Introduction
There are generally four stages of tissue healing: hemostasis, inflammation, proliferative/granulative, and maturation/remodeling. Specific timelines of injury healing vary depending on numerous factors, such as the type of tissue (inert versus contractile), severity of injury, age of patient, and pre-injury status. We will mainly be referring to muscles, tendons, fascia (surrounds muscles) and ligaments in this post.

Acute Versus Chronic- What Does it Mean?
First, we will discuss the difference between an acute and chronic injury. 

• An acute injury is characterized by a specific time, place, and instance that occurred that caused the injury. Typically, an impact or a fall.
  • Developing an ankle sprain from tripping whilst running where immediate pain was felt in the ankle is an example of an acute mechanism of injury. 
    
    
• A chronic injury, on the other hand, is characterized by developing slowly over time from repetitive micro-trauma or overuse. This can cause symptoms such as a dull ache, persistent discomfort, and aggravation of symptoms with certain repetitive activities
  • Developing pain on the outside of the elbow from repeated mousing whilst working a desk job is an example of a chronic injury.
    
    
• An acute injury can become chronic typically if it surpasses 3-6 months of healing (this does not include complex fractures or surgeries).
  
  
• An acute-on-chronic injury can occur when someone has been developing a chronic/overuse injury and then has an acute mechanism/trauma in addition to their previously-developed issue.
  • Developing a lumbar disc herniation in someone who experiences chronic, benign lower back pain is an example of an acute-on-chronic injury. This could happen when someone with back pain bends over to lift something too heavy, and suddenly feels a pop followed by a sharp pain in their back +/- numbness/burning/tingling in the leg(s).
  • Another example of an acute-on-chronic injury would be someone with chronic knee pain (such as patellofemoral pain) who suddenly plants and twists their knee and develops an ACL tear. 
    
    

For the purpose of this blog post, I will be explaining stages of tissue healing as it pertains to acute injuries.


Stages of Tissue Healing- Overview

Each phase is a continuous sequence and range where the extremes are completely distinct, but the parts in between blend into one another without any clear or abrupt dividing lines This is important to note as we dive into stage-defining characteristics. This is also important to note if you are applying these stages to your own injury; it can be hard to determine where exactly you are in terms of tissue healing.

With that being said, the four stages are named as follows:

1. Hemostasis
2. Inflammatory
3. Proliferative or granulative
4. Maturation or remodeling

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Introduction

With spring on the horizon, it is this time that many people jump back into their outdoor running routine. If you plan to hit the ground running (pun definitely intended), you will want to consider adding a couple strength training sessions into your program to improve running efficiency and potentially fend off the oh-so-common overuse injuries associated with running. In this post, I will discuss the importance of strength training for runners (or those who would like to start running) and provide 10 exercises you should include in your routine.

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Why Does Strength Training Matter?

Running Economy/Efficiency 1: 

• Strength training improves muscle co-activation and recruitment patterns, allowing the body to better distribute forces. 
• Strength training builds bigger muscle fibers, meaning that less fibers need to be activated to do the same activity (this means you waste less energy expenditure and can use that saved energy to run longer!)

Cross Training 5: 

• Strength training provides a break from the repetitive submaximal loading of running that is known to contribute to overuse injuries. 
• You can try the method of periodization to optimize your training program. In simple terms, that means that at the start of your training program you strength train more often and heavier alongside your running, but as you draw nearer to your racing event, you train running more frequently with less and lighter strength training days. Don’t forget to schedule rest and recovery!

Injury Prevention: 
The studies examining the impact of strength training on injury prevention are mixed; however, that doesn’t mean we should throw strength training out the window. Here is what we do know:

• Runners with no injury have no difference in strength between legs 2
• Injured runners were significantly weaker in hip abductors and flexors on the injured side 2
• Higher eccentric hip abductor strength (think glute med controlling load while lengthening, such as in a step down) reduced the risk of patellofemoral knee pain (a common knee overuse injury in runners that presents as pain at the front of the knee) 3
• Runners with weaker thigh muscles also had a higher risk of patellofemoral pain 4

With all that said, the risks associated with strength training are few and the effects of strength training for runners are critical for improved performance and possible prevention of injury.

​

Parameters
Frequency: 
In order to balance strength and endurance training without them interfering with each other, it is recommended to do 1 strength training session for every 3 endurance sessions 1. For the typical recreational runner, I would recommend strength training 1-2x/week. 

Intensity: 
It has been suggested that strength training to failure produces too much muscular fatigue, which could reduce muscle power for running 1. Instead, it is recommended to use low to moderate intensity strength training 1. I recommend using reps in reserve (RIR). This is the number of reps you think you can still perform after completing your set. For low to moderate intensity, aim for a weight that you can perform the set with 3-5 RIR left. 

Time/Type: 
It is recommended to perform approximately 2-4 resistance exercises plus some power activities (think jumps and sprints) for a total session of 30-60 minutes 1; however, here I also include some neuromuscular control exercises. ​

Exercise Examples**if you are unsure if an exercise is right for you (or if you are doing an exercise right), check-in with a Physiotherapist before beginning** 

Resistance Exercises:
Squat
Any type of squat you are comfortable with will work! Grab some weights (you can use a barbell, dumbbells, kettle bells, etc) and start squatting!

Control Exercises:
SL Squat
For this exercise, the focus is on knee control. Try watching yourself do it in a mirror and practice keeping the knee from falling inwards or wobbling excessively. It is a good idea to practice with a chair to start.

Power Exercises:
Sprints 
Simply find a length big enough for a sprint and run close to your top speed, ensuring you have adequate space to decelerate as well. Complete multiple sprints. If you are not used to sprinting, start slow and build up from there.

​

Tips:
As with any exercise program, don’t forget to warm up (dynamic stretches, light cardio, sport specific movements) and cool down (gentle cardio to bring heart rate back down, static stretching).

​

With the recent swings in temperature, you may have noticed your joints feeling a bit stiffer or more sensitive than usual. If you’ve ever said, “I can feel the weather changing in my knees,” you’re not alone.

​Many people report that changes in weather or prolonged cold snaps affecting their joint pain. At our clinic, we often hear comments such as this which prompted a deep dive into this subject. In this blog, we’ll explore what research says and practical strategies to stay active throughout the temperature swings and rest of our winter season. ​

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The good news is that there are strategies we can use to stay active both during the winter & when flare-ups occur.
1. Keep moving daily

• 10–20-minute walks help keep joints lubricated and muscles active. When the temperature drops look for indoor facilities such as malls, recreation centers (Field House & Shaw Centre in Saskatoon), or grocery stores. 
  
  
  

2. Warm up before activity

• Avoid jumping right into the activity by doing a gentle warmup first. Try 5–10 minutes of gentle movement with examples such as marching on the spot, arm circles, sit to stands, or light stretching.
  
  
  

3. Layer up & use heat strategically

• Multiple layers can allow the body to warm up faster and stay more comfortable during activities. Additionally, using heating pads over sore joints and having a warm shower can help reduce discomfort. 
  
  
  

4. Choose low impact activity

• Staying active with activities that don’t put excessive strain on joints is a good option during the winter. A few options being yoga classes, elliptical or stationary biking, or pool exercise. 
  
  
  

5. Support the joint & manage inflammation

• Strategic use of compression garments can provide additional support and improve comfort. Staying hydrated, getting adequate sleep and adhering to recommended anti-inflammatory strategies recommended by your provider can all help to manage pain during a flare-up.
  
  ​
  

As with most sports or activities, dance involves extensive repetition and forceful movements.  When you combine this with growing bodies, it is sometimes a recipe for injury.  Dance injuries can be frustrating to recover from due to the frequency of classes or the need to continue training prior to a competition or exam. Physiotherapy may be required to help with the rehab process!
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Nutrition and hydration are very important to fuel dancers’ bodies properly. 

A well-balanced diet can be challenging at times because of classes affecting meal times or busy lifestyles limiting the opportunity for proper meals.

It is important to plan out snacks, meals and nutrition in advance to ensure dancers are getting the quality and quantity of food they need to fuel their bodies. 

Some serious consequences are possible and all too common, when nutrition is lacking.  Historically, this has been a concern in the teenage, female dance group. 

Adequate hydration before, during, and after dance classes should be encouraged due to the physical nature of the activity.

​

Dance is a great activity for improving

• strength,
• flexibility, and
• coordination. 

It can lead to a tremendous level of fitness and athletic development for children.

It can also be a source of lifelong friendships and fun as well as create discipline and creativity. 

Our team at Donald Physiotherapy is more than happy to work with dancers of any age to achieve their goals safely and effectively.

Any questions, be sure to reach out and ask!


~ Trevor Donald, Physiotherapist 

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Introduction
This blog post will be the first of a series of three where we will talk about bone health throughout stages of life. Today’s post will provide a brief overview of bone composition, purpose, and what happens to our skeleton during growth and development, primarily in childhood and adolescence. We will also look at ways to optimize bone health at the stage in life where we can have the biggest impact on overall health- childhood!

Bone Physiology 
There are two main types of bone:
1) cortical bone, the hard, outer layer which is strong and dense and
2) trabecular bone, the inner portion, which is spongy and less dense.

Bones are made up of a protein called collagen as well as minerals such as calcium phosphate. Inside our bones contains bone marrow, blood vessels, nerves, and connective tissue vital for the health of our whole body. There are three main cells that work to produce, regulate, and maintain our bone health: osteoblasts, osteoclasts, and osteocytes [1]. 
​
1. Osteoblasts: B = build

• Purpose: depositing materials to create new bone (such as during growth, in response to stimuli such as exercise, or after a fracture)

​2. Osteoclasts: C = clean up

• Purpose: bone reabsorption; these cells help break down damaged bone

​3. Osteocytes

• The most abundant cells in our bones. These cells make up most of our bones and also regulate the work of osteoblasts and clasts!

Questions?
If you ever have a question, never hesitate to reach out - it's why we are here!

​What Are Winter Blues?

​Many people use the term “winter blues” to describe feeling a little low, tired, or stiff during the colder months. The winter blues are usually mild, temporary, and related to seasonal changes, rather than a clinical condition.
Common signs of winter blues include:

• Feeling slightly tired or low in energy
• Mild mood changes or irritability
• Loss of motivation or reduced interest in usual activities
• Stiff or achy joints due to less movement

Winter blues typically improve with small lifestyle adjustments, like getting more sunlight, staying active and maintaining routines.

Winter Blues vs. Seasonal Affective Disorder (SAD)

While winter blues are common, some people experience more severe, persistent symptoms known as Seasonal Affective Disorder (SAD). SAD is a form of depression directly linked to seasonal changes, usually starting in autumn and lasting through winter, with improvement in spring.

Common Symptoms of SAD

According to the American Psychiatric Association, people with SAD may experience:

• Persistent sadness or low mood
• Loss of interest or pleasure in activities you usually enjoy
• Changes in sleep patterns (often oversleeping)
• Changes in appetite, often craving carbohydrates or sweets
• Low energy or fatigue, even after a good night’s sleep
• Difficulty concentrating or making decisions
• Physical restlessness or slowed movements
• Feelings of hopelessness, worthlessness, or guilt
• In severe cases, thoughts of death or suicide
  ​
  

Understanding the difference between winter blues and SAD is important because it helps you respond appropriately. Winter blues can often be managed with movement, routines, and sunlight, while SAD may require professional support, structured exercise plans, and physiotherapy guidance.

How Cold Temperatures Affect Your Body

Cold weather doesn’t just make you shiver — it has real effects on your joints, muscles, and circulation. Here’s what happens:

• Blood vessel constriction: Your body naturally narrows blood vessels to conserve heat, which reduces circulation to the extremities like hands, feet, and joints.
• Stiff muscles and joints: Reduced blood flow means muscles around your joints are less warm and flexible, making movements feel heavy or stiff.
• Thicker joint fluid: Synovial fluid, which lubricates joints, can become less fluid in the cold, making your joints feel “rusty” or harder to move.
• Worsening of existing conditions: People with arthritis, old injuries, or chronic back/neck pain may notice more discomfort as circulation and oxygen delivery to joints and muscles decreases.

The result is more stiffness, aching joints, and reduced mobility.

Simple strategies like gentle stretching; warm-ups, indoor walking, or heat therapy can increase blood flow and reduce stiffness. Physiotherapist can guide their clients on how to move safely and stay comfortable even in cold weather.

Why Staying Active in Winter Matters

Movement is one of the most powerful tools to fight winter blues and joint stiffness.

Benefits of regular exercise

• Keeps joints flexible
• Reduces stiffness and pain
• Releases endorphins and serotonin (mood boosters)
• Supports heart and lung health
• Improves sleep quality

• Strengthens immunity
  
  

Research shows that aerobic exercise naturally improves mood by increasing serotonin levels — which often drop during colder, darker days.

WHO Exercise Guidelines

​According to the World Health Organization (WHO):

• Adults 18–65:
  • 150–300 minutes of moderate-intensity aerobic activity per week, or 75–150 minutes of vigorous activity.
  • Strength training at least 2 days per week to maintain muscle mass and support joints.
• Adults over 65:
  • Functional exercises (balance, cardiovascular, gait training) three times per week to maintain mobility, prevent falls, and reduce stiffness.

Following these guidelines improves physical function, mood, and energy — even in winter.

Start Moving, Start Feeling Better

Some simple indoor options include:

• Walking indoors or treadmill walking
• Dancing
• Stationary cycling
• Gentle aerobics
• Resistance band exercises

For people who are new to exercise, starting can feel overwhelming.

At Donald Physiotherapy, we guide our clients step-by-step. We teach safe techniques and create beginner-friendly, personalized programs using resistance bands, light weights, and bodyweight movements.

Consistency is more important than intensity. Just a few minutes daily can keep joints flexible and muscles strong, reducing stiffness and improving overall comfort.

Tips to Stay Active and Motivated

1. Make movement part of your routine: Stretch after your morning coffee, walk indoors after meals, or do exercises during TV breaks.
2. Set a schedule: Morning or early afternoon workouts are ideal for energy and mood.
3. Stay social: Join walking groups, exercise classes, or invite a friend to join you.
4. Combine movement with relaxation: Yoga, deep breathing, or gentle stretching help the body and mind.
5. Warm-up before activity: Heat therapy, warm showers, or gentle stretches loosen stiff muscles before exercise.
   
   

How Physiotherapy Helps

Physiotherapists play a key role in helping you stay mobile, strong, and positive throughout the winter:

• Assess your body: Identify stiff joints, weak muscles, or balance issues.
• Design personalized exercise plans: Safe, effective, and tailored to your needs.
• Provide hands-on treatment: Joint mobilization, soft tissue massage, and stretching.
• Teach pain management strategies: Proper posture, stretching, and relaxation techniques.
• Prevent falls: Balance and strength training for older adults.
  
  

With the right guidance, movement and exercise can become enjoyable and safe, reducing stiffness, improving mood, and boosting overall well-being.

Final Thoughts

You don’t have to just “get through” winter — you can thrive during it. With regular movement, gentle exercises, and the right support, you can stay active, energized, and positive, even during the coldest months.

At Donald Physiotherapy, we help you move safely, strengthen your muscles, and maintain flexibility, so winter doesn’t slow you down. Whether you’re dealing with mild winter blues or more serious symptoms of SAD, our team can create a personalized plan to keep your joints healthy, your mood lifted, and your energy levels high.

Start today: keep moving, stay warm, and take care of yourself — your body and mind will thank you!
​
"Feeling low this winter? Don’t let the cold slow you down! Learn how simple movement and physiotherapy can boost your mood, energy, and joint health this season."
​

1. Brisk Walk – 2 minutes
Walk around your house or up and down the driveway to get the blood flowing.
2. Lower Body

• Hamstring stretch x 30 second hold per leg
• Calf Raises standing x 10-15
• Sit-to-stands x 10
• Standing trunk circles x 10

3. Upper body

• Arm circles, forward and backward x 15
• Shoulder blade squeezes x 15
• Forearm stretch 20-30 seconds each side

This quick routine warms the muscles, increases joint mobility, and prepares your body for pushing, pulling, and lifting.

Shovelling Technique Tips to Stay Injury-Free
1. Keep the snow close to your body
The farther the load is from your body, the more strain on your back and shoulders.

2. Bend your knees, not your back
Use your legs to lift not the low back. If your legs are sore after a session, you’re on the right track! 

3. Avoid twisting while lifting
Step in the direction you’re throwing snow instead of rotating through the spine.

4. Push snow instead of lifting when possible
This reduces strain dramatically. If you must lift, take smaller shovel fulls than larger ones. 

5. Take breaks every 5-10 minutes
Short breaks reduce fatigue, which is a major risk factor for back injury.

Post-Shovelling Stretches (5 minutes)
Once you’re inside and warming up, spend a few minutes with:

• Bending down to touch the toes (low back stretch) x 30 second hold
• Hamstring stretch x 30 second hold
• Forearm stretches  x 30 second hold
• Chest stretch  x 30 second hold

This helps restore mobility and reduce next-day soreness.

Conclusion
Shovelling may be part of winter life here, but injuries don’t have to be. A short warm-up, good technique, and post-shovelling mobility can go a long way in keeping your back, shoulders, and joints healthy all season. If you’re already noticing pain during or after shovelling or want some additional tips, we’re always here to help! 

Understanding Heat Therapy (Thermotherapy): Best for Chronic Pain and Muscle Relaxation
Heat therapy involves applying warmth to a painful or affected area. It works by:

• Improving blood circulation through the widening of blood vessels
• Relaxing tight or tense muscles, helping to reduce discomfort
• Easing stiffness in joints and surrounding soft tissues
• Promoting healing by increasing the flow of oxygen and nutrients to the area
• Relieving chronic pain, such as that caused by arthritis or long-term muscle aches
• Reducing stress-related discomfort, like tension in the neck, shoulders, or back

Heat therapy is ideal for:

• Chronic Muscle and Joint Pain: Conditions like arthritis, muscle stiffness, and lower back pain respond well to heat therapy.
• Muscle Spasms and Tension: Heat relaxes tight muscles and improves mobility.
• Before Exercise or Physical Activity: Applying heat before activity warms up muscles and reduces the risk of strain.
• Menstrual Cramps: Heat can soothe abdominal pain by increasing blood flow and relaxing uterine muscles.
  
  

Methods of Heat Application

• Heating Pads: Provide controlled warmth for localized pain relief. Always place a towel between the pad and skin to regulate temperature and prevent burns.
• Warm Compresses: Damp, heated towels can effectively relieve muscle tension.
• Hot/Warm Baths and Showers: Immersing in warm water soothes widespread discomfort and enhances relaxation.
  
  

Precautions When Using Heat Therapy

• Avoid excessive heat to prevent burns and skin irritation. Always place a towel between the heating pad and skin.
• Do not apply heat to fresh injuries, open wounds, or inflamed areas, as it can worsen swelling.
• Limit application to 15–20 minutes at a time to avoid tissue damage.
• Avoid using heat therapy if you have poor circulation, diabetes, or sensory issues.

Cold therapy is most effective for:

• Acute Injuries: Sprains, strains, and bruises benefit from cold therapy as it reduces immediate swelling and pain.
• Post-Exercise Recovery: Cold therapy helps alleviate soreness and muscle fatigue after intense physical activity.
• Joint and Tendon Inflammation: Conditions such as tendonitis and bursitis respond well to cryotherapy.
• Headaches and Migraines: Cold packs applied to the neck or forehead can relieve migraine symptoms.
  
  

Methods of Cold Application

• Ice Packs: Commonly used to reduce swelling and numb pain in injuries.
• Cold Compresses: A chilled towel or gel pack applied to the affected area.
• Ice Baths: Used by athletes to decrease muscle soreness and inflammation.
• Cryotherapy Chambers: Advanced cold therapy involving whole-body exposure to freezing temperatures.
  
  

Precautions When Using Cold Therapy

• Do not apply ice directly to the skin to prevent frostbite. Always use layer of clothing in between ice pack and skin.
• Limit cold exposure to 15-20 minutes at a time.
• Avoid cold therapy if you have conditions like Reynaud’s disease or poor circulation.

Heat vs. Cold: Which One Should You Choose?
Selecting the appropriate therapy depends on the nature of the pain or injury. Below is a general guideline:

Can You Use Both Heat and Cold Therapy Together?
Yes! Contrast therapy involves alternating between heat and cold to maximize healing. This is especially useful for joint pain, muscle recovery, and chronic conditions.

The Benefits of Contrast Therapy
In some cases, alternating between heat and cold, known as contrast therapy, can be beneficial. This method involves switching between heat and cold applications to stimulate circulation while reducing pain and inflammation. It is often used for:

• Post-Exercise Recovery: Alternating heat and cold can accelerate muscle recovery.
• Chronic Joint Pain: Conditions like osteoarthritis may respond well to contrast therapy.
• Swelling with Stiffness: Cold reduces swelling, while heat relaxes stiff muscles.
  
  

How to Use Contrast Therapy:

• Best research-backed ratio: 4 minutes of heat followed by 1 minute of cold.
• How it works:
  • Heat widens blood vessels → boosts circulation and relaxes muscles.
  • Cold narrows blood vessels → reduces swelling and pushes out waste products.
• Duration: Repeat the 4:1 cycle for a total of 20–30 minutes.
• Tip: Start with heat and finish with cold for optimal results.
  
  

When to Avoid Heat and Cold Therapy both…
It's important to use heat or ice carefully—and sometimes not at all. Avoid these treatments or consult a healthcare provider if you have:

• Poor circulation or reduced sensation in the area
• An active infection
• An open wound or broken skin
  
  

​We are back to spring! And with it, gardening is a fantastic way to stay active, relieve stress, and connect with nature. But as a physiotherapist, I often see clients with gardening-related aches and injuries. The good news? With a few mindful habits, you can protect your body and enjoy your time in the garden pain-free. 

Warm Up Before You Dig In:

Gardening is physical work - treat it like exercise! Before starting, spend 5-10 minutes warming up: 

• Shoulder rolls
• Gentle trunk twists
• Marching in place
• Wrist and ankle circles

This boosts blood flow and prepares your muscles for movement. ​