Category Archives: Posture

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
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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!

Screen

  • 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

  • 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!

Microbreaks

  • 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! 😊

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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!

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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!

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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 😊

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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:

Diaphragm

  • 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…

  • 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!

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Common Misconceptions of Yoga

It’s the beginning of another year and many people are getting back into workout routines and making goals for 2017.

It can be intimidating to

begin or resume an activity.

Our Physiotherapists often have people ask us about what is the “best” activity for them. Whether it be after a having a car accident, a back injury, or simply to get moving, Yoga can be a great option.

There are several misconceptions when it comes to beginning Yoga:

You need to be flexible to start yoga.

This is a common misconception. It’s easy to believe this when photos, websites and social media depicting yoga often show a person in a complicated and challenging pose. There are steps and progressions for challenging poses. Every body is different. Finding an instructor that can show you the best way to use available props and modify movements to best suit your body and situation is ideal. To start in small yoga classes and even in private yoga instruction even with the intention to progress to a home based or studio practice is ideal.

Use the straps and blocks to assist in your poses and movements to ensure optimal alignment and prevent injury. As a Physiotherapist, it is more important to be able to control your movement rather than over stretch.

Oakville Yoga Therapy, massage, chiropodist, physio

Yoga is for “hippies”

Yoga is for everyone. Seriously. It depends on what brings you to yoga, and what type of  yoga you are practicing? Certainly there is a mind-body component of yoga. There is nothing wrong with practicing yoga simply for the physical aspect, although many people feel a pull for something more.

Yoga is only for Women.

Yoga is not a feminine or masculine activity. It is an activity. Both men and women are welcome at studios. It really is about the individuals own practice and goals. There are some studios that have men’s yoga classes for a less intimidating environment.

This misconception can stem from the thought that you need to be flexible to do yoga. If this is an intimidating premise, start with one-on-one yoga or a men’s class.

Stones and flowers showing North Oakville Yoga and Physio clinic
Yoga is only for relaxation.

Certainly there are relaxing components of yoga, but this is dependent on the class or variety of yoga you are practicing. Is there a focus on slow and sustained movements or is it a faster flow. Try an Ashtanga class and you will realize that is is not a relaxation class.

Yoga can help a person develop range of motion, mobility, flexibility, balance and strength. This can be accomplished through body weight movements, sustained postures and repetition.

If relaxation is what you seek, yin classes, restorative classes, classes with longer shavasana, yoga nidhra classes or even guided relaxation may be the way to go. One-on-one sessions can help you accomplish these goals also.

Relax - words to show oakville massage and physio

You have to go to a studio to practice yoga.

Once comfortable and safe with the movements of yoga, a home practice is perfectly attainable. You can do occasional drop-ins or work one-on-one with an instructor.

Yoga is dangerous

Yoga is not dangerous. Like any new activity, people benefit from specific and individualized instruction from qualified teachers. People can get hurt from doing too much too quickly. Avoid trying to keep up or pushing beyond safe boundaries into pain.

There is no rush in progressing a practice. Ego is a dangerous thing. Yoga is safe. Know your body, be patient and be gentle. Approach the teacher an let them know you are new, or out of practice and they may keep a closer eye on you. I welcome gentle “adjustments” or corrections as feedback.

I can go on about yoga

misconceptions,

but you get the point.

Your experience with Yoga or any activity is what you make of it. Do the research and ensure you begin with a solid foundation. Invest in the foundation. Whether it be starting small group classes or one-on-one sessions that guide you into a home practice or a studio practice.

Ensure your teachers are the right ones for you.

Ask them about their philosophy regarding poses and props. Also what is their training? Traditionally a 200 hour yoga teachers training is industry standard to teach but “yoga teacher” is not a protected term like “Physiotherapist” or “Massage Therapist” or “Chiropodist” is. Ensure you teachers have at least that level of training, if not more, as well as a thirst for knowledge.

 

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Feeling Dizzy? Ways Physiotherapists Treat Dizziness

We see many people at our North Oakville clinic who may be in for Physio, Massage, or Chiropody treatment for another issue who complain of dizziness or vertigo. These people may be getting up and down, onto or off of a treatment table, or simply bending over to tie their shoes, and complain of the room spinning. It then takes a few seconds to minutes to settle their symptoms.

Nearly a quarter of adults over the age of 65 report feelings of dizziness or vertigo, but a significantly smaller percentage actually receive treatment for it1. If you’ve ever experienced prolonged dizziness, you know what kind of impact it can have on your ability to do your job, enjoy your hobbies, or to simply complete the tasks necessary to maintain a life day-to-day. Some cases of dizziness or vertigo resolve spontaneously – that is, without treatment – and a person carries on as if nothing happened. Others require some form of intervention. At Palermo Physiotherapy and Wellness, our Physiotherapists are trained to assess and treat several forms of dizziness and vertigo.

What Causes Dizziness?

Dizziness can result from any number of medical reasons including an infection, vascular issues, high or low blood pressure, medication side effects, and dehydration. Even though you do not require a Physician referral to attend Physiotherapy, it is a good idea to be screened by your Family Doctor if you are experiencing dizziness, just to rule out any big problems. Physiotherapists are better trained help with inner ear issues, whiplash injuries, and dizziness related to the neck.

How this all works:

The inner ear is a complex maze of fluid, tubes, and hair cells. They all work in concert to Oakville Physio cliniccommunicate to your brain where your head is in space. Close your eyes and tilt your from head to the side – you don’t need your eyes to tell you where your head is. If things worked that way, we’d have an awfully hard time getting around at night or when doing something that demands our visual attention. Under normal circumstances, this process runs quite smoothly. Sometimes, such as after an ear infection, a car accident, or for no reason at all, this system gets confused. Essentially, the signals being transmitted to the brain do not reflect the reality of the situation. As a result, your brain enters a cycle where it is compensating for what it thinks is a change in head position – except you haven’t moved. This mismatch of information can result in the feeling of spinning, or vertigo. If you have ever been car sick, this is usually the mechanism for it.

Bones of head and neck showing oakville vestibular rehab

Dizziness is a little more complicated. In our clinic, we treat primarily symptoms arising from the neck, usually as a result of car accidents or other trauma (although this can also arise for no obvious reason). Our nervous system works like a series of highways, with lanes constantly merging and exiting. Much like in traffic, a problem in one part of the system can impact other areas that do not appear to be directly connected. In our case, the first three bones in the neck share nerve pathways (highways) with many parts of the brain. This makes sense geographically as they are quite close. Stiffness or muscle tension/weakness in this area often can result in headaches, dizziness, or both, occasionally without symptoms of neck pain.

What we (Physiotherapists) do:

                During your assessment, your Physiotherapists will identify the source of the dizziness or vertigo. Treatment will usually fall into one or more of three categories

Balance Training

Because the body’s feedback mechanisms are thrown off, clients quite often need help with balance skills. If the brain is getting bad information, it is difficult to keep the body stable.

Balance on line showing how North Oakville massage can help

Manual therapy

If the inner ear is involved, we use special techniques to correct the flow of fluid through the ear. If it is the neck, we help to mobilise the joints of the upper neck and stretch and/or strengthen the muscles in the same area as needed.

Eye exercises

This is the weirdest one and the least intuitive. People experiencing dizziness or vertigo have been consistently shown in research to have worse eye reflexes than the average person2,3,4,5. They often struggle to track moving objects, focus on something coming towards them, or shift focus from one thing to another. Imagine not being able to wear your glasses or contacts for a day and you can get an idea of what this would feel like. We use specific exercise prescription to train the eyes to operate properly again. As the ability to focus and track objects improves, symptoms decrease. Much of the new research in this area is being done on people after experiencing a concussion, as the symptoms tend to be very similar.

What you can do

                If you or a loved one is experiencing dizziness or vertigo, do not simply write it off as a consequence of aging. Dizziness can be debilitating, but is very treatable. The longer you wait, the more difficult it gets to fix the problem. Have a discussion with your family doctor about treatment options, and consider an assessment by a Registered Physiotherapist.

Couple on bike showing seniors focused oakville Physio clinic

Glossary

Dizziness: A feeling of lightheadedness, faintness, or unsteadiness

Vertigo: A perception of movement or spinning, either of ones self or the environment around them

 

Tim Childs, PT

Registered Physiotherapist

MScPT, BA Kin

  1. Collerton J, Kingston A, Bond J, et al. The personal and health service impact of falls in 85 year olds: cross-sectional fi ndings from the Newcastle 85+ cohort study. PloS one.2012;7(3):e33078
  1. Gimse R, Tjell C, Bjorgen IA, Saunte C. Disturbed eye movements after whiplash due to injuries to the posture control system. J Clin Exp Neuropsychol. 1996;18:178-186
  1. Heikkila H, Wenngren B. Cervicocephalic kinesthetic sensibility, active range of cervical motion, and oculomotor function in patients with whiplash injury. Arch Phys Med Rehabil. 1998;79:1089-1094.

               

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Did you know Physio’s Treat TMJ Issues?

What is the Tempomandibular Joint (TMJ)?

The Tempomandibular joint (TMJ) is more commonly known as the jaw joint, and is located directly in front of the inner ear and below the temple. It is used many times throughout the day when we talk, yawn, eat, drink and chew, but only becomes noticeable when these activities become painful or difficult. If you place your fingers in front of your ear and slightly lower, then open and close your mouth, that is the TMJ you are feeling.

What Causes the the Jaw to become Painful?

TMJ dysfunction can stem from a number of different causes. The joint is complex, consisting of a fibrocartilage disc that sits between the joint surfaces. The joint is densely innervated with sensory nerves and therefore can be a pain sensitive structure if damaged or irritated. Most common causes include:

Derangement or displacement of the disc, muscle dysfunction and imbalance, bruxism

Oakville Physio showing how neck muscles and posture affect TMJ and jaw pain
Posture often Contributes to TMJ issues

(grinding of the teeth at night, leading to increased pressure and asymmetrical movement) or an occlusal problem with the teeth. TMJ dysfunction can stem from a history of motor vehicle accidents and associated whiplash and neck pain, a previous history of jaw or dental surgery, stress and anxiety causing tension and grinding of the teeth or poor cervical posture, putting the joint at a disadvantage biomechanically.

Other causes may include movement or dislocation of the disc between the joint or wear and tear related to arthritis. There are no comprehensive explanations that account for all of the causes of TMJ dysfunction. In many cases the onset of pain comes on slowly and without a direct or obvious injury. In these cases, symptoms likely arise from problems with the muscles of the jaw or with the joint itself.

What does TMJ dysfunction feel like?
  • Pain or tenderness in or around the ear when you eat, speak or yawn
  • Pain or tenderness in the face, around the jaw, neck or shoulders
  • “Locking” in the jaw in the open or closed position
  • Clicking or clunking when opening and closing the mouth
  • Difficulty eating hard or chewy foods
  • Deviations or shifting of the jaw when opening and closing the mouth
  • Headaches
  • Limited opening of the jaw and associated pain with yawning

Other signs and symptoms include toothaches, headaches, neck aches, dizziness, earaches, hearing problems, upper shoulder pain, and ringing in the ears (tinnitus).

How Can Physiotherapy Help TMJ Dysfuction??

TMJ dysfunction is a less common issue seen in Physiotherapy compared to back or shoulder pain, and often some people are unaware that a Physio can help. The jaw is a joint just like any other in your body, and is put through much more stress throughout a day with talking, eating and speaking. Physiotherapy can help restore range of motion, improve the mechanics of the joint through mobilizations and motor control exercises, control pain and provide useful tips on bad oral habits! A Physiotherapy assessment of the TMJ will include:

  • Thorough history of the present problem, symptoms, aggravating factors and oral habits (grinding, clenching, etc)
  • Postural assessment
  • Examination of the jaw to assess range of motion, mobility, pain sensitive structures and muscle tone
  • Examination of the cervical spine, with particular emphasis on the upper cervical region
  • Assessment of motor control and movement patterns of the jaw
  • Treatment focused on joint mobilizations of the TMJ and upper cervical spine, motor control exercises of the TMJ, postural correction exercises and pain relieving modalities, such as acupuncture or heat therapy have been shown to be effective in the treatment of TMJ disorders

Claire Corbett, BScKin, MScPt

Registered Physiotherapist

Yoga Therapy at Oakville Physio clinic in Palermo medical building

The Physiotherapists at Oakville’s Palermo Physiotherapy and Wellness Centre treat and assess the TMJ using a variety of techniques that are dependent on the individual. Our Oakville Physio’s use range of motion techniques, joint mobilizations, soft tissue work, acupuncture and exercises to help with TMJ stiffness, TMJ “clicking”, TMJ pain etc. We can work with your dentist or orthodontist to with your jaw issue. Contact us to see how we can help you with your TMJ issues.

 

 

 

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Osteoporosis: Are you doing enough? How Physio Can Help!

At our Oakville Physiotherapy, Massage and Foot Care (Chiropodist) Clinic we treat many people for injuries and aches and pain who also happen to have Osteoporosis (low bone mass and deterioration of bone tissue) and Osteopoenia (a precursor for Osteoporosis). A Physiotherapist can be a key person to have as part of the health care team for those with Osteoprosis and Osteopaenia, in addition to your family doctor and Osteoporosis Specialist.  Exercise is recommended for those with Osteoporosis for many reasons including:

  •  Strengthening postural muscles to help prevent compression fractures (breaks) in the spine. (Think that progressive rounding forward of the upper back that is often painful)
  • Increased balance, core strength and lower body strength to help prevent falls that could cause fracture / breaks in fragile bones (eg wrist and hip fractures). A hip fracture depending on other health variables can often lead to a downward spiral of hospitalization, immobility causing Pneumonia.
  • Increased bone strength through weight bearing activity.

Kettlebells at Physio clinic in Oakville
Improve your function with Physiotherapy!

Osteoporosis Canada in 2014 released new exercise recommendations. Click HERE to find the specific guideline. They are comprehensive involving a variety of types of exercises to aim for overall health including:

  • Aerobic conditioning
  • Strength Training
  • Balance / Proprioceptive Exercises
  • Postural Training / Exercises

It’s not too late to begin an exercise and strengthening program to help increase function and decrease risk factors associated with having weak bones. Often people will participate in one aspect of the above list such as walking but not participate in any specific strength training, or do strength training but forget about balance exercises.

treadmill in Oakville Massage in oakville, Foot Care Oakville, Chiropody oakville, Physiotherapy in Oakville
Oakville’s Palermo Physiotherapy and Wellness Centre. Call Now to Book Your Assessment for a Customized and Appropriate Osteoporosis Exercise Program

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