle sprains can affect the stability of your ankle. As a result, this may create problems in the future. Also, the reduced stability in your ankle may cause compensations in your knees and hips. This can complicate the picture and make your injury more complex.
It is therefore recommended that you seek out proper Registered Physiotherapy care to address an ankle sprain soon after it occurs. This ensures that your acute ankle sprain heals in a timely manner without added complications. The most important part of treatment is regaining your balance. If you do not do this, another injury in quite likely.
Motor vehicle accidents happen everyday in Ontario. As a result, they produce a lot of pain, disability and stress for those involved. The impact can be quite debilitating. Accident rehabilitation is treatment that is given after being involved in a motor vehicle accident. It is important to seek out Registered Physiotherapists who are experienced in Accident Rehabilitation to ensure proper recovery. At PhysioNow we offer high quality Registered Physiotherapy and Registered Massage therapy treatments to help you recover from your injuries.
Registered Massage Therapy
Who is entitled to receive Accident Rehabilitation?
Any person who has been involved in a motor vehicle accident in Ontario is entitled to receive Accident Rehabilitation benefits . This would include if you were a pedestrian hit by a vehicle. It would also include coverage for treatment if you were involved in an accident outside of Ontario, but reside in Ontario. However, if you are injured and do not have your own insurance, you can still apply for accident benefits. The circumstances of the accident will determine which insurance company will pay for the benefits. For instance, you may be covered by the person that hit you or the Motor Vehicle Accident Fund.
How much accident benefit coverage is available?
The amount of the benefits that you are entitled to depends on the severity of your injuries. There are two categories of benefits available:
Minor Injury Guideline (MIG)
This plan is for people who have minor injuries including whiplash and sprains and strains.
The majority of motor vehicle accident injuries fall within this category
The MIG plan is standardized across all of Ontario in terms of its entitlement to Treatment benefits no matter where you receive treatment.
If you are under a MIG, the maximum benefit under the MIG is $3500
Major Injury Guideline (non-MIG)
This plan is for people who have suffered serious injuries from an accident
Examples include fractures, surgeries, major neurological trauma and concussions
The maximum entitlement under this plan will vary depending on your injuries, but could be up to $65,000.
What is the process of receiving accident benefits?
Once the accident is reported to the insurance company, the adjuster will ask if there are any injuries from the accident. The adjuster will send you a package of forms that you have to complete and send back. The adjuster will also likely put you in touch with an approved physiotherapy clinic in the area closest to you. The clinic will then contact you to schedule an initial assessment.
1st visits with a Physiotherapist can take place within 1 day of the accident. You are also able to go directly to your Approved Physiotherapy Clinic to initiate a claim and get started on your treatment. The Approved Clinic can get the paperwork started for you.
PhysioNow is an approved company for the purposes of Motor vehicle accidents in Ontario. PhysioNow is allowed to directly bill your treatment to your Auto Insurance company. They can provide all of the forms that you need to get started.
Whiplash Pain
What are the most common injuries from a Motor Vehicle Accident?
Most car accidents tend to be minor in nature. The most common types of injuries are:
Whiplash
Happens when the force of the impact pushes your neck back and forth really fast
This causes a sprain/strain of the your muscles and ligaments of the neck
Symptoms range from pain, stiffness, numbness/tingling into the arms and hands, headache and loss of motion
Thoracic & Lumbar strains
The impact causes the joints and muscles of the spine to be over-stretched
The mechanism is similar to whiplash
Symptoms include pain, limited movement, numbness/tingling into the arms and/or legs, weakness
Shoulder strains
It is common for the shoulder to get injured in a car accident, especially for the driver – this is because their arms are usually holding on to the steering wheel
Concussion
Concussions are a form of a traumatic brain injury and can vary from mild to severe
It is possible for Concussions to occur as a result of either direct or indirect trauma to the brain
The most common symptoms of a concussion are dizziness, nausea, sensitivity to light and sound, headache, fatigue, difficulty concentrating and fogginess
Concussion
What can I expect from my first visit at the physiotherapy appointment?
During the initial visit, you will have to complete some forms. These forms are essential to submitting a successful claim. The experienced administrators at PhysioNow can help you to fill them out to make the process easier for you. The good thing about the paperwork is that you only need to complete it once! After the initial paperwork, you can focus just on your recovery.
What can I expect from my Initial Assessment with the Registered Physiotherapist at PhysioNow?
Your Registered Physiotherapist will meet with you. We will start by asking some questions to get an understanding of your injuries. For example, some sample questions can include:
How did the accident happen?
Questions that will screen you for more serious injuries that could require further medical attention
Locating all the painful areas and injuries that have occurred
Details about past medical and injury history
Once this information has been collected, your Registered Physiotherapist will do a full assessment. We will check all of your affected areas for movement and strength. This will start to give us an idea of the severity of your symptoms. We will then use this information to decide whether you will be classified as either MIG or non-MIG.
After this, we will then fill out the required treatment plan for you. In conclusion, we will go over what the plan will look like with you. Lastly, they will discuss treatment timelines and treatment goals. At PhysioNow, there will also be time allocated to start some light treatment to give you pain relief.
What kind of treatment will be provided for Accident Rehabilitation?
The types of treatment provided after vehicle accidents will depend on the nature of your injuries. It will also depend on what your Physiotherapist feels is most appropriate for you, taking into account all of your injuries. As a result, your treatment plan may include a variety of different treatments such as:
Treatment will start slowly at first and focus first on pain control,
Modalities – Ultrasound, Laser, Interferential Current
Exercises – range of motion, postural and strengthening exercises
Concussion Treatment if needed
Education – explanations of the injuries and do’s and don’ts to help the recovery process
After that, this will be followed by recovery of movement, and then strength.
Lastly, we will work on helping you get back to all of your normal activities both at home and work
Accident Rehabilitation
How long will the treatment take to complete for Accident Rehabiliation?
The length of the treatment plan depends on whether you are on a MIG or non-MIG pathway.
MIG (Minor Injury Guidleline)
2 phases
1st phase: 12 weeks in length
2nd phase (if required): additional 4-8 weeks
Non-MIG ( Non- Minor Injury Guideline)
Timeline is at the discretion of your physiotherapist and will vary depending on your injuries
For post-surgical cases or individuals with multiple serious injuries, the timeline can be well over 1 year
As a result, it is very important to seek out Accident Rehabilitation as soon as possible when you have been involved in a car accident. The pain and limitations that you experience after an accident can really affect your quality of life. Therefore, scar tissue from injuries starts to form quickly after an injury.
Patellofemoral pain syndrome happens when your knee cap does not track properly. The knee joint consist of two joints. The tibiofemoral joint which is between the two long bones in your leg and the second one is the patellofemoral joint. This is between the femoral condyle (end of thigh bone) and the knee cap. The cartilage on the back of the knee cap glides on the cartilage on the front of the condyles of the femur. The knee cap usually sits in a snug groove at the end of the thigh bone.
Knee movements are controlled by a number of muscles connected to the knee cap. Your thigh muscle helps to stabilize the knee cap and enables it to move smoothly in the groove. When this is pulled out of the groove, you can develop Patellofemoral pain syndrome.
Causes of Patellofemoral pain syndrome or Anterior knee pain
Patellofemoral pain syndrome, is one of the most common causes of pain in the knee. Pain is usually felt under the knee cap. This is where it glides on the femur/thigh bone. If you have patellofemoral pain syndrome, it hurts when you bend and straighten your knee . There are a number of factors which can cause the pain.
Common Causes of Patellofemoral pain syndrome
Weakness in the hip and thigh muscles-Weakness in the thigh muscles can cause increased load which may lead to pain. Pain in your knees will further limit the activity of your muscles and over time can cause further weakness. Weakness of the inner thigh muscle will affect the movement of the knee cap as you do your normal activities. Weakness in your hip muscles also can affect activities like climbing stairs and walking.
Excessive loading or rapid increase in the load for muscles around the knee-Depending on your usual activities, your knee will have a level of activity that is tolerated by your joint. Rapid increases in loading of activity may lead to a highly irritable or sensitive joint. This can cause Patellofemoral pain syndrome.
Posture or position of hip, knee and feet-Flat feet or excessive turning in of feet can change movement mechanics further up the leg and cause excessive strain in your knee cap.
Tight muscles around the knee-Tightness in the muscles can reduce the movement of your knee and affect how your joint works . This will lead to excessive loading during activities. The common muscles that become tight are your hamstrings, Quadriceps, Iliotibial band and calf.
Previous injury or dislocation of knee cap
Desk top work, where a lot of sitting can cause pressure on the kneecap.
Irritation of fat pad around the knee
Tendinitis of quadriceps tendon
Bursitis around the knee
Osteoarthritis
When poor biomechanics are repeated with each step of your walking and running it may lead to a highly sensitive joint and Patellofemoral pain syndrome.
Symptoms
The onset of knee cap pain is normally gradual rather than traumatic.
Pain at the front, back and sides of the knee with or without swelling.
Bending and straightening of knee can cause pain.
Pain after prolonged sitting or when you keep the knee bent for longer periods of time.
Clicking or grinding when you bend or straighten your knee.
Pain when you go up and down the stairs, up hill /down hill, squatting, running or jumping.
Poor knee control or stiffness
Physiotherapy Treatment
Physiotherapy is the most effective treatment for short- and long-term management of Patellofemoral pain syndrome. Your Physiotherapist will fully assess you on your first visit to identify your functional limitation. They will also help to set goals and identify contributing factors for the pain. They will provide a customized rehabilitation program.
In the initial phase of rehabilitation, treatment is directed towards reducing the pain, swelling and muscle inhibition. To do this PhysioNow will use electrotherapy modalities, acupuncture, rest, taping, gentle motion or joint mobilization and muscle setting exercises.
Once the pain and swelling reduces, treatment is focused towards modifying the factors that have been identified as a cause for the problem.
Rehabilitation typically emphasizes increasing strength and pain free movements. It also will address postural correction, improving the stability of the pelvis, balance and functional abilities.
Stretching exercises to address the tight muscles and strengthening the weak muscles will improve your load tolerance.
Successful rehabilitation requires adherence to your exercise program .
You will also need to reduce the aggravating movements and slowly build the endurance and strength for those activities over time.
Prior to discharge you will be given a safe progression of exercises and functional activities.
For long term management, your foot and knee control will be assessed by your Physiotherapist.
As a result, you may require custom foot orthotics to correct your foot position.
This will help to improve foot and knee control.
Others might need a hip stabilization program and your Physiotherapist will be happy to discuss with you the long term rehabilitation plans if this is needed.
How long it will take to get better?
We expect to see improvements with Physiotherapy over a 3 to 6-month period. Further improvements continue beyond this period. Adherence to your specific exercise program is important in maintaining the improvement. Most people will get back to their normal function with rehabilitation in the short term. Many patients can continue in their chosen activity during rehabilitation. Some modification of activity may be all that is needed.
If you play sports, you will need to do sports specific exercises to ensure a safe return to sports. It is good to wear proper supporting footwear to help keep your feet in a good position. This will improve alignment of your knees.
How to book an appointment with a Physiotherapist at PhysioNow?
We have four Physiotherapy clinics of which three are located in Mississauga and one is in Etobicoke. You can call 289-724-0448 to book into any of these clinics for an appointment with a Physiotherapist.
Most of the time we can arrange your initial visit on the same day in a location which is nearest to you. Your initial appointment will be a one to one 40-60 minute session with a Physiotherapist which includes treatment as well on the first day.
Your follow up appointments will typically take 40 minutes. Normally, we would recommend 2 to 3 sessions per week depending on the factors identified on initial assessment, treatment plan and your goals. If you have limited funding available, we will be happy to work with you to develop a home exercise program.
Please call today to get started on your treatment for Patellofemoral Pain Syndrome at PhysioNow!
Sciatica is a term that gets used quite frequently in the physiotherapy world. This refers to pain, tingling and/or numbness that goes down the back, hip or entire leg.
Who can get Sciatica?
It can happen to both younger and older adults for a variety of reasons.
For some, it starts after a traumatic event like a slip and fall or after a motor vehicle accident.
It can seem like pain develops out of nowhere for others.
Pain can start gradually then suddenly increase in severity.
The majority of the time, sciatica is a condition that starts with some mechanical changes in the low back that build up gradually over a period of time.
What is Sciatica?
The term sciatica itself refers to irritation of the sciatic nerve
It is the largest nerve in our body
This nerve has its roots at the lower levels of the lumbar spine
It runs through the buttock area, and down the back of the thigh
Around the level of the knee, the sciatic nerve splits up into several smaller nerves that run down to supply the muscles of the lower leg, ankle and foot
What are the symptoms of Sciatica?
The symptoms produced by sciatica follow the pathway of the nerve and can reach all the way down to the toes. The symptoms can range from:
pain
pins and needles
numbness
weakness in the leg or all of the above
ACUTE Sciatica
Sciatica can be very debilitating when it is in the acute stage.
Pain can be quite sharp and severe.
As a result, sciatica can limit your movement and function completely.
A lot of patients at this stage will rate their pain intensity at a 9 or 10 out of 10.
Any position or movement may be pain producing.
Anything you try, including over the counter medication, may not help with the intensity of pain.
You may feel very helpless and scared at this stage.
The sudden onset of intense pain may make you wonder if there is something seriously wrong.
You may even feel that you need to go to the emergency room because the pain is so severe.
Should you go to the Hospital for Sciatica?
It is not necessary to go to the Hospital for Sciatica.
Typically, most people with Sciatica can recover quickly with the help of a trained Registered Physiotherapist!
PhysioNow has trained professionals standing ready to help you Now!
We do not need a doctors referral to see you at PhysioNow.
However, you may require a doctor’s note for your insurance plan to cover your treatment.
Our Physiotherapists will screen for any serious issues and send you to a doctor if they find any ‘red flags’ with your Sciatica.
We will direct bill to your Extended Health Plan if your plan allows us to do so.
However, if you feel more comfortable seeing a doctor first, head to the Hospital or your family doctor.
At the hospital, the standard procedure will be to rule out anything potentially serious. Some of the more serious causes of severe low back pain can include:
• Fracture
o History of significant trauma
o If there is osteoporosis present, then minor traumas are risk factors
o Loss of function with all movements making pain worse
• Cancer
o 55 years of age or older
o Previous history of cancer
o unexplained weight loss
o Increasing levels of pain that are not relieved by rest
• Infection
o Fever
o Malaise
o Constant pain
o All movements make the pain worse
• Cauda Equina Syndrome
o Severe low back pain
o Pain, numbness or weakness in one or both legs
o Saddle anesthesia – loss of or altered sensations in your legs, buttocks, inner thighs, backs of your legs, or feet
o Sexual dysfunction
o Sudden changes in bowel or bladder functions – difficulty with relieving yourself or difficulty with holding it in
The role for Physiotherapy in Sciatica
Any of the above-mentioned conditions would require emergency treatment, which the hospital would provide.
Thankfully, for most patients, their sciatica is not from anything serious.
Most incidences of sciatica are mechanical in nature and can be treated with Physiotherapy.
Once the hospital has ruled out anything serious, they will likely prescribe some medication for pain management and provide a referral for physiotherapy.
For most people, sciatica can be treated with conservative treatment such as physiotherapy.
The important thing about treating sciatica effectively is to determine the correct source of the pain and address those specific areas.
What is causing the Pain from Sciatica?
With most sciatica patients, the pain is coming from pressure on one or more of the roots of the sciatic nerve.
The pressure on the nerve affects the proper function of the nerve and causes the symptoms to go down the leg.
What about if I have Tingling and Numbness? Is that more serious?
The tingling, numbness and weakness that a patient may experience is not something that will be permanent in most cases.
A good analogy for this process is like when someone is stepping on a water hose.
The pressure from the foot stops the water from passing through the hose.
However, once that foot comes off the hose, the water will flow through without any issues.
Similarly, the symptoms along the leg will get better once the pressure is removed off the nerve. Physiotherapy will help with this!
This pressure on the nerve may be caused by an injury to the disc or bony changes in the area.
An experienced physiotherapist will be able to perform a thorough assessment that will determine the potential cause of the sciatica.
Physiotherapy Treatment
Once the cause of your sciatica is established, the Physiotherapist will be able to provide the most appropriate treatment to take the pressure off the nerve.
Lots of research out there has shown that passive treatments such as heat, ice, and electrical modalities, like IFC and ultrasound, do not provide long term solutions.
These types of modalities may be useful in the acute phase to help with the management of pain.
They can be combined with other treatments as part of the overall treatment plan for sciatica.
However, on their own, they are unlikely to make any significant and long-lasting changes.
Specific movements are usually the most effective at shutting off your Sciatica Pain!
Your Trained Physiotherapist will determine the best movement for you to shut off your Pain!
Sciatica Treatment
Positions and Movements that can Help with Sciatica Pain
More importantly, there has to be an evaluation of what positions and/or movements are pain producing and which are pain relieving.
A physiotherapist who has lots of experience working with low back issues will be able to help make this discovery.
Therefore, the results of the movement assessment will allow for the prescription of the appropriate exercise to help take the pressure off the nerve roots.
For example, if you feel less leg symptoms when you arch your back backwards, then that means your nerve is less irritated with that movement.
As a result, your treatment plan will then include exercises that involve various forms of backwards movements that continue to improve your leg symptoms.
Possible Sciatica Treatment
What Does Centralization of the Pain mean?
As the pressure on the sciatic nerve improves, the pain will move upward towards the low back in a process called centralization.
In general, these changes may happen quickly for most patients.
However, with more complex cases, it can take longer to ease the pain and regain function.
As a result, any movements that produce centralizing symptoms are going to be beneficial in reducing pain.
In the majority of cases, pain can be resolved completely, and you can return to your normal level of activities quickly.
What do I need to know to keep the pain away?
It is important that the physiotherapist provides proper education.
They should give you a good home exercise program for the continued maintenance of your sciatica condition.
As a result of the pain, some patients will continue to avoid certain activities or movements because of their experience with sciatic pain.
Therefore, it is important that your physiotherapist work with you to regain full function and confidence with your mobility.
Fractures are common injuries . They can happen to people of all ages, from the very young to the very old. The majority of fractures occur with trauma to the bone. It could be either from a fall or a blunt force. Most people can readily feel that they have a broken bone. This is because the signs and symptoms can be very obvious.
Some of these indicators of Fracture are:
Swelling or bruising over a bone
Deformity of an arm or leg
Pain that gets worse with any movement or added pressure
Inability to put any weight through the injured area
Protruding bone through the skin (in the case of open fractures)
In some cases, however, fractures can be less obvious. Some ankle fractures may look a lot like ankle sprains. You may not even know that it was a fracture until it shows up on an X-ray.
Spine Fractures
Fractures through the spine may feel a lot like back pain initially. This is due to the make-up of the spine. Bony injuries to the back do not produce any of the obvious signs and symptoms . However, one of the key components of a spinal fracture is that it occurs after some sort of trauma. This is most commonly a fall. Therefore, if there is a traumatic event reported, the physiotherapist will rule out any potential spinal fracture. They will do a thorough assessment. If the Physiotherapist suspects a potential fracture, we will refer you back to your doctor to get X-rays done.
Fragility Fractures
In people with osteoporosis, fractures can happen with very minor stumbles or movements. Osteoporosis is a condition where the bones become fragile or brittle from loss of bone. Fractures associated with osteoporosis are called fragility fractures. They occur due to the weakness of the bone itself.
If you have Osteoporosis, your bones can be injured with small traumas that would not normally affect the average person. If you have back pain and you have had trauma, the Physiotherapist will ask whether you have osteoporosis. This is to rule out potential fragility fractures.
Diagnostic tests for a Fracture
In any incident where there is a suspicion of a fracture, X-rays are necessary. This will confirm the presence of the fracture, its exact location and severity. However, in some cases, an X-ray may not be sensitive enough to show the fracture. In these situations, if a fracture is still suspected, more sensitive tests like a CT, MRI or bone scan may need to be completed.
Fracture Classifications
There are 4 main classifications of fractures:
Displaced – the bone snaps into 2 or more parts and moves so that the two ends are not lined up straight.
Non-displaced – the bone breaks partly or all the way through, but the ends remain lined up
Closed – the bone breaks but there is no puncture wound in the skin
Open –the bone breaks through the skin
Types of Fractures
There are also 7 different types of fractures to describe the specific nature of the break line:
Greenstick – incomplete fracture, where the broken bone is not completely separated
Transverse – the break is in a straight line across the bone
Spiral – the break spirals around the bone, common in a twisting injury
Oblique – the break is in a diagonal line across the bone
Compression – the bone is crushed, causing the broken bone to be wider or flatter in appearance
Comminuted – the break is in three or more pieces
Segmental – the same bone is fractured in two places, so there is a ‘floating’ segment of bone
Fracture Treatment
In terms of management of fractures, the treatment depends on the type of fracture. The fractured ends of the bone must be set in their proper place and held there for the bone to heal properly. This process is called reduction.
Fracture Repositioning
Most fractures are repositioned without the need for surgery. This is called closed reduction. Once the bones are positioned properly, the joint is casted . The length of casting is usually 6 weeks. This is how long it typically takes the fractured bones to heal. There are circumstances where the period of casting may be either shorter or longer. This depends on the nature of the fracture. If it is an ankle or foot fracture, the doctor may also recommend that you wear an aircast boot to stop your foot from moving.
PhysioNow carries a full supply of these aircast boots if you need one.
Open Reduction (Surgery) after Fracture
Open reduction (surgery) is done for fractures that are more complicated. The repositioning of the bones wil be done with surgery in this case. The surgeon will use screws and or plates to keep the bone fragments in proper position. This allows for proper healing. Following open reduction, you will have a period of immobilization . The length of time for a fracture thathas required surgery will depend on the bone that was fractured. It also depends on the severity of the fracture. Also, depending on the fracture and the needs of the patient, the hardware may either be left in permanently or taken out with another surgery. If removal of the hardware is necessary, it will happen once the fractured bone has completely healed.
Spinal and Rib Fractures
There are however some fractures that cannot be effectively immobilized such as spinal and rib fractures. For these types of fractures, the affected area is protected with avoiding certain activities or postures.
Healing times for Fractures
In terms of healing times, most uncomplicated fractures take approximately 6 weeks for the bones to fuse. Although medically, the fracture would have healed, there may still be a lot of limitations. For fractures that are more complicated and required surgery, the healing times may be a little longer due the surgery.
Delayed Healing of Fractures
There are also some people who will heal at a slower rate because of various health conditions or medication use. So, if you have diabetes, osteoporosis or are a long time user of prednisone, you may fall into this category. Scaphoid Fractures also may have delayed healing because there is a poor blood supply to the bone.
Registered Physiotherapy after Fractures
Once the fracture itself is healed, there may still be some remaining problems from the injury. Since the fracture would have been immobilized for several weeks, there will be a significant loss of movement and strength around the broken bone.
It is important to follow up with Physiotherapy for Fracture Rehabilitaton. This helps to ensure that there can be a safe return to all previous activities. A Registered Physiotherapist will be able to assess the limitations. They will prescribe the necessary range of motion and strengthening exercises and then you can get back to all of your normal activities quickly!
PhysioNow Etobicoke and Mississauga
PhysioNow has highly trained Registered Physiotherapists on staff to help you after a Fracture. We are open evenings and weekends to help meet your needs. We also do direct billing to your insurance plan if you have one and if they allow us to do so on your behalf.
There are various conditions which are treatable under male and female pelvic pain.
Vulvodynia
Pain that affects the entire vulva
Symptoms
• Burning
• Stabbing
• Stinging
• Itching
• Sensitive to touch and pressure
• Functional limitation (Sex/ tampon/clothes)
Vestibulodynia
The vestibule is where the vulva (area of the skin on the outside) meets with the vagina. It is an extremely sensitive part of your body. Symptoms:
Hypersensitivity on light touch, such as during intercourse and on insertion of tampons.Some women have pain but are able to tolerate penetrative sex. They may have soreness and tenderness. This may include soreness with tight clothes and even light touch to the area.
Dyspareunia, Vaginismus, Dysmenorrhea, Irritable Bowel Syndrome (IBS) and Endometriosis
Vaginismus: Inability to penetrate due to spasm of the muscles Dyspareunia: Painful vaginal penetration in the absence of disease Dysmenorrhea: Irritable Bowel Syndrome (IBS): Abdominal Pain or discomfort, At least 3 days per month in the last 3 months.
Pain is associated with 2 or more symptoms:
– Improvement with defecation
– Onset associated with a change in stool frequency
– Onset associated with a change in stool form
Physiotherapy Treatments for Female & Male Pelvic Pain
Connective tissue massage
Dermoneuromodulation or non?nociceptive input
Improve mobility of affected areas
Down regulate the sympathetic nervous system (nervous system restore and relax)
Nutrition
Behavioural techniques (manage stress)
Movement Therapies
Kegel exercises depending on the type of muscle tone and condition.
Contract relax and Reciprocal inhibition techniques
Add mobilizations–? massage with movement
As you can see, there are many things that can be done to help with Female & Male Pelvic Pain. PhysioNow can Help! We have fully trained Pelvic Health Physiotherapists to help with all of these conditions. Call today to book an appointment!
Urinary tract infections typically occur when bacteria enter the urinary tract through the urethra. Bacteria then begin to multiply in the bladder. The most common UTIs occur mainly in women and affect the bladder and urethra.
• Infection of the bladder (cystitis).
• Infection of the urethra (urethritis)
Symptoms
• A strong, persistent urge to urinate
• A burning sensation when urinating
• Passing frequent, small amounts of urine
• Urine that appears cloudy
• Urine that appears red, bright pink or cola-colored — a sign of blood in the urine
• Strong-smelling urine
• Pelvic pain, in women — especially in the center of the pelvis and around the area of the pubic bone
Urinary tract infections can be painful. You can take steps to ease your discomfort until antibiotics treat the infection. Follow these tips:
• Drink plenty of water. Water helps to dilute your urine and flush out bacteria.
• Avoid drinks that may irritate your bladder. Avoid coffee, alcohol, and soft drinks containing citrus juices or caffeine until your infection has cleared. They can irritate your
bladder. These drinks tend to aggravate your frequent or urgent need to urinate.
• Use a heating pad. Apply a warm, but not hot, heating pad to your abdomen to minimize bladder pressure or discomfort.
• Wear cotton underwear on a daily basis. Cotton underwear allows more air movement to occur. This keeps the urethra dry.
• Do NOT wear thongs. They track bacteria from your anus forward to your vagina (to the underwear section).
Physiotherapy Treatment
Physiotherapists that are trained in pelvic floor dysfunction can greatly improve a UTI patient’s quality of life. A typical approach includes training pelvic floor musculature, manipulative techniques and local heat. It also includes breathing and relaxation techniques. Lastly, treatment includes postural education, muscle coordination reeducation, and behavioral therapy.
• Reverse Kegel Down training
• Dynamic ROM program including dynamic stretching and core exercises
• Pain education
• Internal pelvic muscle work including trigger point release techniques
• Connective tissue mobilization
If you suffer from urinary tract infections, consider getting a consultation from one of our pelvic health physiotherapists today. They can help! Please call Physionow to book an appointment and get back to living a comfortable life!
Female & Male pelvic pain
