I hope you enjoy this blog post I wrote to share with you all some observations I have made over the past year working as a physical therapist. As I continue to learn and support others I have been making observations and have slowly been adding to a list of skills from my physio brain perspective that are important to not only maintain but enhance quality of life!

• Getting on and off the floor. Why? Because to get on and off the floor means that our lower bodies joints have to be flexible and our leg muscles have to be able to lower and lift us. This in my opinion is also a functional task because with this ability we are confident and strong enough to get down low to reach something we dropped on the floor, get something from the bottom shelf if we need to be on our hands and knees, as well as allows us to play with littles ones who frequently are on the floor.
• Spine Mobility. Why? I can’t tell you how important is it to have a spine that is able to move in all directions. There are few things that are worse than neck pain or back pain and in many cases untreated pain in the spine at one level manifests into troubles up or down the system. Our spine is our “back bone”, one of the more major joint systems in our body that allows us to function and accomplish the tasks we want to!
• Glute strength. Why? Our glutes support us in some many ways - they support the pelvis, the low back, and are even working when we are reaching for an item on the top shelf, or swinging a golf club. Our glutes/buttocks muscles are mover muscles and we use them constantly to support our everyday movements.
• Maintenance of Balance. Why? Without our balance we are unable to move safely and poor balance predisposes us to falls. Balance is something I feel we take for granted because it is a skill for most of our life that we don’t have to practice, but as we get older, if our activity levels decrease and our joint range of motion and strength becomes limited we naturally are not challenging our balance. This meant that slowly over time our balance decreases. One of the best ways to maintain balance is to keep active, keep moving!
• Health and Well-being goals. Why? When we have goals it means that we are working towards something, and this generally means that we are active. Having movement or fitness goals for yourself as we progress through life I believe are truly some of our most valuable goals. Movement supports our ability to get out and socialize, participate in the activities we love, supports or physical health, as well as our mental and emotional health. This goal can be as simple as “until the end of my days I will always be able to get on and off the floor”. Having a goal of this nature allows us to check in with our health status and supports everything else we wish to achieve.  

Ankle sprains are a very common lower body injury that often occurs when walking on an uneven surface, slipping on ice or while playing sports. All too often physiotherapists hear people say, oh it’s “Just an Ankle Sprain”...

The term “sprain” means that a ligament has been overstretched and damaged. The degree of damage can be anywhere from a mild stretch to a full tear to an avulsion fracture (the ligament pulls a small piece of bone off). In addition to the ligaments being injured, you can also damage the muscles in your foot or fracture a bone.

It is encouraged that you have a physiotherapists review EVERY ankle sprain, even if you consider it to be mild. Injuries to the ligaments/muscles/tendons/bones can lead to long term complications and risk of re-injury, if not addressed properly.

Physiotherapists will assess your range of motion, joint mobility, strength, function, balance, and proprioception of your ankle following an injury. Proprioception is awareness of where your body and joints are positioned in space. The ligaments and muscles in your foot/ankle communicate with your brain regarding proprioception. This information is crucial for maintaining balance, strength and control. Unfortunately many ankle sprains affect many of these areas and they don’t necessarily spontaneously recover or get better with time. Something else we see as physiotherapists is stiffness in joints following an ankle injury. As mentioned previously, we will evaluate joint mobility as part of the assessment. It is imperative that all the bones in your foot are moving properly to maximize function. Joints that are stiff or immobile, can translate forces elsewhere which in turn can cause issues in other areas, such as your knee.

Once a physiotherapist has carried out the assessment, they will design a treatment plan tailored to your objective findings and personal goals. Treatment often includes: biomechanical care, soft tissue release, education and a home exercise program.

So next time you think “it’s just an ankle sprain” remember that your foot is made up of 28 bones, 30 joints and more than 100 muscles, tendons and ligaments.  All of these structures must be doing their jobs to ensure optimal movement of your foot.  So whether you have a new, recurring or old ankle injury, we are here to help at Donald Physiotherapy. Contact us to book your next appointment!!            

The semicircular canals are a series of what are essentially tubes that exist in pairs on either side of our skull. We have one oriented towards the front, the side, and back of our skull that provide information to the brain on the position and movement of our head through space. Each canal is paired to the opposite one on the other side of our head and they are a highly coordinated system that can detect very small changes in position and posture. Inside the canal are specialized sensory cells and nervous system tissue that reside within the fluid-filled canal. The fluid inside the canal is slightly heavier than water and will slosh back and forth depending on how the head is positioned and how it moves. The pressure change from the fluid moving will stimulate the cells in the canal and produce an electrical signal that our brain can interpret as movement. It is important that both sets of canals provide the brain with the same information and at the same time to avoid confusion.
​
BPPV is thought to occur when a small crystal (otoconia) or clump of cellular debris (the body’s own tissues) ends up in a part of our semicircular canals where it does not belong. The otoconia are typically stored in small organs called the utricle/saccule that reside in our inner ear. These organs attach to the ends of our semicircular canals and it is possible for small objects to pass between these areas. The crystals that normally reside inside our ear organs are used by our body to send information about gravity or the movement of our body through space in very specific directions to our brain. They are denser and heavier than the surrounding tissues which allows them to tell the brain what is changing between the relationship of our body and the environment. The current hypothesis is that these crystals can sometimes be dislodged and inappropriately move into the semicircular canals. There is some evidence to suggest that a clump of cells from our own body can sometimes form an object big enough and dense enough to create the same effect.

A typical presentation will be of an individual who reports episodes of dizziness or the sensation that the room is spinning (vertigo) when they position themselves or their head in a certain way. It may be that it is always when they roll over in bed, or always when they look up at a particular cupboard in their kitchen. The vertigo will sometimes last for only a minute or two, but in rare cases will continue until the position is changed. People will usually interpret this as a feeling that the room is spinning and can be associated with nausea, headache, and pain in the neck and upper shoulders. Many people will learn how to avoid symptom creating positions and some can go days at a time without an episode if they restrict their activity and movement. However, avoiding symptoms can promote stiffness of the neck and upper portion of the body and lead to secondary issues in the muscles and joints of these areas. It is recommended to seek assessment from a physiotherapist who understands BPPV and the various treatment options that exist.
In some cases, BPPV will resolve spontaneously. The body has the capacity to reabsorb the otoconia or the clump of cells and things will return to normal once the crystal is gone. On the other hand, sometimes people will experience episodic or constant symptoms that can last for months or years. Even after successful treatment there is the chance that the condition will reoccur, but this can typically be resolved with the appropriate treatment.
Treatment for BPPV typically consists of the following:
Canalith repositioning maneuvers - Special positions and movements that a trained therapist can guide a patient through in an effort to relocate or dislodge a misplaced crystal or clump of cellular debris.
Exercise instruction in self-treatment and management strategies - Including self-applied movements for BPPV, balance and gait exercises, or stretching and strengthening exercises for the neck and jaw.
Education regarding the condition, the treatment, and further strategies for returning to regular activity.
Biomechanical treatment of the neck and/or jaw as required - Including hands-on therapy for the joints and muscle tissues.
The first interaction with a therapist will include a detailed assessment. It is important to understand the cause of the disorder as different kinds of treatment and therapy are not indicated for all types of dizziness. The therapist will perform a mechanical examination that can include the neck and jaw, as well as a specialized assessment of the nervous system, walking patterns, balance, and positional tests for the dizziness/vertigo. If BPPV is the diagnosis, the first treatment can often be provided during the initial assessment. Depending on the person's personal situation, exercises can sometimes be prescribed for home use to assist with recovery in between sessions with the therapist. However, as dizziness and compromised balance can be a risk factor for falls and injury, not everyone is a candidate for home exercise programming at first.
- Trent, PT
References
​·         Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Bhattacharyaa, N., et al. Otolaryngology - Head and Neck Surgery. 2017. Vol. 156(3s) S1-S47.
·         Treatment of benign paroxysmal positional vertigo. A clinical Review. Perez-Vazquez, P., Franco-Gutierrez, V. Journal of Otology. 2017. Vol. 12 165-173.
·         Vestibular rehabilitation in benign paroxysmal positional vertigo: Reality of fiction? Bressi, F. et al. International Journal of Immunopathology and Pharmacology. 2017. Vol. 30(2) 113-122.

Hello all,

My name is Kristyn and I am a physiotherapist. This is my VERY FIRST blog post ever so here we go…

Let’s talk about something that I have treated frequently over the past few years– the TMJ. “What is the TMJ” you ask? TMJ stands for temporomandibular joint. They are your two jaw joints and you can feel them just in front of your ear openings while you open and close your mouth. When I tell people that it is a part of the body that I treat they are often surprised that a physiotherapist can treat the jaw and they often tell me that they currently have issues or have had issues in the past with their TMJs.

Let’s talk about common issues or symptoms associated with the jaw. Most commonly, people come to me with jaw pain that is causing headaches and limiting opening. Frequently their jaw swings to one side and can click with either opening or closing. They often tell me that they clench or grind at night, and generally hold tension in their jaw. They also say that it feels like their teeth aren’t fitting together and it feels like their bite is “off”. Sometimes they tell me that they have ringing in their ears as well. And sometimes their dentist notices signs of wear in the teeth or gums due to clenching and grinding and sends them my way when they can’t keep their mouth open for dental procedures.

All of these things are limiting in life when someone with jaw issues is having pain from headaches due to muscular tension or imbalance, having discomfort when taking a large bite of food or when they are chewing something chewy like a steak, when their ears are ringing or they are having ear pain related to the jaw, or if they are having pain while talking, singing, or playing an instrument.

Some of the common causes of TMJ issues include:
·         Tension due to clenching, grinding, or holding tension during the day or the night
·          Hyper or hypomobility (extra movement or reduced movement) of one or both joints.
·         Joint issues due to degeneration or disc entrapment/derangement
·         Trauma to the jaw

People often discuss their jaw issues with their dentist, who is able to offer them the option of a mouthguard to protect the teeth (yes, I have seen several people who have cracked their own teeth due to clenching and grinding). A mouthguard is a plastic device that is designed to protect the teeth from wear caused by clenching and grinding at night, during the day or with impact sports. It also protects the TMJs from compression. I enjoy working with dentists to assist mutual clients with the recovery of their jaw health. I also screen my clients to ensure that they are a good candidate for physiotherapy and I will refer back to a dentist or physician if that is what is required.

Something that may surprise you is that the jaw joints and their function are closely connected with the neck! Neck issues can result in weakening or reduced coordination of the jaw muscles which can result in dysfunction. The neck provides the core foundation on which the jaw moves. Therefore, when I am treating someone’s jaw, I almost always have a look at neck mobility and function. This could be a whole other blog topic…
​
If you are experiencing issues with your jaw joints we would love to help you with your recovery and restoration of jaw control and mobility. If you have any questions about how you may benefit from physiotherapy for your jaw, do not hesitate to give me a call.
 
-          Kristyn, PT
 
References
·         Wright EF, North SL. Management and Treatment of Temporomandibular Disorders: A Clinical Perspective. J Man Manip Ther. 2009; 17(4): 247–254.
·         Mota LAA et al. Signs and Symptoms Associated to Otalgia in Temporomandibular Disorder. International Archines of Otorhinolaryngology. 2007;11(4):411-415.
·         Rocabado M, Johnston Jr. BE, Blakney MG. Physical Therapy and Dentistry: An Overview. Journal of Craniomandibular Practice. 1982;1(1)46-49.

We are starting something new - throughout the coming months, various team members will be writing to tell you about some of the things the love about physiotherapy, some of their expertise, and some useful information about the human body, conditions, the clinic, etc.

Please stay tuned and check back often.  Facebook and Instagram will also share these posts - find us on Facebook and DonaldPhysiotherapy and Instagram @donald_physio!

If you have anything of interest, please feel free to drop us a comment or an email at [email protected].

Thanks for popping by!

​~Michelle