Search Results: pelvic

Pelvic floor physiotherapy and what to expect in your assessment

Pelvic floor physiotherapy is a relatively new branch of treatment which involves the assessment and treatment of various conditions which may manifest from the pelvic floor. Often learning to do Kegel exercises is the most recognized and prescribed form of therapy, but treatment goes far beyond these simple exercises In fact for some Kegel’s are exactly the wrong exercises for your problem.  Many Obstetricians and Gynaecologists now recognize that the first line of treatment is working with a physiotherapist trained in pelvic health.

When should you consider pelvic floor physiotherapy ?

If you suffer from the following symptoms you should consider an assessment to determine which type of therapy will help:

  • Incontinence
  • Frequency
  • Rectus Diastasis – a gap between your abdominal muscles, commonly occurs after child birth
  • Prolapse – a condition where organs, such as the uterus, bladder or rectum, fall down or slip out of place
  • Pelvic Pain – during or after intercourse

What does our pelvic floor do?

medically accurate illustration of the pelvic floor muscles

The pelvic floor is a hammock of muscles and ligaments that extend from back to front and side to side across the bottom of the pelvis. They attach to the pubic bone in the front, our sit bones on each side, and to our tailbone at the back.

Their function is to:

  • support the uterus, rectum, bladder, and bowel
  • help control the bladder and bowels
  • works together with the muscles of the back and abdominal wall to support the low back
  • plays an important role in sexual function and pleasure.

What to Expect in Your Pelvic Assessment?

Prior to your initial assessment, you will complete a detailed questionnaire regarding your pelvic health. Your physiotherapist will review this form with you during your evaluation.  Further information will be asked regarding your medical history and any information that will help her better understand the reason for your visit.

The physical assessment will include both an external and internal evaluation to assess the strength, function and integrity of your pelvic floor muscles. You will be asked for your consent to proceed with the evaluation at every step of the way.  The complete assessment will help your physiotherapist determine the best plan of action prior to initiating treatment. A full discussion of the examination procedures and treatments will occur prior to proceeding at each step to ensure your comfort and safety. Once the assessment is complete your program may consist of direct treatment to reduce the tension in the muscles or to teach you proper pelvic contraction.  Home exercises are often included to address your specific symptoms, goals and concerns.

Why is an internal exam needed?

Research shows that when the pelvic floor muscles are assessed internally, that consequently the treatment carried out by a physiotherapist with advanced training in this area is highly successful. Thus, it should be the first line of defense, before surgery or any other medical intervention, for both pelvic pain and incontinence.

Contact us

If you are having pelvic floor symptoms or would like to have more information, please consult our registered physiotherapist Svetlana Marianer at or call 416-925-4687 to book an assessment.

Stress Incontinence, Organ Descent and Pelvic Pain

Physiotherapy is often associated with the treatment of athletes. Although this statement is true, the scope of physiotherapy is much broader and there are many areas of specialization which remain unrecognized. This article aims to highlight one of these lesser-known approaches being perineal, or otherwise known as, pelvic floor rehabilitation. We will specifically talk about how perineal rehabilitation helps relieve stress incontinence, organ descent, pelvic pain and more.

Who Benefits from Perineal Rehabilitation?

Women and men suffering from any of the following symptoms can benefit from perineal rehabiliations:

  • Stress Incontinence– inability to control the loss of urine with coughing, sneezing, laughing or exercise
  • Urge incontinence–loss of urine associated with a strong, uncontrollable need to void (i.e. leaking while running to bathroom )
  • Frequency– needing to urinate so often that your everyday routine is disrupted
  • Diastasis recti – a gap between your abdominal muscles, commonly occurs after child birth
  • Pain – during or after intercourse

What is Perineal Rehabilitation ?

Perineal rehabilitation focuses on pelvic pain and problems such as urinary incontinence.  It helps with the discomfort associated with organ descent and more. Research shows that pelvic floor muscle retraining is the first line of treatment for urinary incontinence.

Perineal rehabilitation may consist of strengthening the muscles of the pelvic floor (perineum) as strong perineal muscles can improve the pelvic health, prevent leakage of urine and decrease potential problems. However it is important to recognize that these problems are not always about improving strength.  Pelvic distress can be a result of too much muscle tension.

When muscles are tight and/or painful you may need to increase the elasticity of the fibers before strengthening them.  In this case doing the oft prescribed Kegel exercises can cause more weakness and/or pain.  Perineal treatment and specific exercises aim to increase the elasticity of the tissues and your ability to contract as well as relax the pelvic floor muscles.

Kegels are not for everyone!

Stress Incontinence

Statistics show that  3.3 million Canadians experience urinary incontinence. That’s 1 in 3 women and 1 in 9 men, and that only 1 in 12 discuss this with their health care professionals.

Stress urinary incontinence can affect up to 77% of women in the postnatal period. Studies show that nine out of ten women with stress urinary incontinence three months after childbirth WILL continue to suffer five years later.

However, on the upside, the same study shows that  pelvic floor muscle retraining is the first line of treatment for urinary incontinence. As a matter of fact, in Britain, it is standard for women to undergo pelvic floor muscle retraining before any perineal surgical procedure  is considered.

Common Misconceptions:  

Often these problems are accepted as there are many common misconceptions around urinary incontinence.

–> it is a misconception to think that it is normal to have urinary leakage after childbirth

–> it is a misconception to think that it is normal to have urinary leakage as you age

–> it is a misconception to think that there is nothing you can do about urinary leakage

Causes of Urinary Incontinence (UI):

  • Pelvic floor damage or nerve damage during pregnancy and labour
  • Surgical procedure such as a hysterectomy
  • Overweight / High body-mass
  • Muscle weakness
  • * A variety of other factors also appear to play a role, such as diabetes and smoking.

Pregnancy and childbirth are the primary causes of impairment of the pelvic floor muscles and resulting in urine or gas leakage, organ descent, decreased sexual satisfaction and low back pain.

Function of the Pelvic Floor:

  • Ensures the continence of urine and stool
  • Supports our pelvic organs (bladder, uterus and rectum)
  • Helps with sexual function (clitoral orgasm and erection)
  • Participates in improving the lumbar support, in conjunction with the abdominals

What to Expect in Your Pelvic Assessment?

Prior to you initial assessment, you will complete a detailed questionnaire regarding your pelvic health. Your physiotherapist will review this form with you during your evaluation.  Further information will be asked regarding your medical history and any information that will help her better understand the reason for your visit.

The physical assessment will include both an external and internal evaluation to assess the strength, function and integrity of your pelvic floor muscles. This complete assessment will help your physiotherapist determine the best plan of action prior to initiating treatment. A full discussion of the examination procedures and treatments will occur prior to proceeding at each step  to ensure your comfort and safety. Once the assessment is complete your program may consistent of direct treatment and/or home exercises to address your specific symptoms, goals and concerns.

If you are among the 11 out of 12 people with incontinence who do not seek help and would like to improve these or other pelvic floor problems please consult our registered physiotherapist Svetlana Marianer at or call 416-925-4687 to book an assessment.


New Staff – Hafsa Sheik

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

Pelvic Floor Rehabilitation

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

Scoliosis Presentation

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

Foam Roller Self-Treatment Techniques For Mid-Back Pain And Discomfort

Are you experiencing pain between your shoulder blades?  Does your mid-back ache at the end of a day at the computer?  If you experience this discomfort on a regular basis, these Mid-back pain self-treatment foam roller techniques will give you quick relief from stiff muscles. But before you get started its important to know which muscles to choose and how to apply pressure, as these tips can make the difference between finding instant relief or causing more discomfort.  

In my last blog I covered the principles of using the foam roller and other self-treatment techniques. Now it’s time to get rolling.  Helpful self-treatment strategies in this blog will focus on relieving the tension on the outer leg, front of the thigh, hip, mobilization of thoracic spine and releasing the chest. These techniques can be used in conjunction with your physiotherapy, kinesiology program or become part of your regular program at home. However if discomfort continues or progressively gets worse, then I recommend seeing your physiotherapist as it can be helpful to have an assessment to understand which specific muscles need to be targeted.

What causes mid-back pain?

Although it may seem unconnected, the pain in your mid-back area can be caused by general muscle tension even if the muscles that are tight, are even located in the mid-back. For example: tight hip flexor muscles (iliopsoas, rectus femoris, sartorius, TFL) pull your body forward, changing your posture and putting your body in a position that can cause strain on this area.

Other causes of mid-back pain include:

  • fracture
  • pressure on a spinal nerve
  • osteoarthritis
  • overuse
  • injury to the muscle, ligament and discs that support your spine

The pain you are feeling may be related to problems in the myofascial system. All structures in our bodies are wrapped in a thin membrane called fascia.  The pain is caused by an autonomic phenomena referred from an active trigger point.

Which muscles to target?

Although there are many muscle in the body that can contribute to mid-back pain, this blog focuses on the ones that I find often refer pain directly into the mid-back.  This group also has a big influence on your posture which is a major contributor to mid-back pain.

Some of the muscles I target are predicted by understanding that they are the opposites to the ones which you are having trouble connecting with.  This difficulty in being able to access muscles when you exercise can be caused by the opposite muscles being too tight. Using treatment tools allows these muscle to lengthen, allowing for a more efficient contraction. The foam roller aids in releasing muscles and fascia, allowing you to correct your posture, move better and gain more strength.

Before you get started take a moment to review the principles outlined in my previous blog.  This will help you to know what to expect and how to apply pressure safely and effectively as you get rolling with these self-help techniques.


Iliopsoas influences our posture by drawing the pelvis forward and changing our alignment. It connects our lower body and upper body and it gets tight as a result of weak core and buttock muscles.

This muscle is often held in shortened positions in our daily activities. For example: sitting for long periods of time, as many of us do because of our jobs, or sleeping with your knees to your chest. Anytime you hold your body in a posture for a prolonged period of time, the muscles shorten to that position and can develop areas of irritability within it (trigger points).

Symptoms: The referral pattern for trigger points in the iliopsoas muscle can be felt on the outer edge of the spine, tailbone (sacrum) and front of the thigh. If you find that you are unable to stand straight, if your legs feel heavy, if you feel tightness in your groin or even if you are having difficulty strengthening your butt, it may be because you have trigger points in this muscle.

Rolling Technique: If you have lower back discomfort, consult your physiotherapist prior to doing this stretch. Place a towel bolster to support the lower back area. Lie on the ground with the towel under the low back and hips. Place your buttock on the foam roller. Bring one knee to your chest and allow the other leg to relax and stretch. Hold until you feel the tissue lengthening or for at least one minute. When stretching, it should feel like a comfortable stretch however you should stop if you experience pain. I would not recommend this stretch for someone with a history of low back pain.



The chest area is often a big contributor to mid-back pain. When our chest muscles get tight, they pull our shoulders forward and bring our mid-back into a rounded position. Many of us find ourselves in this slumped body position on a daily basis. In addition to reducing muscle tightness, maintaining a healthy posture with muscle strengthening is also an important part of relieving mid-back pain and discomfort.

Symptoms: The pectoral muscles refer pain into the front of the shoulder, inner arm, inner aspect of the elbow and fingers.

Technique: To stretch your chest, lie on a foam roller lengthwise ensuring that your head is fully supported. Start with your arms at your side and gradually move your arms up to the place where you feel the first bit of a stretch and hang out until the stretch disappears or for 1 minute. Then gradually move your arms towards your head as you are lengthening the tissue. If you experience tingling in your arms, then ease off the stretch until it disappears. You can practice holding your arms for 1 min at varying degrees to stretch the different muscle fibers of the pectorals.



The rhomboids, along with the other shoulder girdle muscles, act to stabilize the shoulder. Typically the rhomboids are weakened and inhibited by the rounded shoulder posture that so commonly results from our computer work. Other activities that involve overhead work with the arms raised above the head or sleeping on one side can cause over activity in these muscles.

Symptoms: This muscle refers pain and discomfort to the inner border of the shoulder blade and spine.

Technique: Lie on your back or stand against a wall. Place the tennis ball between your shoulder blades and roll up and down on the rhomboids until you feel the spot you want to release. Hold the spot until you feel the softening of the tissue and the “good sore” sensation disappear.

Rectus Abdominus

The Rectus Abdominus muscle is the”six pack” we all admire.  It is one of four abdominal muscles that help to give us core support. It’s function is to bend the spine forward. 

Symptoms: This muscle can refer pain to a lot of areas. It refers pain into the mid-back area, and upper pelvic crest. In addition it can mimic numerous conditions such as:

  • heartburn
  • chronic diarrhea
  • Irritable Bowel Syndrome
  • gallbladder
  • genital pain
  • kidney symptoms

A surprising connection was found by Dr. Travell regarding other symptoms from abdominal trigger points which could take the form of nausea, chronic diarrhea, loss of appetite, projectile vomiting, and simple indigestion.

If the rectus abdominus is too tight or harbors trigger points we tend to lean forward and slouch. If you find you prefer to sleep curled up in bed it may be because your rectus abdominus is too tight.

Technique: Lie on your back with a pillow under your knees, place your fingers on your breastbone and walk your fingers down until you find the first soft spot. This area is the upper attachment of the rectus abdominis muscle.  It can help to activate the muscle to let you know you are on the right area.  Do a little abdominal crunch to feel the muscle contract and then gently walk your fingers up and down the muscle belly, locating the sore spots or referral points. Hang out with your fingers on the sore spots until they disappear or for up to two minutes.


Using self-treatment tools is not a cure for chronic pain, although it helps. Implementing trigger point release in conjunction with a stretching and strengthening program, will aid in a quicker results. It allows you to get relief at your own convenience at no cost.

If you have any questions or would like to know other strategies with self-treatment for different area’s of the body, please contact me, Juliette Woodruff at or call us to make an appointment 416-925-4687.


Travell, Janet, 1901 (copyright 1992) Volume 2 Myofascial Pain and Dysfunction-The Trigger Point Manual-The Lower Extremities


Low Back Pain and Core Strength

I DON’T HAVE TIME FOR THIS!  Second in a series on causes of low back pain.

You got to have core!

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

The role of a strong core is almost undisputed when it comes to winning the battle against low back pain.  No matter how fit you are or how flat your belly, the most common recommendation is to get a better core.  For most people this recommendation translates to strength exercises.  More sit-ups or Pilates-type leg lifts. Often bird dog, Superman’s and planks enter your daily therapy routine but as the research in this area expands we need to know whether doing exercises will give us what we need.  Not only do we want to recover from our current episode of low back pain but we also want to limit future occurrences. Ultimately we need to know whether we should put our time and energy on low back pain and core strength exercises or whether other strategies such as sleep habits[1] make the bigger difference in recovery and causing low back pain in the first place.

What is core?

Although the need for muscle support for a healthy spine is undoubted, the experts have yet to agree which muscles constitute “core” or what aspects of these muscles’ support is critical to your recovery.  Some experts limit their definition of core to the abdominals whereas others include the buttock and back muscles.  When it comes to determining the relationship of low back pain and core I find that I generally need to look for deficits in several muscles but typically one of the first groups I check are the ab’s.

Low back pain inhibits core functioning

There are several compelling studies outlining the role of the abdominal muscles in low back pain.  For example in 1998 Dr. Paul Hodges[2] literally revolutionized our perspective on a relatively ignored abdominal muscle. As a result of this seminal study Transversus Abdominis went from relative anatomical obscurity to becoming almost a household name in the lexicon of back pain.  Dr. Hodges showed us that a change in function of this muscle could be predicted strictly by experiencing back pain.  In other words there was no need for injury or damage to the back, simply feeling pain was enough to change the muscle’s function.

Low back pain prevention and coordination of abdominal and core muscle response

Another factor causing low back pain is the speed at which your abdominal muscles react to unanticipated events. To prove this theory Dr. J. Cholewicki[3], a pre-eminent biomechanist, recruited Varsity athletes with no previous history of low back pain.  Each participant sat on a bench with their chest leaning into a support until a magnetic force released the support without warning. The subject suddenly and unexpectedly needed to establish independent posture. Electrodes  were used to measure how quickly the abdominal muscles reacted to create more support.  The results showed that if these muscles were delayed by as little as the time it takes you to blink your eye (>14 milliseconds) that this was enough to predict future problems.  Although there were no injuries from the testing over the next three years they found that this delay predicted the likelihood of the athlete experiencing their first episode of low back pain. To further understand Dr. Cholewicki’s study it might help to imagine  the post you are leaning against suddenly and unexpectedly gives way. How quickly your muscles sense this change will determine whether you will fall however back pain is typically more insidious than this more predictable injury.  Instead think about how your muscles react to every turn in the road or every shift in the bus. Your muscles need to absorb these forces to keep you upright, otherwise all of us would still need to be strapped into an infant’s car seat.  Failure to support our spine sufficiently against these and other small repetitive irritants means that repetitive strains are being transmitted to our back.  Over time these irritants accumulate and cause injuries.  This is why many of us can never fully identify the factor hurting our back – the forces are too small and too repetitive for us to take notice of. The key message I take from these studies is that our body is protected by a quick response in the muscle system which limits our risk for injury.  If that response is slow or insufficient then the repetitive strains can cause injuries.

  • The role of our muscles is to prevent injury and the faster and the more comprehensively they react the less likely we are to get hurt
  • The delay in the abdominal muscles reacting to an unanticipated event is predictive of a future episode of low back pain

Symptoms of poor core support

  • Low back pain
  • Back stiffness
  • Poor sport or recreational performance
  • Poor balance

Tests to see if your low back pain caused by poor core

Unfortunately for most clinicians the equipment needed to test these muscles is too elaborate and too expensive to allow for wide availability however there are some simpler tests[4] which I have found helpful in determining if abdominal stabilization is a problem.  Try these simple tests to determine if you should seek out a therapist to try to prevent future episodes of low back pain.

  1. Single leg lifts: Lie on your back with your knees bent.  Place your fingers on the bumps on the front of your pelvic bones (ASIS).  As you lift one leg check to see whether the bones stay still or feel like they rock or tip under your fingertips.  If everything holds steady it is likely that your abdominal muscles are stabilizing your spine against the force of moving your leg. If you feel movement it is likely that you need to improve your stabilization.
  2. Lying arm reach: Lie on your back with your knees bent. Bend your elbows and tuck them into your sides.  Lead with your fingertips as you reach your arms straight to the ceiling.  You should feel a sensation of deep hollowing as the Transversus tightens and your abdominal muscles pull inward toward your back bone.  This test shows whether your core is providing support for the simple motion of moving your arms.  I find this test particularly important for back pain in computer workers and students as the support for the arms should come from the abdomen, not the back or the neck muscles.

 When to seek therapy 

You may benefit from seeing a spine therapist if during the leg lifting self-test you:

  • Felt your hip bones tip or rock
  • Felt a gripping in your ribs and/or tension in your back or neck
  • Felt your back arches or your head lifts off the mat
  • Felt your “six-pack” (rectus abdominis) and/or abdominals next to the pelvic bumps (internal oblique) pop outward.

You may also benefit from an assessment if during the arm lifting self-test:

  • You did not feel your abdominals react[5] at all.
  • You felt your “six-pack” (rectus abdominis) and/or abdominals next to the pelvic bumps (internal obliques) pop outward.
  • You felt a gripping in your ribs and/or tension in your back or neck

When deciding where to put your time and energy to prevent low back pain I would recommend that if you failed any of these tests or have experienced low back pain you should consider seeing a registered physiotherapist or registered kinesiologist whose perspective goes beyond looking at the relationship of low back pain to core strength.  Their examination should include tests to look at muscle activation and coordination.  If you passed all of these tests than your low back pain may not lie in the activation or the coordination of the abdominal muscles.  Perhaps it lies in the sleep deprivation[6] we previously looked at, other “core” muscles and/or the second factor in Dr. Cholewicki’s study which we have yet to have a look at, body weight.

The next topic: How weight changes cause 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] [2] [3] Biomechanics is the study of physics applied to the human body. [4] Tests based on the movement patterns described by Dr. Hodges [5] Most people have difficulty feeling reaction on the leg lift test but it is quite apparent with the arm reach [6]  

Hip 101

The hip joint consists of a deep socket formed where the thigh bone (femur) meets the pelvis (acetabulum). Although this shape makes the hip joint quite stable and relatively low risk for injury, its role in supporting our body weight raises our risk for arthritis. Poor muscle support, excess weight and inefficient movements contribute further to this risk.
In addition to arthritis there are several other structures that can cause pain around the hip joint. Bursitis and tendonitis are common conditions. Strains to the muscles in the buttock or front of the hip are a frequent source of symptoms. More recently the cartilaginous lip around the hip socket, labrum, has been implicated as a source of harder to diagnose symptoms. And as if this is not complicated enough the low back will often mimic hip pain.
The outer aspect of the hip has a fluid filled sac (bursa) which helps the tendons to glide over the roughened bony surface (greater trochanter). If this structure becomes inflamed it causes pain whenever the tendons contract and squeeze the bursa, i.e. as we walk, stand or climb stairs.
Low back referred pain.
The low back is a frequent contributor to pain in the hip and pelvic area. This means that an assessment often looks at both areas to determine the primary source of the symptoms. The location of the pain can sometimes help as the hip typically causes pain in the groin and the low back causes pain in the buttock however pain on the outer aspect can be caused by either structure.
Muscle strains
Piriformis syndrome and IT band syndrome are common diagnoses for pain in the buttock or outer thigh however these muscular strains are frequently symptoms of other imbalances. These areas are often strained when other muscles are providing insufficient support. The muscles at the front of the thigh, hip flexors, can also become inflamed if they are over-used. Although direct treatment can temporarily relieve your pain, a thorough analysis is required to determine the underlying cause and to develop a plan to correct these muscular imbalances.
Whether your symptoms are caused by the hip joint, muscles, bursa, labrum or are being referred from your low back the most important first step is to understand what you have. At The Orthopaedic Therapy Clinic your therapist will provide a thorough assessment and partner with you to determine the best course of treatment for your injury.
Once the injury is diagnosed the next step is to determine where you are in the recovery sequence. Treatment is based on your stage of healing as more acute injuries typically require a plan to reduce pain and inflammation. The use of traction, Kinesio-taping or electro-therapeutic modalities i.e. ultrasound, can be helpful to reduce pain and allow you to remain more active as you heal. As you continue to progress the restoration of flexibility, rebuilding strength and re-establishing normal movement patterns becomes the focus of your therapy. The final stage is to determine a strategy to help you return to full activity, work, sport and long-term prevention.

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.

Registered Physiotherapists

MaureenDwightMaureen Dwight PT, B.Sc. PT

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

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

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

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

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

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

Association memberships and awards

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

GarethSneathGareth Sneath

Registered Physiotherapist, MScCH, MCPA, MMPAA,

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

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

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

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

Association memberships and awards

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

SvetlanaMarianerSvetlana Marianer


Registered Physiotherapist, MSc. Pht

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

As a former ballet dancer and a present CrossFit athlete, Svetlana is particularly interested in orthopedic care, the prevention and treatment of sport injuries and the biomechanics of movement and all it encompasses. Moreover, although Svetlana’s nature is that of an athlete, she has a strong foundation in managing acute and chronic low back and neck pain, various repetitive strain injuries and a variety of musculoskeletal impairments resulting from every day and or recreational activity. Svetlana’s recent passion has been in women’s health which prompt her to get her training in pelvic floor therapy. Her focus is to create a comfortable environment where issues related to the  bowel, bladder and the sexual health are openly discussed and treated. Her skills allow her to treat clientele of all ages. Svetlana is fluent in four languages : English, French, Hebrew and Russian.

MiladMilad Bazaz Jayzayeri

Registered Physical Therapist BSc. M.P.T.

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

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

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