Conditions We Can Help With

A form of joint disorder that involves inflammation of one or more joints. With over 100 different types of arthritis, they can be divided into 2 groups, degenerative (wear and tear, also known as Osteoarthritis) or inflammatory (infection in a joint, an example is Rheumatoid Arthritis). Other common types of inflammatory arthritis are Psoriatic Arthritis, Lupus, Ankylosing Spondylitis, Gout, and Fibromyalgia. Arthritis is a progressive disease, therefore early recognition of the symptoms and detection of the disease, as well as having knowledge and awareness of the type of arthritis is extremely important. This allows you to setup a self-management plan and seek out treatment to slow down the progression of the disease. Physiotherapists can provide education, coping strategies and develop a rehabilitation program aimed at joint-specific exercises, physical fitness programs, and recommendations for assistive devices.

Heather Smyth is a certified therapist of the GLA:D Canada program for the management of mild to moderate osteoarthritis.

Carpal tunnel syndrome is a hand and arm condition that causes numbness, tingling and other symptoms. Carpal tunnel syndrome is usually caused by a nerve that may be pinched or compressed in your wrist.
A number of factors can contribute to carpal tunnel syndrome, including the anatomy of your wrist, certain underlying health problems and possibly patterns of hand use.
Bound by bones and ligaments, the carpal tunnel is a narrow passageway located on the palm side of your wrist. This tunnel protects a main nerve to your hand and the nine tendons that bend your fingers.
Compression of the nerve produces the numbness, tingling and, eventually, hand weakness that characterize carpal tunnel syndrome. It is important to note that symptoms of carpal tunnel syndrome may be felt with certain conditions of the neck, where a nerve may be potentially irritated or compressed.

A concussion is a mild form of a traumatic brain injury (TBI). A concussion occurs when an impact causes the head and brain to shake quickly back and forth, similar to what occurs during a whiplash. Common causes of concussion include:

• Motor vehicle accidents
• Work injuries
• Playground accidents
• Sports injury to the head or neck
• Direct blow to the head, face or neck

Concussions are not usually considered to be life threatening, however they can cause some serious symptoms which require treatment. Some of the common symptoms may include:

• Memory problems
• Confusion
• Drowsines or feeling sluggish
• Dizziness
• Double or blurred vision
• Headache
• Nausea or vomiting
• Sensitivity to light or noise
• Balance problems
• Slowed reaction to stimuli

How can We help?
Your physiotherapists will evaluate and treat many of the problems related to concussion. During the examination they will assess your individual symptoms and challenges to setup a plan of action. Some treatments may include:

Rest and recovery
Your physiotherapist can help you understand why limitations of your activities (physical, sport, recreational, electronics, school) is important after a concussion and when it is safe to return. Rest helps the brain recover and heal, and helps symptoms clear up.

Restoring strength and endurance
When the time comes, it is important to work on regaining strength and endurance that has been lost throughout the periods of physical and mental rest required. Your physiotherapist will design an exercise program for you that takes into account your abilities and limitations, monitoring your symptoms through this process.

Stopping dizziness and improving balance
Dizziness and balance difficulties are common following a concussion. The vestibular system, which is very important to your balance and in preventing dizziness, can be worked on by physiotherapists through manual therapy and specific exercises.

Reducing headaches
Physiotherapists can assess the possible causes of persistent headaches (link to headache section), and apply treatments and exercises to address them. Treatments can include stretching, strengthening, mobility exercises, eye exercises and hands-on techniques.

Returning to normal activity or sport
As symptoms decrease and normal strength and endurance returns, your physiotherapist will assist you in adding normal activities back into your routine. There will be ongoing monitoring to ensure that there is no overloading of the brain and nervous system. Overloading of the brain slows down the healing and recovery and can make symptoms return.

Frozen shoulder, also known as adhesive capsulitis, is a painful and disabling disorder in which the shoulder capsule (the tissue that surrounds the shoulder joint) becomes inflamed and stiff, which greatly restricts moving and causes significant pain. Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one or two years.
Your risk of developing frozen shoulder increases if you’re recovering from a medical condition or procedure that affects the mobility of your arm — such as a stroke or a recent injury or surgery. Those with diabetes or rheumatoid arthritis are at a higher risk for developing this.
The normal course of a frozen shoulder has 3 stages:

1. “Freezing” or painful stage, which lasts from 6 weeks to 9 months. The patient has a slow onset of pain and the pain worsens as the shoulder loses motion.
2. “Frozen” or adhesive stage, which is marked by a slow improvement in pain but the stiffness remains. This stage usually lasts from 4 to 9 months.
3. “Thawing” or recovery phase, the motion slowly returns to normal. This generally lasts from 5 to 26 months.

Golfer’s elbow is a condition that causes pain on the inner side of your elbow, where the tendons of your forearm muscles attach to the bony bump on the inside of your elbow. The pain may spread into your forearm and wrist.
Golfer’s elbow is similar to tennis elbow but it occurs on the inside, rather than the outside, of your elbow. It is not limited just to golfers, tennis players and others who repeatedly use their wrists or clench their fingers also can develop golfer’s elbow.

The pain of golfer’s elbow doesn’t have to keep you off the course or away from your favorite activities. With rest and appropriate treatment, you can get back into the swing of things.

Almost 20% of headaches are of the cervicogenic variety, meaning they are caused directly by the cervical spine (neck). The pain of cervicogenic headache is usually on one side of the head; it originates in the neck and then spreads towards the front of the head. The headache starts as intermittent episodes and then progresses to an almost continuous pain. Pain may be triggered or exacerbated by neck movement or a particular neck position; it can also be triggered by applying pressure over certain parts of the neck. One of the most prominent causes of a cervicogenic headache is simply undergoing an excessive amount of stress to your neck and spine, often due to bad posture or repetitive strain of the muscles surrounding the neck. The pain that is felt may be a dull ache, sharp, throbbing, constant, mild, or intense.

Foot pain is a common complaint, and it can have many causes. There are many types of foot pain, diagnosis, and treatments.
Pain in the foot can be due to a problem in any part of the foot. Bones, ligaments, tendons, muscles, fascia, toenail beds, nerves, blood vessels, or skin can be the source of foot pain.
Some of the common foot conditions include:

• Plantar fasciitis
• Heel spurs
• Metatarsalgia
• Arthritis
• Turf Toe

The lower back is an intricate structure of interconnected and overlapping elements:

• Tendons and muscles and other soft tissues
• Highly sensitive nerves and nerve roots that travel from the lower back down into the legs and feet
• Small and complex joints
• Spinal discs with their gelatinous inner cores

An irritation or problem with any of these structures can cause lower back pain and/or pain that radiates or is referred to other parts of the body. Pain from resultant lower back muscle spasms can be severe, and pain from a number of syndromes can become chronic.
While lower back pain is extremely common, the symptoms and severity of lower back pain vary greatly. A simple lower back muscle strain might be excruciating enough to necessitate an emergency room visit, while a degenerating disc might cause only mild, intermittent discomfort.

A motor vehicle accident (MVA) can cause a variety of injuries to both the driver and any passengers. Some injuries, such as broken limbs, are obvious. Other injuries, such as soft-tissue damage or whiplash, are less visible, with symptoms not even appearing until several days after the accident. When a person has sustained an injury in an auto accident, it is important to work with your healthcare team to get healthy again. Auto accident injuries can lead to a lifetime of chronic pain if not dealt with immediately after an accident. Your auto insurance covers a portion of your physiotherapy treatment.

Most episodes of neck pain are due to muscle strain or soft tissue sprain (ligaments, tendons), but it can also be caused by a sudden force (whiplash). These types of neck pain often improve with time and non-surgical care, such as physiotherapy. Cervical degenerative disc disease, cervical herniated disc, cervical stenosis, and cervical arthritis can all lead to neck pain, limit range of motion and reduce overall function.

Some common pediatric conditions treated include:

• Sports Injuries & General Orthopedic Conditions. Conditions such as sprains, strains, and fractures are not uncommon in children with their active lifestyles and developing bodies. However, conditions such as these can dramatically impact a child’s ability to go through their day to day lives.
• Torticollis and Plagiocephaly. Torticollis, or wry-neck, is a condition in which neck movement is limited in one or more directions. This, as well as other conditions, can cause plagiocephaly – the flattening or a baby or child’s head in one or more planes.
• Post-Concussion syndromes, Dizziness, and Vertigo: Headaches, dizziness, and vertigo can all occur in children for a number of reasons – including following a head injury or concussion. These conditions can drastically limit a child’s ability to perform in school as well as participate in everyday activities they enjoy the most.

Commonly treated conditions for both men and women include:

Incontinence
There are 5 types of incontinence. Stress Incontinence is leaking of urine when coughing, sneezing or laughing. Vigorous exercise can also lead to leaking due to the over- recruitment of abdominal muscles and breath holding. If we are increasing intra-abdominal pressure, our muscles in the pelvic floor have to respond to the increased load and contract to not let any urine out. Urinary incontinence is generally caused by a weak pelvic floor. Doing Kegels and working with a Pelvic Floor Physiotherapist to determine if your pelvic floor is tight or weak (including an internal exam) is the only way to treat this type of incontinence. Urge incontinence is associated with a strong, uncontrollable need to void, with an inability to delay voiding. Mixed incontinence is a combination of both stress and urge incontinence. Other types of incontinence can include physical mobility issues getting to the washroom in time and frequent urination during the night.
There are 2 main types of incontinence. Stress Incontinence is leaking of urine when coughing, sneezing or laughing. Vigorous exercise such as gymnastics or Crossfit can also lead to leaking due to the over- recruitment of abdominal muscles and breath holding. If we are increasing intra-abdominal pressure, our muscles in the pelvic floor have to respond to the increased load and contract to not let any urine out. Urge incontinence is associated with a strong, uncontrollable need to void, with an inability to delay voiding. Mixed incontinence is a combination of both stress and urge incontinence. Other types of incontinence can include physical mobility issues getting to the washroom in time and frequent urination during the nigh

Over active bladder

Increased urgency to urinate.

Nocturia

Having to urinate throughout the night.

Pelvic Organ Prolapse

Pelvic organ prolapse occurs when organs such as the bladder, cervix, or rectum descend into the vaginal canal. This can occur more commonly after a pregnancy, and into menopause. Research has shown that lower levels of estrogen can contribute to loss of muscle mass and lead to weakness of the pelvic floor muscles. Physiotherapy can effectively treat and even cure mild to moderate cases of pelvic organ prolapse without any form of surgery.

Pre and post-natal education and exercise
Pre and post-natal physiotherapy provides a continuum of care through the childbearing years. It includes prenatal screening for pregnancy-related orthopedic or pelvic floor problems, prenatal exercise, education for labor and delivery, post-natal education and exercise, and gradual progressive training for return to sports or other recreational activities. A strong emphasis is placed on optimizing the flexibility, coordination, tone, and strength of the muscles of the pelvis and abdominal unit, especially the pelvic floor and abdominal muscles.

Blocked milk ducts
A plugged milk duct is a common problem during breastfeeding. A mother has a painful, swollen, firm mass in the breast that can cause pain during breastfeeding.

Constipation
Chronic constipation is frequently a cause of damage to the pelvic floor muscles and fascial support (ligaments). Chronic constipation can cause stretching of the pudendal nerve due to prolonged and repetitive straining (leading to pelvic floor weakness secondary to nerve damage). Constipation also creates more pressure on the bladder and urethra which may cause increased urinary frequency or retention.

Fecal incontincence
Fecal incontinence is the inability to control bowel movements, causing stool (feces) to leak unexpectedly from the rectum. Also called bowel incontinence, fecal incontinence ranges from an occasional leakage of stool while passing gas to a complete loss of bowel control. Common causes of fecal incontinence include diarrhea, constipation, and muscle or nerve damage. The muscle or nerve damage may be associated with aging or with giving birth.

Diastasis rectus abdominus
A Diastasis rectus abdominus is a separation in the rectus abdominis, also known as the “6-pack” muscle. It most often occurs during pregnancy. Sometimes it will spontaneously correct following birth, but it does not always.

Coccydynia
Painful tail bone

Pelvic pain and abdominal weakness
There can be many reasons for experiencing pelvic pain from vulvodynia to dysmenorrhea (pain with menstrual periods) to pain with intercourse. There can be tightness or increased muscle tone in the pelvic floor muscles that may be contributing to pelvic pain. Internal manual therapy and breathing techniques can help release trigger points and stretch tight muscles, which can effectively treat these painful syndromes.

Your surgeon or family physician may refer you for physiotherapy after surgery. If you’re not sure or it wasn’t mentioned, ask. Often after surgery you may experience: pain; stiffness; weakness; swelling; decreased range of motion; weakness; and adhesions of the skin near the scar. Physiotherapy can help you get back to your normal activity, quicker.

Repetitive strain injuries (RSI) are a family of injuries affecting tendons, tendon sheaths (the layer covering the tendon), muscles, nerves and joints. They cause persistent or recurring pains most commonly in the neck, shoulders, forearms, hands, wrists, elbows and lower limbs.
The term “repetitive strain” injury is misleading. Unlike other diseases, RSIs are not easily classified because they have a variety of causes and include injuries to different parts of the body. A number of terms are applied to such injuries including: repetitive injury, repetitive motion injury, repetitive trauma, overuse injury, cumulative trauma disorder and occupational musculoskeletal disorder. The different terms indicate that such injuries involve repetition, and can also be caused by force, rapid movement, overuse, static loading, excessive strain, uncomfortable positioning of limbs or holding one’s posture in an unnatural, constrained or constricted position. These types of injuries are very common in the workplace, especially with repetitive tasks.

The rotator cuff is a group of muscles and tendons that surround the shoulder joint, keeping the head of your upper arm bone firmly within the shallow socket of the shoulder. A rotator cuff injury can cause a dull ache in the shoulder, which often worsens when you try to sleep on the involved side.
Rotator cuff injuries occur most often in people who repeatedly perform overhead motions in their jobs or sports. Examples include painters, carpenters, and people who play baseball or tennis. The risk of rotator cuff injury also increases with age.
Many people recover from a rotator cuff injury with physical therapy exercises that improve flexibility and strength of the muscles surrounding the shoulder joint. Severe rotator cuff injuries, involving complete tears of the muscle or tendon, may require surgical repair.

Running is a popular activity, it’s a great way to exercise, it makes people feel good and has a significant social aspect to it as well. The downside of running is that it can put a significant strain on your body, especially if you push yourself too hard (overtraining), have poor running technique or inadequate equipment (footwear). Some common running injuries include:

• Plantar fasciitis
• Achilles tendinitis
• IT Band syndrome
• Runner’s knee
• Shin Splints

Sciatica refers to pain that radiates along the path of the sciatic nerve — which branches from your lower back through your hips and buttocks and down the back of each leg.
Sciatica most commonly occurs when a herniated disk or a bone spur on the spine compresses part of the nerve. It can also be due to any pressure on the nerve anywhere along the pathway of the nerve. This causes inflammation, pain and often some numbness in the affected leg.
Although the pain associated with sciatica can be severe, most cases resolve with just conservative treatments in a few weeks.

Sports injuries are injuries that occur in athletic activities or while exercising. They can happen due to an acute trauma (i.e. rolling an ankle while landing from a jump), or from overuse of a particular body part (i.e. shin pain while or after running). Other common causes of these types of injuries include poor training practices, improper equipment, poor physical fitness level before beginning an intensive exercise program/sport, or an inadequate warm up or stretching routine. Physiotherapists can treat sports injuries, and provide strategies and education to prevent injuries from happening and returning to sport or activity safely.

A strain is an injury of a muscle and/or tendon. Tendons are fibrous cords of tissue that attach muscles to bone. The injury occurs when muscle fibers tear as a result of being overstretched. A strain is often referred to as pulled muscle. Chronic strains are the result of overuse (prolonged, repetitive movement) of muscles and tendons. Inadequate rest breaks during intensive training precipitates a strain. Acute strains are caused by a direct blow to the body, overstretching, or excessive muscle contraction.
A sprain is an injury of a ligament which is often caused by trauma, more specifically when the joint has been taken beyond its functional range of motion. The severity of the injury can range from a minor injury that resolves in a few days to a major rupture of one or more ligaments requiring surgery and a period of immobilisation.
Common symptoms include pain, decreased range of motion (stiffness), swelling and/or bruising, or weakness. Because muscle and ligamentous tissue is affected with these injuries, strengthening is essential to have a complete recovery, return to sport/activity and to prevent possible recurrence of pain or injury.

Tendons are tough, flexible, fibrous bands of tissue that connect muscles to bones. When tendons become inflamed, irritated or suffer microscopic tears, the condition is called tendonitis. Tendons can be small, like the delicate, tiny bands in the hands, or large, like the heavy, rope like cords that anchor the calf or thigh muscles. In most cases, the condition usually happens for one of two reasons:
Overuse – A particular body motion is repeated too often.
Overload – The level of a certain activity is increased too quickly.

“Tennis elbow” is a common term used for what is medically known as lateral epicondylitis. It is a condition caused by overuse of arm, forearm, and hand muscles that result in pain on the outside of elbow. You don’t have to play tennis to get this, but the term came into use because it can be a significant problem for some tennis players.

Tennis elbow is caused by either abrupt or subtle injury of the muscle and tendon area around the outside of the elbow. Tennis elbow specifically involves the area where the muscles and tendons of the forearm attach to the outside bony area (called the lateral epicondyle) of the elbow. Your doctor may call this condition lateral epicondylitis. Another common term, “golfer’s elbow,” refers to the same process occurring on the inside of the elbow — what your doctor may call medial epicondylitis. Overuse injury can also affect the back part of the elbow as well.

The jaw can be a source of pain, can also limit movement of the mouth, cause headaches, ringing in the ear, and neck pain. TMJ dysfunction is often due to muscular imbalance in the jaw and/or neck. It is one of the smallest joints in the body, but can be one of the most debilitating because we must frequently use it throughout the day when eating or talking.
One of the major causes of TMJ dysfunction is bruxism, a repetitive clenching or grinding of the teeth. This typically happens at night while sleeping, so people may not be aware of it until their dentist notices early wearing on the teeth or a spouse or family member may hear the grinding sound. Another potential cause of TMJ dysfunction includes activities where the mouth is forceful closed in a misaligned position such as in excessive gum chewing and nail biting. Degenerative joint disease, structural mouth and tooth issues, and neck and upper back posture can also contribute to TMJ dysfunction. It is important to assess posture because when posture is poor, it disrupts the normal mechanics of the muscles responsible for chewing, putting additional strain on the joint.
Physiotherapy is beneficial for people who suffer from TMJ issues. Physiotherapists, who have specific training in the TMJ, will properly assess not only the jaw, but also the neck.