Headaches can come from a variety of sources. Some people get true migraines, while others get “cervicogenic” headaches, meaning the cause of a headache is the neck. A physiotherapist can help you determine the type of headache you’re experiencing. They will then be able to help you take the appropriate steps for pain management. This will likely include education and advice on how to manage your headaches, and how to determine the type of headache you’re having. In many cases, they will also be able to show you appropriate exercises geared at reducing your headache frequency, and severity.
2. Falls prevention
Falls prevention is, well, the prevention of falls! As we age, our body’s systems change in ways that can make us more susceptible to falling. Often, it becomes more difficult to balance due to changes in our visual, proprioceptive, and vestibular systems. (FYI, proprioception is our subconscious awareness of where we are in space, and our vestibular system is our inner ear system that senses acceleration/deceleration and head position). Physiotherapists love to treat people before there’s a problem. Typically, teaching someone how NOT to fall is less stressful (for everyone), easier, and requires fewer treatments than teaching someone how to recover from their injuries after they’ve already fallen. Not sure if you should seek falls prevention physiotherapy? Ask yourself this question: Are you afraid to fall? The biggest risk of falling is a fear of falling.
3. Athletic injury prevention
Playing sports requires a significant amount of combined coordination, flexibility, and strength. Physiotherapists are equipped to measure your current functional and athletic abilities to help you identify potential weaknesses or asymmetries. Using this information, they can then teach you how to improve these deficits, which in turn, can reduce your injury risk. As mentioned above, identifying and modifying weaknesses and asymmetries BEFORE they cause an injury is less stressful, easier, and usually requires fewer treatments than teaching someone how to recover from their injuries after they happen. A physiotherapist can also provide you with the most up-to-date education on how to reduce injury risk even if your coordination, flexibility, strength (etc…) are already excellent! For example, did you know that single sport specialization (playing the same sport year round) has been shown to increase injury risk in kids? Additionally, you’re actually less likely to become a professional athlete in many sports if you specialize in solely that sport.
Does your bladder leak when you cough, sneeze, jump, or perform physical activity? Did it start randomly, or after you had children? Do you think this is the new normal after having children? The good news is that although it’s fairly common, it’s not considered “normal”, and in many cases, physiotherapy can help! Pelvic health physiotherapists are becoming increasingly common and for good reason! Dysfunction in the pelvic floor musculature doesn’t just cause a leaky bladder! These dysfunctions can also be a contributing factor in back pain, hip pain, leaky bladders, frequent urination, and painful sexual intercourse. Although we currently do not employ any pelvic health physiotherapists at Strive Physiotherapy & Performance, we feel strongly about their role in the management of overall health, especially pre and postpartum. A pelvic health physiotherapist will assess the function of your pelvic health musculature and help you understand if and how these muscles are contributing to your pain or dysfunction. Then, as most physiotherapists will, they will teach you home exercises and a few tricks on how you can continue to help yourself!
5. Diastasis Recti
Diastasis Recti is the separation of your abdominal muscles. This can happen to both men and women but is most commonly experienced by women postpartum. As the baby grows, he/she pushes on the abdominal wall from the inside, causing the abdominal muscles to stretch outwards, and potentially separate along the middle of the rectus abdominis muscle. A physiotherapist can teach you tips/tricks for safe movement and the promotion of healing, all while showing you safe exercises to help strengthen your core musculature without further damage to your abdominal wall.
6. Temporomandibular Joint (TMJ) Disorders
Your temporomandibular joint (TMJ) is your jaw. Yes, your jaw is a joint. Well actually, it’s two, one on each side of your face, just in front of your ears. Do you have trouble opening your mouth widely? Does your jaw click or clunk when you open it, eat, or talk? Do you have stiffness or soreness in your cheeks or temples? This could be coming from dysfunction in your temporomandibular joint. A physiotherapist can help you determine whether or not the source of your pain is your jaw joint, while also teaching you some exercises on how to improve your symptoms.
7. Cancer-related fatigue
The best evidence for the management of cancer-related fatigue includes participation in both cardiovascular and strengthening exercises. Physiotherapists are experts in exercise prescription and modification. Whether you’re undergoing active cancer treatments, have just finished a bout of treatment, or are trying to prevent the recurrence of cancer, a physiotherapist can help you understand how to perform safe, appropriate, and progressive exercises to battle fatigue, weakness, and stress.
Are you experiencing pain or dysfunction that you didn’t realize a physiotherapist could help with? Are you experiencing something not listed above and wondering if we can help? Call us at 519-895-2020, or use our online booking tool on www.strivept.ca to book an appointment with one of our knowledgeable physiotherapists, and they will be sure to help you understand your injury.
Physiotherapist at Strive Physiotherapy & Performance
On October 17th 2017, the “Putting Your Best Foot Forward Act” was introduced which would ban mandatory high heels as part of the uniform in the workplace. Beyond being uncomfortable, wearing high heeled shoes can put you at risk for injury. Injuries can be acute (from wearing high heels one time and having an accident), or chronic (from wearing high heels repetitively over time).
The most common acute injury is an ankle sprain, from “rolling over your ankle”. The pointed position of your ankle increases the likelihood that you will sprain the lateral ligaments of your ankle. Take a look at the image below to see the most common mechanism of injury for ankle sprains.
Your base of support with high heels is also decreased because the contact area with the floor is smaller, which makes it more difficult to balance. To see how changing your base of support affects your balance, try standing on one foot! It takes more effort to stay standing than when you have both feet on the ground. Another way to try this is to raise both of your heels off of the ground and walk on your toes. This is also more challenging! Now check out the decreased base of support for the shoes below.
This risk of ankle sprain increases with employees in very active jobs who are wearing heels all day, like servers in restaurants. For information on the recommended rehabilitation for ankle sprains, check out our post on ankle sprains: It's Just An Ankle Sprain, Do I Really Need Physiotherapy?
Additional problems with high heeled footwear include the lack of space in the shoe and changing the mechanics of your foot. Let’s take a look at an X-ray of a foot without footwear, and a foot inside a high heel to see some of these changes.
Did you know???
There are 26 bones in each foot, that are controlled by many more small muscles and ligaments.
By maintaining your foot in a high heel for an 8 hour work day, 5 days a week, over a long period of time, you are over stretching some muscles and ligaments (ie. turf toe - a sprain of the ligament underneath your 1st toe’s proximal joint), shortening others (like your Achilles tendon and calf muscles) and changing the way your muscles have to function in order to walk. These changes can contribute to a variety of chronic foot problems including plantar fasciitis and bunions (hallux valgus). These can result in foot and ankle pain even when you don’t have your high heels on!
Finally, wearing high heels changes how your joints and muscles work even above the ankle! This can contribute to discomfort or pain in your knees, hips, and even your back.
If you’re hooked on your heels, there are still changes that you can make to better your foot health. You can choose a shoe with a lower heel, wear heels for fewer days of the week, or take micro breaks from your heels by switching to a flat shoe throughout the day in order to reduce the forces on your muscles and ligaments. If you want to wear a pair of heels to match the perfect outfit for a special occasion, great! But there are so many more options for footwear at work that don’t have the risks that high heels do. This bill is a great step in the right direction for foot health. Do your feet a favour and ditch the heels.
Are you having pain in your feet, knees, hips or back from your choice in footwear? Call us at 519-895-2020, or use our online booking tool on www.strivept.ca to book an appointment with one of our knowledgeable physiotherapists, and they will be sure to help you understand your injury.
Physiotherapist at Strive Physiotherapy & Performance
Myth 1: Benefits of massage therapy are not scientifically proven.
Fact: In fact, through rigorous research and studies, massage therapy has been shown to reduce pain, reduce cortisol (stress hormone), boost the immune system, and release endorphins (feel good hormones). Just like a good workout!
Source: Field, T. (2014). Massage therapy research review. Complementary therapies in clinical practice, 20(4), 224-229.
Myth 2: "I should feel sore after a massage, or it didn't work".
Fact: Totally untrue! Depending on the type of massage you have, whether it be a deep tissue massage for decreased muscle tension, or a relaxation massage to reduce stress, one may or may not feel soreness. Muscles and joints have been manipulated, but that doesn't necessarily need to be felt the next day to be effective! Although it is normal to experience some soreness post-massage, it does not mean it was a waste of a massage if you don’t!
Myth 3: During my massage: “No pain, no gain".
Fact: Deep tissue massage can have great effects, but time and time again people think they must push through the pain and not tell the therapist if they’re using too much pressure. What I've told my clients is: We don't want the “teeth-clenching, no breathing" type of massage, we want the "this feels like it's helping, a good hurt" type of massage. As one of our physiotherapists Tyler said in a previous blog post: "know pain, know gain", know your limits, and don't be afraid to tell the therapist they’re using too much pressure! We will appreciate it!
Myth 4: Infants and children don't benefit from massage therapy.
Fact: Children and infants can experience a wide range of pains and stresses. Massage therapy has been shown to help children with anything from a sore back (backpacks are getting heavy!) to helping their immune system. Further, RMTs can help guide breathing techniques that can help with anxiety. Infants can benefit from massage therapy, and the parents can learn techniques from an RMT to help keep the little one from fussing.
Source: Field, T. (2014). Massage therapy research review. Complementary therapies in clinical practice, 20(4), 224-229.
Myth 5: One massage should be enough.
Fact: This depends entirely on the client's symptoms, condition, and goals. In most cases, your RMT will ask you to come in for a short follow up or have a continued treatment plan.
Myth 6: Longer is better.
Fact: It is possible to overwork muscle tissues and joints. Again, depending on the client's symptoms and condition, a 30-minute massage will be sufficient (for example, if treatment is focusing on a single body part, like a calf issue). That being said, if a full body massage for significant discomfort is needed, it may take 90 minutes to be most beneficial. Once your therapist has a good understanding of what your needs are, they will discuss a treatment plan that works best for you.
Myth 7: A massage will fix that.
Fact: Although a massage will contribute to helping the pain or discomfort a client is experiencing, to reach the client's goals, homework, such as exercises, will likely be needed. In many cases, a conjunction of physiotherapy and massage therapy will be beneficial to reach your goals!
Most importantly, listen to your body. Only you can feel your discomfort. The more information regarding pain or limitations you can give, the better your treatment will be! Lastly, remember to always keep your health history up to date and let your healthcare professional know of any health changes.
Thank you for reading! If you have any other potential ‘myths’ you are curious about, feel free to ask us on social media! Our Facebook page is ‘Strive Physiotherapy & Performance’, or you can find us on Instagram @striveptandperf.
Dawn Nafziger, RMT
Registered Massage Therapist at Strive Physiotherapy & Performance
As you know from our blog post on rotator cuff surgery, we used to work alongside a shoulder surgeon. What we didn’t mention is that we actually worked with two surgeons. The second surgeon specialized in hip and knee surgeries. This also translated to significant experience treating post-operative knee replacements, hip replacements, ligament reconstructions, knee scopes, and meniscus repairs. This blog post will cover the last two: knee scopes and meniscus repairs. If you’re patient, we’ll cover those other surgeries in the future. Be sure to let us know on social media which surgeries you’re most curious about!
Thus, the purpose of this blog is to try and clarify the ins and outs of a knee scope/meniscus repair. There’s LOTS to know, and if you’re going to go through any surgery, it’s nice to feel prepared!
Aside: We will use the same headings in this post as we did in the rotator cuff surgery post. We’ll try to stick with the same format so that it’s easier to navigate. Some things might look similar, as some advice is “surgery” related, and less specific to the type of surgery.
How do I know if I even need a knee scope/meniscus repair?
Typically, to qualify for a knee scope or meniscus repair, the following statements are true:
Now for the science. Some people might find this science hard to swallow, so we’ll be sure to back it up with scientific proof. We’ll then go on to state the couple more statements that should be true if you intend on undergoing a knee scope/meniscus surgery.
To limit the plethora of different research papers we could include to show the most effective treatment option for degenerative knee arthritis and meniscal tears, we’ll focus on just 1.
Here’s the reference:
Here’s what it says:
The authors of this research paper did the following for us:
This is their conclusion:
If you’re interested in more than just 1 reference, go read these clinical practice guidelines. They include more than 30 references, including multiple systematic reviews (which are the highest level of evidence). You can find it here, for free:
In short, this is what the research says: do not have a knee scope surgery for degenerative knee/meniscus changes. Do physiotherapy instead.
If you think surgery is still the right option, consider these statements in addition to the ones listed above. As they should also be true:
Do I have to do pre-operative physiotherapy?
In short, yes, you should. It helps in the following ways:
What else should I do before I get a knee scope/meniscus surgery?
How is a knee scope or meniscus surgery performed?
Every surgeon has their individual preferences, however, most surgeons do meniscus surgeries arthroscopically (arthroscopic is where “scope” comes from). Arthroscopic means that the surgeon will use a tiny camera called an arthroscope. The arthroscope is inserted into your knee joint via a fairly small incision. The tools required to fix your meniscus/complaints are inserted through additional small incisions. Therefore, you’ll likely only have a few (2-3) small incisions around your knee!
Typically, when only the term “knee scope” is used, the surgeon is using a small tool to perform a ‘debridement’ of the knee joint surfaces. Debridement essentially means that the surgeon is ‘cleaning up’ the degenerative/damaged tissue within the knee (like small pieces of bone called “osteophytes”). Even though a meniscal surgery is also technically a “knee scope”, usually people are more specific and include the word “meniscal” somewhere. When doing a meniscal surgery, the surgeon has a couple of options. At their discretion, they will perform a meniscus repair, in which they will stitch the meniscus tear back together. Or they will perform a “meniscectomy”, in which they will remove a section (“partial meniscectomy”) or all (“full meniscectomy”) of your meniscus (and no, they don’t replace it with anything).
Psst. If you want to know more about knee anatomy, check out our post here: ACL, MCL, Meniscus - My Knee Injury Sounds Complicated.
Before we get into the next part of this blog post, it is important to note that everything in this blog post is for information purposes only. This blog post is not intended to be strict medical advice. As previously mentioned, everyone is an individual, and therefore, individual variances do occur. It is important to consult your physiotherapist, surgeon, or doctor for the most applicable advice for you.
What does the typical rehabilitation process look like?
It depends on the exact procedure you had done. If you had a meniscus repair in which your meniscus was stitched back together, some surgeons will instruct you to have a period of non-weight bearing (meaning you can’t put weight on your surgical leg). Typically this is somewhere in the 2-6 week range.
That being said, studies are showing that this may be an out of date practice as research indicates that both early (accelerated) and restricted range of motion/weight bearing yield similar, good to excellent results. (VanderHave, K. L., Perkins, C., & Le, M. (2015). Weight-bearing versus non weight-bearing after meniscus repair. Sports Health, 7(5), 399-402.)
If you had a debridement or meniscectomy, you will most likely have no postoperative restrictions!
Therefore, post-operative care looks something like this (keeping in mind that every surgeon has their preferences):
How long does it take to heal after a knee scope/meniscus surgery?
In uncomplicated cases,
As with any surgery, here are some additional things to consider:
What exercises are safe to do right away after a knee scope/meniscus surgery?
Again, this will depend on whether or not you have any post-surgical restrictions.
If you have NO post-surgical restrictions, most exercises are considered safe. That being said, you’ll want to listen to your body, start slow, and progressively increase the load on your knee (We don’t recommend going for a run or jumping on a trampoline right after surgery!). Roughly, you will progress in this order with rehab:
If you DO have post-surgical restrictions, your exercises must respect those restrictions. For example, if the surgeon recommends a range of motion restriction to 90-degrees of bend, you can work on range of motion exercises, but you must not push past 90-degrees of bend. In these cases, your physiotherapist will be a huge asset in helping you understand what exercises are safe, and what exercises should wait.
Lastly, it’s highly likely that you and your physiotherapist will work on other joints (such as the ankle and hip) together. You should be able to work on hip musculature (which greatly supports the knee) safely, regardless of restrictions. This should help to reduce any postoperative complications in your other joints, all while decreasing your pain, and improving your overall function!
How much function and how little pain can I expect at the end of my rehabilitation?
Alas, the loaded question.
Again, everyone is an individual, everyone heals differently, and therefore final pain and function is highly individualized.
Here are some things we consider:
Remember the beginning of this blog post
What are the potential complications associated with a knee scope/meniscus surgery?
All steps will be taken to limit complications postoperatively, however, it’s important to understand the possibilities. Complications include:
Although this isn’t considered a surgical “complication”, research has shown that having a knee scope for osteoarthritic changes (with meniscectomy) leads to a three-fold increase in the risk for future knee replacement surgery. (Rongen, J. J., Rovers, M. M., van Tienen, T. G., Buma, P., & Hannink, G. (2017). Increased risk for knee replacement surgery after arthroscopic surgery for degenerative meniscal tears: a multi-center longitudinal observational study using data from the osteoarthritis initiative. Osteoarthritis and cartilage, 25(1), 23-29.)
There’s a lot of information in this blog post. But there’s also a lot to know. Be informed, ask questions (even the hard ones), and look out for yourself.
Let us know if you thought this blog post was helpful, and we will try to post new ones outlining the helpful points for other types of surgeries!
Do you have a knee/meniscus injury and need to know more? At Strive Physiotherapy and Performance, we are committed to providing an in-depth assessment to ensure we can work together to find the best plan of action for each individual client. Call us at 519-895-2020, or use our online booking tool on www.strivept.ca to book an appointment with one of our knowledgeable physiotherapists, and they will be sure to help you understand your injury.
Tyler Allen & Mike Major
Physiotherapists at Strive Physiotherapy and Performance
Strive Physiotherapy & Performance
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