Heel pain could be from any reason either your inflamed plantar fascia causing plantar fasciitis or any abnormal bony growth causing heel spurs. To get in further details plantar fasciitis is an irritation and inflammation to the tissue that runs at the bottom of the foot extending from the heel to the toes, causing heel pain. It supports the arch of the foot which helps in shock absorption. On other side, heel spur is when a bony outgrowth forms on the heel, which causes heel pain while walking and standing.
What are the causes of heel pain?
Causes are not limited to high and low arches causing irritation to the plantar fascia with running, jogging, playing any sports, prolonged standing and walking. Also, any strain or tear to the fascia. As a result, if this condition is left untreated can lead to bony growth causing heel spurs.
5 Most common risk factors of pain
Improper foot wear: The foot wear without proper arch support or worn-out shoes.
Improper footwears
Weight gain leads to changes in arches and support and affects the weight transmission and shock absorption.
Foot mechanics: flat feet or high arches, stiff mid foot and ankle.
Types of Arches
Age: commonly seen between 40 – 60 years old.
Occupation: commonly seen in clients with jobs that requires long standing.
What are the symptoms:
With plantar fasciitis it is like a stabbing pain felt at arch of foot and near the inner part of heel whereas pain with spurs is in the center of heel and also feels like a stabbing.
Location of pain
Pain is usually worse in the morning taking first few steps with plantar fasciitis. It usually gets better with walking but comes back with long hours of standing and sitting. On other hand pain with spurs gets worse as the day progresses with long hours of standing and walking. Sometimes, there could be swelling present over the heel area.
How will Physiotherapy help you with heel pain?
Your physiotherapist after a detail assessment would be able to identify the cause of the problem and give you advice on how to modify and handle the situation and life style which will help in the road to recovery. Advice would include,
Foot insoles for arch support
How to modify activities of daily living.
Advice on foot wear.
Suggestions on arch supports and custom-made orthotics, night splint.
Hands on techniques to release the tight plantar fascia, calf, mobilization of foot and ankle manually or with a tool. Stretches for the tight surrounding structures.
Hawk tool to release plantar fascia
Strengthening exercise for the supporting structures and muscles that maintain the arches and functional training
Kinesiotapping to relieve stress from the affected structures.
Don’t let your pain affect your quality of life and stop you from doing your activities. Book your assessment session now with qualified physiotherapists of PhysioNow. We have various locations to serve the communities in Mississauga, Oakville and Etobicoke. Contact us and get started today!
What has led to the increased interest in gardening?
Interest in gardening and farming has increased in North America, especially during the pandemic. Lots of people have taken to gardening for several different reasons. For instance, for some it is to develop a green thumb. Meanwhile for others it is to reduce their stress level during these difficult times. However, because gardening can be very physically demanding, it can lead to gardening injuries.
Most commonly affected joints in gardening injuries
Back and Sacro-iliac (SI) joint
Hip and Knee joints
Wrist and hand
Neck and shoulder
Back and SI joint injuries
Examples include discogenic pain, sciatica, sprain, strain, and mechanical low back pain.
Sacro-iliac strains are commonly seen conditions. Prolonged bending or repetitive bending is a major trigger for back and SI pain. Pain and stiffness are usually felt at the end of the day or the next day. However, some people might feel an immediate sharp back pain while performing their gardening tasks.
Discogenic pain can occur in any area of the spine, from the neck to the lower back. More specifically, with this type of pain, the disc protrudes and irritates the surrounding structures that may lead to pain. These structures include the nerve roots, ligaments, muscles, and fascia. Furthermore, one can present with neck pain with or without referral into the arm if it involves the neck. Similarly, there can be referral into the legs if it involves the low back. Other common symptoms of discogenic pain include stiffness and muscle spasms.
Things can help you manage or recover from these types of injuries or pain include
Back exercises
proper positioning
appropriate medication
treatment and advice from a registered physiotherapist
massage therapy
Hip and Knee Injuries
Commonly known terms include knee or hip sprain/strain, bursitis, and knee derangement.
Hip and knee pain is commonly seen if a person spends prolonged periods of time squatting or kneeling during their gardening activities. Pain can start several hours after gardening or the next day. However, sudden movements can produce immediate pain and injury as well.
Mechanical knee pain occurs when the joint is put into a constant or repetitively stressful position for a prolonged period of time. Specifically, with gardening injuries, prolonged squatting or kneeling are common triggers for pain. One presents with difficulty moving the joint or difficulty getting up after a prolonged period of rest. Furthermore, pain, stiffness, difficulty going up and down stairs, and walking are other common symptoms.
Sprains occur when there is an injury during a task and it involves the ligaments such as ACL, MCL, LCL, PCL, and the meniscus. Specifically, one presents with sudden pain, with or without swelling, difficulty walking, limited movement and function.
Hip and knee bursitis involves the inflammation of the bursa. The bursa is a fluid filled sac that sits between the bone and the tendon to protect the areas from constant irritation. One presents with constant pain which is worse with movement, restricted mobility and decreased function.
Elbow, Wrist and Hand injuries
Commonly injuries include Tennis elbow, Golfer’s elbow, sprains/strains, Tenosynovitis of wrist, tendonitis of wrist and fingers.
Elbow injuries are seen with repetitive usage of garden tools. Examples include pruning, digging, and hedging.
Wrist and hand injuries are mainly due to repetitive stress to the small joints. For instance, pulling out weeds which is time consuming, repetitive and puts a lot of stress to the joints and surrounding structures. Wrist and hand injuries are commonly triggered in people with an already existing inflammatory or a degenerative joint condition.
Symptoms usually include pain, swelling, decreased mobility, and loss of grip strength.
Neck and shoulder injuries
Common injuries include neck sprains/strains, mechanical neck pain, Rotator cuff injury, bursitis, and tendonitis.
Heavy lifting, pushing, and pulling can cause immediate pain and injury to shoulders and neck. Importantly, this is most commonly seen when a person tries to perform a task without knowing the capacity and the ability of the joints to handle the load.
Tendonitis is an inflammation to the tendon that attaches to the bone. Repetitive movements, muscular imbalances or improper techniques can lead to inflammation.
Bursitis is an inflammation of the bursa that sits in between the tendon and the bone. The function of the bursa is to reduce the friction between the two. Tight muscles and tendons or muscular imbalances, can cause irritation to the bursa causing limitation to the joint function.
Tips to reduce your risk of gardening injuries
Lifting: Avoid lifting heavy objects in one attempt – instead, use a wheelbarrow or garden cart. Empty half a bag of soil into smaller containers and transfer. Additionally, lift with your legs and avoid bending and twisting at the same time. Also, get heavier objects closer to your body while lifting.
Weeding: Try to always take frequent breaks and do stretches to avoid the effects of prolonged position and stress to your joints. Try to change positions such as being on all fours, kneeling with knee pads, sitting on a step stool, and using standing weeding tools to avoid injuries. If it is an option, try to use ground cover plants to avoid the effects of weeding.
Planting: To avoid injuries to the smaller joints, try using bigger handled garden tools. Plant in a kneeling position using a kneeling pad or cushion. Try container gardening, using raised beds or flower boxes.
Mowing the lawn: Try to use an electrical mower over a gas one. Use your abdominal muscles and shoulder muscles and avoid twisting your back while pulling the cord of the lawn mower.
Stretching! Talk to your physiotherapist about which stretches are most appropriate for you.
In conclusion, gardening injuries can be challenging but it’s always important to listen to your body. Being mindful of how you are feeling and keeping the following tips in mind will help prevent gardening injures. Firstly, take frequent breaks and change positions when your feel aches, fatigue, or cramps. Secondly, try to do a variety of work, rather than doing the same repetitive movements. Also, always stay hydrated and apply a sunscreen while gardening. Lastly, contact a Registered Physiotherapist to help you stay safe while working in your garden.
Call PhysioNow today to book your appointment with a Registered Physiotherapist and Massage Therapist!
Why choose PhysioNow for Physiotherapy Mississauga?
• Over 16 years of providing top rated Physiotherapy Mississauga
There are 4 convenient locations- Erin Mills, Applewood, Lorne Park and Long Branch
• Awards/nominations? PhysioNow: nominated for a Top Choice Award in 2020.
• A team of highly qualified physiotherapists and massage therapists
All of our physiotherapists and massage therapists have several years of experience in their field and are registered in good standing with the College of Physiotherapy and Massage Therapy.
• Services we offer
Services are provided for all ages and for a variety of conditions. For instance, our therapists are specialized in several areas including manual therapy, acupuncture, vestibular rehabilitation, concussion , sports injuries, pelvic health and soft tissue techniques.
Lower Back Pain Treatments
Donjoy Defiance ACL Repair Brace
Return To Sport After ACL Ligament Repair
In addition, we do custom orthotics and braces. For your convenience, we are currently also offering our physiotherapy services virtually .
• Direct billing available
In addition, Direct billing is available to most of the insurance companies so it is convenient for you. For instance, we also deal with third party insurers like MVA and WSIB.
• Flexible hours and free parking available
Above all, we are open for extended hours ( ) to help you at a time that is best for you.
What to expect at Physiotherapy Mississauga?
First, you have an assessment with our physiotherapist. They will do a full check up of the problem area .
Next, the physiotherapist will then prescribe a treatment plan especially for you.
Further, they can also help you understand more about your condition.
We will answer your questions .
Lastly, changes may be made in your daily routine.
As a result, this will help you to get better faster.
COVID considerations: We take excellent precautions!
• Providing a face mask and use of 70% alcohol hand sanitizer for each patient upon arrival into the clinic
• Installation of sneeze guards at the front desk
• In addition, Sanitization of treatment beds after before each patient use
• Disinfecting commonly touched surfaces between every patient
• Switching out pillowcases with each patient use
• All staff will wear a gown and mask and wash hands between each patient contact
Car accidents are events that no one wants to be in. Unfortunately, traffic, weather conditions and bad driving result in hundreds of car accidents. These accidents occur daily, such as in Mississauga, Etobicoke and Oakville. These accidents can range from minor to horrible accidents. As a result, these terrible accidents can cause serious injuries. Thankfully, many of the accidents have few long lasting effects on your health. However, any accident can really affect your life. Physio for car accidents can help restore your health.
Role of your Car Insurance
There many things you need to do after a car accident. Firstly, you will need to tell your car insurance about the accident. Secondly, you will need to deal with the damages of the vehicle.
Above all, you need to recover from your injuries. It is important to report the accident as quickly as possible. As a result, it makes dealing with the car insurance a lot easier. If there are injuries , you can use the car insurance benefits to get physio for car accidents.
You will be assigned an adjuster from your car insurance to help you with your claim. As a result of the injuries, your adjuster will suggest Physio for car accidents.
The adjuster has a list of preferred clinics that provide Physio for car accidents. Many of these clinics will be located in Mississauga, Etobicoke and Oakville. PhysioNow is a preferred car insurance provider that will be included on the list from your adjuster.
What to expect at your assessment?
PhysioNow has 4 locations across Mississauga, Etobicoke and Oakville. We receive many referrals from people involved in car accidents. Our front desk staff will call you to book your initial Physio appointment. When you come in for the assessment, firstly we will get a bit of information about you and the accident. The role of the clinic administrator is to simplify the process of booking and billing.
Physio for Car Accidents Plan
Secondly, you will meet with the Registered Physiotherapist. The Physiotherapist will ask about the accident and assess your painful areas. Once the Physiotherapist has all of the information, they will complete your treatment plan. We will submit this to the car insurance adjuster on your behalf. This document will outline your injuries, and any medical history. It will also include the number and type of treatments that the Physiotherapist is recommending for you.
Car Accident Physio Options
Your Physiotherapist may also recommend massage therapy or other products to help you get better faster. The exact timeline of the treatment plan and how many visits are allowed will be dependent on whether the injuries are considered “minor” or “major” by the car insurance company. The Physiotherapist will be able to decide which treatment guideline that applies to you and they will discuss this with you. Once the forms are completed, the Physiotherapist will review the contents of the plan with you.
Follow-up Car Accident Physio Appointments
Follow-up appointments will focus on treatment and helping you to get better. The type of treatment received depends on the injuries. Normally, treatments will be as follows:
Firstly, you will get machines put on that reduce pain.
Secondly, hands on treatment techniques and lastly, exercises for home.
Recovery from a car accident can take time. The body takes in a lot of stress from the accident. Therefore, these injuries take a long time to heal. As a result, it is important to stay consistent with your treatment. In this way, the body can benefit the most. The goal is to help you to return to all of the activities that you were able to do before the accident.
FEES for Physiotherapy/ Massage Therapy after a Car Accident
All fees should be covered for the treatment you receive after a car accident. By law, your Physiotherapy clinic is required to first bill any extended health insurance (EHC) that you may have. Anything that is not covered by your EHC insurance is then passed on to your car insurance. You should never be out of pocket for treatment received for Physio after Car Accidents.
Our Physio clinic administrators will try to take the work out of the billing and paperwork for you! If you or someone you know has been involved in a car accident, Please give us at 289-724-0528. At PhysioNow we are ready to help! Same day appointments are often available. We have highly trained Physiotherapists and Massage Therapists at all of our locations.
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.
Shoulder injuries are a common problem for many people. It can happen to people of all ages from children to the elderly. The pain from shoulder injuries can be very severe and cause a lot of limitations with work and activity. Shoulder pain is one of the top 5 reasons why people seek out Physiotherapy and Registered Massage Therapy treatments.
What Causes Shoulder Pain?
There are several reasons why people suffer from shoulder pain.
Trauma
– any type of direct or indirect trauma can produce shoulder pain if the arm and/or shoulder is involved
Motor vehicle accidents
Falls
Sports injuries
Violent incidents
Poor workplace ergonomics
– For people who work in offices, they may spend the majority of their time sitting in front of a computer. If the desk set up is not properly, then this may start to produce stress and pain into the shoulder. For example, poor ergonomics can include:
poor desk and screen height
improper positioning of the keyboard and mouse
inadequate chair height and support
Proper desk ergonomics
Poor posture
– Many people have developed poor body postures over time. For some it starts young with spending a lot of time studying. It can also happen after carrying a heavy backpack or playing a lot of video/computer games. For others it starts later in life with workplace demands and poor office set up.
Good-Posture-vs-Poor-Posture
Repetitive activities
– Some people perform tasks that are repetitive at work and/or home. If the shoulder is not strong enough to support the work that it’s having to do, then injury may occur. For example,this can include:
Overhead lifting
Sorting things on a belt
Operating heavy machinery
Typing
Congenital or Developmental changes –
Some people are born with a unique bone structure that may place them at increased risk of injury. For example, the acromion of the shoulder blade can have 4 different shapes. For instance, if you have a hooked shape, there is more potential for rotator cuff injury.
Some Basic Shoulder Anatomy
Having some knowledge of basic shoulder anatomy will help with understanding why shoulder pain develops. The shoulder joint is quite complex. There are a lot of structures that attach to or around the shoulder. The shoulder allows for a lot of movement . As a result, there is less stability through the area. It’s a joint that is held together by soft tissues. Therefore, there is not a lot of bony protection. The shoulder is made of 4 separate joints that work together to allow function:
Shoulder Anatomy
Glenohumeral (GH) joint – this is a ball and socket joint and is where majority of our arm movement happens. The socket is made up by part of the shoulder blade and the ball is made up of the humerus, which is the long bone of the upper arm.
Acromioclavicular (AC) joint – joint between the acromion of the shoulder blade and the collar bone.
Sternoclavicular (SC) joint – joint between chest bone and the collar bone.
Scapulothoracic joint – the joint between the shoulder blade and the ribs at the back of the chest.
The Soft Tissues around the Shoulder Joint
We know that the shoulder is held together by many soft tissues including ligaments, muscles and tendons. Other important structures include the joint capsule surrounding the ball and socket joint. Lastly, your shoulder has subacromial and subdeltoid bursae. The function of the joint capsule is to protect the joint and produce a lubricating fluid. Shoulder bursae are small fluid-filled sacs that act as a cushion between the bone and other moving parts.
Bursae of the shoulder joint
What are some of the types of injuries that can happen to the shoulder?
Sprains/Strains of any of the muscles, tendons and ligaments
Tears/Ruptures of any of the muscles, tendons and ligaments
Rotator Cuff Tear
Rotator Cuff Tendonitis
Tendonitis/Tendinosis
Fractures
Bursitis
Dislocations
Adhesive Capsulitis or Frozen Shoulder
Osteoarthritis
Nerve entrapments/injuries
Signs and Symptoms of Shoulder Injuries
Pain
Swelling
Restricted movement
Weakness
Instability
Bony deformities
Healing Times for Shoulder Injuries
The healing time for shoulder injuries will vary depending on the injury. Most simple sprains/strains will likely take anywhere from 6-8 weeks to get better.
Fractures of the Shoulder can take 6-8 weeks to heal the fracture. After the fracture is healed, the soft tissues may require up to 4-5 months to heal fully with proper Physiotherapy.
However, frozen shoulders can take over 1 year to improve. There are also a lot of individual differences in healing time amongst different people, even for similar injuries. For example, some of these factors can include:
Age
Severity of Injury
Was surgery required ?
Level of fitness and/or mobility
Commitment to treatment
Ability to modify workplace or home environment to allow for best treatment response
Presence of other injuries
Amount of time that the injury/pain has been present
Physiotherapy/Massage Treatment for Shoulder Injuries
Treatment for shoulder pain will depend on the type of injury. It will also depend on the area that has been injured.
However, since the shoulder is made up of 4 joints, treatments should target the whole shoulder and not just the individual area injured. This will allow the shoulder to return to its full function. It will also reduce the risk of re-injury.
In sum, the main goals of any shoulder pain treatment will be to:
Decrease pain
Regain full movement
Recover strength and stability
Return to pre-injury activities
Registered Physiotherapy for Shoulder Injuries
A Registered Physiotherapist will start with a full assessment so that we can identify the source of the shoulder pain. This will allow us to provide the best treatment for you. Treatment can typically include:
Manual therapy
soft tissue work
mobilizations
assisted stretching of the shoulder and nearby areas
Modalities – these are usually used in the early phase for pain relief
Ultrasound
Laser
IFC or TENS
Heat/Ice
Exercise prescription
Movement and strengthening exercises that are specific to the injury
So, it is important that you complete the prescribed exercises on a regular basis at home.
In short, this will ensure that you are continually providing treatment to the shoulder even when you are not physically present in the clinic.
Education
Explanation of the condition
Rationale for the treatment choices
In essence, Do’s and don’ts to help the injury along
Registered Massage Therapy for Shoulder Injuries
Registered Massage Therapy can be very helpful to release tight muscles around the upper back, neck and shoulder blades
Registered Massage therapy for shoulder injuries
Shoulder injuries can be quite debilitating, and it is important to seek out a Registered Physiotherapist for assessment and treatment sooner rather than later. Like most other injuries, the longer an injury is left untreated, the more chronic it becomes. As a result, it makes it more difficult to resolve in a timely manner.
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.
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.
Vaginismus is a painful feeling of discomfort or inability when inserting a tampon, finger, penis or during a doctor’s internal pelvic exam. It occurs when there are involuntary contractions of the muscles in the outer third of the vagina.
Primary Vaginismus: when a woman has never been able to have pain free intercourse due to pelvic floor muscle spasm.
Secondary Vaginismus: pain that develops sometimes later in life after a traumatic event such as childbirth, surgery, or a medical condition.
With Vaginismus, there is usually significant Connective Tissue Dysfunction that needs to be addressed first before any internal work. It is suggested that you follow up the self-help treatment for connective tissue dysfunction before embarking on the stretching exercises with the dilators.
Pelvic floor exercises and Desensitisation techniques
A physiotherapist may be able to teach you pelvic floor exercises, such as squeezing and releasing your pelvic floor muscles, that can help you gain control over the muscles causing the vagina to close involuntarily. Occasionally, a technique called biofeedback may be useful. A small probe is inserted into your vagina. This monitors how well you are doing the exercises by giving you feedback as you do them.
Biofeedback can help with the following:
• Teach you strategies that may help to relax the muscles that are contracting involuntarily
• Teach you appropriate timing of the contraction and relaxation of the pelvic floor muscles.
• Educate you about your condition and why it might be occurring.
• Teach you various strategies for getting the muscles to relax
• help you to Use manual therapy to release the muscles either externally and/or internally that are causing the contractions.
More information about Vaginismus can be found here.
Some general tips about pelvic floor muscle exercises:
• Choose a convenient time and place where you can exercise regularly.
• Put a reminder about pelvic muscle exercises somewhere obvious to you (or set an alarm on your watch or mobile phone).
• Avoid quick pelvic floor muscle exercises where you don’t hold the contraction. This tends to cause an increase in pelvic floor muscle resting tone.
• Be aware that it will take 6 to 8 weeks of regular exercise before you can expect to see improvement. It will take approximately 3 months for the pelvic muscles to strengthen.
• You could try inserting one finger into the vagina to check the strength of your squeeze as you pull in the pelvic muscles. Alternatively, you may be able to feel a pelvic floor contraction if you place the tip of your index finger on the perineal body (on the outside, between the vagina and back passage).
Other tips to reduce Vaginismus:
• If you are overweight, try reducing your weight.
• Try not to become constipated, as a full bowel will put pressure on the bladder. Straining to empty your bowel will weaken the pelvic muscles.
• If your job involves lifting, think of your pelvic muscles as well as your back. Pull up your pelvic muscles when lifting a heavy weight.
• If you smoke, consider quitting. Frequent coughing puts a strain on the pelvic muscles.
If you or someone you know suffers from Vaginismus, please call PhysioNow today! Our specially trained Physiotherapist can start your treatment Now!
