All posts by Palermo Physio

C-Section Pre-hab and Rehab

While many people experience a pivot from an expected vaginal delivery to an emergency Cesarean Section (C-Section) birth. There are also many people who have a planned or scheduled C-Section.

If this is the case, Physiotherapist can help prepare you in advance for the birth as well as the first few days. While many people try and soften the process by titling it a “C-Section birth” and a view point that it is as valid of a birthing process as a vaginal birth (which it IS!). A C-Section is still a surgical procedure that has different considerations when it comes to recovery than a vaginal birth.

It is possible to have have pelvic floor issues post c-section even when / if a person has not laboured, had to push, or delivered vaginally.

yoga stretching poses from an oakville virtual physio
Postnatal Physio-C-Section
These pelvic floor issues post C-Section may be:
  • Pain / discomfort with urination
  • Stress or urge urinary incontinence
  • Pelvic floor pain or discomfort
  • Bowel issues / constipation
  • Pelvic organ prolapse (POP)

In the early days post C-Section your pelvic floor focussed physio can provide you with a plan in how to set your home environment up to best help your own recovery as you care for a newborn.

Once your C-Section incision is healed, your pelvic floor focussed physio can assess and gently treat your scar / incision or the surrounding area. Your Physio can also assess your pelvic floor. You should be provided with some education and a plan of how you can self treat at home and how to fit it into your new life!

If you have not had your scar massaged or worked on by a physio and you are further down the road of your recovery, if is never too late. People are often surprised by how much C-Section scar work as part of physio treatment can help with low back issues and pelvic floor tension / issues as well as in the local area.

If you are interested in a pre-hab or prenatal physiotherapy session for a schedule C-section we are here for you. We are able to see you in person in our North Oakville Physio clinic. We are also able to “see” you virtually via Telehealth if you are residing or have a permanent address in Ontario.

Contact us to book in!

We are able to provide direct billing to most insurance companies.

Thank you for 8 Years!

This past long weekend marks 8 years since we opened the doors at North Oakville’s Palermo Physiotherapy and Wellness Centre!

Some of you may remember walking through the hallways of the brand new medical building in which our clinic is located, when there was no carpet and other units were still being completed.

We have grown and changed over the years. We have learned things about business, honesty, loyalty and service. Our team has always worked hard to provide you, our patients and clients the best possible professional services. Whether it be Physio, Acupuncture, Massage, Chiropody or Yoga.

We have seen many of our patients reach major milestones and helped you work towards your goals. You have trusted us with your care and the care of your loved ones.

We’ve seen team members reach wonderful milestones and goals as well. Palermo Physiotherapy and Wellness would not be where it is without every bit of positive energy contributed from our team members, students, and volunteers of these 8 years.

It has been wonderful to learn and grow as Oakville’s Palermo neighbourhood has developed. We have also loved being part of this building with some of our awesome neighbours.

Here’s to many more fabulous years of service to our Oakville and surrounding Milton and Burlington communities!

-Lisa Clifford Owner and Physio

Oakville Mayor, Physio, Massage Therapy, Chiropody
Lisa Clifford Physio, Meeting Oakville Mayor Rob Burton at our Grand Opening ribbon cutting

PRE-hab- What is it?

“We”, in the physiotherapy field speak often about pre-habilitation. However we still see people after the procedures they have had, not necessarily while they wait for them.

With people waiting longer to see specialists it is not as commonly known as it should be that Physiotherapists are “direct access”. This means you can be assessed and treated by a Physio without a Doctor’s referral. It means that it is within a physiotherapists scope of practice to diagnose musculoskeletal issues (think knee sprains, ankle sprains, muscle pulls, tennis elbow etc).

It also means that even though you were not referred to a Physiotherapist by your orthopaedic surgeon or obstetrician, that it will not be helpful to prepare you for your recovery.

Picture this:

You are waiting for a knee replacement surgery. It is scheduled in 6(+) months time. Your knee has been sore, you are walking “funny”, you aren’t moving as much because your knee hurts. You stop doing activities of enjoyment…the muscles around your knee are getting more weak. They are atrophying. Your knee joint is getting more stiff. Your heart, lungs, brain, bones and body systems are declining because you haven’t been moving or exercising.

You see where this is going….

Then, you have the knee replacement surgery, or the hip replacement surgery, or even an ACL reconstruction, and the recovery seems HARD. It’s hard to get up and down from the couch and bed. It’s hard to move around it bed. You’re VERY tired from the exercises.

Recovery and rehabilitation from these major surgeries can be challenging at the best of times.

What if they can go more smoothly?

A Physiotherapist can help prepare you for these surgeries within your capabilities. It doesn’t have to be all or none. Your knee, or hip, or shoulder etc are part of a larger body system that doesn’t stop while you’re waiting to be seen by the Ontario medical system.

Choose Your Own Adventure:

Seeing a Physio for pre-hab doesn’t necessarily mean you will be seeing them multiple times a week leading up to your surgery or procedure. What it means it there will be an assessment and a discussion of goals.

If you are safe and independent you and your physio may choose to set up a home program that gets revisited, modified and made more challenging as needed every few weeks.

If you appreciate the help a physio can provide and know that you will not do a home program by yourself you may choose to attend an active physiotherapy program more frequently (think 1, 2 or 3 times a week).

As your surgery gets closer your physio may suggest some modifications you can make in your home during the early stages of recovery.

Remember, you do not have to decline while you are waiting for surgeries. Physiotherapists are educated and trained to help prepare you for these surgeries and to help with your recovery afterwards.

Why just “get by” when you can thrive!?

Our Physiotherapists and Massage Therapists are available to help you with your pre-habilitation and rehabilitation. We are able to treat people virtually all over Ontario and in person in our North Oakville clinic.

shows woman receiving Telehealth / tele rehabilitation in Milton, Oakville, Burlington Ontario for pain.
Virtual Physio available at Palermo Physio and Wellness.

Contact us to book in with one of our awesome Physios or if you have any questions in how we can help you!

Elbow Pain – Is it Tennis Elbow?

You have elbow pain.

It seems simple enough. You may go online to look for advice or ask a friend who had the “same” problem.

It doesn’t seem to be getting better. Is it Tennis elbow? Is it Golfers elbow? Is the pain even coming from the elbow?

If you have pain that is not going away or that is affecting your daily life our North Oakville Physiotherapists are here to help.

A thorough assessment will give information if your elbow pain is from your elbow, or maybe your neck, or forearm. The physio will get to the bottom of the causes of your pain. They will take into account your lifestyle and activities / sports.

With this information advise and a treatment plan will be tailored specifically to YOU. Why spend weeks do someone else’s exercises that may not be helping as much as they could.

Contact us to book in with one of our awesome North Oakville Physiotherapists. We see patients in person from Oakville, Milton, Burlington and Mississauga. Our physio’s are also able to assess and treat patients virtually (Telehealth) over Ontario. We can direct bill to most insurance companies.

shows woman receiving Telehealth / tele rehabilitation in Milton, Oakville, Burlington Ontario for pain.
Telehealth Physio in Ontario available at Palermo Physio and Wellness

Physio for SUP (Stand Up Paddle-boarders)

Stand up paddle boarding or “SUP” has increased in popularity around Oakville, Burlington and Halton. We are so close to lake Ontario, 16 mile creek, Christie Lake, and other fun places to explore.

We see lots of Facebook groups popping up which is such a perfect place to share information and tips.

Some frequent concerns are trying to avoid falling in, how to get back on a board after falling, and importantly how to initially stand up on your board.

Another complaint we see is of the arches of the feet fatiguing quickly as well as pain in the shins after standing on the paddle board.

Most of the “help” for these problems comes from looking at the underlying problem. The body is ill prepared for the new activity.

Things Needed to Stand on a SUP:

  • Lower body strength – how do you usually get up from the ground. Do you climb your legs with your hands? Do you use the furniture or walls? Do you avoid going down to the ground because it is difficult to get up? Lower body strength is needed to stand up on the paddle board (think a lunge from the ground or a deep squat on an unstable surface). Lower body strength and endurance in the hips, thighs and calves is needed to stay standing and to compensate with waves etc.
  • Upper body strength– climbing onto the board from in the water is like a dip. This uses your chest and triceps. If laying flat on the board, you will need to push back onto a hands and knees position. This is like a pushup.
  • Vestibular sense. Your inner ear, neck, eyes and brain work together to tell you where you are in space, how fast you’re going etc. Feedback is given to your muscles to help correct your position. If something is off in the system staying standing on a SUP board may be challenging.
  • Proprioception – we have sensory apparatus around our muscles, joints and tendons that help in a similar way to the vestibular system. It sends messages to the brain or spinal cord where we can react and accommodate movement and position change if needed.
  • Core strength. I’ve left this for last because in many ways this is the one think that people assume they lack when they have trouble starting off on the SUP. While this may be true it is often the complete picture of the above. It is the coordination of messages being sent and received as well as strength and endurance. Hip strength and coordination of moving the paddle and arms away from the body is about reaction as well as strength.
  • Foot Strength – leading up to SUP season it is helpful to strengthen these small muscles in addition to working on the above. To start, try walking around the carpet and grass in bare feet!

How can a Physio help with my SUP pains and goals?

A Physiotherapist will work with you and develop a program based on your goals and abilities. If you are recovering from an injury or are just starting activity that includes SUP, a Physio can get you ready to feel good while on the water and after!

Contact our North Oakville clinic to book an appointment with one of our awesome sports focussed physiotherapists!

patient doing strengthening and physio after knee surgery in north Oakville physio clinic
  • Did you know most insurance companies cover part or all of your physio assessments and treatments?
  • Did you know Physiotherapists are able to treat people virtually? Because a lot of what we do is education and exercises our Physios are able to treat people virtually (Telehealth) anywhere in Ontario.
  • Did you know we are able to direct bill to most insurance companies for Physio and Massage? (Check with your individual insurance situation.)

Injury in Adult Recreational Sports -when to see a Physio or RMT?

So many of us like to play sports into our adulthood. This is for many reasons; to stay fit, be social and simply because we love the sport! Our intensity may change depending on what we’re doing the next day.

I’m sure the thought that “I have to work tomorrow!” Has run through many peoples minds as play becomes rough or the conditions may not be optimal. We may even be playing with and against others who have not had the same level of experience in a sport but are maybe reckless or unnecessarily aggressive.

Why Massage Therapy?

Massage Therapy can be so helpful in general muscle tightness and soreness. When we move in ways that are different and repetitive, we may experience delayed onset muscle soreness or tightness. Scheduling massage when we add in new activities, for example, at the beginning of soccer season can be a helpful recovery tool.

Massage therapy with an RMT can also be focused for injury recovery from specific injuries. For example runners increasing distance or speed may benefit from routine massage focussed on the thighs, glutes and calves. Starting stand-up paddle boarding or SUP? Scheduling a massage therapy session that focusses on the feet, calves and back may feel awesome!

Why Physio?

You’ve injured yourself playing a recreational sport , accessing a physiotherapists opinion may be helpful in relieving pain and getting you back to movement and life more effectively.

Physiotherapists are direct access. This means that you do not need a doctors referral to have an assessment. Your physiotherapist will send you to your doctor, urgent care, or the ER if they feel that you require imaging (eg X-rays). Do not wait in a limbo if you have accessed the ER and they send you home after telling you that you do not have a fracture (broken bone). There is more that can be done in terms of early care post injury. Early, appropriate movement as well as protection, compression etc after an assessment by a physio can help immensely in the early stages of an injury.

A Physiotherapist will help with what you should do and maybe avoid for a time. They will also help you build up to a return to activity should that be your goal.

It is easy to go back and forth after experiencing an injury, returning to play too soon and having to take more time off.

As Physiotherapists we see the value in being and staying active! We want you to be able to the the things you love!

Physiotherapy for hockey players

Here are some brief examples for context:

  • Started playing soccer on turf. Has been having foot and shin tightness and pain that has been gradually worsening. Massage Therapy may be helpful to address the muscle tightness. They may suggest physio to help provide stretches and additional treatment to be able to continue playing and avoid a worsening issue.
  • Playing softball / baseball. Has been making long throws from the outfield and after one throw the shoulder has sharp pain. It’s hurting to lift it and lay on it. A physiotherapist can do an assessment of the shoulder and provide treatment. They may suggest imaging initially but not always. They will let you know if you should take some time off or just modify your activity. You will be given exercises for your particular case.
  • You are playing soccer and step into a rut. Your ankle turns and you have sharp pain. You have gone to the hospital and had X-rays and are told there is no fracture….. A physiotherapy appointment can be helpful at this point to help assess the soft tissues (muscles, tendons and ligaments). You may be given education on how to use crutches or a cane safely and at the best height for you. The physiotherapist can show you how to use a tensor bandage and start you with early management. They can see you through the stages of injury healing and get you ready for return to play.

Even when we are playing recreation sports, it is easy to forget that our body has a natural rate of healing. Sometimes when we stop having pain our inclination is to go back to sport / activity 100%.

Remember that even the best athletes in the world start with practice first and if they are not ready to practice, they find some way to move and keep the rest of their body strong. This is one of the roles of the physiotherapist. We are here to help with different phases of injury and pain. It never has to be all or none!

Contact us to book a Physiotherapy or Massage Therapy appointment. Our North Oakville team is here to help!

Frozen Shoulder and Physio

Shoulder pain and injury can affect a persons life immensely.

You don’t always appreciate what your shoulders do on a daily basis until basic activities are affected.

Your shoulders are ball and socket joints. They are “made” more for mobility. We reach and grab things in all directions. We push and pull and press over head.

The joint is made more stable by the suction cup effect of the socket, the ligaments connecting the bones, the capsule as well as the strength and coordination of the surrounding muscles.

Frozen shoulder is also known as adhesive capsulitis. It can be quite painful and problematic for people due to the pain as well as the range of motion limitations. Frozen shoulder progresses through 3 phases and is often described as being “self-limiting”. While this is the case, range of motion loss, if not addressed can continue beyond.

The 3 phases have no specific timeline and vary depending on the person. They are considered to be the freezing / painful phase, frozen / adhesive phase and the thawing phase. Often there is no known underlying issue shown in imaging like a rotator cuff tear. This can be frustrating and confusing because the condition can be very painful and have a large impact on function.

physio for shoulder range of motion for person with painful shoulder north oakville physio

People with diabetes or Parkinson’s disease have an increased likelihood of developing frozen shoulder. Experiencing a shoulder injury such as rotator cuff tendonitis, calcifications and impingements, or having your shoulder immobilized after an injury or surgery also places a person at higher risk for frozen shoulder.

Range of motion of the shoulder in frozen shoulder, like the name indicates, is limited actively and passively in all directions. Notably external rotation is often affected and painful.

It is best to have your physiotherapist and physician help you with this diagnosis and treatment plan. It’s helpful to have both on your team. For example, when appropriate the use of NSAIDs / anti-inflammatories are more effective when coupled with physio rather than NSAIDs on their own.

There is a lot of information and opinions to sort through online and as always through loved ones. Your physio will work with you as an individual to formulate a treatment plan with you. This is based on how your shoulder is presenting, and what your goals are. Working with a Registered Massage Therapist (RMT) over this time can also be a helpful adjunct as muscles in the neck and around the shoulder blade and upper back can become stiff and sore.

Contact us to book in an assessment with one of our North Oakville Physiotherapists or RMTs. We are able to provide in person physio assessment and treatment as well as virtual physio anywhere over Ontario.

Spring Training & Injury Prevention in Youth Sport- From an Oakville Physio

Spring and summer sports are ramping up in Oakville / Halton. As school comes to an end soccer, baseball, football, lacrosse, golf, tennis, and beach volley ball amongst others are starting to ramp up. Athletes and teams are starting to increase their training, practice and game schedules.

This is where certain habits in young athletes can set them up for greater success and decrease the chances of injury. While all sports have nuances in the specifics there are some general habits that can be helpful.

Let’s first separate injury in youth sports into acute versus overuse types of injuries. While there can be overlap where an overuse injury has sudden acute pain, it is easiest for our purposes to separate them.

Acute Injury in Youth Sports:

Acute injuries in sports are a sudden injury. They are often a strain or sprain and would also include concussions and bone breaks (fracture). These injuries can happen due to contact, such as knee to knee injuries in soccer, an ankle sprain or break sliding into a bag improperly in baseball, a shoulder dislocation or separation in a fall or with contact. They can also be things like a contusion from a hit with a lacrosse stick or a knee into the thigh.

Some of these injuries are more difficult to prevent. We don’t have as much control with our external environment.


Many of these injuries can be lessened or avoided as well.

  1. Build Overall Strength – being strong overall is helpful in preventing injuries. For example, having a strong upper body and neck decreases chances of whiplash from heading soccer balls awkwardly, or with a fall. Having overall core and hip strength when in close and contact situations allows for increased maintenance of positioning
  2. Check your Environment – be aware of ruts
  3. Build Specific Strength
  4. Rest and Recovery – having a well rested body and recovering well from increased training helps prevent injuries like muscle strains from sprinting and kicking. This category includes eating for recovery and hydrating but also sleeping well. Think about how a young athletes body may feel after a couple games or matches on a Saturday, then staying up late playing video games, eating chips for dinner and having to wake up early for a couple more games on a Sunday?
  5. Treat Small Injuries – if your youth player has hurt themselves, it is important to address those injuries. For example why have they sprained their ankle? Was it the field, mechanics, poor proprioception?

basketball injury and sports medicine physiotherapist in oakville doing online or virtual physiotherapy

Overuse Injury in Youth Sports:

  1. Avoid early sport specialization – having a diverse skill set, moving in different ways, training different body systems allows for the body to develop in a more well rounded way. Playing one sport or training in one way over a year
  2. Building General Strength – having a stronger body with more endurance helps prevent overuse types of injuries. Starting a season with “spring training” helps increase tendon and muscular strength and resilience. Timing and planning for this in the general timing of a season is important. Your physio or coaches should be able to help with this.
  3. Take an Offseason – see the above. If a young athlete is training in one primary sport competitively it is important to have an “offseason”. Yes, even if they love it. Have a period of time where they do more flexible activities. Go for hikes, bike rides, try a different activity etc. This lets the body recover, repair and be ready to ramp up for their next season.
  4. Rest and Recovery – taking appropriate rest, sleeping well, eating well etc are all things that help the repair of the body during a season.
  5. Mechanics – starting sport, especially competitive sport with better mechanics is helpful in injury prevention. Good coaching is helpful for this as well as specialized coaching should there be issues.
  6. Proper Equipment – Wearing equipment that is sport and environment appropriate is helpful in preventing overuse injuries. For example, in box lacrosse running on turf versus thin turf over concrete is very different. Having proper shoes for the surface as well as things like compression socks may help prevent shin splint and achillles tendonitis.
baseball player showing post ACL reconstruction rehab at Oakville Physio clinic

If you have concerns about repeated injuries in your youth athlete or are interested in setting up a program to help prevent injury, our North Oakville Physiotherapists are happy to help.

We are seeing patients in person. We also continue to have virtual availability if you are not able to make it into the clinic. We are able to virtually treat patients from all over Ontario!

Contact us with questions or to book an appointment! If your season has started it is still not too late!

Physio is not just for Sports Injuries- Musical Injuries

Physiotherapy assessment and treatment is often associate with sports injuries, surgeries and car accidents. While all these things are true, physiotherapists also treat more than this.

Physiotherapists treat aches and pains associated with occupations. Many of these involve repetitive movements and falls.

Our North Oakville Physiotherapists also treat repetitive strain types of pains associated with playing musical instruments. Injuries or pains can happen when weeks of rest have been taken and then practice, playing, and performing has increased. Changes to the instrument played, when practice and playing time is significant can also make a difference in how the body responds. This may be a new guitar with fret differences or having a new setup for your drums.

Maintaining your body for your music is helpful whether you play for fun or a profession.


Breathing is an important aspect of singing as well as wind instruments. Being able to fulling inhale and expand your ribcage and real your abdomen allows for full lung expansion and recoil for sound. Pain, stiffness, or dysfunction along this pathway can impact your singing.

Accessory muscles to breathing include some of our neck muscles. These muscles can help move our upper ribs. Some of our neck muscles also help with opening the mouth and supporting the vocal cords. Having strength, endurance and mobility in the area is important for singing.

TMJ. The tempero-mandibular joint allows us to open wide to produce sound. The surrounding facial muscles help us modify our mouth shape for different vocalizations. Having this joint move well and the muscles have strength but limited tension allows for our best singing sounds. Think of the warmup exercises to “loosen the face”.

Physiotherapists can assess for range of motion and function of these areas. We can review proper breathing techniques, help loosen joints and muscles. Physiotherapists can also help with a home program of self care to maintain function allowing you to avoid musical related injuries and even assist with the craft.

TMJ picture showing Oakville Physiotherapist that treats TMJ issues


Playing the drums is very physical. Having strong core and shoulder girdle muscles is helpful when playing for long periods of time. The low back wrists, hands and elbows are also areas that can be affected from drumming.

Strength – Having core strength and endurance allows for the low back to be more protected when sitting for log periods playing the drums. When muscles are strong further up the chain in the chest and shoulders, it supports the muscles and joints further down the chain.

Mobility – playing in a way that is strong but loose / mobile is a way to be more efficient with for and effort. Taking time for drills and learning helps with this.

Set-up – having and video of your drum setup or pictures where you look at your playing critical may help with strategies for ergonomic setup. Having lessons where your positioning and technique is looked at is also helpful.


There are many factors in injuries and aches and pains associated with guitar playing. The weight of the guitar or bass, the strings, the frets, having a strap etc.

Hand, wrist, and elbow injuries can be common with guitar playing. Changes in the guitar or changes in the amount of time spent playing, or a combination of the two can impact injuries.

Physiotherapists may give mobility exercises for hand and wrist tendons as well as self care for the areas. Strengthening the small muscles of the hands and adding a stretching routine may be helpful as well.

It is always best to be assessed to ensure a physio treatment plan is designed just for you.

Why Physio?

Physiotherapists can assess for range of motion and function of these areas. We can review proper breathing techniques, help loosen joints and muscles. Physiotherapists can also help with a home program of self care to maintain function allowing you to avoid musical related injuries and even assist with the craft.

Contact us to book an appointment for Physiotherapy to address your musical related aches and pain.

Chiropodist Callus Treatment

You look down at your feet in the spring / summer and you notice areas that may not be smooth. You’re wanting to wear sandals so you just go for a pedicure. You don’t know where to start

Did you know that Chiropodists treat a variety of foot and toenail issues? This includes the skin.

What is a Callus?

Calluses are areas of hard, thickened skin. On the foot there may be calluses on the heel, the ball of the foot and on the inner side of the big toe.

What Causes Calluses?

Calluses form from repetitive friction and pressure from shoes or the ground. The skin responds to pressure and friction over time through forming calluses.

Calluses that occur on the bottom of the foot form when small areas of the foot carry more than their share of body weight force. This can happen at the bases of the toes at the ball of the foot and can vary with how we walk and bare weight.

Calluses can become a painful area that may affect how we walk or move and therefore the body above it.

We see people of all ages in our North Oakville foot clinic for calluses. Hockey players or skaters can often develop calluses as well as dancers, baseball players and soccer players. Runners and distance runners also have a tendency to develop calluses.

Post-partum women who have had foot changes during pregnancy, may notice that they have callus formation in different or new areas. Our Chiropodists can help with this.

oakville foot clinic treating thick toenails

What will a Chiropodist do?

A Chiropodist will not just treat your calluses, they will look at the causing factors as well. There may be things they can suggest to prevent callus formation or to slow their development. This may include footwear and other protection.

They will look at how you stand, move and the skin itself. they will assess the area and ensure it is a callus they will be treating and not something like a plantar wart. They will offer treatment suggestions and get your permission to move forward with treatment of the foot.

They may refer you to a physiotherapist to provide you with exercises to help with your strength and range of motion. This can help if the way you walk or weight bare has a role in your callus formation.

The Chiropodist Difference:

There can be times when calluses hide ulcers and infection underneath. This can happen in cases of diabetes and in people who have numbness or sensation differences. It is important to not only treat the callus in these cases but also address these areas of pressure. In these cases the Chiropodist may suggest custom orthotics that are built for you that relieve these areas of pressure and allow the area to heal more effectively.

Chiropodists use tools that have cleaned and sterilized using an autoclave. The autoclave must be maintained to ensure the effectiveness of the process. This prevents infections through the use of clean tools.

Chiropodists are medical professionals who are trained in a post graduate doctorate program. They view your foot from a medical and health lens rather than a purely aesthetic lens. You are paying for their medical expertise as well as their sterilization and medical equipment. Although we have had patients call this process a “medical pedicure”!

Please contact us to book in with one of our wonderful Chiropodists to assess and treat your foot issue.