- Physiotherapy is a health care profession directed at evaluating, restoring and maintaining physical function.
- Physiotherapists are university-educated, regulated health professionals whose extensive training includes anatomy, physiology and the effect of illness or injury on various body systems. We are able to provide a diagnosis and treatment for a wide range of injuries and conditions and are trained to assess and improve functional movement and to relieve pain.
- Physiotherapists provide valuable health care for people throughout their life – from birth to retirement and beyond. We help to prevent and treat sports injuries, restore and increase range of motion in joints, increase co-ordination, and help injured individuals return to work successfully. Physiotherapists promote optimal health by encouraging their patients to improve and increase control over their own lives.
- Your initial appointment will include a thorough evaluation by a Registered Physiotherapist and a consultation with you to discuss the findings of the evaluation and to establish mutual treatment goals.
- An individualized program will be developed to meet your needs and goals and may consist of hands-on manual therapy, pain relieving treatments such as modalities, biomechanical taping and specific exercises. Your program will also include a thorough educational component.
- Manual therapy is a hands-on approach used to restore mobility and function and to reduce pain. Manual Therapy often involves mobilization and/or manipulation of stiff or fibrotic joints. It also incorporates soft tissue treatment with the ultimate goal of maximizing the body's functional mobility. Specific exercises are utilized to maintain the restored range of motion and function.
- Your physiotherapist may use one of several different kinds of machines to speed up the healing process and relieve pain. Options to treat inflammation and/or pain may include:
- Interferential Current
- Transcutaneous Electrical Nerve Stimulation (TENS)
- Our philosophy is based on active participation in treatment, therefore exercise will be an integral part of all treatments.
- Physical balance in terms of strength and flexibility is vital for joint stability and postural alignment. An individualized, condition-specific exercise routine will be designed to achieve personal and treatment goals. Your physiotherapist will also provide an exercise program for you to continue by yourself. This is key to preventing a recurrence of your injury.
- Education is another key to prevention. We will help you to understand how injuries occur and what makes you vulnerable.
- Your physiotherapist will provide a clear explanation of the anatomy involved, the stages and factors affecting healing and the factors to be addressed to ensure a successful recovery.
- It is often thought that nothing can be done for those with incontinence, prolapse or pelvic pain. It is also thought that Kegels are the only treatment for pelvic floor dysfunction – this is absolutely not the case! Kegels are often not appropriate, and if they are indicated, they are frequently performed incorrectly.
- The pelvic floor muscles are a group of muscles that attach to the front, back and sides of the pelvic bone and sacrum. They are like a hammock or a sling, and they support the bladder, uterus, prostate and rectum. They also wrap around the urethra, rectum, and vagina (in women). These muscles must be able to contract to maintain continence, and relax to allow for urination, bowel movements, and in women, sexual intercourse.
- Pelvic floor dysfunction can be caused by HYPOTONICITY (weak pelvic floor muscles) contributing to Stress Incontinence, Urge Incontinence, and Pelvic Organ Prolapse. Incontinence is NOT a normal part of aging, nor is it normal post pregnancy.
- Pelvic floor dysfunction can also be caused by HYPERTONICITY (tight pelvic floor muscles) and can contribute to Urinary and Fecal Urgency, Urge Incontinence, Chronic Pelvic Pain, Pudendal Nerve Irritation, Interstitial Cystitis, Chronic Prostatitis, Dyspaerunia, Vaginisimus, and Vulvodynia.
- Other reasons to see a physiotherapist with pelvic floor training could include: Chronic Constipation, Irritable Bowel Syndrome, Coccydynia, Rectus Diastasis, Post-Prostatectomy, Pelvic Girdle Pain in pregnancy/post labour and delivery, pain during intercourse, difficulty starting urine stream, if you have unresolved low back, hip or pelvic pain or if you have pain in the vagina, perineum, rectum, bladder region, or penile, testicular or prostate pain.
- A pelvic floor assessment includes a thorough history taking and evaluation of lumbopelvic function, abdominal stability and pelvic floor function which may include an internal examination. The goal of the assessment is to determine the cause of your incontinence or pain and which treatment would be most beneficial for you. Treatment may include education regarding normal bowel and bladder function (including dietary and lifestyle factors), pelvic floor muscle awareness and retraining exercises, manual therapy techniques, and myofascial trigger point and connective tissue treatment. Education about persistent pain may also be an important part of treatment as the pelvic area is often an area where we hold our stress.
- Best Evidence Guidelines (Cochrane, 2010) state that Pelvic Floor Physiotherapy (using internal examination to teach the exercises) should be the FIRST line of defence against all forms of stress, urge and mixed incontinence before surgical consultation. Your physiotherapist will work with you to achieve your goals and improve your quality of life.
- Acupuncture has a solid scientific basis; it has been proven to stimulate the endorphin system which can result in reduced pain and inflammation.
- The response rate to acupuncture treatment is high, especially for patients with pain of musculo-skeletal origin or headaches.
- The complication and side effect rate is extremely low. Physiotherapists who incorporate acupuncture in their practice must complete post-graduate clinical education through institutions recognized by their regulatory body.
- Following an assessment by your physiotherapist, treatment is tailored to your individual needs. Typically, fine needles are inserted through the skin and left in position briefly, sometimes with manual or electrical stimulation. The number of needles varies but may be only two or three.
- Physiotherapy plays a key role in the prevention, treatment and rehabilitation of sports injuries.
- A physiotherapist can help design safe and effective training and conditioning to maximize sport performance. We can also work with you to develop a regime that will prevent injury recurrence.
- Unfortunately injuries do happen; most sports injuries fall into the following categories:
- Sprains - tears to tendons or ligaments, usually in or around a joint.
- Strains - tears or ruptures in the muscle fibres.
- Contusions - swelling in soft tissue, usually as a result of a direct blow.
- Prompt care is imperative to a speedy recovery. If symptoms persist for more than 2-3 days, it is advisable to seek professional help.
- Although your primary goal may be pain relief, the injury may not be completely healed until flexibility, strength and function are restored.
- Radial Shockwave Therapy sends acoustic shock waves into soft tissue, breaking up scar tissue and essentially re-injuring the area on a cellular level. The controlled re-injury enhances blood flow and stimulates the immune system, allowing the body to heal an injury which had become chronic and stagnant. Radial shockwave is a stimulus for tissue remodelling, which is why it often succeeds when other treatment approaches have failed.
- The effect of the shockwaves is threefold: they stimulate a metabolic reaction; they generate cavitation bubbles that break down calcific deposits; they induce an analgesic effect by stimulating the brain’s gate-control mechanism, blocking pain signals.
Who can benefit from Radial Shockwave Therapy?
- The nature of Radial Shockwave treatment makes it ideally suited to those suffering with chronic muscle and tendon injuries or calcific tendinopathy. Research supports the use of Radial Shockwave Therapy to treat:
- plantar fasciitis/fasciosis
- lateral epicondylagia/tennis elbow
- golfer’s elbow
- calcific rotator cuff tendinopathy
- patellar tendinopathy
- gluteal tendinopathy/greater trochanteric pain syndrome
- Those who have not had success with other types of treatment are particularly good candidates for radial shockwave therapy.
What is a treatment like and what does it cost?
- A typical protocol involves 3 sessions each spaced 7-10 days apart. The treatment itself involves the application of a gel to the area to be treated to help conduct the acoustic waves into the tissue. The sensation of mild discomfort can be expected and treatments take anywhere from 5-10 minutes. Should they be needed, breaks can be taken whenever requested by the patient. Most patients describe the sensation as a “good hurt”, and it is well tolerated by all.
- A radial shockwave treatment protocol costs $475 and will be covered under physical therapy services of an extended health care plan. The maximal effect is not achieved until approximately 12 weeks after the initial treatment. Often pain is improved after the first session, however, this is not always the case. We encourage patients to have all 3 treatment sessions even if they are pain-free after their first session – the additional treatment ensures full healing and long term resolution of the issue. Even in the absence of pain, healing continues which is why the maximal effect is delayed for 12 weeks. If pain is not abolished after 12 weeks, a 4th session will be provided at no charge.
What does the research say about Radial Shockwave Therapy?
- The Swiss Dolorclast machine used at Lake Country Physiotherapy is the world’s most extensively researched radial shockwave delivery system. It remains the only approved unit covered by the National Health Services in the United Kingdom for shockwave treatment.
- International, peer-reviewed literature has demonstrated that radial shockwave therapy is a non-invasive therapeutic modality offering effectiveness, convenience and safety. It has the potential of replacing surgery in managing certain orthopeadic disorders without the surgical risks. The complication rates of radial shockwave therapy are low and negligible.
- A sample of the research demonstrating the effectiveness of Radial Shockwave Therapy:
- Gerdesmeyer L, Frey C, Vester J, Maier M, Weil L Jr, Weil L Sr, Russlies M, Stienstra J, Scurran B, Fedder K, Diehl P, Lohrer H, Henne M, Gollwitzer H. (2008).
Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis: results of a confirmatory randomized placebo-controlled multicenter study.
- American Journal of Sports Medicine; 36: 2100-2109
- Ibrahim Ibrahim M, Donatelli R, Schmitz C, Hellman M, Buxbaum F. (2010).
Successful treatment of chronic plantar fasciitis with two sessions of radial extracorporeal shock wave therapy.
- Foot and Ankle International; 31: 391-397
- Shaheen AAM. (2010).
Comparison of three different treatment protocols of low-energy radial extracorporeal shock wave therapy for management of chronic plantar fasciitis.
- Independent Journal of Physiotherapy and Occupational Therapy; 4: 8-12
- Rompe JD, Furia J, Maffulli N. (2009).
Eccentric loading versus eccentric loading plus shock-wave treatment for midportion Achilles tendinopathy: a randomized controlled trial.
- American Journal of Sports Medicine; 37: 463-470.
- Rompe JD, Furia J, Maffuli N. (2008).
Eccentric loading compared with shock wave treatment for chronic insertional Achilles tendinopathy. A randomized, controlled trial.
- Journal of Bone and Joint Surgery; 90: 52-61.
- Rompe JD, Segal NA, Cacchio A, Furia JP, Morral A, Maffulli N. (2009).
Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome.
- American Journal of Sports Medicine; 37: 1981-1990.
- Furia JP, Rompe JD, Maffulli N. (2009).
Low-energy extracorporeal shock wave therapy as a treatment for greater trochanter pain syndrome.
- American Journal of Sports Medicine; 37: 1806-1813.
- Cacchio A, Rompe JD, Furia JP, Susi P, Santilli V, De Paulis F. (2011).
Shockwave therapy for the treatment of chronic proximal hamstring tendinopathy in professional athletes.
- American Journal of Sports Medicine; 39: 146-153.
- Wang, CJ. (2012).
Extracorporeal shockwave therapy in musculoskeletal disorders.
- Journal of Orthopaedic Surgery and Research, 7:11
What is Gunn IMS?
- Hypersensitivity and muscle shortening cannot be operated on and ‘cut away,’ while ‘painkillers’ and other analgesic pills only mask the pain (often poorly) and promote toxicity, compounding the problem. Neuropathy only responds to a physical input of energy.
- Intramuscular Stimulation (IMS) is a total system for the diagnosis and treatment of myofascial pain syndromes (chronic pain conditions that occur in the musculoskeletal system when there is no obvious sign of injury or inflammation). IMS is grounded in Western Medical Science, and has a solid foundation in its radiculopathic model of pain, which is now supported by many experts in the field. It was developed by Dr. Gunn while he was a physician at the Worker's Compensation Board of British Columbia in the 70's, where he investigated the large number of mysteriously stubborn cases after frustration with the ineffective modalities at his disposal. The treatment, which utilizes acupuncture needles because they are the thinnest implements available that are designed to penetrate deep within muscle tissue, specifically targets injured muscles that have contracted and become shortened from distress.
- IMS relies heavily on a thorough physical examination of the patient by a competent practitioner, trained to recognize the physical signs of neuropathic pain. This physical examination is indispensable since chronic pain is often neurological as opposed to structural, and therefore, invisible to expensive X-rays, MRI Tests, Bone and CT Scans. Failure to recognize these signs will result in an inaccurate diagnosis, and thus, a poor starting point for physical therapy.
- The treatment involves dry needling of affected areas of the body without injecting any substance. The needle sites can be at the epicenter of taut, tender muscle bands, or they can be near the spine where the nerve root may have become irritated and supersensitive. Penetration of a normal muscle is painless; however, a shortened, supersensitive muscle will ‘grasp’ the needle in what can be described as a cramping sensation. The result is threefold. One, a stretch receptor in the muscle is stimulated, producing a reflex relaxation (lengthening). Two, the needle also causes a small injury that draws blood to the area, initiating the natural healing process. Three, the treatment creates an electrical potential in the muscle to make the nerve function normally again. The needle used in IMS, by stimulating muscle spindles, essentially becomes a specific and unique tool for the diagnosis of Neuropathic Muscle Pain.
- The goal of treatment is to release muscle shortening, which presses on and irritates the nerve. Supersensitive areas can be desensitized, and the persistent pull of shortened muscles can be released. IMS is very effective for releasing shortened muscles under contracture, thereby causing mechanical pain from muscle pull. IMS, in effect, treats the underlying neuropathic condition that causes the pain. When competently performed, IMS has a remarkable success rate, as proven by the amelioration of symptoms and signs, even for chronic back pain with root signs.
- IMS is comparable in some ways to acupuncture; however, there are a number of important differences. IMS requires a medical examination and diagnosis by a practitioner knowledgeable in anatomy, needles insertions are indicated by physical signs and not according to predefined, non-scientific meridians, while subjective and objective effects are usually experienced immediately.
What is Neuropathic Pain?
What is Neuropathic Pain?
- Often we treat pain without bothering with its definition. The majority of all pain patients recover quickly from their injuries; in fact, more than 90% will be fully functional within eight weeks simply because of the body’s ability to heal itself, regardless of treatment. However, it is the remaining people, who after months of persistent pain, become frustrated when medical examination does not yield a diagnosis and their doctors prescribe medications and therapies without producing lasting relief. The persistent physical discomfort of chronic pain can bring an individual to their emotional limit.
- Pain is an entity that is commonly misunderstood because medical diagnosis traditionally presumes that pain is only a signal of tissue injury conveyed to the central nervous system. However, there are actually
three distinct categories of pain: Nociception, Inflammation, and Neuropathy.
- Nociception: The immediate response conveyed to the brain, signaling tissue injury (noxious input). An example is the response from a slap to the skin.
- Inflammation: A local response to cellular injury resulting in redness, swelling, heat, pain and sometimes loss of function, and that serves as a mechanism initiating the elimination of noxious agents and facilitating the healing process.
- Neuropathy or Radiculopathic Pain: Ongoing pain with no obvious signs caused by a malfunction in the peripheral nervous system, leading to supersensitivity in the pain sensory system.
- Neuropathy is a relatively new word, specifically referring to any functional disturbances or pathological changes in the Peripheral Nervous System (PNS); though it is often used incorrectly to describe the nervous system as a whole. It is imperative to distinguish these entities as separate, since they show different outcomes and presentations. The CNS is well-protected by the skull and the spine, unlike the often overlooked PNS, which is much more vulnerable to damage and denotes the greatest number of chronic pain cases.
- Medical professionals are apt to treat pain in the first two categories, but are perplexed by pain that shows no sign of tissue damage or inflammation. Long-term pain can exist in ongoing nociception/inflammation such as a fracture or rheumatoid arthritis (treated with surgery or anti-inflammatory drugs), a psychogenic disorder such as clinical depression (treated with medication or counseling), or most commonly neuropathic pain (explained further below). Neuropathic pain has several indicators:
- There is pain in the absence of ongoing tissue damage.
- There is a delay in the onset of pain after a precipitating injury.
- Mild stimuli are very painful.
- There may be a stabbing component.
- Pronounced summation and after-reaction from stimuli (ie. the pain gets worse with exercise).
- This explains why you might feel fine immediately following a car accident, but a week later complain of whiplash. The most common cause of neuropathy is everyday wear and tear or overuse. The significance of this discovery is that disorders such as low back pain, whiplash, frozen shoulder, tennis elbow, fibromyalgia, myofascial pain, and Achilles tendinopathy are all physiologically the same.
- Graston Technique® is an innovative form of instrument-assisted soft tissue mobilization that enables clinicians to effectively break down scar tissue and fascial restrictions. The technique utilizes specially designed stainless steel instruments to specifically detect and effectively treat areas exhibiting soft tissue fibrosis or chronic inflammation.
- An emollient is placed on the skin in the area to be treated and each instrument employs a bevelled treatment edge. The treatment edge facilitates the breakdown of scar tissue and stimulates blood flow to the injured area, accelerating the natural healing process. There is some mis-information about Graston on the internet: the treatment is not painful and should not cause any bruising.
- Physiotherapists that are trained in Vestibular Rehabilitation are able to perform an evaluation enabling them to recognize common vestibular conditions and to provide treatment to effectively alleviate symptoms.
- Dizziness is a term used to describe everything from feeling faint or lightheaded to feeling weak or unsteady. Dizziness that creates the sense that you or your surroundings are spinning or moving is called vertigo.
- Dizziness is one of the most common reasons adults visit their doctors - right up there with back pain and headaches. Although it may be disabling and incapacitating, dizziness rarely signals a serious, life-threatening condition. Treatment of dizziness depends on the cause and your symptoms, but is usually effective.
- Lymphedema is swelling that occurs in any body area, but typically the extremities and is categorized as either a primary (no known cause) or a secondary lymphedema. Secondary lymphedema is caused by trauma or insult specifically to the lymphatic vessel system. This commonly occurs after surgery or radiation where the lymph nodes have been directly affected.
- Typically the lymph vessel system regulates and removes excessive fluid including waste products from the body. It returns a percentage of the fluid back to the blood stream. If the lymph vessels are disrupted, than a back up of fluid occurs, creating lymphedema.
- Lymphedema can cause pain, mobility restrictions, feelings of tightness or burning in the area, infection and thickening of the skin. A significant increase in the girth of the affected area will often occur as the condition progresses.
Combined Decongestive Therapy (CDT)
CDT is a combination treatment for lymphedema. It includes:
- A distinct massage technique that requires certified training to provide improved function of the lymphatic system to regulate body fluid. This technique can also encourage the use of alternate pathways to manage fluid when pre-existing pathways have been disrupted.
- Use of special bandages/garments to manage swelling.
- Teaching self-massage, skin care, use of bandages, and understanding the condition.
- Using appropriate exercise to fit an individuals needs.
- With a certified CDT therapist's help, the signs and symptoms of lymphedema can be managed well so that an individual with the diagnosis can live an active lifestyle.
- Physiotherapy can play a significant role in optimizing your ability to function after a neurological injury or after a diagnosis of a neurological disorder. Neurological Rehabilitation can benefit those who have sustained a neurological injury (such as a stroke, traumatic/acquired brain injury or spinal cord injury) or have been diagnosed with a neurological disorder (such as Cerebral Palsy, Multiple Sclerosis, Parkinson’s Disease or Post-Polio Syndrome). As with all services provided at Lake Country Physiotherapy, treatment will be goal-centered; this is especially important after a neurological injury as your brain is the control centre for your body. Treatment sessions will be longer to allow adequate time to treat the neuromuscular system, and to accommodate for the cognitive and emotional changes that can often occur alongside the physical changes that you are seeking treatment for.
- A Neuro-Developmental Treatment (NDT) trained physiotherapist has an understanding of typical and atypical development and movement patterns. A physiotherapist with NDT training will use a problem-solving approach to assess activity and participation to identify and prioritize relevant impairments to establish achievable outcomes and goals. Specific therapeutic handling techniques will be used during assessment and treatment in order to achieve participation in meaningful activities. Most importantly, neurological rehabilitation focuses on functional training; while treatment with your therapist will focus on specific skills and tasks, practicing these skills within safe and enjoyable activities outside of your treatment time will maximize the benefits achieved in your therapy sessions.
- Concussion is a form of brain injury caused by a force directed to the body, head, face or jaw causing changes in brain function. Concussion symptoms are varied and can be effectively treated by a physiotherapist who will tailor treatment to an individual with the goal of return to sport and activities of daily living.
- Ideally, athletes undergo baseline testing so that if they sustain a concussion there is a baseline for comparison. Baseline testing, as well as post-concussion assessment, involves neurocognitive testing, balance testing and oculomotor testing. Neurocognitive testing measures memory, reaction time, attention span and problem solving. These measures allows the physiotherapist to track an athlete’s recovery while providing a measurement of readiness for return-to-play.
- Treatment of concussion by your physiotherapist will include education, exercise, home instruction on academic/workplace accommodations and resting strategies. Additionally, manual therapy and physical rehabilitation are often required for the treatment of concurrent musculoskeletal injuries. Timely treatment of concussion is essential not only for successful return to sport or activities of daily life, but also in the prevention of Post Concussion Syndrome and Second Impact Syndrome.
- If you or a loved one have sustained a concussion, or are involved in activities that may place you as risk for a concussive injury, contact Lake Country Physiotherapy to schedule an assessment.
- If you are involved in a sports team in Simcoe County and the surrounding area, and are interested in opportunities for your team regarding concussion management, please contact us at firstname.lastname@example.org for more information.
- At Lake Country Physiotherapy, several of our therapists are trained in the fitting of custom orthotics. An orthotic is a custom-made three-dimensional insert that is placed in your shoe to help relieve the pain and discomfort caused by lower extremity and lower back dysfunction. Depending on an individual’s needs, orthotics can serve many purposes: decrease high-pressure areas, stabilize foot alignment and improve the mechanics and efficiency of the lower extremity.
- A fitting will take approximately one hour and involves detailed measurements of the feet and lower extremity, gait analysis and finally a casting of both feet. One can expect a pair of custom orthotics to last for a minimum of 2 years and depending on wear and tear, considerably longer.
For more information or to book an appointment:
Address: 7 Progress Drive,
Orillia Ontario, L3V 6C9
Hours: Monday to Thursday 7:30am to 7:30pm
Friday 7:30am to 4:30pm