Category Archives: Virtual Physiotherapy

Thumb Pain – from an Oakville Physio

For being a small joint, having pain or issues in our thumbs can cause us big problems!

Our thumbs help us grip, and grab in fine ad gross motor tasks. From carry a baby seat to holding your hand open in a baseball mitt, to knitting and chopping dinner, you don’t realize how important you thumbs are until you have thumb pain that prevents you from doing these things comfortably.

Even though it’s a small area, your Physiotherapist and Massage Therapist take your complaints seriously. Like all injuries and pains in the body your physiotherapist will take a thorough history of our health, habits, the onset of the issue and how it is presenting. They will take you through movements and special tests to rule in and rule out various issues and types of tissues.

Like many issues in the body thumb issues and pains can from the joints (where the bones meet), the tendons, the muscles, and the ligaments. In some cases it can be more than one thing contributing to the pain.

Chronic Thumb Pain / Issues

With chronic or ongoing thumb pain Physiotherapists often look to the joints or the tendons as a primary culprit.

Osteoarthritis (OA) – the carpometacarpal joint of the thumb can cause ongoing thumb issues. As Physiotherapists we look to patterns of pain. The thumb joint may have a squaring type of change and the joint line may be tender to the touch. Your physiotherapist will work with you on your goals to help you protect the joint, manage your pain and get you closer to activity. Having osteoarthritis does not mean you cannot improve your pain.

Tendinosis – The tendons of the thumb connect the muscles to the bone. They act as a pulley system. These tendons over time and with repetitive loads can wear and thicken. Although less common than other areas of the body this can be an issue in the thumb. Your physio or massage therapist may suggest working on these tendons and the surrounding muscles. They may provide you with exercises to strengthen the area as well. Sometimes modifying what you do can also be part of the trick.

Trigger Thumb – Having the thumb catch and get stuck during movement can be painful, or not. When you move your thumb into a fist and then try and open it it may catch or click. For some people, they have to use their other hand to open the thumb back up. This can also happen in the fingers and is aptly named “trigger finger”. This is also known as “stenosing tenosynovitis”. The tendons move through the tendons sheaths and a series of pulleys. In trigger thumb or finger, an enlarged flexor tendon gets trapped or caught up in the pulley system. The area of entrapment may be closer to the palm than the area that gets “stuck”. This area of entrapment can be painful, but is not always. Your physiotherapist or massage therapist will give you treatment depending on how this presents and how it is affecting your daily life.

Like most things, these painful thumb issues are best treated early. If you have been having thumb pain that is new, not going away, is impacting your activities of enjoyment, or is worsening, it is helpful to have a thorough physiotherapy assessment. If the issue has been there for longer or there has been an increase in pain, physiotherapists are also a part of your team.

Our next blog post will talk about more acute, or sudden injuries of the thumb.

Contact us at our Oakville Physio, Massage, Yoga, and foot clinic to book with one of our trained practitioners.

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.

Most common issues people are experiencing during the pandemic!

Ever since we re-opened our physical doors on June 1st, 2020 (during the initial lockdown, we were only available for virtual therapy!) some cases have stood out more than others…

  1. A lot of neck / upper back / shoulder / arm pain as people are working exclusively from home
  2. Injuries resulting from people taking advantage of being home to exercise more, specifically by running (e.g. Achilles issues)
  3. Chronic issues resurfacing because people have not being able to work out regularly at the gym (e.g. back pain)

1. Neck / upper back / shoulder / arm pain

The first issue has been directly as a result of the change in ergonomics and working longer hours! Think about it. If you didn’t have a home office, you probably ended up working at the kitchen table, or from the couch. Sitting for eight hours in a kitchen chair, or sinking into the couch the whole time, can get quite uncomfortable.

Plus, at home we don’t have meetings in conference rooms… we don’t drive to see clients… we don’t get up to go talk to someone at another desk… There are lot less breaks from sitting and a greater opportunity to work longer, especially when there is no commute back home!

So… we end up spending longer time in positions that are less than ideal, and end up putting stress on certain muscles or joints.

Not to mention the stress associated with a pandemic! You don’t know how long it’s going to last and it affects your life in so many ways both work and non-work related… And stress causes us to tense up, raises our heart rate and blood pressure, reduces our adaptability and immune system…

It’s no wonder we start having pain!

So what can you do about this?

The pandemic is not going away any time soon. If you haven’t already, it might be a good time to invest in your workspace at home. Here are some suggestions about how to optimize your workspace:

  • Desk and chair height should allow for your forearms to be parallel to the ground while keyboarding and mousing
  • Ideally, chair height should allow your feet to comfortably rest on the ground
  • Seat depth and distance from desk should allow for you to sit as far back as you can, so that you are taking advantage of the backrest
  • Backrests for the full back are preferable to backrests that only go up halfway
  • Backrests with adjustable lumbar support are preferable
  • Screen(s) should be at eye level so you are not constantly looking down
  • If you use a laptop only  consider getting a riser table so that the screen is at eye level, and a wireless keyboard so that your forearms can still be parallel to the ground
  • Consider setting up reminders on your phone to get up to move and stretch, or get a drink of water
  • If possible, consider switching for half an hour to the kitchen island with your laptop so you spend some time standing instead of sitting. Or, when you have conference calls, taking them standing.
physio blog at palermo physio about common injuries and pains during pandemic, discussing tips for home ergonomics
An optimal workspace ergonomic setup at home can make a huge difference!

These ergonomic modifications can make a difference over time. But if your pain has been worsening, let us know so we can help! We are considered an essential service and remain open during lockdown for all of our services: physiotherapy, massage therapy, yoga therapy, chiropody, and acupuncture!

2.  Injuries from exercising more

A lot of people have been walking more, especially in the past Spring and Summer. There have also been a lot more runners and cyclists. This is great news! These are activities that don’t require much (or any) fancy equipment and can be done alone, or with family.

However, when you are adding a new activity for exercise, overdoing it is a concern.

Here are some tips when adding in new exercises to your routine:

  • Do not go from 0 to 100! If you never used to run, start with 2-3x week, not every day.
  • Do not push yourself right off the bat! Start with light jogs, or a run-to-walk ratio. Think more about endurance (pacing yourself) rather than speed. Same goes for biking.
  • Fit bits and 30-day challenges are great motivators. However, pushing yourself to the limit for the sake of hitting a mark can cause more issues than it’s worth. If you are getting pain, do NOT push through it! If you really don’t want to skip the day, replace or modify the activity.
  • Recovery days are just as important as workout days. Whether it’s a full day of rest, or a lighter activity like yoga, recovery days are important to let your tissues recuperate and adapt. What’s more, exercise normally increases your heart rate, blood pressure, and muscle tension. Recovery activities are meant to reduce these metrics so your system is in more balance. This reduces the risk of injury.

If you’ve taken up running have you been having any foot, ankle, knee, hip, or back pain? If you’ve been cycling, any wrist or elbow or shoulder pain?

Oakville Physio clinic showing shoe tying
Running and walking are great activities during the pandemic to stay active.

Let us know so we can help! If you’re not comfortable coming in due to COVID-19 concerns, we continue to offer Telehealth services (video calls). Click here for more information.

3. Chronic issue resurfacing because we are not going to the gym

Do you have any chronic neck or back issues? Did you have a regular workout routine prior to the pandemic? Was this routine interrupted as a result and you’ve been noticing your old issues creeping back in?

If so, you are not the only one!

A lot of people manage certain conditions with regular exercise. They usually notice that if they are not as diligent about their exercises, their pain and mobility may worsen.

Unfortunately, access to gyms has been spotty. Even when lockdown restrictions were lifted in Summer and Fall, gyms were operating at limited capacity and by appointment-only. Unless you have all or most of your workout equipment at home, you were likely affected.

While investing in a new desk or office chair is cheaper and more pressing, investing in workout equipment is not. You may buy some free weights, or splurge on a stationary bike, but you likely are not replacing all the equipment you used to use at the gym.

Or perhaps it’s not the equipment that you miss, but the dynamic and instruction of group exercise classes.

Unfortunately, in-person exercise classes are gone for a while, but there are other options!

So what can you do?

Even if you don’t have chronic pain but would like to get back to being active, here are some ideas:

  • Accept that your workouts do not have to look like what they used to be. A lot of shoulder, core, and leg exercises have equipment-free alternatives that rely on body-weight resistance only!
  • If you have some free-weights but you used to use machines, the free-weights are still better than nothing!
  • If you miss the group classes, a lot of places have online classes. It may not be the same but it’s still better than nothing! Sometimes, it just takes a while to get into a new routine.
  • Take the opportunity to try a new form of exercise that doesn’t require gym equipment (just make sure you follow the tips outlined in the previous section!)
  • If you find it hard to get motivated at home, consider what puts you in the right state of mind… what kind of music do you like working out to? Is there a time of day that works best? Do you like having the motivation of peers? Then ask if some friends want to join you in a remote challenge! Are they free 2-3x week to attend an online class with you? Do they want to check in at the end of each week or each day to make sure everybody is meeting their activity goals?
  • If you need 30-60 minutes on your own 3x week for your health and well-being, have this conversation upfront with family members about helping you do this and how it’s going to work! You don’t have to do this alone!

If your chronic issue has flared up because of the lack of maintenance, let us know! We are here for you whether it’s an in-person appointment or virtually!

Is Your Mask Making you a Mouth Breather?

Our Oakville Physio’s, RMT’s, Chiropodists and Yoga Therapists all wear medical masks throughout their day at work.

Wearing them for so long, many of us are aware that we’ve been spending more time mouth breathing.

Is wearing your mask making you more of a mouth breather too?

There are many surprising negatives about being a consistent mouth breather rather than a nose breather. It is generally much healthier to breath through your nose rather than your mouth.

The resting position of your jaw and mouth should be as such:
  • Lips closed gently
  • Tongue rests gently on the roof of your mouth behind the front teeth (not pressure the teeth)
  • Teeth rest around 3mm apart (molars are not touching)

Negatives of Mouth-Breathing:

  • Mouth breathing is be associated with snoring and sleep apnea
  • Can cause bad breath through altering the bacterial population in the mouth
  • Leads to dry mouth, teeth, tongue and gums. This alters levels of acid in the mouth and can lead to tooth decay
  • Some evidence shows that ADHD symptoms can be exacerbated with mouth breathing
  • Mouth breathers can have altered head and neck positioning. This can lead to neck pain and tension as well as TMJ (Jaw) pain.

Positives of Nose-Breathing:

  • Removal/ filtering of germs, irritants and bacteria
  • Nitros Oxide is released in the nasal passages and follows the inhaled air into the lungs. This is important to immune responses and vasoregulation.
  • The nose and nasal passages warm and humidify the air inhaled
  • Breathing in and out of your nose keeps air in the lungs for longer. This can increase the amount of oxygen that enters the blood stream with each breath.
  • Allows for better jaw, neck and shoulder posture.
  • Allows for better mouth, jaw and facial development.

Check in with yourself during the day in and out of your mask.

What is your resting state of breathing?

Try and revisit the above resting state of breathing we discussed.

Many people our Oakville Physio’s and Massage Therapists treat with neck, shoulder and TMJ issues can benefit from revisiting this type of breathing. Our Yoga Therapist does and excellent job linking this breath with stretching and movement. This helps it become more natural once again.

Contact us to book in with one of our professionals. We are able to direct bill to most insurance companies. We continue to see people in- person from the surrounding Oakville, Milton and Burlington areas and virtually (video call) from all over Ontario!

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!

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!

What Does Self-Care Look Like During Isolation…

Ever since social distancing has been enacted to prevent the spread of COVID-19, our Palermo team has been adapting to the “new normal” along with everybody else…

Everything we post is also our own way of coping 😊 Whether it’s making sure we keep moving, setting up our own workstations from home in order to begin Telehealth, prioritizing our sleep and stress management, meditating to ease our own stress and anxiety, or delving into other interests, such as yoga or gardening or writing or crafts!

There are things within and things outside of our control, so we are focusing on what we can control and accepting what we cannot.

That is, accepting the situation for what it is (and seeing the opportunities that may inadvertently have opened up as a result)

                                                → so we can move forward with life.

Part of that is establishing a “new normal” routine. Humans are creatures of habit and do well with a well-established routine (even if it needs shaking up once in a while). You may have already found your new routine amidst self-isolation and that’s great!

A question to ask yourself is whether or not this routine is incorporating stress-management and self-care so that you emerge from quarantine happy, healthy, and thriving?

For a lot of people this is a unique opportunity to start integrating more self-care into their lives precisely because while we are adapting to a new normal, our routine is already in a state of change and more flexible. Plus, for some there is a lot more free time!

What is self-care?

The official definition of self-care is: “the practice of taking action to preserve or improve one’s own health.” Specifically, “taking an active role in protecting one’s own well-being and happiness, in particular during periods of stress.”

This will look different from one person to another. We have different interests, different stressors, different jobs and schedules… there is no one-size-fits-all.

Self-care is something that refuels rather than drains you. It is something you enjoy doing, rather than something you feel you should do.

For example, you know exercise is good for you and you know you “should” exercise, but every minute spent on that stationary bike is torture! Every time you force yourself to do it, it’s a struggle.

Tennis player doing mobility exercises from a Oakville Physio clinic

Sure, sometimes we also procrastinate on doing the things we enjoy either because we don’t think they are a productive use of our time, or because we are too focused on the outcome rather than the process. But if you don’t even enjoy the process, then that particular thing is not refueling you.

Isn’t self-care selfish?

Short answer, no.

Long answer? Ever heard of the expression, “you can’t pour from an empty cup?”

All the human beings you take care of have emotional, mental, and physical needs. So do you.

If you’re always busy tending to theirs and never to yours, you become fatigued, unhappy, resentful. You are less present in their joy and accomplishments because your mind is running a mile a minute thinking of everything else that needs to get done.

But the problem is, that list will never end. So waiting until you “have” more free time is pointless. The moments with your family and friends are now, not tomorrow or next summer or next year.

The thing about time is you don’t “find” it or “create” it – you “prioritize” it. Yes, that means some other things have to fall off the list, or take a backseat. And that’s okay. Sometimes that priority list has to be reshuffled throughout different times of the year, and that’s okay too.

One of those things to prioritize is your self-care. When you come from a happier, healthier and more energized place, your actions carry more impact. You accomplish more and the people around you feel that you are happy, healthy, and energized. Mood is transmissible. Ever notice how when someone snaps at you because they’re in a bad mood, your good mood drains away and you snap back? And what’s an easy way to be in a bad mood? Feeling fatigued, unhappy, resentful.

Enter self-care!

So what does self-care look like?

Woman in a reclined butterfly restorative yoga poseat oakville physiotherapy clinic
  • Determine what you need. What would self-care look like for you? What do you enjoy doing? What do you find relaxing? What do you find helps you feel happy, healthy, or energized? It can be taking a long bath, going for a walk or a run, knitting, gardening, reading, meeting up (virtually) with certain friends, etc.
  • How will this look? Is 1x week enough? Or 1x day? For how long? Is it going to work better in the morning or the evening?
  • Self-care has to be planned. If you are to prioritize that time for yourself, you have to plan ahead and then protect that time when other things sneak up to say they’re important (“Oh, I need a ride.” “Oh, are you available at this time for a meeting?”). Work, family, and even friends will always have requests. Depending on the urgency of those requests, sometimes you have to reschedule. But when you plan ahead, unless something is an emergency, it would have also been planned ahead. At first, others may be annoyed with you saying “I am not available right now” but it’s because they’re not used to it! Give them time to adjust by letting them know in advance when you’re not available and then enforcing your protected time for yourself.
  • Make sure you are also addressing other factors: enough sleep (and no, catching up on your sleep on weekends doesn’t count), a healthy diet, some form of exercise or movement (let it be something you actually enjoy!), and looking after your health (is there something you’ve been ignoring?)

Need ideas?

  • Nutrition: make it a goal that you get at least thee servings of fruits & vegetables throughout the day and drink at least two full glasses of water. Look up a new recipe to try 1x week, bonus points if it is plant-based!
  • Sleep: the average adult needs 7-9 hours of sleep. Do you feel refreshed enough not to have to hit snooze in the morning after 7 hours? Great. If not, then maybe experiment by going to bed half an hour earlier or waking up half an hour later.
  • Movement: commit to a daily walk. Or a twenty-minute yoga practice in the morning before you start your day. Or doing your favourite exercise video three times per week.
  • Nature: It has been shown that nature has a calming and even therapeutic effect. If a daily walk outside near greenery is not always feasible, then commit to getting at least some fresh air daily. Set a timer and sit on your balcony or in your backyard for 10-15 minutes.
  • Relaxation: there are many different forms of meditation. There are breathing exercises. Journaling can also be a great tool. Or as mentioned above, even sitting in nature.
Meditating in nature, relaxation and stress-management strategies at Oakville Physiotherapy Clinic.
  • Social connection: depending on your situation right now, this may not be easy. Maybe you are self-isolating alone. Maybe the people you live with are sometimes your biggest stressors. Maybe there are people you miss but cannot see right now. If you are alone, consider a daily phone-call with a friend or loved one, or a virtual hangout every Friday night for 1-2 hours. Maybe make every Saturday afternoon an activity day for the whole family. Make sure these are interactive rather than something like a movie night when no one is talking.
  • Try a new hobby: something you’ve always been curious about but never had a time to try. Start small with no expectations of outcomes. It’s not about how good you get at it; it’s about enjoying it. It can be learning a language or an instrument. It can be drawing or crafting. Even if it’s one hour a week! Yes, finances may be tight right now and most businesses closed. But the internet has so much free content!

Tip: Don’t try too many things at once. Even one or two at a time is enough. Often, trying to add several things to our routine becomes stressful to integrate and balance. Just like everything else in life, it takes practice and tweaking until you find what works best for you. And remember, self-care is a routine, not a treat a few times per year!

In the meantime, if you are experiencing pain or have had an injury for a while that has been sitting on the backburner, let us know how we can help. Virtual sessions are now available! Most private insurance (benefits) companies now cover theses types of sessions.

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

Yoga Basics, Part 1: Balance

Are you new to yoga? Tried it on occasion? Always wanted to but never got around to it? And now that you are social distancing, you finally have some extra time to try!

Don’t worry, you don’t have to be all that flexible or fit. 

Start Where You Are…

Today we can cover some basic positions to challenge your balance!

  1. Tadasana, or Mountain Pose
  • Stand upright with the bases of your big toes touching and heels slightly apart. 
  • Tighten your thigh muscles and keep kneecaps pointing forward, or even, slightly outward. 
  • If the arches of your feet tend to collapse, imagine pulling up from the inner arches of your feet.
  • Tuck in your tailbone, and open up the chest as you pull the shoulder blades slightly back and downward. Allow arms to hang by your sides, palms facing forward.
  • Keep head held high and imagine a string pulling you upright, as if attached to the top of your head.
Mountain Pose

This pose may be easy to balance in. If holding the position for 30 seconds feels easy, close your eyes and try again. You can slowly shift weight forwards and backwards as well. If it continues to be easy put feet so they are touching beside one another, or even in tandem like a tightrope.

If you use a cane or crutches you may want to try this pose with them. Or you can always set up stable chairs or do this beside a counter and chair. Please make sure you are safe.

  1. Warrior I Pose
  • From Mountain Pose, reach left leg back behind you, as far as you are comfortable. 
  • Shift the left foot so that it is pointing out at a 45-degree angle.
  • Pull the right hip and pelvis back to square the hips forward comfortably.
  • Maintain left knee straight while right knee is bent (trying to get the thigh parallel to the ground if able) and stacked over the right ankle. If the right knee starts going past your toes, shift the left leg farther back.
  • As you inhale, raise arms overhead, palms facing each other, shoulders relaxed.
  • Imagine pulling up the inner left arch to avoid the foot collapsing.
  • Tuck in the tailbone and gently pull belly in.
  • Bring palms together and look up into the thumbs.
Crescent Lunge from Warrior I

Hold for 5 deep breaths, then switch sides. If easy, transition into Crescent Lunge Pose: instead of angling out the left foot, keep toes pointing forward, lift the heel up and stay on the toes. When bending the right knee over the right ankle, try lowering the left knee toward the ground as far as you are comfortable.

You can have a counter or wall beside you for this. Try to step backwards as one transition movement but it you need a couple small steps to be safe, please do that. Arms can start on hips and move to reach up (one or both).

  1. Tree Pose
  • Starting from Mountain Pose, brings palms together at heart center.
  • Shift weight onto the right leg and then place the sole of your left foot onto your right inner calf or inner thigh (never on the knee itself). You can use your hands to help position the foot onto the inner thigh if needed. Option is to keep toes on the ground and heel rests on inner calf / shin.
  • The left knee should point outward comfortably.
  • Maintain a strong right knee, do not let it lock back. Keep kneecap pointing forward. 
  • Open up the chest and hold crown of head high. 

Hold for 5-10 deep breaths. If easy, you may try eyes closed.

  1. Eagle Pose 
  • Starting from Mountain Pose, bring arms in front of you, placing left elbow on top of right. 
  • Bend the elbows so that forearms are vertical and then bring palms together. If not able to reach the palms together, place the backs of the hands against each other.
  • Keep elbows at shoulder height and back upright.
  • Then, shift your body weight to your left leg, lift up the right knee, and cross the right thigh over the left, hooking the right foot behind the left calf.
  • If your leg can’t wrap around you can always rest it on a yoga block in front or beside the planted leg
  • Bend the knees slightly as if to sit.
  • Squeeze inner thighs together to maintain your stability.

Hold for 5 or more deep breaths. You can then try switching sides.

Eagle Pose
  1. Warrior III Pose
  • Starting from Mountain Pose, shift your body weight onto your right leg and lift your left leg up behind you. 
  • Your torso and left leg should be as parallel to the floor as possible.
  • Reach your arms forward to that they frame your head, and spread out the fingers.
  • Avoid locking the right knee back and keep your left foot flexed, as if pushing away the wall behind you.
  • Engage the core by pulling in the belly button slightly inward.

Hold for 5-10 breaths, then switch legs.

Bonus challenge: Half Moon Pose

  • Starting from Warrior II, straighten the right knee and reach the right hand down to the ground behind the right foot. 
  • Reach the left arm up to the ceiling, turn the chest up to the sky as much as possible, and look up toward your left hand. You are now in Triangle Pose. 
  • From there, you may use a block underneath your right hand so you can support your balance.
  • Lift your left leg up into the air, in line with your torso. You are now in Half Moon Pose. 

All of these yoga poses can be modified or adapted for ANYONE. We will break down various poses in future blog posts for more comprehensive modifications. Like anything, to make something better or stronger (like balance), it needs practice. It also needs to be challenging for change to take place. One day may feel different from the next, one side may feel different than the other.

As Physiotherapists, we modify and tailor programs for all of our patients to ride this challenge edge in a safe way.

Contact us to see how we can (virtually) help you! Right now we are connecting with people from Oakville and Halton, as well as all over Ontario to meet up virtually for video physio sessions. Most private insurance (benefits) companies allow theses types of sessions!

Low Back Pain – In the Age of Virtual Physio

Low back pain?

Our virtual physios can help!

Back pain is one of the most common chronic conditions in Canada. In fact, statistics show that 4 out of 5 adults will have at least one occurrence of back pain at some point in their lives. 

Low back pain is definitely a common complaint we see in clinic, prior to going virtual.

If you Google low back pain, your search results will take you from The Top 10 Exercises for Back Pain to electrical pain modulating units to medications and creams.  

But is all low back pain the same? 

The truth is, some of those exercises you find online may help. Some may make you feel worse. And some may not seem to do anything at all.

For some people, Dr. Ho TENS machines feel amazing, and for others, they are temporary relief if any relief at all. For some people, using a hot pack and maybe a topical analgesic (e.g. A535), and resting for a day or two, is enough.

The fact that not everything works for everyone is a clue that not all low back pain is the same.

People jumping showing Physiotherapy for sports injuries in Oakville

What kinds of low back pain are there?

Pain severity and duration can be:

  • Acute

Acute refers to symptom duration of six weeks or less. Pan can be sharp or dull, and it can often be severe in intensity. There may be pain shooting into the buttocks and/or into the leg. Range of motion is usually limited and there may be muscle spasm, making daily activities difficult. The pain may affect your sleep quality, as well as your ability to go to work. 

  • Chronic 

Chronic refers to symptoms lasting longer than 3 months. Pain is usually deep, aching, dull, or burning. It can be in in the low back and/or travel into the legs. It is often triggered by prolonged positioning (e.g. prolonged sitting) or repetitive movements (e.g. bending forward). Similar to acute pain, chronic pain can affect daily tasks, recreational activities, and ability to work. Because of its prolonged presence, it can cause emotional stress and even depression.

Type of pain can be:

  • Sharp, stabbing, sudden
  • Dull ache, soreness
  • Located in a very specific area or feel very general and vague
  • It can be on one side of the back, in the center, or across the low back
  • It can be radiating into your hips, buttocks, thighs, to your knees or into your calves
  • There may be numbness, tingling, pins and needles sensations

All of these characteristics are clues as to the type of pain (inflammatory, mechanical, neuropathic) and where it may be coming from. Something to keep in mind is that where the pain is located is not always where it’s coming from. Pain, especially when neuropathic, can be radiating somewhere else away from its source.

Causes of pain can be:

  • Muscle strain / tightness
  • Joint or ligament sprain
  • Disc inflammation / bulge
  • Nerve inflammation / irritation 
  • Arthritis (osteoarthritis, ankylosing spondylitis, etc.)
  • Scoliosis / postural 
  • Central sensitization (some component of a stronger pain pathway etc)

As an example… for disc issues bending forward might make the pain worse. For a muscle strain, it might feel like a good stretch. Depending on the joint issue, it might feel relieving. 

So what can I do about my low back pain? 

Now that you know not all low back pain is created equal, what should you do?

Depending on the severity of your pain, you may see your physician (now Telehealth). Based on your symptoms they may decide to:

  • send you for imaging, just in case (many may suggest this if your pain is not resolving with the next 2 steps)
  • prescribe anti-inflammatories and muscle relaxers (sometimes, this may not be enough to resolve the issue)
  • refer you to physiotherapy! 

In Ontario, unless specified by your insurance company, you do not have to have a Doctor’s referral to see a Physio.

And if in the times of COVID-19 you’re not keen on visiting the doctor’s office as your first option, you can always consult with a Physiotherapist virtually! 

While Telerehab (virtual physiotherapy), is a little different than an in-clinic assessment and treatment, the same principles apply: 

  • we will ask you to perform certain movements in different positions to test what you can and cannot do
  • we provide education on assessment findings and self-management, as well as answer any questions you may have
  • we prescribe an exercise program specific to what you are experiencing and gradually progressing it as you improve 
  • we provide education on self-maintenance and prevention, especially if this is a recurrent issue 
Man at desk showing tennis elbow being treated by an Oakville Physio

What do I need for a Telerehab session?

The silver lining is, depending on how much your back is bothering you, you can be assessed without leaving the house! And if your home workspace is also a problem, our physios can take a look virtually!

What you need:

  • Internet connection (you may even use your phone’s hot spot if the WiFi at home is not always reliable) 
  • Camera (preferably mobile, as in the case of a smartphone, table, or laptop)
  • Comfortable clothing to move around in
  • Some open space where you can stand, turn, bend, maybe squat
  • A place you can comfortably sit and also lie on (it can be a bed, the couch, the floor)
Telehealth physio, virtual physio in Ontario, port credit, lorn park, oakville, Rosedale, vaughn, barrie, caledon, Collingwood, blue mountain,

Do I still need imaging to diagnose my back pain?

Imaging (e.g. X-rays, MRI) is not always necessary to diagnose low back pain issues, as different methods of imaging have their limitations. E.g. X-rays only see bone, so they cannot diagnose a muscle strain. 

In a lot of people over the age of 30, imaging may find evidence of osteoarthritis or Degenerative Disc Disease (DDD). However, studies show that degenerative changes in the spine are just as likely to be found in someone with no symptoms, and these changes cannot predict future development of pain. 

That’s not to say that osteoarthritis or DDD cannot be a source of pain, but in the absence of any other testing, their presence is not a definitive cause. 

Of course, imaging does have a role. If you’re already seeing a health care practitioner for your back pain (or even other issues) but not improving, imaging can be done to rule out any underlying causes. It can diagnose more specific diseases such as Ankylosis Spondylitis, or conditions such as spondylolisthesis. It can give a more accurate scoliosis diagnosis. And in the rare cases that it’s the source of pain, imaging can be used to detect cancer. 

Do I need medication from my Doctor to get better?

Not necessarily!

In minor acute cases, medication and rest may resolve the pain. But if this is a recurrent issue, or the rest and medication are not enough, you will likely be referred to physiotherapy.

Sometimes people do well with only physiotherapy, without needing the medication. Other times, if the pain is too severe (i.e. more acute) anti-inflammatories and/or muscle relaxers can certainly help ease the intensity of the symptoms, improving sleep quality and making it easier to progress through the physiotherapy exercises. The goal is that medication is not something you end up relying on!

Medications do not speed up tissue healing, nor do they make your muscles or other tissues stronger or more robust. Those are all things that are within YOUR control. In terms of Physiotherapy low back pain, the things that we can help you with in virtual physical therapy sessions are the tings that will help you the most and have the longest lasting effect!

Our team at Palermo Physiotherapy and Wellness Centre is happy to help you. We are able to provide virtual physiotherapy sessions to anyone in Ontario. Most insurance companies now allow this type of physio treatment from physiotherapists, but we advise you to check on your individual case.

Contact us to book in or see how our Physiotherapists can help you virtually, with your low back pain.