Search Results: scoliosis

Physiotherapy in the Treatment of Scoliosis

The Role of Physiotherapy in the Treatment of Scoliosis

(published Orthopaedic Division Review, CPA September 2017) 

Maureen Dwight[1], Dr. Josette Bettany-Saltikov[2], Dr. Eric Parent[3]

Introduction

The role of physiotherapists in the treatment of scoliosis can be somewhat unclear and sometimes controversial. Many therapists have little exposure to the treatment of this condition[4] [5] which is in part related to the lack of education on spinal deformities at university as well as the relatively low acceptance rate by scoliosis surgeons and specialists for the inclusion of physiotherapy in the comprehensive management of scoliosis.  Despite increasing research supporting treatment, the number one reason given for this lack of inclusion is limited evidence of efficacy.

This article seeks to review the diagnostic factors which influence physiotherapy treatment and to review the known efficacy and role of physiotherapy in the treatment of Adolescent Idiopathic Scoliosis.

Key Considerations in the Treatment of Scoliosis

1. Diagnosis

Scoliosis is a structural alteration to the normal curves in the spine. During active growth periods the spine develops curves in the frontal and sagittal planes however the scoliotic spine develops with axial rotation which alters the normal development of these curvatures.  These changes can result in a rib hump or a rotational lumbar prominence as well as altering the normal lordosis and kyphosis resulting in a kypho-scoliosis, thoracic lordosis, sway, flat back, etc.

For a patient to be diagnosed as having a scoliosis, the lateral curvature in the frontal plane must measure greater than 10 degrees.  Approximately 2-3%[6] of children under the age of 16 will have scoliosis however the majority will not progress.

Curves are commonly defined by the location of the apex and the Cobb angle.  The Cobb angle is a measurement of the angle in the frontal plane between the superior vertebral end plate of the most tilted vertebra above the curve apex and the lower endplate of the most tilted vertebra below the apex. Measures of vertebral rotation may also be quantified through imaging.

Curves may be classified as major and minor[7] which denotes the relationship of their magnitude to each other.  If more than one curve is present it may be described as a double major or a major with an associated minor curve(s).  The Lenke[8]  or SRS classifications are the most commonly used taxonomies of curve type.

The Lenke system, while widely used by surgeons to plan surgeries, is not widely used by physiotherapists as it requires side-bending radiographs and is meant for bigger curves. Scoliosis Research Society (SRS) definitions with reference to curve apex are as follows: Cervical (C1 to C6-6 disc), cervico-thoracic (C7 to t1), Thoracic (T2 to T11-12 disc), Thoraco-lumbar (T12 to L1), Lumbar (L1-2 to L4-5 discs), and Lumbosacral (L5 and below)[9].

For a physiotherapist the location of curve can be important when using Physiotherapeutic Specific Scoliosis Exercises (PSSE)[10] as these treatment techniques base their approach on the specificity of curve location.  This knowledge also determines the need and effectiveness of other types of treatment which can influence treatment planning i.e. bracing is less effective in a thoracic double major curve.

2. Idiopathic vs. Non-idiopathic scoliosis

Scoliosis is typically divided into two major categories: idiopathic and non-idiopathic. This division reflects the underlying causes with the term idiopathic identifying the lack of consensus on the cause of these curves. One of the key features of the idiopathic-type of scoliosis is that it is not associated with any other conditions.

a. Idiopathic scoliosis

Idiopathic scoliosis is typically divided into 4 categories based on age and risk for progression.  There is more difficulty determining risk for progression of the early onset types of scoliosis (<age 10) which justifies the need for closer monitoring in this age group. The risk for progression is more predictable in the adolescent age group and is sometimes described as linear, however each patient should be approached individually as not all curves progress as predicted.

I. Infantile idiopathic scoliosis is diagnosed when first seen in a child under age 3

II. Juvenile idiopathic scoliosis is diagnosed in children ages 4 to 9

III. Adolescent idiopathic scoliosis is diagnosed when the spine curvature changes during the growth spurts commonly occurring around puberty(between ages 10 and 18)[11]

IV. Adult idiopathic scoliosis occurs in patients older than 18. This condition can also be referred to as de Novo scoliosis.  Many of these new diagnoses are related to spinal degeneration however, when the onset is not coincident with periods of skeletal growth, other non-idiopathic causes should be considered.

b. Non-idiopathic scoliosis

The non-idiopathic type of scoliosis is associated with other conditions and/or underlying causes.  The causes are typically divided into two categories.

I. Neuromuscularscoliosis.  This type of scoliosis is associated with neuromuscular diseases i.e., Arnold-Chiari malformation/syrinx or trauma to the spinal cord.

II. Syndromicscoliosis is related to other diseases i.e. Marfans syndrome, spina bifida.

 3. Indications for additional monitoring

For a physiotherapist working with scoliosis a primary consideration is determining the type of scoliosis.  If the patient has been seen by a specialist or pediatrician this diagnosis may already be clear however when the physiotherapist is the first to diagnose the condition consideration should be given to the need for further investigation and/or referral.

Screening for further testing can be particularly important in the non-idiopathic patient as an undiagnosed Marfan’s syndrome, syrinx, Chiari Malformation, etc. can have serious health consequences[12].  These patients should be referred for monitoring/testing by the appropriate specialist.  The following considerations can assist in determining the need for additional testing[13]

1. Is the patient under age 10?

The most common scoliosis (AIS) occurs in the teens.  Earlier onset need to be monitored and/or investigated more closely both for the unpredictability of the progression and for the likelihood of non-idiopathic causes.

2. Is the patient still growing?

Bracing is only effective while the spine is still growing. There is typically a window of approximately 2 years, occurring around puberty, when this treatment can limit the likelihood of curve progression.  If the patient is under age 18 consideration should be given to referral for quantification of spinal maturity and degree of curvature.

3. How large is the curve?

The larger the curve the more likely it is to progress[14]. The younger/less skeletally mature the patient is the greater the risk for progression[15].   Younger children and adolescents, particularly with larger curves, are more likely to require additional monitoring and/or intervention.

4. Is the patient male or female?

Although the incidence of scoliosis in males and females is equal the presence of larger curves is more typical in females.  A significant curve in a male can be more indicative of non-idiopathic type of scoliosis and sometimes represents an indication for an MRI[16].

5. Are there other signs of concern?

The presence of upper motor neuron signs, connective tissue disorders, café au lait[17] spots, spinal hairy patch etc. all can be markers of non-idiopathic types of scoliosis These factors can be indicative of the need for additional investigation.

4. Treatment of AIS

Primary goal of treatment

As there is no consensus on causation, the prevention of scoliosis cannot be a goal at this    time.  The primary goal of treatment is prevention of curve progression.

Within this goal the first consideration is to keep the curve to less than 30-35 degrees.  This magnitude is often a threshold for other treatment as these curves are more at risk for progression.  Curves less than 30 degrees at skeletal maturity present a low risk of continued progression in adults. Untreated curves of 50 degrees and greater are predicted to progress at .5 degree per year[18].

The second threshold is 50 degrees.  When the curve exceeds this magnitude surgery is often recommended. Most studies[19] report the strongest predictive factors in determining the risk for progression of idiopathic scoliosis are age, magnitude of curve, and gender.

Currently the strongest acceptance for prevention of progression is for bracing and surgery.  Recently, the BrAISt randomized controlled trial demonstrated convincingly the ability of bracing to prevent progression to surgery indication thresholds with 72% success compared to only 48% in the group under observation[20]. This trial also demonstrated clearly the role of compliance in the brace treatment effect showing that when a rigid brace prescribed for full time wear (<18hr/day) is worn at least 13 hours a day the probability of success is high (<90%).

Despite the wide acceptance for surgery, a systematic review by the Cochrane Collaboration failed to find sufficient evidence to support its use in severe curve management.  Bettany-Saltikov et al[21] looked to compare surgical vs. non-surgical treatment of curves over 45 degrees but were unable to find any RCT’s or prospective studies that met the criteria.  They were unable to make any conclusions of the effectiveness of surgical vs. non-surgical management of severe adolescent idiopathic scoliosis of over 45 degrees.

Physiotherapy Goals of Treatment

In physiotherapy the goals of treatment are broader than strictly the prevention of curve progression. 

The SOSORT survey by Marti et al.[22] of SRS scoliosis specialists documented the key reasons for referral to physiotherapy. These referral patterns were separated into standard physiotherapy treatments and PSSE’s.   In Parent et al’s study the survey of the standard physiotherapy techniques listed the following approaches used in the treatment of AIS:

  1. stabilization exercises (76%)
  2. non-scoliosis specific postural approaches (73%)
  3. mobilizations (55%)

In the Marti study the most common specific PSSE used were:

  1. Schroth – Germany (57%)
  2. Side Shift – UK (22%)
  3. SEAS – Italy (21%)
  4. FITS – Poland (19%)

The top reasons for the surgeon’s prescribing standard physiotherapy were:

  1. in conjunction with brace treatment (58 %),
  2. small curves (48 %)
  3. improving post-operative outcomes (37 %)
  4. treatment of pain (25 %)[23]
  5. Improving aesthetics (40 %

The top reasons for the surgeon’s prescribing PSSE’s were:

  1. improve aesthetics (62 %)
  2. to prevent curve progression (60 %)
  3. improve quality of life (53 %).

Similarly, the SOSORT guidelines[24], from the international Society on Scoliosis Orthopedic and Rehabilitation Treatment identify the following four common objectives to be pursued when using PSSE’s:

  1. limit curve progression
  2. prevent respiratory dysfunction
  3. control pain
  4. improve postural appearance.

 Physiotherapy Role in Prevention of Curve Progression

Although one of the goals of physiotherapy may be to reduce curve progression, despite increasing research support, this goal remains controversial at this time.  Early support is seen in the 2012 Cochrane systematic review[25] for the use of PSSE’s in reducing curve progression.  The Negrini study[26] has shown value of the use of PSSE’s in reducing curve progression both with and without bracing.

Of note, in Monticone et al’s study[27], the percentages of patients presenting improvement >5o), stable curves (changes < 5o) or deterioration over 5o were 62%, 38% and 0% in the exercise group and 0%, 92% and 8% in the control group, respectively. In response to 6 weeks of supervised therapy, participants in Kuru et al’s trial[28] assessed after 24 weeks showed larger improvements in Cobb angles, Angle of trunk rotation, height of gibbosity and waist asymmetry but not SRS-23 scores than both controls under observation or having done unsupervised exercises. Other exercise trials[29] are ongoing and other results await publication which suggests the evidence base on PSSE effectiveness will continue to grow stronger in the near future.

With this increase in data, a shift in the acceptance of scoliosis treatment is starting to be seen in changes to the position statements of the Scoliosis Research Society (SRS) and other influential scoliosis-related associations.  The 2014 SRS Statement on Physiotherapeutic Scoliosis Specific Exercises Dr. Timothy Hresko, MD: Chair, SRS Non-operative committee includes the following statement:

Physiotherapy Scoliosis Specific Exercises have been used with spinal orthotic management in the treatment of progressive idiopathic scoliosis. The combination of the two modalities may offer advantages over more simplified treatment plans”. 

In the 2015 Screening for the Early Detection for Idiopathic Scoliosis in Adolescents SRSPOSNA/AAOS/AAP[30] position Statement Dr. Timonthy Hresko, MD included the following statement supporting PSSE’s in scoliosis management:

Other means for non-operative treatment of scoliosis have also been studied. Scoliosis specific exercises used to supplement brace wear or prevent progression in mild curves have been reported. A randomized clinical trial of patients with mild scoliosis of 10-20 degrees has shown that scoliosis specific exercises may prevent progression to the level of deformity that would result in brace treatment”.

4. Physiotherapy Role in Pain Management

In her review Marti noted that the most common concern of the specialists is the alleviation of pain (72%).  Despite this high level of concern only 25% of the specialists surveyed refer to physiotherapy for pain management.   This discrepancy may reflect the perception that pain in scoliosis is considered a relatively negligible factor and/or the lack of research in this area.

The 50 year longitudinal review by Dr. Weinstein et al[31] confirmed an increased prevalence of low back pain in untreated scoliosis. With an average age of 66 at the conclusion of the study, 61% of the scoliosis group reporting chronic low back pain vs. 35% of the age-matched control group.  However this study also determined that the intensity of the pain was no worse than controls. There was no impact on disability with the majority being gainfully employed or homemakers.

The following two concluding statements from this review on the relationship of low back pain to function have likely had strong influence on perceptions of pain and the requirement for treatment in this population.

“Although the prevalence of back pain in untreated scoliosis likely exceeds the general population it does not appear to cause excessive disability.” 

“Although scoliosis patients report more chronic back pain, those with pain have similar profiles in terms of duration and intensity of their peers and their ability to work and perform everyday activities is similar to their peers.  Additionally, back pain had no larger impact on work and activities for scoliosis patients than it did for controls.”

When reading Weinstein’s article the conclusions should be viewed in context with the reference that previous perceptions of scoliosis by health care professionals predicted a life of pain and disability.  These results support a better prognosis for function however based on this study the need for physiotherapy treatment for pain is at a minimum consistent with what is required in the general population and is likely to have a higher requirement.

While at this time there is limited research looking at the provision of physiotherapy for back pain in the scoliosis patient, recent evidence is promising. Of note, in Monticone et al’s[32] study, participants in the exercise group also showed larger improvements in the function, pain, self-image and mental health of the SRS-22 questionnaire.

Schreiber et al[33]  also found significantly larger benefits with Schroth exercises than in controls on SRS-22 pain and self-image domains. Further Zapata et al[34] showed in a RCT that spinal stabilization exercises helped reduce the numeric pain rating scores and the patient-specific functional scales scores in patients receiving supervised than unsupervised 8 week of therapy. 

5. Physiotherapy and Screening for Scoliosis

Although screening for scoliosis is no longer standard, there is increasing support for regular testing during growth periods.  A task force from the Scoliosis Research Society[35] recommends that females be screened twice, at age 10 and 12 years of age.  Males should be screened once at between ages 13-14.  This frequency reflects the increased risk in females for larger curves.

 

 

Observation of standing posture asymmetries followed by observation of the spine in forward flexion[36] are the norms for determining if further testing is required i.e. 3 foot standing view X-ray.

 

 

 

 

Physiotherapists are well suited through their education and training to perform these screening tests. The observation of posture for asymmetries should include the frontal alignment of the spine, the height of the shoulders, the hip and waist shapes and the forward bending test.

The forward bending test consists of checking if the spine is straight while the patient bends forward slowly beginning with the neck with the hands together while keeping the legs straight until the hand are between the knees. If a side to side back difference is noted and a spine deviation is noted it suggests a scoliosis is present.

 

 

The importance to emphasize screening for scoliosis is further supported by the fact that bracing and exercise treatments to be effective need to be applied to smaller curves before reaching skeletal maturity. Early detection of scoliosis is therefore important to identify adolescents at risk of progression and offer the chance to try non-operative therapies while they may be most effective[38].

 

 

 

6. PSSE’s vs. Standard Physiotherapy

Physiotherapeutic Scoliosis Specific Exercises, also known as Scoliosis Specific Exercises (SSE’s), differ from standard physiotherapy exercises.  In the 2014 European Journal of Physical Medicine and Rehab, Dr. Josette Bettany–Saltikov et al[39] listed the key features of PSSE as: 

  1. Individually adapted to a patient’s curve site, magnitude and characteristics
  2. Performed with the therapeutic aim of reducing the deformity and preventing its progression
  3. Aim to stabilize the improvements achieved with the ultimate goal of limiting the need for corrective bracing or the necessity of surgery

Additional elements may include:

  1. Auto-correction,
  2. Spinal elongation,
  3. Isometric exercise contraction,
  4. Individually taught
  5. Inserted into stabilizing exercises
  6. Rotational breathing

A review of the difference in the schools of thought are beyond the scope of this article however Dr Bettany-Saltikov’s[40] chapter in the text book Physical Therapy Perspectives in the 21st Century provides a substantial review of the differences and commonalities of the major schools of scoliosis treatment.  Similarly, a recent overview has been published in Scoliosis and Spinal Disorders[41].

In Parent et al’s survey of the highest ranked perceived useful treatment methods by Alberta physiotherapists, the top choices included:

  1. stabilization exercises (76%)
  2. non-scoliosis specific postural approaches (73%)
  3. mobilizations (55%)

No physiotherapist reported the use of PSSE’s in this review.  This likely demonstrates a need to educate Canadian physiotherapists on the most recent evidence supporting the use of PSSE in the management of scoliosis.

7. Additional Resources for Scoliosis

Patients

a. Curvy Girls

International scoliosis peer support group.  Providing support for adolescent girls both online and through meetings.  Looks to destigmatize the diagnosis and the wearing of braces through peer support.

Website address: http://www.curvygirlsscoliosis.com/

b. SOSORT – Society on Scoliosis Orthopaedic and Rehabilitation Treatment

An international multidisciplinary organization including scientists, healthcare professionals, patients and their families

Website address: http://www.sosort.mobi/index.php/en/

c. National Scoliosis Foundation

A patient led advocacy and support foundation.

Website address: http://www.scoliosis.org/

Therapists

a. SOSORT – Society on Scoliosis Orthopaedic and Rehabilitation Treatment

Founded in 2006, and brings together scientists and clinicians focused on the conservative treatment of spinal deformities. A multidisciplinary organization including scientists, healthcare professionals, patients and their families.

Website address: http://www.sosort.mobi/index.php/en/

b. SRS – Scoliosis Research Society

Founded in 1966 its membership includes spine surgeons, researchers, physician assistants, orthotists and welcomes other allied health professionals working with scoliosis.  It provides information for practitioners and families.

Website address: http://www.srs.org

c. Outcome measures

The core outcomes monitored to determine if scoliosis is progressive or if curves are improved by treatment is the Cobb angle obtained from radiographs of the full spine[42].

The degree of vertebral rotation in particular has been shown to be a useful predictor of progression[44]. The sagittal spinal alignment, especially in adults is closely related to pain and quality of life[45].

Depending on the domain of research several different types of outcome measures have been used including pain ratings, Roland Morris Questionaire, Oswestry, Euro-Qol D5.  In addition, the following two questionnaires are common outcome measures more specific to AIS.

  1. SAQ – Spinal Appearance Questionnaire[46]
  2. SRS 22 – Scoliosis-Research Society questionnaire[47]

However, in patients with small curves, these questionnaires originally designed for surgical cases have demonstrated high ceiling effects[48]. Since physiotherapists work with scoliosis is also focused on esthetics, a number of subjective[49] [50]  photographic [51] [52] and 3D sophisticated postural assessments[53] have also been recommended.

Conclusions

The role of physiotherapists in the treatment of scoliosis is evolving.  Increasingly, research is identifying the need for treatment as well as defining role of physiotherapist in the management of this condition.  Screening for early diagnosis, prevention of curve progression, bracing stabilization exercises, pain management are all roles that physiotherapy may assist in however awareness of the critical points, which require the involvement of other members of the team, are important to ensure comprehensive care.

Acceptance of the physiotherapist’s roles in the treatment of this condition requires further dissemination of the existing research within and beyond our profession.  Continued studies are also needed to further consolidate the role of the area of pain management and to further define optimum protocols for prevention of curve progression.

References

[1] Maureen Dwight, R.P.T., Co-founder Spine Therapy Network, Clinical Musculoskeletal Specialist, Adjunct Lecturer University of Toronto Dept. of Physical Therapy, Scoliologic Therapist

[2] Dr Josette Bettany-Saltikov PhD MSc MCSP PGCE-HE Senior lecturer in Research Methods, Chartered physiotherapist and Schroth Therapist, Doctorate of Health and Social Care TEESSIDE University, Institute of Health and Social Care

[3] Eric Parent, P.T., M.Sc., Ph.D., Schroth Therapist, Associate Professor Dept. of Physical Therapy, University of Alberta

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[10] See below

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[50] Kotwicki T. Evaluation of Scoliosis Today: Examination, X-Rays and Beyond. Disabil Rehabil. 2008;30(10):742–51.

[51] Fortin C, Feldman DE, Cheriet F, Labelle H., Clinical Methods For Quantifying Body Segment Posture: A Literature Review. Disabil Rehabil. 2011;33(5):367-83.

[52] Fortin C, Feldman DE, Cheriet F, Gravel D, Gauthier F, Labelle H. Reliability of a Quantitative Clinical Posture Assessment Tool Among Persons With Idiopathic Scoliosis. Physiotherapy. 2012 Mar;98(1):64-75.

[53]Patias P, Grivas TB, Kaspiris A, Aggouris C, Drakoutos E., A Review of the Trunk Surface Metrics Used as Scoliosis and Other Deformities Evaluation Indices. Scoliosis. 2010 Jun 29;5:12

Scoliosis

Scoliosis – posted by Maureen Dwightback_5scoliosis
Scoliosis is a condition where the spine curves sideways rather than the more standard front to back curvatures. This change to the shape of the spine may be caused by genetics, underlying conditions or as we age – degeneration.
Adolescent idiopathic scoliosis is the most common type and is detected around puberty. Although this condition is often painless it is important to have it evaluated as untreated curve that may continue to progress.
You may not notice the changes in the spine at first. Scoliosis is often first noticed by a change in the angle of the waist or the observation of a higher shoulder. A physician or a physiotherapist with training in scoliosis can assess whether these changes are caused by the spine and are sufficient to warrant an X-ray. In adolescents early detection is best as there are more options for treatment if they are still growing.
Treatment is determined by the degree of curvature and the maturity of the bone. Options range from exercise, to bracing, or surgery.
Your therapist at The Orthopaedic Therapy Clinic will help you to understand the treatment options as well as provide exercises to improve your core and correct underlying muscle imbalances. We are experienced in the treatment of adult and adolescent, operative and non-operative scoliosis conditions. We work with you through all stages of treatment to ensure the best recovery and long-term plan for managing this condition.

When did you lose it?

 

When we are younger the question “when did you lose it” provokes a completely different response than later in life.  As grandchildren enter our life, or as we finally find time to get back to the activities we were always meaning to resume, we are struck by the change in our physicality.  Suddenly and without warning we are no longer able to:

  • Get off the floor
  • Go jogging
  • Run for the bus
  • Walk an hour on the beach
  • Stand in the mosh pit with our kids at the concert

As we reflect on these changes we may also notice that other things have changed.  We’re stiff when we get up in the morning – even when we haven’t worked out the day before.  Its hard to straighten-up when we get out of a chair.  We find it easier to walk with our hands behind our back.   We avoid cocktail parties because the alcohol is insufficient to off-set our back pain.

Should you accept physical aging?

If you mention these changes to your health practitioner, they often bring up the “A” word.  When faced with the Age pejorative some give in and accept their fate.  Others rail against it, sometimes creating injuries as they are unable to accept the changes in their body.

There is no doubt that physicality changes as we age, however there are some changes we should never accept.  Keeping or restoring these physical abilities will not only help your quality of life, but many of these activities are predictors of longevity and independence.  Here’s what the research is telling us:

Can you still get off the floor?

I prefer my clients do their exercises on the floor, not only because of the firmer surface, but also because I want them to be able to get off the floor for the rest of their life.  Researchers have realized that this basic physical ability is a predictor of longevity.   We now know that whether you can get yourself off the floor, and the technique you use, is predictive of how long you will live.

When analyzed it becomes apparent why this simple movement would be so predictive.

  1. Falls are one of the most common problems as we age. Not only do we want to prevent falls we also need to be able to get off the floor when it happens.
  2. Getting off the floor requires balance, flexibility and strength. All these elements come together in this basic movement, making it a quick screen to determine your overall physical health.

If you are playing on the ground with your grandchildren or can manage your exercises on the floor, then keep this up.  If you struggle to get off the ground and avoid picking anything up off the ground, it’s time to have your physiotherapist or kinesiologist assess the barriers and develop a program to restore this important life skill.

Staying independent

I may have given up any dreams of Wimbledon, but the one physical expectation I will never give up is staying independent.  Anyone who has worked with me knows that I am obsessed with posture.  A few years ago, a study out of Japan gave me even more reason to maintain my obsession.  It looked at the predictors of independence.  Over a 20+ year period it analyzed which physical measures were predictive of whether you would need to go to a nursing home and require help with everyday activities such as dressing. It concluded that one of the key factors predicting the need for assistance was your posture.  In a nut shell, if you cannot stand up straight, with your spine directly over your pelvis, you are more likely to need help as you age.

You may have nagged at your teenagers to stand up straight, but it’s now time for your children to nag you.  Ask them what they have noticed.  Do you stand tall or are you bent forward when you walk? If you find it difficult to stand up straight, working on your flexibility and core strength should be on your list of exercises for the long term.

How low should you go?

In my youth the buzz was about Sebastian Coe breaking the 4-minute mile.  The headlines around the world read “How low can he go”? Usain Bolt and Andre De Grasse have taken over the headlines but the message remains the same.  Many of us have been brought up with the belief that faster is better however we now know that there is a range of speed which is ideal.  Throughout our lifetime we should target our running, and then our walking, for between 3.5 and 4.5 mph.  If you are metric it’s an 8-11 minute kilometer.

These numbers should guide us, our children and our grandchildren on doing enough, but not too much. Whether it is speed or strength there is an optimum demand – do more and you cause injury, do less and you might as well eat bonbons by the pool.

As we age, many people find they can’t walk.  The wear and tear on our spine has resulted in overgrowth of bone.  Spinal stenosis (narrowing of the spinal canal) gets in the way of our retirement. Instead of taking cruises and exploring the ports we take the bus tours or stay onboard – professing we prefer to read or play cards when the reality is that it hurts to walk.

Maintaining your spinal health is paramount to enjoying an active retirement.  Target 8-10,000 steps per day but also time your walk.  Your goal is to manage 3 km in 30-33 minutes every day.  If that causes back pain, leg heaviness or other symptoms then seek advice from your spine therapist.

Find me a chair!

Many of my clients hurt when they stand or walk slowly. They avoid shopping, limit visiting art galleries and decline invitations to cocktail parties.  As it gets worse even standing to cook causes pain.  Often attributed to aging this change in physicality is more likely due to poor back posture, tight hip flexors and weak hip muscles.

A protruding belly is often a marker that we have a sway back.  Many of my clients think they need to lose weight when a simple adjustment in their posture will not only relieve the pain in their back but it also looks better!  If you can’t stand for an hour consider seeing your spine therapist for an assessment of how to change your posture.

When did you lose it?

Although ageing is inevitable, the changes of physicality are not.  The one system that is not affected by age is our muscles.  Research is showing that we can build strength into our 80’s, and that limiter is only because we have yet to study the 90 year olds. If you are over 50, the only physical restriction on my list that you should consider accepting is jogging.  None of the other losses in physicality need to be attributed to age.

To quote one of my colleagues, Dr. Adonis Makris, D.C. , you not only need a financial plan, you also need a physical plan to stay healthy and active.  Although it’s best to start this plan by age 60, even if you are older an exercise program can help to restore much of what you have lost.  If you need help with your physical plan our physiotherapists, chiropractor, massage therapists and therapeutic fitness team can help to target your program to change the dialogue around “when did you lose it?”

Announcements

New Staff – Hafsa Sheik

Many of you have met our new staff person Hafsa Sheik.  Hafsa joined us in September to fill our afternoon reception position.  She has previously worked in a busy medical clinic as well as working for a medical insurance coordinator.  Hafsa enjoys working with people and traveling.  Her favourite place to visit is Sri Lanka.  Please join us in welcoming her to our team.

Pelvic Floor Rehabilitation

Svetlana Marianer Registered Physiotherapist is continuing her advanced training in pelvic floor rehabilitation. She has recently worked with an advanced practitioner in a clinic setting to apply her skills and has completed the second section of a three part course.  Pelvic floor therapy is emerging as one of the strongest, evidence based areas of physiotherapy.  If you would like to know about what it can do for you, you can read about it in her article http://orthophysio.com/?s=pelvic or contact her directly at smarianer@orthophysio.com

Scoliosis Presentation

Maureen Dwight presented a paper on scoliosis at the National Orthopaedic Division Conference held on October 20th, in London Ontario.  This will represent her third presentation to treatment professionals on managing and treating scoliosis.  These engagements have been based on the pater she  co-authored last year on scoliosis treatment.  Although primarily written for treating professions, it is available on our website at http://orthophysio.com/?s=scoliosis. These efforts are helping to raise the awareness of treatment professionals on evidence-based treatments for scoliosis.  This year she will be attending the International scoliosis conference (SOSORT http://sosort2018.com/ ) in Dubrovnik Croatia.

Publications

1. Physiotherapy in the Treatment of Scoliosis

 

 

How Brain Plasticity Causes Low Back Pain

Maureen Dwight Registered Physiotherapist, Clinical Musculoskeletal Specialist, Advanced Spinal Practitioner ISAEC

There is a common saying in our industry stating that nerves which fire together wire together. This principle is the basis of motor coordination and reflects our brain’s capacity for plasticity. Brain plasticity causes low back pain by making it harder to relearn how not to be injured. The key premise is that as we develop motor skills our nervous system is learning which muscles work together to produce a movement.  The more we practice, the smoother and more automatic the movement becomes until finally it is “grooved” and we no longer have to think about it.

This principle applies to our early childhood, when we learned our basic motor skills of rolling over, sitting and walking.  It also applies to the sports we learn.  We see it at its best in the finest athletes.  Even when they are performing the seeming impossible, they look effortless.  Their refined coordination means they exert less energy, take longer to get tired and just plain look better than everyone else when they are working at maximum.

Compensatory Movement Patterns

Brain plasticity also applies to injury.  While we are injured many of us use compensatory movement patterns to keep going.  These adaptations allow us to stay active while avoiding strain on the damaged tissues. When a muscle is damaged the body innately shifts our movement to engage other muscles, limiting the demand on the weakened structure[1].

Whether you sprain a ligament or hurt a joint, you will naturally splint the area, stiffening your muscles to avoid further damage. These changes are reflected in our movements.  We may limp, lock our knee or even hop on one foot to avoid putting weight on an injured leg.  During this period our brain and spinal cord (Central Nervous System) are “learning” these movement patterns.  Committed to efficiency the nervous system begins to re-wire these muscles to work together. Initially these adaptations can be useful however when we use compensatory movements too long the wiring becomes established.  We over-ride healthier movements, making it harder to go back to our original, more efficient movement patterns.

Even though the injury may be short lived, the effect of compensatory movements can last long after our tissues have healed.

Although compensatory motion can occur with any injury, these changes are more likely to be a problem when we hurt our back or neck.  Injuries to ankles or knees may involve the joint, ligament or muscle but when we hurt the spine it will often affect our nerves. Once nerves are involved the nature of the injury changes.  Nerves are exquisitely sensitive structures which directly affect pain.  Their involvement has a more direct impact on coordination as they are the communication pathway between our muscles, the brain and spinal cord.

Brain plasticity causes low back pain

I find the implications of brain plasticity on low back pain one of the most interesting research areas to emerge in my field.  At the forefront are researchers such as Dr. Paul Hodges, Dr. L. Danneels and Dr. Simon Brumagne, whose presentations I had the fortune of sitting in on at the North American Spine Society meeting last fall.  Their research uses highly sophisticated equipment, including Transcranial Magnetic stimulation and functional MRI (fMRI), to watch the brain function in real time. One aspect of these studies looks at which areas of the brain are used to coordinate certain movements.  This information is then compared to the brain of individuals who have low back pain.

In fMRI the activity in the brain is represented by light.  The more areas that light up, the more energy we are using to perform the task.  The larger the area that lights up, the “harder” we are working to complete the task. What these studies confirm is that the activity in the brain is changed from back pain.  Whereas a non-back pain sufferer may “light up” only a few areas, the low back pain person recruits a much larger area to perform the same motor activity[4]. This finding is consistent with the theory my colleague John Gray wrote about in When Hamstrings Attac[5]:

low back pain sufferers often use a high load strategy for low load activities

This theory, along with this impressive quality of research to support it,  indicates that after back injuries some movement patterns are less efficient.  Too many muscles and/or too much thought process is being utilized to perform a simple task.

This pattern is also consistent with another function studied with fMRI several years ago, [6].  Most of us understand that it is easier to learn a language when we are young.  Studies confirm that this is because we are more efficient at coordinating speech.  We use a relatively smaller number of areas of the brain to process and produce language.  If we add more languages later in life we access a larger number of areas of the brain, increasing the “work” and reducing the efficiency of speaking in another language.  This lower level of efficiency is one of the theories proposing why age, brain injury or stroke causes some people to revert to their first language.

Brain smudging

The current terminology describing the changes seen in the brain with low back pain is “smudging”[7].  Instead of seeing localized pockets of specific and efficient muscle activity, there is a broader area of involvement[8].  It’s as though someone has taken those points of light and smudged them all together into an indistinct pattern.

The implication of this research for therapy is that it tells us to get better you need to un-smudge these movement patterns. The therapeutic research in this area is just beginning however in the interim this information provides us with important guidance.  We now know that in addition to improving strength and more flexibility, most people with chronic or recurrent low back pain need to re-establish muscle coordination (Symptoms of compensation.)

All too often I see clients where their therapy has stopped once they learn how to tighten their abdominal muscles to brace their spine or clench their gluts when they lift. The problem with relying on “remembering” to tighten muscles before you move is that it is slow and takes too much thought process.  Movement needs to become easy, automatic and efficient, otherwise the moment you forget to activate these muscles you may get hurt.  For our everyday movements we need to strive to be like the athlete, effortless in our walking, sitting, standing etc.

Fortunately brain plasticity and efficiency also work in our favour.  The body has been described as being indolently lazy which means we naturally gravitate to movement patterns requiring less energy.  Your therapy should take advantage of this innate laziness and focus on re-establishing your more efficient primary “language of movement”. Just as we never forget how to ride a bike, the re-establishment of these pre-injury movement patterns is recognized by your nervous system as requiring lower resources. This propensity helps us to re-establish these basic, more efficient movement choices.  Working on a daily program to “remember” how to move non-injured will help to restore your healthier movement patterns, improve your energy, reduce pain and lower your risk for re-injury.

To learn to work less hard and to have less back pain requires an assessment by a therapist who understands the effects and knows where to look for compensatory muscle patterning after injury.  The therapists at the Orthopaedic Therapy Clinic are knowledgeable in this retraining.  Please contact us to book an assessment if you have chronic or persistent low back pain.

The advice in this article is not meant to replace advice from your health care professional.

[1] The compensatory relationship of muscles was understood by Leonardo da Vinci in the 1400’s

[4] Changes in the fMRI have also been seen in scoliosis

[6] http://www.ncbi.nlm.nih.gov/pubmed/14683721

[7] http://www.ncbi.nlm.nih.gov/pubmed/21508892

[8] http://www.ncbi.nlm.nih.gov/pubmed/27244113

Physiotherapy, Injury and Therapeutic Yoga

Joanna Miller Registered Physiotherapist

In my physiotherapy practice in downtown Toronto, I have seen the increased popularity of yoga as mostly a positive trend, giving many people the opportunity to learn this ancient practice. Unfortunately along with this widespread exposure comes the risk of doing these movements improperly, increasing the possibility of injury. Prevention and correction of injuries is where Therapeutic Yoga plays a part in planning your exercise program.

Why work with a Yoga Instructor?

Working one-on-one with a yoga instructor can help you to develop a personal home yoga practice.  Once you learn proper technique you can take part in studio classes or follow along online at home. It can be beneficial to have a therapist  observe your movement to pick up incorrect habitual patterns that can be difficult to detect in ourselves. Follow-up sessions with your therapist should reflect improvements that have occurred in your body from your practice. Your body’s awareness of the poses will progressively deepen and help you to improve your form.

Physiotherapy and Yoga

As a Registered Physiotherapist and yoga instructor, my approach is to help you to find a program to address your injuries and to help you to return to exercise.  A specifically designed yoga practice will help you correct pain, imbalances and weakness.  Each program is based on the physiotherapy assessment done by me or one of my colleagues. Your fitness goals, schedule, and previous experience with yoga will all be considered in this process. Both acute and chronic conditions can benefit from Yoga, including:

  • frozen shoulder
  • herniated discs
  • scoliosis
  • low back pain
  • hip pain
  • many soft tissue injuries

Re-assessments with your physiotherapist are scheduled to measure improvements in range of motion, strength, posture, and function and to set new goals and exercises to enhance your progress. Usually I recommend a daily routine consisting of active poses, breathing exercises, and relaxation which can be completed in 20-60 minutes depending on the time you have available and your goals. Sessions are available Tuesdays and Thursdays from 8am-7pm. Feel free to email me directly or contact the clinic directly to book your appointment. The advice in this article is not meant to replace advice from your health care professional.

Registered Physiotherapists

MaureenDwightMaureen Dwight PT, B.Sc. PT

Registered Physiotherapist, Clinical Musculoskeletal Specialist, Advanced Spine Practitioner ISAEC, Clinic Director

mdwight@orthophysio.com

Maureen founded The Orthopaedic Therapy Clinic Inc. in 1987. She is committed to excellence in her practice and to the advancement of the physiotherapy profession. She was one of the first physiotherapists in Ontario to receive a nationally recognized specialist designation as a Clinical Musculoskeletal Specialist.

After graduating from the University of Alberta physiotherapy program with distinction in 1980 she has gone on to study with world recognized experts in the fields of physiotherapy and medicine. These studies have gone beyond the borders of Canada and taken her to the U.S., England, Australia and the Czech Republic. Her areas of interest include chronic neck, back and post-operative spinal conditions.

She has extensive experience with adolescent and adult scoliosis, including both non-operative and post-operative rehabilitation. She has studied with Dr. Rudolph Weiss, grandson of Katerina Shroth, of Germany and received a certification in his Scoliologic method.  She has studied with renowned Czech neurologist, Dr. Vladimir Janda.

She is committed to the understanding of underlying issues which impact chronicity and the non-traumatic causes of musculoskeletal pain. Her experience in complex post-surgical conditions has led her to recently expand her practice into the area of post-treatment cancer rehabilitation.

Maureen’s commitment to the physiotherapy profession’s education has been recognized through her appointment as an Adjunct Lecturer with the University of Toronto, Department of Rehabilitation Medicine. In this capacity she provides clinical placements for Master level students in physiotherapy as well as assisting with the education of foreign trained physiotherapists who are transitioning their practice to Canada (OEIPB). These experiences have helped her to remain at the forefront of physiotherapy education both in Canada and in the world at large. She enjoys public speaking and is frequently requested as a guest lecturer at conferences and seminars. Her status as an expert in physiotherapy practice has been accepted in the Civil Courts of Ontario and by the College of Physiotherapists of Ontario.

Association memberships and awards

She is a member of the Canadian Physiotherapy Association (CPA) and the College of Physiotherapists of Ontario. She actively participates in the CPA oncology and orthopaedic divisions. She received the Recognition Award, Professional Contribution – External Support from the Ontario Physiotherapy Association. She has been recognized by the readers of NOW Magazine as the best physiotherapist in Toronto. For over 10 years her peers have recognized her leadership and she has received the designation of an ‘Educational Influential’ in Physiotherapy the Institute for Work and Health (IWH). She has been awarded an honorary membership in the Czech medical society.

GarethSneathGareth Sneath

Registered Physiotherapist, MScCH, MCPA, MMPAA,

 

gsneath@orthophysio.com

Gareth has been a member of the Orthopaedic Therapy Clinic team since 1997. His initial training was at the Salford School of Physiotherapy in the UK where he graduated with merit. He has worked in several teaching hospitals in the UK National Health Service and Canada where he developed a keen interest and gained extensive experience in the diagnosis and treatment of acute and chronic orthopaedic conditions.

Gareth’s post-graduate studies in manual therapy have been extensive. Shortly after graduating he successfully completed the Chartered Society of Physiotherapy (UK) Advanced Spinal and Peripheral Joint Manipulation programs. To continue his professional growth he traveled to Australia to complete an advanced, in-depth program of manual therapy training at Curtin University, Perth, West Australia. This course further developed his passion for clinical work building on the teachings of Geoffrey Maitland, Robert Elvey and Brian Edwards. He was awarded the Brian Edwards Prize for the highest clinical competence for his performance in clinical practice with patients and received a Post-Graduate Diploma in Manipulative Physiotherapy. His manual therapy qualifications are internationally recognized by the International Federation of Manual Therapists (IFOMPT).

Gareth’s treatment approach focuses on the resolution of pain and movement imbalances to help optimize outcomes after injury, arthritis or surgery. A sound knowledge of the basic sciences of anatomy, biomechanics and pathology form the foundation of his clinical practice and are applied in conjunction with an enthusiasm for clinical care using manual therapy, exercise and client education. Gareth is committed to excellence in clinical care. His specific clinical interests are the spine, sports physiotherapy, joint replacement therapy, and neuro-dynamic mobilization based on David Butler’s work. As part of his role at The Orthopaedic Therapy Clinic he provides physiotherapy care in an industrial setting, working with employees in the treatment and prevention of repetitive strain problems. Gareth holds Adjunct Lecturer status at the University of Toronto.

Gareth is committed to education of MSc PT students from the University and is a clinical supervisor as well as being a regular lecturer for the department of physiotherapy. He has been a teaching assistant in the Departments of Anatomy and Physical Therapy for the BSc and MSc PT programs and post-graduate courses. He is the Assistant Chief Examiner for the clinical component of the Physiotherapy National Examination (PNE) Toronto site. He has served on the Toronto committee responsible for developing questions for the exam and has been involved in the production of videos for the PNE. Gareth has recently completed a Masters degree through the Dalla Lana School of Public Health, School of Graduate Studies, University of Toronto focusing on health professions teacher education (MScCH HPTE). His areas of interest are the development of clinical reasoning skills and the assessment and development of clinical competency.

Association memberships and awards

Gareth is registered with the College of Physiotherapists of Ontario and is a member of the Orthopaedic Division of the Canadian Physiotherapy Association.

SvetlanaMarianerSvetlana Marianer

 

Registered Physiotherapist, MSc. Pht

smarianer@orthophysio.com

Svetlana Marianer graduated from McGill University with a Bachelor’s in Rehabilitation Science and a Master’s in Physiotherapy in 2012. Since completing her degree, she has taken various continuing education courses such as Manual Therapy, Mckenzie’s Cervical, Thoracic and Lumbar spine, Mulligan’s Lower Quadrant assessment and treatment, Blaise Dubois’s Prevention of running injuries and non-traumatic lower extremity injury, numerous courses from the Advanced Physical Therapy Education Institute (APTEI) and many more.

As a former ballet dancer and a present CrossFit athlete, Svetlana is particularly interested in orthopedic care, the prevention and treatment of sport injuries and the biomechanics of movement and all it encompasses. Moreover, although Svetlana’s nature is that of an athlete, she has a strong foundation in managing acute and chronic low back and neck pain, various repetitive strain injuries and a variety of musculoskeletal impairments resulting from every day and or recreational activity. Her skills allow her to treat clientele of all ages. Svetlana is fluent in four languages : English, French, Hebrew and Russian.

MiladMilad Bazaz Jayzayeri

Registered Physical Therapist BSc. M.P.T.

mbazaz@orthophysio.com

Milad graduated from the University of Western Ontario in 2014 with a Master’s degree in Physical Therapy. He also holds a Bachelor of Science degree from York University’s Kinesiology and Health Science program where he graduated Summa Cum Laude in 2012.

Milad’s passion for physiotherapy led him to pursue additional courses to advance his knowledge and skills, both during and after university. He is currently completing his Level 2 manual therapy training and has completed the McKenzie training level A for treatment of spinal conditions, Mobilization with Movement (Mulligan concept) for treatment of lower quadrant conditions and Soft Tissue Release workshop. His interest in the application of acupuncture for pain management led Milad to partake in multiple courses in acupuncture and dry needling techniques through the Advanced Physical Therapy Education Institute (APTEI). He has been involved in physiotherapy research on exercise and post-concussion recovery. To further his knowledge in this field, Milad has recently completed a concussion management certification program through Shift Concussion.

Outside of the office, Milad likes to stay healthy and active. He is an avid photographer and when his time allows, he enjoys traveling and learning about different cultures as well as different perspectives on physiotherapy treatment. During his training, he completed a residency at the world famous Groote Schuur Hospital in Cape Town, South Africa; for which he was awarded the Leslie A. Bisbee Clinical Experience Bursary from Western University. During this placement Milad treated acute musculoskeletal, post-operative and trauma patients. Through necessary personalized care program and support, Milad aims to help every patient reach their best possible physical state. He is fluent in 2 languages: English and Farsi.

Registered Massage Therapists

Juliette WoodruffJuliette Woodruff

Registered Massage Therapist and Acupuncture Practitioner

jwoodruff@orthophysio.com

Juliette joined The Orthopaedic Therapy Clinic Team in 2004. She is a graduate of the Sutherland-Chan College of Massage Therapy. After graduating her ongoing commitment to professional development has led her to complete advanced studies in manual lymph drainage and she is currently pursuing certification in breast cancer treatment and myofascial release therapy. In 2012 she received her certification in acupuncture from McMaster University. Juliette is committed to collaboration.

Juliette is an integral member of our treatment team working to find solutions to pain and helping to relieve the barriers limiting recovery. She has worked with a diverse range of people including athletes, expectant mothers, and business professionals. She is particularly interested in treating conditions such as scoliosis, lymphedema, and frozen shoulder. She believes in helping her clients to become an active participant in their own healing process through body awareness, postural education, and self-care exercises.

Juliette has a personal as well as clinical experience with the different stages of cancer. She works towards creating improved quality of life for her clients through education, exercise, self-bandaging, acupuncture and manual lymph drainage techniques. She believes in implementing a variety of modalities and current knowledge to improve and personalize care.

Juliette has a specific interest in the relief of pain and restoration of mobility in scoliosis. She has worked with clients following extensive reconstruction surgery as well as non-operative conditions. She has studied with Dr. Rudolph Weiss of Germany (Katerina Schroth’s grandson) and received a certification in his Scoliologic method. She has a developed an approach to the application of massage therapy in scoliosis which has been recently published by her professional alumni newsletter. SutherlandChan_FingerPrint

Juliette implements knowledge and clinical techniques from a variety of post-graduate courses such as: treatment techniques for post-operative breast cancer, cervical joint mobilizations, Structural Integration for structural alignment (Nisa), Scoliologic method, myofascial techniques, and acupuncture. She utilizes and incorporates several different treatment approaches to develop an individualized approach for each client.

Association Memberships

Juliette is registered with the College of Massage therapist of Ontario. She is a member of the Canadian Massage Therapy Association and the Canadian Academy of Medical Acupuncture. Her interest in sports and movement led her to obtaining a level II theory/practice National Coaching Certification in swimming.

Igal Untershats

Registered Massage Therapist

igalu@orthophysio.com

Igal is a graduate of Sutherland Chan School of Massage.  As a registered Massage Therapist he brings a passionate interest in the application of soft tissue therapy for recovery after injury, restoration of health and injury prevention. 

Igal applies a focused and goal-oriented approach to determine the best techniques for maximizing your recovery.  Using myofascial release, Swedish massage, positional release, as well as several other techniques, he provides targeted treatments to reduce soft tissue adhesions and muscle tightness.  As an integral member of The Orthopaedic Therapy Clinic team he collaborates with your therapist to determine the most comprehensive approach to maximize your recovery. 

Igal has a particular interest in sports injuries and deep tissue massage.  He has worked with marathon runners and cyclists to reduce scar tissue and restore tissue resiliency after injury.  He has provided massage therapy for young athletes including the National Girls Gymnastics competition for young athletes between the ages of 5 and 15.

During his training he provided treatment to assist better breathing and relaxation for lung cancer patients at Princess Margaret Lodge Cancer Outreach Program.  He has helped patients with Multiple Sclerosis reduce pain and spasticity. 

Prior to training as a massage therapist, Igal was a jet-engine mechanic with the Israeli air-force and a high-rise carpenter.  He enjoys swimming, yoga and lifting weights. He is a percussionist and plays with an Afro-Brazilian percussion group.  Igal is fluent in Russian and Hebrew. 

 

Massage Therapy

Registered Massage Therapy: how can it help me?

OTC_massageRegistered massage therapy is an integral part of recovery after injury. It can help to speed up tissue healing, restore mobility, reduce inflammation and reduce post-injury compensatory movement patterns.

We recommend massage therapy for relief of:

  • Discomfort from every day and occupational stresses
  • Muscle over-use
  • Many chronic pain syndromes
  • Reduction in muscle compensatory patterning
  • Post-injury and post-surgical swelling (lymphedema)
  • Reducing side-effects of Cancer-related treatments

Massage can speed recovery and is a powerful tool in the treatment of both chronic (long-term) and acute (brief and severe) injuries. Our experienced Registered Massage Therapists (RMTs) work with your body’s soft tissues, including muscles, skin and connective tissue, tendons, ligaments and membranes. If applied soon enough after accidents involving trauma or injury, Registered Massage Therapy can greatly reduce inflammation as well as the development of painful muscular compensatory patterns which are often a result of pain and injury i.e. piriformis syndrome, iliotibial band syndrome, etc.

Who will I see?

When you work with any of our Registered Massage Therapists, you’ll be dealing with a thoroughly trained professional. Each therapist is a graduate of a government-approved massage therapy school and has completed a minimum of 2,200 hours of anatomical, physiological and clinical studies, including intensive practical instruction. In addition our  therapists have extensive post-graduate education and are an integral part of our inter-disciplinary team working to provide a comprehensive approach to your recovery.

What techniques will my therapist use?

Our Registered Massage Therapists are schooled in an extensive variety of techniques. After completing your assessment they will discuss their approach and help you to determine which technique is appropriate for you. A treatment session may consist of several techniques depending on your specific needs.

  • Therapeutic Treatment Massage
  • Manual Lymph Drainage
  • Myofascial Release Therapy
  • Cranial-Sacral Massage
  • Scoliosis Therapy
  • Sports Massage
  • Relaxation Massage
  • Pregnancy Massage

Therapeutic Massage:: used to reduce the risk of repetitive strain injury, as well as reducing pain and inflammation associated with acute and chronic conditions and in cancer-care. Therapeutic massage helps to facilitate healing and can decrease the time needed for healing through the use of deep tissue techniques, point-specific friction techniques and trigger point massage. The benefit of these approaches may be enhanced by the addition of hot and cold modalities to relax tissues and promote circulation.

Manual lymph drainage: Manual lymph drainage techniques can help improve healing after surgery or injury. These gentle techniques promote healing by enhancing circulation and reducing swelling. Manual lymph drainage techniques can also assist in the long-term management of lymphedema after surgical removal of lymph nodes. Our therapists have also completed post-graduate training in compression bandaging which can be a powerful adjunct in the management of the initial stages of lymphedema.

Myofascial Release:: can reduce adhesions and improve mobility. The application of a gentle stretch to restricted fascial tissues can help to restore movements. These treatments are beneficial if you are recovering from injury, surgery or cancer-related treatments i.e. radiation.

Cranial-Sacral Therapy:: a gentle, hands-on treatment. It is used to reduce tension and stress to improve the functioning of the body. It is particularly beneficial in chronic pain conditions and conditions where stress and tension are contributing to the restriction in healing.

Scoliosis Massage:: beneficial for individuals who have pain and are working to ensure maximum flexibility or to reduce movement imbalances. These techniques can be applied after surgery* to assist in healing as well as in non-operative conditions. At the Orthopaedic Therapy Clinic our scoliosis Massage Therapist applies a unique approach to address muscle imbalances. Our therapists are well-schooled in the over-all management of scoliosis in both the adult and the adolescent.
*Once your post-operative healing is stable.

Sports Massage:: a great technique for both serious athletes and the weekend warrior. Massage can be used as a preventive tool to avoid injury, as well as to decrease recovery time. It facilitates an increase in the range of motion in a muscle, enhancing performance and decreasing the risk for injury. It can also reduce spasms by decreasing hypertonic muscle tissue, increasing circulation and improving lymphatic return to assist in tissue healing.

Relaxation Massage: beneficial in the management of headaches and reduction of tension. It is used to increase circulation and decrease muscle tension. Relaxation massage can be used as a preventive maintenance tool as it helps to reduce stress. Best of all relaxation massage leaves you with an overall feeling of well-being.

Pregnancy Massage: beneficial throughout all three trimesters. Massage helps by reducing swelling, alleviating lower and upper back pain or discomfort, increasing circulation throughout the body and creating an overall feeling of relaxation and well-being.

What should I wear during a massage?

Generally we ask you to remove all clothing except undergarments. Our therapists protect your privacy with draping that only exposes the parts of your body being treated.

Is massage therapy covered under OHIP?

Massage therapy is not covered under OHIP however many health care plans provide full or partial coverage. Look for Registered Massage Therapy in your benefits guide. If your injury is due to a car accident, you might also want to check your automobile insurance policy for coverage.

Do I need a doctor’s referral?

No, you do not need a doctor’s referral to be treated by a Massage Therapist in private practice. Some extended insurance plans require a doctor’s referral for you to be able to access your benefits. Be sure to check your benefits policy before you make your appointment or give us a call and we will be happy to help you sort out what’s needed.

Can you bill my insurance company directly?

Many policies allow direct billing. Bring in your policy information and our reception team will help you to determine if direct billing is possible.

Teenage angst

Recommended reading for adolescents

I have had a few young clients recommend a book titled ‘Deenie’, by Judy Blume, as being helpful in coping with their scoliosis. Deenie is a thirteen year old girl in high school, experiencing the physical and emotional changes of adolescence, while finding out she has scoliosis – a condition that causes the spine to curve abnormally as she grows. She feels frustrated that her clothes never fit her properly, insecure about people knowing she has scoliosis, or people seeing her brace. She worries constantly about what her cheerleading team will think of the brace, and will they think she is a freak or will they be supportive.  Read more…