The following is a list of common conditions treated at ProHealth Physiotherapy. This list is not exhaustive as there are many conditions that we can help improve, including headaches, jaw pain, and tennis elbow. If there is a condition that you would like to know a little more about, please call us and we will be happy to answer your questions.

Headaches and Neck Pain

Headaches and neck pain are most commonly felt in the forehead, back of the head, behind the eyes or over the entire scalp. Many times, the headaches arise from muscles of the head and neck, caused by muscle spasms, constriction or dilatation of the blood vessels in the brain.

Many headaches are primary, and can be classified as tension, migraines, cluster and cervicogenic. Cervicogenic headaches are most commonly caused by dysfunctions of the upper cervical joints, especially facet joints. They usually become stiff, thus restricting the physiological movements between vertebrae, and cause irritation of nerve roots. Secondly, the cervical musculature becomes tight and forms trigger points that can refer pain into the head, neck and sometimes behind ears and eyes. Complicating factors can include increased stress, improper work or study posture, whiplash injuries, or trauma.

Physiotherapy can help reduce cervicogenic headaches by decreasing muscular tension, including trigger points, and improving cervical joint mobility. Ergonomic advice and adjusting workstations for proper postures are helpful.

At ProHealth, the Registered Physiotherapist can use a variety of physiotherapy techniques and modalities, such as ultrasound, laser and electrotherapy to relax muscles and reduce muscular spasm. Your physiotherapist can also perform taping, soft tissue techniques (massage, acupressure) and joint mobilizations, including manual and mechanical traction to restore passive cervical movements. Stretching and strengthening exercises are important in keeping the newly achieved mobility while improving neck stability and strength. Your Physiotherapist will guide you through an exercise program, including postural strengthening.

Treatment can involve education regarding stress reduction, massage, acupuncture, alteration of posture and workspace and self-pacing strategies to prevent further neck pain and headaches episodes.

Back Pain

Back pain is primarily caused by poor posture and bad habits. More than 70% of back ailments start during routine functional activities. Among the main causes of back pain are: postural stress, muscular strains, ligament sprains, and disc pathology, wear and tear of lumbar spine, degenerative arthritis, or severe whiplash. Frequently, active population sustains an injury at work or at home, when one of the lumbar discs are affected (prolapsed, bulging, or even herniation or rupture), as a result of a major mechanical stress associated with prolonged, sitting, lifting or twisting. The pain can be limited to the back, or it can radiate to the lower abdomen, groin, leg, buttock or foot. Sometimes, there could be other symptoms associated with back pain, such as tingling, numbness or a burning sensation. These symptoms are an indication of a nerve root damage. This type of low back pain, which may or may not involve leg pain, varies in severity: mild, moderate, severe, depending on the severity, gravity and re-occurrence of disc dysfunction.

At ProHealth, the Registered Physiotherapist will perform a thorough assessment and determine the potential cause of the problem, and will develop a management plan for your dysfunction.
Such a management plan may include:

- Manual techniques, including mobilizations, manual and mechanical traction and soft tissue techniques
- Modalities, such as Ultrasound, Laser, moist heat, ice, or acupuncture, to decrease pain and tightness
- Stretching and strengthening exercises, to improve joint and muscle flexibility, core (deep abdominal muscle) stability and strengthening
- Postural strengthening and general conditioning
- Education in proper body mechanics and ergonomics at work, school and home with activities of daily living.

Frozen Shoulder

Frozen shoulder, or adhesive capsulitis, is characterized by pain in the shoulder, sometimes leading into the upper arm and shoulder blade. This may cause a decrease in shoulder movement, stiffness of the shoulder joint. Frozen shoulder can be secondary to other medical problems such as thyroid illness, Parkinson disease, and cardiac disease and post-surgery. It may also be secondary to a fracture of the shoulder or arm, tendonitis, trauma or other condition requiring shoulder immobilization for a period of time. During this time, the capsule of the shoulder joint becomes inflamed and thickened, sometimes contracted.

Patients often complain of an intense pain, dull or aching, with difficulties sleeping and a very restricted range of motion. The decrease in the range of motion decrease usually shows a pattern; some movements are more affected than others. In time this condition leads to decreased strength and stability, as well as scapular stability, and therefore reduced arm function in different degrees.
 
The normal course of frozen shoulder has three stages: freezing, frozen and thawing, which can last up to 2 years. Frozen Shoulder is a self-limited condition. However, physiotherapy has been proven to shorten the healing process. After assessing the physical and functional restrictions and impairments, the physiotherapist will aim the treatment towards pain and inflammation reduction, and restoration of the motion.

At ProHealth, as part of the treatment, the Physiotherapist will use modalities, such as: Ultrasound, Laser, TENS, ice and heat are used to reduce the pain and inflammation. Through manual techniques, passive range of motion, stretches, mobilization and traction, the mobility of the shoulder can be gradually increased. The physiotherapist will direct and supervise patients through a gradual flexibility, range of motion and strengthening program, to restore normal mobility and strength and to help improving shoulder function.

The education and close monitoring with a comprehensive exercise program, provided by your physiotherapist, are keyways to successfully heal and restore function of a frozen shoulder. 

Rotator Cuff Injuries

Rotator cuff injuries are some of the most common conditions affecting the shoulder, created by the inflammation of one or more rotator cuff tendons. The “rotator cuff” complex is formed by a group of 4 muscles: Supraspinatus, Infraspinatus, Teres Minor and Subscapularis.
 
The rotator cuff complex plays an important role in arm movements, such as rotation and elevation of the shoulder as well as stabilization of the shoulder socket. The most common injured is the Supraspinatus. Patients complain of pain and tenderness at the front of the shoulder, sometimes in the upper arm. Pain is usually aggravated by sudden movement like throwing or reaching over head or over shoulder, lifting, reaching sideways and/or backwards and sometimes reaching into back pockets. Progressively, there is a limitation of shoulder joint movement and strength. In the chronic (advanced) cases, x-rays will show calcium deposits that can lead to small tears in the tendon.

Your Physiotherapist at ProHealth will aim to reduce local symptoms, like pain and inflammation, through modalities (Ultrasound, TENS, heat, ice, Laser, Acupuncture) and manual techniques. A gradual exercise program focusing on increasing the range of motion, flexibility and stability of the shoulder blades, and strength of the rotator cuff will be beneficial to full recovery. Other techniques used can be taping and education aimed at avoiding certain aggravating activities, self-applying ice and education on proper body mechanics at home or office. 

Repetitive Strain Injuries

Repetitive Strain Injuries, also known as RSI, is a term describing more than 20 disorders of the musculoskeletal system, including Carpal Tunnel Syndromes, tendonitis and bursitis. RSI develop as a result of repetitive motion, combined with improper postures and excessive force, at work or during leisure activities. Some of the symptoms reported are pain, tingling, numbness, weakness, restricted mobility and stiffness in the affected joints. If left untreated, RSI can become chronic and can affect the non-occupational life of the person. It is important to take preventative measures before RSI develop.
 
Physiotherapists are skilled in detecting the early signs and symptoms of RSI and can develop the appropriate treatment plan for you.
 
Usually, many patients seek help after the first symptoms have already developed – i.e. pain at the shoulder or tingling and numbness in the hand, pain and swelling at the elbow, and decreased grip strength. Patients complain that some tasks require more effort to complete than before, or they are unable to finish the tasks. This is when they visit their family doctor, which, in many cases, will refer them to Physiotherapy.

The Physiotherapist will assess and determine the risks and aggravating factors leading to RSI, and advise on ways to prevent further injuries. Your therapist will then develop the injury management plan.
 
The Canadian Physiotherapy Association recommends the following tips, to help prevent RSI:
 
- Maintain correct posture while working to reduce strain on joints
- Have your work station evaluated to make sure it  is ergonomically correct for you
- If your work involves heavy activity, warm up before you start and do simple stretches during the day
- Decrease excessive force in any activity. For example, avoid typing forcefully; or use a dolly to transport heavy items etc.
- Change your posture often and take frequent breaks, alternating between sitting and standing when possible, especially if you have a sedentary job
- Report problems early so that something can be done to help you or to change the work process
- Aim to be fit and healthy. Good muscle strength, flexibility and endurance help improve your body’s ability to absorb repetitive strain.

At ProHealth, the Physiotherapist can provide combined active and passive treatment, to help relieve the symptoms, and promote tissue healing. Physiotherapy treatment includes modalities, such as Ultrasound, LASER, TENS, heat or ice, to decrease the inflammation, reduce the pain and minimize scar tissue formation. You will be also instructed in specific stretching and strengthening exercises that will help preventing reoccurrence of further episodes of pain. Your physiotherapist will also advise you on modifications at home or in the workplace environment.

Osteoarthritis

Also called Degenerative Osteoarthritis, it is caused by a deterioration of the cartilage in the affected joints. This condition can affect mainly the elderly, but may also occur in younger people. Osteoarthritis has an insidious onset, and its symptoms can develop after many years.

Canadian Physiotherapy Association defines Osteoarthritis as: “Wear and tear of your joints which may occur due to the aging, injury, prolonged poor posture, overuse of joints, or excess weight”.
 
Often clients describe morning stiffness and pain in their affected joints. These symptoms are worse after keeping the joints in a fixed position for lengthy periods of time. Clients affected by Osteoarthritis usually notice joints swelling and redness and limitation of their mobility, which will lead to decreased functional level with activities. For some people, despite irreversible changes to the joint, they can be pain free, or only suffer mild and occasional episodes of pain following prolonged use of joints or minor trauma. Other people can have disabling symptoms affecting their walking (weight bearing joints, such as knees, hips, spine), and their functioning in day-to-day activities.
 
At ProHealth, the Physiotherapist will design a complex program helping to reduce pain and inflammation of the affected joints (using modalities and manual techniques), improve movement and posture, increase flexibility and mobility, and strength around the specific joints. This approach can be very effective in helping people dealing with their disabling symptoms and improving their quality of life.
 
All these physiotherapy approaches can contribute to increasing the client’s independent function. The reason for maintaining the function of the joint, while decreasing pain and inflammation, is that by non-using or misusing a joint, the muscles, tendons and ligaments that surround it become weaker, and the joint loses its flexibility and mobility.
 
The Physiotherapist at ProHealth will work with you, to help you manage Osteoarthritis symptoms by maintaining and increasing mobility, restoring muscle balance and flexibility, improving circulation and endurance and improving strength and stability of the affected joints. They will also educate you on the benefits of splints, along with advice on how to further prevent joint damage. It is very important to balance rest and activity and tailor your exercise program accordingly, to avoid excessive stress on your joints.
 
As the Canadian Physiotherapy Association recommends, there are many other ways to help manage your Osteoarthritis:

- Always ‘respect pain’ - do not keep ignoring the discomfort
- Avoid overstressing joints - use proper body mechanics
- Avoid jerky or sudden movements when possible
- Maintain a healthy body weight
- Use splints or walking aids if necessary
- Never overdo activity or exercise.
 
Osteoporosis

Osteoporosis is a condition in which bones weaken and start losing their bone mass. Weakened bones are more likely to fracture. Sometimes, only a mild trauma, like coughing or sneezing, can produce “fragility fractures”. The Osteoporosis Society of Canada reports that one in four women and one in eight men over the age of 50 have osteoporosis.

There are three stages of bone loss:

- Osteoporosis with mild loss and changes to bone density
- Osteoporosis with significant bone loss, but without history of fractures
- Osteoporosis with significant bone loss, with a history of fractures

Knowing the factors that increase the risk of osteoporosis will help avoid or delay its onset and could minimize its severity. According to the Osteoporosis Society of Canada, below are the most important risk factors:

- A family history of osteoporosis
- A slight body build (small bones)
- Smoking
- Eating disorders, such as anorexia
- Low dietary Calcium intake
- Excessive alcohol intake.

For women after menopause the influence of these risk factors increases.

For people who are at risk of developing, the Osteoporosis Society of Canada recommends a dietary intake of 1500 mg/day of Calcium and 800 IU/day of vitamin D. In addition, to optimize bone health, 30 minutes of exercise or more, at least three times a week are recommended. The exercise can include regular walking, low impact exercise classes and low impact strength training.

At ProHealth, we can help you maintaining an optimal quality of life, by advising what exercise is appropriate for you and how to decrease the risks of fractures, pain, or other mobility and strength problems.

At ProHealth, your Registered Physiotherapist will design a personalized and comprehensive exercise program that may include weight bearing, aerobic and strength training, mobility and flexibility exercises. It has been shown that weight-bearing exercises can slow down the bone loss process and stimulate bone remodeling. Balance or proprioceptive exercises are effective in decreasing the risk of falling and associated complications. A customized exercise program can be very effective in helping you to regain strength, balance and reduce the risks associated with osteoporosis.

For complete info about the prevention and management of osteoporosis, please visit the Osteoporosis Society of Canada website (www.osteoporosis.ca ).
 
Knee Pain

Knee pain is very frequently encountered in all age groups, affecting patient’s participation or performance in many aspects of their daily activities.

The knee comprises four bones. Three of them, the femur, the tibia and the fibula, are your leg bones. The fourth, the patella, or simply said, the kneecap, covers and protects the joint and also provides leverage for the knee and hip muscles, as they bend and straighten the legs.

Normally, muscles and ligaments working together as pulleys and ropes control the kneecap movement. Therefore, the patella glides smoothly in its track (the femoral groove). When muscular imbalance (excessive tightness or weakness) appears, or due to an injury, or overuse, the patella will not glide as smooth as before; the excess give and uneven pressure that builds up can cause wear and tear of the cartilage. The patella tracking problems can lead to cartilage damage (osteomalacia), dislocation or sub-luxation of the patella, patellar tendonitis (“jumper’s knee”) or plica band tendonitis. You may hear your doctor or your physiotherapist using the term: “patello-femoral syndrome”. This term will include anterior knee pain, especially with stairs, walking, squatting, grinding, clicking, limitation of movement, knee stiffness, early tiredness, overall knee weakness.

At ProHealth, the Physiotherapist will identify the real cause of your knee pain, performing a thorough history and examination of your knee.

There are usually several stages in the rehabilitation program:

1. Reduce pain and inflammation, and improve knee movement.
2. Increase knee flexibility and strength.
3. Return to previous daily and sport activities.

At ProHealth, your Physiotherapist will decrease your pain and inflammation by various modalities, such as electrotherapy, ice, heat, Laser, and Ultrasound, and gentle manual techniques. She will also instruct you on bracing, taping, compression, and passive and active range of motion. Once the pain and inflammation subsides, you will be prescribed a specific exercise program that will increase the strength and flexibility of your hip and knee. Electrical Muscle Stimulation will help activate and re-educate the weak and inactive knee muscles and correct imbalance. If needed, you will also be trained on self-pain management, and how to control your knee position, to avoid further injuries.

Once your leg muscles are flexible and strong enough, your Physiotherapist will teach you how to resume all previous daily, including sport activities, with minimum impact on the knee joint and optimal patella function.

Our goal at ProHealth is to protect you from another reoccurrence of the knee damage, while enjoying your routine activities, WITH NO PAIN.
 
Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is a condition in which the median nerve is compressed at the wrist level. The median nerve controls the sensation of the palm (D1, D2, ½ D3) and the musculature of the hand, especially the thumb. The Carpal Tunnel is a narrow canal at the wrist that contains the median nerve and tendons of the wrist muscles. In most of the cases, thickening of inflamed tendons produces a narrowing of the Carpal Tunnel, which will cause the median nerve to be compressed. This in turn will cause nighttime pain, burning sensation, tingling and numbness in the hand and wrist.

Patients may experience weakness, decrease in grip strength, difficulty to grasp small objects, or hold them for a longer period. Initially, the symptoms appear at night, while sleeping, due to the fact that we all tend to sleep with the wrists flexed. As symptoms worsen, the patients will feel tingling and numbing episodes during the day. In time, other symptoms may appear, like loss of muscular contour of the thumb area and loss of sensation.

There are many causes of CTS, all related to increased pressure on the median nerve and tendons inside the narrow Carpal Tunnel:

- repetitive, improper posture, like excessive keyboarding with flexed and unsupported wrists
- congenital cause (tunnel is smaller than normal)
- different endocrinologic dysfunctions
- rheumatoid arthritis
- mechanical causes (trauma, wrist fracture, chronic wrist tendonitis)
- repetitive use of vibrating hand tools
- fluid retention during pregnancy.

Physiotherapy is extremely important in the prevention and treatment of Carpal Tunnel Syndrome. If you are at the risk of developing Carpal Tunnel Syndrome, your Physiotherapist at ProHealth will encourage you to take frequent stretching breaks from the repetitive movements which cause pain, in order to reduce force and improve the working position of your wrist. You will be trained on improving posture, keeping your hands and wrists warm and flexible, to prevent or delay the occurrence of Carpal Tunnel Syndrome.

If you have already developed Carpal Tunnel Syndrome symptoms, such as wrist pain, burning, tingling and numbness sensation, your Physiotherapist may use modalities (such as laser, ultrasound, electrotherapy, acupuncture, heat, ice) and manual techniques (soft tissue massage, myofascial release, active stretches) to decrease pain and inflammation. Once the pain and inflammation are under control, you will be instructed in various exercises (range of motion, flexibility, grip strengthening, neural mobility), to increase wrist function. If symptoms persist at night, the physiotherapist will prescribe you a night splint or a brace.

Carpal Tunnel Syndrome is a common condition that can be prevented or alleviated. At ProHealth Physiotherapy, we can help you deal with your symptoms and lead you towards recovery.
 
Joint and Muscle Stiffness

Many times after an injury, a period of inactivity, illness, a surgical procedure, or a prolonged and heavy activity, you might complain of joint and muscle stiffness.

Your Physiotherapist at ProHealth can help you return to your regular activities, with no pain or discomfort, and give you the confidence to manage and prevent future problems. At ProHealth, we use a variety of methods, depending on your specific situation, to help you overcome joint and muscle stiffness:

- Manual techniques, including soft tissue massage, specific joint mobilizations, myofascial releases and active stretches, traction, mobilizations with movement, deep friction.
- Modalities to decrease pain and stiffness, like acupuncture, electrotherapy, Ultrasound, Laser, heat, ice.
- Close instruction on a tailored exercise program, including ROM, flexibility, strengthening, core stability, proprioceptive, and balance.
- Education on body awareness, tips on recovery and healing, sleeping, proper posture, ergonomics at work, and how to identify and avoid aggravating factors.

You will be working together with your physiotherapist at ProHealth Physiotherapy, to maintain the improvements achieved at the sessions. These will speed-up your recovery and get you back to 100% function.