Search Results: scoliosis

Aniela Amio – Bio

Pilates, Yoga & movement teacher

Certified Reiki Practitioner level 2

Aniela completed her yoga certification at The Yoga Sanctuary in 2011, adding courses in meditation, Yin Yoga and Restorative Yoga shortly after.  She then went on to become certified in Mat Pilates with Body Harmonics in 2013, Reformer Pilates with The Mindful Movement Centre and Leslie Parker. She is currently working towards her Comprehensive Pilates Diploma with Body Harmonics (2019) with a special focus on spinal health and injury recovery, as well as pre and post-natal care.

Aniela  empowers people of all ages and abilities by teaching them how to move and care for their own bodies.  She hopes her students find joy, safety and strength in their sessions which translates into better quality and functional movement in their daily lives.  She is interested in and continues to expand her studies with workshops on the mind body connection, chronic pain, scoliosis, fascia, pre and postnatal health and recovery as well as working with the aging population. Aniela has had the opportunity to work with professional athletes, dancers, chronic pain suffers and those recovering from spinal injuries and surgeries.

Aniela is excited to collaborate and learn from the team at The Orthopaedic Therapy Clinic to further her education.  She looks forward to being an integral part of your recovery and journey to health and vitality. To arrange an appointment please call 416-925-4687 or email: aamio@orthophysio.com

Recently she has added the following courses and certifications to her education.

  • Movement and Exercise for Pregnancy
  • Post-Natal Reconditioning and Diastasis Recti Repair
  • Towards a Healthy Pelvic Floor
  • Strength, Balance and Fall Prevention for Seniors
  • Handedness and Scoliosis
  • Kinesiology of Pilates

She is currently completing her Pilates Level 3: CCSB Cadillac Chair Springboard and Barrels which requires 275 hours of training.

When Aniela isn’t teaching or taking courses you can find her in the park with her dog, travelling, or in a plant store deciding which plant baby to add to her home.

Post-surgical spinal care1A

 

Post-surgical spinal care

Physiotherapy has been shown to help reduce pain and improve your function after spinal surgery. We provide an individualized program of core exercise, general conditioning, posture correction, stretching and therapeutic modalities, once your initial healing is completed.

Who will benefit?

Our program is designed for anyone who is still experiencing back or leg pain after surgery. We have experience in neck, thoracic, lumbar and scoliosis surgeries. Contact us if you have had a spinal fusion, discotomy, decompression or kyphoplasty and are still experiencing symptoms or who would like guidance on safe and effective return to activity.

When should I start therapy?

Therapy can begin as soon as your surgeon indicates that you can return to full activity.  We recommend most people wait a minimum of 6-12 weeks post-operatively to begin treatment if you have a fusion.  Therapy can begin sooner after a decompression or discotomy providing your surgeon does not have any concerns with you starting a gentle and individualized exercise program.

Service provided by:

Maureen Dwight RPT, Clinical Musculoskeletal Specialist, Advanced Practitioner ISAEC

Taylor Sipos, RPT            (Bio)

Tiffany Shi, RPT               (Bio)

More information: https://orthophysio.com/?s=spine+surgery

To Book an appointment call 416 926 4687 or email physio@orthophysio.com

Juliette Woodruff – Bio

Juliette WoodruffJuliette Woodruff

Registered Massage Therapist and Acupuncture Practitioner

jwoodruff@orthophysio.com

Juliette joined The Orthopaedic Therapy Clinic Team in 2004. She is a graduate of the Sutherland-Chan College of Massage Therapy. After graduating her ongoing commitment to professional development has led her to complete studies in manual lymph drainage, craniosacral therapy and receive certification in contemporary/medical acupuncture from McMaster university.

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

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

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

Juliette implements knowledge and clinical techniques from a variety of post-graduate courses such as: techniques for post-operative breast cancer, joint mobilizations, Structural Integration for structural alignment (Nisa), Scoliologic method, myofascial techniques, muscle energy techniques (METs), positional release, acupuncture and craniosacral techniques. She utilizes and incorporates several different treatment modalities to develop an individualized approach for each client based on their assessment.

Association Memberships

Juliette is registered with the College of Massage therapist of Ontario. She is a member of the Canadian Massage Therapy Association and the Canadian Academy of Medical Acupuncture

Maureen Dwight – Bio

MaureenDwightMaureen Dwight PT, B.Sc. PT

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

mdwight@orthophysio.com

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

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.

When did you lose it?

 

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

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

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

Should you accept physical aging?

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

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

Can you still get off the floor?

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

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

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

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

Staying independent

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

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

How low should you go?

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

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

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

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

Find me a chair!

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

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

When did you lose it?

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

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

Announcements

Announcements:

OTC Social Media Platforms

We have been working hard to develop content that helps you to manage your injuries and pain by making better choices on exercises, products and even how you manage your therapy type i.e. Telehealth. You can keep in touch with us on the following platforms:

Fee changes due to COVID

Please note that effective August 18, 2020 the fees will be increased by $10 per 1/2 hour appointment or $20 per 1 hour appointment. This reflects the increased costs of COVID control. You can read about our process here

If you have any concerns about the fee change, please contact Maureen Dwight directly at mdwight@orthophysio.com?

Functional Fascia Therapeutics (FFT)

In 1996 Zhonghua Fu, PhD, invented a technique which inserts needles under the skin into the fascia.  The technique is different from traditional acupuncture as the needles are inserted horizontally and more superficially.  Only one needle is inserted at a time and the therapist provides the treatment by gently moving (swaying) the needle. The technique is relatively pain free.

The technique is used to reduce tightness in the myofascial system.  Its effect can be an immediate increase in mobility.

The theory behind the response is that the collagen tissues are most abundant in the subcutaneous layer of the body.  As the technique targets this layer of tissue it stimulates more change in connective tissues.

At the Orthopaedic Therapy Clinic we find that this technique is most effective when paired with soft tissue treatments that assist your full myofascial system to lengthen i.e. massage, soft tissue manipulation.  This technique, coupled with therapeutic exercises and posture change awareness creates a comprehensive catalyst for recovery from persistent musculoskeletal restriction.

Igal Untershats therapist at Orthopaedic Therapy Clinic in TorontoIgal Untershats is trained in Functional Fascia Therapeutics. To arrange an appointment please call 416 925 4687 or email: igalu@orthophysio.com

 

 

Welcome to our new Registered Physiotherapists!

Please join us in welcoming Taylor Sipos,  Tiffany Shi to the team at The Orthopaedic Therapy Clinic. 

Taylor Sipos Registered Physiotherapist MPT, BKin

Taylor completed his Master of Physical Therapy degree from Western University after earning his Bachelor’s degree in Kinesiology from McMaster University. His passion for physical therapy developed as he grew up participating in competitive sports.

Since graduation, Taylor has taken numerous courses to improve his skills and advance his professional development. These courses include the Mulligan Concept Lower Quadrant course, Soft Tissue Release and Acupuncture. He plans to complete his manual therapy levels through the Orthopaedic division of the Canadian Physiotherapy Association.

Taylor delivers treatment with a great deal of empathy and compassion for his clients. He strives to provide evidence-based therapy with a strong focus on exercise and education. He believes in motivating his clients in taking an active approach in their rehabilitation to meet their individual goals.

In his spare time, Taylor participates in mid and long-distance running and as such, he has a keen interest in the rehabilitation of running-related injuries. In addition to running, he also enjoys weightlifting, playing hockey and cycling.

For an appointment please call The Orthopaedic Therapy Clinic at 416 925 4687 or contact Taylor at tsipos@orthophysio.com

 

 

 

 

Tiffany Shi Registered Physiotherapist, MSc.PT, BSc

Tiffany graduated from the University of Toronto with a Master of Science in Physical Therapy in 2019. Prior to pursuing a career in Physiotherapy, Tiffany obtained a Bachelor of Science degree in Honors Biochemistry from McMaster University in 2017.

Tiffany is passionate about helping people recover from their conditions and return to the activities they love. She loos to obtain a thorough history and a holistic physical examination of patients to identify the root cause of the condition. Tiffany’s treatment approach includes manual therapy and evidence-based exercise prescription tailored to the different goals of each client.

Tiffany is a strong believer in life-long learning. She is interested in continuing education in areas of manual therapy, acupuncture/dry needling, concussion rehabilitation, and pelvic health. She has recently received her certification in level 1 orthopaedic manual and manipulative physiotherapy.

In her spare time, Tiffany is busy practicing in sabre fencing and refereeing at competitions. She also enjoys photography, sewing, life drawing, and reading. Tiffany is bilingual, she is happy to provide service in Mandarin if needed.

For an appointment please call The Orthopaedic Therapy Clinic at 416 925 4687 or contact Tiffany at tshi@orthophysio.com

Announcing:  Aniela Amio – Pilates and Yoga Instructor, Reiki practitioner

We are excited to announce Aniela Amio is joining our team at the Orthopaedic Therapy Clinic. Aniela brings extensive experience in injury rehabilitation through Yoga and Pilates. She is certified in Pilates, Yoga and Reiki. Her focus is on spinal health and injury recovery as well as pre and post-natal care. Aniela will be an integral part of the team, along with our registered kinesiologist, John Gray, in helping you to advance your recovery to return to fitness while reducing your risk of injury.

Aniela’s passion is to empower people of all ages and abilities to improve how they to move and help them to take care for their own bodies.  She is interested in and continues to expand her studies with workshops on the mind body connection, chronic pain, scoliosis, fascia, pre and postnatal health and recovery as well as working with the aging population.  Aniela has had the opportunity to work with professional athletes, dancers, chronic pain suffers and those recovering from spinal injuries and surgeries.

Call us  at 416 925 4687 to book an appointment or chat with your therapist to determine when you are ready to benefit from working with her.

Scoliosis Presentation

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

Herniated Discs and Sciatica

herniated disc treatment in TorontoHerniated Discs are common causes of low back pain and neck pain treated at the Orthopaedic Therapy Clinic. The disc functions as an important biomechanical shock absorber between the spinal bones. If the outer layer (the annulus fibrosus) cracks, the inner portion (the nucleus pulposus) can push through and compress a nerve causing back pain and/or pain, tingling and numbness into the leg (sciatica). This is called a disc herniation.

Physiotherapy treatment initially focuses on strategies for symptomatic relief followed by progression of flexibility and strengthening exercise once pain control has been achieved to maintain and restore physical function.Integrating a brisk walking routine can also make your discs healthier.  Education also plays an important role in treatment in order to give you the tools to manage these conditions.

 

Publications

1. Physiotherapy in the Treatment of Scoliosis

 

 

How Brain Plasticity Causes Low Back Pain

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

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

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

Compensatory Movement Patterns

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

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

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

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

Brain plasticity causes low back pain

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

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

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

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

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

Brain smudging

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

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

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

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

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

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

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

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

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

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

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

Back Pain: Spondylolisthesis and Andre Agassi

Many of us who learned to play tennis in the ‘80’s and 90’s were taught to emulate Agassi’s mini-step style of movement. Small steps were believed to make you more adaptable, allowing you to adjust for the unexpected bounce of the ball. Then along came Pete Sampras with his long legs, loping gait and highly successful career. Almost overnight mini-steps were out and coaching focused on increasing the speed you could run to the ball. What a surprise for those of us who have lived through both of these style paradoxes to find out that Agassi’s movement was not a philosophy but rather the result of an impairment imposed on him by his back – spondylolisthesis.

What is Spondylolisthesis

Agassi and approximately 7% of the population suffer from a structural defect in the spine called spondylolisthesis. This condition is characterized by a fracture (lysis) that causes the front body of the vertebrae (spondylo) to separate (thesis) from the bone and joints located at the back of the spine. This defect allows the body of the vertebra to shift forward (thesis) in relation to the rest of the vertebral column, leaving this section of the spine inherently less stable than other areas of the spine.

What Causes Spondylolisthesis

When this conditions occurs in young people the cause has been attributed both to genetics and to injury. Injury has recently gained more support as it is well known that participants in certain sports are more at risk for this condition. Gymnasts, divers and football players all have a higher frequency of spondylolisthesis than what is typical for the rest of the population. It is speculated that immature bones cannot withstand the forces generated by these sports and the bone breaks under the stress. It is not known why the fracture never heals.

How serious is Spondylolisthesis?

Fortunately most spondylolistheses are stable, however when first diagnosed it is important to periodically monitor the condition to be sure that the shift is not increasing. The degree of instability can be quantified on X-ray by measuring the amount of shift in relation to the adjacent stable vertebra. The most common, and least unstable shift, is labelled as a grade 1 when the vertebral body shifts forward from 1-25% of its depth. There are a total of 5 grades with each level increasing by 25% until it reaches the extremely rare grade 5 where the front of the vertebrae has shifted completely forward of the spine.

Symptoms of Spondylolythesis

The age at which someone first experiences back pain can often be a marker for the presence of this condition. Whereas most people can expect to experience their first episode of back pain after age 30, the pain associated with a spondylolisthesis frequently manifests itself in our teens. The pain is often caused by certain movements straining the fracture site as it allows movement at the area commonly called a pseudoarthrosis (false joint). For example the sufferer may feel pain from the compression of the two surfaces while he or she is leaning back to serve the ball. It may also be caused by the increased stress on the disc. The firm attachment of the intervertebral disc to the margins of the adjacent bone is under more strain by the vertebra’s forward displacement.

Treatment of Spondylolithesis

The treatment for this condition depends on whether the condition is acute or chronic and the degree of instability. A highly unstable listheses will require surgery however most people with this condition do well with more conservative approaches. During the acute stage, the pain from the irritation of the pseudoarthrosis and/or the disc means that therapies which help to control pain are the priority. Ice, advice on modifying activity, rest, medication, acupuncture and/or a variety of electrical modalities can all be beneficial. Over the long term the goal shifts to strategies to prevent further strain on the weakened structure as this is what will ultimately limit future painful episodes and prevent additional damage.

Rehabilitation and prevention programs’ primary focus should be on posture and adequate muscle strength. This approach will help to ensure that the stress of everyday movements can be absorbed by the muscles rather than being transmitted to the mechanically challenged vertebral-disc complex. As with all back pain the importance of having a strong core cannot be overemphasized however in this condition you may also need to broaden the scope of exercises as depending on where the defect is located you will be more prone to specific muscular weaknesses. For example the most common location for a spondylolisthesis is in one of the bottom two vertebrae of the low back, L4-5 or L5-S1. The problem with this location is that it houses the nerves that supply the muscles of the buttock and outer hip and is a possible cause of sciatica. Damage in this area can cause compression to the nerves and this means it is more likely that strength will be lost in the muscles they supply.

Compensation and muscle weakness’

Although Agassi does not reveal the location of his spondylolistheses he alludes to having these specific muscle weaknesses when he attributes his back to the cause of his pigeon-toe gait. Having a toed-in position is often an indicator that the buttock muscles (gluteus maximus) and outer hip muscles (gluteus medius and minimus) are relatively weak. A postural and gait mal-alignment results when the muscles which turn the legs outward do not ounteract the pull of the muscles turning the legs in. Unfortunately this over-reliance on the inner thigh and groin muscles causes tightness and compensatory movement patterns which increase the risk of injury, particularly in someone like Agassi who competed at such a high level. His biography shows the outcome of these imbalances as he was often unable to finish matches once his over-worked groin muscles started to spasm.

Despite all of these anatomical stresses and strains many people who have a spondylolisthesis can be completely symptom free and may only find out that they have had this condition much later in life when they are being investigated for age related back pain. Having good core muscles is invaluable in counter-acting the effects of this condition and preventing pain.

The effects of a good training program can be seen in this example of Andre Agassi, as not only was he able to play tennis with this condition he was able to excel at it.

 

Registered Massage Therapists

Juliette WoodruffJuliette Woodruff

Registered Massage Therapist and Acupuncture Practitioner

jwoodruff@orthophysio.com

Juliette joined The Orthopaedic Therapy Clinic Team in 2004. She is a graduate of the Sutherland-Chan College of Massage Therapy. After graduating her ongoing commitment to professional development has led her to complete studies in manual lymph drainage, craniosacral therapy and receive certification in contemporary/medical acupuncture from McMaster university.

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

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

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

Juliette implements knowledge and clinical techniques from a variety of post-graduate courses such as: techniques for post-operative breast cancer, joint mobilizations, Structural Integration for structural alignment (Nisa), Scoliologic method, myofascial techniques, muscle energy techniques (METs), positional release, acupuncture and craniosacral techniques. She utilizes and incorporates several different treatment modalities to develop an individualized approach for each client based on their assessment.

Association Memberships

Juliette is registered with the College of Massage therapist of Ontario. She is a member of the Canadian Massage Therapy Association and the Canadian Academy of Medical Acupuncture

Igal Untershats

Registered Massage Therapist

igalu@orthophysio.com

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

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

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

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

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

 

Massage Therapy

Registered Massage Therapy: how can it help me?

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

We recommend massage therapy for relief of:

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

Massage can speed recovery and is a powerful tool in the treatment of both chronic (long-term) and acute (brief and severe) soft tissue injuries.  It promotes an overal physical well-being and can be used to improve physical perfomance and body awareness.

Our experienced Registered Massage Therapists (RMTs) work with your body’s soft tissues, including muscles, skin and connective tissue, tendons, ligaments, nerves and membranes. If applied soon enough after accidents involving trauma or injury, Registered Massage Therapy can greatly reduce inflammation as well as the development of painful muscular compensatory patterns which are often a result of pain and injury i.e. piriformis syndrome, iliotibial band syndrome, etc.

Who will I see?

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

What techniques will my therapist use?

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

  • Therapeutic Treatment Massage
  • Manual Lymph Drainage
  • Myofascial Release Therapy
  • Craniosacral Therapy
  • Scoliosis Therapy
  • Sports Massage
  • Pregnancy Massage
  • Positional release (Strain-Counterstrain)
  • Muscle Energy
  • Cupping
  • Acupuncture including:
    • Medical acupuncture
    • Dry needling
    • Electro-acupuncture
    • Fascial needling (Functional Fascia Therapeutics)

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

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

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

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

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

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

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

Positional release (strain-counterstrain): a therapeutic technique that uses a position of comfort for the body, and its tissues to resolve physical restrictions and pain.

Muscle energy: a technique using the muscles own energy in the form of a gentle contraction to relax the muscles and lengthen the tissue

Cupping therapy: Cupping uses silicone or glass cups to create a vacuum which draws the circulation to the surface. When the cups are removed the circulation flushes creating the therapeutic effect.

Acupuncture including:

      • Medical acupuncture – is a therapeutic technique that involves inserting sterile fine needles into certain points on the body, encouraging the healing process and relieving pain. It is based on the points established along meridians (energy channels).
      • Dry needling (DN) or Intramuscular Stimulation (IMS)– this is a Western approach to acupuncture. In this technique thin needles are used to directly stimulate and release knots and trigger points in muscles. /
      • Electro-Acupuncture – is a technique that uses acupuncture needles to pass a pulsated current through the tissues to promote healing and/or reduce pain.  The current acts as a peripheral nerve stimulator for inhibited/weak muscles. It can increase the muscles activation/engagement and decrease pain.
      • Fascial needling –  (Functional Fascia Therapeutics) The technique is different from traditional acupuncture as the needles are inserted horizontally and more superficially. The technique targets the subcutaneous (below the skin) layer of tissue to stimulate change in connective tissues

What should I wear during a massage?

Depending on the technique or goals of treatment you may wear fitness clothing or we may ask you to remove all clothing except undergarments.  We recommend you bring shorts and a tank top.  Our therapists protect your privacy with draping to ensure that we only expose the part of your body that is being treated.

Do I need a doctor’s referral?

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