Target Therapeutics

Getting You Out Of Pain & Keeping You There

Target Therapeutics

Keep Your Body Healthy & Pain-Free This Gardening Season

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Work on the vegetable garden

The secret to a healthy garden is a healthy gardener. Gardening is an active pursuit that can cause muscle strain to the lower back, shoulders, knees and arms, especially if you are out of shape and do not move properly.

To get the most of your gardening season, physiotherapists recommend following the following tips and techniques. Enjoy the fruits of your labour. Don’t be limited by the aches and pains!

Stretch! Before, During & After Activity

Stretching – as a warm-up, as a break during repetitive movement, and as a cool-down – helps you to move more easily, keeps your muscles flexible and relaxed, your joints mobile and relieves tension and strain.

When stretching, remember:

Movements should be slow and controlled, you should feel a gentle stretch of the muscle – stretching should never be painful.

Once you feel a stretch, hold the position for 10 – 15 seconds. Do not bounce or jerk, and repeat each stretch two or three times.

Do some shoulder circles, trunk rotation, and heel/toe stands. You might even ‘rehearse’ movements, like raking, as part of your warm-up. Then, take a few minutes to do the following stretches, and repeat them again at the end of your gardening activity. If you begin to feel a bit stiff while gardening, pause and do more stretches.

Male farmer picking vegetables from his hothouse garden

Stay In The Zone

Find a place and position that permits your body to work in a comfortable posture – and try to do your work within this “easy zone”. Activity outside your “easy zone” may cause sprains and strains. Avoid potential injury by:

Moving with your work – keep your work in front of and close to your body to avoid reaching and twisting.

Lift with your knees bent, keeping your back straight.

Spend More Time in Your Garden & For Longer Periods

To maintain your existing mobility, make every movement count. Add up all you do in a day and aim for a minimum of 60 minutes of movement every day.

To gain more mobility, you should plan activities throughout your day that keep you moving for periods of at least 10 minutes at a time.

Be realistic! Your body can only perform at the level of effort and endurance it is accustomed to. For maximum benefit, physiotherapists recommend regular physical activity and stretching to maintain your physical mobility throughout the year.

Middle aged asian woman gardener trimming plants in the garden

Work Within Your Physical Strength

Standard safe lifting loads are 64 lbs. (about 29 kg) for middle-aged men and 28 lbs. (about 13 kg) for women, but a ‘safe’ lift is less than this when the load is difficult to reach or an awkward shape.

Pace Yourself!

Take a break, spread tasks over a period of time, and take time to recover between projects.

Rotate Tasks Regularly

Avoid over-use injuries by doing different activities throughout the day to reduce strain on major muscle groups and joints.

Use the Right Tools

Gardening tools and equipment are meant to ease work, not cause additional strain. Take measures to fit the tools to you, not you to the tools. Also:

Keep your supplies within easy reach – consider using an apron with pockets.

Use tools to reduce work – a wheelbarrow to transport supplies, an extended handle to reduce the reach, and tools with good grips or ergonomic handles.

When Raking or Hoeing

Keep your tools close to your body and your back straight to reduce strain. Use your arms and avoid twisting your trunk. Use long-handled tools suited to your height.

If you tend to bend over or reach too far while raking, consider using an ergonomic rake (available at garden centres). It will make the job easier and reduce strain to your back.

When Weeding or Planting

Do not bend from the waist. Squat or kneel on a kneeling pad. If you have difficulty getting up, use a kneeling pad/bench with a support handle for assistance.

Give your back, legs and knees a break from stooping and kneeling by using tools with long handles to help with the weeding.

Squat or sit on the ground to trowel, rather than bending over.

Person digging in garden

When Digging or Shoveling

Insert the head of the shovel vertically into the ground and step on the blade.

Lift small amounts at a time. Keep your back straight and bend at the knees. Avoid twisting. Use a wheelbarrow to move big or heavy loads.

Choose a shovel with a weight and handle length that is appropriate for your size and for the job you are doing.

Give your back a break by using a smaller shovel, reducing the temptation to lift large amounts of soil.

Spread heavy lifting and digging tasks over a week rather than a weekend, and spread major projects throughout the seasons. Take time to recover between them.

When Lifting or Carrying

Know your limits and lift properly: bend your knees, not your back. Keep the load close to your body. Don’t lift items that are too heavy for you to handle – get help!

Use a wagon or wheelbarrow to transport supplies and/or to move or carry heavy items.

A four-wheeled cart is sturdier and easier to use than a wheelbarrow.

Lift with your knees slightly bent and your back straight. Avoid twisting or reaching.

When Pruning Or Trimming

Get as close to your work as possible. Don’t stretch beyond your reach or past your stable footing. Rehearse the movement as a stretch first to test your ability and positioning.

Match the size of the gardening tool handle to the size of your hand. Choose tools that you can hold so that your hand remains positioned in line with your forearm.

Hold your tools in a loose comfortable grip. Holding too tightly may cause injury;

Be creative! Adapt or create your tools for ease and comfort:

Pad the handles of your gardening tools.

Use knee pads or a foam pad for kneeling.

Wrap a slippery handle with tape to improve your grip (hockey stick tape will do).

Selecting the right tool, for the right task, for the right gardener, is critical to creating a beautiful garden safely.

Osteopathy Treatment, Spinal Manipulation.

Physiotherapy & Chiropractic Can Help

Physiotherapists are healthcare professionals who help people of all ages and lifestyles gain and maintain their desired level of active living and physical mobility. With their understanding of the human body in action, physiotherapists are able to help you increase your mobility, relieve pain, build strength and improve balance and cardiovascular function. Physiotherapists not only treat injuries, but they also teach you how to prevent the onset of pain or injury that can limit your activity.

What To Do About Your Flat Feet

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Female feet on yoga mat at home

What are Flat Feet?

Pes planus or flat feet is a postural deformity relating to the collapse or flattening of the medial longitudinal arch. It can also be referred to as hyperpronation or overpronation. Although there are varying degrees of collapse, people are still able to live completely pain-free with flat feet.

What Causes Flat Feet?

This condition can be congenital (e.g. from birth) or acquired (e.g. adults, increased exposure to weight-bearing).

Congenital flat feet occur when someone is born with or predisposed to having a more flexible midfoot region resulting in pronation or collapsing of the arch. Ethnicity is an important factor surrounding flat feet, with the condition being more likely in certain indigenous cultures.

Acquired flat feet are caused by a loss of active (e.g. intrinsic foot and ankle stabilizers) or passive support (ligamentous laxity, hypermobile joints) during dynamic weight-bearing activities. Muscular insufficiency in the ankle and arch stabilizers are the most common etiological factor for flat feet.

How Do Flat Feet Progress?

Flat feet progress slowly as you increase your feet’s exposure to weight-bearing activities. The two most common progressions from flat feet are foot deformities and bony stress injuries.

In the active person, hyperpronation alters the load transference up through the leg and can cause stress responses such as shin splints and in the worst case, stress fractures.

At the opposite end, the bones through your foot are also exposed to altered loads potentially causing a bunion. As seen in the image, the midfoot pronation and collapse of the arch change the line of force to the outside of the first metatarsal (from green to red), creating the bony protrusion. As the head of the metatarsal is forced out, the rest of the big toe is forced inwards further accentuating the bunion.

How are Flat Feet Diagnosed?

Your Certified Pedorthist will observe you conducting numerous single leg tasks in order to investigate your overall dynamic control, from your foot and ankle to your hips. This will include activities that challenge your strength, endurance, proprioception, and balance. Integrated into the entire kinetic chain, the main focus will be identifying any active insufficiencies through your arch and its’ respective stabilizers.

In some cases, a weight-bearing Xray may be ordered in order to investigate the integrity and dynamic control of the specific joints of the arch under stress and load.

Woman feet running on road closeup on shoe

Flat Feet Treatment

Treatment can vary largely considering the broad etiological factors. Below is a range of treatment directions focussing primarily on improving the active stabilization of the foot and ankle to endeavour to correct the flat feet deformity.

Restore Intrinsic Muscle Control and Foot Arch Biomechanics

Your foot arch is dynamically controlled via important intrinsic plantar muscles, which may be weak or have poor endurance. These foot muscles have a vital role in dynamically stabilizing the base of your foot plus preventing overpronation of the midfoot and loading through your plantar fascia.

Dynamic Foot Posture Exercises

Any deficiencies will be an important component of your rehabilitation. Your physiotherapist is an expert in the assessment and correction of your dynamic foot control. They will be able to help you to restore your normal foot biomechanics and provide you with foot stabilization exercises to alleviate any deficiencies.

Custom Orthotics

After your biomechanical assessment, you may be recommended a soft temporary orthotic to help provide protection and relief through over-loaded structures. If your physiotherapist deems an orthotic will be of benefit for long-term use, a referral to your local podiatrist for a specialized orthotic may be recommended. The good news is that most flat feet sufferers will not need permanent passive arch support such as an orthotic.

At Target Therapeutics, our Certified Pedorthist can make sure you get the best possible custom orthotics.

Restore Normal Calf & Leg Muscle Control

You may find it difficult to comprehend, but all of your leg (calf, thigh and hip) muscles play an important role in controlling your ankle position and foot arch mechanics. Your physiotherapist will assess your leg muscle function and provide you with the necessary treatment or exercises to correct any ankle, knee or hip stabilizer insufficiency. Ask your physiotherapist for more specific advice.

Footwear Analysis

Sometimes it is poorly designed footwear that can predispose you to acquire flat feet or an associated injury. If you do suffer pain or discomfort that is impacting your active lifestyle, you should seek the professional advice of your healthcare practitioner to assist your ability to determine the best footwear for your feet.

Do you suffer from flat feet? You’re not alone. There are many possible solutions that can help you immensely.

 

Concussion Management

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ice hockey goalkeeper

What is a concussion?

A concussion is a type of traumatic brain injury caused by a direct blow to the head or by a hit to the body that causes the head and brain to move rapidly back and forth.

It considered a mild, reversible brain injury that affects the normal functioning of the brain.

What is so special about the brain?

The brain is made up of billions of neurons and the communications between these neurons are how we think, move, and feel. We want to protect these neurons and connections so we can accomplish our day to day activities and long term goals.

What should be done if a concussion is suspected?

If the signs and symptoms of a suspected concussion are observed, it is imperative to immediately be removed from the activity (whether it be work, school, or a sport).

The individual should first be evaluated for any signs and symptoms that would warrant a referral to the emergency department. There are many tools designed to help with the detection of concussion, including the Sports Concussion Assessment Tool 5 (SCAT 5) which is intended to be used by licensed healthcare professionals and the Concussion Recognition Tool 5 (CRT 5) which is intended for use by anyone.

These tools help with recognition of the signs/symptoms of concussion, removal from the activity as well as provide guidance surrounding the immediate care of a suspected concussion.

How do you manage concussions (based on the Berlin International Consensus Statement)

It is important to be assessed by a healthcare professional if a concussion is suspected.

The assessment for concussion is multifaceted and may include evaluation of cognition, balance/coordination, neurological function, neck joints & musculature, and temporomandibular (jaw) joints & musculature based on the symptoms being experienced.

After the assessment is completed, the 24-48 hours immediately following a concussion require both cognitive and physical rest to ease discomfort and decrease demands on the brain during the early stages of healing. After this immediate rest and the acute symptoms resolve, both physical and cognitive activities can then be gradually incorporated once again provided they do not increase symptoms.

There are designated Return to School and Return to Sport protocols that will help to gradually increase cognitive and physical demands. Although these protocols can be performed simultaneously, returning to cognitive demands (such as school or work) are to be completed prior to physical demands (such as sports or rigorous physical activity).

The majority of concussions resolve on their own within 14 days for adults and up to 4 weeks in children. However, if the concussion does not resolve as expected, rehabilitation can be done based on findings of an individualized assessment.

Concussion Treatment may include:

  • Cervicovestibular rehabilitation
  • Manual therapy of the cervical spine and temporomandibular joints and
    muscles
  • Adaptation, habituation, and balance exercises
  • Gait and head movement
  • Activity/sport-specific training drills”

Custom Orthotics vs. Store Bought Orthotics

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When weighing the options between a pair of custom orthotics vs. a pair of store-bought orthotics there are a number of things to consider.

The Pedorthic Association of Canada defines store-bought orthotics or over the counter foot orthotics as “mass-produced devices that are not unique to any person”.

Custom orthotics are defined as “an internal foot appliance which is manufactured from a three-dimensional image of the foot, and made from raw materials. Custom orthotics can accommodate bony deformities, and/or modify the movement pattern of the foot and lower limb”.

Store-Bought Orthotics

Store-bought orthotics are made with lower quality materials and are not very supportive through the arch.

Advantage: for a person with a lack of padding on their feet (i.e. fat pad dystropohy) or a person with normal feet who spends a lot of time standing or walking on hard surfaces, may find that a cushion may be all that is necessary.

Disadvantage: Materials break down faster than the higher quality materials used in custom orthotics.

Store-bought orthotics are made for an “average” foot shape and may not be ideal for all people.

Advantage: these orthotics provide a small amount of support for the average shaped foot.
Disadvantage: If the patient’s foot is not the same or similar to the shape of the store-bought orthotic then the level of comfort and support will be minimal if any is achieved at all.

Store-bought orthotics tend to be less expensive.

Advantage: They are less expensive which can be a good thing.

Disadvantage: Insurance companies will NOT cover the costs associated with store-bought orthotics and due to the wear and tear to the materials used, replacement is usually required every 3 to 6 months which is much more often than custom orthotics.

Custom Orthotics

Custom orthotics provide a large number of design options with respect to materials used so that the orthotic can be designed exactly to your needs.

This allows for a customized fit, feel and design for each individual and for the types of shoes that they wear. We can take into account the person’s foot, biomechanical control needs, the type of shoe the custom orthotic will need to fit into, the persons’ activities and any material allergies or discomfort the patient may have.

Custom orthotics tend to be more expensive.

Disadvantage: It is recognized that custom orthotics do have a rather large upfront cost

Advantage: When custom orthotics are made by a properly licensed professional, insurance companies will cover a portion, if not the entire cost, of the custom orthotics.

Key Factors to Consider:

Durability: The “lifespan” of store-bought orthotics are shorter than custom orthotics due to wear and tear on the materials used.

Cost: Custom orthotics are much more expensive however some or all of the costs are covered by most extended insurance policies and custom orthotics last much longer.

Time Sensitive: Custom orthotics require time to be manufactured and there is a 2-3 week time period from the examination to dispensation. In moments of urgency, store-bought orthotics can help with immediate relief.

Biomechanical / Motion Control: custom orthotics can be designed with exact specificity to suit your needs. These features are not available in off the shelf orthotics.

For further questions give us a call and we would be happy to answer any questions that you may have.

Bursitis

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shoulder bursitis

What is a Bursa?

A bursa is a bag of lubricant which provides a low-friction, slippery and smooth interfaces between two tissues in your body eg a tendon and a bone.

Bursae are found throughout your body, where muscles and tendons glide over bones. You have more than 150 bursae in your body. Without your bursa between these surfaces, your movements would be painful due to friction. Much like the pain associated with bursitis.

What Causes Bursitis?

Your bursa can be injured via direct trauma, or more commonly via repeated irritation.

During painful bursitis, your bursa loses its painless and low-friction gliding capabilities. The added bulk of the swollen bursa causes more friction within an already confined space.

There are several common causes of bursitis. They include the following:

  • Repetitive bursa irritation
  • Traumatic injury
  • Systemic disease
  • Any bursa in your body

— And remember there are 150+ can be susceptible to repetitive trauma due to poor muscle control of movement patterns. Identification and correction of these poor movement patterns falls into the professional skill profile of physiotherapist. Please seek their professional opinion especially in longstanding or repeat episodes of bursitis.

Movements and activities can become painful from either the pain-sensitive chemical reaction within the bursa or the swollen bursa can provide additional frictional forces in the subsequent movements.

A fall and land onto your knee can acutely compress your prepatella bursa resulting in knee bursitis

Bursitis Treatment

Bursitis treatment has several phases:

  • Reduce the acute bursitis pain,
  • Reduce the bursa inflammation,
  • Assess the cause and rectify any reason that would predispose to bursitis,
    Reduce Bursa Inflammation & Pain

Bursa treatment will usually commence with treatment modalities that aim to reduce bursa pain and inflammation. Treatment options may include:

  • Ice
  • Anti-inflammatory Medications
  • Anti-inflammatory Gels
  • Electrotherapy
  • Deloading taping eg Kinesio taping
  • Assess Non-Traumatic Causes

Bursitis pain usually settles within a few weeks with the appropriate bursa treatment. All non-traumatic origin bursitis should be investigated to discover what is causing your bursitis.

Recurrent flare-ups or recalcitrant bursitis can be common and frustrating for the sufferer. The important thing when managing persistent bursitis is to delve deeply into WHY your bursa is inflamed. Once the reason is identified, controlling your bursitis becomes a much easier project.

Remember the source of recalcitrant bursitis might be your poor biomechanics, muscle weakness, tightness, movement patterns or postural habits that your physiotherapist can identify and help you to correct.

Secondly, the cause may be disease-related. If this is the case, please consult your doctor. If they deem it appropriate, they may advise some tests, eg blood tests, to eliminate or confirm a potential systemic cause of your bursitis.

Prevent a Recurrence

Bursitis is often a secondary symptom caused by many other factors. The best form of bursitis treatment is to identify, and then address, any abnormal biomechanical of muscle control findings, to reduce your likelihood of a bursitis recurrence. Your physiotherapist is highly skilled in identifying these deficits to help you recover quickly from bursitis and then prevent a bursitis recurrence. After thoroughly assessing you, your physiotherapist may prescribe a stretching, strengthening, movement correction/control program.

The 7 Most Common Running Injuries

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young African american woman runner with headphones jogging outdoors in nature beautiful summer night - Fitness, people and healthy lifestyle

How physiotherapy can help prevent the most common running injuries

As a runner, you know how to push through. From bad weather to blisters to stitches on your side, you’ve trained to let the little things slide in order to cross that finish line—even when that comes to pain.

Though the joy of running is unlike anything else, the repeated movements involved can be hard on the body. We’ve all heard the stories or maybe even experienced some of them firsthand—the full-blown injuries that keep a runner’s shoes in the closet for weeks or months.

Whether you’re running for pleasure or training for a race, you’re bound to have aches and twinges along the way. Injury prevention isn’t about the absence of pain; it’s about having the right reaction when that pain comes along. A timely response will help you avoid acute injuries that could pull you from the pavement for an indeterminate hiatus.

A physiotherapy appointment is a great way to get answers to the questions you have about your running pain:

  • Is it safe to run through the pain?
  • What are the signs it’s getting more serious?
  • How can I treat the pain at home?
  • What exercises will help me keep running?

Your physiotherapist can help you with information, advice, and treatment
to keep you running, injury-free.

Here are the 7 Most Common Running Injuries and When to Book a Physio Appointment.

1. Runner’s knee

While it can affect other athletes, runners are the most commonly afflicted with this pain or tenderness in and/or around the kneecap.  According to a University of Calgary study, this type of pain accounts for 57% of all knee problems in Canadian runners— if you’re having pain in this area, it’s most likely runner’s knee.

Book a physio appointment when: You’re having twinges on the outside or inside of the knee when you begin your run, but then seem fine throughout, only to flare up afterward or during prolonged sitting—this is a sign that things could get worse without physio treatment.

2. Achilles tendinitis

Up to 20% of runners are affected by this injury, which appears when the Achilles tendon (connecting the two major calf muscles to the back of the heel) comes under too much stress. The tendon tightens and gets irritated, leading to the pain in the back of the foot.

Book a physio appointment when: You’ve got a dull pain in your heel during and after a run, but at home remedies like ice usually take care of it—book a physio appointment before this pain shows up even when you’re not running

3. Hamstring issues

Your hamstrings make up the majority of the muscles in the back of the thighs, propelling you forward during your run; injuries involving this group can be an issue of flexibility or strength. Hamstring strains are common and take a lot of time to heal—re-injuries often occur without the proper physiotherapy and if the re-introduction of training is rushed.

Book a physio appointment when: You have a constant ache or tightness in the back of your legs when you run, which you try to ease with a slower pace or a shorter stride—you’ll want to get physio before there’s a pop, snap or bruise.

4. Plantar fasciitis

Foot pain accounts for 15% of all running injuries, with plantar fasciitis mat the top of that list. This injury involves small tears and inflammation of the tendons and ligaments of the foot, resulting in pain that might feel like a dull ache or bruise along your arch or heel.

Book a physio appointment when: You’re having foot pain when you first get out of bed, walking around after sitting or the first few strides of a run. It may disappear after that, but you’ll want to avoid having that constant pain by consulting with a physiotherapist as soon as possible

5. Shin splints

Also known as medial tibial stress syndrome, this achy pain down your shins makes up about 15% of all running injuries. It may seem small, but these are actually tears happening around your shinbone and can develop into something more serious.

Book a physio appointment when: You can walk and even jump without pain, but there’s a tightness and ache around your shin when you run. Before it becomes too tender to touch (or walk), see a physiotherapist for simple ways to correct the issue.

6. Iliotibial (IT) band syndrome

When the band that runs along the outside of your thigh—connecting hip to knee and shin—gets irritated, runners experience a pain down the outer area of the knee joint. At 12% of all running injuries, it’s often mistaken for a knee injury.

Book a physio appointment when: Two to three kilometres into your run, you start experiencing pain and tightness on the outside of your knee. If you walk it out, the pain disappears, but this means it’s time for physio—before you hear the clicking or popping sensation of the IT band snapping against the joint.

7. Stress fracture

For runners, the constant impact of activity can cause too much strain on the shins, feet or heel bones and lead to a stress fracture—the most serious of all running injuries. Different than an acute fracture that happens in one brief moment, stress fractures happen gradually, which means they can be prevented.

Book a physio appointment when: You’ve got pain when you run, but also sometimes when you’re on your feet for too long. Like any progressive injury, it’s key to listen to your pain and respond early—a physiotherapist can help make sure you’re on track to prevent or recover from stress fractures caused by running.