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The ACL, or the anterior cruciate ligament, is one of the key ligaments in the knee that work to stabilize the knee by preventing the shin bone from sliding in front of the thigh bone. The ACL is the most common torn ligament in the knee.

When you tear the ACL, most people hear a pop in the knee at the time of the injury, followed by significant pain and swelling. Often it is difficult to weight bear.

According to the American Journal of Sports Medicine, in the U.S. there are between 200,000 – 250,000 ACL injuries per year.  This  mainly consists of the age group under 20 or older than 40.  A growing group experiencing ACL injuries are the weekend warriors. There are a few reasons why we may be seeing an increase in ACL injuries in this older population.

1. Just like kids today who mainly play one sport, we see this with adults as well. This leads to the overdevelopment of some muscles and the underdevelopment of others.
2. Adults tend to spend a large part of their day sitting and  being mostly inactive during the day.  They then go from 0% activity to 100% of intense activity, without anything in between, resulting in an increased chance of injury.

Prevention of ACL Injury

1. It is important for the weekend warrior to pinpoint weaknesses in their core, hips, knee and proprioception (unconscious awareness of movement and spatial orientation).
2. Injury prevention should involve single leg training for activities such as soccer as these activities involve standing on a single leg most of the time.
3. Focus of Balance.  The majority of ACL injuries that occur during sports activities result from quick change of direction, sudden slowdown, a faulty landing or a collision.  Improving balance and strengthening the small muscles of the feet and ankle can help prevent twists and pivots which could damage an ACL.
4. Don’t forget to warm up and stretch before.  Cold, stiff muscles are far more prone to injury.  Warming up prior to your sport can help loosen up muscles which in turn can help prevent injuries.

If you have suffered an ACL, or other injury, call the Durham Orthopedic & Sports Injury Clinic at 905-428-7800 and see one of our physiotherapists, who will help you get back on the road to recovery.

Torticollis, also known as wryneck, cervical dystonia or spasmodic torticollis, is a condition in which the muscles that control neck movement are locked into an involuntary contraction.  This causes the head to rotate and tilt in an abnormal angle towards the shoulder.

Torticollis often occurs in newborns due to the sustained position of the baby in the womb resulting in a shortening of the sternocleidomastoid muscle on one side of the neck.  Infants may develop torticollis from sleeping with their heads in the same position against the mattress.  Physiotherapy is indicated for this population to stretch the tight muscles in the neck.  This condition is easily treatable with physiotherapy.

In adults, there are usually three main causes for torticollis.

Trauma

Bending or twisting your neck too far can lead to acute torticollis.  A whiplash injury to the neck may also cause a torticollis.

Family History

We tend to see a genetic link to torticollis where torticollis may affect siblings in the same family and first degree relatives.  It is believed that an abnormal gene is responsible for a proportion of these conditions that run in a family.

Infection

Viral infections, respiratory or soft tissue infections of the neck may cause cervical torticollis.  For these conditions, you must see a doctor for medication to help with the infection.

Clinical Presentation

Torticollis can cause disabling pain worse with turning your head to the opposite side.  There is a significant limitation in the range of motion.  The neck muscles on the affected side hurt and are often tender to touch.  

Treatment options for adults with torticollis include:

• Heat to help the tight  muscles relax.
• Medications including muscle relaxants and anti inflammatory medication.
• Physiotherapy treatments including manual stretches and mobilizations to the neck to help increase the range of motion and decrease the pain
• Botox. In cases of chronic muscle spasms and cervical dystonia, Botox may provide relief by preventing the muscles from contracting.

If you are in need of physiotherapy for a neck injury, call the Durham Orthopedic and Sports Injury Clinic to see one of our knowledgeable professionals at 905-428-7800 to get you on the road to recovery.

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Ankle injuries are one of the most common injuries doctors and physiotherapists see. The three most common sites of injury are the tendon, ligament, and the bone. Treatment protocol and recovery time is dependent on the type of injury sustained and the severity of the injury.

Tendon Injuries

Tendons are strong rope like structures that connect muscles to bones and allow you to move your ankle, toes and feet. We tend to put a lot of demands on our tendons around our ankles and feet with our day to day activities. They have to push the entire weight of our body constantly while standing and walking. Running activities add many times more stress on these tendons. The daily constant stresses on these tendons make them prone to developing tendonitis (inflammation of the tendon), partial tears or even complete tears.

Four main types of tendon injuries of the ankle include:

Tendonosis is a chronic condition characterized by the degeneration of the collagen in the tendons which occurs due to overuse or age.

Tendonitis occurs when the tendon swells (becomes inflamed) after a tendon injury. 

Tendinopathy is a term used for any tendon injury or condition which causes pain and swelling.

Acute Tears usually happen suddenly and occur most often with activity and sports.

Some of the more common tendon injuries are Achilles tendon tears, Achilles tendonitis, Posterior tibial tendonitis and Peroneal tendonitis.

Achilles Tendon Tear

The Achilles tendon is a tendon that attaches the calf muscle to the heel bone.  It provides the strength to push off with your foot with walking, running and climbing stairs.  It also is one of the most commonly torn tendons in the body.  A tear usually occurs when performing higher impact sports like volleyball, basketball or racket sports.  Most often there is an audible “snapping or popping” sound over the back of the ankle with immediate weakness and pain.

Achilles Tendonitis

The Achilles tendon is one of the most common tendons to develop inflammation in the lower extremity.  Pain is usually worst when first getting up in the morning or after prolonged sitting or when beginning any activity.  This pain with activity often decreases once the tendon warms up.  Pain is located at the site where the Achilles attaches to the bone or just above this point.

Posterior Tibial Tendonitis

The posterior tibial tendon stretches across the inner part of the ankle and attaches to the inner part of the foot.  It is a major support structure for the arch of the foot.  Posterior tibial tendonitis causes pain and swelling over the inner portion of the ankle and along the inside of the foot, worst with standing on your toes.

Peroneal Tendonitis

There are 2 peroneal tendons that are located over the outer part of the ankle and run behind the outer ankle bone (fibula).  The main symptom is pain and swelling around the outside of the ankle, often making it difficult to walk or run.  Pain is often worst in the morning.  These tendons are prone to developing tears or dislocating.

Ligament Injuries

A sprained ankle is the sudden stretching or tearing of the ankle ligaments which support the joint and give it stability.  A sprain occurs when your ankle is forced to move out of its normal position, most commonly seen when you “go over on your ankle”.  The ligaments on the outer side of the ankle are the most frequently injured.

Bone Injuries

A broken or fractured ankle is an injury to the bones of the ankle.  Fractures or breaks vary from hairline fractures, tiny cracks to a full and complete break.  Some fractures are cast, more serious fractures may need pins and plates to allow the bone to heal.  Symptoms include:

• Immediate intense pain at the site of injury
• Bruising
• Unable to weight bear
• Swelling
• There may be an obvious deformity of the ankle

If you are in need of physiotherapy for an ankle injury, call the Durham Orthopedic & Sports Injury Clinic to see one of our knowledgeable professionals at 905-428-7800 to help you get on the road to recovery. 

Pickleball has taken Canada by storm as the fastest growing sport in the country. Pickleball is easier on our body than most other sports, but, like any other sport, there is always the risk of injury that comes with playing.

Some of the more common injuries seen with pickleball include:

Ankle sprain

Most ankle sprains heal without any need for treatment.  Remember the R.I.C.E. principal to heal mild injuries, Rest Ice Compression and Elevation.  For the more serious ankle sprains, physiotherapy is indicated to improve your range of motion, reduce swelling, increase the ankle strength and improve balance.

Achilles Tendonitis

Achilles tendonitis is an overuse injury that develops from high impact exercise or repetitive stress to the lower leg.  It occurs when the tendon running down the back of the leg becomes irritated or inflamed.  Tendons, when injured or torn, create “scar tissue” in an attempt to heal and repair itself leaving the tendon compromised in terms of strength and elasticity.  It is important to see a physiotherapist to help regain normal strength and range of motion in the tendon and help avoid further injury.

Shoulder Strain

A common injury to the shoulder seen with Pickleball is rotator cuff tendonitis due to overuse of the shoulder.  Symptoms include swelling, tenderness and pain in the front of the shoulder.  Stiffness and loss of range of motion when raising the arm along with loss of strength are also common symptoms.  Physiotherapy helps with decreasing the inflammation on the tendon, and works on increasing the strength of the rotator cuff muscle group to help avoid reinjury.

Pickleball Elbow/Tennis Elbow

“Pickleball Elbow” is similar to tennis elbow and causes pain when the elbow is overused due to repeated movements of swinging the racquet.  This can put ongoing stress on the elbow over time.  Pickleball can cause soreness on the outside of the elbow and may be aggravated by gripping movements.  It is important to get treatment before it becomes chronic and more difficult to treat.

How to Avoid Pickleball Injuries

• Stretch and warm up your body before you play
• Wear proper court shoes that are comfortable and have rubber soles with a tread pattern conducive to quick lateral movements.  Pickleball shoes do have an expiration date, usually they should be replaced after 60 hours of play
• Improve your conditioning.  Improving your overall strength and endurance will help prevent injury and improve your overall performance on the court.  Choose exercises that include balance, flexibility, strength and endurance
• Avoid wet pickleball courts
• Always communicate with your partner to avoid confusion on the court which may lead to accidents

If you sustain an injury playing Pickleball, contact one of our physiotherapists at the Durham Orthopedic & Sports Injury Clinic at 905-428-7800 to help get you on the road to recovery and back to playing your sport.

Over the last few years, pickleball has been rising in popularity and is one of the fastest-growing sports in Canada.

Pickleball is a cross between tennis, badminton and ping pong and can be played either as singles or doubles, although doubles is typically more popular.

It was invented in Washington and has gained popularity during the pandemic, growing almost 15% between 2020-2021.  More than half of the participants are 55 or older and a third are 65 plus.

There are many benefits to the sport including physical, psychological and social benefits.  

Physical Benefits

Pickleball is an easy sport to learn and is relatively low impact.  It allows you to work on our balance, agility, reflexes and hand-eye coordination.

One study shows that players burned 40% more calories during 30 minutes of playing than during a 30 minute walk, increasing their heart rates to within the moderate-intensity exercise zone.

Another study showed that people between the ages of 40-85 who played an hour of pickleball 3 days a week showed improvements in cholesterol, blood pressure and cardiorespiratory fitness.

Psychological Benefits

Evidence is increasing on the beneficial effects of exercise on mental health, possibly due to the increasing blood circulation to the brain, endorphin release and its effect on reducing stress.  Pickleball is no exception to that rule.  And, as a bonus, if you play outside, sunshine makes us feel good as well!

Social Benefits

Pickleball is a great social outlet.  It allows you to socialize more, combat loneliness and boosts mood.  Pickleball brings people together and fosters the development of new friendships which will benefit your mental health as well.

So how do you get started?  All you need is a paddle and a few balls.  You will soon make many new Pickleballer friends and the health benefits will follow.

If you need treatment for any injury, call the physiotherapists at the Durham Orthopedic & Sports Injury Clinic at 905-428-7800 and start your road to recovery today.

Osteoporosis is a bone disease that is caused by the loss of calcium in the bones, resulting in them becoming more brittle. This leads to a decrease in bone strength and bone structure resulting in an increased risk of fracture, especially in the hip and spine.  It is a major cause of disability, causing pain and affecting one’s quality of life.

Bone is living tissue and there is a balance between the natural cycle of degeneration and regeneration of bone.  In osteoporosis, bones weaken when not enough new bone is formed (regeneration) and too much bone is lost (degeneration). 

Most at Risk Groups

Post-menopausal women are at the greatest risk of developing osteoporosis and have a greater risk of developing osteoporosis, especially if:

• They are Caucasian or Asian
• Have a small frame
• Are inactive
• They are smokers
• Have a family history of osteoporosis
• Have used medications such as steroids or thyroid hormone for a long period of time
• Have calcium or Vitamin D deficiency

How is Osteoporosis Diagnosed

Osteoporosis is best diagnosed through a specialized x-ray called the DXA which measures bone density.  Other methods of measuring bone density may include an x-ray, ultrasound or CT scan.

Treatment

Physiotherapy can offer personalized treatment to help improve your overall bone health and help you avoid fractures.  The exercises help with bone building by sufficiently stressing the bone.  Bone gets stronger with exercise just as muscles get stronger with exercise.  The three types of exercises used are weight bearing exercises, resistance exercises and postural exercises.

Weight-bearing exercises may include:

• Walking
• Dancing
• Hopping or stomping
• Easy jogging

Resistance exercises may include:

• Weight lifting in proper spine and lower extremity alignment
• The use of resistance bands
• Gravity resistance exercises such as push ups, squats, standing yoga poses

Postural exercise:

• Exercises to reduce or stabilize the increased kyphosis (hunchback) that is often seen with people with osteoporosis
• Education on correct posture and exercises to help maintain ideal posture
• Exercises to improve your balance to avoid falls

Contact the Durham Orthopedic & Sports Injury Clinic at 905-428-7800 if you are seeking help from our physiotherapist managing your osteoporosis.

Physiotherapy for seniors  is a great way to help keep an active lifestyle and help promote independent living. Many seniors deal with daily or chronic pain or loss of function with activities of daily living that can be managed by physiotherapy. Physiotherapy can help prevent disease and disability. 

Is physio helpful for the elderly?

As we age, our mobility, stability and muscle strength starts to deteriorate. Physiotherapy helps to restore and improve our muscle strength and balance. This can help to prevent falls, slips and injuries in the elderly and help maintain independent living. It is NEVER too late to start working on improving our physical health.

Physiotherapy is also a safe way for seniors to exercise. Exercising under the direction of a registered professional makes physiotherapy a great exercise idea for seniors and the elderly. This can help reduce the risk of exercise related injuries. 

Common Ailments in he Elderly

The most common reasons seniors may want to see a physiotherapist are; 

• Injuries from Falls
• Osteoporosis 
• Reduced Mobility 
• Heart Disease
• Osteoarthritis 

Improved Blood Flow

Physiotherapy can also help to improve blood flow also by using a variety of stretches and low impact strengthening exercises. Typically, your physiotherapist will give you a list of stretches and exercises that you can do at home under the supervision of the physiotherapist.

Exercises to increase blood flow

Aerobic exercises have been found to be the best types of exercise to increase circulation and blood flow. These may include:

• Walking 
• Aerobics Classes 
• Swimming
• Cardio classes 
• Biking
• Tennis or pickleball
• Lawn Bowling 

Other treatments your Physiotherapist might provide are; 

• Strength Training
• Mobility Training
• Balance training 
• Massage Therapy
• Mobility Aids 

In conclusion, physiotherapy is a safe and effective way for seniors to exercise and is a great way to improve your overall health. 

If you have been injured or are trying to recover from an injury, call Durham Orthopedic Sports & Injury Clinic to start your treatment and get on the road to recovery today!

Plantar Fasciitis is a fairly common ailment that causes pain and inflammation along the bottom of your foot. It frequently causes pain localized in the heel and is the most common reason for heel pain. 

The plantar fascia is a band-like ligament that attaches from the heel and stretches to the toes. It supports the arch of the foot and absorbs pressure with weight bearing activiies.

The repetitive motion of pushing off with your feet can injure the plantar fascia and cause symptoms ranging from a feeling of a mild bruise on the bottom of your foot with walking to a sharp, intense pain that causes you to limp.The pain tends to be worst in the morning when you first get up or after prolonged periods of inactivity.

Symptoms

The main symptoms of Plantar Fasciitis are; 

• Pain at bottom of the heel
• Pain in arch of the foot
• Swollen Heel
• Tightness in the calf muscle
• Pain that is worst in the morning or when you stand after prolonged sitting.
• Increase pain after exercise, it is not as common to have pain during exercise.

Causes

The plantar fascia is designed to absorb the stresses and strains that we continuously place on our feet. Occasionally the excess pressure we place on these tissues damages or tears them. Our body’s natural response to injury is inflammation. Damage or irritation  to our plantar fascia causes heel pain due to this inflammation.

Some of the factors which may increase the risk of developing plantar fasciitis may include:

• Age. Plantar  fasciitis is most common in people between 40-60 years of age.
• Certain types of exercise that place increased stress on the plantar fascia such as running, jumping or dancing can contribute to plantar fasciitis.
• Obesity. Increased weight can put extra stress on the plantar fascia.
• Occupations that keep you on your feet for prolonged periods of time may predispose you to plantar fasciitis. Teachers or factory workers who spend most of their day walking or standing have an increased incidence of  plantar fasciitis.
• Altered biomechanics of the feet may contribute to heel pain, such as flat feet or very high arches
• Wearing shoes that don’t support your feet properly such as flip flops
• Tight calf muscles

Treatments

There are many different ways to treat foot pain or plantar fasciitis; 

• Taking NSAIDS to help with the pain and the inflammation.
• Icing
• Putting orthotics in your shoes to support the foot and education on proper shoe wear to help the fascia heal.
• Night splint. Some find wearing a nite splint helps with the heel pain from plantar fasciitis.
• Rest. Stop doing the activities that make the pain worse, which include such activities as running or jumping.
• Roll feet with a can or frozen water bottle to stretch the fascia
• Physiotherapy. Exercises are prescribed that stretch the calf muscles and the facia and strengthen the foot muscles which make the foot more stable. Ultrasound helps decrease the inflammation and taping helps support the foot and take the pressure off the plantar fascia, allowing it to heal.
• Icing the foot

If you have been diagnosed with plantar Fasciitis call the professionals at Durham Orthopedic Sports & Injury Clinic to speak to a registered physiotherapist today. 

It is not unusual to feel pain in your muscles after a workout. Muscle soreness after a workout is
often called Delayed Onset Muscle Soreness or DOMS and is a side effect of stress put on
muscles after exercise. It is a completely normal reaction to exercise. Muscle soreness is a sign that your workout was successful and that you are getting stronger. When you stress your muscles with exercise, the muscle fibres break down.  As fibres repair themselves, they become larger and stronger. DOMS usually begins within 6-8 hours after exercise and can last 24-48 hours after exercise. There are ways to ease some of the post work-out muscle soreness.

Hydrate

Our bodies are made of 60% water so it should be no surprise that hydration is a key component
to recovery.  To flush damaged muscles out, you need fluid.  Ideally, drink 8 ounces of water
every 15-30 minutes of exercise.  A tip as to how much water you require for your workout
recovery:  step on a scale before and after your workout.  Did you lose weight?  Drink 8 ounces
of water for every pound lost.

Balanced Diet

A balanced diet is key to any person who exercises or is working out on a consistent basis. 
Fruits and vegetables not only provide nutrients for our body, they can also help hydrate our
bodies during recovery.  Carbohydrates are a great source of food for our bodies and they can
help restore glycogen levels.  Proteins help with the repair of muscles.

Warm Up

Take a few minutes to stretch out your muscles before exercise with some stretching exercises
followed by a light aerobic activity such as a slow jog or a brisk walk.  This helps increase the
blood flow to the muscles.

Massage

Massaging a sore muscle helps decrease the tightness.  It also increases blood flow to the
muscles and helps push out pooled fluid out of the muscles and helps speed recovery.

Cool Down

One of the most ideal ways to cool down is to reverse the order of your warm up.  At the end of
your workout, slow down your workout rather than stopping cold turkey, ie. end your run with a
slow jog or a brisk walk.  This helps with the blood flow to the area and pushes pooled fluid out
of the body.

If you have been injured or trying to recover from an injury, call the Durham Orthopedic &
Sports Injury Clinic at 905-428-7800 to start your physiotherapy or massage therapy treatment
and get on the road to recovery today.