Category Archives: Exercise

Growing Pains in Children – Should You See a Physiotherapist?

School has officially begun for the year and with that comes an increase in activity levels for many children. As the fall and winter season approaches, many kids will participate in school sports as well as extra-curricular organized sports and activities. This ramp-up in exercise levels can sometimes lead to aches and pains, particularly in young children who are still growing at fast rates.

The term “growing pains” refers to this sort of injury. This pain is muscular in nature and occurs because bones are growing and changing at a faster rate than the muscles can keep up, which puts added stress and tension on the muscles. This can be more prevalent in children who participate in sports all year long, or children who play multiple sports at the same time.

Common Growing Pains

  • Sever’s Disease: pain in the back of the heel where the Achilles tendon attaches.
  • Shin Splints: pain in and around the shins.
  • Osgood Schlatter’s Disease: pain below the knee from the quadriceps muscle pulling on the shin bone.

Symptoms of Growing Pains

  • Pain in the thighs, knees, shins, or ankles.
  • Pain after playing sports or engaging in activity.
  • Pain at night when sleeping.
  • Pain is described as an “ache” or “burning.”

Physiotherapy and Growing Pains

Physiotherapist Nada demonstrating stretches that can be relieving for Severs Disease

Physiotherapy treatment is a very effective way to treat and manage activity-related pains in growing children. The aim is to reduce inflammation and improve muscle flexibility and strength. This includes techniques like mobilizations, manual stretching, and soft tissue work. The physiotherapist can also instruct you on how to manage your symptoms at home and what exercises to do to effectively target the area.

Single leg step ups for Osgood Schlatter Disease
Single leg heel rises used for Severs Disease
Exercises that are beneficial in strengthening relevant muscles in individuals with Severs or Osgood Schlatter Disease

If your child is experiencing pain and discomfort with exercise, book an initial assessment here with one of our physiotherapists. They will design a treatment program individually tailored to your child’s needs, age, and activity level.

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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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Muscle Contusions-Can Physiotherapy Help?

Are you familiar with the term contusion? A contusion is the medical term for a bruise. Muscle contusions are a result of direct impact or trauma to the area. The most common sites for this to occur are the thighs, knees, arms, or calves. This direct impact leads to muscle bleeding and fiber damage which is what causes the swollen and reddish-purple bruise appearance. Contusions can occur from any form of contact sport, rough play, falls, or accidents where the body bangs into a hard object. Muscle contusions are different from muscle strains, which usually occur from sudden fast movements or overworking a muscle more than it’s used to.

Contusions are graded by their severity as Grade 1, 2 or 3.

Grade 1 contusions produce minimal pain and swelling. You may feel some soreness and stiffness with movement, but your range of motion is likely unaffected.

Grade 2 contusions will likely have more consistent pain and swelling may be present. You may not be able to walk or move normally without experiencing pain. Your range of motion may be decreased.

Grade 3 contusions are the most severe. Pain with any small movement will be present and significant swelling will occur. You may need to use crutches to help you walk. Strength and range of motion are significantly impacted.

Physiotherapist Kristina working on range of motion after an arm contusion

After a contusion, a physiotherapist can provide you with education on how to properly care for your injury and promote healing at home. Physiotherapy can also help restore your range of motion and strength to the affected area through movement and exercises. For more severe contusions, manual therapy can gently mobilize the muscle and surrounding tissue to promote blood flow and good alignment of the healing muscle fibers. 

If you have experienced a muscle contusion, schedule an assessment here and one of our physiotherapists will be happy to assist you.

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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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“It’s Just A Sprain” – The Importance Of Physio For Ankle Sprains

An ankle sprain is a common musculoskeletal injury caused by a tear or damage to one of the ligaments surrounding the ankle joint. It is frequently the outcome of an event, such as a sports contact, a trip, or a misstep while walking. It can affect people of all ages and athletic abilities.

Ankle sprain symptoms can vary greatly in terms of the degree of pain, limitation of movement, and swelling present. These are usually determined by the location and severity of the sprain.

Physiotherapist Nada Testing For Mobility

However, regardless of the severity of your symptoms, if you suspect you have hurt your ankle, you should consult a physiotherapist as soon as possible. Ideally, within 36-48 hours after the injury, to ensure that the pain and swelling have a chance to settle before starting.  In the meantime, at home, use the R.I.C.E. routine (rest, ice, compression, and elevation) to promote the healing process.

Physiotherapy early on can reduce the chance of additional ankle issues such as persistent pain, stiffness, lack of movement, or strength. Your physiotherapist will be able to check the severity and instability of your ankle sprain, as well as any functional limitations, and rule out anything more serious, such as a fracture.

Nada Checking Pain, Swelling, and Stiffness of The Injured Ankle

Treatment with a physiotherapist will use a combination of exercise and manual hands-on therapy to improve strength, range of motion, and proprioception of the ankle.

In the case of most ankle sprains, rest alone is unlikely to be an effective treatment method. Being proactive and obtaining treatment will not only encourage and accelerate your ankle sprain recovery time but will also maximize ankle strength and prevent re-injury in the future. A physiotherapist can educate you and design an exercise program for you to restore the function of your ankle joint and surrounding muscles.

If you believe you have sustained an ankle sprain or are experiencing ankle pain, book an assessment with one of our qualified physiotherapists here!

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Is it Sciatica?

Chances are, if you’ve had back pain or leg pain, you’ve heard the term Sciatica.

So what is it?

Sciatica refers to an injury to or compression of the Sciatic Nerve. This is a very large nerve that originates in the lower back and runs down the back of each leg.

To give a bit of background detail… nerves innervate our whole bodies, and via electrical impulses, provide both power to the muscles and sensation to the skin. When a nerve is injured or compressed, we can experience symptoms of pain, weakness, numbness, or tingling.

Symptoms of Sciatica:

Pain that can go down the back of the leg (from the gluts, down into the back of the thigh, into the calf, and into the top or sole of the foot)

Numbness along the same area

Weakness in the leg with certain movements (e.g., does your foot get caught tripping as you walk? Are you able to walk on your toes?)

Tingling along the same area

Causes of Sciatica?

Disc bulges or herniations in the lumbar spine (the disc can press on the nerve)

Spinal stenosis (the canal through which the Sciatic nerve travels has narrowed due to arthritic changes and that can cause pressure on the nerve)

Piriformis syndrome (muscles in the glut area can get tight and compress the nerve as well)

If you are experiencing any Sciatic symptoms and they are not improving/worsening after 2-3 days, then Physiotherapy can likely help!

We do a thorough assessment to find the source of the nerve compression and provide:

Manual therapy techniques to relax tight muscles and help the nerve glide more easily

Additionally, manual therapy techniques can help take the pressure off from disc bulge or herniation and improve joint mobility

Exercise therapy to strengthen the back and core, stretch the tight musculature, and glide the nerve more freely

There are exercises we can show you that also help take the pressure off the nerve if the compression is happening in the spine

PT Kristina performing the slump test

If you’re not sure, you can always give us a call and ask one of our physiotherapists!

Other recommendations in the meantime:

Performing gentle stretches like the image above can help relieve symptoms!

Try ice or heat on your back or gluts

Speak to your primary physician regarding pain management options

Avoid exclusive backrest

If you are doing any exercises that aggravate your symptoms, STOP them temporarily

Reduce your general activity i.e. “take it easy” for the first few days

Alternate positions (sit, stand, walk) rather than doing one for a prolonged time

Do not lift anything heavy, e.g. >20 lb, especially from the floor

Do not ignore this issue for weeks because it likely WILL get worse and it will then take longer to heal…

If you would like to learn more or book your initial physiotherapy assessment along with treatment, book your appointment now.

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Why Stretching is Essential for a Healthy Body


Benefits of Stretching:

Improved Flexibility: Stretching helps to increase your flexibility by lengthening your muscles and improving your range of motion. This can help prevent injuries and make everyday tasks easier to perform.

Reduced Muscle Tension: Stretching can also help to reduce muscle tension and soreness. It can improve blood flow and help to release any built-up tension in your muscles, allowing you to feel more relaxed and less stressed.

Improved Posture: Stretching can help to improve your posture by reducing any imbalances in your muscles. This can lead to a better alignment of your spine and improve your overall body mechanics.

Increased Energy: Stretching can also increase your energy levels by stimulating your body and mind. It can help to improve your circulation and oxygen flow, allowing you to feel more alert and focused.

Effective Ways to Stretch:

Dynamic Stretching: This type of stretching involves movements that take your body through a full range of motion. It is an effective way to warm up your muscles before exercise and can help to prevent injury. Examples of dynamic stretching include lunges, leg swings, and arm circles.

Static Stretching: This type of stretching involves holding a stretch for a period, typically around 30 seconds. It is an effective way to improve flexibility and reduce muscle tension. Examples of static stretching include hamstring stretches, quad stretches, and shoulder stretches.

Foam Rolling: Foam rolling is a type of self-massage that involves using a foam roller to apply pressure to your muscles. It can help to release any knots or tension in your muscles and improve your range of motion.

Yoga: Yoga is a form of exercise that involves stretching, breathing, and meditation. It can help to improve flexibility, reduce stress, and promote relaxation. There are many different types of yoga, so it’s important to find one that suits your needs and abilities.

In conclusion, stretching is essential for maintaining a healthy body. It has numerous benefits and advantages that can improve your overall health and wellbeing. By incorporating stretching into your daily routine, you can improve your flexibility, reduce muscle tension, improve your posture, and increase your energy levels. There are many effective ways to stretch, including dynamic stretching, static stretching, foam rolling, and yoga. So why not start incorporating stretching into your daily routine and experience the benefits for yourself?

If you would like to learn more or book your initial physiotherapy assessment along with treatment, please feel free to contact us.

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More Snow Advice!

We still have all of February and even March for snowfalls so we are not done with the season just yet!

Which is why today we will expand a bit on the advice from Part 1 and Part 2 of our blogs on Snow Shoveling Tips…

1. Warming up

The reason why we need to warm up prior to shovelling is because when we get out in the cold, all of our blood vessels constrict, which increases their pressure when trying to bring the blood to the rest of the body.

At the same time, we suddenly burst into mostly upper body activity, which requires a lot more blood supply!

This puts a strain on your cardiovascular system…

The heart pumps oxygenated blood through the entire body. More physical exertion = more strenuous pumping!

Therefore, before you step outside and pick up the shovel, warm your system up first so it is ready for shovelling:

  • Jog in one place for 30 seconds
  • Do jumping jacks for 10 seconds and repeat a few times
  • Do some air punches forward and overhead for 30 seconds
Jumping jacks get your heart rate going!

It’s also a good idea to do some stretches to warm up your muscles and avoid strains!

  • Do shoulder/arm swings (perform slowly and with control to avoid straining a muscle with quick, sudden movements)
  • Lightly stretch the backs of your shoulders by crossing one arm across your body, then the other for a few seconds at time (don’t hold for a long stretch so you don’t overstretch before having to shovel) and without pushing too hard into the stretch
Warming up the shoulders!
  • Twist your torso from side to side with arms across your chest (perform slowly and with control to avoid straining a muscle with quick, sudden movements)
  • Slowly bend forward to stretch the back and the backs of the thighs for a few seconds, repeating a few times
  • Slowly lean back with hands on hips for a few seconds, repeating a few times
  • Do some lunges
Lunges warm up your quads, hamstrings, gluts, and calves!
  • Do leg swings (perform slowly and with control to avoid straining a muscle with quick, sudden movements)
  • Pull ankle to buttock while standing to get a quad stretch, holding only for a few seconds and repeating a few times before switching legs (don’t hold for a long stretch or pull too vigorously so you don’t overstretch before having to shovel)
  • Do some calf stretches for a few seconds, repeating a few times on each side

Once you feel warm and limber, you’re set to head outside!

2. Technique is important.

A lot of people try to get it done as quickly as possible. They rush to shovel, try to move a lot of snow at once, and end up twisting their back a lot to get the snow off to the sides. This can lead to muscle strains or back sprains.

  • A good rule of thumb is only move the shovel in the direction of your toes! As you push the snow with the shovel, push in the same direction that your feet are pointing.
  • Use the power of your legs instead of bending a lot through the back or pushing a lot through your arms. Think mini lunges as you propel the force through your legs and push the shovel and snow forward.
When shoveling, check in: Are the toes pointing in line with the shovel? Are you bending with your back or more with your knees like in a mini lunge?
  • When you have to lift the snow to throw it out of the way, make sure you are not twisting at the back. Keep toes pointing in same directions as the shovel. Lift with your legs in the mini lunge (or mini squat) position, rather than bending. Then, to throw the snow, use the momentum of the lift as you straighten out to also throw the snow off the shovel and into the snowbank.
  • As you throw that snow off the shovel, you shouldn’t have to extend your arms all the way out. The shovel should remain fairly close to your body.
Check in: When you throw the snow, are you twisting the back or are your toes pointing the same way as the shovel? Are you using the force from coming up from the lunge? Are your arms staying closer to your body or fully straightening out?
  • If you are quite tall, standard size shovels might not work as well for you. Look for longer and/or bent handle shovels to reduce the bending needed through the back.

3. Staying active in general!

Not a lot of us will commit to working out so we can be ready for snow season, but definitely including cardio (running or brisk walks, swimming, cycling) into our workouts will make our cardiovascular system more resilient.

Swimming picture in blog re: importance of cardio when it comes to being prepared for snow shoveling season.
Swimming is great cardio that also incorporates your upper body, unlike running or cycling!

When it comes to shoveling, upper body cardio work e.g. light weights, boxing, etc., is great!

Adding in weighted squats and lunges are great for strengthening those leg muscles we will use to propel and lift the snow!

Adding in some upper body strengthening will be helpful for maneuvering the heavy shovel and snow! E.g. shoulder presses, chest presses, bicep curls and triceps extensions, front arm lifts with straight elbows, etc.

If you do end up getting injured and it’s not improving within a week, give us a call to see how we can help!

Good luck out there in the snow!

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