Category Archives: Virtual Physiotherapy

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.
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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!

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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.

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