Tag Archives: Physiotherapy

Massage therapy can help with TMJ dysfunction

by Nik Panagos, RMT

What is Temporomandibular joint (TMJ) dysfunction?

(1) TMJ dysfunction is a disorder of the muscles of mastication (chewing), the temporomandibular joints, and associated structures. This disorder also presents with pain, discomfort, or limitations whilst at rest or movement.

(1) Image above depicts TMJ location and each part of the moving area.

How do I tell if I have issues with my TMJ?

TMJ dysfunction may present with a combination of the following symptoms:

  • Pain in the TMJ at rest or with movement
  • A clicking feel or sound with pain
  • Movements impaired such as chewing/swallowing/opening the mouth/closing the mouth/moving the mouth side to side
  • Headaches
  • Sinus congestion with pain
  • Ear pain
  • Poor posture

I have clicking or popping in my jaw when I chew or yawn, is that normal?
Clicking or popping sound in the jaw is normal as long as no pain occurs or no movements of the jaw are impaired. If none of the listed symptoms occur,then it is not TMJ dysfunction.

Are there different types of TMJ Dysfunction?

The three main types of dysfunctions are:

  1. Internal derangement of the joint: Dislocation, displaced discs, trauma to the lower jaw
  2. Degenerative joint disease: overuse or aging of joint, osteoarthrosis, rheumatoid arthritis, or perforation (puncture) of disc
  3. Myofascial Pain: Muscles surrounding the joint in a hypertensive state (high tension). Usually caused from overuse of clenching of the muscles of mastication (chewing muscles)

What are some common representations of TMJ dysfunction?

(2) Up to 70% of TMJ dysfunction patients suffer from pathology or malposition of the TMJ disc (disc displacement).

Normal movement of the jaw function: the lower jaw opens as the disc slides with the lower portion of the jaw (condyle) allowing for normal opening and closing without pain or dysfunction

Anterior disc displacement with reduction (ADDWR): The disc is displaced slightly forward causing a clicking and potentially some pain as the lower portion of the jaw (condyle) slides over the condyle ending in the proper open position

Anterior disc displacement without reduction (ADDWOR): The disc is displaced so far forward it prevents thejaw from opening fully.

(2) Image above illustrates some common anterior disc displacement of the TMJ

How do TMJ dysfunctions occur?

There are many different factors that can lead to TMJ dysfunction. Some common reasons why it occurs include:

  • Excessive use of mastication (chewing) muscles (I.e. chewing gum, chewing tobacco)
  • Careers with repetitive strain on muscles around the TMJ often due to prolonged seated posture (I.e. call centers, receptionist, instructors)
  • Accidents involving neck/upper back/shoulder trauma (I.e. Moter vehicle accident, contact sports)
  • Dental issues (I.e. missing teeth, uneven overbite or underbite, deviation of jaw)
  • Stress grinding during sleep

How can Massage Therapy help with TMJ dysfunction?

Massage therapy will help with TMJ dysfunction by physically manipulating restricted muscles, ligaments, and joint capsules surrounding the TMJ. Reducing the restricted muscle tissues will allow for movement to resume without pain or limitation. Mobilizing the joint ligaments and stretching will allow for proper function of the joint space to resume. Stretching the joint capsule will reduce pain, improve function, and reduce clicking if present. Manipulation of these structures will also help improve the overall function of the jaw.

What can I do at home to help prevent or reduce symptoms of TMJ dysfunction?

There are many different ways to help with TMJ dysfunction at home; some of the following ways you can help at home are:

  • Self-massage to the muscles of mastication (chewing muscles)
  • Reducing the use of chewing gum or chewing tobacco products
  • Keeping overall dental hygiene in good standing as tooth decay or wear can cause alignment issues that can put extra strain on muscles surrounding the TMJ
  • Follow a prescribed home exercise program to improve the strength and motor control of the muscles that influence the TMJ as well as postural strengthening exercises for the neck and upper back.

Do you treat inside the mouth as well? Is this the only way it can be treated?

Due to the nature of where the TMJ is located, treating within the mouth is usually the best way to access the joint itself for manipulation. However, the TMJ can also be treated without internal mouth manipulation.

In summary, the TMJ is an overlooked area for treatment unless it advances to a point of dysfunction or severe pain. Physical manipulation of TMJ dysfunction is an effective method of treatment for the condition.

Text References

1 Clinical Massage Therapy, Fiona Rattray, Linda Ludwig, Jan, 2005 Pg 597 (Citation 2021-07-13)

2  Meghan K Murphy, BE, Regina F, MacBarb, BS, Mark E. Wong, DDS, and kyracos A. Athanasiou, PhD, PE. November/December 2013. Temporomandibular joint disorders: A review of etiology, Clinical management, and tissues engineering strategies Volume 28, Issue 6 (Citation 2021-07-13)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4349514/

Image References

1 Depiction of temporomandibular joint and associating structures, (Citation 2021-07-13), motionspecficrelease.com. http://bodytechphysio.files.wordpress.com/2021/11/5a1f7-4a037c_398c46d6c03c45e0bf0fe91839b2fc33mv2.webp2 A schematic representation of the position of the TMJ disc in three different conditions, (Citation 2021-07-13), researchgate.net.
https://www.researchgate.net/profile/Tarun-Goswami-3/publication/24147487/figure/fig6/AS:668687967195141@1536439043532/A-schematic-representation-of-the-position-of-the-TMJ-disc-in-three-different-conditions.png

Management of Osteoarthritis

What is Osteoarthritis (OA)?

Osteoarthritis is the most common form of arthritis and occurs when the protective cartilage that provides cushion and support at the ends of bones gradually wears down. This is a degenerative disease that can worsen over time, often resulting in chronic pain affecting your day-to-day activities. Eventually if the cartilage wears down completely, the bones in the joint will rub directly on each other exacerbating the symptoms.

Common Symptoms of OA

  1. Pain and Tenderness
  2. Joint Stiffness
  3. Muscle Weakness and Loss of Flexibility
  4. Grating Sensation
  5. Bone Spurs- not a symptom but a sign
  6. Swelling

Most Common Risk Factors

  1. Old Age
    • Articular surfaces on the end of bones can wear down over time due to the natural aging process that occurs to muscles, joints, and bones.
  2. Obesity
    • Excess weight puts more stress on the joints (commonly occurs to weight bearing joints such as the hip and knee).
  3. Repeated Stress on the Joint
    • Over time this will cause the articular surfaces to wear down.
  4. Joint Injuries
    • A break or tear can lead to the development of OA over time.
  5. Genetics and Certain Metabolic Diseases
    • People with a family history of OA are at a greater risk.

Treatment for OA

An effective approach is seeking physiotherapy treatment at earlier stages, accompanied with an exercise program specific to you. You may feel some discomfort during exercising, but this feeling is normal and should calm down. If it is unbearable then do not continue with the exercise. Of course with any exercise, there are always risks associated, therefore consult your doctor prior to beginning any new exercise program.

                Exercise has many benefits for ALL people including improved health, fitness, and mood. Many people believe that exercising with OA could harm your joints and cause more pain, but research shows that people can and should exercise when they have OA. It is considered the most effective, non-drug treatment for reducing pain and improving movement in those with OA.

Recommended Types of Exercise

So now we know that exercise can ease symptoms of arthritis, but what is best for you? Well that varies from person to person so here are a few main categories of exercises to include in your program:

  1. Flexibility

                This category includes exercises that will help to improve or maintain the range of motion of the affected joint(s). By relieving stiffness in the joint and increasing the ability for the joint to move through its full range, you will decrease the risk of further damage, improve the function of the limb and joint, and decrease overall pain. There are two main categories of stretching to consider:

  • Dynamic Stretching: these are movement-based stretches that involve multiple joints. They should be performed prior to activity to prepare the body.
  • Static Stretching: these are stretches that take the muscle to its end range before holding that position for a minimum of 30 seconds. These stretches should be performed after activity when the muscle is already warmed up.

2. Strengthening

                These exercises work to build stronger muscles to help support and protect the joints. This allows for offloading of the affected joint which has the potential to relieve many symptoms. It is recommended to engage in strengthening exercises 2-3 days/week. Examples of strengthening exercises include lifting a limb against gravity, using free weights or elastic bands, or weight machines requiring you to push or pull against resistance.

3. Aerobic / Endurance

                These exercises help with overall fitness and improve your cardiovascular health. They typically involve the use of large muscle groups in the body in a repetitive and rhythmic manner. Canada’s guidelines for adults are to achieve 150 minutes of moderate- to vigorous-intensity aerobic physical activity per week. This intensity typically involves you to breathe a little harder and sweat but not be out of breath. Activities falling under this category include walking, biking, dancing, or even everyday activities such as mowing the lawn or shoveling as long as you are achieving a moderate- to vigorous-intensity.

4. Balance

                This is a fourth, less recognized category that is very important to consider in your exercise plan. These exercises will target smaller groups of muscles to decrease your risk of falling and can help improve your ability to do other exercises. Balance exercises include anything with a smaller or unstable base of support such as performing activities on a foam pad or single legged exercises.

Summary

                Arthritis doesn’t have to keep you from living your life and participating in your everyday activities. Exercise and arthritis should coexist! Research has shown that people with osteoarthritis who exercise regularly have less pain, more energy, improved sleep and a better day-to-day function. Work with your Physiotherapist to create an exercise program that is right for you and kick start your road to a healthier life!

BodyTech Physiotherapy

Let’s Talk About the Complexity of Pain

What is Pain?

Pain is an unpleasant complex experience that occurs in response to a potential threat to our body’s tissues. No one really wants to have pain and if you do get pain you typically want to get rid of if ASAP. What we need to remember is that pain is normal and necessary to our survival as it is our body’s alarm system. The alarm system is there to help bring our attention to potential threats and to change our behaviour to avoid the threats if necessary. 

Everyone experiences pain differently. The way we experience pain depends on many factors such as the following: the severity of tissue injury, our emotional responses, previous experiences with pain, cultural experiences, the social and physical environment, our sensory inputs from receptors in our body, beliefs and knowledge about pain and our expectations about the consequences of pain.

For example: A person who is a major league soccer player that fractures their ankle will feel the pain very differently compared to a 65 year old person who is relatively sedentary because the soccer player may feel anxious about how is he going to make money if he can’t play soccer, whereas the 65 year old who generally is not very active will not have much change in their day. 

How Do We Experience Pain?  

When your body is injured in some way whether it be from stubbing your toe, repetitive use of you shoulder or appendicitis, the receptors and nerves in your body send this information to your brain and it is your brain that decides whether or not you feel pain. These receptors in your body are called nociceptors and they respond to thermal, chemical or mechanical changes on the tissues. For example, when you place your hand on a hot stove top the receptors in your fingers and hand sense that the temperature has changed. They then send messages to your brain about the temperature change and your brain decides if this change in temperature is a threat and if you should feel pain to make you take your hand away from the potential threat of a burn.

The signals from the nociceptors do not create pain. It is the brain decides that receives the signals from the nociceptors and other information such as your memories of pain, your beliefs about pain, your emotions at the time of the signal, your expectations and the information about the environment and uses all the information to decide whether or not there is a threat of damage and whether we should feel pain. The brain may decide that a nociception signal is not important and that we do not need to feel pain, so we ignore it. An example of this is when we are sitting in a chair the receptors in our bottom notice the change in pressure an send this signal to the brain. The brain then takes the information from the signal, and the environment and decides that sitting in the chair is not harmful so therefore we do not feel pain.

An analogy that can be helpful understand pain is to think of pain like a ship that is sailing in the ocean. The receptors are the lookouts on the ship, and they notice lights in the distance (these are the potential danger signals). The brain is the captain of the ship and makes all the decisions about how to sail.

The lookouts notice lights in the distance and tell the captain about them. The captain then considers his memories about these waters and takes in information about the environment. Maybe the captain knows these waters well and knows that these waters are safe and pirate free. He would then decide that the information was good to know but not very important, he may tell the crew members not to worry about it and they continue to sail as normal. This is like the when you sit in the chair and the brain decides that it is not a threat, so you continue sitting as normal without pain.

But if the captain is concerned by the information because he has never sailed these waters before and thinks that the lights may be pirates coming to rob the ship, he may tell the other crew members to stay on high alert. This is like when you place your hand on the hot burner and the brain creates a pain experience to make sure you are aware of the potential threat. He may even change the way he was sailing to avoid the pirates. This is like when pull your hand away from the burner because of the pain to avoid the threat of a burn.

Types of Pain

Pain can be either acute or chronic.

We tend to consider acute pain as pain that has a “mechanism of injury” such as a fall, motor vehicle accident, slamming your finger in a door etc. Acute pain typically is short lived, most times is not present past 3 months (BUT not always) and usually follows the stages of tissue healing (which are outlined in the picture below).

Chronic pain is when the pain is occurring for a longer period of time. It is often disproportionate to the stages of tissue healing and may or may not have a mechanism of injury that explains why the pain is there. Chronic pain can be very complex and is not fully understood. Chronic pain is usually pain that is present past the usual tissue healing process. Meaning that the tissues have likely healed, and no more damage is likely being done. But a reason we may still get pain is because our tissues have become more sensitized. If you think of the body as a ship again. Sometimes even through the ship has long since cleared the pirate-infested waters the captain and the crew remain hypervigilant to be sure they are safe. This means that now, even normal and helpful signals such as lighthouses, and ship horns may be perceived as threats. This can be the same as if we are in pain for a long time the entire system including the nociceptors and the brain become hypersensitive to all the information that even the normal signals that the brain usually ignores will be considered threats and you feel pain even though there is no tissue damage occurring.

Management of Pain

Management of pain can be complex because of all the factors that contribute to pain. Therefore, management of pain may have to be individualized. Pain management can include many things such as resting the area of injury, use of modalities such as ice or heat, education by a health professional about exercises, work or activity modifications, education about what to expect, healing duration as well as management strategies of stress or anxiety.

BodyTech Physiotherapy

Why is your core so important?

By Courtney White, Registered Physiotherapist

Have you ever wondered what makes up your core, why is it important, or how to safely train your core without getting back pain? Keep on reading to find out these answers and more!

Your core is more than just the muscles that you can see. There is a group of muscles below the big six pack muscles that wrap around you like a corset. Their job is to support you during every movement. This inner unit is like a TRANSFER STATION. To get power generated from your legs all the way to your shoulders, it must pass through the inner core. So, if you do not have proper control over your core, that power will not move between your upper and lower body as smoothly as you want it to.

What Makes Up the Inner Core Unit?

The inner core consists of the following: the diaphragm, the pelvic floor, transversus abdominus (TA), and multifidus. Collectively, these 4 structures create a CORE CANISTER.IMG_5235-01Pic for Core

Diaphragm: The diaphragm is our primary breathing muscle and it forms the top of the core canister. The diaphragm is the component that has the primary control over the intraabdominal pressure within the canister. It moves up and down as you breathe which changes the space in the abdomen and as a result, influences the pressure within the core canister.

Pelvic Floor: The pelvic floor is a group of muscles that form the bottom of the canister. It supports the weight of all the internal organs within our abdomen, assists with bowel and bladder control, and helps to control the intrabdominal pressure along with the diaphragm. The pelvic floor is partners with the diaphragm. When the diaphragm moves up and down, so should the pelvic floor.

Transversus Abdominis (TA): This muscle connects the top and bottom of the canister as well as creates the front and sides of the core canister. It runs deeper than the external six pack muscles that you can see. Its role is to support your lower back during movement and transmit forces between your upper and lower body.

Multifidus: This muscle forms the back of the core canister and runs along the spine. Multifidus serves as a primary support for the spine, pelvis, and hips.

[1]Canister

What Are the Functions of the Core Canister? 

  1. To support the back, pelvis, hips, and trunk during movement
  2. To serve as a transfer station for power and energy between the upper and lower body
  3. To assist with bowel and bladder control
  4. To improve performance during physical activity

How Does the Core Canister Work?

To gain a stronger core overall, it is important to learn how to “pressurize” the core canister. Previously, inner core training has focused largely on tensing the walls of the core canister through focused contractions of TA. Learning how to activate the diaphragm and pelvic floor was often missed or brushed over. More recent evidence now suggests that breath is the driving force behind influencing the intrabdominal pressure. Therefore, the diaphragm is the leader behind pressurizing the core.

When you breathe in, your diaphragm contracts and pushes down into the abdominal cavity which increases the intraabdominal pressure. In response to this increased pressure, the pelvic floor relaxes and lengthens to accommodate the abdominal organs translating downward. During your inhale, the pressure in the front part of the core canister is increased as your belly expands. This is counteracted by multifidus in the back as well as TA which work together to try and keep the intraabdominal pressure evenly distributed. When you breathe out, the diaphragm relaxes and rises which decreases the pressure within the core cannister. As a result, the pelvic floor should normally contract and rise.

[2]GifCore blog

How Do We Train the Core Canister? 

Many people focus on crunches, planks, and other large abdominal exercises when training the core but negate breathing. Learning to connect your breath with movements is the key to developing a stronger core. It will allow you to control the intrabdominal pressure within the core canister. Exercises like planks and crunches are not necessarily bad exercises as they can be very effective later if you first learn to optimize the control of your core canister.

The first step is to learn how to engage your diaphragm through diaphragmatic umbrella breathing. Once you have achieved this, it is time to add in the pelvic floor so that you learn how to engage your diaphragm and pelvic floor together as a unit, referred to as piston breathing. You can also learn how to connect and activate TA and multifidus to further optimize your control over the core canister. However, it is important to highlight that the goal here is to learn how to change the size of your core canister by recruiting all these muscles together, rather than focusing solely on how to contract each specific muscle. Once you have learned how to control the pressure within the core canister, it is now time to perform bigger movements that require you to maintain control over the canister while doing a larger activity.

Check out our post on our Facebook and Instagram pages (dated May 21, 2020) for exercises you can try at home to increase your control of the core canister!

What Can Happen If You Do Not Have Control Over Your Core? 

It is not uncommon to have a weak inner core or lack control over your core canister. This can originate from prolonged sitting and slouching which distorts and changes the shape of the core canister (see part B in Figure 3 below). This positioning leads to breathing through the accessory muscles in your neck and chest, decreasing the engagement of your diaphragm. As you can see in the figure below, this puts a lot of strain on the lumbar spine which can lead to pain and injury. Ideally, your core canister should look something like part A in the figure below where the intraabdominal pressure is equally distributed. Without proper control over your inner core, it makes it very difficult for you to be able to hold your body in a good position during exercise and physical activity. This increases your risk for injury.

[3]DNS-Scissor

Now that you have learned more about what the core is and why it is important, if you have any questions or are interested in setting up an appointment with one of our Physiotherapists, contact us today! We will be happy to help you achieve your goals by developing an individualized treatment plan. 

BodyTech Physiotherapy

Text References

Diane Lee & Associates: core training vs. strengthening (internet). South Surrey: D G Lee Physical Therapist Corp; (cited 2020 May 22). Available from: https://dianeleephysio.com/education/core-training-vs-strengthening/

Key J. ‘The core’: understanding it, and retraining its dysfunction. Journal of bodywork and movement therapies. 2013 Oct 1;17(4):541-59.

Pronatal Fitness: the first move to teach your clients (internet). 2018 July 18. (cited 2020 May 22). Available from: https://pronatalfitness.com/2018/07/18/360-breathing/

Image References 

[1] The role of the diaphragm. Digital Image. Chiroup.com. Nov 2016. [Accessed on 2020 May 22]. Available from: https://chiroup.com/the-role-of-the-diaphragm/. 

[2] Breathing variations. Digital Image. S. McLaughlin. Aug 2019. [Accessed on 2020 May 22]. Available from: https://www.alignforhealth.com/self-care-for-pain/category/core%20stabilization 

[3] The “pop can” core. Digital Image. J Smeaton. Apr 2019. [Accessed 2020 May 22]. Available from: https://www.depthtraining.ca/the-pop-can-core/.

Is Virtual Physiotherapy for you?

knee painBodyTech Physiotherapy is offering virtual physiotherapy appointments with our most experienced therapists. All you need is a phone, tablet or computer. It is as simple as clicking a secure link to connect with us in a video chat.

What to expect?

Your first appointment with us will be an assessment. The Registered Physiotherapist will ask questions to complete a history and gain a complete understanding of your injury in order to provide a diagnosis.

You will be asked to do a series of movements to allow the therapist to examine your range of motion and strength, as well as be able observe how you move and perform certain tasks. You may be asked to demonstrate walking, stairs, sitting, standing or any movement pattern specific to your injury.

Treatment

Based on the findings from your assessment, the therapist will be able to cue and correct your movement patterns. You will also be given specific exercises to help in your recovery. Your therapist may give you some self-directed treatment techniques, or teach another person how to assist you with these techniques.

You will have a chance to ask questions and clarify your abilities and restrictions. Your therapist will educate you about your condition and provide suggestions on how to modify your activities if needed.

Still not sure if virtual physio is right for you? Schedule a free 10 min phone consult with one of our therapists.

Call 519-954-6000 or email: info@bodytechphysio.ca

BodyTech Physiotherapy

Treatment for a Blocked Milk Duct

By Kelsey Jack

Blocked ductFor nursing or pumping mothers a blocked milk duct is something that can happen with a sudden onset. Early treatment of a blocked milk duct is recommended to prevent progression of the condition. If not treated a blocked milk duct may turn into a condition called Mastitis, a bacterial infection in the breast that requires immediate medical attention.  Fortunately, at BodyTech Physiotherapy all of our therapists are trained to provide ultrasound treatment to help clear the blocked duct. 

What is a Blocked Milk Duct?

Milk ducts are tubes that connect the glandular tissue where the milk is produced to your nipple. There are approximately 15-30 ducts in each breast. A combination of the let-down reflex and proper latching from your baby helps to pull the milk along the ducts and out the nipple. Blocked milk ducts occur when there is a clog in one of the ducts that affects how milk is able to drain.

What causes a Blocked Milk Duct?

Although the causes of a blocked milk duct are not fully understood, common risk factors include:

  • Poor latching
  • Residual milk
  • Irregular, short, or skipped feeds
  • Pressure on the breasts such as tight clothing or restrictive gear

How can I tell if I have a Blocked Duct?

Symptoms of a blocked duct include:

  • Tender or painful area of the breast
  • Lumpy, ropey, or firm feeling breast tissue
  • Swelling and redness around the affected area
  • Warmth over the affected area

Additionally, you may find that your baby is fussy about feeding from that breast as milk flow can be slower than usual.

Signs of Mastitis

Mastitis is inflammation of breast tissue caused by an infection. A blocked duct has the potential to develop into mastitis if left untreated. Other causes include a cracked or sore nipple that allows bacteria to enter the breast. If you develop mastitis, medical treatment is required as soon as possible.

Symptoms of mastitis include:

  • Fever and chills
  • Increased feeling of being run down or tired
  • Increased redness and swelling around the affected area
  • Pain or burning in the breast while feeding
  • Muscle aches and pains

What can I do if I have a Blocked Duct?

Most blocked ducts will resolve on their own within 24-48 hours, however several things can be done to help the issue resolve more quickly:

  • Continue to breastfeed on the affect side. Try and point your baby’s chin towards the area of hardness. It is also beneficial to use breast compressions while your baby is feeding to aid with drainage.
  • Heat to affected area
  • Soak affected breast in a warm, Epsom Salt bath. You can also massage the affected area while the breast is soaking.
  • Massaging the affected area, starting closest to the nipple and working away. Always massage towards the nipple to aid with drainage. Some women find using an electric toothbrush to massage helpful.
  • Pump or hand express after nursing
  • Wear loose fitting clothing and a bra that isn’t overly constrictive
  • Rest as much as possible

How can Physiotherapy help with a Blocked Duct?

If the above self-treatments are unsuccessful at resolving the blockage, therapeutic ultrasound with a trained Physiotherapist can be used to resolve the blockage. The ultrasound treatment is applied directly to the area of the blocked duct. Immediately following a blocked duct treatment pumping or feeding the child is required to help clear the duct. One treatment is often all that is required to resolve the issue. If two treatments on consecutive days do not resolve the issue, further medical attention is recommended.

BodyTech Physiotherapy

Osteoporosis and Exercise

By Lauren Harding, Registered Kinesiologist

What is osteopenia and osteoporosis?

unnamedOsteopenia and osteoporosis are conditions characterized by a loss of bone mineral density (BMD). BMD is a measure of the quantity of minerals (calcium and phosphorus) in a precise volume of bone. The difference comes in their severity.

Osteopenia indicates a lower BMD causing bones to be generally weaker. This bone weakness becomes more pronounced with osteoporosis as the bones become more brittle and porous (filled with air pockets), ultimately increasing the risk of fracture. Though less severe, osteopenia is a serious risk factor for developing osteoporosis.

Osteoporosis is often labeled as the ‘silent thief’ since bone loss occurs gradually, typically without symptoms. However, these four factors can signal underlying osteoporosis:

  • Loss of height over time and/or development of a stooped posture
  • Sudden back pain without any obvious cause
  • Fracturing after a seemingly minor incident

 

How are these three conditions treated?

An excellent approach is early intervention physiotherapy treatment, accompanied by a well-designed exercise program. It is important to consult your doctor before starting a new exercise plan. As with any exercise, there is always risk associated.

Osteoporosis Canada recognizes exercise not only for increasing cardiovascular endurance, but also as a fundamental component to protecting your bones. Exercise maintains bone mass and builds muscle strength, as well as increases flexibility and range of motion, balance and coordination. Benefits also include reduced pain and inflammation, while promoting loss of excessive weight. Additionally, the risk of falling is reduced.

 

What types of exercise should I be doing?

There are 5 types of exercises recommended for individuals with osteopenia and osteoporosis:

Types of Exercise How Often Should I Do These?
Aerobic 3 to 5 days per week, a minimum of 150 minutes per week
Strength Training 2 to 3 times per week
Balance Every day
Stretching Every day
Posture Training Always

 

Aerobic Exerciseunnamed

Aerobic exercise is considered any continuous, rhythmic activity that strengthens and stimulates the heart and lungs, thereby improving the body’s use of oxygen. It is recommended that ALL adults get 150 minutes of moderate to vigorous physical activity a week, or about 20 to 30 minutes per day, for at least 10 minutes at a time. During moderate-intensity activity, your heart beats faster and you breathe harder. The rule of thumb is that you are able to talk during these activities, but you are working too hard to be able to sing. During vigorous-intensity activity, your heart beats faster still and you continue to breathe harder. You are unable to say more than a few words at a time during vigorous activity. It is important with osteopenia and osteoporosis to do weight bearing aerobic exercises. Examples of weight bearing aerobic exercises include:

  • Brisk walking, dancing, stair climbing, running, step aerobics, hiking, jogging, jump rope, and treadmill walking/running

 


Strength Training

Elderly_exercise

In order to increase your muscular strength, you must work against resistance until your muscles feel tired.

This helps to reverse muscle atrophy, a condition that occurs when your muscles start to waste away due to lack of use. Furthermore, resistance training strengthens the muscles surrounding your joints, ultimately reducing further joint damage and decreasing risk of injury. ALL adults should do 2-3 days of strength training a week. Exercises using free weights (dumbbells), exercise bands or weight machines are strongly recommended. Examples include:

  • bicep curls, sit-to-stand, lunges, rows, calf raises, bridges, triceps kickbacks, countertop push ups

 

Balance Exercises

Balance exercises help maintain your footing when an unexpected movement occurs in your daily life. Improving balance and coordination can reduce your likelihood of falling, therefore decreasing your fracture risk. Ironically, in challenging your balance, you run the risk of falling. For this reason, you must always take precautions such as having a chair nearby to hold onto. When you are training your balance, there are two main types of balance exercises:

  • Static Exercises – Stand still in one spot holding a certain posture in order to practice balance. For example, standing on one foot on the floor.
  • Dynamic Exercises – Balance is challenged more with adding movement. For example, walking ina straight line while touching the heel of one foot to the toe of the other with each step.

 

Stretching

unnamed (1)As you age, you lose flexibility which can increase your stiffness and discomfort, often preventing you from staying active. Stretching exercises help you to counteract this by increasing the range of motion of your joints and improving your flexibility. It is important to note that stretching should always be done after the muscles and the body are warmed up since stretching cold, stiff muscles increases your risk of injury. Just like in balance training, there are two main ways to stretch:

  • Static Stretching – Take the muscles to their end range of motion and maintain that position for at least 30 seconds in order to enhance soft tissue and muscular flexibility.
  • Dynamic Stretching – Functional, multi-joint movements that typically increase in range of motion and speed as the body begins to warm up.

While both are effective, dynamic stretching has been shown to be more beneficial than static stretching as a way to warm up prior to activity since it has been found to improve balance, strength, reaction time and agility. Static stretching, however, is still important and is most beneficial when performed at the end of exercise as a cool down. Static stretching can also be done separately when the body is warm as part of an everyday attempt to improve body mechanics, posture and flexibility.

 

Posture Training

unnamed (1)We all have a natural curve in our spine, however, weak back muscles and/or spinal fractures can cause an excessive forward curvature of the spine. Rounding of the upper back is known as exaggerated kyphosis. This puts pressure on the front of your vertebrae, placing them at even great risk of fracture. Posture training exercises help to improve the alignment of your spine by correcting shoulder, back and neck positioning. Focus should be placed on exercises that strengthen the back muscles and reduce forward head posture. Abdominal exercises that strengthen the core muscles, help to maintain good posture as well.

 

To Sum Up

An exercise program is a vital component in the management of osteoporosis.

Regular participation in aerobic and strength training is fundamental, as well as balance, posture management and stretching.  All in all, physical activity for individuals with osteopenia or osteoporosis can promote bone health and overall quality of life.

BodyTech Physiotherapy

Physiotherapy after a Fracture

By Courtney Lacey, PT

fractureIf you have recently broken a bone, you may be wondering when you will be able to return to all of your normal activities. While it typically takes 4-8 weeks for a bone to heal, you will likely require physiotherapy to help get you back to full function.

How do fractures happen?

A broken bone, also known as a fracture, can occur in many ways. Most often, broken bones are the result of a traumatic mechanism of injury such as a fall, motor vehicle accident or contact during a sporting event. Fractures can also occur from repetitive motions which place stress on the muscles and bones. A common example of this is stress fractures in the legs from running. Finally, fractures can more easily occur in people with osteoporosis – a disease which weakens bones and makes them more likely to break.

How do you know if you have a fracture?

These are some signs and symptoms which may indicate that you have a fracture:

  • Immediate and severe pain following a fall or accident
  • A “pop” or “click” heard or felt during the incident
  • Swelling in the area
  • A bump or deformity
  • Unable to weight-bear through the injured limb

If you suspect you have a fracture, you will need to see a doctor who will order an X-ray to confirm the diagnosis. Often, those who experience an injury causing a fracture will go to the hospital to be evaluated.

Does a fracture heal?

While bone healing takes approximately 4-8 weeks, the timeline depends on both the person and the type of fracture.  In order for a bone to heal properly, it has to first be set in the proper position, which is called reduction. The doctor may be able to reposition the bones without surgery, which is called a closed reduction. Sometimes, surgery may be required to bring the ends of the bone close together, which is called an open reduction. Pins, plates or screws may also be used to keep the bones in place. If the fracture did not cause any part of the bone to shift out of place, no reduction is needed. Once the doctor has determined the bones are in a good position to allow for healing, the area will be immobilized in a cast or a splint.

When can the cast come off?

To determine if you are ready to have the cast removed, you will have an X-ray done with the cast or splint in place. The doctor will look for the formation of a callus, which demonstrates that healing has taken place. The doctor will then remove the cast and may recommend that you have physiotherapy. Physiotherapists play a key role in returning you to your full function as quickly as possible after a fracture.

Why do I need physiotherapy?

There are several reasons why physiotherapy is needed after fracture. Depending on the amount of healing that has occurred, your doctor may have special instructions (how much weight to put through the limb, certain activities to avoid, etc.) that your physiotherapist can help you understand. Once the cast is removed, you may still have some swelling and pain around the fracture site. Physiotherapists may use modalities (such as ultrasound or TENS) to help decrease pain and swelling and improve your mobility and tolerance for using the injured limb in daily activities. If you had surgery, you may also have a scar which creates scar tissue and can disrupt movement. At BodyTech Physiotherapy your therapist will use manual therapy techniques to help mobilize the scar tissue and the areas around the injury as needed to  restore normal movement around the surgical site.

Physiotherapy is crucial to improve your functional mobility that you may have lost during your time in the splint or cast. Immobilization over 6-8 weeks will cause loss of range of motion and strength, which will make daily tasks difficult to do. Your physiotherapist will help restore your proper range of motion using manual therapy techniques. While the fracture site will be stiff and sore, you may also lose range of motion at surrounding joints that were moving differently during the healing process. For example, if you have broken your elbow, it is also necessary to  assess your shoulder, wrist and hand to ensure that these joints are moving properly. Not correcting the mobility around the fracture site can prolong your healing process and lead to future injuries as well.

Once your range of motion has been restored, you will need to regain strength in order to return to your pre-injury activities. Your physiotherapist will work with you to create a proper strengthening program to re-introduce your bones to loads and stresses that you encounter in your daily activities. Lack of strength or going back to activity too soon puts you at risk of re-injury or prolonging the healing process. Physiotherapy will help you understand the correct exercises to do and will tailor your program to the activities you plan to return to, whether it be high level sport or recreational activity.

How long until I am back to my regular activities?

Your rehab program will vary in length depending on the type of fracture, if there was surgical intervention, and the type of activity you plan to return to. Depending on the nature of the injury, physiotherapy can take anywhere from 8 weeks to one year for more complex fractures. Your physiotherapist will guide you through your rehab program, ensuring you are progressing at an appropriate rate and prevent complications or future injury.

BodyTech Physiotherapy

Frozen Shoulder/Adhesive Capsulitis

By Carla Cranbury, PT

What is it?

Frozen shoulder, also called adhesive capsulitis, is a gradual onset shoulder condition characterized by pain and limited range of motion. This is caused by inflammation and tightening of the shoulder capsule. Typical initial symptoms are pain midway between the shoulder and the elbow and difficulty reaching behind the back. Most women will report that they have difficulty doing up their bra and men difficulty putting on their belt.

Why does it happen?

Limited research has been able to discern one certain cause of frozen shoulder – in short, we don’t know. We do know that it is most common in middle aged women (aged 40-65) and people with diabetes. It also is more likely to occur after a virus, a lingering shoulder injury or after shoulder or upper limb surgery.

How long does it take?

Frozen shoulder goes through three main stages, each of which can take weeks to months:

  • Freezing – pain is noticed and range of motion becomes progressively limited
  • Frozen – pain is reduced, but range of motion is further restricted
  • Thawing – pain is reduced and range of motion gradually returns

Can physio help?

Physiotherapy cannot speed up the course of the condition – everyone has to go through each of the three stages in order to recover. The total process of frozen shoulder can take one to two years to resolve.

What physio can do is help you retain function while going through frozen shoulder, decrease some pain, and ensure a full recovery. Maintaining mobility through the process is important and is where physiotherapy can help the most. Physio will also help prevent other injuries that can be caused by compensating for the frozen shoulder – this is especially significant as it is common for the other shoulder to get the same condition.

Your physiotherapist will give you exercises to maintain as much movement as possible and instruct you on how to perform them properly to ensure you are not compensating for the limited range of motion. Hands on manual therapy will help stretch out the capsule to make the exercises easier to perform. Modalities such as ice, heat, TENS, and acupuncture can also be used to decrease pain.

Though frozen shoulder can be a lengthy and frustrating process, the right care can make it more manageable and prevent any further complications.

BodyTech Physiotherapy

 

Reeves B. The natural history of the frozen shoulder syndrome. Scand J Rheumatol. 1975;4:193–6.[PubMed]
Greene WB. Essentials of musculoskeletal care. 2. Rosemont, IL: American Academy of Orthopedic Surgeons; 2001
Pal B, Anderson J, Dick WC, Griffiths ID. Limitation of joint mobility and shoulder capsulitis in insulin- and non-insulin dependent diabetes mellitus. Br J Rheumatol. 1986;25:147–51. doi: 10.1093/rheumatology/25.2.147. [PubMed] [Cross Ref]
Bridgman JF. Periarthrits of the shoulder in diabetes mellitus. Ann Rheum Dis. 1972;74:738–46.
Hazleman BL. Frozen shoulder. In: Rockwood CA Jr, Matsen FA III, editors. The shoulder. 2. WB Saunders: Philadelphia; 1990.
Harryman DT, Lazurus MD, Rozencwaig R. The stiff shoulder. In: Rockwood Cam Matsen FA, Wirth MA, Lippitt SB, editors. The shoulder. 3. Saunders: Philadephia; 2004.

Exercises and Strategies for Stair Climb Events

Stair climbing is both a functional activity that most people complete daily and an activity that can be used for exercise. There are two different strategies that can be used to climb a flight of stairs: the knee first strategy (Figure 1) and the hip first strategy (Figure 2). In the knee first strategy, the movement is broken up into two distinct vectors with a horizontal vector (1) initiating the movement and the vertical component (2) following. This movement pattern relies on the quadriceps muscles as the primary mover and places increased stress on the knee which increases the likelihood of knee pain developing during stair climbing. The hip first strategy combines the vertical and horizontal components and results in a diagonal vector of movement. It relies primarily on the gluteal muscles to initiate the movement. This strategy decreases loading through the knee and reduces the risk of knee pain with repetitive stair climbing. Using a hip first strategy becomes especially important when using stair climbing as an exercise or when training for/completing an event like the CN Tower Climb.

Stair climb Fig 1 and 2

Excellent strength and endurance of the gluteals (buttocks), quadriceps (front thigh muscles), and core are required to successfully complete the CN Tower Climb without injury. A good preparation program will involve both strengthening exercises and stretches for the major muscle groups of the lower extremity and core.

Strengthening Exercises

As the CN Tower climb requires good muscle endurance, each exercise should be performed for a minimum of 20 repetitions.

Squats

Stair Climb - Squat

Stand with feet hip width apart, toes facing forward. Keeping the chest open and shins vertical, reach the hips back as if sitting on a chair, allowing the knees to bend. The knees should never go in front of the toes.

 

 

 

 

Single Leg Squats

Stair Climb- single leg squatStand on one leg, keeping the pelvis level. Keeping the knee in line with toes and maintaining a level pelvis, reach the hips back and allow the knee to bend as if sitting on a chair. The knee should never go in front of the toe.

 

 

 

 

Step Ups

Stair Climb- step upsPut one leg up onto a step. Keep the knee in line with the toe and drive through the glute to straighten the knee and hip. Weight should not shift forward prior to initiating the movement.

 

 

 

Monster Walks

Stair climb- monster walkStand on a band and cross it in front or tie the band around mid thigh as shown in the picture. Do a mini squat, ensuring that the hips are back and knees are behind toes. Keep the pelvis square and level and take a step to one side, slowly bring the other leg in. Perform to both sides.

 

 

 

 

Plank

Stair climb- plankWith forearms shoulder width apart, gently squeeze shoulder blades together and pull down from ears. Balance on knees (easier) or balls of feet (harder), keeping the spine long, hips in line with shoulders, and chin tucked. Hold 30-60 seconds.

 

Single Leg Jump

Stand on one leg, keeping the pelvis level. Do a mini squat, power through glutes and calf to jump off ground. When landing, ensure heel is on the ground, knee is bent, hip is back and knee is in line with toe.

Box Jump

Stand with feet hip width apart a comfortable distance from the box. Do a mini squat before powering through glutes and swinging arms up to jump onto the box. Land keeping knees behind toes and core engaged. Stand up straight. Jump off the box and land in a controlled squat.

Sprint

With good running form, sprint for 60 seconds. Walk or lightly jog to recover for 2-3 minutes. Repeat 5-8 cycles.

Stretches

All stretches should be held for 30-60 seconds and repeated twice. Stretches should be performed daily when trying to lengthen a muscle or after a work-out when the goal is to maintain muscle length.

Hip Flexors

Hip flexor and quad lungeIn a lunge stance with the back knee on the floor, tuck the pelvis under keeping the back straight.

 

 

Glutes

Piriformis supine #2 (1)Lying on your back, keeping shoulders and back on the floor, cross the leg to be stretched over the other in a figure 4 position and bring both hips to a 90 degree angle.

 

 

Hamstrings

Hamstring seatedSit with the leg to be stretched straight and the other foot tucked in. Keep the back straight and lean forward towards the straight leg by hinging at the hips.

 

 

Quadriceps

Quad standingStand and bring the heel of the leg to be stretched towards the buttock. Ensure that the bent knee does not drift forward in front of the other knee.

 

 

 

Calves (Soleus and Gastrocnemius)

image6Soleus

Stand in a lunge stance. Keeping the torso

upright, bend both knees and sit back over the back leg.

 

 

image7

Gastrocnemius

Stand in a lunge stance. Keep the back leg straight and bend the front leg keeping the back heel on the ground.

 

 

 

Child’s Pose

Stair climb- prayer stretchStart on hands and knees with hands and knees shoulder and hip width apart, keep hands on the ground and sit hips back towards the heels until a stretch is felt through the back.