Category Archives: Balance Issues

What Happens When You Have A Body Part That Is Immobilized?

Maybe you are healing from a fractured wrist and have it in a cast.

Maybe you are recovering from knee surgery and have a brace on.

Maybe you have a torn Achilles and have a boot on.

Maybe you dislocated your shoulder and have it in a sling.

Or maybe you had to be on bedrest for a significant length of time due to other health issues.

The point is… you as a whole, or a certain body part, were immobilized.

Interestingly, when you get referred to physio after the brace or cast or sling come off, we are not really treating the original injury at that point. We are treating the secondary effects of it, along with the effects from the immobilization!

So What Are Those Secondary Effects?

When you’ve had a fracture, or a dislocation, or a ligament / tendon / muscle tear, what you can expect is:

  • Decreased range of motion
  • Decreased strength
  • Pain with use
  • Swelling
  • Overall lack of function i.e. you’re not able to do all the things you were doing before the injury
Physiotherapist Kristina working on range of motion with a patient post knee surgery

Similarly, when a body part is immobilized, these issues get compounded.

Let’s take a fractured ankle for example. Maybe it didn’t need surgery but you were still put in a cast or a splint for 4-8 weeks:

  • When the muscles of that ankle and foot aren’t been used for that length of time, they begin to atrophy – you lose muscle mass and therefore, muscle strength. Your body has a strict “use it or lose it” policy and it’s not going to put in energy into maintaining something that’s not being used. Not to mention, it now has to redirect energy and resources into healing the fracture.
  • Without movement in the ankle joint, the joint gets stiffer and the muscles around it get tighter. Not to mention the swelling that’s been pooling will also block additional movement. Which means, the range of motion and flexibility of your ankle once the cast or splint come off, will be very minimal and likely have some pain.
  • Along with trying to move it, putting weight on it will likely also cause the ankle some pain. Part of that is due to the muscle weakness, swelling, and decreased range of motion. The presence of these adds to the pain of an area that’s already recovering from injury and is still sensitive.
  • And as you can imagine… if you have limited range of motion, muscle weakness, and pain… your walking, standing, and balance will be affected. Not to mention your ability to do things that require more exertion such as climbing stairs, squatting, lifting heavy objects, running, jumping, dancing, etc.
  • Lastly, let’s not forget about the rest of you! If you’ve had a fractured ankle, you aren’t using the whole leg very much either, so all of those muscles will be a bit weaker. On the contrary, the other leg might be tired from overcompensating, and maybe even getting a bit sore. Plus, you’re less active than you were before the injury, so you might also lose some cardiovascular fitness.

Cue Physiotherapy! We are here to gradually get you back on track with all of the above and as much as possible back to normal!

Depending on the injury, we follow protocols for restoring range of motion and strength, as well as reintroducing day-to-day, work, or recreational activities back into your routine.

Oh, and what about when you’ve had to be on bedrest?

Although no specific body part was immobilized, depending on how long bedrest was necessary for, there will likely be some general muscle atrophy.

Physiotherapist Kristina explaining how the patient can work on secondary effects from recent knee surgery

It’s due to the same “use it or lose it” principle.

And it’s not just your muscles… Other impacts of prolonged bedrest include:

  • Backache from the atrophy of core and postural muscles
  • An overall decrease of cardiovascular fitness and respiratory system efficiency
  • This leads to less energy and more fatigue once you start moving and trying to be more active
  • Increased risk of falls due to weakness and decreased balance
  • Increased risk for fracture because bones also get weaker without weight-bearing activities (i.e. walking). Just like muscle mass is maintained with use, bone strength is maintained with use.
  • Tendons and ligaments also lose some of their natural properties that allow them to do their jobs effectively. As a result, when you start being more active following bedrest or immobilization, they are now more prone to injury.

You may experience some of these effects in as little as 3-5 days of bedrest.

The good news is, bedrest is not prescribed as often as it used to be. That’s because research has shown that in most cases, there are minimal to no benefits. We are now also much more aware of the detriments it can cause.

However, when it is necessary, depending how long you were on bedrest for, it might be worth doing a few physio sessions to get you back into activity safely. Book here for an assessment today!

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Dynamic Warm Up Magic

You’ve probably been told to “warm up” before working out or participating in an activity many times in your life. But what really is the importance of a warm-up and what does it look like?

Physiotherapist Nada leading Through A Dynamic Warm Up

What are the benefits of dynamic warm-ups?

In the past, warming up meant stretching out your muscles. However, evidence has since shown that a dynamic warm up is much more beneficial in preventing injuries and improving athletic performance as compared to static stretching. Static stretching focuses on loosening up muscles. Benefits of dynamic warm-ups include:

  • Increasing heart rate
  • Increasing blood flow – which helps deliver nutrients to muscles
  • Improving elasticity of muscles and tendons – which improves the range of motion through the joints
  • Activating the central nervous system 

This prepares your body, particularly your cardiovascular system, for the exertion of the sport or activity. 

Who should do dynamic warm-ups?

Dynamic warm-ups should be implemented by athletes of all levels. In fact, if your lifestyle is mainly sedentary, you would probably benefit more from a dynamic warm-up routine. Whether you are participating in your routine work out at the gym, playing recreational soccer on the weekends or competing at higher levels in sports, dynamic warm-ups will positively impact your performance. 

What does a dynamic warm-up look like?

Physiotherapist Nada Demonstrating A ladder Exercise As A Dynamic Warmup

While static stretching involves putting a muscle in a lengthened position and holding, dynamic warm-ups involve moving through a joint’s range without holding in one area. In general, dynamic warm-ups should include movements of the joints and muscles that are going to be used during your specific sport or activity. For example, if you are playing in an adult league soccer game on the weekend, your dynamic warm-up might include a light jog around the field, leg swings forwards/back and side to side, and side stepping or shuffling. The warm-up should be at least 10-15 minutes in duration to be effective. 

Though it may seem tedious, investing a little bit of time at the beginning of your workout or activity can significantly impact your body and your athletic performance.

If you have any questions about whether this is something you would benefit from, call us at (905) 582-9700!

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What is a Concussion and How Can Physio Help?

A concussion is a traumatic brain injury. It can be caused by:

  • a blow to the head
  • impact from a fall
  • a sudden acceleration of the head and upper body (e.g., as your head and neck whip forward during a car accident). KEY NOTE – This means you don’t need actual head impact to have a brain injury! This is because the brain can still be injured by the impact against the walls of the skull.

Diagnosing a Concussion…

Signs (observable by others):

  • appears dazed and delayed in answering questions.
  • Easily confused, appears foggy.
  • Slow to respond, slow reaction times.
  • forgetful, no memory of the events prior to or immediately after the injury (usually short-term memory loss).
  • mood/behavior/personality changes (usually presenting as irritability and/or depression).
  • Loss of consciousness (rare).

Symptoms (reported by the patient):

  • Headache or “pressure” in the head
  • Nausea or vomiting
  • light sensitivity
  • noise sensitivity
  • Feeling foggy or in a daze
  • Concentration or memory difficulties
  • difficulty reading
  • unusual fatigue
  • disrupted sleep
  • low mood
  • Difficulty with balance/dizziness
  • Double or blurry vision
  • ringing in the ear
  • screen intolerance
Physiotherapists Testing For Balance and Vision Issues.

Signs and symptoms might not be immediately apparent. They may appear hours or days after the injury. Therefore, it’s important to keep checking in after a hit, fall, or whiplash-type injury for the rest of the week.

Sometimes, there can be more serious signs and symptoms indicative of a brain bleed that leads to a hematoma (a dangerous collection of blood that causes swelling in the area and compresses the rest of the brain).

When to call 911 / go to the ER:

  • One pupil is larger than the other.
  • Extreme drowsiness or not waking up.
  • A worsening headache
  • slurred speech, weakness, numbness, worsening coordination
  • continued vomiting.
  • seizures
  • loss of consciousness

Note – in infants and toddlers, any of the above signs, inconsolable crying, or continued refusal to feed should all be considered a red flag.

Timeline

Most concussion signs and symptoms resolve within two weeks. It is still normal to have lingering effects for up to 3 months.

However, it is always a good idea to get the concussion checked out by a medical professional (e.g., a family doctor) within the first week.

Do not wait to see if it will resolve before consulting your doctor. Concussions ARE brain injuries, and they can have long-lasting residual effects that affect your daily living.

What helps the healing process?

  • Get more rest than usual.
  • Pace your activities (e.g., break down into smaller chunks, take microbreaks, stop when symptoms increase).
  • hydrate more often.
  • Eat more whole foods and focus on food high in omega 3s and 6s.

Why you should see a Physio

Now that we’ve covered what a concussion is and its effects, let’s talk about why Physiotherapy can be an appropriate treatment.

Physio treatment involves:

  • Manual therapy (soft tissue and joint mobilizations).
  • Exercise therapy (range of motion, strength, stretch, cardio, balance, vision exercises).
  • education (on the recovery process, self-management strategies, relaxation techniques especially for improving sleep hygiene, return to work/sport/school).
Physiotherapist Kirsten Providing Manual Therapy on a Patients Neck.
An Example of Exercise Therapy to Work on Balance for a Concussion Patient.

A combination of these can help with post-concussive symptoms such as:

  • fatigue
  • Double or blurry vision
  • balance impairments
  • dizziness
  • neck pain                                                                                                                                            
  • headaches
  • low tolerance for activity (e.g. school, screentime, sports)

Return to activity.

Rest is recommended for the first 24-48 hours with very limited screen time and no exercise. After the first 48 hours, depending on the severity of symptoms, general activity and screen time should be gradually introduced, increasing them based on the level of symptom aggravation (typically mild to moderate symptoms are normal, while moderate to high symptoms indicate the need to stop the activity and wait until symptoms have settled before resuming).

This includes a return to work, whether it is a return to a desk job or a job that is more physically demanding.

Return to sport.

The table below is taken from the Zurich 2012 conference CONSENSUS STATEMENT: McCrory, Paul, et al. “Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012.

GRADUATED RETURN TO PLAY PROTOCOL
Rehabilitation StageFunctional exercise at each stage of rehabilitationObjective of each stage
1. No activitySymptom limited physical and cognitive restRecovery
2. Light aerobic exerciseWalking, swimming, or stationary cycling keeping intensity <70% maximum permitted heart rate. No resistance trainingIncrease HR
3. Sport-specific exerciseSkating drills in ice hockey, running drills in soccer. No head impact activitiesAdd movement
4. Non-contact training drillsProgression to more complex training drills, e.g. passing drills in football and ice hockey. May start progressive resistance trainingExercise, coordination, and cognitive load
5. Full-contact practiceFollowing medical clearance participate in normal training exerciseRestore confidence and assess functional skills by coaching staff
6. Return to playNormal game play

Contact us to learn more or book an initial assessment here to get started with your therapy today!

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