Category Archives: Posture

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!

Balancing the Body’s Harmony: The Ancient Art and Modern Science of Acupuncture

Acupuncture is becoming increasingly popular, yet many people remain reluctant to use it as a form of treatment. So, what exactly is it, and how can it help you? We answer these and more below!

What Is Acupuncture?

Acupuncture is a therapeutic technique of inserting fine, one-time-use pre-sterilized needles into very specific points along the body to assist in pain management and healing of injuries. Patients often ask us if acupuncture is painful. The needles used for acupuncture therapy are extremely fine – patients likely feel a small poke but once the needle is inserted, most patients do not feel much pain.

How Does It Work? – Traditional Chinese Medicine

Acupuncture was developed more than 3,000 years ago in China. In Traditional Chinese Medicine (TCM), injuries or illnesses are believed to be the results of an imbalance of energy within the body, specifically within meridians, which are channels of energy flow throughout the body. Acupuncture is used to help restore energy balance by placing fine needles at specific points along these meridians.

How Does It Work? – The Gate Control Theory of Pain

Although acupuncture is an ancient practice in Eastern medicine, its use in Western medicine is relatively recent. Though the exact reason why it works is not totally clear, Western medicine has several different theories as to how acupuncture helps with injury recovery. One of those is the Gate Control Theory of Pain.

The Gate Control Theory of Pain outlines how pain signals reach the brain from the spinal cord. In simple terms, if the ‘gate’ is open at the level of the spinal cord, a pain signal can pass through, reaching the brain where the pain is perceived. If the ‘gate’ is closed, a pain signal cannot pass through, and therefore the brain does not perceive pain. So, using this theory, applying a non-painful stimulus when someone experiences a painful stimulus can activate the closing of the gate and decrease the pain signal to the brain. An example of this would be if someone bangs their knee against a hard surface. Usually, our first instinct is to rub the knee (a non-painful stimulus), which helps us feel less pain.

What Injuries Can Be Treated With Acupuncture

Acupuncture can help in the healing process of many muscle and joint injuries. However, it is important to note that it won’t exactly heal these injuries. For example, if a muscle is torn, acupuncture will not repair the tear. However, it can assist in the symptoms associated with the tear, primarily by decreasing pain. Acupuncture has been used to aid in the recovery of a number of injuries, such as rotator cuff tendonitis, tennis elbow, and mechanical neck and back pain.

What Are The Risks Associated With Acupuncture?

The risks associated with acupuncture treatment are relatively minimal. The most common side effect is soreness and/or bruising in the region where the needles are inserted. The risk of infection is extremely LOW since the needles are pre-sterilized and used once. Some people might feel light-headed or dizzy after acupuncture treatment, so it is important to make sure you are well-hydrated and have eaten before your treatment session. If you are pregnant or have had other medical conditions (ex., cancer, stroke, etc.), there are certain points or areas that your practitioner will avoid. This is why it is extremely important to be thorough when reporting your medical history to your practitioner.

If you would like to learn more, ask your practitioner to discuss whether it would be an appropriate option for you, or book an initial assessment with us here!

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.

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.

What if my child has scoliosis?

What is Scoliosis?

A normal spine has three main curves: cervical lordosis, thoracic kyphosis, and lumbar lordosis. These curves occur in the frontal plane, meaning they curve front to back. A scoliotic curve curves to the side.

Therefore, a scoliosis refers to when the vertebrae in the spine do not follow a straight line but are curved sideways. Sometimes they can also rotate, or twist, like a corkscrew.

A small scoliotic curve may be barely noticeable by eye, or it might be so slight that an X-ray (or MRI) would be needed to measure it. In those cases, the scoliosis is unlikely to cause any issues.

However, when a scoliosis is present in children, the curve may continue to grow until their skeleton is fully developed. This means that if the curvature becomes significantly large, it can cause more than just bad posture.

It can lead to headaches and back pain, loss of normal range of motion, digestive issues, affect breathing, and eventually cause early arthritis due to the unusual pressure on some of the joints, etc.

Observable symptoms of Scoliosis

  • The head is not centered with the rest of the body
  • Uneven shoulders
  • Constant leaning to one side
  • Difference in hip height
  • Difference in shoulder blade height or position
  • Uneven arm position as the arms hang on both sides of the body when the child is upright
  • A sideways curvature of the spine when the child bends forward
Signs Of Scoliosis. Normal healthy spine and curved spine with scoliosis.Scoliosis in children

Causes of Scoliosis

Most commonly (80-85% of the time), scoliosis is idiopathic, meaning the cause of it is unknown. In some cases, the development of idiopathic scoliosis can be due to a genetic predisposition.

While it can be diagnosed at any age, it is usually diagnosed in kids 10 and older.

There may be a correlation with poor posture as well. This is where we can differentiate if a scoliosis is functional or structural.

  • A functional scoliosis develops due to certain postures and compensations that are likely due to muscle tightness and imbalance. In those cases, the spine appears to be curved but is not actually.
  • A structural scoliosis originates in the spine and cannot be corrected by correcting posture and muscle imbalance

Less commonly, scoliosis can be:

  • congenital, meaning that there were problems in the spine before a baby is even born. Usually, the spinal bones are either not fully formed or are fused in ways they should not be.
  • neuromuscular, meaning that conditions that affect the nerves and/or muscles of the body (such as cerebral palsy or muscular dystrophy), will affect their ability to support the spine, leading to the development of a scoliotic curve
Oakville Paediatric physiotherapy, massage, yoga therapy

Severity of Scoliosis

Mild – Curve is less than 25 degrees, and risk of progression is 22%

Moderate – Curve is between 26-40 degrees, and risk of progression increases to 68%

Severe – Curve is above 40 degrees, and risk of progression is quite high at 90%

What to do about scoliosis?

In mild cases, if there are no symptoms or cosmetic concerns, then often the course of action is nothing.

However, until the child or adolescent is fully grown, the risk of progression is there. This means that the scoliosis should be monitored regularly (usually annually) and a referral to physiotherapy might be appropriate for preventative strategies and education.

In moderate cases symptoms are more likely, such as headaches, back pain, digestive issues, and fatigue with activity. A brace is often recommended to reduce the risk of progression and give the organs more room.

Physiotherapy and sometimes other disciplines, such as registered massage therapy and chiropractic, may also be an effective adjunct to bracing to help with symptoms and postural correction / education.

In severe cases, especially if a curve is above 50 degrees, a brace is not going to be able to able to slow progression, and surgery is likely to be recommended. Surgery usually involves spinal fusion to realign the vertebrae.

There have been many advances in surgical correction of scoliosis so the kind of surgery required will depend on the type of misalignment, the severity of symptoms, and the location of the scoliosis.

Overall, surgery has good outcomes.

What can Physiotherapy do about my child’s scoliosis?

In mild cases, treatment is preventative:

  • Postural correction and education
  • Postural exercises to correct muscle imbalances that have developed due to the scoliosis
  • Manual therapy (soft tissue release, joint mobilizations) to help improve flexibility and restore range of motion that have been impacted by the scoliosis
  • Postural taping to give proprioceptive feedback to the body and provide awareness to the child so they can better self-correct as they become aware of how their body is sitting in space

In moderate cases, treatment also helps to eventually wean off bracing while managing any associated symptoms.

In severe cases, physiotherapy might be helpful post-operatively to correct the muscle imbalances that had developed pre-operatively.

If you have questions, don’t hesitate to contact us for more information!

Can my child still play sports?

Yes, exercise and sporting activities (especially ones that focus on core strength) are encouraged!

In the severe cases, there may be some sport restrictions following a surgery. This is usually because after a fusion there will be some permanent loss of overall range of motion. However, kids often are able to return to sporting activities within 6 to 9 months after surgery.

baseball player showing post ACL reconstruction rehab at Oakville Physio clinic

Back to school…

In-person classes are scheduled to resume in just over a week! That’s hardly any time at all!

What is your back-to-school preparation looking like?

Today we will cover a few tips to get us back into the back-to-school mindset and to make the transition easier…

1. Sleep Quality

Sleep quality is so important. What time is the whole family going to bed and what time are they waking up at during the summer? Will you need to adjust that time once school starts?

It might be a good idea to start practicing getting up a bit earlier and going to bed a bit earlier. Start in small increments!

Did you know that exposure to sunlight early in the morning can actually reset your biological clock and sleep cycle?

It doesn’t happen immediately but if on average you view sunlight at a similar time each day, this will begin to shift your sleep cycle based on that time of day.

  • For this to be most effective, make sure you are actually outdoors and not viewing the sun merely through a window.
  • Do not wear sunglasses unless you are very sensitive to bright light.
  • You do not have to look directly at the sun (nor should you, especially if it is hurting!)
  • Do this first thing in the morning when you wake up (or as soon as able)
  • If it is bright and sunny out, then even 2 minutes is enough!
  • If its overcast, then up to 10 minutes would be needed
  • Bonus points if you go outside for 2-10 minutes around sunset / dusk so your eyes can also be exposed to the fading light
sleep quality is so important, especially for kids as they resume back to school schedule. Oakville Ontario physio blog on back to school tips

2. Meal Schedule

How has your eating / snacking schedule been at home during the summer?

It might be worth it to start adopting a meal schedule that would mirror the one at school!

Bonus points for practicing with younger kids how to open their lunchbox, take out the tupperwear, unwrap the snacks, and then put everything away on their own!

healthy eating and snacking, especially in a back to school routine, are important. Oakville physio blog on return to school tips

3. Getting the backpack ready!

  • If picking out a backpack for a younger child, ensure the sizing is correct. The width of the backpack should be similar to that of the child’s back and shoulders. It should sit just below their shoulders and on top of their hips!
  • Avoid carrying unnecessary textbooks or supplies… the weight of the backpack should be maximum 10-15% of the child’s body weight. Make sure your child is wearing both straps, well-adjusted, to evenly distribute the weight of the backpack.
  • Maybe even a waiststrap might be appropriate if the backpack is on the heavier side!

4. Desk and computer ergonomics…

If you or your child is an older student who will be spending a lot of time in front of a computer for school, make sure the ergonomics are set up for success!


  • should be ideally at eye level (for laptops, consider a riser table, or connecting it to a larger monitor)

Keyboard and mouse

  • should be close enough so that you are not always reaching your arm forward for them
  • Elbows should be close to body and forearms parallel to ground while using mouse and keyboard
  • A mousepad can avoid bending your wrist too far up and creating strain
  • Avoid having the table too high because that will cause tension in your neck and shoulders!


  • sitting as far back in your chair will allow full use of the back support (ideally, the backrest should support the whole back)
  • Feet should be able to fully touch the ground even when sitting all the way back in the chair
  • Adjustable chairs and tables can really help!


  • Can really help avoid the strain of prolonged positioning
  • Microbreaks can be just getting up to move around, get a snack, drink some water, go to the washroom…
  • They can also be some postural stretches… E.g. wall angels! Neck ear to shoulder stretches! Reaching arms forward as far as you can until you feel shoulder blades pull apart from each other!

5. Team Sports

  • If getting back into team sports, remember…
  • Eat well to fuel up and hydrate!
  • Stretch and warm up… don’t pull something on day 1!
  • Wear appropriate clothing and footwear
  • Listen to your body! Don’t push yourself back too quickly into what you were able to do back in early 2020! If it’s been a whole year since you’ve been that active, your body is going to need time to rebuild that strength and flexibility.
are you getting back into team sports as schools resume in-person? make sure you listen to your body and don't push yourself too hard or overtrain. oakville physio blog on return to school

If you are having any aches and pains transitioning back to school, let us know so we can help! 😊

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!

Part 2 – How important is our breathing pattern?

Hi all! Welcome back to why our breathing pattern is important!

In Part 1 we talked about the muscles involved in breathing and how to test if your breathing pattern is “optimal.”

Today we will delve a bit into the why this matters!

Role of breathing in ribcage expansion and joint mobility

If you remember… when we inhale, our intercostal and diaphragm muscles contract to spread out and elevate our ribcage to make room for the lunges to expand as they fill with air.

But stiffness in our joints between the spine and ribs can affect how well this expansion happens.

Alternatively, if our breathing pattern is not optimal, or not all of the muscles are engaging, we may get more expansion on one side than the other. The side that gets less expansion gradually gets stiffer.

As the ribcage attaches to the thoracic (upper and mid back) spine, its mobility also affects how our torso moves (e.g. turning our body to look over our shoulder).

As you can see, spine and ribcage mobility can both affect and be affected by our breathing!

image of ribcage as it attaches to sternum and spine in order to illustrate how joint mobility during breathing is impacted. Blog post by oakville physio on importance of breathing pattern.
Our ribs attach to the sternum (breastbone) in the front and to the vertebrae of the spine in the back

Role of breathing in posture

In Part 1 we briefly talked about “accessory breathing muscles”, or muscles that are not active during regular breathing. Instead, they are activated during heavy exercise, a stressful situation, or an asthma attack, i.e. when breathing becomes hard work and more energy is needed!

These muscles also become active depending on our stress levels, our posture, or even when the major breathing muscles are not being optimally used.

When these accessory muscles are habitually used, our breathing pattern changes so that we become more “apical” breathers. This means that most of the movement happening is through our chest and shoulders.

However, most of the movement should be happening from the expansion of the ribcage!

These accessory muscles then become overactive and tight, while our diaphragm is underused, and our ribcage becomes stiffer.

This leads to, and is reinforced by, a more slouched posture:

  • Head and neck positioned more forward
  • Greater curve (or “hump”) in the upper and mid back
  • More rounded shoulders and tighter pec muscles
prolonged slouched positions aka poor posture can also be impacted by, and impact, your breathing pattern. Blog post by oakville physio.
Prolonged positioning in slouched postures also reinforces suboptimal breathing patterns

Role of breathing in stress and anxiety

A lot of people carry stress in their neck and shoulders. This is also reinforced by a lot of us sitting in front of a computer all day. As we sit for prolonged periods of time, we naturally crane the neck forward toward the screen, round the shoulders and upper back, and slouch through the lower back.

Our stress and anxiety can affect how much muscle tension we carry. Have you ever noticed that when you are cold, you hike your shoulders up and tighten the neck?

What about when you are stressed, anxious, or even just overly focused on your work? Do you hike up your shoulders, or clench your jaw?

Interestingly, our respiratory rate (our breathing) can influence our nervous system and therefore, our muscle tension.

For example, if we are in a more stressed state (fight, flight, or freeze response), if we consciously slow down our breathing and lengthen our exhales, we can switch over to a more relaxed state (rest and digest state).

There are known as the sympathetic and parasympathetic nervous system… When we are in an amped up state (sympathetic response), we carry more tension. When we are in a relaxed state (parasympathetic response), our muscles are also more relaxed.

You can try this as a stress management technique!

Every time you find yourself stressed or anxious, take a moment to close your eyes, consciously relax your shoulders, or anywhere else you feel you are tense.

Then, take five deep breaths, making the exhale twice as long as the inhale.

e.g. Breathe in to the count of three. Exhale to the count of six.

Woman in a reclined butterfly restorative yoga poseat oakville physiotherapy clinic
Restorative yoga is also a great way to manage stress.

Another breathing technique for when feeling anxious is alternate nose breathing:

  • Exhale through the nostrils
  • Then, close the right nostril with your right thumb and inhale slowly through the left nostril
  • Then, close the left nostril with the right ring and pinky fingers, and slowly exhale through the right nostril
  • Still covering the left nostril, slowly inhale through the right nostril
  • Then, close the right nostril again with your thumb and slowly exhale through the left nostril
  • Repeat either nine rounds, or for about 5 minutes
  • End on a left nostril exhale

Role of breathing in low back pain

If your ribcage and spine are stiff, you may experience some upper and/or mid back pain.

That stiffness may be also contribute to low back pain

Gardening injuries, low back pain prevention with physio, massage, foot care, podiatrist
There are many causes of back pain, and sometimes, multiple factors…

Let’s take the psoas muscle as an example. The psoas flexes your hip, but can also function as either a spine stabilizer or a spine mover. In others words, it affects our back stability and mobility.

That’s because the psoas attaches to both the lumbar spine and to our hip bone. However, it also attaches to the diaphragm through the fascia! Therefore, it has the potential to be affected by our breathing.

If we are chest or belly breathers, our ribcage and low back do not expand much with our breath. This is the path of least resistance for the breath.

If our psoas is tight, it reinforces a suboptimal breathing pattern because we are going to continue breathing through that path of least resistance into either the chest or the belly.

But when we focus our breathing into our sides and back, we can help relax some tight muscles, like the psoas, that can be contributing to low back pain and/or tightness.

Here is an exercise you can try to do this:

Start by lying on your side. Curl into the fetal position so that we are opening up the back and blocking the abdominals. You can even hug a pillow to brace the abdominals.

Now, take a few regular (or slightly deeper) slow breaths. Every time you inhale, think about forcing that breath into the back (upper and/or lower), feeling it slightly expand out.

Then, as you exhale, feel the the expansion come back in.

You can even place your top hand on your lower ribcage, pushing the hand away on inhale, and pushing the hand down into the ribcage on exhale.

Picture of Oakville physio demonstrating a sidelying exercise in fetal position, to brace the abdominals and force the breath into the back
Breathing into the back in a side-lying position

Role of breathing in core strength

The diaphragm attaches to the ribs, sternum, and lumbar spine.  As such, it is both a respiratory muscle and a postural stabilizer.

Imagine the core units surrounding the abdominal cavity as a container:

  • Transversus abdominus muscle at the front and sides
  • Back stabilizer muscles like the multifidus and erector spinae at the back
  • The diaphragm at the top
  • The pelvic floor muscles at the bottom
Imagine the core units forming a cylinder

As you can see, the diaphragm is part of our core unit! Therefore, how well it is functioning can impact the rest of our core muscles.

Our breathing pattern is foundational. In fact, more and more research is showing that the first step to core strength, stability, and overall function is diaphragmatic breathing.

More than that, we want that diaphragmatic breathing to expand our ribcage from all sides, rather than just focusing on pushing out the belly with the inhale. In others words, we want a 360 degree expansion with each inhale!

Role of breathing in diastasis recti

If you remember from Part 1, as you inhale, the diaphragm contracts and moves down to allow for the lungs to fill with air.

This causes the pressure to go into the abdominal cavity (see the cylinder diagram above!).

Pressure will follow the path of least resistance, which means it will usually go to the belly and distend some of that front fascia (i.e. the abdominal diastasis).

If we carry a lot of tension in our abs and tend to brace there, breathing into the fascia is a good thing. We can help relax and stretch that fascia.

But if we have some weakness there (e.g. postpartum), then belly breathing reinforces stiffness/tightness in the back and weakness in the abdominals because the breath is constantly following the path of least resistance, and pushing into the weak abdominals.

This can then reinforce the diastasis recti, rather than help heal it.

Therefore, focusing the breath into tighter areas, like the back, is preferable.

Role of breathing in pelvic floor

As shown in the cylinder diagram above, our pelvic floor muscles form the base of our core. This means that your pelvic floor is also a spine stabilizer. (In fact, sometimes pelvic pain can refer to the back!)

When we are belly breathers, we often breathe through the upper abdominals. However, women postpartum often have more weakness in the lower abdominals, which means that’s where the path of least resistance will be.

This puts more pressure down into the lower abdomen and pelvic floor.

As a result, women who close their diastasis recti more quickly postpartum often have a greater risk of prolapse!

To prevent the pressure system from placing too much strain on the pelvic floor, we want to reduce the upper abdominal tension, strengthen the lower abdominals, and overall encourage a breathing pattern that expands on all sides (front, sides, and back)! And eventually, even breathing down into the pelvic floor!

Pregnancy is a common cause of diastasis recti

If you are having back pain, or recovering from a diastasis recti, and would like to learn more about what you can do (including the role of breathing for core strength and general mobility), let us know! We offer both in-person and Telehealth Physiotherapy services 😊

How does breathing work… Part 1

Breathing… it’s essential for life! It’s also something so basic we never give it a thought.

That’s because breathing (AKA respiration) is an automatic function, subconsciously controlled by the respiratory center at the base of the brain.

While we can control our breathing rate and even hold our breath voluntarily, we do not need to think about it all the time. Breathing continues whether we are awake, asleep, or even unconscious!

Respiratory muscles

There are several respiratory (or breathing) muscles involved in the process:


  • this is our most important respiratory muscle!
  • It is a dome-shaped muscle that separates our chest cavity (where the heart and lungs reside) from our abdominal cavity (where the rest of our internal organs are).
  • What’s more, the diaphragm has multiple attachments: the sternum, ribcage, and spine

Intercostal (rib) muscles

  • These muscles lie between your ribs, attaching them to one another.
  • There are three layers: external, internal, and innermost.

Cervical (neck) muscles

  • these are referred to as the “accessory” muscles of respiration, and include the scalenes, sternocleidomastoid (SCM), levator scapulae, and the upper fibers of trapezius (“traps”).
Posterior view of neck musculature (layers of muscles in the back of the neck)

Abdominal muscles

  • include the rectus abdominus (our “six-pack” muscle), the internal and external obliques, and the transversus abdominus (the “inner core”)


  • Other accessory muscles that are in the chest and back area include: pectoralis major and minor (“pecs”), latissimus dorsi (“lats”), and the superior serratus posterior.

What are “accessory” muscles of inspiration?

Accessory muscles (found in the neck, chest, and back) are typically needed during heavy exercise, a stressful situation, during an asthma attack, or in someone suffering from COPD. In other words, when breathing becomes hard work and more energy is needed!

However, when these accessory muscles are habitually used, our breathing pattern changes and that can have wide-ranging effects…

So how does breathing work?

Breathing in…

  • As you breathe in (or inhale), the diaphragm contracts and moves down in order to increase the space in the chest cavity. That’s because your lungs are filling with air and need additional space to expand.
  • The intercostal muscles also help to spread out the ribs (by pulling them upward and outward) and allow for the chest cavity expansion.
Schematic of the path air takes as it travels into the lungs and where the diaphragm sits
The Diaphragm

Breathing out…

  • Interestingly, exhalation is a “passive” process, meaning that no muscle work is required.
  • As we naturally breathe out (or exhale), there is an elastic recoil from the lung tissue, which pushes the air out of the airway.
  • However, if we are engaged in vigorous exercise, or if we forcefully exhale, that will require muscle work. Specifically, the abdominal muscles help out the most. They contract to raise the abdominal pressure so that they can push the relaxed diaphragm up into the lungs, and in this way, push the air out.

The “correct” breathing pattern

Normally, as we inhale and the diaphragm and intercostal muscles contract, the ribcage expands from all sides. While the chest rises a bit, the lower part of the ribcage (upper part of the abdomen) should rise even more.

As we exhale, the chest and upper abdomen fall back in.

You can test this yourself! 😊

Place one hand on your chest and the other hand below the chest (upper abdomen). Take several regular (or slightly deeper) breaths, pressing the hands into the chest and upper abdomen. On the inhale, you should feel the bottom hand rise a bit more than the top hand.

Image of Oakville physio hand positions when testing for (or cuing for) diaphragmatic breathing
Hand cues for diaphragmatic breathing

To test overall ribcage explosion, place your hands on your sides, high enough that you are pressing into your lower ribs. The thumbs will be feeling more the back portion while the rest of the fingers more of the front portion. Press into your ribs as you take several regular (or slightly deeper) breaths. You should feel equal expansion on both sides as you inhale. Note if there is movement on the front, side, and back of where you are pressing!

Hand placement ensuring full ribcage expansion

Why does this matter?

Aside from bringing oxygen into our body and expelling carbon dioxide, our breathing has an impact on many other areas of our body and health…

Stay tuned for Part 2 to learn how breathing can impact our ribcage and joint mobility, our posture, our core strength, our pelvic floor function, and even our stress levels!