All posts by kristina

How does breathing work… Part 1

Breathing… it’s essential for life! It’s also something so basic we never give it a thought.

That’s because breathing (AKA respiration) is an automatic function, subconsciously controlled by the respiratory center at the base of the brain.

While we can control our breathing rate and even hold our breath voluntarily, we do not need to think about it all the time. Breathing continues whether we are awake, asleep, or even unconscious!

Respiratory muscles

There are several respiratory (or breathing) muscles involved in the process:

Diaphragm

  • this is our most important respiratory muscle!
  • It is a dome-shaped muscle that separates our chest cavity (where the heart and lungs reside) from our abdominal cavity (where the rest of our internal organs are).
  • What’s more, the diaphragm has multiple attachments: the sternum, ribcage, and spine

Intercostal (rib) muscles

  • These muscles lie between your ribs, attaching them to one another.
  • There are three layers: external, internal, and innermost.

Cervical (neck) muscles

  • these are referred to as the “accessory” muscles of respiration, and include the scalenes, sternocleidomastoid (SCM), levator scapulae, and the upper fibers of trapezius (“traps”).
Posterior view of neck musculature (layers of muscles in the back of the neck)

Abdominal muscles

  • include the rectus abdominus (our “six-pack” muscle), the internal and external obliques, and the transversus abdominus (the “inner core”)

Other…

  • Other accessory muscles that are in the chest and back area include: pectoralis major and minor (“pecs”), latissimus dorsi (“lats”), and the superior serratus posterior.

What are “accessory” muscles of inspiration?

Accessory muscles (found in the neck, chest, and back) are typically needed during heavy exercise, a stressful situation, during an asthma attack, or in someone suffering from COPD. In other words, when breathing becomes hard work and more energy is needed!

However, when these accessory muscles are habitually used, our breathing pattern changes and that can have wide-ranging effects…

So how does breathing work?

Breathing in…

  • As you breathe in (or inhale), the diaphragm contracts and moves down in order to increase the space in the chest cavity. That’s because your lungs are filling with air and need additional space to expand.
  • The intercostal muscles also help to spread out the ribs (by pulling them upward and outward) and allow for the chest cavity expansion.
Schematic of the path air takes as it travels into the lungs and where the diaphragm sits
The Diaphragm

Breathing out…

  • Interestingly, exhalation is a “passive” process, meaning that no muscle work is required.
  • As we naturally breathe out (or exhale), there is an elastic recoil from the lung tissue, which pushes the air out of the airway.
  • However, if we are engaged in vigorous exercise, or if we forcefully exhale, that will require muscle work. Specifically, the abdominal muscles help out the most. They contract to raise the abdominal pressure so that they can push the relaxed diaphragm up into the lungs, and in this way, push the air out.

The “correct” breathing pattern

Normally, as we inhale and the diaphragm and intercostal muscles contract, the ribcage expands from all sides. While the chest rises a bit, the lower part of the ribcage (upper part of the abdomen) should rise even more.

As we exhale, the chest and upper abdomen fall back in.

You can test this yourself! 😊

Place one hand on your chest and the other hand below the chest (upper abdomen). Take several regular (or slightly deeper) breaths, pressing the hands into the chest and upper abdomen. On the inhale, you should feel the bottom hand rise a bit more than the top hand.

Image of Oakville physio hand positions when testing for (or cuing for) diaphragmatic breathing
Hand cues for diaphragmatic breathing

To test overall ribcage explosion, place your hands on your sides, high enough that you are pressing into your lower ribs. The thumbs will be feeling more the back portion while the rest of the fingers more of the front portion. Press into your ribs as you take several regular (or slightly deeper) breaths. You should feel equal expansion on both sides as you inhale. Note if there is movement on the front, side, and back of where you are pressing!

Hand placement ensuring full ribcage expansion

Why does this matter?

Aside from bringing oxygen into our body and expelling carbon dioxide, our breathing has an impact on many other areas of our body and health…

Stay tuned for Part 2 to learn how breathing can impact our ribcage and joint mobility, our posture, our core strength, our pelvic floor function, and even our stress levels!

Why Are Bike Helmets Important…

We’ve had an early summer this year and beautiful weather! Combine that with the disruption of our routine and staying home a lot more during Coronavirus closures of public spaces, people have been taking advantage of the warm weather. Everywhere I go, I see lots of walkers and lots of bikers…

Interestingly, a lot of bikers without helmets!

While wearing a helmet is left up to the discretion of those 18 years and older, it is required by law for those under the age of 18.

Why are helmets important for cycling?

The reason is quite simple… the risk of falling and hitting your head is much higher. Specifically, hitting your head can result in:

  • Concussion
  • Acquired brain injury
  • Death

When it comes to children, we often say they heal and bounce back much faster than adults. However, when it comes to the developing brain, the opposite is true. Because the brain is not yet fully developed in childhood, this makes children more vulnerable to head injuries.

While the plasticity of the brain, especially in childhood, means that the brain can reorganize itself and create new connections to heal, the problem is that we often cannot tell how a brain injury in someone younger will affect their future development. Some longitudinal studies do suggest that children with a history of head trauma are more likely to be treated for mental illness in the future, be on disability, or not finish secondary education.

picture shows children wearing bicycle helmets while cycling in a physio blog regarding helmet and cycling safety
Bicycle helmets are mandatory for anyone under the age of 18

Therefore, it makes sense that the law requires those under 18 and not yet old enough to make all of their safety and health decisions independently, to wear helmets. But if you are an adult, you know better. Right?

However… would you say that seatbelts in cars or motorcycle helmets should be up to adult discretion as well? While they differ from cycling in that they are going much higher speeds, these are still the same vehicles that a cyclist has to share the road with…

You may feel confident in your cycling ability and doing so safely, but it doesn’t mean you can control everything and everyone in your environment!

More than that, while someone in a vehicle is quite protected in the event of an accident, someone on a bicycle is much more vulnerable to injury.

Did you know?

  • In a 2013-14 study, only 42% of cyclists aged 12 years and older reported “always” wearing a helmet.
  • Wearing a bicycle helmet can reduce the risk of head and brain injury by 85%! Those are great odds!
  • As a side benefit, helmets can protect you from inclement weather and direct sunlight, helping riding visibility!

Here are some other facts to consider… According to CAA and Statistics Canada:

  • July sees more cyclist injuries and fatalities than any other month of the year! (No doubt the beautiful weather brings out everybody who has a bike on the roads and trails…)
  • Most cyclist injuries and fatalities occur at intersections, or locations with a traffic light or sign
  • Most cyclist fatalities occur on city roads

The reality is that a split second can change your life. A helmet in that moment can be a deciding factor in how much everything changes.

Rules of the road for cyclists…

While cyclists and drivers often don’t meet eye-to-eye, they still have to coexist.

Since city roads tend to be the most dangerous routes for cyclists, here is a quick review of the rules of the road to follow for everyone’s safety!

  • A bicycle is considered a vehicle on the road, same as a car or a truck
  • Therefore, cyclists must obey all of the same traffic laws as cars and trucks
  • This means, obeying all traffic lights and signs. (Therefore, it’s good to familiarize your children with the common traffic signs seen on roads and intersections.)
  • Cyclists must signal their intentions on the road, e.g. turning or stopping
Oakville physio demonstrating left hand turn signal for cyclists in bicycle safety and helmet blog
Left hand turn signal
  • Cyclists can ride on most roads, except highways (e.g. the QEW and other 400-series highways)
  • As per Toronto’s bylaws, anyone over the age of 14 cannot ride on the sidewalk. If they feel it is dangerous to ride on the road, they must dismount the bike and walk it along the sidewalk. This rule is not specific to the Ontario Highway Traffic Act but can be part of local city by-laws!
  • Cyclists must stay as safely to the right side of the road as possible when being passed
  • The One Meter Passing Law states that all vehicles passing a cyclist must do so at a one meter minimum distance from the cyclist
Oakville physio demonstrating right hand turn signal for cyclists in bicycle safety and helmet blog
Right hand turn signal
  • Cyclists must dismount across a road with a crosswalk at the intersection and walk their bike to the other side
  • If there is a crossride section at the intersection, and the light for cyclists is green, you can ride across
  • Cyclists cannot take passengers, unless the bicycle is designed for more than one person
Oakville physio demonstrating stop hand turn signal for cyclists in bicycle safety and helmet blog
Stop (or slow down) hand signal

Failure to comply with the above laws can result in a fine!

For more detailed information, visit the Ontario’s Ministry of Transportation website!

What is an approved bicycle helmet?

An approved bicycle helmet that meets safety standards should have a sticker on the inside from one of the following organizations:

  • Snell Memorial Foundation: Snell B90, Snell B95, Snell B90S, or Snell N94
  • American National Standard Institute: ANSI Z90.4-1984
  • American Society For Testing and Materials: ASTMF1447-94
  • British Standards Institute: BS6863:1989
  • Standards Association of Australia: AS2063.2-1990
  • United States Consumer Product Safety Commission (CPSC) 16 CFR Part 1203

Make sure the helmet is the right size and fits comfortably.

Lastly, here’s a Safety Checklist to look over before getting on your bike!

  • Go over your ABCs! Air, Breaks, and Chain checks!
  • Standard issue bike helmet
  • White light/reflector mounted on the front
  • Red reflector on the back
  • White reflector on the front wheel
  • A red or white reflector tape on the back wheel
  • Functional bell

The reflectors are all mandated by law to ensure you are visible to other vehicles!

Reflector lights and tape are mandatory for cyclist visibility on the road

Other Safety Tips:

  • Do not wear open toe shoes or slip on shoes
  • Wear reflective clothing when it’s dark out
  • Ride on the right side of the road (with the flow of traffic)
  • Check your blindspots when making a turn (look over your shoulder)
  • Let drivers know your intents, e.g. using your arm to signal a turn
  • Be cognizant of driveways where a vehicle may be pulling out

Here at Palermo Physio we treat any bike-related injuries from falls to vehicle collisions, and from fractures to concussions… If you’ve had a bike-related injury, let us know so we can help!

Happy biking! 😊

Why Imaging Isn’t Everything…

When we have pain, we often expect that imaging the area will tell us the cause. However, there tends to be a lot of controversy in the health care field about how helpful imaging actually is in the diagnosis of pain.

If you’ve had a fall resulting in…

  • pain, swelling, bruising in the area
  • difficulty with movement or weight-bearing

Then X-rays to rule out a fracture are important! Knowing early on if it is a fracture and the extent of it can dictate minimum the next 6-8 weeks of your treatment plan.

Showing leg fracture or broken leg and physiotherapy after injury provided virtually by Oakville Palermo Physio, to Ontario, Halton, acton, Georgetown, Burlington, Milton
Ankle fractures are diagnosed on X-ray

If you’ve hit your head and/or suffered a concussion with the following symptoms:

  • weakness on one of side of your face or body
  • difficulty speaking, hearing, or swallowing
  • impaired vision
  • seizures
  • repeated vomiting
  • one pupil is larger than the other
  • severe headache
  • loss of consciousness

Then, ruling out skull fracture and bleeding would be critical and time-sensitive!

Girl with stars around head showing vertigo and other symptoms post concussion, and/or head impact. Concussion is treated by Physio.
Concussion and other head impacts may be assessed using a CT scan, or MRI

Or, if you are experiencing any of the following “Red Flags”:

  • loss of bowel / bladder control
  • difficulty voiding either bowel or bladder
  • loss of sensation in groin, genital, and anus areas
  • unexplained weight loss / gain

Then, ruling out any serious causes would be critical and time-sensitive!

However, when the pain is more insidious and/or persistent, imaging results may not always give the most useful information…

What are the different types of imaging anyway?

Here we’ve listed the more common types of imaging for musculoskeletal (muscle, bone, general soft tissues) injuries:

X-ray radiography: X-rays are a form of electromagnetic radiation and are used primarily to detect bone fractures or degenerative changes. Can also pick up on certain tumours, pneumonia, calcifications, and foreign objects.

Computed Tomography (CT) Scans: combines X-rays with computer processing to get cross-sectional images of the body in order to form a 3D X-ray image. They are more detailed than regular X-rays and can show different angles of the imaged area.

CT scan machine depicted in blog discussing different types of imaging, when imaging should be used, and when it does more harm than good.
CT Scan

Diagnostic Ultrasound: Not to be confused with Therapeutic Ultrasound often used in Physiotherapy clinics, Diagnostic Ultrasound is a form of imaging using high-frequency sound waves. It is used for monitoring fetal growth during pregnancy, as well as visualizing organs (e.g. heart, liver, etc.), blood vessels, and soft tissues (e.g. muscles, ligaments). However, it is not good for visualizing bones or tissues that contain air (e.g. the lungs).

Magnetic Resonance Imaging (MRI): using powerful magnets, MRI machines are able to provide detailed 3D anatomical images. They are used to visualize bones and soft tissues in great detail. Unlike X-rays or CT, they do not use damaging radiation. However, the magnetic field is dangerous for people with implants, especially ones containing iron (e.g. pacemakers).

Fetal ultrasound picture, in blog discussion different types of imaging, their uses, and when imaging does more harm than good.
The most common type of Ultrasound people are familiar with is Fetal Ultrasound

So why not get imaging just to be on the safe side?

Maybe you haven’t had a fall, or hit your head, but you still have pain. So why not get imaging just to make sure nothing is wrong? Of course you can, and oftentimes, that is precisely what doctors do.

But do not go into the lab expecting the imaging results to provide all of the information for why you have pain, or point you toward the best solution. Imaging is often only one puzzle piece in the diagnosis and solution, and sometimes it is not needed at all.

Image depicts hands holding puzzle pieces to illustrate that medical imaging is only part of the diagnosis and hardly ever tells the whole story, in a blog by Oakville Physio discussing the pitfalls of imaging.
Imaging results can only provide a part of the answer but hardly ever tell the whole story…

Based on your symptoms and their onset, your doctor may also weigh the risks associated with imaging. After all, if imaging is unlikely to provide useful information, is it worth being subjected to the radiation from X-rays or CT scans?

  • Radiation from X-rays and CT scans increases risk of cancer
  • X-rays and CT scans to the low back in child-bearing adults will expose the ovaries and testicles to radiation
  • Imaging will often reveal benign abnormalities unrelated to the pain, which can lead to unnecessary worry, testing, and more invasive procedures
Caution sign illustrating the need to weigh pros and cons to medical imaging in a blog by Oakville physio discussing the pitfalls of imaging and the effects on the patient.
Imaging may come with risks so it’s good to stop and weigh the pros and cons…

A lot of health care practitioners worry about what the effect of the imaging results have on the person on the receiving end.

Often, our imaging results begin to define how we view our body…

The language on the imaging reports can be harsh and difficult to parse out, because it’s laid out in medical terms and categories that are usually not explained to patients in terms of:

  • what is normal,
  • what it actually means for quality of life,
  • how these results are influenced by our environment, lifestyle, or stress
  • or, what symptoms can be reasonably expected based on these results

As a result, our story changes to one where our body is brittle and falling apart… when the reality is that our bodies are actually quite adaptive and resilient.

Senior couple practising yoga in nature. Blog post on pitfalls of imaging and not being defined by our test results.
Degenerative changes on imaging shouldn’t stop you from living an active life!

Maybe you have some experience with this… If you’ve had imaging in the past that has found some disc bulges and degenerative changes in your back, you might be more conscious of having a “bad back” and worry frequently about which activities you should avoid.

If you’ve had more chronic pain and recurrent imaging, think about whether or not the new images have ever shown much change in your joints or tissues, or given an explanation for a recurrence of acute pain. If not, perhaps you agree that there must be more to the story than just what the X-ray or MRI shows!

So today we will take some time to lay out the facts…

1. Degenerative changes in your spine, joints, and soft tissues are normal.

  • After age 30, bone density begins to decrease, cartilage can thin, discs and ligaments and tendons become more rigid and stiff, and we lose muscle mass faster. This is why nutrition and exercise matter more as we get older.
image depicting knee x-ray results in a blog by Oakville Physio discussing when imaging should be done, and when there may be more harm than good
X-ray image of degenerative changes in the knees

2. You can have degenerative changes (including disc bulges, rotator cuff tears, joint degeneration ranging from mild -> moderate -> severe) and have no pain!

  • Imaging studies show that a high proportion of asymptomatic and healthy individuals can still have any of the above findings. E.g. Prevalence of disc bulges in asymptomatic 20-year-olds was found to be 30%! In asymptomatic 80-year-olds, it was 84%!

3. OA changes were present for a long time before your sudden onset of pain. While they may be contributing to the symptoms, they were not an issue before, which means that they are not the only factor to consider.

  • Studies show that other factors have a significant impact on whether or not these OA changes become an issue (e.g. weight, muscle mass / strength, previous injuries, lifestyle factors including activity level and nutrition).

4. Disc herniations may not heal in the traditional sense, but it doesn’t mean they will always be source of pain!

  • Eventually, they become asymptomatic as the inflammation and/or nerve irritation subside. Studies have also shown that herniated parts of the disc can sometimes be reabsorbed by the body so they are no longer an issue.
Low back pain, often associated with disc injuries, can restrict our recreational activities, such as gardening. Image in blog discussing facts about imaging and degenerative changes, including disc bulges and herniations.
Low back pain can have many causes but becomes a more persistent concern when X-rays show degeneration

5. Almost all musculoskeletal injuries will heal between 3-6 months. Rehab for a fracture, such as the ankle, can take about 1 year. Which means that the persistent pain you may be experiencing has less to do with what you find on imaging, and more to do with other factors.

  • Sometimes the nervous system can be a contributing factor to persistent pain. Check out our Pain Series blogs to learn more!

So what does all of this tell us?

Hopefully all of this information has given you a clearer insight into when should we image and why imaging isn’t everything. From this point on, take all imaging with a grain of salt and remember that it’s only a part of the puzzle, not the whole story!

If your imaging has shown degenerative changes, know that there are things you can do to help pain, quality of life, and focus on prevention. If you are having joint or muscle pain, if you have osteoarthritis, if you have nerve pain… ask us how we can help!

Lifestyle changes as a theme – Part 3

Welcome back to our Lifestyle Changes series. Today’s theme is… themes! 😊

In Part 2, we talked how to get started on making healthier changes to our lifestyle, using a more goal-oriented approach.

But maybe if you’ve already tried SMART goals (or something similar) and it didn’t work for you. Or maybe you find the idea of having a specific goal and deadline daunting.

Perhaps you have a general idea for lifestyle changes which doesn’t fit too well into a “specific” goal.

That’s alright!

But how will I progress if I don’t have a goal?

The approach we take to lifestyle changes is not one-size-fits-all. Depending on the person, the goal, or even in which phase of change you find yourself in, sometimes it works better to have a specific target… but other times the change needs to be more broad.

This is where THEMES come in!

When we are looking at a more general topic such as “lifestyle changes” to improve health and wellbeing, the roadmap may not be as clear. These kinds of changes can be as simple as wanting “more of something” or “less of something” in your life.

Think of Life as a series of choices, or a branching path. Every choice can take you on a slightly different path, which then opens up other opportunities. Having a theme for the changes you wish to enact can help guide those choices!

Examples of Themes

Usually, a theme corresponds to a more long-term period of time, such as a year. Here are some examples:

  • Year of Health
  • Year of Nutrition
  • Year of Gratitude
  • Year of Mindfulness
  • Year of Reading
  • Year of Learning
  • Year of Saying Yes! (check out a book of the same idea and title by Shonda Rhimes, creator of the TV series Grey’s Anatomy!)

Choose a word (or theme) that resonates with what you need more of in your life. And as you go through the days and weeks, every time a choice comes along, you can ask yourself if it aligns with your theme.

In this way, you may even start to be aware of choices or paths that you would not have noticed otherwise!

This method also allows your idea of what the theme means to you to evolve over time…

So when you have a year of Health, choices like parking further away to walk to the store, or taking the stairs instead of the elevator, or getting the less calorie-dense smoothie, or picking up a less sugary snack, or going for a walk instead of watching another episode… naturally come up without you having to plan or force them.

And as you continue making these types of choices, your ideas of what is healthy may gradually evolve to what works best for you!

A year is such a long time…

If you feel a year is too long-term, you can try seasons instead! Here are some examples 😊

  • A Spring of Movement (focusing on being more active for instance)
  • A Summer of Nature (connecting more with Nature and spending time outside)
  • A Fall of Family (spending more quality time with your family, whatever that means to you)
yoga stretching poses from an oakville virtual physio
  • A Winter of Reading (getting to that ever-growing book list and replacing time spent scrolling on your phone with a good book… whether it be a physical copy, audiobook, or Kindle version!)

In the meantime… we are here for you!

If you are being limited by pain or injury, let us help. From Physiotherapy and Massage Therapy to Chiropody, and even Yoga Therapy, we can support you along your health and wellness journey.

We are getting ready to re-open our physical doors, but we will also continue seeing patients virtually for Physiotherapy to accommodate for those who may be immunocompromised, still maintaining social distancing, or are located more remotely!

Tips on how to start and maintain Lifestyle Changes – Part 2

Welcome back! In our last post, we talked about what lifestyle changes are, along with some examples to get you started.

As we noted before, making changes in your routine or behaviour is easier said than done! Often, like New Year’s resolutions, these changes fall by the wayside within a few weeks.

Today, we are going to share some tips on how set yourself up for success from the beginning, and how to maintain those changes when the going gets tough!

How to get started…

Making changes to our routine and lifestyle is not something that happens spur of the moment. Making healthy choices requires conscious effort. Ultimately, we will not have the same motivation every day, or at all times of day.

So first things first, give yourself grace and permission to fail once in a while. It’s not a big deal! The important thing is to get up and try again, instead of giving up altogether 😊

Next, help yourself in advance! Make a specific plan that will give you clarity on what you want to achieve and how you will achieve it, so it can carry you through future obstacles that arise.

If you haven’t heard of SMART goals, this is a good time to brush up on them!

image of a post-it note that says "set goals" with to-do list and phones in background, to demonstrate SMART goal setting for lifestyle changes, by an Oakville Physio

S – be specific

What exactly would you like to achieve?

A lot of people might say “Exercise more”but that is too vague. What does that mean to you? What, when, where, how, and for how long? What about… exercise for 20 minutes, 3x week. Or… go for a fast-paced walk for half an hour every weeknight.

M – how can you measure your progress?

If you have a walking or running goal, it can be measured by how often in the week you go (frequency), the duration or distance covered, the speed, the effort exerted…

A – is this goal achievable?

If you don’t believe it is, modify it. What would make it achievable? If you had started with “lose 50 lbs in 3 months”, maybe change it to something more realistic like “lose 15-20 lbs in 3 months.”

R – is this goal relevant?

Is it relevant to your values and beliefs, or to a bigger picture goal?

If you want to quick smoking to manage your diabetes and hypertension, so you can reduce your reliance on medication and be healthy enough to keep up with your grandchildren, that makes sense.

If you are doing it just because you think you should, or other people are telling you to, then the motivation behind it might not be strong enough to see you through.

T – is it time-bound?

A time-bound goal is more likely to motivate you.

If you’d like to be fit enough to spend hours walking on your trip in Scotland in six months, or if you are training for a half-marathon scheduled in eight months, then that’s a clear deadline.

Based on that deadline, you can work your way backwards to create smaller checkpoints along the way to make sure you are improving. E.g. check-in with your progress at the end of every month, then plan out your next steps.

It’s a good idea to sign up for something before you feel ready (as long as you have a reasonable amount of time to get ready for it). When you’ve put money down and the date is set, you are more motivated to work on it!

Tips on how to keep going once you start!

  • Remember to start SMALL! As you progress, you can then take bigger steps, or add a second small goal. If your goal is to meditate regularly, know that starting with 20-30 minutes / day will likely not go well. Instead, start with 5 minutes and a timer. Then after 1-2 weeks, try 8 minutes, then 10 minutes, etc.
  • Focus on one behavioural or routine change at a time! The more you add at once, the less likely you are to succeed. However, it is reasonable that if you are starting with a small change, such as drinking more water, then perhaps a second change such as walking 3x week, can be added at the same time.
  • It is important to remember that lifestyle changes of any kind will take time and will benefit from the support of our loved ones. Even if people around you are not as supportive, you can find inspiration on social media accounts that reflect your interests and goals, as well as on podcasts and in books.

Support can take many forms. For example:

  • Having someone babysit the kids, or help with some household chores while you go to a yoga class
  • Meeting with friends at restaurants with healthier food options, or for a walk instead
  • Giving you encouragement instead of making negative comments
Boy growing shoing physio to kids, massage, foot clinic, wart treatment

To take this a step further, accountability is key. If you have no one to be accountable to, you’re much less likely to stick to your change. Examples can be:

  • A friend or family member you’ve asked for support beforehand
  • A social media group where you can post your progress regularly
  • A habit tracking app, because as the days add up it becomes more of a motivator to keep going! For example, DONE app allows five habits / time for free and can give reminders!

Lastly…

  • If you are looking to quit a habit, rather than adding one, consider replacing the unhealthy behaviour with a healthier one. This probably makes the most sense with food, or with too many hours of screen time.

How can Physio help?

If you do have health issues that may limit some lifestyle changes, do speak with your doctor about what may or may not be right for you.

When it comes to Physiotherapy, we can help if…

  • your lifestyle goals relate to getting more active,
  • or reaching a fitness goal safely
  • or you are returning to sport after an injury

…but you are limited by pain or injury, live with a chronic illness, or have recurrent injuries.

If you are still unsure if Physiotherapy is right for you, Contact us for more info. We are in the process of re-opening our physical doors which is very exciting!

shows woman receiving Telehealth / tele rehabilitation in Milton, Oakville, Burlington Ontario for pain.
Virtual therapy!

But in the meantime, virtual sessions are available and will continue to be so even after re-opening, for anyone who is immunocompromised, still keeping to social distancing, or located remotely.

Also, stay tuned for the last instalment of our guide on Lifestyle Changes! If making SMART goals is not working for you, or you find the idea overwhelming, we will be discussing a theme-based approach!

What are some lifestyle changes YOU can benefit from? – Part 1

What are “lifestyle changes” anyway? It’s a rather vague expression that gets thrown around a lot.

And just how easy is it to actually change your lifestyle?

Lifestyle changes are modifications you can make in your daily routines or behaviours.

Often, they are mentioned in regards to making healthier choices when it comes to mobility, exercise, nutrition, stress, and sleep.

These choices, however, are only going to enact effective change if they eventually become habitual. Therefore, just like New Year’s Resolutions, they’re easier said than done!

This is because changing our routine and our lifestyle can be met with resistance from:

  • Our environment: no matter how big we may dream, when the going gets tough, we fall back on the convenience of our environment. If you want to wake up early and go to the gym, it makes a difference if the gym is a 15 minute drive away, or downstairs in your basement.
barbell and weights shown in lifestyle changes blog when giving an example of our environment e.g. the convenience of home gym vs going to a gym

This is why you need to plan in advance, start small, and be realistic!

  • The people around us: ever heard of the expression “you are the average of the five people you spend the most time with”? The people closest to us tend to mirror (and reinforce) our lifestyle choices, values and beliefs. Though they care about us, when you start making choices that make them feel like you’re changing into someone different, leaving them behind, or doing better than them, they may initially be resistant.
Nordic pole walking can be a form of exercise when looking to make positive lifestyle changes; it helps to have a friend support you when making changes

This is why it helps to either talk to them about your decisions to change beforehand and maybe ask for their support, or find other people you can turn to for support!

  • Ourselves: chances are, a lot of our current choices are made on autopilot. Conscious decision-making throughout our day is a finite resource, which is why we often resort to autopilot. Additionally, our routines and current lifestyle are likely rooted in our deeper value and belief systems. E.g. If we view exercise as punishment, even we when resolve to exercise more, we are much more likely to sit back on the couch and watch another episode.

This means that change will be an active, conscious process that takes time, and in some cases may benefit from the help of a professional!

Could you benefit from making some tweaks in your life?

If you can identify with any of the following, then you probably could!

  • Do you live with chronic pain? (For more information on Chronic Pain, check out our Pain Series posts Part 1, Part 2, and Part 3!)
  • Do you live with a chronic illness? E.g. Type II Diabetes, Hypertension (high blood pressure), Arthritis, Heart Disease, Multiple Sclerosis, etc.
  • Do you regularly take multiple medications, long-term?
  • Do you struggle with managing your weight?
  • Do you live with high levels of stress, worry, or anxiety?
  • Do you have trouble sleeping?
  • Do you have a high rate of injury? E.g. back, knees, shoulders, neck, ankle, foot, etc.

Here are some examples of Lifestyle Changes…

If you know you need to change some things for your health and quality of life, but are at a loss for where to begin, here are some suggestions you can use to get you started!

MOBILITY & EXERCISE

  • One minute movement breaks, e.g. set a timer for every 2-3 hours and then get up to stretch, or do a specific exercise (such as heel raises, squats, forward bends, marching in place, etc.)
  • Parking farther away when going to the store, so you have to walk more
  • Taking the stairs for 1-2 floors, instead of the elevator (or getting off the elevator a floor earlier)
Lifestyle changes for greater exercise and mobility can mean taking the stairs more often if you can
  • Choose an activity you enjoy rather than something you think you should do (e.g. if you prefer biking to running, or a Zumba class to going to the gym, that’s fine!)
  • 2-3 days per week commit to going for a half hour walk
  • Commit to a yoga video at home for 20 minute, 3x week. (If you are new to Yoga, check out our Yoga Series for beginners!)

GETTING FRESH AIR & CONNECTING WITH NATURE

  • Sit outside on your patio or balcony for 10-15 minutes daily. Bring a book or a cup of tea. Maybe enjoy the scenery instead of scrolling on your phone!
  • 2-3 days per week commit to going for a half hour walk
  • Try to find routes that are along trails and in parks, rather than by a busy street
Mount Nemo - encouraging walks and time spent in nature as part of lifestyle changes for improved health and wellbeing

SOCIAL CONNECTION

  • Commit to at least one family meal on weekends without any screens or devices
  • Commit to a phone-call (or a Zoom call!) with someone whose company you miss at least 1x week…
  • Or a coffee-date with friends whose company you enjoy 1x every two weeks (once social distancing comes to an end)
Couple on bike showing seniors; emphasizing importance of social connection, mobility, and spending time outside for positive lifestyle changes and wellbeing.

STRESS MANAGEMENT

  • Meditation: sit comfortably and set up a timer. You can use a guided meditation from YouTube or a phone app if you prefer. (You can also follow this Meditation for Anxiety and Stress!)
  • Breathing techniques, e.g. 3-4 seconds of inhalation for every 6-8 seconds of exhalation for 10 breaths
  • Start a a gratitude practice! Every day, find three things you are truly grateful for, no matter how simple or mundane they may be!
  • Try journaling about how you are feeling, your goals, what brings you joy, what you are excited about, etc. at least 1x week.
  • Try out expressive writing! Set a timer for 10 minutes, and write (or type) freely about a problem you are having without worrying over grammar or punctuation. If you run out of things to write, keep repeating what you have already written until the time is up.
  • Check out our earlier post on Stress Relief
Meditating in nature, relaxation and stress-management strategies at Oakville Physiotherapy Clinic.

NUTRITION

  • Substituting unhealthy food choices for healthier ones begins at the grocery store. E.g. instead of buying Cheetos for a snack, buy nuts or quality granola bars. Instead of chocolate, buy dates and other fruits you like. It’s best to make a list and plan this in advance! Keep in mind that it’s not enough to take out the unhealthy food, but you also have to find something to replace it with.
  • Try natural smoothies instead of pop (or fruit juice with sugar added) as a beverage throughout the day. Believe it or not, a green smoothie of 1 banana, 1/2 cup of spinach, 1/2 cup of almond milk, a spoonful of almond butter and a spoonful chia seeds needs no added sugar! (You can substitute any of the ingredients based on preference or presence of food intolerances!)
Spinach green healthy smoothie featured on lifestyle changes blog post by Oakville Physio Clinic to help people improve their health and wellbeing, especially when weight and nutrition are contributing factors
  • Drink 6-8 glasses of water / day. E.g. set up a reminder on your phone, carry a water-bottle with you, substitute pop with a glass of water during meals, etc.
  • Commit to looking up 1 new, interesting, and healthy recipe to make every week
  • Involve other family members in meal prep and cooking as a way to spend time together increase awareness of what goes into making everyone’s food

REDUCING SCREEN TIME

If you are looking to reduce your screen time (phone, tablet, Netflix), you have to find something to replace it with! Try something you would enjoy!

image showing tree growing out of book to encourage mind stimulation with reading and nature rather than hours of screen time; suggestions for healthy lifestyle changes
  • Commit to reading 1-2 chapters from a book you are interested in every evening, instead of watching another episode from the latest TV show you are binging
  • Make one night / week Family Games Night instead of watching a movie… e.g. cards, board-games, charades, puzzles, crafts, etc.
  • Pick a goal you’ve had for a long time, or an activity you miss doing (e.g. drawing, crafts, knitting) and dedicate one hour in your evening to working on it

SLEEP QUALITY

  • If your mind is busy with planning to-do lists when you go to sleep, consider keeping a notepad by the bedside to write things down so you can let them go.
  • Try melatonin, or herbal tea meant to promote relaxation (e.g. Sleepytime). Note: it’s always good to discuss with your doctor what sleep strategies may or may not be for you (especially if you have allergies, or are on specific medications)!
  • Also, check out these tips from an earlier post on how to improve our Sleep Hygiene!
showing woman relaxing in supported child's pose in order to promote improved sleep quality in a lifestyle changes blog post at Oakville Physio Clinic

QUITTING UNHEALTHY HABITS

Just as with making changes to our eating habits, when looking to reduce or quit an unhealthy, habit, it helps to replace it with something healthier.

  • When reducing caffeine intake, we can substitute for herbal tea, natural smoothies, or water beverages.
  • When looking to quit smoking, sometimes you need to wean off the habit rather than quitting cold turkey, and replacing it with something else. Commonly, that can be nicotine patches, or chewing gum. Speak to your doctor about a strategy that is right for you!
  • Reducing sugar and/or junk food by replacing them with healthier alternatives. Stock up your pantry and fridge with nuts, dates, and fruits as snacks instead! Switch from milk to dark chocolate. Every time you get a craving, maybe drink a glass of water and take a movement break instead.

Stay tuned for Part 2 where we will talk about tips and strategies to stay on track with your lifestyle changes! 😊

If you want to be more active but are limited by pain or a chronic injury, contact us to find out how we can help! Hopefully, we will soon be able to open our physical doors. But in the meantime, virtual sessions are available.

Yoga Basics, Part 6: Styles of Yoga

There are many styles of yoga, some more modern than others, and some which are combinations or derivatives of more traditional styles.

For our purposes here, we will describe the five main styles you are likely to encounter in a yoga studio near you!

This way, when you sign up for a class, you will have a better idea of what to expect and if it’s for you! 😊

1. Hatha Yoga

Hatha is referred to as “physical-based” yoga because it is more grounded in physical practice (as opposed to other types of yoga that are grounded in more abstract concepts such as spirituality, self-discipline, or even energizing techniques).

It is also a more generalized style of yoga which makes it great for beginners:

  • Provides an introduction to the most basic asanas (yoga postures, or poses)
  • Practised at a slower pace
  • Provides some focus on meditation, breathwork, and relaxation

 In fact, most Western classes are hatha-based.

Milton physio showing tree pose as part of classic hatha yoga practice for an educational blog
Tree Pose is one of the classic Hatha poses

Therefore, best for beginners and those who prefer a more relaxing practice!

2. Vinyasa Yoga

Translated from Sanskrit, Vinyasa means “to place in a special way”, as in the arrangement of steps, or the flow from one asana to the next. This flow sequence is coordinated by the breath, from an inhale to an exhale.

Vinyasa Flow practice is more intensive than Hatha:

  • More challenging poses, focusing on strengthening all parts of the body
  • Poses and sequences are variable, depending on the creativity of the teacher
  • Classes can have different themes, and so, no Vinyasa class is the same!
Burlington Physio demonstrating a step by step vinyasa chaturanga flow sequence for an educational blogpost on different styles of yoga
A typical Vinyasa Flow from Chaturanga to Down Dog

Therefore, great for those seeking a challenge, faster-pace, more variability, and wish to focus on strength!

3. Bikram Yoga

Developed by Bikram Choudhury in the 1970s, Bikram Yoga is a very specific practice that takes its poses from traditional hatha techniques:

  • Always 90 minute sessions
  • Always the same sequence of 26 poses
  • Always two breathing exercises
  • In a heated room of about 40C (or 105F)
  • In a carpeted room, with mirrors, and brighter lights

Bikram Yoga is meant to be more intensive:

  • Focuses on strength, flexibility, and aerobic practice
  • Does not usually adjust for the practitioner
Mississauga physio showing an eagle yoga pose, typically practised in hot yoga, and always part of bikram yoga, in an educational blog
Eagle Pose, one of the 26 asanas in Bikram Yoga

So, are Bikram and Hot Yoga the same thing?

Short answer, not quite.

Hot Yoga, is a derivative of Bikram Yoga, and as the name implies, it is also practised in a heated room:

  • Poses and sequences vary from the original Bikram Yoga to avoid trademark disputes and the controversies surrounding the founder
  • In a heated room of about 26-37C (or 80-100F)
  • Often in a dim, candlelit room with music playing
  • Adjusts for the practitioner’s needs

The heated room has several benefits:

  • Sweating a lot more, which is suggested to be good for both detoxification and calorie loss
  • Increased heart rate increases the aerobic challenge
  • The warmth loosens up the muscles and tissues, and is more comfortable for joint pain
stock photo of thermometer showing nearly 40 degrees Celsius, indicating how how hot yoga typically is
Hot Yoga is usually practised at above 30C

For either one, make sure you bring water and a towel!!!

Therefore, best for those who like the heat and prefer to break a sweat during their workout!

4. Restorative Yoga

Introduced in Part 5 of our Yoga Basics Series, Restorative Yoga as the name suggests, is meant to restore or rejuvenate:

  • Focuses on winding down after a long day, relaxing the mind, and calming the nervous system
  • Minimal number of poses during a class, usually 5-6
  • Poses can be modified to be easier and more relaxing
  • Supports such as blankets, bolsters, and yoga blocks are used so you can relax further
  • Resting in each position comfortably for approximately 5-10 minutes
  • No yoga experience needed
burlington physio showing a supported child's pose in an educational blog about restorative yoga
Supported Child’s Pose in Restorative Yoga

Therefore, great for anyone who is looking to reduce anxiety and improve their sleep quality, or for anyone recovering from an injury or illness!

5. Yin Yoga

Yin Yoga was established in the late 1980s, based on the ancient Taoist concepts of “yin” and “yang”. The idea being that we often need to complement the Yang in our lives with a bit more Yin.

Yang represents more the masculine, active, fast-paced, and energetic aspects of our lives. On the other hand, Yin represents more feminine, passive, slow-paced, and calm energy.

There is a misconception that Yin and Restorative Yoga are the same thing. While both:

  • focus on passive positions (rather than the “Yang” poses of the more active Yoga styles)
  • are slow-paced
  • appropriate for any level of experience
  • calm the mind and nervous system
  • cultivate an aspect of meditation by increasing inner awareness and focusing on the breath

Yin Yoga specifically:

  • Works to release the deep connective tissues with challenging and slightly uncomfortable prolonged stretch positions (whereas Restorative poses are entirely about comfort and relaxation)
  • Increases and maintains flexibility by helping release the fascia
  • Lubricates the joints by improving circulation
  • The poses work into the meridians (or energy flows) of the body as per traditional Chinese Medicine
  • May or may not use supports during class, depending on the teacher
Oakville physio demonstrating a butterfly pose stretch in yin yoga for an educational blog
Butterfly Pose in Yin Yoga

Therefore, great for anyone looking to improve flexibility, or balance out an already strong Yang practice, such as Vinyasa!

Bonus: Prenatal Yoga

Prenatal Yoga is adapted for pregnancy to avoid poses that would otherwise stress the joints. As long as your doctor has cleared you for physical activity during pregnancy, Prenatal Yoga is a great activity for expectant moms:

  • Usually focuses on pelvic floor and breathing exercises, meant to prepare for labour and delivery
  • Uses props (e.g. bolsters, blankets, wedges, yoga blocks)
  • The focus is more on stability rather than flexibility, as pregnancy hormones already loosen your ligaments, which can sometimes lead to joint pain
  • Gentle and relaxing, it may also help lower your blood pressure and stress, as well as help stabilize emotional ups and downs  

Ask your yoga teacher for modifications as you go through the changes of the different trimesters and your center of gravity continues to shift.

For example, you may need to take more breaks as you feel more tired during the first trimester. Focusing on Cat-Cow rather than Downward Facing Dog may be helpful when experiencing morning sickness.

As you get your energy back in the second trimester, it might be best to focus on strengthening.

Relaxation and breathing techniques might be more beneficial as you near the end of your pregnancy.

Pregnant woman on an exercise ball, prenatal exercise and therapy

If you are struggling with your Yoga practice, or recovering from an injury that is affecting your ability to engage in Yoga, we offer one-on-one Therapeutic Yoga sessions! Contact us for more information to find out how both our Physiotherapists and/or our Yoga Therapist can help!

What role does medication play in recovery?

When we have hurt our back, or have fallen and broken something, or have been in a car accident, or even been dealing with chronic pain… our go-to is to see our family doctor. Often, they will prescribe something to help:

  • Muscle relaxers
  • Anti-inflammatories
  • Pain-killers

But what happens when the medication doesn’t “fix” the problem? Or if the issue we take the medication for keeps coming back?

Here is what is happening following an injury…

Recovery from an injury has roughly three stages. Timelines for each can vary based on the type of injury and degree of injury…

If medication is needed, most often it will be during the Inflammatory stage, and sometimes during the Repair stage.

Stage 1: Inflammatory

  • As soon as an injury occurs, e.g. contusion or strain, tissues can tear internally as well externally (muscle fibers, blood vessels, bone break), etc.
  • The injured area fills with blood but also inflammatory cells
  • Any areas that are bleeding are quickly sealed off by special cells
  • Classic inflammatory response of swelling, redness, heat, and pain occurs
  • Physio Role at this stage: This is usually the time when we immobilize the area (e.g. bracing, splinting, taping, crutches)
Patient walking with ankle, foot cast and using crutches, at North Oakville Physio for broken bone, fracture, following initial injury
The initial injury may require immobilization…

Stage 2: Proliferative / Repair

  • Specific cells in the body are now clearing out the debris of dead tissue and dried blood
  • Others are starting to create new tissue, including scar tissue
  • Physio Role at this stage: This is the time to start gradually mobilizing the body in order to begin restoring range of motion, strength, proprioception, circulation, and to guide scar formation (scar tissue is laid down at random; use and movement is needed to guide which scar orientation is best for that particular part of the body)
Muscle tissue to show healing process from oakville physiotherapy and foot care clinic
Muscle and other tissue are gradually repaired…

Stage 3: Maturation / Remodelling

  • The body continues to remodel the scar tissue
  • New tissue is maturing into final stages of muscle, connective tissue, or bone
  • Physio Role at this stage: This is the time to be returning to regular function and normalizing our biomechanics
Returning to soccer recreational activity for athletes following injury at North Oakville Physiotherapy Clinic
Getting back to functional and recreational activities…

Which is better, Physio or Medication?

This is like comparing apples to oranges. Physiotherapy and Medication often have different roles, with some general overlap. In the context of injury, medications seek to reduce pain, inflammation, and muscle spasm.

Physiotherapy seeks to do the same, along with returning to regular range of motion, strength, proprioception, and function. If the injury is something very minor with a short duration of recovery, Physiotherapy (or medication) might not even be necessary.

On the other hand, in more severe injuries, Physiotherapy might not be able to fully manage the acute symptoms…

Elbow pain treatment at an oakville Physio and massage clinic

Medication has a role to play in helping with excessive pain or muscle spasm, or with prolonged inflammation. Emphasis on “excessive” or “prolonged”, because after all, pain and muscle spasm serve a protective function to avoid further re-injury during a critical healing period. While the initial inflammatory response is part of the body’s healing process, when it’s prolonged it can hinder returning to function.

If you are already modifying your activity and avoiding undue strain, medication can help quality of life when the pain is unmanageable, and severely restricting your activity and work.

But, medication cannot make the damaged tissues stronger, or improve the mobility of a joint (unless the only thing limiting the joint movement was pain). This is where Physiotherapy comes in!

If I can do it with Physio, should I still take Medication?

It depends… are you doing alright without any medication, or are you having difficulty managing your symptoms even with the strategies suggested by your physiotherapist?

As explained above, medication can manage certain symptoms a lot better than Physiotherapy but does not address all factors necessary to get you back to your normal. It may have a role early on when symptoms are difficult to manage, but as your body continues to heal, that role should diminish.

In other words, the two can work well together, especially in the earlier stages when mobilizing and strengthening are impeded by pain, swelling, or spasm.

Talk to your Doctor about why they are prescribing the medication, what alternatives may be used (including Physiotherapy), and the pros and cons to both. Medication is not always necessary to get better, and it does carry side effects (especially if you are already on other long-term medications).

What about Medication for Chronic Disease?

This is a more complex question. Certain chronic diseases require pharmaceutical management and that’s okay. In fact, in some cases it is absolutely essential!

However, more recent research does show that medication for certain diseases can be reduced, or even stopped, with lifestyle changes! These lifestyle changes may be helped along with Physiotherapy, or other health disciplines, or you may gradually enact them on your own.

Nordic walking to show lifestyle changes and treatment for chronic disease or pain at North Oakville Physiotherapy Clinic

For example, changes in your eating habits and increasing your mobility can help you reach and maintain normal blood sugar levels, or manage your blood pressure, without the need for medication!

What about Medication for Chronic Pain?

When it comes to what Chronic Pain is, you can get more information from our previous Pain Series posts. The main takeaway, however, is that lifestyle changes are also key for management of Chronic (AKA Persistent) Pain!

Consider this… by nature, Chronic Pain has more to do with changes in the pain pathways and thresholds of the nervous system than with any recent injury. Since there is no recent injury that is responsible for the pain or spasm, and there is little value in an inflammatory response, medication that targets these issues is unlikely to be that effective. If anything, the longer you take it for, the more your body gets used to it and the greater dosage you will need. Not to mention the side affects added to the pain…

Ultimately…

Medication is reactive and often focuses on symptom management rather than addressing root cause. For certain chronic diseases, its role may be more complex and addressing the root cause may not be doable (e.g. genetic disease). But for others, like Type II diabetes, or high cholesterol, lifestyle changes can address the root causes!

Talk to your doctor about which medications are essential and which ones can be cut back with the right lifestyle changes. Come up with functional and recreational goals that are meaningful to you and talk to your physiotherapist about what activities and exercises might help get you closer to those goals!

Telehealth, telerehab, physio services covered by benefits, private insurance

Yoga Basics, Part 5: Restorative Poses

Welcome back to Yoga Basics! Today we will demonstrate five of the most common Restorative Poses.

What are Restorative Poses you may ask?

There are many reasons to practice yoga… Some seek a challenge, looking for a yoga practice that feels more like a workout. Others think of yoga as a way to maintain mobility and flexibility.

Restorative Practice is for everyone. Sometimes you need to unwind… not everything has to make you sweat!

Here is a check list to see if you would benefit from some Restorative Practice:

  • Do you wake up tired and groggy?
  • Do you have a hard time falling asleep?
  • Are you recovering from an injury?
  • Are you more stressed, or on edge, than usual?
  • Do you struggle with anxiety?
  • Do you find it hard to shut off your brain?
  • Are you struggling with concentration?
  • Do you find yourself constantly checking your smartphone throughout the day, even while at work?

Then maybe you should give Restorative Yoga a try!

A class is usually 5-6 poses, often supported by yoga blocks and bolsters, so that you can relax into each stretch for 5-10 minutes.

If trying these Restorative Poses for the first time, start with 3 minute holds. You can set a timer to go off and then slowly come out of each position to the next…

1. Sukhasana, Easy Sit Pose

While Restorative Yoga uses yoga blocks and bolsters to set up supports for most of the positions, you may not have all that at home. That’s okay. Blocks are meant to be smaller and more firm supports, while bolsters are larger, softer objects. You can use pillows and cushions in lieu of bolsters, and a mini step stool, or a big textbook, or a foam roller in lieu of a block.

  • Place a thickly folded blanket, or a horizontally-placed block, on the ground. Sit cross-legged on the floor, your sit bones on the support and your legs off of it.
  • Note: A higher support will be easier if you have issues with the knees, hips, or low back.
  • Place your hands on your knees, palms down.
  • Keep pelvis in a neutral position, so that your low back is not arched or slouched. (You may play around with some movement by arching your low back, opening up the chest, and gazing upward for a Seated Cow Pose. Then, slouching your whole spine and neck to bring chin down to chest for a Seated Cat Pose. Then, returning to a neutral pelvis position once again.)
  • Relax, close your eyes, and lengthen your breathing.
  • Depending on the length of time in this pose, it is good to alternate the cross of the legs.
Burlington Physio showing Easy Sit Yoga pose supported onto a block for Restorative yoga blog
Supported Easy Sit Pose

2. Balasana, Supported Child’s Pose

  • Position a bolster / pillow on an incline. Ideally, with two blocks: one midway underneath the bolster on its horizontal edge, and one underneath the far end of the bolster, on its vertical edge. If you cannot achieve a perfect incline, that’s okay.
  • Sit back on your calves in front of the lower end of the bolster. Your knees should be on either side of the bolster.
  • Then, lay your body onto the bolster, arms on the floor and palms down, relaxing. Your head will be turned to one side for half the time, and the other side for the other half. If you have neck pain turning to one side, then stay on the other side only.
Burlington Physio showing a supported child's pose using a bolster and blanket for Restorative Yoga Blog
Supported Child’s Pose
  • Note: if sitting back on your calves bothers your knees, you can substitute with Supported Wide-Legged Forward Fold Pose. Using the same support and your torso laid on top, have your legs extended out on each side of the bolster, the width between them based your comfort.

3. Matsyasana, Supported Fish Pose

  • While sitting with legs extended out in front of you, place a bolster or a long pillow behind you, touching your lower back. (Alternatively, you can use one vertical and one horizontal block as shown in the picture!)
  • Then, lay back your head and torso onto the bolster, your arms spread outward and palms facing up.
Oakville physiotherapist showing a supported fish pose, using yoga blocks, for a restorative yoga session
Supported Fish Pose

4. Supta Baddha Konasana, Supported Reclining Bound Angle Pose

You can try this one with some, all, or none of the supports, based on what is most comfortable for you!

  • Use the same bolster set-up as with Child’s Pose, but create a steeper incline if able.
  • Sit with your low back to the lower end of the bolster. Then bend knees and bring the soles of the feet to touch, as the knees drop down on either side of you.
  • Lay back your head and torso onto the inclined bolster behind you.
  • You can place your left hand over your heart and the right just under the ribcage, or have the arms stretched out on the ground on either side of you, palms up.
Oakville physio showing a supported reclining bound angle pose using yoga blocks and a pillow, for a Restorative Yoga Blog
Supported Reclining Bound Angle Pose

Note: If you have knee or groin pain, you can place blocks / bolsters underneath each knee so you are not overstretching and feel supported. Alternatively, when you initially bend your knees, do not bring the soles of the feet together or drop the knees to the sides. Instead, place a bolster directly underneath the knees and allow them them to comfortably rest on top.

5. Jathara Parivartanasana, Master Revolved Abdomen Pose

Most commonly known as Supine Twist (or Supine Spinal Twist Pose), you can either perform it with both legs at the same time, or one leg straight while the other goes over it.

  • Variation 1: lie on your back with knees bent and feet on ground.
  • On an inhale, spread out the arms at shoulder height and lay them on the ground, palms up.
  • On an exhale, drop the bent knees to the tight side so that the right outer knee is on the ground (and approximately level with the pelvis), and the left knee and hip are stacked directly over the right.
  • Ground down the left arm and shoulder blade as a counterbalance.
  • Revolve your abdomen back so that it is facing upward as much as possible.
  • Hold position for 2-3 minutes, then slowly return to start position, and repeat the same for the other side.
Mississauga physio showing a master revolved abdomen yoga pose, AKA supine twist stretch, for a restorative yoga blog
Supine Spine Twist Pose
  • Variation 2: lie on your back with both legs straight. Bring left knee to your chest.
  • On an inhale, spread out the arms at shoulder height and lay them on the ground, palms up.
  • On an exhale, bring left knee over the right thigh and toward the ground. The left knee will be approximately level with the right hip and the left foot will also be on the ground, approximately level with the right knee. You can use your right arm to hold down on the left outer thigh and keep the leg in place, controlling the amount of stretch.
  • Ground down the left arm and shoulder blade as a counterbalance.
  • Hold position for 2-3 minutes, then slowly return to start position, and repeat the same for the other side.
Supine Spine Twist Pose Variation

Bonus pose: Viparita Karani, Legs-Up-To-The-Wall Pose

This pose is referred to as a “restorative inversion.” It is great for venous drainage and improving circulation, especially for swelling in the feet. Additionally, the position stretches the hamstrings, relaxes the pelvic floor, and may relieve some low back tension. Contrary to the name, it does not necessarily have to be done with legs against the wall.

  • Variation 1: Bring your mat or a blanket next to a wall at home. Then, getting close to the wall, lie on your back and place your feet onto the wall.
  • Scoot your hips as close to the wall as you are comfortable, then straighten out the knees, so that you for an “L” shape in this position.
  • You may place a cushion underneath your head or tailbone for increased comfort.
  • Spread your arms out about 45 degrees away from your body, palms up. Relax into the pose.
  • Note: if you are less flexible, use a lower cushion under the hips and tailbone and position yourself a bit further from the wall. If more flexible, you can use a higher cushion and get closer to the wall!
Burlington Physio showing Legs-up-to-the-wall yoga pose for restorative yoga session
Legs-up-to-the-wall Pose
  • Variation 2: Waterfall Pose is an alternative position of Legs Up that does not require a wall!
  • Begin by laying down on your back with knees bent and feet on the ground.
  • Lift up the hips to slide a block (at its horizontal positioning) underneath the sacrum (the bony part just below the low back and just above the tailbone). You are now in a Supported Bridge Pose.
  • Bend one knee up toward you, then the other, with the block feeling like a comfortable support underneath.
  • Then, straighten out the knees so that the legs point up to the sky. If you have tight hamstrings, having the knees slightly bent to accommodate the tightness is okay.
  • Spread your arms out about 45 degrees away from your body, palms up.
  • Relax your breathing and enjoy the feeling the legs elevated!
Burlington physio showing a waterfall yoga pose using yoga block supports for a Restorative yoga educational blog
Waterfall Pose
  • Note: if preferred, you can even stay in a Supported Bridge position, with the block underneath the sacrum, the knees bent, and the feet still on the ground (hips and knees hip-width apart)!
Oakville Physio showing a supported bridge post, using a yoga block, for a Restorative Yoga session at home
Supported Bridge Pose

Congratulations! You have completed a session of Restorative Yoga! Practice for a few weeks to reap the benefits, expanding the 3 minute holds to 5-10 minutes, and modifying your supports as needed. Remember, it’s not about perfection but rather what feels like a comfortable and restful position for you.

If you are having difficulty with these poses, or they are aggravating a pre-existing pain, let us know so we can help!

Yoga Basics, Part 4: Core Strength

Welcome back to the Yoga Series!

This series for anyone who is a beginner at yoga and would like to learn more about the individual poses so they can build the foundation for their practice…

Today we will talk about yoga poses that focus on building your core strength (check out Part 2 for some Common Poses that are used as starters in today’s post). If you are new to yoga and thought it’s all about stretching, guess again!

These core poses will definitely challenge you, but that’s okay! You don’t have to be super flexible and you don’t have to be super strong to start because it’s through a regular practice that you improve 😊

1. Dandayamana Bharmanasana, Balancing Table Pose

Balancing Table Pose, also dubbed the Bird-Dog, works your core, glutes, and back stabilizer muscles.

  • Start in Table Top, hands under shoulders and knees under hips (and placed hip-width apart)
Mississauga Physio showing four-point or table-top yoga pose.
Table-Top Pose
  • The whole spine is parallel to the ground, head is in line with the body, and the gaze is toward the ground as well
  • Gently pull belly-button in 2 inches toward the spine
  • Then, on an inhale, reach one arm forward so that it is parallel with the ground
  • Then, without arching the low back or tilting the pelvis, straighten out the opposite leg so that it is parallel to the ground and in line with the torso
Mississauga Physio showing bird-dog yoga pose
Bird-Dog Pose

Hold position for 5 breaths, continuing to pull the belly-button inward. Then, slowly lower arm and leg down while keeping the whole torso in a neutral position. Repeat on opposite side. If you find having both arm and leg up is too challenging for the balance, perform only with the arm, or only with the leg, alternating between both sides.

2. Kumbhakasana (AKA Phalakasana), High Plank Pose

High plank is a great core exercise but it does put a lot of weight-bearing through the wrists and shoulders. If this is uncomfortable, try it on your forearms instead (Dolphin Plank). In Dolphin Plank, keep the elbows under the shoulders. You also have the option of either a straight torso, or hips higher in the air to make holding the pose easier.

  • Start in Downward Facing Dog (described in Part 2!) and on an inhale, lower your hips as you shift your torso forward
Burlington Physio showing downward facing dog yoga pose.
Downward Facing Dog Pose
  • In this way, your arms should become perpendicular to the ground and your shoulders position directly over your wrists
  • If needed, you can slide the toes farther back
  • Your whole spine should make a straight line and turn your gaze toward the floor, without letting the head hang down
  • Gently pull the belly button in 2 inches toward the spine in order to engage the core
  • If feeling wrist discomfort, press more into thumbs and index fingers
Burlington physio showing a high plank yoga pose
High Plank Pose

Hold position for 30 seconds, or 5 breaths. Then, bring knees down to come into Table Top to rest. Repeat 3-5 times.

3. Phalakasana (variation of), Knee-to-Elbow Plank Pose

This pose is a more advanced variation of the plank and can flow as a sequence from the Three-Legged-Downward-Facing-Dog (AKA One-Legged-Downward-Facing-Dog), or can simply be done from a High Plank position. We will describe the flow sequence in order to challenge your balance further and begin to get you more comfortable with the flow of regular practice.

  • Start in Downward Facing Dog and then extend the right leg up into the air, foot flexed so that the heel points toward the wall behind you
  • Keep the pelvis square to the floor, do not let it twist or dip with the leg raise
  • As you are now on “three legs” now (Three-Legged-Downward-Facing-Dog), your balance will be challenged by the asymmetry of the pose
Burlington physio showing a three-legged downward facing dog yoga pose
Three-Legged Downward Facing Dog Pose
  • From here, on inhale, shift torso forward as you lower the pelvis and bring the right knee toward the right elbow
  • Pull belly button in two inches toward the spine to engage the core and stay in this position for 1-3 breaths
Burlington physio showing a knee-to-elbow plank yoga pose for core strengthening
Knee-to-elbow Plank Pose
  • On an exhale, return to Three-Legged-Downward-Facing-Dog
  • Lower right leg down, and repeat with left

For further challenge, bring knee to opposite elbow, thereby adding a twist to the Knee-to-Elbow Plank.

4. Vasisthasana, Side Plank Pose

Side Planks are a great core exercise that works your balance and concentration. Additionally, they are a weight-bearing exercise that strengthens wrists, forearms, and shoulders. If you have wrist or shoulder pain, or find the straight arm position too challenging, try this position on your forearm instead!

  • Start in either High Plank or Dolphin Plank (forearm plank)
  • Twist your lower body (pelvis and legs) to face to the left, and place left foot on top of right (or in a staggered position, just in front of it)
  • Putting your body weight through the right arm, slowly turn the torso to face to the left as well, extending the left arm up toward the ceiling. If extending the arm to the ceiling is too challenging, your can place it on your left hip instead.
  • Pull belly button in two inches toward your spine to engage the core
  • Make sure your hips are stacked one on top of the other; your body should form one straight line from the feet all the way to the crown of your head
  • If you started from High Plank, the supporting hand should not be directly under the shoulder but slightly in front of it. Press through the base of your thumb and index finger.
Burlington physio showing high side plank yoga pose for core strengthening
High Side Plank Pose
  • If you started from Dolphin Plank, the forearm should be adjusted to be perpendicular to the body
  • Keep your head neutral and gaze forward, or if able turn to look up toward the left hand as it reaches for the ceiling
Mississauga Physio showing low side plank (on forearm) yoga pose for core strengthening
Low Side Plank Pose

Hold position for 10 seconds while continuing to engage the core and take gentle breaths. When ready, return to High Plank (or even Table Top) to rest. Repeat 3 repetitions on each side.

5. Paripurna Navasana, Boat Pose

This pose works both your abs and hip flexors!

  • Begin seated with legs straight out in front of you
  • Place hands on the floor slightly behind the hips and press down
  • Lean torso slightly back, keeping chest open and low back straight
  • You should now be sitting more on the sit bones and tailbone area
  • On an exhale, bend the knees and then lift the feet off the ground
  • Gently pull the belly button in 2 inches toward the spine to engage the core and keep the low back straight
  • If able, straighten out the knees. In this way, you’re creating a V shape with your body! If not able, keep knees bent and shins parallel with the ground.
  • Lift arms in front of you so that they are alongside the legs and parallel to the ground. If not able, keep the hands on the floor, or lightly hold on to the backs of the thighs for stability.
Mississauga Physio showing half boat yoga pose with calves parallel to the ground, for core strengthening
Boat Pose

Hold position for 10-15 seconds, gently breathing throughout that time. Repeat 3-5x. Gradually increase the hold time as per your tolerance. Always keep the low back straight!

Bonus Sequence:

It’s time for another flow sequence! The main challenge here is the Chaturanga Dandasana, (Four-Limbed Staff Pose).

  • Start from Downward-Facing-Dog
  • On an inhale, shift forward to High Plank and pull the belly button in 2 inches toward the spine
  • On an exhale, slowly lower your body to a few inches above the ground by bending your elbows to 90 degrees (or as close as you are able)
  • Try to keep your body as parallel to the ground as possible. Aim to have your upper arms in line with your torso and your forearms perpendicular to the ground.
Oakville physio showing chaturanga, or four-limbed staff yoga pose for core strength.
Chaturanga, or Four-Limbed Staff Pose
  • On an inhale, straighten out the arms again as you lift up the chest and gaze toward the sky. Going into Upward-Facing-Dog, stay propped up on your toes, knees + thighs + pelvis still hovering above the ground. If this is too challenging, go into Cobra Pose instead (knees + thighs + pelvis can all rest on the ground).
Oakville physio showing upward facing dog yoga pose.
Upward Facing Dog Pose
  • On an exhale, engage the core and pull your hips up toward the sky to return to Downward-Facing-Dog

Congratulations, you have completed the bonus challenge! If you struggled with any of the above positions, that is okay. Start wherever you are able and gradually progress from there!

If you are experiencing pain or difficulty with range of motion while attempting these poses, or have specific goals you are working toward, or would just like some more guidance with your practice, let us know!