Back pain can develop over months or years and is often triggered by an activity.  I get to the root cause of your problem rather than just treating the symptoms.

After an extensive assessment, I will discuss treatment options which may be a combination of manual techniques / acupuncture / dry needling / soft tissue massage and very specific exercises for your condition which may include McKenzie (MDT).  I will provide education on your condition and strategies to stop it re-occurring or manage it.

Once you are moving pain free, I start an extensive strengthening program which addresses key muscles.  You will receive access to a state-of-the-art app with your tailored exercise program to use at home.

Neck pain can develop for many reasons including bad posture, a slip or fall, stress, inactivity, post sleeping, whiplash/car accident (MVA), age related changes or no injury at all.  It can begin suddenly or develop over a period of time.  It can feel like your neck will never be able to move again and you experience neck pain every time you try to turn your head.

You may even feel pain into your shoulder or your arm/hands.  One hand may even feel cold or have pins and needles. This is a common thing to happen and is simply the muscles in your neck tightening up (muscle spasm) and becoming sensitive protecting the area. In some cases, this may also affect the nerves in your neck sending pain into the shoulder, arms and hands. Neck Pain can be treated by your physiotherapist with a range of techniques including:

• McKenzie Technique
• Joint mobilizations
  
• soft tissue massage
  
• acupuncture/dry needling
• hot/cold therapy,
  
• posture & sleeping advice.
  

A physiotherapist will firstly carry out an extensive assessment to distinguish a simple mechanical neck issue, disc issue, nerve entrapment from more serious conditions such as a fracture.

Neck pain from poor posture (working on a computer, or occupational)

Postural neck pain is often slow onset and vague description, ranging over an area of the body, usually the neck, shoulders, shoulder blade, and upper back to occasionally the arms, elbows, and hands.  It is often worse after an aggravating prolonged posture such as sitting at your computer/ desk all day, every day for months/years or after driving for a long time when not use to it. 

A forward head posture (poking of your chin forward when working and a collapsed core can also contribute to many other issues such as headaches, migraine, dizziness, shoulder and rotator cuff issues, TMJ (jaw pain), lower back pain, upper back pain, radiating arm pain, carpal tunnel syndrome, tennis elbow, degenerative joint and/or disc disease. Simply trying to sit up tall and pull your shoulders back does not fix postural neck pain.

There are many muscle and joint issues during and after pregnancy, Pelvic girdle pain is the most common. Symptoms range from mild to severe, vary from person to person and often worsen with straining, lifting twisting, or changing positions. Pain can be felt:

• At the back of the pelvis over the sacrum.
• At the front of the pelvis over the pubis bone
•  Into the heroin, perineum and buttocks

Pain can start anytime during pregnancy or labour and can last well after delivery. Aside from pelvic pain many women also suffer dyspareunia (painful intercourse).

Causes of pelvic girdle pain

In the past, women were told stretched ligaments, pinched nerves or altered hormones were to blame, and pain would go away as soon as the baby is born. Many experts now recognize this is not true. While causes of pregnancy-related pelvic girdle pain are not well understood, the possibilities include:

• Lax ligaments due to hormonal changes in pregnancy
• Over-active or under-active pelvic and abdominal muscles
• Stress on the joints, muscles and ligaments during and after pregnancy
• Trauma to the pelvis and pelvic muscles during labour
• Genetically lax or loose joints

How physiotherapists help

While all physiotherapists can help women with pregnancy-related pelvic pain, Alberta has a number of physiotherapists experienced in women's/ pelvic health and pregnancy related pelvic issues.

The treatment approach will vary depending on the cause but individualized supervised treatment is preferable to more general pelvic pain therapies. Treatment may include one or all of the following:

• Education about postures, positioning and lifting during or after pregnancy
• Use of sacral belts or tape to support the pelvic girdle
• Manual therapy to restore normal joint and soft tissue movement
• Targeted pelvic or care muscle exercises to improve the control, endurance and strength to the core pelvic muscles
• Breathing techniques and targeted exercises to relax pelvic muscles that may be overactive. Modalities (e.g.,. acupuncture, electrical stimulation) for pain control or muscle relaxation

Your physiotherapist will:

• Take a detailed history
• Screen for medical conditions requiring medical follow-up
• Perform a detailed examination of joints and muscles affecting the Pelvis
• Watch how you walk, sit, stand, bend and move.

Source:  Physiotherapy Alberta College + Association

Vertigo is a type of dizziness where you feel like the world is spinning. Nausea and vomiting are common and you may feel unsteady. Often vertigo is eased by lying down and made worse by sitting up or moving. It's not the same as simply feeling faint, dizzy or lightheaded when getting up, Vertigo can be very disabling.  

Causes of vertigo

Vertigo can have many causes. The most common is from a disturbance of the vestibular system, the part of the inner ear and brain that controls balance and maintains eye focus during movement. Special sensors in the inner ear send messages back to the brain that help you maintain balance and focus.

Common causes for vestibular system problems include:

• illness or disease
• aging
• certain medications
• stroke and/or brain injury
  
• head trauma (e.g., car accidents, falls, impact sports)
• ear Infections (neuritis, labyrinthitis)
  

How physiotherapists help

Physiotherapists are specifically trained to assess and treat vestibular problems and are highly skilled at treating vertigo. Research demonstrates vestibular rehabilitation improves balance, decreases dizziness vertigo symptoms and increases general activity levels.

Getting an accurate diagnosis is important for effective treatment. If your condition is suitable for vestibular rehabilitation, a physiotherapist may include one or all of the following:

• Balance retraining exercises
• Specific exercises for the vestibular system
• Special repositioning maneuver for vertigo caused by the crystals in the inner car becoming stuck
  
• Challenges to the vestibular, visual and balance systems
• Home program of individualized vestibular exercises
  

Your physiotherapist will:

• Take a careful history to determine the type of vertigo
• Screen for conditions requiring medical follow up
• Assess your balance and Coordination
• Complete a full examination of your nervous system
• Test your vestibular system using special eye and head movement testing   
  

Often Improvement or complete resolution of symptoms can be achieved within six to eight weeks.

Source:  Physiotherapy Alberta College + Association

Whiplash is the term used to describe neck pain and injury after an accident. It's actually the spraining of your neck's soft tissues ligaments, tendons, muscles, discs, and small joints and can occur in car accidents, sporting activities and accidental falls. Symptoms can include neck pain, stiffness and headaches and sometimes radiating pain to the shoulder blades and arms.

The amount of pain and stiffness varies between people and the type of injury. Turning your head or looking up (eg., driving working at a computer can all be painful and restricted.

Causes of whiplash

Whiplash is caused by a sudden violent jerking of the neck. Experts agree that whiplash causes injury to the muscles, ligaments, tendons, discs, and small joints of the spine. Fortunately most whiplash injuries aren't serious and often recover in a few weeks, Small percentage of people can have persisting symptoms that last several months but more serious injuries (eg,. fractures, nerve injuries) are not common.

How physiotherapists help

Physiotherapists are highly skilled at examining and treating whiplash Research shows that getting your neck moving soon after the injury speeds up Recovery. Rest can cause more stiffness, increased muscle weakness and delayed recovery. Physiotherapists can help you improve your neck’s strength and movement. Treatment may include:

• Education on posture and positioning to manage pain
  
• Specific exercises to reduce pain, restore mobility and strength
  
• Manual therapy treatments to reduce pain, restore mobility
• Modalities (eg, acupuncture, electrical simulation, heat, cold) for temporary pain relief
• A rehabilitation program to safely prepare you for return to normal activity, sport or work
  

Your physiotherapist will:

• Ask questions and observe how your neck is aligned, moves and where it hurts
  
• Screen out more serious injuries that require medical follow-up
  
• Examine the area, test range of motion, muscle strength, and perform special tests that assess nerve function
  
• Develop a treatment plan tailored to you, depending on the situation and time since the accident
  

Source: Physiotherapy Alberta College +  Association

Shoulder pain is a common condition. Symptoms vary from person to person but generally include:

• Pain in your shoulder and upper arm
• Difficulty raising your arm and reaching overhead
  
• Inability to carry objects or use your arm normally
• Difficulty sleeping and lying on your shoulder  
  

Causes of shoulder pain

Many factors can contribute to the development of shoulder pain. Often it is not a single factor but a combination of the following:

• Age
• Injury or trauma
  
• Repetitive overhead activities (eg., swimming, baseball, occupation)
• Weak muscles or muscle imbalances  
  

Some of the more common conditions include:

• Rotator cuff tendonitis (inflammation of the rotator cuff tendons)
• Rotator cuff tear (tearing to the rotator cuff tendons)
• Shoulder instability (looseness of the shoulder joint) - Frozen shoulder pain and stiffness
• Impingement (pinching of the shoulder tendons and soft tissues) 
  

How physiotherapists help

Getting an accurate diagnosis and identifying the contributing factors is key to effective treatment. Physiotherapists are highly skilled at assessing people with various types of shoulder pain. Physiotherapists can determine the best treatment for your condition, Generally, they prescribe:

• Mobility exercises to increase shoulder movement
• Specific exercise to improve shoulder muscle control
• Manual therapy to increase movement of stiff shoulders
• Education on activities to continue or reduce
• Modalities for pain control

Your physiotherapist will:

• Assess and determine the cause of your pain
• Screen out serious conditions requiring medical follow-up
• Examine your strength and how you move your shoulder
• Apply special tests to isolate the problem
• Determine if your posture, work or sporting activities contribute to the problem  
  

For most shoulder conditions, there is no Quick fix. Progress often takes several weeks.

Source:  Physiotherapy Alberta College + Association

Frozen shoulder is a common condition where you lose the ability to move your shoulder in all directions. Your shoulder freezes.  Reaching overhead, behind your back or to the side becomes restricted and painful. Most of the time, frozen shoulder gets better but some people are left
with permanent stiffness.

Frozen shoulder has three stages:

• Painful stage. Pain is present most or all of the time. Sleeping is difficult and all movements aggravate the pain. Usually lasts three to six months, sometimes more.
• Frozen stage. Pain lessens but shoulder continues to stiffen. Can last up to 12 months.
• Recovery stage. Pain goes away and shoulder movements begin to come back. Can last up to 24 months.

Causes of frozen shoulder

Normally, tissues around the shoulder joint are well lubricated and able to stretch so your arm moves easily in all directions. If these tissues become inflamed, they shorten, lose their stretch and cause the shoulder to stiffen.

There are two causes of frozen shoulder:

• Pain and stiffness start gradually without any obvious cause. Women over 40 with a history of diabetes or thyroid problems are at greater risk.
• After an injury or following surgery where the shoulder is kept still for a long time (e.g. in a sling).

How physiotherapists help

Physiotherapists are highly skilled at assessing and treating people with frozen shoulder. Physiotherapists can conduct a thorough examination to determine if you have frozen shoulder and what stage it's in. It is important to understand the stage as treatment differs for each stage.
Pushing the movement too early can worsen the pain, not pushing enough can lead to more stiffness. Physiotherapists can tell you how much to push.

Your physiotherapist will:

• Focus on pain control in the painful stage (eg., gentle exercises, treatments to gently stretch the joint, work with your doctor to get something for pain/relax tight muscles)
• Focus on range of motion in the frozen stage (e.g., strengthening exercises, manual therapy)
• Focus on exercises and rehabilitation in the recovery stage to restore range of motion and function

Recovery takes time and success depends upon participation in the treatment plan provided by your physiotherapist.

Source: Physiotherapy Alberta College + Association

The largest joint in your body is your knee.  It consists of the femur (thigh bone), the tibia (shin bone), the patella (knee cap).  It is supported by ligaments, interarticular cartilage and a collection of muscles.  The knee joint is one of your most complex joints and there are many reasons why you may be experiencing knee pain.

How do Physiotherapists treat knee pain?

Treatment for knee pain will involve carrying out an extensive assessment of your knee moments, biomechanical movements of your body, detecting positions and activities that trigger pain, assessing for muscle imbalances, muscle tightness and muscle weaknesses.  Once the correct diagnosis has been made, hands on treatments may be carried out dependent on your presenting symptoms, including:

• dry needling / acupuncture
• soft tissue massage
• mobilizations
• McKenzies technique (MDT)
• Electrotherapy
• McConnell taping
• Specific exercises to address any muscle imbalances, weakness

Some common knee conditions

This is a list of the most common injuries involving the knee. Please remember that this list is not exhaustive and that, in many cases, pain does not just involve one particular structure it may be a combination and may even include your spine.

• Osteoarthritis
• Rheumatoid arthritis
• Gout and Pseudogout
• Dislocations
• Meniscal sprains, strains and tears
• Tendonitis also now known as a Tendinopathy
• Anterior Cruciate Ligament (ACL) injuries
• Posterior Cruciate Ligament (PCL) injuries
• Medial Collateral Ligament (MCL) injuries
• Lateral Collateral Ligament (LCL) injuries
• Fat pad irritation
• Bursitis
• Baker’s Cyst
• Patellofemoral joint pain/runners’ knee
• Iliotibial band pain (ITB)
• Chondromalacia patellae
• Osgood Schlatters
• Fractures
• Radicular pain (pain referring from your back)

The foot and ankle is a complex system consisting of 28 bones, 33 joints and 112 ligaments. It is controlled by 34 muscles, 21 intrinsic muscles, which are in the foot and 13 which are extrinsic. The foot consists of three sections, the rearfoot, midfoot and forefoot.

How do Physiotherapists treat foot and ankle pain?

Treatment for foot and ankle pain involves carrying out an extensive assessment of your ankle and foot moments, bio-mechanical movements of your body, detecting positions and activities that trigger pain, assessing for areas that are painful, muscle imbalances, muscle tightness and muscle weaknesses.  They will also rule out any red flags which may indicate you need to be referred for further investigations.

Once the correct diagnosis has been made, hands on treatments may be carried out dependent on your presenting symptoms, including:

• dry needling / acupuncture
• soft tissue massage
• mobilizations
• McKenzies technique (MDT)
• Electrotherapy
• McConnell taping
• Specific exercises to address any muscle imbalances, weakness, reduction in movement
• Balance re-training

Common conditions of the foot and ankle

The ankle and foot are designed for weight bearing, stability and balance with walking and running as their main functions. They bear the full weight of the body and manage tasks such as sudden change of direction in sports like football and rugby, jumping and landing in sports like basketball and netball. They also provide proprioceptive feedback to the brain and the vestibular system which controls your balance.  Injuries and pain in the foot and ankle may include:

• Ankle sprains
• Achilles tendinopathy / tendinitis
• Plantar fasciopathy / fasciitis
• Plantar heel spurs
• Retrocalcaneal bursitis
• Metatarsalgia
• Fractures
• Stress fractures
• Ligament tears
• Nerve injuries and Morton’s Neuroma
• Turf toe
• Bunions
• Foot and ankle osteoarthritis
• Rheumatoid arthritis

This section is under development.  Please visit us again in the future.

Osteoporosis affects over 2 million Canadians; it can affect you at any age but predominantly over 50’s.  It is characterized by low bone mass and deterioration of bone tissue, which can lead to increased risk of fracture. Known as the “silent thief”, bone deterioration can occur over a number of years without any symptoms.

Unfortunately, by the time affected bones break or fracture, the disease is already fairly advanced and less treatable. The most common fractures associated with osteoporosis are in the hip, spine, wrist, and shoulder.

How can physiotherapy help with Osteoporosis?

Treatment for osteoporosis involves carrying out an extensive assessment of your medical history, the way you move your body, detecting positions and activities that trigger pain, assessing for areas that are painful, muscle imbalances, muscle tightness and muscle weaknesses.  They will also rule out any red flags which may indicate you need to be referred for further investigations.

They will then provide you with specific exercises tailored to your condition to help you strengthen your bones, your muscles,  improve your posture and balance. This can prevent further bone thinning, reduce falls and help you manage any pain.  They will also advise on strategies to manage your condition, any pain and help you become more active.

Bone is a living tissue that can be improved through some types of exercise. A physiotherapist will work with you to find activities that suit your needs and that will strengthen your bones.

Some patients may experience a compression fracture or multiple compression fractures of the spine, where bones in the spine collapse, these can produce pain. Physiotherapy can help you to manage this pain and teach you safe exercises and strategies for dealing with activities of daily living while you are healing.  You will need to be cleared by your family doctor before treatment can commence.

Osteoporosis is more common in older people and often the reason why they fall. Falling is a common problem for people aged 65 and over. If you are at risk of falling, a physio can help you improve your balance.  Osteoporosis can also develop in younger patients, if you have recently had a number of fractures from minor falls or running it may be worth seeing your doctor for a bone density scan.

Source:  Osteoporosis Canada

You have been rear-ended by another car. You felt fine at the time, but the next day your neck was quite sore and tight when you woke up. You talked to your neighbor who said they thought you might have whiplash.

What is whiplash?

The term “whiplash” is often used to describe neck or shoulder injuries and pain following a car crash. Whiplash injuries occur when the head is rapidly moved forward and then backward. This motion can cause injury to the soft tissues (muscles, ligaments and tendons) and the bony structures (joints and vertebra) in the neck, back, and around the shoulders.

Most often we relate whiplash to a car crash, but it can occur from falls, sports, or fun activities such as roller coaster rides. You may also hear the injury referred to as a “WAD injury” by physiotherapists or other health-care workers. Whiplash-associated disorder (WAD) is the term given for the collection of symptoms affecting the neck that are triggered by a car crash. 

These different symptoms may include neck or back pain and stiffness, numbness or tingling in the arms, shoulder pain, dizziness, and headaches. You may also hear that you have been diagnosed with a WAD I, II or III injury. These numbers relate to the degree of injury experienced. WAD I and WAD II injuries relate to different degrees of injury to muscles, ligaments and joints. People diagnosed with WAD III injuries have symptoms that come from nerve injuries. WAD I and II injuries are the most common types of WAD injuries.

What should you do first?

Go to see your physiotherapist, doctor or other health-care provider for an assessment within 10 days of the crash.  Early treatment has been shown to prevent or reduce long-term issues. Research also suggests that most recovery occurs within the first two to three months after your injury.  Your physiotherapist will do an assessment to rule out any serious injury to the neck or back. This is done by taking a thorough history, completing a physical assessment, and asking standard questions that can direct the physiotherapist towards the best treatment path or identify if further assessment is needed.

Do I need approval from my insurance company before I can start treatment?

No. The Alberta Diagnostic and Treatment Protocols are rules that apply to WAD I and II injuries caused by car crashes in Alberta. The protocols outline treatment parameters for the different types of WAD injuries and are designed to prevent delays to accessing treatment. You do not have to get insurance approval to start treatment under these protocols.

Why did I not get sent for an x-ray?

If you show signs of a serious nerve injury or broken bone, your health-care provider may order an x-ray, but in most cases an x-ray is not necessary. Most often WAD injuries impact soft tissues rather than bony tissue and don’t show on an x-ray. In fact, the x-ray reports may confuse the picture as unrelated changes due to aging and overuse or past injury may be present. Don’t forget that x-rays expose you to potentially harmful radiation and should only be done if there are reasons to suspect nerve or bone injury.

I need a collar, right?

In the past, the usual advice was to rest and take anti-inflammatory medication. Often people would also be given a soft neck collar as well. However, over the last decade it has been shown that limiting the movement of the neck following injury is not effective and may in fact prevent good recovery of normal function.  Using a collar leads to decreased neck movement, the tendency to not participate in normal activity and an overall sense of being hurt. For these reasons, collars are usually not recommended.

OK, so I don’t need an x-ray or a collar, what should I do?

In Alberta, the Diagnostic and Treatment Protocols guide the actions of physiotherapists and other health-care providers who provide care to people injured in car crashes.  The treatment protocols were developed based on research about WAD injuries and recovery from them. They are used to guide treatment provided by all practitioners treating patients under insurance claims.

The severity of the injury is identified and the treatment plans developed with you, the client. Research suggests that “acting as usual” and participating in active exercise are the most effective treatment choices for the treatment of whiplash injury.  Acting as usual means that you should return to your normal daily activities as soon as you are able to within your pain tolerance. This includes activities around the home, work activities and normal leisure activities. It probably does not mean doing all your spring cleaning, window washing and yard work in one weekend. Nor does it mean starting a new high-intensity aerobics class or going mountain climbing until your pain and symptoms have settled down and your physiotherapist recommends it.

Active exercises are more effective in reducing pain and improving function especially when started within 96 hours of the injury.  Active exercises include exercises to move your neck, exercises to work on posture and the muscles that control your posture as well as general exercises to strengthen the muscles around your neck and back.

Your physiotherapist will provide you with an exercise program that fits your needs and abilities. Always remember the following advice: When you are performing the exercises, stop and contact your doctor or physiotherapist if you notice:

• dizziness, light headedness, blurred vision, fainting or disorientation
• sudden pain shooting down your arm, or numbness or weakness in your arm or hand
  
• unusually severe neck pain
  
• exercises consistently produce a headache, which persists.
  

Your physiotherapist will also provide you with information about what to expect throughout your recovery. Some key points include:

• Pain and stiffness are a normal reaction to being hurt
• Maintaining normal life activities is important to get better
• Staying active is important in the recovery process
• Choosing to limit your activity may cause a delay in recovery
• It is important to focus on improvements in function
  

The Diagnostic and Treatment Protocols were developed so that patients can access immediate, appropriate care without financial barrier. However, you must see your health-care provider within 10 days to be assessed to be covered.

Source:  Physiotherapy Alberta + College Association

Sports injuries can develop from over-training, lack of conditioning, improper form or technique, failing to warm up, slips or falls, collisions, bad posture, muscle imbalances to poor equipment. Sports injuries may consist of anything from bruises, strains, sprains, tears, ruptures, dislocations to stress fractures or broken bones.   Soft tissues like muscles, ligaments, tendons, fascia, and bursae may be affected or the brain from mild concussion to a traumatic brain injury (TBI).

Physiotherapist are highly trained in assessing and treating sports injuries.  Over my career I have worked with may elite athletes, professional sports teams, dancers and musicians as well as recreational athletes.   In order to address their injuries successfully I will:

• carry out a detailed assessment to find the root cause of the problem
• use treatment techniques as appropriate for your injury presentation
• provide a specific exercise program to address the problem
• provide strategies to stop re-occurrence of the issue eg advise on technique, training, equipment, posture etc.  
  

A selection of sports injuries I treat:

• Knee pain and ruptures
• Groin pain
• Hip pain
• Bursitis
• Tennis elbow/golfer’s elbow
• Plantar fasciitis
• Shin splints/shin pain
• Stress fractures
• Bunions
• Sprains and strains
• Tendonitis
  
• Concussion
• Shoulder injuries
• Ankle injuries
• Wrist injuries
  
• Hamstring tears/ruptures
• Achilles pain/ruptures
• Foot pain
• Back pain/neck pain

Treatments that may be used:

• dry needling / acupuncture
• soft tissue massage
• mobilizations
• McKenzies technique (MDT)
  
• Electrotherapy
• McConnell taping

This section is under development.  Please visit us again in the future.

This section is under development.  Please visit us again in the future.

Tendonitis is a common sports Injury but can also result from work or recreational activities.  It is commonly referred to as an overuse or repetitive strain injury and can happen to any tendon tissue that attaches your muscles to your bones).

Common types of tendonitis occur at the:

• Elbow (tennis/golfers' elbow)
• Shoulder rotator cuff tendonitis)
• Knee (patellar tendonitis)
  
• Achilles tendon (achilles tendonitis)
  

Tendonitis causes pain and loss of function in the affected area. Typically, it starts with a pain that only occurs when using the area and quickly goes away with rest. Left untreated the condition can get worse until pain persists even with rest.

Causes of Tendonitis

Tendonitis was once thought to be caused by inflammation, but the latest research shows it more likely results from a break down in the tendon tissue. That's why treatment only focusing on reducing Inflammation (e.g.. rest, ice, medications) only provides temporary relief. Repetitive activity e.g.,... jumping, forceful gripping is thought to overload the tendon and break down the tissues. This results in pain and difficulty using the affected area.

Many factors contribute to developing tendonitis including:

• Muscle weakness or imbalance
• Poor coordination of movement
• Stiff Joints
• Working in awkward postures
• Poor work, leisure or sports techniques

How physiotherapists help

Physiotherapists provide effective treatment for various types of tendonitis. Physiotherapists can identify what is causing the problem and provide suggestions to avoid re-injury. Although its sounds like the wrong thing to do, research shows specific exercises for the tendon helps stimulate the tendon's internal repair system and restore strength and flexibility. Not any exercise will work. Programs must be specifically tailored to your problem. Treatment is not a quick fix because it takes time to build strength and flexibility and restore function.

Your physiotherapist will:

• Examine and assess the tendon causing the problem
• Assess if posture, muscle tightness, joint stiffness, or activities contribute to the problem
• Develop a customized treatment plan that considers how easily your pain is aggravated
• Provide a specific stretching and strengthening program to gradually and safely restore the tendon's strength and flexibility

Source:  Physiotherapy Alberta College + Association

Carpal tunnel syndrome is a common, painful and sometimes disabling condition of the hand and wrist. Symptoms can include pain and pins-and-needles in the thumb, index and middle fingers, Night pain and discomfort are common and more severe cases may cause weakness in the hand muscles making it difficult to grip.

Causes of carpal tunnel

Carpal tunnel syndrome can be difficult to diagnose because other conditions can cause similar symptoms (eg., tendonitis, neck pain). Symptoms start when the median nerve gets squeezed as it runs through the wrist's carpal tunnel. The carpal tunnel is a narrow tunnel just big enough to fit all the tendons, nerves and blood vessels that run into your hand, Postures or conditions that narrow or use extra space in the tunnel can squeeze the median nerve. Many factors can cause this narrowing reduced space) and often a single specific cause is difficult to identity. It may be caused by a combination of:

• Swelling (e.g., inflammatory arthritis, tendonitis, thyroid conditions, pregnancy, hormonal conditions) Body factors (eg., excess body fat, a wrist fracture, genetics)
• Postures or physical activities (e. forceful gripping.
• Working with awkward wrist postures, exposure to vibrating hand tools)

How physiotherapists help

Physiotherapists are highly skilled at assessing and treating people with carpal tunnel. Physiotherapists can make sure the problem is from your carpal tunnel and will examine your neck, shoulder, wrist and hand. Effective treatment requires an accurate diagnosis and understanding the underlying causes. Physiotherapists can:

• Help reduce pressure or inflammation, pain and weakness in your hand, wrist or arm
  
• Determine if a wrist brace is appropriate Provide a specific program to improve function and get you using your wrist
  
• Teach you effective stretching exercises to prevent or minimize future flare-ups
  
• Provide specific advice on returning to work and/or normal activities
  

Your physiotherapist will:

• Assess and determine If your symptoms are caused by median nerve dysfunction
  
• Help identify if the things you are doing at work or home contribute to the symptoms
• Work with your doctor if medical testing is needed
  

Source: Physiotherapy Alberta Collage + Associates.

This section is under development.  Please visit us again in the future.

What is temporomandibular dysfunction (TMD)?

TMD describes problems including pain in the jaw muscles or joint, decreased movement (limited mouth opening), catching or locking of the jaw, and joint noises.

TMD can also be associated with headaches and pain with chewing. Occasionally, people also notice changes in their bite related to TMD. Though jaw noises are often associated with TMD, joint noises themselves do not typically cause pain or limited movement and do not require treatment unless accompanied by other problems like pain or loss of movement.

TMD can also be associated with other head and neck problems such as headache, ear pain or neck problems. TMD occurs at a higher frequency among patients who have experienced a whiplash injury.

Why does TMD occur?

Why people develop TMD aren’t entirely clear.  Contributing causes may include a history of injury or trauma (such as a direct injury to the jaw or even a motor vehicle accident), emotional stress, neck problems and chronic pain conditions. Non-traumatic TMD may relate to a repetitive movement disorder or arthritis in the joint. Other contributing factors include habits such as teeth clenching and grinding and gum chewing. Bite issues have been suggested as another potential cause of TMD.

What treatments are offered?

The goals of physiotherapy treatment in TMD are to reduce pain and inflammation of the temporomandibular joint (TMJ), and to improve TMJ movement and function. Treatment focuses on both the TMJ and other body parts that are contributing to the problem. Physiotherapists treat TMD using exercises including:

• Jaw movements and posture correction
• Manual therapy including soft tissue release (massage), joint mobilizations and stretching
• Modalities such as laser and ultrasound
• Other treatments such as relaxation training and biofeedback
  

Patient education focuses on changing habits such as altering the resting position of the jaw, avoiding daytime teeth clenching and gum chewing, and modifying food textures to avoid eating hard or chewy food. Some physiotherapists also use acupuncture or other dry needling techniques to treat TMJ pain.

Dental splints, most commonly used while sleeping, may also be prescribed by dentists to help prevent the negative side effects of clenching and grinding of the teeth.

Who’s on the team to manage TMJ?

A multidisciplinary team of physiotherapists, dentists, psychologists, and physicians (and occasionally orthodontists) may be involved to help manage TMD symptoms. If you have TMD, it is recommended that you look for physiotherapists and dentists with experience and a special interest in treating this problem.

Arthritis is the name for a group of conditions that damage joints causing pain, stiffness and reduced mobility. It affects 34% of Albertans and nearly four million Canadians 15 years and older - almost one in six people.

Arthritis isn't just an older person's disease; it can affect children and people in the prime of life. Arthritis can be relatively mild or very severe, but common symptoms include:

• Joint swelling
• Muscle weakness
• Joint stiffness or reduced movement
• Reduced function

Causes of Arthritis

Arthritis is the thinning or destruction of joint cartilage caused by inflammation or excessive wear and tear. There are over 100 different types of arthritis, common forms are:

• Osteoarthritis (usually affects hands and weight-bearing joints like hips, knees, feet, and spine)    
  
• Rheumatoid arthritis (can affect all joints in the body)
• Gout (affects the foot)
  

There are many possible contributing factors for arthritis including:

• Genetics or inheritance
• Weight
• Previous injury or fracture
  
• Infection
  
• Overactive immune system
  

How physiotherapists help

Physiotherapists are highly skilled at assessing how arthritis affects joint movement, muscle strength and physical function.  Research demonstrates that specific exercises targeted at improving joint mobility and increasing muscle strength help manage arthritis and improve function.

Your physiotherapist will:

• Assess the affected area and ask about daily activities to determine the impact on your joints
  
• Develop a treatment plan to safely improve or restore movement and mobility affected by arthritis
• Help you manage your condition through education and treatment to reduce pain and swelling, strengthen muscles and increase joint mobility without worsening your arthritis symptoms

Source:  Physiotherapy Alberta College + Association

Chronic pain is pain that persists for more than three to six months. It usually develops after a minor injury or illness. Instead of getting better over time, the pain often increases, long after the initial injury or illness has healed. It becomes difficult to move, work and enjoy a normal life.

Chronic pain sufferers often become depressed and isolated and develop a sense of frustration and helplessness. It's estimated up to 15% of Canadians suffer from chronic pain.

Causes of chronic pain

Chronic pain is different from the short-lasting acute pain that occurs after an injury. Treatments that normally work for acute pain don't often work for chronic pain. That's because the pain is no longer coming from the injured area but instead from how the brain and body senses pain.

In chronic pain, the body's nerves and brain rewire themselves to become supersensitive to normal things like touch and movement. This makes simple everyday tasks like getting out of bed, walking and sitting very painful. Emotional stimulus such as stress and anxiety increase the pain by producing chemicals that make the body and brain sensors even more sensitive. As yet, there is no cure, but new research shows a combination of medication management, graduated physical activity, education, and strategies to control stress can all help manage the pain.

How physiotherapists help

Effective management of chronic pain requires a team of health providers working together to:

• Help you understand chronic pain
• Help you take back control and better manage your pain
• Improve your physical function and mobility
• Get you back to a better quality of life

Physiotherapists are highly skilled at assessing how the pain affects your ability to move and will help find ways to get you moving again. Research shows physical activity is an important strategy to manage chronic pain. Physiotherapists can work with you to set up a realistic program that is safe to perform.

Your physiotherapist will:

• Help you unlearn some of the abnormal postures and movements your body may have adopted to guard the pain
• Teach you how to move again
• Develop a safe but effective exercise program
• Assess what specific treatments (e.g., manual therapy, modalities, acupuncture) will help  
  

Source:  Physiotherapy Alberta + College Association

Multiple sclerosis (MS) is an unpredictable and often disabling neurological condition. Canada has one of the highest rates of MS in the world, with 133 out of every 100,000 people affected. The disease is commonly first diagnosed in younger adults, and woman are three times more they to develop MS than men.

Symptoms are unpredictable and vary from person to person, MS symptoms can be confusing and can include vision problems, dizziness, tremors, muscle-related symptoms, pain, fatigue, sensory and cognitive problems. People with MS can have one or many symptoms and these symptoms can improve and relapse many times over.

MS is not contagious and while not inherited, there seems to be a higher incidence of MS for those who have MS in the family.  The closer the family relation (e.g., sister vs. cousin), the higher the incidence.

Causes of MS

The disease attaches the protective covering of the nerves in your brain and spinal cord. The nerve's protective outer coating called myelin, insulates them and allows impulses messages to run from your brain, along your nerves, to the muscles that control movement.

MS attack the myelin coating causing inflammation and damage. The damaged areas, called lesions or plaques, interrupt, distort or prevent nerve impulses setting through, thus producing the symptoms of MS. The exact cause of MS is not known; however, current research increasingly points to a complex interplay of environmental and possibly genetic risk factors. Research also shows the tissue damage experienced by those with MS is caused by an abnormal immune response.  While there is no cure, there are treatments to help manage most MS symptoms.

How physiotherapists help

MS affects your ability to move as well as your balance, muscle strength and flexibility. A physiotherapist will first assess how MS is affecting you and your movement. They can then help you maximize your physical movement and functional abilities and teach you compensation strategies, like how to move differently and discuss aids/equipment that could help.

Physiotherapists can also help you find appropriate exercise classes or a facility where you can connect with others with MS and practice these exercises You may require follow-up advice expertise from the physiotherapist including a review of your exercise program and additional or different strategies to address any changes to your symptoms.

Your physiotherapist will:

• Help lessen secondary symptoms of MS (wetness, spasticity. reduced endurance) by teaching you three types of exercises:
  
• Strengthening exercises to strengthen muscles not affected by MS
  
• Flexibility or stretching exercises to reduce spasticity and improve your range of motion
  
• Cardio or endurance exercises to help maintain heart and lung health and give you greater endurance when performing everyday activities   
  

Source:  Physiotherapy Alberta College + Association