Barrie Physiotherapy Clinic Blog

Neurological Physiotherapy Rejoins Therapeutic Mobility

April 26, 2012 By admin Leave a Comment

The most effective rehabilitation is when you can go to one place and have a plethora of skilled therapists within your reach. Adding the neurological component to the already multi-dimensional and exceptionally skilled team at Therapeutic Mobility will allow individuals with an injury or illness which affects the central nervous system to achieve the most positive outcome possible.

I have just recently moved to Barrie from Toronto in search of a city with a warm, small town feel and to enjoy outdoor playground which surrounds it. I have also recognized the need within the community for an additional resource for neurological physiotherapy.

I have been working with individuals with acquired brain injuries, stroke, spinal cord injuries, multiple sclerosis, cerebral palsy, and other neurological impairments for over 8 years. I took my first neurological focused post-graduate course with the Canadian Bobath Instructors Association in 2003 and was amazed by the effect they had on the individual they treated. I continued with this training with the 3-week Basic course, 2 different advanced courses in functional walking and core control, and a Master’s course with the International Bobath Instructors Training Association.

What is Bobath?

The Bobath Concept:

Is a continually evolving treatment strategy which uses a problem solving approach to both the assessment and treatment of individuals with impairments in function,movement and postural control due to an issue with their neurological system.
Identifies specific impairments through movement analysis.
Addresses main components of postural & core control, selective movement and patterns of movement to achieve efficiency in activity, participation and ultimately function.
Is based upon today’s knowledge of motor control, motor learning, neural plasticity, and biomechanics.
Maintains a goal of treatment to create selective movement by balancing mobility and stability. Basically, in order for one body part to move on its own you have to be still and stable somewhere else.
Is a one on one, hands-on approach to treatment, speaking both to the sensory and proprioceptive systems through facilitation. Facilitation is an active learning process between the patient and physiotherapist to make daily function possible and easier.
Incorporates purposeful, task-directed movement to develop a treatment plan specific to the individual’s needs, goals and abilities.

For more detailed information on the Bobath Concept, you may find the following links helpful:

International Bobath Instructors Training Association (IBITA): www.ibita.org
Canadian Bobath Instructors Association (CBIA): http://bobathcanada.com

To further address an individual’s needs in a holistic way, I have training in myofascial release, craniosacral therapy, and vestibular rehabilitation.

If you or someone you know is dealing with the challenges of an illness or injury which affects the central nervous system and have questions about whether neurological physiotherapy would benefit you, please don’t hesitate to contact me by either contacting Therapeutic Mobility or emailing ckreidpt@gmail.com

Filed Under: Nero Rehabilitation, neurological physiotherapy

Congrats for your hard work Lindsay

April 24, 2012 By admin Leave a Comment

Lindsay Pleasance just passed her intermediate level manual therapy exams.

The whole team is proud of your accomplishment as it allows us to continue to better assist our clients.

Filed Under: Lindsay Pleasance, Manipulation, Manipulative Physiotherapy, Uncategorized

How much activity is right? Let’s Get Moving!!

March 22, 2012 By admin Leave a Comment

With the onset of spring and this phenomenal weather, the urge to get outside and do something is finally winning. Many of us are finally doing more than talking about getting more active and healthy.

In spite of knowing the risks of inactivity and ‘carrying a bit of extra weight’ most of us have a hard time doing anything about it. To make fitness and activity part of your lifestyle the most important things are to do something that you enjoy, do it with someone and to make it achievable!!

Choose activities that you enjoy.Find an activity that you will enjoy participating in, and will look forward to attending each time. For example if you enjoy the outdoors, join a hiking group; or if you like to swim join an aquafit class.
Have an exercise buddy or group.Having someone to workout or exercise with can bring about a social aspect of exercise that makes and how likely you are to stick with them. Research has also shown that having someone expecting you to show up regularly can significantly increase attendance and adherence to activity.
Set attainable and measurable goals.Having specific but realistic goals for yourself with exercise can make participation seem much more able work toward. Once you reach your own personal goals reward yourself! But, don’t forget to set new ones!

Following these simple rules when entering a new exercise regime can be extremely useful in helping you to get more active. Being more active is very safe for most people. However, it is best to check with your doctor before you start becoming much more physically active.

You may be able to do any activity you want—as long as you start slowly and build up gradually. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice.

Use these hints in helping you implement the updated activity guidelines.

NEW 2011 CANADIAN PHYSICAL ACTIVITY GUIDELINES

Canada is in an inactivity crisis, with over half of the population not meeting the physical activity guidelines. In fact, only 7% of children and youth are active enough to meet the current guidelines; the average child or youth spends 8.6 waking hours each day being sedentary. The Public Health Agency of Canada (PHAC) reports that at least half of the functional decline in adults between the ages of 30 and 70 is due to an inactive lifestyle, as opposed to ageing itself.

Physical inactivity plays a significant role in the overweight and obese state of Canadian children and adults. Being overweight or obese can negatively impact an individual’s physical and mental well-being and is a risk factor for diabetes, heart disease, osteoarthritis, certain cancers, and lowered self esteem.

The Canadian Society for Exercise Physiology (CSEP) is the driving force behind the development of Canada’s current Physical Activity Guidelines and the Sedentary Behaviour Guidelines for children and youth. Their recommendations are as follows:

Children and Youth (5-17 years)

minimum 60 minutes of moderate to vigorous-intensity physical activity daily
vigorous-intensity activity at least 3 days per week
strength exercises at least 3 days per week

Adults and Older Adults (18-65+ years)

minimum 150 minutes of moderate- to vigorous-intensity aerobic activity per week, in bouts of 10 minutes or more
strength exercises at least 2 days per week

To view the formal guidelines and stay current with advances in physical activity research, log onto the CSEP website at www.csep.ca. In addition, the PHAC website www.publichealth.gc.ca provides tips on how to integrate physical activity into everyday activities and further explains the importance of active living.

Filed Under: let's get moving

Therapist Heal Thyself – Week 8

January 9, 2012 By admin 1 Comment

Happy New Year everyone!

My recovery is progressing very well. I am so lucky that I did not have to experience some of the unfortunate circumstances that others have faced including:

Blood clots
Infection
Illness during recovery
Inadequate care at home

With a great deal of soft tissue healing taking place in the first 6 weeks, the goal of the next 6 weeks is to positively impact the strength of the healing process by gaining mobility and strength in a controlled and step-wise fashion. So gym visits and home activity progressions are a regular occurrence now. I have started with working on isometric pelvic floor and breathing, range of motion, and gentle cardiovascular exercise (walking, elliptical, stationary bike, and swimming). I am also working with light weights and tubing.

As our patients can attest, weakness, fatigue and stiffness are wonderful de-motivators and I am getting my fair share of these. Thankfully those around me keep me grounded and focused, as well as helping me with clear direction. Despite my own therapy background, we are not objective when it comes to ourselves.

A special thanks to Dr. M. Kreidstein and team for their dedicated before, during and aftercare. To Dr. K. specifically for answering my unending questions. After all, I teach my patients to advocate for themselves!
Look forward to seeing you all in the near future.

Heather Tennant, PT

Clinic Owner

Filed Under: Heather Tennant

Therapist Heal Thyself – Week 4

December 6, 2011 By admin 1 Comment

The last 3.5 weeks have definitely been a journey in building huge empathy and understanding for the brave patients we see every day. For all the wonderful medical knowledge and sophisticated techniques, nothing replaces the reality of experience. What have I learned on this post-operative journey?

1. A Reacher/Grabber is essential. Without one of these miracle devices I would have been truly disabled and intensely frustrated. Unable to bend or reach I dropped everything and suddenly barriers I never noticed were everywhere. With it, though, I have been able to quickly get back to many of the home activities on a modified basis.

2. Narcotic pain medication, necessary while severe pain is related to tissue damage and initial healing, can become sneakily dependent even for those who are aware. Even with very gradual weaning there can be uncomfortable side effects like chills/sweats, muscle tension, and rebound pain. Support and education during this time are essential.

3. There are many factors that have an affect on our pain that we can control. These include fatigue, position, level and type of activity, and fear/anxiety/ frustration. To be aware of this take a special focus. The negative impact of not addressing these factors can be further tissue irritation/impaired healing/excess medication useage.

4. The knowledge of good posture and the ability to achieve it after certain injuries or surgery (in this case extensive abdominal surgery) are two separate things. In the future this will teach me that, despite an individual’s best efforts and understanding, achieving a physical goal takes time.

5. Asking for help opens up space for relationships to grow.

6. There are things we can do to improve our healing process, such as good nutrition, rest and hydration, but the process itself takes time. It teaches patience and gives us a chance to reflect on the rest of what is going on in our lives.

7. Temporarily losing our independence makes us that much more motivated to not lose it again. Truly what does not bring us down makes us stronger. I believe that now more than ever.

8. It is important to be your own advocate and listen to your body’s intuition during the healing process. Ask questions and do your research and you are more likely to stay calm and relaxed and reach your goals more sanely.

Look forward to seeing you all in the New Year!

Filed Under: diastasis rectus abdominus, Heather Tennant, Physiotherapist, Physiotherapy

Therapist Heal Thyself

November 16, 2011 By admin 1 Comment

As many of my patients are aware, I have struggled with back pain for several years. The episodes have become more frequent with less resolution each time making a return to full fitness more challenging. The literature reassures me that this is really a downward spiral, as our fitness and ability to stabilize our spine helps ensure our longer term pain-free function.

Attached is a link to an article written by Diane Lee, physiotherapist, helping to outline a condition with which I have been struggling for the past 16 years. The condition referred to as “Diastasis Rectus” can be surgically corrected when it has not returned to good function in the early post-partum period or with careful rehabilitation in the years that follow. I have been “unlucky” enough to be in the percentage of women who do not recover and require surgical repair.

I underwent the surgery on November 10 and am recovering well at home. As a physiotherapist I am lucky to have firsthand expertise in pacing and proper biomechanics and posture for healing. My challenge is that I am also exceedingly independent and I need to continually remind myself that I am unable to bend or strain for at least 6 weeks.

I look forward to keeping you informed of my recovery. This experience and the progressively more severe back episodes have reminded me of the importance of understanding our patient’s journey. It is much more than a physical one. I extend my greatest appreciation to my amazing team at the clinic who are carrying the reins while I recuperate!

- Heather Tennant

Filed Under: diastasis rectus abdominus, Heather Tennant

The Truth About Pain

August 31, 2011 By admin 1 Comment

Pain is a sensation we have all experienced at some point in our lives. It is a real puzzle because there is no test to measure it, it is simply a subjective experience. This means that it is descriptive in nature and affected by many things including our age, our level of maturity, our life experiences and influences, and the situation we find ourselves in at the time that we feel it. It is a complicated blend of nerve signals that give messages from the painful part along a series of circuits leading to our brain to help us register, describe and respond to the pain.

To understand more fully pain can be subdivided as follows:

Acute Pain:
It is commonly thought that this term means severe pain. It actually refers to pain that is of recent onset, generally the first 4-6 weeks. Pain can be quite severe at this time depending on the degree of the injury or cause. During this phase an injury or problem causing the pain has set up a series of events with the goal of healing the problem. If tissue injury such a ligament has occurred, there is a period of time where inflammation increases as the body responds to injury. Swelling, heat and redness, as well as reduced mobility and function are common.

Sub-Acute Pain:
Again this generally refers to a period of time perhaps between 6 and 12 weeks following an injury such as an ankle or back sprain. The main healing efforts of the body have progressed, although depending on the severity, healing and function may not be fully complete. Pain has generally settled down and may be described more as an “ache” rather than a “sharp” pain. Mobility may be very limited due to scar tissue formation and weakness may be a problem due to lack of use and muscle wasting. Quite often inflammation is less of an issue.

Chronic Pain:
This term refers to pain of longer duration. Both the patient and the health care provider find this phase the most challenging to understand and treat. We have been taught to believe that pain signals tissue damage and that we must restrict our activities if they are painful. Unfortunately in this phase “activation” is essential in order to promote pain relief and to avoid permanent disability. The main hallmarks of the chronic pain phase are fatigue, stiffness, and fear of movement. Much of the body’s efforts at healing are complete but the messages remain the same.

Researchers believe that this type of pain is “mapped” out in a different part of the brain, and can have a significant affect on the way we think and function day to day.

What are the best tools for each phase? Here are a few suggestions:

Acute Pain:
As this is the phase where tissue damage may have occurred, begin with R.I.C.E. which stands for REST, ICE, COMPRESSION, ELEVATION. An assessment by a health professional is very important as well to determine the diagnosis and order any special tests that may be relevant. Pain medication, anti-inflammatories, and muscle relaxants may be prescribed. Depending on the injury a brace, cast, or taping technique may be necessary to protect healing tissue. Gentle movement may be prescribed to prevent further loss of function.

Sub-Acute Pain:
Activation towards normal function is the most important goal. As pain is better controlled weaning of medication is a good idea. Follow the advice of your health care professional to ensure that you do not compromise healing tissue. Your movement at this time helps to influence the strength of scare tissue and maintain strength of non-injured areas.

Chronic Pain:
As this is the most challenging phase of pain management, be sure you have a supportive team around you to help you with all aspects of your life – physical and emotional. Experiencing pain for more than 3 months is strongly correlated with depression. A good team will help you to understand how to cope and provide you with gentle exercise, modalities for pain (appropriate medication for this phase, acupuncture, pain injections etc.), and advice to manage your frustration, sleep and normal activities of daily living.

Thankfully ongoing research is providing welcome insight into the treatment of all phases of the pain cycle. Please visit some of the links below for further information and do not hesitate to contact the caring professionals at Therapeutic Mobility to assist you further.

Links:
www.canadianpaincoalition.ca
www.canadianpainsociety.ca
www.iasp-pain.org

Filed Under: Physiotherapist, Physiotherapy, what is pain?

Chew on This! Tips to Prevent and Treat Jaw Pain

July 1, 2011 By admin Leave a Comment

As physiotherapists we treat a variety of orthopaedic conditions. Physiotherapist are known for assessing and treating acute and repetitive injuries involving the neck, back and upper and lower extremities. Often our patients don’t think of their physiotherapist when it comes to pain or injury involving their jaw.

Jaw pain is more common than you may think. In general, 33% of individuals have one symptom of a jaw disorder, while 7% have more severe signs and symptoms that cause them to seek the help of a health care professional. That’s more than 2 times the frequency of tennis elbow. Just think of how may times your jaw moves during the day, from talking to eating to chewing gum, it’s endless.

(Taken from: teethremoval.com)

The jaw joint is also called the temporomandibular joint (or TMJ for short). It is where the lower jaw attaches on to the skull, just in front of the ear. The joint works like a hinge, swinging down to allow the mouth to open. A disc sits in the middle of the joint, providing cushion.

Patients with TMJ related pain often report pain located directly at the joint with jaw movement. This can be associated with ringing in the ears, dizziness, headaches and eye pain. Often the jaw will click with opening and/or closing, and on occasion can lock completely.

This makes chewing, eating and talking difficult and painful.

Pain is often due to a few main culprits:

Joint arthritis
Muscle spasm/tightness
Disc dysfunction
Cervical spine (neck) dysfunction

You can make small changes in your daily habits to prevent TMJ injury and also to calm down existing symptoms.

Avoid chewing gum, grinding your teeth and biting on objects (ie. pencil/pen, nail biting). This will put increased stress on the TMJ through repetitive use and compression of the joint. Use a mouth guard at night if prescribed to minimize the effects of tooth grinding.
Be conscious of your posture. Posture and positioning, especially of the neck, will effect the position of the jaw and the forces impacted on it. Use a headset instead of holding the phone between the head and shoulder. Avoid sleeping with a hand underneath the jaw or cradling the face.
Take frequent work breaks. TMJ disorders are common in those who have desk jobs and those who are in prolonged postures (ie. musicians). Take mini breaks (a few minutes) at least 2 times per hour.
Manage stress. Stress can often result in clenching of the jaw and increased tone of the muscular structures surrounding the TMJ. Take time for yourself and use relaxation techniques to keep stress at bay.
Consult with your dentist to fix structural problems with the jaw and teeth (ie. replace missing teeth, restructure or immobilize the jaw if necessary)

So, the next time you take too big of a bite out of life, contact the physiotherapists at Therapeutic Mobility. We can help to decrease jaw pain, increase movement and aid in improving the overall function of your jaw in day to day life. This can be accomplished through manual therapy, exercise, education and modalities, such as acupuncture.

Filed Under: jaw pain, Lindsay Pleasance, Physiotherapist

Dizziness/vertigo accounts for 5-10% of all doctor visits

June 6, 2011 By admin 1 Comment

Dizziness/vertigo accounts for 5-10% of all doctor visits. In fact 50% of all adults are affected by dizziness at one time in their lives, and it is the primary reason for physician visits in people over the age of 65. There are countless possible causes of dizziness including; low blood pressure, stroke, traumatic head injury, various neurological conditions, some medications can cause dizziness, as well as various vestibular disorders.

One common vestibular (or inner ear) cause of dizziness is benign paroxysmal positional vertigo (or BPPV). Simply stated BPPV is caused by a dislodging of crystals in the inner ear causing inappropriate excitation of the nerves in the inner ear. The brain perceives this excitation as movement, even when the movement has stopped which causes the feeling of vertigo.

People suffering from BPPV often report the sensation that the world is spinning in front of or around them. This sensation often occurs after movement such as getting up from laying down, and usually settles with time. People may report sleeping sitting up, and may also feel nauseous when dizzy. A history of head trauma is possibly related to the dizziness, but sometimes the onset seems to occur without any apparent cause. They may also have a history of dizziness in their past.

If these symptoms sound familiar, it may be worth seeking out a physiotherapist with training in vestibular rehabilitation. There are techniques that are very effective in treating BPPV and other causes of dizziness. In the case of BPPV often one or two treatments are all that are required to resolve your symptoms. For more information call or email Ryan Shea at rshea@therapeuticmobility.ca

Filed Under: Physiotherapist, vestibular rehabilitation

Are you Fit for Fishing and Gardening?

May 26, 2011 By admin Leave a Comment

As Canadians come out of a long winter of hibernation we embrace the activities of Spring with great enthusiasm. If we have not carried out a regular fitness program throughout the winter our muscles and joints may be suffering from our rapid return to sport and activity. Even if we have continued with general fitness, activities like fishing and gardening introduce very specific “body stressors” that can lead to pain and injury if we are not properly prepared.

Fishing

Avid fishermen and women are navigating the following forces while enjoying and/or competing in this Spring and Summer sport: lifting (motors/equipment), long periods of standing while twisting and balancing on a rocking boat, and repetitive upper body movements while casting, pulling and reaching. To prepare properly be sure to wear footwear on the boat to maximize your safety and balance, use a wide stance for stability and spine protection, and rest frequently when possible to avoid repetitive strain injuries especially in the upper body. Pre-season preparation should include strengthening and endurance for the arms, legs and core, as well as flexibility training and balance work. A wobble board, tubing and a therapy ball would be excellent tools.

Click here to check out some fishing for injury prevention exercises.

Gardening

As physiotherapists we have seen a multitude of injuries related to gardening. This much loved Spring and Summer activity involves frequent bending, twisting, reaching, lifting, and repetitive gripping. Back, wrist, elbow and hand problems are very prevalent, and even more likely to occur in those that have been sedentary throughout the winter months, or suffer ongoing difficulties with arthritis or disc problems. Prepare ahead by improving flexibility, and planning your work to pace the stressors more effectively. Wonderful ergonomic products are available now at your local gardening store, and also at Lee Valley (www.leevalley.com). These include long handled weeders and cultivators, stools, and carts that allow you to more effectively manage loads and have tools at an efficient height.

Here is a link to some gardening fitness videos that might provide you with an once of prevention this season.

Enjoy your Spring activities and call your the Therapeutic Mobility team if pain does not subside quickly with rest, ice and a change in technique!

Filed Under: Physiotherapy, Sports Injury