Physiotherapy

• What is a Physiotherapist?

Physiotherapists are primary health care professionals, university trained, and licensed and registered in the province of their practice. They can assess and treat musculoskeletal, neurological, and cardiovascular conditions.

• What is involved in a Physiotherapist Assessment?

Through a detailed history and a thorough physical assessment, the Physiotherapist will determine the potential causes of your pain and discomfort, your level of mobility, strength and endurance, and how they impact on your physical function.

The Physiotherapist will determine the primary diagnosis and develop a treatment plan to reduce pain, inflammation, and to start restoring the movement and strength. The physiotherapist will encourage your active participation in your plan of care.

During your session you will be educated on prevention of recurrence, and how to identify main causes causing your impairment. Working as a team, the physiotherapist will advise you on how to manage your physical problem independently, and through regular follow-ups, adjust your treatment, according to your own needs and progress.
You do not require a doctor’s referral to see a physiotherapist.  

• What will physiotherapy treatment include?

At ProHealth, as a part of the treatment, your Physiotherapist can use:

•    Manual techniques (hands-on), including soft tissue techniques, such as myofascial stretches and releases, soft tissue massage, joint mobilization and traction (specific and graded).
•    Modalities, such as Ultrasound, TENS, Interferential current, Heat/Ice, Laser, Neuromuscular stimulation, Paraffin Bath. The modalities play an important role in your improvement, by decreasing pain and inflammation, therefore reducing swelling, and increasing tissue extensibility and reducing stiffness. They also improve circulation to enhance tissue repair.
•    Exercise Programs, including specific range of motion, flexibility, strengthening, conditioning exercises, and core stability/ ball exercises. These specific designed programs will target various muscle imbalances that can lead to potential problems. The therapeutic exercises are taught one on one, and you are supervised during the program. The exercise program will be specific to your individual fitness level and stage of recovery.
•    Postural re-training is a major component of physiotherapy treatment.  Poor posture leads to muscle strain, joint wear and tear, fatigue and pain.  A Physiotherapy assessment will identify specific muscle imbalances, joint restrictions and areas of weakness. As part of postural re-training, treatment may include postural taping, education, stretches and strengthening to promote neutral alignment, and to alleviate unnecessary strain on joints and muscle.
•    Education is an important part of ProHealth Physiotherapy sessions.
The Physiotherapist will help you understand how your injury, or the dysfunction occurred, and what anatomical structures were involved.You will be educated on the stages of the healing process, and how to avoid the aggravating factors, and to enhance the biological healing. Our focus is your early and functional recovery.

 
Acupuncture

• What is a Acupuncture?

Acupuncture is a safe and effective therapeutic method, used to enhance body’s natural healing, reduce pain and improve function. It involves the insertion of very fine needles through the skin and tissues, at very specific points of the body, known as “energy meridians”.

The Anatomical (Western) Acupuncture stimulates the body to produce its own pain relieving chemicals, called “ Endorphins”. Being similar with chemical endorphins found in stronger pain medication, these endorphins block pain pathways, which result in a relief of pain, general relaxation and regulation of body’s own homeostasis. As a result, the Acupuncture increases body’s natural healing properties, reducing inflammation, and promoting health and well being. It also prevents other illness from occurring.

• Acupuncture at ProHealth:

At ProHealth, your Physiotherapist is trained and certified with the Acupuncture Foundation of Canada Institute (AFCI). During the sessions, the needles can also be stimulated with electrical impulses (Electro-Acupuncture) or with an electromagnetic field (“heat lamp”). Also, for patients that have a phobia of needles, we use low power/cold laser, instead of needles, to stimulate the appropriate acupuncture points.

• Benefits of Acupuncture:

The World Health Organization has identified the benefits of acupuncture in the treatment of wide range of medical problems including:

•    Digestive disorders: gastritis, hyperacidity, spastic bowel, constipation, diarrhea
•    Respiratory disorders: sinusitis, bronchitis, asthma
•    Neurological and muscular disorders: headaches, neck and back pain, neuralgia, frozen shoulder, tennis elbow, tendonitis, sciatica, arthritis
•    Urinary, menstrual and reproductive disorders, etc.

At ProHealth, the Physiotherapist registered with AFCI, practices Acupuncture within physiotherapy scope of practice, as an effective pain relief modality in the following dysfunctions:

o    Low back pain, due to disc degenerative disease, facet,
o    Osteoarthritis of the hip, knee, and ankle
o    Tendonitis including tennis elbow and rotator cuff, and Dequervain.
o    Whiplash
o    Carpal pain syndrome
o    Neck pain
o    Headaches
o    Post surgical conditions

• Are there any side effects of acupuncture?

There are very few side effects.  Occasionally, the original pain worsens for a few hours or days, or some changes in appetite, sleep, bowel and bladder may occur. These are temporary and are not a cause of concern. Some patients will report that they are more tired, or feel more energetic.  Most patients find that the treatments are relaxing and cause minimal discomfort.

• Does it hurt?

There is only minimal discomfort as the needles are in place, and sometimes even no pain at all. Once the needles are in place, there should be no discomfort.

• How many acupuncture treatments are required?

This is variable with each individual, depending on the condition treated. For acute cases, few treatments may be required. Acupuncture has a cumulative effect, sometimes, 6-8 sessions are recommended before achieving good and long lasting pain relief. Treatment sessions usually last between 20 and 30 minutes. Relief may be immediate, or within a few hours.

• Any advice to follow before or after an Acupuncture treatment?

Patients are advised not to eat large meals before and after treatment. It is important to avoid alcohol or sedatives for four hours prior to treatment. Pain medications may be taken as required. A short rest is desirable, but not necessary. You should avoid strenuous activities, including excessive physical effort for 48 hours after treatment. Avoid alcohol, caffeine and cigarettes for two hours.

Massage Therapy

• What is Massage Therapy?

Massage therapy includes the assessment and manipulation of the soft tissues and joints of the body to treat and prevent physical dysfunction. Through the techniques used (effleurage, petrissage, percussion), the massage reduces the pain (by stimulating the release of the endorphins), increases the muscle flexibility and joint mobility, leading to an increase of function and promotion of the well being.

• Benefits of Massage Therapy:

- Improve the circulation
- Improve the immune system functioning
- Increase lymphatic drainage
- Reduce depression and anxiety
- Reduce general body tension
- Reduce mental stress and increase the state of alertness
- Increase the “relaxation” of the body, inducing lowering of the Heart Rate, Blood Pressure, respiration.

• Conditions treated by Massage therapy:

Massage Therapy effectively and safely help in many acute and chronic conditions, such as:
-    Strains/Sprains
-    Muscle tension/spasm
-    Headaches
-    Neck and back pain
-    Inflammatory Conditions
     (i.e. tendonitis, bursitis)
-    Fractures/edema
-    Insomnia
-    Fibromyalgia -    Stress
-    Whiplash/car accidents
-    Post surgical rehabilitation
-    Pregnancy/Labor Support
-    Cancer
-    Arthritis

• What is Registered Massage Therapist (RMT)?

Registered Massage Therapists are independent health care professionals, who are regulated by the College of Massage Therapists of Ontario, and are licensed by the Regulated Health Professional Act. In their practice, RMTs adhere by a strict set of standards of practice, set by the College.

• What a client should expect at a massage therapy session?

On your first visit, the RMT will ask you questions regarding your symptoms, current physical condition, and life-style and stress level. Then she will perform a complete examination, focusing on specific areas of symptoms. The client will be examined on the massage table, and covered by linens and only the parts being massaged will be undraped.  During the examination, the client will be asked to provide feedback in regards to the pressure and comfort level.

• Massage Therapy at ProHealth

At ProHealth, our Massage therapist is highly trained in various techniques, and delivers top-quality hands-on in a caring, effective and professional manner. She has an extensive experience, is very approachable, and you will want to book again, because you just felt so much better after the session.

Mechanical Traction

Mechanical Traction uses gentle or moderate manual or mechanical forces to traction (pull apart) the bones and joints of the spine and surrounding connective tissue, including fascia and muscles.

• When do we use mechanical traction?

- Joint dysfunction
- Degenerative disc disease, spine arthritis
- Nerve root compression
- Disc bulging, protrusion and herniation
- Radiculopathy, neck and lower back pain (acute and chronic)
- Spinal stenosis

• Our traction equipment

TM400 Traction Unit, microcomputer controlled, 8 mode-programmable

• Effects of traction 

- Separation of vertebral bodies, enlarges joint spaces
- Mobilization of spinal joints
- Improves circulation and nutrition of the spine
- Minimizes compressive forces between discs
- Decreases muscle spasm and stretches muscles and connective tissue

• Is mechanical traction safe?  Is it comfortable?

Modern mechanical traction is a very safe and controlled procedure. During the traction session, the patient will not feel pain and will feel relaxed. After several sessions, the patient should feel an overall decrease in intensity and frequency of radicular, neck and low back pain. Their tolerance to functional activities will increase, due to reduced pain.

Post-MVA Rehabilitation

Whiplash is an injury to neck and head, including soft tissue and bones and is caused by a sudden exaggerated thrust of the head backwards, forward and sometimes sideways. Abnormal forces are applied to muscles, ligaments, nerves, bones, intervertebral discs and blood vessels. There are several mechanisms of injury: hyperflexion (head in a forward and downward motion), hyperextension (head in a backwards motion). During whiplash, spinal ligaments can be affected (stretched, partially or completely ruptured). The neck muscles can get injured, too, ranging from minor strains to severe tears. In the severe whiplashes, spinal cord injuries can occur. Many whiplashes are produced in motor vehicle accidents and sports, while others can be occupational.
Clients affected by whiplash describe the following symptoms:
•    Headaches and lightheadedness
•    Neck pain and/or stiffness
•    Upper back pain and/or stiffness
•    Lower back pain
•    Dizziness, blurred vision
•    Arm pain, tingling or numbness in the arm or shoulder blade
•    Irascibility, withdrawal from social life
•    Memory problems (forgetfulness)
•    Tiredness, exhaustion through, or at the end of the day
•    Sleep problems (awake in pain, unable to fall or stay asleep, difficult to find a comfortable position)
•    Fear of driving, or nervousness when driving
•    Lack of productivity, at work or at home

The symptoms can have a gradual or an acute onset, from several hours to several days after accident. They may change in location and severity. Sometimes, patients report that the symptoms are “travelling” and then suddenly change, with no apparent cause.

Treatment of whiplash

The Canadian Physiotherapy Association indicates that “almost 90% of whiplash cases heal in days or in a few weeks, and do not require intensive treatment. The key to a successful and complete recovery is to get early and effective treatment to deal with the symptoms of whiplash”. For additional information, you may see the Whiplash Information Sheet on the Canadian Physiotherapy Association.

We understand that early intervention results in a faster recovery. At ProHealth Physiotherapy, your Registered Physiotherapist will assess the injury and will help you immediately with short-term pain relief, such as manual therapy, ice, heat, electrotherapy. We will then prescribe you exercises for range of motion, flexibility and strengthening, to improve your affected spinal mobility and strength, and condition damaged joints and soft tissue. You will also receive advice on self-pain management, safe and proper ergonomics and body mechanics, post-recovery care. The Physiotherapist will encourage you to safely perform your daily activities and to pace yourself. This will increase your independence and confidence in all aspects of your life that were affected by whiplash.

It is important that, after a whiplash, you follow your doctor’s directions and physiotherapist’s instructions as best as you can in order to quicken your recovery. This can be a serious injury, which should be dealt with accordingly. Depending on the findings of your physician and your physiotherapist, the treatment may include:

•    Ice applications for the first 24 hours – applying a cold pack or even a small bag of frozen vegetables, such as peas or corn, placed in a light towel to the sore area for 10-15 minutes every few hours can be helpful. This will decrease the inflammation and cramping.
•    After 24 hours, use of both heat and cold can give you relief. Alternating between these will help.
•    Cervical (soft) collar – Rest your neck by wearing a soft supportive collar or small towel roll pinned under the chin as needed for fatigue. Take care to preserve the normal curve of the neck while wearing a support. This should generally be worn for only two days, as relying on a collar for a longer period can potentially be harmful; the muscles supporting your neck can become weak.
•    Gentle active movement after 24 hours. Movement is important for healing. Move the head frequently and gently in all directions, as long as the movement is comfortable and not forced.
•    Nonsteroidal anti-inflammatory medication – Take as directed and approved by your doctor. Inflammation is inevitable after whiplash so the medication can prove to be of significant importance during the first week post injury.

Getting the Facts about Whiplash: Grades I and II

The following education material provides general information about whiplash injuries. It does not replace advice from a qualified health care professional that can properly assess a whiplash injury and recommend treatment.
This material summarizes current scientific research related to Grade I and II whiplash injuries.

There are four grades of whiplash according to the severity of the injury, of which Grades I and II are by far the most common and least serious. The information below applies specifically to these two grades. People injured in car crashes sometimes experience a strain of the neck muscles and surrounding soft tissue, known commonly as whiplash. This injury often occurs when a vehicle is hit from the rear or the side, causing a sharp and sudden movement of the head and neck.

Whiplash may result in tender muscles (Grade I) or limited neck movement (Grade II). This type of injury is usually temporary and most people who experience it make a complete recovery. If you have suffered a whiplash injury, knowing more about the condition can help you participate in your own recovery.

Understanding Whiplash

-    Most whiplash injuries are not serious and heal fully
-    Signs of serious neck injury, such as fracture, are usually evident in early assessments. Health care professionals trained to treat whiplash are alert for these signs.
-    Pain, stiffness and other symptoms of Grades I or II whiplash typically start within the first 2 days after the accident. A later onset of symptoms does not indicate a more serious injury.
-    Many people experience no disruption to their normal activities after a whiplash injury. Those who do usually improve after a few days or weeks and return safely to their daily activities.
-    Just as the soreness and stiffness of a sprained ankle may linger, a neck strain can also feel achy, stiff or tender for days or weeks. While some patients get better quickly, symptoms can persist over a longer period of time. For most cases of Grades I and II whiplash, the symptoms usually decrease with return to regular activity.

Daily Activity and Whiplash

-    Continuing normal activities is very important to recovery.
-    Resting for more than a day or two usually does not help the injury and may instead prolong pain and disability. For whiplash injuries, it appears that “rest makes rusty.”
-    Injured muscles can get stiff and weak when they’re not used. This can add to pain and can delay recovery.
-    Active treatment and exercises can help towards the faster return to normal activity.

Getting Whiplash

-    Cervical collars, or “neck braces,” prevent motion and may add to stiffness and pain. These devices are generally not recommended, as they have shown little or no benefit.
-    Returning to activity maintains the health of soft-tissues and keeps them flexible – speeding recovery. Physical exercise also releases body chemicals that help to reduce pain in a natural way.
-    To prevent development of chronic pain, it is important to start moving as soon as possible.

Tips for Return to Activity

-    Avoid sitting in one position for long periods.
-    Periodically stand and stretch.
-    Sit at your workstation so that the upper part of your arm rests close to your body, and your back and feet are well supported.
-    Adjust the seat when driving so that your elbows and knees are loosely bent.
-    When shopping or carrying items, use a cart or hold things close to the body for support.
-    Avoid contact sports or strenuous exercise for the first few weeks to prevent further injury. Ask your health professional about other sporting or recreational activities.
-    Make your sleeping bed comfortable. The pillow should be adjusted to support the neck at a comfortable height.

Treating Whiplash

-    Research indicates that successful whiplash treatment requires patient cooperation and active efforts to resume daily activity.
-    A treating health care professional will assess your whiplash injuries, and discuss options for treatment and control of pain.
-    Although prescription medications are usually unnecessary, temporary use of mild over-the-counter medication may be suggested, in addition to ice or heat.
-    Your treating health care professional may recommend appropriate physical treatment.

Avoiding Chronic Pain

-    Some whiplash sufferers are reluctant to return to activity, fearing it will make the injury worse. Pain or tenderness may cause them to overestimate the extent of physical damage.
-    If your health professional suggests a return to activity, accept the advice and act on it.
-    Stay connected with family, friends and coworkers. Social withdrawal can contribute to depression and the development of chronic pain.
-    If you are discouraged or depressed about your recovery, talk to your health professional
-    Focus on getting on with your life, rather than on the injury!

Preventing Another Whiplash Injury

Properly adjusting the height of your car seat head restraint (headrest) will help prevent whiplash injury in an accident. In an ideal adjustment, the top of the head should be in line with the top of the head restraint and there should be no more than 2 to 5 cm between the back of the head and the head restraint.

• What is Work Hardening Program?

WHP is a physiotherapy-based and active rehabilitation program that is designed for clients who have not returned to their full job duties after being off work due to musculoskeletal injuries and pain, especially after 3 months, (Mayer et al. 1984). The program ‘s main goal is to increase the participant’s level of conditioning and physical tolerance in preparation to return to work, or to increase present work duties.

• Work Hardening Program’ Goals are:

-    Teach clients learn how to self-manage pain more effectively
-    Increase ROM (range of motion), flexibility and strength of affected area(s)
-    Increase functional abilities, and physical ability to work
-    Build and increase confidence in proper safe techniques (ie. lifting, carrying), and proper biomechanics with functional activities
-    Increase cardiovascular conditioning
-    Include many work simulated movements (ie. proper lifting) mostly as a preventative measure, and to ensure proper biomechanics
-    Increase the rate of return to work by 52% in patients off work for greater than 4 months and helps the employer’s bottom line!
-    Ultimate goal: to increase the ability to gradually return to pre-accident/injury state

• Components of WHP:

-    Education sessions that focus on hurt vs. harm, proper body mechanics related to work tasks, work pacing, and injury prevention. Client will also be educated regarding optimal posture, back and neck care, pain management during work tasks.
-    Supportive treatment may be used by the physiotherapists and assistants (when required), to alleviate pain, decrease inflammation and promote healing. The modalities consist of: Ultrasound, TENS, acupuncture, interferential current, laser, heat/cold, and manual techniques. 
-    Structured exercise program, including range of motion, flexibility, stability, focusing on strengthening, and conditioning exercises, which are progressed upon patient’s tolerance. The exercise program is performed in a supervised environment and using various gym equipment (pulleys, resistance bands, free weights, stability ball, strengthening machines, treadmills, stationary bikes, steps, wobble boards).
-    Work simulated tasks are designed according to essential tasks that are required on regular duties. A Physical Demands Analysis (PDA) is completed with client and employer’s input. The physiotherapist will create specific job simulation tasks which are initially supervised and will be progressed in frequency, load and duration.
-    Return to Work and Progression of duties Coordination. This will include follow up calls to either the Employer or WSIB (or both) regarding client’s progress and goals achieved and targeted. Employer will be contacted in order to allow gradual return to work, as will be increasing the hours and duties and ensure proper body mechanics, and appropriate stretching breaks. Functional Abilities Forms can be completed by Physiotherapist upon WSIB and Employer’s requests (Dayo et al. 1997).
-    Develop a home exercise program. Upon completing this program, the client is instructed on continuing ROM, flexibility, stability, strengthening, and conditioning exercises, at home, at his own pace. The client should be able to apply learned strategies of pain management, and use the correct ergonomics and body mechanics with work tasks.

Most commonly, a Work Hardening Program is recommended at 3-5 sessions per week, for 6-8 weeks, depending on the participant’s level and type of job to which participant returns to. The client is expected to spend from 1 to 3 up to 4 hours in facility. The length of the session will gradually increase, as the worker exercise tolerance and functional abilities are improving. These sessions can be optimally provided up to 8 hours/day, with a frequency of 5 days/week for 8 weeks (Mayer et al. 1984). 

Custom Made Orthotics

•  What are Custom Made Orthotics?

Custom Orthotics are medical devices that support and gently reposition the heel, arch, muscles, ligaments, tendons, and bones in the feet. They ensure a proper alignment of the feet during standing, walking, and other functional activities including sports. They help create an enjoyable and pain free walking experience.

•  Benefits of Orthotics

By restoring the normal balance and alignment of the body, Custom Orthotics alleviate feet, knee, hip and lower back pain, associated with flat feet, heel spurs, plantar fasciitis, hip and lower back dysfunctions. After wearing them for a long period of time, they can reduce the fatigue, and discomfort, making weight-bearing activities comfortable.

•  Gait Analysis

At ProHealth, we use TOG (The Orthotic Group) GaitScan™, an innovative diagnostic tool and digital casting device that allows us to analyze patient biomechanics and order custom orthotic products. 

GaitScan™ system is the industry leader in dynamic scanning capabilities. It provides an in-depth method of assessing patients’ gait cycle, based on a wealth of information that cannot be obtained with the naked eye. Over a million points of data are recorded, tracking minor flaws in patients’ biomechanics and shedding light on issues that if left untreated, could develop into painful conditions over time.

The GaitScan™ offers quantifiable pressure and timing information, clear and concise images to assess:

- the need for orthotic therapy
- diabetic ulcers
- overpronation
- leg length discrepancies
- Achilles Tendonitis
- Iliotibial Band Syndrome
- Metatarsalgia
- Morton's Neuroma
- Plantar Fasciitis
- Runner's Knee
- Sacroiliac Syndrome
- Shin Splints

The use of electronic gait analysis also provides comprehensive documentation for insurance claims.