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Patellofemoral pain syndrome

November 16,2018 Sharon Tierney Leave a comment

Patellofemoral pain syndrome

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!

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Sciatica

November 15,2018 Sharon Tierney Leave a comment

Sciatica

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.

PhysioNow has highly trained Registered Phyiotherapists ready to help you with Sciatica. We have same day emergency appointments available. Call today to help with the Sciatica Pain! 289-724-0448.

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Fracture Rehabilitation

November 5,2018 Sharon Tierney Leave a comment

Fracture Treatments Mississauga, Etobicoke & Oakville _ PhysioNow

Fracture types

Fracture Rehabilitation

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.

Call today to get started on your Fracture Rehabilitation!

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Female & Male Pelvic Pain

November 12,2016 Sharon Tierney Leave a comment

Female & Male pelvic pain

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

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.

Irritable Bowel Syndromes

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

Anal Disorders

Men have pelvic pain!

• Chronic Pelvic Pain Syndrome
• Interstitial Cysts
• Bladder Pain Syndrome
• Levator Ani Syndrome
• Urethral Syndrome
• Coccydynia
• Pudendal Neuralgia
• Anal fissures

Physiotherapy Treatments for Female & Male Pelvic Pain

Kegel Exercise

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!

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Urinary Tract Infections

November 12,2016 Sharon Tierney Leave a comment

Urinary Tract Infections

Urinary tract infections

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

Check out this video for more information: http://www.webmd.com/women/guide/your-guide-urinary-tract-infections#1

Lifestyle changes:

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!