Shoulder Prehabilitation (prehab) involves the process of implementing a physical, psychological, nutritional intervention before an individual goes into surgery. The goal behind prehab programs is to maximize an individual’s physical and psychological fitness/health before surgery in order to reduce pain, increase physical function and allow you to return to your normal activities sooner following surgery.
Although there is limited evidence regarding shoulder prehab programs, there is promising and growing evidence that suggests prehab programs for hip, knee, and spinal surgery may improve pain, function and reduce the total cost of healthcare spending in the post-operative period.
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Types of Surgeries for Shoulder
- Reverse arthroplasty
- Total shoulder arthroplasty/replacement
- Rotator cuff repair
- SLAP repair
- Bicep tendon repair
- Tenotomy
What Prehab Programs look like:
Most prehab programs can be anywhere from 2-8 weeks leading up to surgery and could potentially involve:
1) Exercise training (2-3x/week)
- Strengthening and stabilization exercises for the rotator cuff and muscles supporting your shoulder blade
- Home exercise program tailored to your needs
- Exercise training 1 on 1 with a physical therapist
2) Education: information delivered regarding
- Shoulder anatomy and mechanics
- Pain science education
- The process of your operative procedure
- Patient-therapist expectations
- Post-operative protocol
- Detailed exercise program and technique
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3) Nutritional support
- Consultation with a registered dietician
- Detailed nutrition programs to optimize physical and mental health
- Nutritional supplements as indicated
4) Psychological support
- Consultation with psychologist/ psychotherapist
- Anxiety and stress reduction
- Cognitive-behavioral therapy
- Relaxation techniques
- Coping strategies for surgery
Shoulder Prehab is a set of exercises and movements designed to strengthen and condition the shoulder joint and surrounding muscles, helping to prevent injury or improve recovery from a previous injury. Prehabilitation may include:
- Shoulder rotator cuff strengthening exercises such as internal and external rotation with light weights.
- Scapular stability exercises to improve posture and reduce stress on the shoulder joint.
- Stretching to improve flexibility and range of motion.
- Plyometric exercises to improve power and explosiveness.
- Core stability exercises to improve overall body control and stability.
Prehabilitation should be performed regularly, especially if you have a history of shoulder injuries or plan to participate in overhead activities such as weightlifting or throwing. By taking care of your shoulder before it becomes a problem, you can help prevent injury and improve your performance.
One of the most common runners’ complaints is Shin splints (also known as Medial Tibial Stress Syndrome (MTSS)). The word shin splints describes pain/discomfort that gets worse during running or exercise around the front of the lower shin. Shin splints are usually developed by overuse, and a registered physiotherapist will do a detailed assessment to diagnose shin splints and develop a treatment plan to resolve them.
Shin splints are painful and uncomfortable but here are a few tips to effectively manage them.
Woman suffering from an ankle injury while exercising. Running sport injury concept.
Rest
Shin splints are considered an overuse injury. In the short term, rest will help the pain, and it is advised to rest for a period of time before beginning to run again. Start with shorter, slower distances instead of jumping right back into long distances when you start running again. Start running once a week and work up to twice a week if you usually run 3 days a week.
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Ice
Place ice packs on your shins for a few minutes at a time. Icing will not treat your shin splints but will help effectively manage your pain after running.
Change up your workout routine
Adding resistance training to your workout routine can help reduce your pain by helping your muscles & tendons increase their capacity. Incorporating other types of aerobic exercise into your routine, like cycling, rowing, or the elliptical in place of running, can also help. Shin splints commonly come from the impact from running on hard or uneven surfaces. Replacing running with a different type of exercise once a week can help.
Stretching, warm-ups and cool-downs
Stretch your calves and shins before running to increase the flexibility in your legs. Warm-up before your workout to prepare your muscles and cool down at the end of it to help your muscles recover.
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Footwear & Orthotics
Think about how long you have had your running shoes. Good shoes are important as they act as shock absorbers every time your foot hits the ground. If the sole of the shoe is worn, shoes lose their shock absorption. Try a new pair of shoes with more cushioning and see how you get on.
Also, consider seeing a chiropodist for a pair of orthotics. Custom orthotics can help align and stabilize your foot and ankle, taking stress off of your lower leg. They can also be beneficial if you have flat feet.
Our physiotherapists at Triangle Physiotherapy can help resolve your shin splints and get you back to running or any other sport that you may love! Call us to book your assessment or book online here.
We’ve all heard how good running can be for you. Running helps to lose weight, prevent disease, lower stress, strengthen joints, manage blood pressure… the list goes on and on. But there’s a suprising problem you may be experiencing if you’re a long distance runner. It’s called leaky gut. I know, it sounds gross, but if you’re a runner then it’s something to keep in mind. How do you know if you have a leaky gut? Read on to find out common symptoms and how to treat it.
What is leaky gut, anyway?
Leaky gut, also known as intestinal permeability, is a dysfunction in the lining of our intestine. Our intestinal walls are only one cell layer thick. Their job is to absorb nutrients and prevent bacteria from getting into our bloodstream. When the cells of the gut lining start to separate and let bacteria enter the bloodstream, we get what we call leaky gut. This can lead to all kinds of health issues, including:
- allergies
- asthma
- autoimmune disease
- eczema
- psoriasis
- rheumatoid arthritis
- food sensitivities
- irritable bowel syndrome
- Crohn’s disease
- ulcerative colitis
- thyroid problems
- acne
- nutrient deficiencies
- depression and other mood disorders
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How does running lead to leaky gut?
It’s actually not just running that can lead to leaky gut. Powerlifters and people who do cross-fit are at risk, too. Same goes for anyone who does vigorous strength training or heavy exercise. The gut lining becomes more permeable due to the amount of stress put on your body by these types of activity. High physical stress leads to higher metabolic demands. Endurance sports do appear to have the most profound effect on leaky gut though, which is why you might be more concerned if you’re a marathon runner, cyclist, or triathlete.
When you exercise, plant-derived carbohydrates are digested and fermented by the gut. This can create some harmful byproducts that play a role in creating leaks in your gut. Once you have a leaky gut, toxins are more easily able to cross from your intestines into your bloodstream.
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Endurance exercise can also increase our secretion of pro-inflammatory cytokines. This means that more inflammation is happening in the gut, which can throw off the balance of good bacteria versus bad bacteria in the intestines.
If you know me, you know I don’t like talking about health issues without some scientific studies to back up what I’m saying. So let’s take a look at one. Researchers looked at LPS (lipopolysaccharide) levels in athletes. They chose to look at LPS because it is a toxin found in bacteria. They measured LPS from blood samples of 29 athletes before, immediately after, one hour after, two hours after, and 16 hours after a triathlon. What they found was that LPS in the blood increased immediately after the race. But guess what? LPS was even higher than that one hour later. This demonstrated that there was an increase in leaky gut both during and after intense exercise.
I think I might have a leaky gut… now what?
Don’t hang up your running shoes just yet, folks. There might be a solution to those leaks in your gut. Remember how I mentioned that the balance between good and bacteria in the gut can get thrown off? Well, one way to help restore that balance is by taking probiotics. Probiotics are known as the good, healthy bacteria that we want and need in our gut. There are many different strains of probiotics. The two that have been shown to be most helpful with leaky gut is called Lactobacillus and Bifidobacterium. These strains help cells of the intestinal wall to tighten up the gaps between them.
A study demonstrated that probiotic supplements reduced LPS levels in the blood. This led to less leaky gut as well as an increase in the amount of time it took to reach fatigue while exercising in hot temperatures. This means that probiotics could actually help to improve athlete performance, too!
If you are a runner and suspect you may have a leaky gut, don’t wait until deteriorating health issues come along. Act now by calling the clinic to book your appointment with Dr. Corina Kibsey, ND today.
Isn’t it so unfair?! Last night you were all fine before going to bed but the next morning you woke up with a sore shoulder. The un-invited shoulder pain makes you continuously look back and think of how you might have injured it. Maybe it was an intense dance lesson from last week, a strenuous workout, or even sleeping incorrectly. Not being able to figure it out, you carry on with your day, all the while noticing that something is feeling off.
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Below are a few common reasons that can cause “random” shoulder pain:
- Thoracic Spine Stiffness: The stiffness in the thoracic spine is mainly caused by lack of movement or prolonged sitting, which is more likely to happen since more people are having sedentary jobs. In such cases, we tend to round our shoulders more which eventually puts too much stress on underlying structures.
- Frozen Shoulder: A condition which causes a significant amount of scar tissue to be deposited all around the shoulder capsule, causing a noticeable range of motion restrictions, strength loss, and pain.
- Rotator Cuff Tendonitis: This usually occurs when the rotator cuff tendons in the shoulder are overworked or strained because of an injury. You might even hear a snapping sound when you move your shoulder. Exerting pressure on the shoulder, sleeping incorrectly, and poor shoulder mechanics are some of the causes of this condition.
- Shoulder Impingement: Sleeping on one arm can result in shoulder impingement. Shoulder impingement can also be caused due to excessive shoulder movements, ligament laxity, muscular weakness around the joint, poor posture, previous injury, etc.
- Scapular Dyskinesis: Also known as Chicken wing shoulder blades, this condition causes you to have poor muscular control of your shoulder blades. There can be muscle pain or joint pain around the scapula when carrying heavy objects.
- Referred Pain: Many people come to our physiotherapy clinics complaining about their shoulder pain, but after a thorough examination we realize that the pain is referred from their neck. It is important to see a Physiotherapist that understands this link and treats the right thing!
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A few simple solutions which will give you some relief:
- Avoid intense activities
- Maintain a proper posture
- Don’t sleep with your elbow over your head; this can compress the tendons of the shoulder and increase your pain
We, at Triangle Physiotherapy, will assess your shoulder and create a comprehensive treatment plan for you. Our treatment will involve a combination of hands-on manual therapy techniques as well as a custom exercise plan to help you on your road to recovery. Book your appointment now and stop letting your shoulder prevent you from doing the things you want to do!
Winter is on its way out and spring is almost upon us. With the warmer change in weather, we shake off our desire to hibernate and become more active, doing activities we haven’t done in months! However, we sometimes rush into things too quickly and can put too much pressure on our feet, leading to the development of various foot problems. Orthotics might be the answer for you as they can help change the way your foot makes contact with the ground and can take pressure off high-pressure areas in the foot.
What are Orthotics?
Orthotics are insoles that you use inside your shoes that help rectify biomechanical problems of the foot. They are usually made of a combination of rubber, metal, plastic, leather, or any other synthetic material. Our feet have so many muscles, bones, and joints that abnormal biomechanics of how they’re moving can result in numerous foot problems along with pain in your knee, lower back, hip or leg.
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How can Orthotics correct foot conditions?
- Orthotics help balance pressure placed on the feet by redistributing the weight appropriately
- They help stabilize the heel
- Support the arch of the feet
- Provides cushioning to delicate and inflamed areas of the feet that arise from too much walking, jogging, running, etc.
There are generally two options when it comes to selecting orthotics: over-the-counter orthotics and custom-made orthotics. Over-the-counter orthotics are available at your local pharmacy and big box store and they can be used with your regular shoes to correct trivial problems. However, because they are prefab, generalized products, there is a possibility that they might make your foot pain worse due to it not being the right kind of support that you need. Custom made orthotics work best because they are tailor-made to correct the problems specific to your feet. Check out our earlier blog on the most popular kinds of Orthotics for further detail.
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Here’s a tip
Orthotics can still benefit you even if you don’t suffer from any foot issues but are an active participant in sports. If your foot is dealing with stress and impact, or if you have recently gained weight, orthotics will help you walk better!
Put your best foot forward and in the right direction!
We at Triangle Physiotherapy will quite literally help you get back on your feet! Our Chiropodist can advise you on how to look after your feet and what type of shoes or orthotics to opt for. Book an appointment with our Chiropodist today at any of our 6 clinics located across the GTA: Etobicoke, Oakville, Mississauga, North York, Toronto (King Street West) and Yonge Street. If you have any questions regarding any kind of foot conditions, please call or email us and we will be happy to help you!
Our feet are likely the most used body parts of all of our limbs. Be it sitting or standing, we are always using our legs in one way or the other. In fact, the use of our feet and legs usually begins the moment we wake up. So it is safe to say that our feet play a vital role in our day to day life and as such, it is important to take good care of them.
Our feet carry the entire weight of our body throughout the day. They undergo tremendous pressure with every step we take as they get compressed and endure repeated movement against our footwear. Over a period of time, pressure on certain parts of the foot can increase and the body compensates by adding extra layers of scar tissue and skin on parts of feet that undergo high pressure, such as the ball and heel & toes of the foot. This can cause there to be painful areas of pressure on the foot, or the formation of callouses on areas of higher pressure on the foot.
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Why schedule an appointment with a Chiropodist?
Walking, running, sitting – everything involves your legs. A minor injury or pain can cause huge discomfort in your everyday life and can escalate to become a serious issue. For example, an ingrown toenail or an infection can be very painful and uncomfortable. Seeing a Chiropodist at an earlier stage will help immensely in preventing and managing these kinds of foot related problems.
An appointment with a Chiropodist will involve a thorough assessment of your foot-related problem and treatment that will help alleviate the problem. Even without a significant ongoing foot issue, a visit to the Chiropodist can help you in preventing one from developing by gaining more insight into your walking pattern or providing education on correct foot care. They are trained to diagnose and treat a wide variety of foot-related conditions and are able to understand their patients’ needs in order to prevent and treat both acute and chronic conditions that involve the foot and lower limb functions.
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What do we treat at Triangle Physiotherapy?
Our Chiropodist is a highly skilled professional that is an expert in their field. At Triangle Physiotherapy, our registered Chiropodists diagnose, assess, and treat a wide range of foot related health issues and abnormalities including but not limited to:
- Alignment and support to prevent or correct abnormalities in the lower limbs
- Abnormal gait patterns
- Foot pain
- Sports injuries
- Diabetic foot care
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How to Contact Triangle Physiotherapy?
We have 6 clinics located across the GTA: Etobicoke, Oakville, Mississauga, North York, and Toronto (King Street West and Yonge Street. If you have any questions regarding what type of chiropody treatment may be appropriate for you, please call or email us and we will be happy to answer your questions. You can also Book an Appointment with a Chiropodist now.
What is a Podiatrist? A podiatrist deals with the assessment, diagnosis and treatment of the lower limbs and feet. What is a Chiropodist? A chiropodist deals with the assessment, diagnosis and treatment of the lower limbs and feet. Sound familiar? That is because these two professions are one and the same!
While there may be differences in terms of scope of practice in other areas of the world, in Canada, both podiatrists and chiropodists are qualified to treat patients with arthritis, diabetes, lower limb sports injuries, and various other ailments of the feet. They have received specialized training which allows them to work with patients of all ages and to help the elderly stay mobile and independent. The only practical difference between the two professions, in terms of their scope of practice in Canada, is simply their title.
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Chiropodists can advise patients on how to look after their feet and what type of shoes or orthotics to wear. They can also treat, alleviate and benefit day-to-day foot conditions, such as:
- Thickened, fungal, or ingrown toenails
- Varicose veins
- Athlete’s foot
- Smelly feet
- Dry and cracked heels
- Flat feet
- Bunions
- Heel pain
- Ageing feet
- Blisters
- Gout
- Sports Injuries
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Seek help from a Chiropodist for advice or treatment if you have:
- Painful heels or arches
- Thickened or discoloured toenails
- Cracks, cuts, or hardened skin on your feet
- Growths, such as warts
- Scaling or peeling on the soles
- Any other foot condition
Don’t bury your head in the sand and ignore small foot problems! These small “problems” can quickly transform into major issues that can affect the quality of your life. As they say, “prevention is the best cure “. Patients who make regular check-up appointments can avoid many potential feet problems as Chiropodists are specialists at recognizing problems before they have occurred.
Don’t’ let your feet problems keep you from stepping into our clinic! Seek the help of our foot specialists at any of our locations in Etobicoke, Oakville, North York, Mississauga & Toronto and say goodbye to your foot dilemmas!
Wearing heels maybe a fashion statement for some, but for others it is a work necessity.
Studies have shown that
- 72% women wear high heels at some point or the other
- 50% of them wear them at parties
- 39% of them wear them everyday
- And 31% of them wear them to work
But wearing heels for a prolonged period of time can lead to multiple issues. So what are the “heel issues” that affect most women? And how can you deal with them?
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Do your toes hurt and your feet feel numb? You might have Morton’s Neuroma, commonly known as forefoot pain. People with this ailment most often complain of pain between the 3rd and the 4th toe. Pain between the 2nd and the 3rd toe is less common, but also known to happen. This ailment occurs when the nerves between the toes get irritated and inflamed.
Another common issue with wearing high heels is back pain. Constantly wearing very high heels puts stress on the thighs and hip flexors, which in turn puts more pressure on the spine and causes it to curve. The curving of the spine then leads to back pain.
Pain in the knee joints is also an issue that occurs if you wear high heels too often. High heels put too much pressure on knee joints and can create an imbalance in your leg alignment, leading to pain and other issues of the knee joint.
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Ditching the heels completely will obviously be the best solution. But if you can’t do that, here are some things that you can do –
- Wear heels that are 2 inches or less in height, this will help take off the pressure from your spine and cause less curving.
- If you absolutely must wear very high heels (4 to 6 inches high) one day, wear low to moderate heels the next day. This way your knee joints, spine and thigh muscles will get a break from undue stress.
- If you have forefoot pain, try wearing shoes that are wider around the toes – a shoe with a round or square shape in front is a better choice than a pointy-toed shoe.
- Opt for shoes that have leather insoles so your feet have better grip. Slippery heels cause even more damage to your posture.
- Wear heels for shorter periods of time. The longer you wear high heels, the more damage you cause to your knees and spine.
- Ditch those heels if you are in too much pain. It is better to sit at your desk without your heels on, rather than cringe with pain for the entire day.
- And finally, visit a physiotherapist and do some simple exercises that he or she may suggest to relieve you of your feet, back or knee pain caused by high heels.
At Triangle Physiotherapy our professionals can help you figure out what will be the ideal solution for your ailment. So visit any of our 5 locations of Triangle Physiotherapy clinics – Etobicoke, Oakville, Mississauga, North York, Toronto to heal the issues caused by them heels!
What exactly is shin splints? Are they treatable? Shin splints is a condition characterized by damage and inflammation of the connective tissue joining muscles to the inner shin bone (tibia). Shin splints are known by many different names such as: Medial Tibial Tenoperiostitus, MTSS, Medial Tibial Stress Syndrome, Tenoperiostitus of the Shin, Inflammatory Shin Pain, Traction Periostitis, and Posterior Shin Splint Syndrome.
Several muscles lie at the back of the lower leg, and are collectively known as the calf muscles. The tibialis posteriror, flexor digitorum longus, flexor hallicus and soleus are muscles which lie deep within the calf and attach to the inner border of the tibia. Connective tissues are responsible for attaching these muscles to the tibia known as the tenoperiosteum. Every time the calf contracts, it pulls on the tenoperiosteum. When the tension becomes forced too much or is repeated frequently, damage is caused to the tenoperiosteum. The results are inflammation and pain. Shin splints can also occur in combination with other pathologies that cause shin pain such as compartment syndrome and tibial stress fractures.
Patients who suffer from shin splints experience a pain along the inner border of the shin. In other cases, the patient may experience an ache or stiffness along the inner aspect of the shin that increases with rest (typically and night or first thing in the morning). Areas of muscle tightness, thickening or lumps may also be felt in the same area of pain. There are several factors that predispose patitents to shin splints:
• Excessive training or exercise
• Poor foot posture (especially in patients with flat feet)
• Inappropriate footwear
• Inadequate warm up
• Training on hard or inappropriate surfaces
• Muscle weakness (especially in calve muscles)
• Tightness in specific joints (such as ankle)
• Tightness in specific muscles (calves especially)
• Poor lower limb biomechanics
• Poor training techniques or methods
• Leg length differences
• Poor balance
• Being overweight
• Deconditioning
• Poor core stability
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Physiotherapy treatment for patitents with shin splints is vital to speed up the healing process. Physiotherapy will ensure the most optimal outcome and reduce the likelihood of recurrence. Treatment may comprise of the following:
• Deep tissue massage
• Joint mobilization
• Dry needling
• Electrotherapy
• PNF stretches
• Arch support taping
• The use of orthotics or shock absorbing insoles
• Crutches
• Biomechanical correction
• Ice or heat treatment
• Exercises to improve flexibility, balance, strength, and core stablility
• Activity modification advice
• Anti-inflammatory advice
• Footwear advice
• Weight loss advice where appropriate
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If you happen to suffer from shin splints and you are looking for a way to relieve pain, stress, and improve over-all health, try adding physical therapy to a routine wellness plan. Our physiotherapists at Triangle Physiotherapy can be a powerful ally when combating daily stress, muscle pain, and general health issues when it comes to shin splints. Not only does physical therapy relieve pain, increase energy levels, and improve overall physical and mental performance, it prevents further injuries. Our experienced, professional physical therapists at Triangle Physiotherapy are available at five convienient locations: Etobicoke, Oakville, Mississauga, Toronto, and Kings West. At Triangle we customize every physical therapy session to address your individual needs.
Do your legs tingle, become numb, or feel weak? You may be experiencing Sciatica. The term Sciatica describes leg pain that originates from the lower back and travels through the buttock and down the large sciatic nerve in the back of each leg. Sciatica is not a medical diagnosis in and of itself –it is a symptom of an underlying medical condition. Common lower back problems such as: lumbar herniated disc, degenerative disc disease, and spondylolisthesis can cause sciatica symptoms. Sciatica is often characterized by one or more of the following symptoms:
• Constant pain in only one side of the buttock or leg (rarely in both legs)
• Pain that becomes worse when sitting
• Leg pain that is described as burning, tingling, or searing
• Weakness, numbness, or difficulty moving the leg, foot, and/or toes
• A sharp pain that may make it difficult to stand up or walk
• Pain that radiates down the leg and possibly into the foot and toes
Physiotherapy exercises incorporating a combination of strengthening, stretching, and aerobic conditioning are a central component of almost any sciatica treatment plan.
• Strengthening exercises- Most of these back exercises focus not only on the lower back, but also the abdominal muscles, and the buttock and hip muscles.
• Stretching exercises- Stretches for sciatica are designed to target muscles that cause pain when they are tight and inflexible.
• Low-impact aerobic exercise- Some form of low-impact cardiovascular exercise such as: walking, swimming, or pool therapy is usually a component of recovery, as aerobic activity encourages the exchange of fluids and nutrients to help create a better healing environment.
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When patients engage in a regular program of gentle exercises, they can recover more quickly from sciatica pain and are less likely to have future episodes of pain. As sciatica is due to pressure on the sciatic nerve, it stands to reason that treatment involves removing this pressure. Your physiotherapy treatment aims to achieve this by reducing nerve pressure caused by poorly moving spinal joints as well as easing muscular tension in the lower spine, buttock, and leg.
If you are suffering from sciatica please do not delay. You can achieve the best results when you address the symptoms early!