Search Results: Yoga

Yoga Breathing Workshop

Yoga Breathing Workshop –

Joanna Miller, Registered Physiotherapist

Wednesday April  26th, 2017, 12:15-1 pm

Yoga breathing can create a deep sense of relaxation or immediately energize you.

Find the temperature in the room too cold – use Yoga breathing to bring up your body temperature.

Too hot – give up the fans and the turn up the A/C as Yoga breathing can cool you down.

This 40 minute workshop will teach you how to use different types of Yoga breathing to make the changes you need in your body.  Provided by Joanna Miller, Registered Physiotherapist and Yoga instructor this session will provide techniques you can practice to alter your body’s response whenever and wherever you need it.

 Format:  Participant workshop

Maximum number: Limited to 15 participants


Joanna Miller Registered Physiotherapist B.A., M.P.T.

Joanna Miller graduated from Curtin University in Perth, Western Australia with a Master’s degree in physiotherapy in 2005. Her practice has been influenced by myofascial release, lymph drainage, and craniosacral therapy, acupressure courses, Visceral and Neural Manipulation courses.

An Introduction to Pranayama/Yoga Breathing

meditation in a yoga group

During my recent Ayurveda internship in India, my teacher Dr. Amruta Athale organized yoga sessions for me with a Professor of Yoga, Prabha Gujrathi.

In order to become a yoga instructor in India, four years of studying at the university level must be completed. To become a yoga professor, practitioners study yoga for four more years in graduate school. It was a great privilege and opportunity to study with Prabha privately in her home and to now be able to share some of what I learned about pranayama yoga breathing exercise in this article.

I will discuss some of the mechanics of breathing here and in subsequent articles will discuss various breathing strategies and techniques. This information can be beneficial to people of all ages and fitness levels, as it is believed that if a pranayama practice is done properly it can be a complete treatment for any health condition.

We cannot live without breath, and if we can control our breath we can control our living capacity.

To understand and eventually master this skill, we must first learn about the breathing process. Each breath involves taking air from outside and exhaling air from the lungs. This follows the law of physics that air moves from areas of more to areas of less pressure. When we breathe in, the ribs move upwards, the diaphragm moves downwards, and the abdominal muscles move forwards. When we breathe out, the exact opposite occurs: the ribs move downwards, the diaphragm moves upwards, and the abdominal muscles move in.

There are four types of breathing:

1. Slow breathing – when the body is calm.

2. Deep breathing – when control over slow breathing is achieved.

3. Fast breathing – inhalation and exhalation are done quickly.

4. Completely controlled inhalation and exhalation with a breath hold in between.

With each breath we take in 500 cm2 of air. With deep breathing we take in 3000-4000 cm2 of air. If you are practicing yoga properly, you can go up to 6000-7000 cm2 of air. There is always 1350 cm2 of residual air in the lungs that does not participate in the inhalation/exhalation process.

Normally people breathe in and out 15-18 times per minute, and the heart rate is 4 times the rate of respiration. 25,000-26,000 breaths are taken every day. Fast breathing, strenuous exercise, and day to day activities can all increase the breathing rate. Every year we take 10 million breaths. There is a lot of potency in the lungs/respiratory system, as they never take a rest from birth to death.

One way we can provide a type of rest is by slowing down the speed.

Pranayama revolves around four things:

1. Inhalation/Purak

2. Exhalation/Rechak

3. Breath hold with lungs filled with air/Antar kumbak

4. Breath hold with empty lungs/Bahri kumbak

The length of kumbak varies. Unless we try to purposely hold our breath, our natural inclination is to breathe out after inhalation and breathe in after exhalation.

Inhalation and exhalation are dependent on:

1. Metabolism – The more oxygen that is required, the more breaths are needed per minute. For example, with asthma deeper and more effortful breaths are needed. While sleeping we need less oxygen, so the respiration rate is slower. With inhalation, oxygen is getting mixed in the blood, and carbon dioxide is entering into the lungs. When carbon dioxide is in a higher concentration in the lungs, the body’s response is to exhale it out. With a very fast metabolism, both things happen very quickly. If metabolism is slower or not excessively fast, the respiratory rate is slower. Once your body relaxes in a yoga asana or pose, the breathing rate is slowed down. It is advised to relax your body as much as possible, even in advanced poses, so you will automatically have a decreased need for oxygen. The goal for each asana is to be: 1) relaxed 2) happy, and 3) steady

2. Emotions – If we are stressed by excess of any emotion, the rate of respiration is higher than normal. When the mind is at peace, the respiratory rate is naturally slower.

3. Will power – All yoga is related to will power, as we use it to control our breathing. The control of breath that comes from metabolic and emotional changes will come from increasing our will power. Slowly we will be able to control our breathing according to our will, and over time as will power becomes stronger, kumbak can become longer. Eventually your body will become more efficient and you will need less oxygen.

The body prepares before inhalation by expanding the lungs and bronchi. As the lungs move downward, this creates a pressure of air inside the lung. For exhalation, this pressure causes us to breathe the air out of the lung and the pressure lowers. With deep inhalation, we have to create tension in the lungs, respiratory tract, and chest. To remove all air from the lungs, we try to reduce this tension, which is why more effort is required for exhalation than inhalation.

As exhalation tension is released, new air automatically goes in. This reduces the effort of inhalation, therefore exhalation should be improved first. With controlled breathing, the exhalation should be prolonged. The measurement of exhalation should determine how long the inhalation should be in pranayama. If you can start by controlling the exhalation, control of the inhalation will come.

An example of it’s importance and how this is used in practice is with chronic obstructive pulmonary disease (COPD). Forced expiratory volume (FEV), the amount of air that can be blown out in the first second, is used to diagnose this disease. It could be as low as 50% or 30% of the Forced Vital Capacity (FVC) or the total amount of air that can be exhaled. Anything below 70% is considered an airflow limitation.

An increased emphasis on exhalation can also be seen during the breathing technique called Kapalabhadi, where the expiration is done forcefully, and the inhalation occurs reflexively. Also, with Omkar chanting or chanting Om, the m sound is always less in people who are new to it, due to decreased exhalation strength.

A breathing exercise that can be tried at home is to practice controlled breathing while slowly increasing the inhalation to exhalation ratio. The first stage to practice is a 4 second inhalation, followed by a 4 second exhalation. The second stage is a 4 second inhalation, followed by a 6 second exhalation. The third stage is a 4 second inhalation, followed by an 8 second exhalation. Each stage can be practiced for 5 minutes, and the sound of a ticking clock can be used to measure the length of the breaths.

There are many benefits to improving our breathing capacity. In yoga literature it is written that God has determined the amount of breaths you will have in your lifetime. You can control the length of your breaths, and in this way you can prolong your life.

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.

Check Your Stretch

Ask anyone why they stretch and you will usually get a pretty consistent answer.  We want to “loosen up”, improve movement in some part of the body, recover faster/reduce pain, and avoid sore muscles.  However, you may find it surprising that your trusty stretching routine you’ve been doing for years could be limiting your progress in the gym, field, or court.  Should we be surprised that a generic list of stretches probably won’t do much for these specific goals?

It is often misunderstood in fitness and health that in stretching, one size does NOT fit all.  Just like those exercises your trainer gave you to improve your game, your stretching program should meet your needs to help you reach your goals.

So if you’re feeling stiff or sore and it’s not getting better, take a minute to identify your goals for stretching.  Here are some of the major reasons I see in the clinic and on the field, and a look at some of the strategies to make them work for you.

  1. Stretching for pain relief and recovery
  2. Stretching for increased flexibility and range of motion
  3. Stretching for injury prevention and performance

Stretching for pain relief and recovery:

People who are recovering from a muscle tear, have had surgery, or a chronic condition such as stroke or Parkinson’s are often prescribed stretching to improve mobility and aid in recovery.  They experience muscle tightness and pain that is caused by overactive nerves holding the muscles in a tightened, protected, state.  Since the muscles are constantly under tension, these people have a much higher risk of muscle injury and inflammation during activities and exercise.

The goal of stretching for pain relief and recovery is to get the muscles to quiet down.  This involves gentle stretches that are low effort and free of pain.  A study by Kubo et al. (2001) showed that consistent gentle stretching caused something called “stress relaxation” of the muscle. Stress relaxation occurs when sensory receptors in the muscle, called golgi tendon organs (GTOs), react to increases in muscle tension.  As a response to protect against potentially damaging stresses, they send a message to the brain to lower the activity of the muscle, causing a relaxation and decreasing muscle tension.  In other words, after stretching the muscle allowed the joint to move more freely through its full range.  The authors suggested that this may be a possible mechanism for a reduced risk of injury with stretching exercises.

Stretch techniques for pain relief and recovery

In order to maximize the results of stretches for pain and recovery, start conservatively but work up to performing your stretches multiple times, as long as you avoid pain.  Always remember that the first priority is to not cause any more pain and swelling (inflammation) in the tissues.  As a muscle lengthens from a stretch, its tension will rise.  The key to stretching for pain relief is to ease the nervous system before muscle tension rises high enough to cause any pain.  That’s why it is very important to slowly progress the number of times you stretch to make sure you don’t get a negative reaction.

You can put this into practice yourself by holding your stretch for 20 seconds so that it you feel a gentle pulling in the muscle, but that does not cause discomfort.  After 3 consecutive days of doing this, you should be confident you can do more without irritating the muscles.  At that time, you can try performing the stretch a second time with at least a minute between stretches for the same muscle.  Continue this strategy until you are able to perform the stretch three times pain free on a daily basis.

Stretching for flexibility and  improved range of motion:

Prolonged postures and repetitive movements can cause our muscles to adapt at the cost of our mobility.  In these cases, the muscles are still normal and healthy, and may not even be sore or painful.  Yet some will have shortened to accommodate the body’s “new normal”.  Improving range of motion is possible by using prolonged stretching that is just “before” the onset of pain, and held for a longer duration than for pain relief.

Laboratory studies on stretching have shown that stretching can promote changes at the microscopic level and make your muscles actually longer.  Sarcomeres are the muscle fibre’s building blocks that are lined up end-to-end to give it its length.  Sarcomeregenesis is a term used to describe an increase in the length of the muscle fibre (Martins et al., 2013).  When applied enough times for long-enough duration, a stretch actually stimulates the body to build more sarcomeres. The more sarcomeres, the longer the muscle fiber, the looser the muscle, and the more flexible you will be.

In order to successfully increase range of motion, the focus must move toward the muscle itself, meaning that tissues need to be able to handle more tension for a longer duration without becoming painful.  Still, the most important rule is to avoid painful stretching habits at all costs.

Stretching to the point of pain makes the muscle fight back against the stretch as it contracts to stop the excessive movement.  In turn, golgi tendon organs won’t help lower muscular tension, and sarcomeregenesis becomes physiologically impossible.  In fact, five of seven studies evaluated in a recent meta-analysis (Apostopoulos et al., 2011) showed that stretching to discomfort and pain produced no improvement in range of motion regardless of the population studied.

Stretch techniques for flexibility and improved range of motion

If you have a muscle that is limiting your mobility but otherwise normal and pain free, you can try the following approach.  Find a comfortable body position that does not involve supporting your bodyweight over the part you are stretching, so that you can relax and use a minimum of effort to hold the stretch position.  Perform your stretch and hold it for approximately 1 minute, repeating it 3 times with at least a minute rest between each repetition.

Stretching for injury prevention & performance:

Despite popular belief for some, stretching doesn’t show any overall effect to reduce overuse injuries.  However, there may be a benefit in reducing acute muscle injuries in running, sports that involve sprinting, or other repetitive dynamic muscle contractions.

Surprisingly, the current research indicates that stretching before exercise may help prevent muscle injuries in sports with a sprint running component but not in endurance-based running activities, where overuse injuries are more common.  They key is to incorporate at least a 10-minute warmup that includes movements in your sport, just at a lighter intensity.

Stretch techniques for injury prevention & performance

Active people who participate in sports and exercise regularly generally don’t have limited movement and do not experience muscle pain as described earlier.  They can stretch more intensely before experiencing pain, and hold a stretch for a longer-duration may have a greater potential to decrease injury risk.  A meta-analysis by Behm et al (2016) observed that several studies on this topic have indicated a 54% risk reduction in acute muscle injuries associated with pre-activity stretching followed by a specific warmup.

Setting Your Stretching Goals

So if the problem is that you stretch and stretch, but never get better, then something in your program is not supporting this long-term adaptation of your muscle fibers.  Start by checking your body position, the intensity you are using to stretch, and the both the frequency and duration of the stretches.  For athletic events, make sure you are fully warmed-up by doing dynamic movements that mimic the sport itself, but are at a controlled speed.

Other important factors that can contribute to tightness and pain include imbalances in your muscles.  Imbalances can get in the way of the normal physical response to appropriate stretching, and should be assessed by a trained musculoskeletal therapist.

If you would like more information or would like to find out how you can improve your range of motion, reduce muscular pain, or improve performance, please feel free to contact John Gray at, or call us at The Orthopaedic Therapy Clinic at 416-925-4687.


Reduce Stress – You Deserve It

Reduce Stress – You Deserve It –

Adonis Makris Registered Chiropractor

May 31 2017, 12:15-1 pm



Many of us are too busy to take care of ourselves.  We know we need less stress in our lives but just the thought of taking the time to learn, let alone practice, these techniques causes more stress.

Provided by Dr. Adonis Makris Registered Chiropractor, this 40 minute session provides easy, practical and quick techniques for reducing stress at home and in the work place.  Simple changes in diet, application of techniques such as tapping and breathing can help you to bring the stress down and improve your general sense of wellbeing.

Format:  Lecture and practical format

Maximum number: Limited to 15 participants

Dr. Adonis Makris D.C.

Dr. Adonis Makris is a graduate of the University of Victoria with a Bachelor of Science in Exercise Physiology. In 1998 he became a Doctor of Chiropractic. He has studied a mix of modern and ancient healing arts. He is a Master in Medical Qigong.

Previous Seminars

2017 Healthy Living Lecture Series

Celebrating 30 years of

The Orthopaedic Therapy Clinic



We provide lunch and learns and education sessions in the workplace. 

Please contact Maureen Dwight ( if you would like more information about our workplace programs.

Previous Seminars



Physiotherapy for Headache and Neck Pain –Milad Bazaz Jayzayeri, Registered Physiotherapist

Headache is the most common pain disorder affecting both your work productivity and your quality of life!

Did you know that neck stiffness is one of the common causes of headaches?  Exercises, posture and self-treatment can be helpful strategies to prevent pain.

( This seminar will be repeated in the near future so keep watching! )



Preventing Running injuries – Svetlana Marianer Registered Physiotherapist

Wednesday March 22, 2017 1-2pm

 This 40 minute workshop provided by Svetlana Marianer, Registered Physiotherapist will talk about common running errors, the reasons behind them and the best prevention to avoid injury. This seminar will look at the most popular running and will tackle them through the most recent evidence based literature. ( This seminar will be repeated in the near future so keep watching! )




Yoga Breathing Workshop

Joanna Miller, Registered Physiotherapist

Wednesday April  26th, 2017, 12:15-1 pm

Yoga breathing can create a deep sense of relaxation or immediately energize you.

Find the temperature in the room too cold – use Yoga breathing to bring up your body temperature.

Too hot – give up the fans and the turn up the A/C as Yoga breathing can cool you down. ( This seminar will be repeated in the near future so keep watching! )

Avoiding the Exercise Hangover – Muscle Soreness

This morning I woke up suffering from DOMS.  You may be wondering why a health and wellness blog is writing about avoiding self-inflicted excess but the lesson in this case is not to moderate my consumption of expensive champagne but rather to reconsider my approach to exercise.  Good pain, sweet pain or the more formally designated term Delayed Onset Muscle Soreness (DOMS) refers to sensations of stiffness, discomfort or pain that doesn’t come on immediately, but is felt for several days after exercise.

Some consider these sensations as essential.  They don’t believe they have had a good enough workout unless this deep ache reassures them that they have taken it to the Max.  Although these pains are not uncommon when starting a new workout, like the hangover, DOMS is a marker that not only did we reach our limit, we have overdone it.

Why do I feel muscle soreness after exercise?

Looking at DOMS from the cellular level provides insight into the cause of these sensations as they are markers that the intensity of your workout has been sufficient to destroy muscle cells.  It is the process of myonecrosis (muscle death) that comes from tearing tissues which creates the irritation you feel. Fortunately, unless you have over done it, this localized tissue injury does not affect the entire muscle. This micro-trauma acts as a catalyst, telling your body that these muscles need to be rebuilt stronger to prevent future strains.

Rest builds strength

Creating a catalyst to build strength is the primary goal of exercise however it is not the exercise that builds the strength but rather whether you have provided sufficient time for recovery.  It is important to shift your thinking to recognize that exercise causes weakness. During the process of myonecrosis you have fewer muscle cells to draw on and your strength is less, not more. During the DOMS period you are more prone to injury and the harder you have exercised the longer you are at risk.

Our knowledge that this initial period of weakness is followed by the rebuilding of the muscle is why most exercise programs are built on a day on, day off strategy.  Providing you have not done too much damage, following this format will give your muscles sufficient time to repair before you expose them to the next catalyst – when we demand even more than we asked for the last time. The key is to repeat the exercise to keep getting stronger, but not until the DOMS is gone.

Although it is occasionally okay to experience DOMS in an exercise program I prefer to avoid it in therapy.  I find the period of waiting for DOMS to abate slows your recovery as it can take days or weeks before your recovery allows us to apply the next catalyst.  I also find that for some people the line can be too fine for avoiding injury if we select the maximum level to build strength.  Working at a lower intensity still gets me what I want, and lowers your risk for set-backs.

This perspective is permeating the training world as even for athletes the presence of DOMS is now controversial.  My exercise physiology text tells me that a good workout prevents DOMS, not causes it.  In other words, you may get some soreness when you first start a program but the right exercises ultimately protect you from these symptoms.

How to build strength and avoid injury

To build strength and avoid DOMS I use the following guidelines:

  1. Begin by thinking about your current level of strength. How active have you been recently?  What does your activity APP tell you about the number of steps you have been taking per day[1]?  This provides a baseline for the intensity of your program.
  2. If you are returning to exercise after an hiatus consider having a fitness assessment with a knowledgeable fitness professional. This should help you to select the initial level of demand.
  3. If you are returning to fitness after injury or have had difficulty avoiding injury when you exercise, then I recommend you work with a health professional who looks for underlying problems.  Often injuries leave behind specific weakness, tightness and/or compensatory patterns which need to be corrected before you can successfully engage in a general fitness program.
  4. Tax your muscles at a level to create the catalyst to build strength but below the level of DOMS. As my colleague, John Gray referenced in his recent Blog you should increase your exercises by 5-10% to avoid re-injury.  Working at a 4-6/10 effort level is another good rule which I find prevents over-strain.
  5. Use a higher repetition, lower load format. A good general rule is if you can’t do at least 8 reps, the exercise is too hard.  If you can do over 25 – you are likely dogging it, go to the next level.
  6. Always build in recovery time. The harder you exercise the longer you need to recover.  If you want to work out every day have more than one workout.  A well-planned program will allow you to rest one set of muscles while you work out another.

Training for success

Right now I am rethinking my exercise strategy.  As my DOMS recedes I know I dodged the bullet.  I pushed to the Max but fortunately avoided injury.  However I don’t plan to keep testing my luck even though I am still planning to go back to that killer Yoga class. Right now I am including some treatment with our registered massage therapists as research shows that this treatment hastens exercise recovery. I am starting to do a bit more work on my own.   I plan to take some instruction from my physiotherapy colleague and Yoga instructor Joanna Miller to improve my technique.  This prep will help me to raise my strength and limit my exercise hangover.

Moderation learned!



[1] Your goal should be to average between 8-10,000 steps per day.


REDUCING STRESS WITH EXERCISE – Maureen Dwight Registered Physiotherapist, Clinical Musculoskeletal Specialist.

If you need one more reason to exercise your core this recently published article may provide the scientific basis that will help to motivate you http://www.theatl. At times it’s a bit technical but the key message is that there are newly discovered pathways connecting the motor cortex – the part of your brain which produces movement,  to your adrenal glands – the organs which produce chemicals related to stress. In other words:

We are hardwired to use exercise to reduce stress.

Reducing stress with exercise

Up until now the reduction in stress from exercise has often been attributed to the psychological impact of relaxation.  Beginning in the 1950’s Dr. Hans Selye showed that body chemistry changed in relation to stress.  More recently Dr. Jon Kabat Zinn gained strong scientific support for Mindful Meditation, showing changes in blood chemistry resulted from performing his techniques. This more recent article shows that the relationship of exercise is much more than psychological. The existence of physical pathways means our nerves are direct connections which regulate the relationship between the movement center of our brain and our organs. Doing radical research, in what at times reads like a biological sci-fi thriller, this neuroscientist used the rabies neurotoxic virus to follow the pathways between these two systems.

The upshot is that strengthening your core is not only good physically, it also may have a greater effect on reducing stress than other types of exercise such as cardio or weightlifting. 

This conclusion is based on the number of connections between the core muscles represented in your brain and these glands.  This larger network of nerves suggests that there should be more to gain in relation to lowering your stress hormones by exercising these specific muscles. The key take away from this article:

Short of time? Focus on exercising your core to achieve stress relief. 

Getting on track

If your goal is to use exercise to reduce stress or if you are trying to get back to fitness after an injury our team can help you get on track.

  • Physiotherapy: Seeing one of our physiotherapists can be a helpful first step in avoiding injuries which can be caused by an over-enthusiastic start to a new program or unaddressed imbalances. An assessment will help you to determine which muscles to target and/or what to treat prior to beginning your fitness program.
  • Kinesiology: Once you are ready to get started on your fitness our Registered Kinesiologist, John Gray, can design a customized fitness program specific to your needs and goals. Focusing on your core will help you to build strength, reduce risk for re-injury, improve balance as well as helping you to manage the effects of stress.
  • Chiropractic: Need a gentle start? Our chiropractor Dr. Adonis Makris is a Master in Medical Qigong.
  • Therapeutic Yoga: Want to do Yoga safely? Joanna Miller, registered physiotherapist, combines her knowledge of physiotherapy and injury to help you to learn Yoga techniques to reduce injury.

Maureen Dwight is a registered physiotherapist working in downtown Toronto.  The Orthopaedic Therapy clinic frequently provides onsite and offsite workplace therapy and ergonomics.  Please contact us if your company would like to explore our education, treatment and/or ergonomic services or if you have or want to prevent repetitive strain injuries.

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

Energy Work: A Holistic Approach to Rehabilitation

Joanna Miller Registered Physiotherapist, BA, MPT 

My journey with energy work started before I became a physiotherapist and is what led me to pursue this career. In my early 20s, I had chronic, severe hip pain and wasn’t getting relief from the various passive and active therapies I had tried. I was referred to a physiotherapist and was confused when she started using a very light hands-on technique on my lower abdominal and hip region. Before I had a chance to think of a good way to politely leave the session, because I knew this method wouldn’t work for me, I started to feel a sensation of something shooting down my leg. It was the first time I felt something finally getting into my hip pain. I was convinced this technique was magic and was surprised when I found out that anyone could learn how to do this. From there, I started the process of applying to school to become a physiotherapist, so I could share this work and help people.

What is energy work?

Energy work is a branch of manual therapy that is part of a holistic approach to rehabilitation. There are many different types of energy work that can be used to treat acute and chronic pain and health conditions. At The Orthopaedic Therapy Clinic we use 3 types of energy work- Evolutionary Process, Reiki, and Craniosacral therapy. This article will focus on Evolutionary Process and will attempt to demystify this type of therapy.

What can I expect from an Evolutionary Process Treatment?

Your Evolutionary Process physiotherapy session will begin with a traditional physiotherapy biomechanical assessment. Once your condition has been determined and explained, you will lie down and begin the energy work session. This technique is provided over clothes and usually takes you into a state of deep relaxation. The initial appointment is 90 minutes, which includes assessment and treatment. Evolutionary Process is an indirect, hands on technique where varying degrees of pressure are used to match the body’s resistance. This means that sometimes the pressure is very light and sometimes moderate to deep pressure is used.

Two fulcrums on the body are selected that relate to lines of tension in the tissues and your physical restrictions. The fulcrums are guided and stretched allowing deep layers of tightness to elongate and release. As the tension in the body releases, habitual postures and patterns ease, which leads to decreased pain and improved mobility.

Who benefits from Energy work?

During my 10 years of practice, I have studied various energy medicine techniques, and am currently treating patients using a technique called Evolutionary Process and have found it very useful in the treatment of:

· rotator cuff tears

· frozen shoulder

· disc bulges 

· decreased mobility following total knee and hip replacements

· headaches

· chronic pain.

Joanna Miller is a registered physiotherapist practising in downtown Toronto at the Orthopaedic Therapy Clinic. She practices energy work, Yoga therapy and traditional physiotherapy. For more information on Evolutionary Process and her practice contact Joanna at; for information on Craniosacral therapy contact Juliette at, and for information on Reiki contact Dr. Adonis Makris at You can also contact us at 416-925-4687 to book an appointment.

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

Poor Balance Causes Low Back Pain

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

4th in a series on causes of low back pain 

Many of my clients tell me they have poor balance.  They find it difficult to stand on one foot.  They trip and stumble over almost imperceptible unevenness in the ground.  In therapy this topic frequently comes up when I ask you to walk slowly.  You may have no issue walking quickly but as soon as you slow down you totter off to one side and/or lose your balance. Poor Balance Srategies Video

In addition to looking old, this tottering is problematic for injuries.  It contributes to falls, hip and knee osteoarthritis and causes low back pain. Whether you are born with poor balance or develop it after an injury there is no doubt that more efficient balance strategies is something worth spending time on.  Not only can improving balance reduce the likelihood of back pain it may also help to prevent catastrophic falls later in life.

Causes of poor balance

After an episode of low back pain, poor balance is quite common.  Weakness and compensatory strategies following nerve impingements predict these issues[1] and providing your spine therapist knows where to look for the cause they often easily corrected.  What is more interesting to me as a therapist is that many people have issues with balance long before they ever hurt their back and these poor balance strategies are now known to be a cause of low back pain.

Most of my clients are well aware of whether their balance issues preceded or followed their back pain.  Some remember being in military training at age 20 and noticing everyone else marching forward while they broke formation by rocking from side to side.  Others describe themselves as the kid everyone thought was clumsy, falling just a bit easier than the rest of their peers.

Testing for poor balance strategies

Even if you don’t tend to trip, fall or totter you may still be using inefficient balance strategies.  People can still find a way to balance even when they are using the wrong muscles. The stronger and more athletic you are the more I find you can look balanced even when you are using these less efficient muscle patterns. To determine whether you are using inefficient balance strategies try the following tests:

Test 1: The Toddler

Stand in front of a mirror with someone standing directly behind you.  Have them position their head directly behind your head.  You shouldn’t see any part of their face.  As you stand on one leg you will naturally shift to one side however if you have good balance you should only see about ½ their face.  An adult shifts about 6” to stand on one leg, rather than toddling from side to side. If you are shifting excessively it would be wise to begin to work out a program to address this shift.  Even if you passed the 1st test you may still be faking balance.  Go through test 2 and 3 to be sure. Toddler balance video

Test 2: The Salsa Dancer

Thread a light, long stick into the front two belt loops of your pants i.e. paint stick. Stand in front of a mirror and position the stick until it is level with the ground.  Stand on one leg and watch to see if the stick moves. If you are using your hip muscles properly the stick will stay level or slightly drop on the leg you are standing on. If it goes up this means your hip muscles are not supporting your body weight correctly.  This movement looks like the hip drop seen in latin dancing i.e. salsa or rhumba. Salsa support video

This lack of support is not a healthy pattern to be using in everyday life activities i.e. walking, standing.  If you see this pattern you should discuss it with your therapist as it is most likely caused by weak or poorly coordinated hip abductor muscles (gluteus medius/minimus).

Test 3: The Masterful Faker

The final test requires you to feel which muscles are working when you balance.  Even when my clients perform the first two tests correctly I sometimes find they are able to coordinate a compensatory pattern that makes it look like they are doing everything right – no excess shift, no hip drop.  Only when I ask them to tell me which muscles they are using to balance do I get any insight that they are faking me with their balance strategies. As you stand on one leg note which muscles you tend to dominantly use:

  • Toe and feet muscles
  • Calves
  • Muscles at the front of your ankle
  • Muscles at the front of thigh (Quadriceps)
  • Inner thigh or groin muscles (Adductors, hip flexors)
  • Muscles at the back of thigh (Hamstrings)
  • Back muscles
  • Buttocks (gluteus maximus)
  • Outer hip muscles (gluteus medius/minimus)
  • Abdominal muscles

Healthy Balance Patterns

Balance is best coordinated using the large muscles of the hips and torso.  In a recent study[2] electrodes were placed on several muscles around the feet, ankles and hips.  They found that people with more difficulty balancing initiated the correction for a loss of balance with their feet whereas the healthier patterns began with the hip and pelvis muscles.

I often see this pattern in my back patients.  Many use balance strategies involving the muscles in their feet and toes. Although this may work for a while, the problem is that these muscles are small and must work hard to balance our entire body weight.  These muscles fatigue and/or have difficulty creating enough power to correct for larger losses in balance.

Involving your gluteus medius and minimus muscles is crucial to healthy balance strategies.  The problem is that these muscles often weaken after injuries to the spine and pinched nerves.  This pattern is also an issue in hip arthritis and knee injuries as excess side to side “toddling” increases the strain on these joints.

Correcting balance issues

If you had difficulties passing any of these three tests I would recommend seeing a registered physiotherapist or registered kinesiologist.  Work to improve these patterns, preferably before you are having issues. To effectively correct balance you need to get to the source of the issue.  Your therapist should look for weakness and poor muscle coordination patterns.

Balance is complex and it is also important to rule out other causes such as inner ear imbalances, etc. Once you determine the source is from the muscles, a program including both strengthening and muscle coordination exercises will help to correct the underlying issues.  The final step is to ensure that you rapidly activate your hip muscles for balance when you are doing stairs, walking, sports or practicing “tree” in Yoga class. A salsa hip may be a great pattern for dance but should be saved for the dance floor.   With just a few minutes of effort every day it’s amazing how much improvement can be made, even if you have had poor balance all of your life.

The next topic:  Compensatory patterns and low back pain. 

Maureen Dwight is a registered physiotherapist practicing in downtown Toronto at the Orthopaedic Therapy Clinic. For more information on treatment options for prevention and alleviation of low back pain please contact us at or drop by our Toronto Clinic.

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

[1] Compensatory strategies and balance will be addressed in a future blog

Self-healing: The Four Teachers Within Ourselves

By Dr. Adonis Makris, Registered Chiropractor

Human beings are built to be self-healing. It’s a survival mechanism within our biology that keeps us healthy. The trouble is, modern society obscures our understanding of how to heal ourselves. We have lost our ancient knowing that we are our own doctors and teachers. If we look at human life – how we’ve evolved and what is needed to be in a healthy state – we can see four concepts that exemplify and express the essentials of a human life. These concepts are the four teachers that live within each of us: Quiet, Diet, Happiness, and Movement. Being in harmony with the ideas expressed by the four teachers brings us a sense of peace, joy, and inner purpose in life. It’s a feeling best described by the word “love”. When we love life and live it fully, we express alignment of body, mind, and soul. But it takes practice to achieve this level of harmonic alignment. Or rather, “practices”: meditation, yoga, eating healthy, accepting yourself, working with purpose, choosing joy. Part of my own practice is to experience the rewards of guiding people to greater awareness of the four teachers. I enjoy helping my patients create their own relationships with these teachers and remember the fundamentals of self-healing. When we master the lessons of the four teachers, we remember our power to heal ourselves. I teach health and wellness because in truly loving and living my life, I’m able to create an environment where clients naturally gravitate toward finding harmony and living their human legacy.

Self-healing and Teacher Quiet

Quiet is rest, and total rest is sleep. Sleep is essential for our repair and renewal, mentally and physically. The vast majority of us need at least eight hours of sleep per night, yet most people living the modern urban lifestyle are sleep deprived. We need to integrate the lessons of Teacher Quiet to avoid become progressively more burned out. We need to sleep better. Sleep is governed by our circadian rhythms, or biological clock. It’s influenced by our genes and hormone balance, as well as factors such light exposure, physical activity, and food intake. You can achieve a better regenerative sleep if you follow these practices:

  • Have complete darkness in your bedroom when you sleep (no blinking lights from electronics; no outside light streaming in through the window)
  • Do not eat a heavy meal within three hours of going to bed
  • Take a good magnesium supplement to support the calming of your brain and nerves
  • Avoid caffeine, alcohol, and other stimulants in the evening
  • Limit exposure to TV, computer, tablet or cell phone screens in the evening; put devices away an hour before bedtime

Self-healing and Teacher Happiness

Most people are on a quest to find happiness but many of us don’t know where to look. We expect to find it in money, a nice house, a good job but often when we have those “important things in life”, we’re still not happy. What I’ve found in my practice is that most people have a misconception about happiness – that it’s not allowed. There are too many other priorities in life. Happiness takes a back seat. Teacher Happiness tells us there is no way to happiness. Happiness is the way. Life, with all its obstacles, problems, and unfinished business, is meant to be lived in happiness. I motivate my patients to reflect on four questions and to find their own answers:

  1. What is happiness for me?
  2. How can I achieve happiness?
  3. Who are the people in my life that can help me find happiness?
  4. Am I happy ?

Self-healing and Teacher Diet

Most of us have heard the expression, “You are what you eat.” Unfortunately, most of us have also succumbed to the modern diet, where food is typically fast, fried, dyed, preserved with chemicals, or processed through industrial farming practices. Yet I am a firm believer that food is medicine and when we know the lessons of Teacher Diet we can heal ourselves with intelligent eating. The basics of intelligent eating are simple:

  • Consume whole food – fruit, vegetables, grains, eggs, meat – and avoid processed, packaged “food products”
  • Eat organic, locally sourced meat and produce as much as possible
  • Limit portion sizes – it’s healthier to feel a bit hungry after a meal, rather than stuffed
  • Eat fats that are good for you (olive and coconut oil; nuts, avocados, organic animal fats); avoid processed fats such as canola, soy, refined olive oil, and trans-fats
  • Get most of your carbohydrate intake from vegetables; avoid consuming too much grain (especially wheat, which is difficult to digest properly due to genetic modification)

For a more thorough eating program tailored to your specific needs, find a qualified health practitioner or nutritionist.

Self-healing and Teacher Movement

Imagine being bedridden for days, due to illness or injury. When you finally feel well enough to get out of bed, you’ll feel aches and pains from being stationary for a long period of time. The body is meant to be in motion. From an evolutionary point of view, our bodies have developed numerous ways to remind us of the importance of Teacher Movement. Exercise releases happy hormones like endorphins; the strong anabolic state of increased lean muscle mass makes us feel more energized, stronger, and healthier; a balanced hormonal system is more efficient. Plus the beauty of feeling good about yourself .

About Dr. Adonis Makris

Dr. Adonis Makris is a licensed chiropractor based in downtown Toronto, where he treats clients at The Orthopaedic Therapy Clinic and in private practice. He also writes about the treatment methods he uses to help people heal on different levels, from physical to energetic. Adonis graduated from University of Victoria in 1993 with a Bachelor of Science in Exercise Physiology. In 1998, he earned a Doctor of Chiropractic degree from the Canadian Memorial Chiropractic College in Toronto. Since then he has studied a mix of modern and ancient healing arts that influence his practice. Read more about Dr. Adonis Makris at The advice in this article is not meant to replace advice from your health care professional.  

New Services at the Orthopaedic Therapy Clinic

1. Individualized Yoga Therapy
2. Home physiotherapy treatments
3. Hospital physiotherapy treatments

Customized yoga therapy is a new form of exercise rehabilitation being offered at The Orthopaedic Therapy Clinic. Yoga therapy and physiotherapy are combined to meet your treatment goals and allow you to be independent with a progressive exercise routine. This program is designed for patients who are recovering from an injury by actively addressing mobility issues and weakness. Biomechanical imbalances will be addressed to prevent recurrence of your injury as well as prevent the occurrence of injuries in the future.
When should I use Yoga Therapy?
Yoga Therapy at our clinic is ideally suited for people currently undergoing treatment with one of our physiotherapists and for people who are looking to address pain and dysfunction with exercise. This program involves regular independent practice, making it ideal for people who are motivated to be active participants in their recovery. It is suitable for individuals with no yoga experience and for those who have practised yoga before and are looking to deepen their practice.
Who will I see?
At The Orthopaedic Therapy Clinic our Yoga Therapy program is provided only by a Registered Physiotherapist who is also a yoga instructor. Teaching is based on an understanding of your diagnosis and physical limitations; combining yoga poses into a sequence that will target your treatment goals. Proper alignment is emphasized by educating you about which muscles are being stretched and strengthened, and gentle adjustments increase body awareness and improve technique.
What can I expect?
At your initial session, your Registered Physiotherapist/yoga instructor will review your health history to determine if there are any restrictions or concerns for your participation. A yoga mat will be provided by the clinic. Please wear clothing suitable for exercise, and bring long sleeves for warming up and cooling down. Sessions are one hour, consisting of yoga poses and breathing exercises. Your therapist will collaborate with your health team to ensure you meet your treatment goals.
Yoga Therapy is provided by Joanna Miller R.P.T.

Home Physiotherapy Treatments
The Orthopaedic Therapy Clinic recognizes that not everyone can make it into the clinic. Injuries, age and/or surgery sometimes makes it difficult to travel. Although we encourage our clients to attend the clinic, as there are more options for treatment, when this is difficult we can come to you. If you need this service check with our reception staff to see if we have a therapist in your area who can come to your home.
Hospital Physiotherapy Treatments
Sometimes patients need more treatment than is available in the hospital. Many hospitals now allow outside therapists to augment treatments. If you feel this service would be helpful you can get the process started by contacting the physiotherapist who is working with you at the hospital and ask them the procedure for bringing in an outside therapist. Once you have the therapists contact information check with our reception staff to see if we have a therapist in your area who can come to you.

Registered Massage Therapists

Juliette WoodruffJuliette Woodruff

Registered Massage Therapist and Acupuncture Practitioner

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

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.