Many of our regular readers (and long time patients of Dr. McDowall and Dr. McIntyre) may not know that Beth has been a part of Burlington Sports Therapy for quite a while. Since 2011, Beth has been practising at our satellite location within Burlington Fitness and Racquets on Dillon road. She has co-treated many patients of ours and we are very excited to finally practise at the same location.

Beth is a registered physiotherapist with the College of Physiotherapists of Ontario. She utilizes various treatment approaches to assist her patients including active rehabilitation, laser therapy, manual therapy, acupuncture and various other modalities of care. Physiotherapy at Burlington Sports Therapy and with Beth Slack is different from many other clinics. The initial physiotherapy examination is always performed by Beth. Likewise, Beth personally treats each patient at every subsequent visit. For more information about Beth, please follow this link to her bio – Beth Slack.

]]> http://burlingtonsportstherapy.com/2013/05/26/physiotherapy-at-burlington-sports-therapy/feed/ 0 http://burlingtonsportstherapy.com/2013/05/05/massage-therapy-chiropractic-and-physiotherapy-at-burlington-sports-therapy/ http://burlingtonsportstherapy.com/2013/05/05/massage-therapy-chiropractic-and-physiotherapy-at-burlington-sports-therapy/#comments Sun, 05 May 2013 19:22:40 +0000 Kevin http://burlingtonsportstherapy.com/?p=1924 We are pleased to announce that we will be offering massage therapy, acupuncture, physiotherapy, chiropractic and athletic therapy all under one roof at our new location.  Over the next few weeks we will post information about the new team and the developments at the facility.  In the meantime, we’ve posted a map to the new location.  Please note that we will not be there until June 1st.   For the remainder of May we will be located at our current location – 4361 Harvester Rd. for chiropractic and within Burlington Fitness and Racquets for physiotherapy.  Keep checking this area of our website for developments in the coming weeks!

Directions from Evolution Training to Burlington Sports Therapy’s new location.

1.  Lower back pain is common.  80% of the population will experience lower back pain at some point in their lives.  For fishermen, standing in a boat for eight hours is very hard on the lower back.  Try pacing yourself, where you sit for short periods when possible.  Core strengthening is helpful as a defense against lower back pain.  The “core” includes the muscles of the abdomen and lower back; essentially, the muscles that wrap around your spine like a back brace.

2. For many injuries, a consultation and home exercise program is sufficient for recovery.  It really depends on the diagnosis.  Consulting with a knowledgeable practitioner who can diagnose your condition properly is key to determining the appropriate course of treatment.

3. No solitary practitioner can treat every condition.  Quite frequently, our clinic sees patients that have conditions not amendable to conservative treatment like chiropractic or physiotherapy.  In these cases, we refer patients to the appropriate medical professionals (like surgeons).

4. Cortisone is a good treatment option for some people, but not all.  Our clinic usually recommends starting with something more conservative.  Depending on the diagnosis, there’s usually something we can offer.  Graston Technique or Active Release are great options for chronic soft tissue injuries, as John the producer of the show was describing he was experiencing.

5. There’s always something that can be tried for any injury.

6.  Modifying your activity may be an important way to assist in recovery.

That’s all I can remember from our conversation.  Like I said, a great group of guys on a very entertaining show!  If any listeners out there want clarification on any of the topics discussed, feel free to email me directly at kevin@burlingtonsportstherapy.com

Have a great weekend!

We frequently see ultrasound reports at our Burlington physiotherapy and chiropractic clinic describing damage to the rotator cuff. This ranges from complete tears to partial tears, or simply just tendinopathy (or tendinitis as many call it). The pain and weakness experienced by these patients can vary. Perhaps the most obvious sign of significant rotator cuff injury would be difficulty with movements like abduction, internal and external rotation. What many people don’t realize is that another, very important function of the rotator cuff can be affected; compression and depression.

If you look at the picture below, you’ll see the arrows of force that I drew on the scapula (also known as the shoulder blade). These arrows show a downward and inward force that the rotator cuff muscles provide. This is very important for normal shoulder movement. This force allows a smooth contact of the shoulder joint surfaces. If this doesn’t happen, the humerus (bone in the upper arm) sits too high in the joint. When this occurs (and when we elevate our arms) everything above that bone in the shoulder gets squished, a condition called impingement. A person with shoulder impingement may report pain with overhead activities or exercises (like shoulder press or bench press). Think of it another way; imagine the bone sits in a groove that is shaped like a pear. At rest, the humerus (arm bone) sits in the top, narrow portion of the pear. When the rotator cuff muscles contract, they pull the humerus (arm bone) down into the wider portion of the pear. This gives the bone a larger area to move in. When the rotator cuff is dysfunctional, the humerus (arm bone) may still be sitting in the narrow portion of the pear while trying to move. Not surprising then that your shoulder gets sore with repetitive overhead work or even push-ups!

Compression and Depression of the bone into the bottom portion of the pear to avoid impingement of the shoulder during arm movement…

So what is the solution? Treatment is often geared toward restoring normal movements of the shoulder and eliminating muscle imbalances. This gives the humerus a fighting chance at moving in the normal part of the “pear”. In most cases, this requires clinical treatment. Along with this treatment though, strengthening of the rotator cuff muscles is usually an essential component of care. If the rotator cuff muscles aren’t performing their role of compression and depression, it’s unlikely that normal joint motion can occur and is therefore more than likely that pain and dysfunction will persist or occur at some point.

References

Hyde TE, Gengenbach MS.  Conservative Managememt of Sports Injuries 2nd Ed. 2007  Jones and Bartlett.

To keep it simple, the humerus is the bone in your arm that forms a joint with the scapula (or shoulder blade as many call it). Of note in the picture is the clavicle (commonly known as the collar bone). The clavicle (visible from the front) has a joint with the scapula (on your back). This joint is called the acromioclavicular joint, which is the joint we injure with a separated shoulder.

This picture illustrates the more superficial muscles. The deltoid has three parts; the front, middle and back. From this view, we can see the middle and rear deltoid. In the next picture we can see the front or “anterior” deltoid. Underneath the deltoid are the rotator cuff muscles.

This is a picture of the front of the shoulder. You can see the bicep muscle / tendon tucks underneath the deltoid. Also under the deltoid are the rotator cuff muscles seen in the next picture

The rotator cuff muscles have attachments on the scapula (shoulder blade) and the humerus. Among other things, they are very important muscles for stabilizing the humerus so that it moves in the right “spot” on the scapula. Rotator cuff muscles are often injured. We regularly see diagnostic ultrasound reports that indicate tendinosis, tendinopathy or tear of these muscles, most frequently the supraspinatus.

Obviously, this is a very basic outline of the shoulder. We plan on tackling various concepts related to the shoulder in the coming weeks so this will serve as a starting point and reference point for weeks to come.

What is arthritis?

There are different types of arthritis. Perhaps the first, obvious distinction to make is the difference between inflammatory and degenerative arthritis. For most people that visit our Burlington clinic, the finding is a degenerative type of arthritis. An easy way to understand this type of arthritis is “wear and tear” in the joint. This is the type of arthritis that we’re discussing in today’s blog. Synonyms (other terms that mean the same thing) are degenerative joint disease, degenerative disc disease, osteoarthritis and degenerative arthritis to name a few. Symptoms of arthritis include pain when trying to move after being still for a period of time. Examples include getting out of bed or getting up from the couch after sitting for a while. Typical symptoms of arthritis are pain, joint stiffness and altered joint movement. Although osteoarthritis is not an inflammatory condition, an arthritic joint can swell or inflame if irritated enough.

Where does arthritis happen?

Arthritis can happen in practically every joint. Common areas include the neck, the lower back, the hips, knees, toes and fingers. In the case of the spine, it is usually called degenerative joint disease or degenerative disc disease.  In other areas of the body we usually call it osteoarthritis.

Spinal Degeneration (Examples)

When does arthritis happen?

Arthritis typically starts in the late twenties / early thirties and progresses from that point. Keep in mind, as mentioned earlier, many patients show degenerative changes on their x-rays yet have no symptoms.

Why does arthritis happen?

Historically, it was believed that arthritis was due to use.  For example, if you had a manual labour job that required a lot of repetitive use over many years, it was logically expected to see early arthritis or wear and tear in that area. Similar, if you’ve had a significant trauma to a joint, it may be more prone to arthritic degeneration (arthritis) in the future. We’ve now learned that genetics play a large role. If everyone in your family had significant arthritis, you may be at risk.

Diagnosis of arthritis?

Arthritis is diagnosed when your practitioner combines your relevant history with your presenting condition. For Chiropractors, x-rays are a useful way to objectively assess joint surfaces and get an understanding of the amount of degeneration present. This degeneration may or may not relate to a patient’s symptoms, so as mentioned, a good practitioner will combine all the relevant information and make an accurate diagnosis accordingly.

Treatment for arthritis?

There are many treatment options for arthritis so it’s important to consider all the relevant information. For example, how significant is the joint degeneration? How severe are the symptoms? What other treatments have been attempted? What home strategies (like stretching or strengthening) is the patient doing? What is the patient’s preference for various treatment options?  After a thorough history, your Chiropractor or Physiotherapist should review the various options for treatment.  Recommendations might include chiropractic adjustments, mobilizations, acupuncture, laser therapy, interferential current, active release technique, graston technique, home stretching or home strengthening.

Do you have arthritis that needs treatment? Unsure if you even have arthritis? Give us a call, we can help! 905.220.7858 or email – info@burlingtonsportstherapy.com

Pain in the front of the shoulder

As the name implies, the bicep tendon has two heads. In the shoulder area, there are two tendons that insert in different areas. The specific anatomy is beyond the scope of this blog but the take home point is that there are two areas of insertion in the area of the shoulder. The muscle extends down the front of the arm to just past the elbow. The reason it crosses the elbow joint is so that it can function to bend the elbow. The bicep in the shoulder area functions to raise the arm out in front, as you would do when reaching for something out of a kitchen cupboard (for example).

 Symptoms of bicep tendon injury include local pain (in the front of the shoulder) and pain with movements that use the bicep. There are various conditions that can affect the bicep. These include (but are not limited to) tendinosis, tendonopathy, tendinitis, tear of the bicep tendon or rupture of the bicep tendon. The most common presentation we see in our Burlington clinic is a simple irritation or degeneration of the tendon as it occurs in bicep tendinopathy. This is usually a fairly simple condition for a knowledgeable practitioner to diagnose.

X-rays are not usually helpful in diagnosing bicep tendinopathy. Your family doctor may refer you for diagnostic ultrasound to confirm the diagnosis or rule out other causes, but is not always necessary. Interestingly, ultrasound reports often mention fluid around on the head of the bicep tendon. Although this may be less common with other tendon disorders, it is part of the reason our practitioners avoid aggressive manual treatment in this area of the shoulder. Conservative options like laser therapy or acupuncture can be more useful in resolving this area of shoulder pain. Of course, this is a generalization and there are many variables. We recommend that you consult with a knowledgeable practitioner who can diagnose your condition and suggest an appropriate management strategy.

 The “take-home” point? Many tendon disorders can benefit from manual treatment like active release and graston. Yet in the case of bicep tendinopathy, you may be best off icing the front of the shoulder and not using aggressive manual therapy. This can perhaps aggravate the area and lead to more inflammation. Perhaps for this area of pain a more “delicate” approach can get you better faster!

Sites of Nerve Compression

Many patients present to our clinic with nerve compression in the wrist. This is often called carpal tunnel syndrome. The symptoms are similar to what was listed above (numbness, tingling and pain) but the discomfort is primarily located in the wrist and hand. Yet numbness, tingling and pain can also occur in the hand because of nerve compression higher up in the arm. Nerve compression can occur in the elbow, shoulder or neck for example. Common diagnoses for nerve compression conditions include carpal tunnel syndrome, lateral stenosis, cervical disc herniation and thoracic outlet syndrome. Interestingly, we’re not necessarily restricted to having just one location of entrapment. For some patients, they can have two sites of injury at the same time. This is often referred to as double crush syndrome.

Double Crush Syndrome

Patients with double crush syndrome can experience a variety of symptoms. In addition to numbness, tingling, pins and needles and pain in the upper limb, a person can also experience headaches and neck pain (if the neck is involved). The patient with double crush syndrome can also display a variety of clinical signs, such as a slouched posture with a forward head. As mentioned, double crush syndrome involves two compression sites. An example of this could be a patient with carpal tunnel syndrome as well as having joint degeneration in the neck (which is also irritating and compressing the nerve). This can prove difficult for the practitioner to detect and diagnose.

Forward Head Posture

Double Crush Syndrome – Treatment

In the above example, if the patient was simply diagnosed with carpal tunnel syndrome and compression in the neck was not discovered, it is unlikely that treatment solely directed at the wrist would be completely effective. Likewise, it would be unlikely for treatment in the neck to eliminate all the symptoms given the compression at the wrist. Therefore, it is paramount for the practitioner to thoroughly examine a patient and determine the areas of nerve compression. Logically, treatment should be targeted at the various sites of nerve compression.

Double Crush Syndrome – Active Release Technique

One treatment option that our clinic uses for double crush syndrome is active release technique. Our active release practitioners have taken a specific active release nerve entrapment course, which focuses on the treatment of conditions like double crush syndrome. Adjunctive treatment options for double crush syndrome include spinal adjustments, joint mobilizations, exercise and postural advice to name a few. As with most conditions that present to our clinic, the best choice of treatment depends on a variety of factors specific to each individual patient. These can include severity of pain, previous treatments and patient preference for a given treatment option.

Double Crush Syndrome in the Literature

Interestingly, there is much still to be learned about double crush syndrome. There is controversy in the literature as to the physiological mechanism of two nerve compressions as well as the mere existence of the condition itself. Perhaps it can be said that as we wait for more information to be published, a prudent practitioner will assume the possibility of more than one nerve compression site. From this, examination and treatment should be tailored accordingly.

Do you think you have double crush syndrome? Give us a call, we can help! info@burlingtonsportstherapy.com

References

Huisstede BM et al. Carpal tunnel syndrome part 1 – effectiveness of nonsurgical treatments – a systematic review. Archives of Physical Medicine & Rehabilitation 2010; 91: 981-1004.

Miedany YE, Ashour S, Youssef S, Mehanna A, Meky FA. Clinical diagnosis of carpal tunnel syndrome: old tests-new concepts. Joint Bone Spine 2008; 75: 451-457.

Schmid AB, Coppeiters MW. Double crush syndrome – a Delphi study. Manual Therapy 2011; 16: 557-562.