Physiotherapy Toronto Blog 

Many people have heard of TMJ (or TMJ Disorder), but not so many know that your Toronto physiotherapist can help with this often painful and uncomfortable condition.

What is TMJ?

TMJ stands for temporomandibular joint, a complex structure that acts as a sliding hinge connecting the jawbone to the rest of the skull. There is one TMJ on each side of the jaw.

TMJ disorders (also dubbed TMD) result in pain and discomfort, and affect the movement of the jaw. The causes of TMJ disorders are often hard to pinpoint. There may be a variety of issues at play, including:

• Jaw injury;
• Arthritis;
• Genetics;
• Clenching or grinding teeth (bruxism).

Much of the time, TMJ disorders are temporary in nature, and surgery and other interventions are relatively rare. 

Symptoms

TMJ disorders can be hard to diagnose. Here’s what you can observe on your own, and let your Toronto physiotherapist know about during your consultation:

• What does your jaw feel like as you open and close your mouth?
• Is the range of motion full, or compromised?
• What areas experience pain or discomfort?

Pain may focus around the joint, or radiate towards the ear, and culminate in a locking of the jaw, meaning it is difficult to either open or close.  If there is persistent pain and tenderness, it’s time to see a doctor for a firm diagnosis.

Once your TMJ has been diagnosed via examination and imaging such as a dental X-ray or CT scan, the underlying problem may also be revealed.

Physiotherapy Can Help

In cases where surgery is not indicated, physiotherapy can help. While the research is as yet limited, TMJ exercises have been known to help induce relaxation of tight jaw muscles, and increase mobility.

• Physical therapy and exercise can serve to strengthen the jaw muscles;
• Stretching jaw muscles can also provide relief;
• Other treatments might include ultrasound therapy, as well as either ice or moist heat.

Your Toronto physiotherapist can suggest a range of exercises designed to relax the jaw, improve mobility, and help reduce pain.

What else can you do?

In some cases, medical acupuncture has also proven to be useful in relieving pressure in the jaw, as well as massaging the joint and muscles around it. Along with physiotherapy, there are other simple measures you can take to alleviate symptoms:

• Choosing foods with a softer texture, and cutting it into small pieces;
• Avoiding excessive chewing (gum, etc);
• Avoiding resting your jaw on your hands, or holding the telephone with your shoulder and ear;
• Avoiding sleeping face down;
• Improving posture, to reduce stress on the neck and jaw.

If you are experiencing pain in your jaw, or you have been diagnosed with a TMJ disorder and would like to add physiotherapy to your treatment plan, don’t hesitate to contact one of our Toronto physiotherapy clinics today for a consultation.

Knee issues are one of the most common problems that our Toronto physiotherapists and other sports medicine specialists treat.

The knee

The knee is a complex joint, and it's located at a crucial part of the body.

• The knee connects the femur (thigh bone) and the tibia (shin bone);
• Several smaller bones connect the patella (kneecap) to both;
• The quadriceps tendon attaches to the patella, and various ligaments connect the bones to the leg muscles.

Many of the injuries and conditions of the knee revolve around the ligaments that keep the bones in place:

• Anterior cruciate ligament (ACL);
• Posterior cruciate ligament (PCL);
• Medial and lateral collateral ligaments (MCL & LCL).

Pads of elastic cartilage cushion the movement of the bones. At either side of the knee, they are called the meniscus.

• Lateral meniscus is at the outer side of the knee;
• Medial meniscus is at the inner side of the knee.

The bursae are small sacs filled with fluid that help to cushion the joint and enhance smooth movement.

Common Problems

Injuries

There are many injuries that are common to the knee and area.

• ACL and other ligaments torn or injured via movements; for example, the sudden changes of direction in basketball can injure the ACL;
• Fractures of the bone or patella are common in falls and vehicle accidents;
• The meniscus can tear with a sudden twist;
• Bursitis: the bursae can become inflamed by over use;
• Tendonitis: injury and overuse can cause inflammation.

Arthritis

There are many types of arthritis. In the knee area, the most common include:

• Osteoarthritis: wear and tear on the cartilage;
• Rheumatoid arthritis: an autoimmune condition that causes inflammation;
• Gout: due to a build up of uric acid crystals.

Home treatment options

When the pain and discomfort is mild, and if you are waiting to see a medical professional, you can take steps that should help reduce the symptoms.

• Use ice within 24 hours of an injury or when pain starts, as it reduces inflammation;
• Use heat packs when swelling is down, or not an issue;
• Over the counter anti-inflammatory medications such as ibuprofen can help;
• Compression bandages can help to reduce swelling and pain;
• Elevate the knee, and rest.

When should you see your Toronto physiotherapist or sports medicine specialist?

Knee pain is a common problem. But, when it goes beyond a little soreness, it requires a professional assessment. Here are the signs you should seek medical help:

• You can no longer bear weight on the leg;
• There is noticeable swelling;
• Movement is compromised—you can't flex your knee, or extend it fully;
• You have a fever in addition to redness and swelling;
• The pain is severe.

Pain anywhere can prevent you from leading the life you deserve. If you are experiencing problems with your knee joints, our Toronto physiotherapy and sports medicine professionals are ready to help. Don’t hesitate to contact one of our Toronto physiotherapy clinics today for a consultation.

Cuboid syndrome is a common etiology of lateral midfoot pain that is often misdiagnosed and not well understood. It is believed to originate from an incongruence of the calcaneocuboid joint from its desired inverted position to an everted position. This incongruence is often caused by the pull of the peroneus longus muscle on the cuboid bone during an inversion ankle sprain. It is commonly associated with a pes planus (flat) foot type which make up 80% of cases. 

Figure 1

The calcaneocuboid joint is a component of the midfoot that has the important job of transitioning the foot from a mobile adaptor to a rigid lever during heel lift. Heel lift causes undue stress on the cuboid bone if it is not in optimal alignment, thus causing pain and an antalgic gait pattern. Impaired peroneus longus functionality may also affect calcaneocuboid joint stability. Interestingly, a study by Marshall et.al., found that 17% of ballerinas with foot or ankle injuries presented with cuboid syndrome (1).

Symptoms include diffuse pain in the lateral midfoot area that may radiate distally into the forefoot. A slight palpable sulcus may be observed on the dorsal-medial aspect of the cuboid bone as it sits in a poor (everted) position. The bottom of the foot may present with mild swelling and/or bruising. Tenderness is often felt with palpation of the plantar cuboid area and along the peroneus longus tendon. 

Figure 2

Radiographs offer minimal aid in diagnosis but there are several specific clinical tests that are reliable for a clinical diagnosis. Radiographs can be helpful to rule out cuboid fracture and other differential diagnoses (2). 

The most successful initial treatment for cuboid syndrome is cuboid manipulation therapy. A low amplitude, high velocity thrust can shift the cuboid into a preferred inverted position. This position can then be maintained with custom foot orthotics that correct the pes planus foot structure and incorporate a cuboid pad that holds the cuboid in the preferred alignment. 

Figure 3

If your patient presents with a history of lateral ankle sprain and continued lateral midfoot pain, consider a referral to Sarah Higgins (Chiropodist/Pedorthist) at Liberty Village Athlete’s Care. Sarah specializes in manual foot therapy and custom foot orthotic assessment and manufacturing. No physician referral or prescription is necessary. 

References

(1) Marshall P, Hamilton WG. Cuboid subluxation in ballet dancers. Am J Sports Med. 1992;20(2)169-175

(2) ​​Durall CJ. Examination and treatment of cuboid syndrome: a literature review. Sports Health. 2011 Nov;3(6):514-9

Many clients at our Toronto physiotherapy and chiropractic clinics have heard of – and may even practice – Pilates as a workout regimen. Did you know that it can also be used as a post-rehab treatment?  Here’s a look at how it works, and when it’s usually useful for the most patients.

What is Pilates Rehab?

In essence, Pilates Rehab uses specific movements to retrain your neuromuscular system. It’s based on the idea of neuromotor training.

Pilates rehab can be used in a variety of treatment situations. A 2016 review of several studies found that Pilates Rehab was useful in treating:

• Chronic back pain;
• Ankylosing spondilitis;
• Non-structural scoliosis;
• Arthritis;
• Degenerative disk disease;
• Shoulder tendinitis or bursitis;
• Tendon injuries, sprains and strains;
• And other conditions.

The studies evaluated:

• Pain levels;
• Flexibility;
• Strength;
• Balance;
• Functionality;
• Posture;
• Fatigue;
• & other parameters.

The results showed improvements in all categories.

How does it work?

The exercises your Toronto sports medicine specialist will guide you through work to forge paths in your neuromuscular system. Those paths are intended to ensure that your body is moving in an optimal way, according to your own biomechanics.

• An optimal movement strategy minimizes wear and tear on joints and soft tissue;
• It avoids over-taxing muscles, joints, and other structures;
• It keeps the rest of the body properly aligned and in balance.

Those best practices can help to reduce pain and improve range of motion. Pilates Rehab can be combined with massage therapy and other treatments as part of a comprehensive rehabilitation program.

• Targeted exercises strengthen the muscles and structures around the joints;
• Core stability is emphasized;
• Flexibility and mobility of peripheral joints can be improved and/or restored.

Healthy optimal patterns of movement are established and/or regained.

• Pilates can be customized to your individual needs.
• Pilates movements are deliberate, and the flow of movement is emphasized. That makes it a safe option if you are already in pain.

With its emphasis on the mind as well as the body, Pilates Rehab can also be useful in helping you overcome any lingering psychological issues after an injury. It’s common – and very natural – to feel some level of anxiety about repeating an action that has resulted in pain or physical trauma. The discipline of Pilates helps many people overcome those fears.

One of the advantage of a Pilates regimen is that it provides a full-body workout using minimal props, and can be performed in an environment where space may be at a premium.

Prevention is the best cure

Because of its emphasis on core strength, leading to both stability and flexibility, along with issues like posture and muscle control, Pilates can also be used as an injury prevention tool. Proper conditioning is particularly important for those who are not regular athletes, and may only workout on weekends or even less often.

If you’d like to learn more about Pilates Rehab, and whether it might help your condition, don’t hesitate to contact one of our Toronto physiotherapy, chiropractic and sports medicine clinics for a consultation today.