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Our osteoporosis exercise approach consists of a four-part program provided by our Registered Physiotherapist. The goals of our exercise program is to stimulate bone and muscle strength, improve balance, increase aerobic fitness and enhance good postural alignment.

Who will benefit?

The program is right for you if you have been diagnosed with osteoporosis or osteopenia (a milder degree of bone loss). It is also ideal for anyone who is concerned about the risk of developing this condition and wishes to be pro-active in learning how to exercise effectively and safely.

Service provided by:

Taylor Sipos, RPT (Bio)

Tiffany Shi, RPT (Bio)

More information:

To Book an appointment call 416 925 4687 or email



Our osteoporosis exercise approach consists of a four-part program provided by our Registered Physiotherapists.  The goal of our exercise program is to stimulate bone and muscle strength, improve balance, increase aerobic fitness and enhance good postural alignment.

Who will benefit?

The program is right for you if you have been diagnosed with osteoporosis or osteopenia (a milder degree of bone loss). It is also ideal for anyone who is concerned about the risk of developing this condition and wishes to be pro-active in learning how to exercise effectively and safely.

More information:

To Book an appointment call 416 925 4687


Osteoporosis Exercise Program

An osteoporosis exercise program is now available at the Orthopaedic Therapy Clinic, in downtown Toronto.  This four part program is provided by Registered Physiotherapists.

Have you been diagnosed with Osteoporosis?   Do you want to be pro-active in developing a safe and effective exercise program as part of a strategy to prevent injury and reduce the risk of fracture? 

An osteoporosis exercise program is an important element in the management of Bone Health

An osteoporosis exercises program is a recognized tool in managing bone health and reducing injury. Current best practice in the overall treatment of osteoporosis recommends a comprehensive exercise program should be part of your overall strategy to manage this condition. The Orthopaedic Therapy Clinic is now offering a state of the art Osteoporosis Exercise program to assist you in managing your bone health. This modular program of exercise is based on the Bonefit © program and endorsed by Osteoporosis Canada  This program will be individually tailored through your physiotherapy assessment. This information is used to determine which exercises are specifically right for you.

Goals of the program

The goal of your exercise program is to:

  • stimulate bone and muscle strength
  • improve balance
  • increase aerobic fitness 
  • enhance good postural alignment

These components are known to reduce the load on bone and decrease the risk of falls and broken bones.

Who can benefit?

The program is right for you if you have been diagnosed with Osteoporosis or Osteopenia (a milder degree of bone loss).  It is also ideal for anyone who is concerned about the risk of developing this condition and wishes to be pro-active in learning how to exercise effectively and safely.

The Program

The complete program consists of four one-on-one exercise instruction sessions.  These sessions will be provided weekly over a four week period. The focus of each session is to provide a combination of instruction and practical exercise performed under the supervision of a BoneFit© certified physiotherapist. Exercises are carefully selected according to your goals, ability, tolerance and safety. Each element is monitored to ensure you understand the purpose, technique and progression of the exercise. The following key exercise components will be incorporated into each of the modules in the program:

  1. Postural alignment
  2. Muscle strengthening
  3. Aerobic fitness
  4. Balance

Once you have completed the initial assessment you can choose to do an individual component or to complete the entire series. As the program is completed you can select an independent program or choose to continue supervision with our registered kinesiologist to support your ongoing management of this condition.

What to expect at your appointments.

Session #1 focuses on determining goals and posture

A thorough history and physical assessment is completed at the first sessionIt is important to bring any test results (X-Rays, Bone Density) or any other diagnostic or medical information (Medications) to the first visit.  In this session, a physical assessment analyzes your spine, shoulder and leg alignment. Height and weight are checked along with specific postural measures, flexibility and strength. Exercise and postural techniques are taught to ensure correct spinal alignment and reduce spinal loading during everyday activities i.e. lifting.  You will practice these exercises under the watchful eye of your physiotherapist to ensure correct technique. The first session is scheduled for 1 hour.

Session #2 focuses on aerobic exercise.

Weight bearing/impact exercises such as walking on a treadmill and/or step training are selected to incorporate an “impact” factor.  Impact is known to have a positive effect on bone cell stimulation and improve bone health.  A practical session helps to ensure an appropriate intensity is selected.

Session #3 focuses on strength and resistance training.

This session identifies and then targets specific muscles and movements with exercise. Your physiotherapist determines an appropriate amount of resistance for free weights, elastic bands and/or exercises using your body weight in conjunction with the pull of gravity. These types of exercise increase function, improve strength and can positively impact balance.

Session #4 focuses on maintaining or improving balance. 

Falling is a common cause of breaking a bone.  Improving balance is an important part of an injury prevention strategy. This session looks at strategies and exercises for maintaining balance.  This is applied to functional movements i.e. getting out of a chair, sitting, walking, changing direction, negotiating obstacles, etc. The goal is to improve your ability to react to challenges to balance that will reduce your risk of falling. Care is taken to ensure your balance is tested without compromising safety. Sessions 2, 3 and 4 are scheduled for 1 hour.

What to wear

We recommend comfortable, loose clothing and gym shoes as the sessions involve active participation in exercise.

Your Individualized Home Exercise Program

You will be provided detailed exercise instructions in a secure web-based format.  This electronic format allows for customized comments and easy access by computer or smart phone connections wherever you may be.  

Contact us

Contact the clinic @ 416-925-4687 to arrange for an appointment

Osteoporosis Exercise Treatment Guidelines

Gareth Sneath PT, MScCH, Grad Dip Man Ther, MCPA

osteoporosis – is a disease of bones that leads to an increased risk of fracture

Osteoporosis is a silent condition.  It reduces the strength of the bone without any outward signs or symptoms until one day you unexpectedly break a bone.  A simple fall breaks your hip,  lifting the laundry compresses a vertebra or when extreme, a sneeze breaks a rib.  These injuries are painful and can change your life. All of us can expect to lose some bone as we age but the best treatment is to strive to have the most bone possible. Fortunately, following the latest osteoporosis exercise treatment guidelines are a key component for preventing and treating this problem but to be effective you need to incorporate several different elements into your program.

I recently attended a two day BoneFit © workshop in Toronto which reviewed the latest research.  It looked at the exercise components in detail, including use of correct technique and form, safe progressions of exercise according to risk factors and avoidance of certain high-risk exercises and positions that are more likely to cause a fracture. The goals of each type of exercise are different and there are several things to consider when you choose exercise to manage your bone health.

What exercises you should you do to reduce the risk of breaking bones and improve bone health? Current research recommends you include these types of exercise:

  • “impact” activity such as brisk walking and stair climbing
  • strength/resistance training
  • balance and agility exercise
  • postural alignment

Impact activities

Impact activities are critical.  Impact loads the bone to stimulate bone cell activity. Walking on its own is not enough. Brisk walking or stair climbing is “job one” as it is safe and provides “impact” stress to bones. To be effective it needs to be performed for 30 minutes in a day.   These sessions should last a minimum of  10 minutes at a time.  Plan to include impact in your day at least 4-5 times per week.

Advantages of brisk walking or stair climbing:

  • Easily incorporated into your activities of daily living.
  • Helps balance
  • Cardiovascular benefits

Strength and Resistance Training

Brisk walking is great but does not build sufficient strength.  Adding in strength training is important and should include all the major muscles groups i.e. arms, legs, trunk.

To build strength, the resistance needs to be sufficient to create a sense of fatigue.  This can be achieved more safely using higher repetition with lower loads.  As you improve, the resistance should be gradually increased while avoiding overload.  To be safe you may need to see a professional for technical advice.  Sessions should be scheduled 2-3 times per week.

Advantages of strength and resistance training:

  • Loads the bones which stimulates bone cells
  • Reduces risk of falls

Balance and agility training

Challenging your balance and flexibility are important to reduce your risk for falling.  These exercises improve your ability to react and maintain balance when you are in more risky situation i.e. ice, uneven pavement. These types of exercises are recommended daily and should be performed for 15-20 minutes.  Incorporating them into your everyday life can make this time commitment more manageable i.e. stand on one leg as your computer boots up.

Typically these exercises incorporate the following movements.  When challenging balance you should ensure that you are in a safe and/or supervised environment to limit the risk of falling.

  • Functional movements in standing and walking
  • Random movements i.e. standing on a BOSU or foam mat
  • Walking and changing direction quickly


Posture is a key element of reducing the strain on the spinal vertebra.  It is also an important element of healthy aging as  a forward stooped posture is known to be a predictor of loss of independence as we age.

Typically postural exercises engage muscles that oppose the tendency to bend forward. Postural awareness exercises should be performed intermittently during each day.  These exercises typically:

  • Engage the “Go Tall” extensor muscles
  • Strengthen the abdominals and glutei muscles

A final component of treatment should also include teaching proper technique to protect the spine when lifting, reaching or leaning forward. Learn to lift with your legs, not your back.

The goal of treatment is prevention of fractures through the application of exercise therapy safely and consistently. Including all aspects can be a  challenge when you have osteoporosis or balance issues as it is important to ensure these exercises are performed safely.  An individually tailored program of exercise is an important part of the treatment of this condition whether for prevention of an injury or as part of recovery after a fracture.

Available at the Orthopaedic Therapy Clinic is a four part program which covers the Osteoporosis Exercise Treatment Guidelines in detail to ensure safe and correct performance of exercise plus tips on lifting and handling and how to move safely. The first session includes a comprehensive assessment followed by postural alignment techniques (1 1/2 hours). Each subsequent session (three in total, 1 hour duration each) covers strength and resistance exercise, aerobic and balance training. Please call the clinic or myself at 416 925 4687 to book this program or call or email me at

Osteoporosis Canada has an excellent website for more information on exercise. The advice in this article is not meant to replace advice from your health care professional.

Can an Inversion Table Help Relieve your Low Back Pain?

I am often asked whether Inversion Tables can help relieve back pain symptoms. You may have seen this treatment in the movies.  It really came into vogue after Richard Gere used Inversion boots in the old movie, American Gigolo.  The concept is that the table tips you upside down and gravity pulls on the weight of your trunk, head and arms.  This stretches your spine to counter the compression created when we are upright. By stretching (“tractioning”) the spine you can reduce the compression on the discs, joints and nerves, with the expectation that back pain can be alleviated.

Although it is a little different in a clinical setting as it is often applied  with a machine on a horizontal table, my early experience with traction was mixed.   At times it was very effective, at others there was no difference and occasionally it could aggravate low back pain. I suspect that if a clinical trial of inversion table treatment was done, you would see similar results.

If you are going to try inversion its important to balance the safety (risk) with the effectiveness, (benefit).  Using an Inversion Table to tip yourself from a slight incline to fully “upside down” is quite unique and unusual for most adults. Although you may benefit from the stretch to the spinal tissues, it can also have negative, potentially harmful effects.

Here are some of the pros and cons of inversion:

Benefits of inversion

  • Relief of low back pain
  • Applying traction type forces to the spine can be helpful in alleviating low back pain symptoms in the short term particularly if done as part of a more comprehensive program of exercise and education.

Risks of inversion

  • Inversion can make your back pain worse. 
  • If the traction-type force created as you suspend yourself “upside down” is excessive you can aggravate the “straight”/extension position of your spine. This may not be tolerated if you have conditions such as spinal stenosis (narrowing of the spinal canal).  You may get more pain if your core muscles are too weak to take the stretch.

Inversion can affect your heart

Another consideration is the effect that tipping will have on other body systems. For example, in the Mayo Clinic newsletter an article on Inversion Tables/Therapy  highlighted the cardiovascular risks if you have a slower heart rate or high blood pressure.  They recommend that if you have a cardiac condition such as an abnormal heart beat or hypertension or if there is a history of stroke or future risk of a stroke that you should not use an inversion table. If you are seeing a cardiologist you should ask what your risks are for this type of treatment.

Other reasons to avoid inversion treatments

  • Any condition where there is increased pressure within the eye i.e. Glaucoma or Retinal disease . Tipping upside down will increase this pressure and put you at risk for damage to the optic nerve.
  • Inner ear problems such as vertigo, dizziness or infections
  • Obesity can be an issue if you have cardiovascular issues as well as from the increased load on your spine and legs
  • Pregnancy
  • Osteoporosis or bone weakening conditions and history of spinal fracture
  • Hernias
  • Taking blood thinning types of medication
  • Gastric issues, such as acid reflux
  • Presence of orthopaedic implants, total hips/total knee replacements

It is strongly recommended that before using an Inversion Table to treat your back pain you discuss any medical issues with your Doctor.  Your physiotherapist can provide you with guidance on whether this is a good treatment option for your back.

The bottom line on inversion tables and low back pain

If you are healthy, with no risk of any of the above conditions, “traction” type forces such as produced by an Inversion Table may be beneficial as part of a more comprehensive program of exercise. A trial of horizontal traction with your therapist can be the first step in deciding if this is the right treatment for you.  If you have back pain and would like to discuss this further or receive other treatment strategies to take control of your pain, please contact me at or 416-925-4687.


Author E. Laskowski MD June 30 2017












Wrist Fractures: What to expect from therapy

Your hand and wrist are a critical part of your everyday function. Until we injure we take these functions for granted.  No one ever thinks it will happen to them but sustaining wrist fractures are an all too common type of injury.  Whether it is from icy, wintry conditions or a loose carpet causing you to slip this injury should be treated to ensure the best outcome possible.  Having assessed and treated so many patients with wrist fractures over the last 35 years I have seen the value of an individualized program of exercise and “hands-on” physiotherapy after wrist fractures. I have found that this approach gives you the best chance of getting your life back to normal as quickly as possible.

If you have recently broken your wrist here’s what you want to know about the injury and what to expect from your therapist during a rehab program. 

Why do we break our wrists?

Injuries to our wrists and arms occur when we fall as we instinctively reach our arms out for protection. Wrist fractures can easily be caused when you land hard on your hands. As you land on the palm of your hand the wrist is forced backwards adding a bending force to the bone in the forearm. The commonest fracture in the arm is the “Colles” fracture, a break of the radius bone (one of two forearm bones, the other is called the ulna).  In medical jargon we call this a “FOOSH” injury. A fall (F)  on (O)  the out-stretched (OS) hand (H)

The arrow/black shading shows the area of a Colles Fracture

Other causes of fractures

Fortunately, not every fall causes us to fracture. A broken bone is more expected when we fall from a height such as off a ladder or down stairs.   Conditions such as osteoporosis, make bones easier to break. While Osteoporosis is thought to only affect older people it can also be present in younger adults. If you fall from a standing height and break a bone your Family Physician should consider whether to order a Bone Density Test to check the quality of your bone structure and discuss treatment options.

Is it a fracture or just a sprain?

Right after the fall you may wonder if you have a broken bone or just a sprain.  Initially, if you have broken a bone, there is usually significant pain around the wrist, swelling and unwillingness to move the hand or wrist. If the bones are displaced, when you look at the forearm from the side, the alignment of the bones looks like a dinner fork.  The presence of a ” dinner fork deformity” is a tell-tale sign of a Colles fracture. If you experience the above an urgent medical assessment is necessary. If the bone is broken an X-Ray confirms the break.

Medical Treatment; What to expect

A physician or Orthopaedic Specialist in the Emergency Room at the hospital will examine your wrist and look at the X-Rays to decide the best course of action. Most breaks are treated with a rigid cast for six weeks. The cast holds the bone in the correct position while healing occurs. While you are in the cast you will usually be allowed to move your fingers, thumb, elbow and shoulder to reduce the risk of stiffness.

A follow up X-ray is typically scheduled to check that healing is progressing. Once healing is confirmed, a referral to Physiotherapy is highly recommended for assessment of your hand and wrist flexibility and strength. A specific treatment plan can then be made to help you regain function as soon as possible.

How long will it take to recover?

The question often asked is “How long will it be before I’m back to normal?” Everyone is different and during your first few treatment sessions progress is measured to see if you are “on track” and improving. Experience with these injuries suggests that most people are recovered by about six months.

The best recovery is realized when you individualize treatment to ensure  the best plan  to regain joint flexibility, strength and function as quickly and safely as possible. 

Contact us

If you have injured your wrist  book an appointment with a physiotherapist while you are in the cast or right after the cast comes off.  Call us at 416-925-4687 .

Do I have TMJ?


If you’ve ever experienced jaw pain, you may have been told, “You have TMJ!”. But do you really have that? The short answer is Yes! In fact, you and everyone you know has TMJ.


TMJ is the short form for temporomandibular joint. As it is in the name, that’s just the name of a joint in your body, to be more specific, the jaw joint. Therefore, as long as you have jaw joints, you have TMJ.

Pathology in this joint is generally referred to as Temporomandibular dysfunction (or TMD for short). Like anything else in life, this joint is all about balance! There are a lot of tiny muscles around your jaw and face that are responsible for opening and closing your mouth, one of the most important functions of the human body. You need this joint for functions like eating and speaking.

What are the symptoms of TMJ dysfunction?

If you experience any of the following symptoms, you might be dealing with TMD:

  • Pain around the jaw
  • Clicking of the joint (associated with pain)
  • Limited range of motion of the jaw (not able to fully open the mouth)
  • Morning headaches
  • Ear pain
  • Neck pain and stiffness (especially around the base of the skull)
  • Pain with chewing and/or talking
  • Pain that increases with stress

Why does my jaw click?

Your jaw clicks when the fine balance around the joint is compromised. There is a disc in the middle of your jaw joint which is responsible for smooth movements of the bones of the joint. This disc can be pushed out of the place due to a variety of reasons (like excessive muscle tension), which can lead to clicking around the joint. Pain and stiffness can be due to many factors such as excessive muscle tension, degenerative changes, tissue irritation, or joints that move too much or too little. 

What can I do to control my TMJ pain?

There are a number of self-management techniques that can help with this pain. The goal of these techniques is to reduce the tension around the joint and give it some rest. Some suggestions that you might find helpful are:

  • Avoid end range movements (e.g. taking big bites)
  • Try a softer diet for a period of time
  • Avoid habitual chewing (e.g. gum)
  • Pay attention to your posture
  • Wear your mouth guard at night (if you have one prescribed by your dentist)
  • Avoid intentional clicking of the jaw
  • consider anti-inflammatory pain medications (talk to your doctor or pharmacist if this is appropriate for you)

Who should I see for TMJ pain?

There is no one healthcare profession who is dedicated just to the treatment of TMJ pain. If you are experiencing these symptoms, you should consider discussing it with your dentist, TMJ trained physical therapist/massage therapist or your physician.

How can physiotherapy help my TMJ pain?

Your therapist assesses your jaw joints, muscles that can affect the balance around the joints, your posture and your neck. Yes, your neck! In certain cases, your neck and posture can lead to pain around the jaw.

Depending on the findings of the assessment, your therapist may consider any of the following treatment options:


If you are dealing with a jaw pain/stiffness that is not improving with self-management techniques, and/or you have seen your dentist or doctor but still have discomfort around your jaw, you may benefit from physiotherapy treatment.

Contact us if you are interested in learning more about the treatment of TMD or would like to book a treatment for your TMJ pain/stiffness.  Speak with Milad Bazaz-Jazayeri, Registered Physical Therapist – – to learn more about the treatment that fits your needs best.


Run, Walk or Jog your Discs to Health

Degenerative disc disease, black disc disease, dehydrated or desiccated discs. When faced with these seemingly bleak diagnoses you may wonder if there is anything you can do to have healthy discs again?

Knowing that these diagnoses indicate a lack of hydration could a type of food help?

Is there a vitamin to take?

Or should we simply drink more water?

female and male runners outdoors


Up until recently the answer was an unequivocal “we don’t know”.  There was little to no research directing us in how to heal or improve the health of your disc.  The widely-held view in the spine community is that the disc as a structure, unless protected, only gets worse.

That is until a study recently published in Scientific Reports convincingly demonstrated that discs are like many other tissues in the body.  Stress them and they get stronger.  The key message is that if you walk, jog or run – the right amount – your disc becomes more hydrated!

Discs are better when they are stressed

How much is enough?

Before getting on the bandwagon and starting a running routine, the question to consider is how much is enough and what is too much.  Up until now, running was perceived by the spine treatment community as injurious to the discs.  We medical-types watch the joggers, cringing at the stresses they put through their joints.  The high level of compression generated with every step sounds to us like nails on a chalk board.

Looking at articles published on the forces associated with running provides some insight as to why the medical community thinks the way we do. Many articles have looked at the ground force[1]  generated when we run.  Ground force is a measure of how hard we hit the ground.  An average jogger is estimated to hit the ground at a minimum of 3x body weight whereas the 100 M sprinters generate upwards of 7x body weight.  Calculate the forces for a 150-lb. person and the math tells the story.  The pressure ranges from 450 lb. to 1050 lb. for every step they take.  It’s no wonder that the medical community’s general perspective is that running is ill-advised for our spine’s health.

Tissues adapt to stress

Discs improving with exercise represents a seismic shift for the spine community.  Up until now we have only looked at what harms the disc.  However, when we look at the science of physiology this conclusion seems logical as it is supported by our knowledge of how other tissues function.  We know that for many tissues in the body there is an optimum level of stress.  Do too little or too much and your tissues won’t be healthy.

We explored this concept last month in my article on Delayed Onset Muscle soreness (DOMS[2] and its relation to injury.  The concept of strain causing muscles to adapt is well known. We understand that if we exercise the right amount we become stronger.  If we exercise too hard or repeat a stress before our muscles have had time to recover these tissues weaken and ultimately damage (tear, sprain, etc.).

We also know this principle holds true for the bones.  The oft-quoted Wolff’s law states “bones conform to the stresses placed on them”.  This principle forms the basis of exercise treatment used in osteoporosis and bone fracture prevention.

The same can be now said about your discs.  Put the right amount of strain on the tissue and your discs will adapt and strengthen, too much and they dehydrate.

The science behind pushing your disc

The walking effect is not surprising.  For decades we have known that this is one of the best treatments for back and neck pain.  What we haven’t known is why.  In this Australian study the results were confirmed using MRI.  Applying a T2 protocol, where the water in the disc is white, they measured the T2 times[3] and the glycosaminoglycan[4] content.  These proven measures of disc hydration were better in the group that exercised regularly at the optimum intensity.

This study gives insight into what can make our discs better.  To be healthy the disc needs to be stressed.  But the most important point is that the stress needs to be at the right amount.  The researchers called this the “right anabolic window”.

When it comes to exercise there are two basic ways to work out.  The steady paced aerobic workouts or the anabolic programs where the intent is to create an oxygen deficit.  This anabolic deficit is the principle behind the current trend of short, high intensity bursts.  Based on this study it is now the principle to follow to stress the discs.

The key to using an anabolic approach is to not incur too much of an Oxygen deficit.  Fortunately, this study gives us the ideal stresses to promote a healthy disc. They found that when the movement was too slow (<1.5 m/sec) the hydration in the disc did not improve.  When the movement was too fast (>2.5 m/sec.) the disc hydration worsened.

How to strengthen your healthy discs 

Consider speed

You need to apply the right amount of strain. Target the optimum anaerobic window of between 1.5 m/sec and 2.5 m/sec. This means you should set a pace of between 7 and 11-minutes per kilometer. At our clinic, we are measuring your speed of walking to determine your baseline.  Once we know if you need to slow down or speed up we provide music choices to help you maintain the optimum speed.

Consider age

This study was conducted on 25 to 35-year-old, experienced runners. If you are over the age of 35 and/or not a regular runner, get advice before you start.  Imbalances, postural problems and/or weakness can change your health initiative into a recipe for injury.  My associate, Svetlana Marianer’s articles on running shows that applying excessive stresses is a major factor in a wide range of running injuries.

Consider distance

This study looked reviewed a range of distances.  The minimum they considered was 20 km. per week and this distance was sufficient to see an improvement.  Some runners did in excess of 50 km. per week and providing the speed was within the optimum rate there was no negative impact on the disc.

Consider injury

If you are coming off an injury, consider seeing your health professional prior to starting your program. Have them assess for imbalances and prepare a program to correct any lurking problems before your healthy initiative is derailed into a painful injury.

Consider your baseline fitness

Many of us have just come off an inactive winter.  If you have been less active then start your program a bit slower or see your fitness professional for an assessment prior to starting your program.

Where to start

There is still a lot more research to do in this area and we hope that these scientists have just gotten started.  We have yet to see what the impact of exercise is on people with known disc degeneration but this looks promising as we know that exercise is one of the most effective tools in improving physical function with low back pain. This study is an amazing start into prevention of degenerative disc disease and ultimately should help us with tailoring your exercise programs to help you heal your discs.

Who to see

To get started if you are otherwise healthy but inactive and need help in implementing these recommendations into your exercise program, see a member of our therapeutic fitness team.  Claire Curtis and John Gray will help you to know whether you are within the therapeutic range when you exercise.  If you are injured or coming off an injury we recommend seeing one of our physiotherapists to look for imbalances prior to resuming a full and active exercise program.  Svetlana Marianer is our go-to physiotherapist for analyzing your walking or running techniques to reduce risk of injury. Gareth Sneath, is certified in bonefit, and provides guidance on how to exercise to prevent and manage osteoporosis.  Contact us at 416-925-4687 to book an appointment or go to to read more on these topics.

[1] There have been a variety of reports on ground forces, all indicate high pressures with running

[2]Delayed Onset Muscle Soreness

[3]T2 times have been shown to correlate with water and proteoglycan content in the disc.

[4]Glycoaminoglycan’s are protein and sugar based substance found in the disc.  One of its function is to promotes water to return into the disc.The pressure of our body on the disc encourages water to leave the disc resulting in the well known phenomena of being taller in the morning that at the end of the day.

Functional Medicine: A Proactive Approach for Long-Term Health

By Dr. Adonis Makris D.C.

About 16 years ago I discovered Functional Medicine and began studying[1] this ground-breaking method of patient care. This holistic approach to treating patients incorporates the latest genetic science, systems biology, and insights into how environmental and lifestyle factors trigger the emergence and progression of disease. As a medical professional this approach to health care is an important part of my toolkit for treating patients.

holistic medicine

What is Functional Medicine

Functional Medicine is truly holistic—it views all the components of the human biological system as a functioning whole. The body is seen as a single, integrated system rather than a bunch of organs and body parts “owned” by different medical specialties. It treats the whole person by looking at how a patient’s complete bio-system interacts dynamically with their environment to produce patterns and effects that change over time.

Bringing the practice of medicine into the 21st century

Conventional medicine today is focused on the diagnosis and treatment of trauma or acute illnesses that require urgent care—for example, pneumonia or appendicitis or a bone fracture. Physicians treat patients with drugs or surgery to try and fix the immediate problem or symptom.

This acute-care approach to medicine, however, is not designed to prevent and treat the complex, chronic diseases that are running rampant in modern Western society. This means that people who have a general sense of not feeling well and those without any confirmed disease often “fall through the cracks” in terms of conventional diagnosis, but can benefit from the principles of Functional Medicine.

The underlying causes of conditions like diabetes, heart disease, osteoporosis, reflux, mental illness, and autoimmune disorders such as fibromyalgia and Sjogren’s syndrome are often missed when the approach is limited to managing the symptoms. Most medical training does not look at preventing chronic illnesses through nutrition, diet, and exercise.  Although the research and information around managing disease is increasing, time  is needed to implement new practices in more traditional professions. Nonetheless, the changes are steadily presenting themselves in the field of medicine.

Heading off chronic disease at the pass

You don’t need to have a chronic disease to benefit from Functional Medicine. The approach addresses the underlying causes of disease even before it has a chance to take root. It engages both patient and practitioner in a therapeutic partnership to support long-term health.

Often one of the early symptoms which is addressed by Functional Medicine is a general sense of feeling unwell.  This may be the start of something that could lead to a disease. Functional Medicine can give you a chance to nip conditions in the bud before they blossom into a disease

The major influences that contribute to chronic disease include:

  • Poor nutrition
  • Sedentary lifestyles
  • Chronic stress
  • Poverty[2]
  • Environmental toxicity
  • Fragmented social networks[3]
  • Chronic infections[4]
  • Aging

How does Functional Medicine Help?

Functional Medicine integrates a patient’s signs, symptoms, and common pathways of disease with seven biological systems where core clinical imbalances are found. These core clinical imbalances bring together the mechanisms of disease with the manifestations and diagnoses of disease:

  1. Assimilation: digestion, absorption, microbiota/GI, respiration
  2. Defense and repair: immune, inflammation, infection/microbiota
  3. Energy: energy regulation, mitochondrial function
  4. Biotransformation and elimination: toxicity, detoxification
  5. Transport: cardiovascular and lymphatic systems
  6. Communication: endocrine, neurotransmitters, immune messengers
  7. Structural integrity: sub-cellular membranes to musculoskeletal integrity

In this way we can see that one disease/condition may have multiple causes (that is, multiple clinical imbalances), just as one fundamental imbalance may cause many seemingly different conditions.

For example, obesity is a condition that can result from numerous imbalances—hormones, mood disorders, diet and exercise, genetics, inflammation. But also a single imbalance, such as inflammation, can cause many conditions (diabetes, heart disease, depression, arthritis, cancer). Functional Medicine seeks to restore balance in the patient’s environmental inputs and in the body’s fundamental physiological processes because balance is the key to restoring health.

Functional medicine, nutrition and science

Scientific research around the therapeutic effects of nutrition give credibility to the Functional Medicine approach. A large and rapidly expanding evidence base about the benefits of clean eating, and the clinical use of vitamins, minerals, and other nutrients such as fish oils, support the treatment method. 

This also applies to Mother Nature’s botanicals (organic fruits, veggies, herbal medicine); exercise (aerobics, strength training, flexibility); stress management; detoxification; acupuncture; manual medicine (massage, manipulation); and mind/body techniques such as meditation. We also use guided imagery and biofeedback. All these alternative tools and practices are gaining more credibility within the medical community based on the growing body of research to support their value.

Because chronic disease is a food and lifestyle-driven, environment and genetics-influenced phenomenon, we need an approach to healthcare that integrates all these elements within the scope of each patient’s personal journey. With Functional Medicine we have a proactive approach to solving the modern epidemic of chronic disease that is creating a global health crisis.

My Approach

As a Functional Medicine practitioner I spend time with patients, listening to their histories and asking questions to uncover the interactions among genetic, environmental, and lifestyle factors. With science, clinical wisdom, and innovative tools, we can identify many of the underlying causes of chronic disease and intervene to correct the clinical imbalances, even before actual disease is present. Even for people who feel relatively healthy but may have a few complaints Functional Medicine optimizes your health and gives you strategies to prevent disease before it takes root. For example this approach can benefit you if you have any of the following concerns:

  • fatigue
  • poor sleep patterns
  • injuries
  • stress

For my patients, it begins with getting a complete history of your illnesses and injuries (about an hour-long interview), answering a series of in-depth health appraisal forms and questionnaires about food intake, plus a commitment to keeping a daily food diary to track eating habits. There’s also a physical examination that involves tests (blood pressure, pulse, respiratory rate, neurological screening) and blood work done with a chemistry lab to assess hormonal balances and metabolic function.

Ultimately, your health is your biggest asset. To get an in-depth understanding of how Functional Medicine can work for you, an initial consultation with a Functional Medicine practitioner is a great investment in preserving that asset for years to come. Contact Dr. Adonis Makris at the Orthopaedic Therapy Clinic to set up an appointment for a thorough assessment and to discuss whether Functional Medicine is a treatment option for you., 416-925-4687.

This information is not meant to replace medical/health advice. Contact your health professional to ensure the diagnosis and treatment options are appropriate for your condition.

[1] (Currently Dr. Adonis Makris is a post-graduate Doctorate candidate at Functional Medicine University.

[2] Fear of financial stability is the No. 1 cause of stress in today’s society; actual poverty disrupts peoples’ ability to access specialized health practitioners, and purchase quality food, supplements, and natural medicines.

[3] Society has become more individualistic; people are addicted to mobile devices and social media at the cost of personal interactions with family and friends.

[4] Candida being the most common 


Good winter boots are like good snow tires – but choose wisely

Want to avoid falling this winter – Choose your boots as carefully as you choose your snow tires

Boots are like snow tires – choose wisely

Slipping on an icy surface sent over 21,000 people to hospital in Canada last year. If you want to reduce your risk for falling, in addition to considering the fit, the warmth and the aesthetic, take a close look at the tread when purchasing a new boot.

Determining what to buy recently became a lot easier thanks to a study published by Toronto Rehab Institute (TRI).  They  looked at 98 winter boots and watched people walk on progressively more risky surfaces.  In a safe environment they increased angles to simulate a ramp and put water over the ice to reduce the grip.  In the end only 9 winter boots received a passing grade.  If you would like to see the 9 boots that can significantly decrease your risk for falling on ice. they are listed at

Although many of us may try to not go out on icy days there are some things that just can’t be avoided. I took this list with me last weekend when we were looking for new boots to walk the dog.   Congratulations to the buyers at Mark’s Work Warehouse for having several of these better choices at their stores! The Tarantula treads look amazing as do several of the other advanced grip technology.  

Looking for other tips for staying safe this winter? This website has a list of items that can make a difference.

At the Orthopaedic Therapy Clinic our goal is to help our clients prevent injuries as well as recover from them.  We know that improving balance and strength are some of the factors that can make a difference.   

It’s not enough to focus just on preventing falls, it’s also important to make sure that if you do fall, that you fall “better”.  New research is looking into the role of upper body strength in absorbing the impact of the fall so that your bones don’t take the full force. The research on falls prevention and falling better are two of the catalysts driving Gareth Sneath’s osteoporosis program.  A certified physiotherapist with Bonefit he completes an individualized assessment to focus your program to help reduce your risk for falling. 

If you would like further information on our Osteoporosis and falls prevention program please contact Gareth Sneath at 416-925-4687 or

Maureen Dwight is a registered physiotherapist and the Clinic Director at the Orthopaedic Therapy Clinic.  She has received no financial benefit from the recommendations in this article and would like to hear from you if you wish to recommend other stores which carry these low-slip boots, email:

Thoracic Pain 101

Gareth Sneath, PT, MCPA, Grad Dip Man Ther, MScCH
July 2015

There are many reasons why patients experience pain symptoms. It is common in practice to see patients with pain in the upper back, or “thoracic” spine, that area around, between or below the shoulder blades. Whilst sometimes associated with a whiplash type injury there are also those patients who deny any traumatic cause for their symptoms. What are some causes of thoracic spine pain? Below is a brief explanation of three causes, one degenerative, one postural and one due to a condition called osteoporosis which can produce a fracture of the vertebrae.

1 Degenerative conditions (discs, facet joints) in the middle to lower part of the neck can refer pain into the thoracic area. There may not always be much in the way of neck pain per se however the cause of the thoracic symptoms is in the neck. Clinically we can determine if this is the case by carefully examining movements of the neck to see if they aggravate the thoracic pain. You can also do your own evaluation by asking yourself if the pain gets worse when moving your neck in certain directions or does it worsen when adopting certain neck postures.

2 If your thoracic pain is worse after adopting certain prolonged (usually stooped) positions the symptoms may be related to postural overloading of the neck or upper back tissues. Think how it feels at the end of a long day after sitting in front of your computer. If it is worse, then consider changing posture by sitting more upright to evaluate the effect. Look at your posture from the side in a mirror. Does it feel “normal” to sit in a slumped posture with your head poking forward? If so, it’s time for change. (This is how most of us tend to sit which can overload the thoracic curve causing postural pain over time) I tell patients to “go tall” in sitting or standing and to work on their ability to maintain a more upright position more consistently. This can take some time and effort to develop tissue tolerance and muscle endurance

3 In some older patients, particularly post menopausal females, osteoporosis (thinning of the bone) is a fairly common diagnosis (1 in 4 females will develop this condition) If you experience sudden onset of pain in the thoracic spine after lifting, bending, twisting or stooping this may indicate a fracture of the vertebral body. X-Ray evaluation confirms or rules out a fracture. Once the acute symptoms have settled down and sufficient healing has occurred an important part of treatment involves developing muscle strength and endurance particularly for the back muscles. These need to be diligently performed and supervised initially to ensure appropriate technique.

There are many potential causes of pain symptoms and the above information gives some brief insight into three of them. Evaluation by your health care professional can help to determine the cause of your symptom(s) before deciding on the appropriate treatment. This process begins with taking your history so giving some thought to when your symptoms started and why plus what makes them worse or better is very important. This information along with a physical examination and consideration of any other medical tests is very useful in determining the cause.

Physiotherapy & Cancer Care

Registered Physiotherapy and Cancer Care

Certified in Cancer CareOur physiotherapists can help you to reduce pain, regain strength and restore mobility after a wide variety of cancer treatments. We work with your oncology team to provide physiotherapy after chemotherapy, radiation treatments or surgery. Physiotherapy treatment is available for:

Post-operative soft tissue, joint and bone surgeries

Our team has extensive experience in post-operative rehabilitation. Whether you have had a joint replacement, a fracture repair or have a large incision that is interfering with your mobility, our physiotherapists can help to develop a plan to regain strength, movement and restore your independence.

Frozen Shoulder Rehabilitation

Frozen shoulder can occur after the removal of lymph nodes in breast surgery and malignant melanoma. In this condition the shoulder suddenly becomes stiff and painful. Physiotherapy can help you to restore the movement through active stretching, manual therapy and a targeted home exercise program.

Post-mastectomy muscle imbalances

Mastectomy surgery can cause imbalances of the muscles around the chest and shoulder region. Often there is tightness in the muscles located at the front of the chest. Although it is uncommon, these procedures can sometimes irritate a nerve which results in a winging of the shoulder blade. Unaddressed these restrictions may cause neck pain and leave you at risk for shoulder pain and immobility.

Physiotherapy can help to restore your mobility and reduce the pain occurring after these procedures. Once your condition is stable we can assess the flexibility and strength of the muscles around the shoulder and chest to help you develop a program to balance these muscles before they cause you any symptoms.

Muscle weakness following radiation therapy

Radiation therapy can sometimes cause weakness and tightness in the muscles in and around the treatment area. Head and neck weaknesses can occur after lymphoma treatment where the radiation has targeted what is termed the “mantle area”. Physiotherapy can determine which muscles have been weakened or shortened. A stretching or strengthening program is developed to specifically address these muscles at a level appropriate for your recovery.

Posture correction

Weakness, fatigue, surgery and/or stiffness can all contribute to poor posture. Posture is one of the most important factors predicting a loss of independence and pain. Read more…

Physiotherapy can assess the cause of your postural changes and develop a specific program to help you alleviate the barriers so you can regain a strong and healthy spine.

Balance retraining

Certain types of chemotherapy and medication can cause a loss of sensory awareness leaving you at risk for falls. Loss of muscle strength after chemotherapy, prolonged rest or surgery can also contribute to falls. Our physiotherapists will assess your balance and strength to develop a program which can help to reduce your risk of falling.


Certain types of chemotherapy and medication cause a loss of bone density leaving you at risk for fractures. Loss of muscle strength after chemotherapy, prolonged rest or surgery can be another cause of falls that, when combined with osteoporosis, leave you more at risk for fractures. Our physiotherapists will develop an exercise program that includes weight bearing exercises and integrate an appropriate level of strengthening to help restore your bone density.  It is important before starting your program to let your physiotherapist know the results of your bone density testing to ensure that the program is targeted at an appropriate level.

Prostate post-surgical incontinence

Physiotherapy training of pelvic floor muscles can accelerate the speed of regaining urinary continence after surgery. Research shows that men who go through pre or post-operative training can regain continence in as little as 3 months whereas natural recovery averages 9 months. We recommend that whenever possible men who are scheduled for prostate surgery meet with the therapist before surgery as learning these exercises is easier at this time.

Post-operative transposition of muscles and nerves

Rehabilitation after these types of surgeries requires the expertise of an experienced physiotherapist to develop a plan to regain your previous level of function. Our therapists apply their extensive knowledge in post-operative rehabilitation and injury to help you to retrain movement, regain mobility and restore strength.