Physiotherapy Areas of Special Expertise

Acupuncture involves the insertion of very fine needles into specific areas of the body (acupuncture points) to bring about a therapeutic effect such as pain relief. Although derived from ancient Chinese medicine, modern or anatomical acupuncture uses the science of Western medicine for diagnosis and treatment planning, and adds the technique of acupuncture needling, thereby combining the best of both worlds. In recent years, major hospitals and health professionals have been researching acupuncture and integrating this ancient technique into their modern medical practices.

Acupuncture practiced by a licensed health professional is safe, effective, and almost completely free of side effects. Only sterile, disposable needles are used, so there is no risk of transmission of disease. Acupuncture needles are atraumatic, meaning that their design allows them to slide smoothly through tissues and makes them unlikely to cause bleeding or damage to underlying structures. Acupuncture is not painful; in fact many people do not feel the needles at all.

Acupuncture is very effective in treating a wide variety of disorders such as headaches, back and neck pain, frozen shoulder, tennis elbow, sciatica and arthritis.

ACUPUNCTURE – HOW DOES IT WORK?
The Traditional Chinese explanation for the benefits of acupuncture involves the balance and flow of energy, or Qi (pronounced chee) in the body. In Western medicine we know acupuncture stimulates the release of chemicals called endorphins, resulting in pain relief, general relaxation, reduced inflammation and natural healing. However, there is still much that is unknown about the many beneficial effects of acupuncture, and research is ongoing.

ACUPUNCTURE AND PHYSIOTHERAPY
Physiotherapists study acupuncture in post-graduate courses and use acupuncture to treat conditions that are within the physiotherapy scope of practice – mainly muscle, joint and nerve pain. Unlike other acupuncture practitioners, a Physiotherapist uses acupuncture as part of a global treatment plan that may also involve exercise, education and manual therapy.

Several physiotherapists at York Rehab are certified by The Acupuncture Foundation of Canada Institute (AFCI) in the practice of acupuncture, and we integrate it into our physiotherapy treatment plans when appropriate.
For more information and research articles, please refer to AFCI at www.afcinstitute.com.

Our goal at York Rehab is to help our clients feel better and do all the things they enjoy in life. Exercises that keep arthritic joints strong and mobile, back care strategies that help you through your day, acupuncture for pain management – these are all ways we can help you control pain and lead active, healthy lives.

Facial Neuropathy is a condition in which the 7th cranial nerve (from the brain) becomes damaged. This damage causes facial paralysis on one side of the face. The most common causes of facial neuropathy are Bell’s Palsy (temporary facial paralysis most commonly felt to be related to a viral or bacterial infection), Acoustic Tumor (a benign tumor growing from the balance and hearing nerves), or a congenital condition (one you are born with). There are other causes of facial neuropathy, however they are less common.

Signs and Symptoms of Facial Paralysis:

1. Inability to close the eye on the affected side
2. Drooping of the affected side (suddenly or slowly over 24 hours)
3. Teariness or dryness of the eye
4. Pain in or behind your ear
5. Sensitivity to sound
6. Drooling
7. Loss of sense of taste

At the first sign of facial paralysis you must seek medical care. During the early days it is important to protect the eye. If you do not protect the eye adequately you can cause permanent damage to the cornea. A facial therapist is able to give you strategies to protect your eye.

At the early stages the facial therapist is able to take your history and assess the ability to move all the muscles of the face. If you have some ability to move the muscles of the face you will be given a treatment plan and home exercise program to assist in the recovery of the muscles. Our goal is to teach you how to use the weak side of your face and also to teach you to use both sides of your face together.

Recovery can have some challenges. Using the facial muscles has always been very automatic. You will have to learn new strategies to promote more normal movements of facial expressions. Your facial therapist will assist with these strategies. These movement control exercises will help to improve the coordination of your facial muscles, refine your facial movement for specific function (for example closing the eye), refine the movements for facial expressions such as smiling and correct the abnormal patterns of facial movement (synkinesis).

Your facial therapist is trying to coach you to use your face as normally as possible through the different stages of your recovery.

TMJ dysfunction is an umbrella term covering acute or chronic pain in the temporomandibular joints (or the jaw joints). The temporomandibular joint is subject to problems similar to those that affect other joints in the body such as arthritis, trauma, dislocations, and subluxations. The most common symptom of TMJ dysfunction is pain, which can be located at the jaw joint in front of the ear, or along the side of the face, or it can come in the form of headaches. TMJ problems can also lead to reduced function of the jaw, interfering with such things as eating, yawning, talking, laughing and smiling. Other common symptoms of TMJ dysfunction are clicking, popping, decreased ability to open the mouth, jaws that lock open or closed, and decreased ability to chew.

The exact cause of your pain can sometimes be difficult to determine. Most TMJ disorders can be managed with conservative care. A physiotherapist will assess your TMJ dysfunction by taking a thorough history. Questions will determine if you have any habits that are contributing to pain in the TMJ area. An assessment will be done analyzing the amount of movement, the quality of movement, the muscle tone and abnormal movement patterns during opening of the mouth. Some of the factors that cause strain and contribute to pain in the TMJ are bruxism (grinding or clenching the teeth), trauma, frequent or prolonged dental work, mal-alignment of the surfaces of the teeth, habits such as excessive gum chewing, nail biting, eating very hard foods, and poor posture.

There are a variety of treatment approaches. Your physiotherapist will work closely with your dentist to optimize your joint position and decrease the stress on the joint. In addition, we will use strategies to decrease pain and improve the muscle coordination around the joint. We will advise you of a home exercise program and outline a treatment plan.

Most people with TMJ dysfunction improve with treatment and can use the strategies at home to self-treat and control symptoms. Your physiotherapist will guide you through this process.

You’ve seen it on Olympic athletes – those patterns of pink, blue and black tape on their joints and muscles. Kinesiotaping is a special taping technique for correcting muscle imbalances, reducing swelling and providing important feedback to muscles and joints. We use kinesiotaping for a variety of our patients – whether athletes, “weekend warriors”, post-surgical or chronic pain patients.

McKenzie Therapy, or Mechanical Diagnosis and Therapy (MDT), is a comprehensive approach to assessment and treatment that is extremely effective and well-researched.

What makes McKenzie Therapy unique is the very systematic examination process, which involves repeated testing of various movements and positions, in order to determine their “cause and effect” relationship on pain or other symptoms. Based on symptom-behaviour, the physiotherapist is able to determine very quickly who will do well with mechanical therapy, and prescribe the appropriate treatment. In many cases, symptom location and intensity can change quite quickly – even in a single treatment session.

Central to the philosophy of McKenzie Therapy is that the patient is taught first and foremost to treat him/herself. Education, posture and “homework” exercises are all key components of McKenzie treatment plans. The aim of McKenzie Therapy is to solve the current problem, but also to provide patients with the ability to prevent or manage their own pain in the future.

One key advantage of McKenzie Therapy is that physiotherapists can quickly determine which patients will benefit from this method of care, and which ones need to be referred for a different approach, thus avoiding unnecessary or overly expensive treatment. This is a very safe treatment method as well, because the patient is in control of his/her movements, with the physiotherapist adding exercises or “hands-on” techniques in a gradual and systematic fashion.

McKenzie Therapy is most commonly applied to spinal problems such as low back pain, neck pain, sciatica and disc herniations. Research has found it to be very effective for these conditions. However, the systematic method of assessment and treatment is also applicable to muscles and joints in the arms and legs. Research in these areas is much newer, but the results are very promising.

York Rehab is committed to using and teaching McKenzie therapy (MDT) because the results speak volumes. We have more credentialed McKenzie physiotherapists at York Rehab than anywhere in the Newmarket area, and we frequently sponsor post-graduate education courses for physiotherapists to hone their skills.
To learn more about the McKenzie method, and to read up on the current research, please refer to the McKenzie Canada website: /www.mckenzieinstitute.ca/

Neurological Disorders encompass Stroke, Traumatic/Acquired Brain Injury, Spinal Cord Injury, Parkinson’s Disease, Multiple Sclerosis, and any other condition that affects the brain or spinal cord.

NEUROLOGICAL DISORDERS – THE NDT/BOBATH APPROACH
Neurological Physiotherapy focuses on the assessment and treatment of neurological disorders using methods that follow the principles and foundations of both NDT (Neuro-Developmental Treatment) and Bobath approaches. Both approaches use specific hands-on techniques used by physical therapists to enhance the participation and function of adults with neurological disorders. These patient handling skills are used to guide the individual through task initiation and completion. Neurological rehabilitation applies therapeutic handling to influence how the individual’s system responds to sensory stimuli and accordingly influence the quality of the client’s movement. It can be used to reinforce desired movement patterns and/or prevent unwanted or abnormal postures and movements.

HOW DOES IT WORK?
The treatment of Neurological disorders focuses on normal movement patterning based on how the brain relearns movement. Individuals living with a neurological disorder often have difficulties in controlling movement. Neurological treatment is intended to allow the individual to relearn, with a damaged neurological system, how to perform everyday actions with efficient motor control in various environments.

Neurological rehabilitation is a complex intervention involving treatment methods used to retrain and optimize functional motor control, balance, cardiovascular fitness, muscular strength and endurance. Individuals living with a neurological disorder come to physiotherapy to optimize their walking efficiency and independence, balance (sitting or standing) in the indoor and outdoor environment with increasing demands, muscular strength and endurance, and functional range of motion or movement patterning.

NEUROLOGICAL DISORDERS – WHAT TO EXPECT AT YORK REHAB
At York Rehab we assess and treat the individual in order to assist the client in becoming functional and independent again. The therapeutic activities are chosen based on functional relevance and tailored to address how the individual can adapt to environmental demands. Each initial neurological physiotherapy assessment includes a thorough and goal-oriented approach to develop and implement a comprehensive home exercise program complemented by a treatment program for each individual. The treatment program incorporates scientific principles and current physiotherapy practice research.

Orthopaedic Manual Therapy (OMT) refers to the skilled and specialized use of mechanically applied movement techniques for the treatment of joints and associated muscles, connective tissue and nerves, as part of a comprehensive physiotherapy treatment program. All physiotherapists are trained in orthopaedic manual therapy. Using gentle, hands-on techniques, we can help reduce muscle tightness, improve movement in the joints, reduce pain and improve function. Physiotherapists with FCAMPT credentials have more advanced, specialized training in this area.

FCAMPT CREDENTIALS (Fellow of the Canadian Academy of Manipulative PhysioTherapy)
FCAMPT members are physiotherapists who have completed post-graduate education in manipulative therapy and have been recognized in Canada and internationally through a certification exam. They are often referred to as Manipulative Physiotherapists.

Manipulative Therapy education includes extensive theoretic studies in advanced anatomy, biomechanics, pathology and the application of physiotherapy treatment techniques including mobilization and manipulation. Manipulative Physiotherapists are highly trained in using their hands to diagnose complicated muscle and joint problems in the spine, arms and legs.

The term Fellow refers to physiotherapists who have successfully completed the Advanced examination. These physiotherapists use the credentials FCAMPT.

Exercise in water is very beneficial for reducing pain and increasing ease of movement. In addition, water provides resistance to movement, which can be a valuable tool for improving strength and core stability. This service is provided in partnership with Southlake Regional Health Centre.

At York Rehab we specialize in Orthopaedic and Sports Therapy. We are committed to identifying (diagnosing) the problem correctly, mending the injury as quickly and completely as possible, guiding the athlete through safe return to sport and preventing recurrence of the injury. Our physiotherapists work closely with the Orthopaedic surgeons in the Newmarket area, providing continuity of care from hospital to clinic, and guiding you safely through post-surgical protocols. Whether you are a “weekend warrior” or a “performance junkie” we are here to give you your life back.

Identify the problem:
Most sports injuries do not “just happen”. More often the injury results from underlying causes such as fatigue, weakness, technique or inadequate balance reactions. At York Rehab we identify these factors through a complete history of the injury and a detailed biomechanical examination. By identifying all the problems, we can direct our energies toward the most effective forms of sports therapy to correct them.

Mend the injury:
No athlete wants to stop playing! At York Rehab the goal of sports therapy is to keep you in the game, or get you back playing as quickly as safety permits. With years of experience and the most up-to-date scientific research available, we can offer you effective treatment strategies that are tailor-made to your body and your goals.

Sports therapy treatments may include modalities for pain or swelling; therapeutic exercise to rebuild injured tissue; manual techniques to loosen tight areas, coaching to improve quality of movement, taping or bracing for support – and education, education, education – so that you can take an active part in your healing.

Safe return to sport:
You want to stay active, but you don’t want to cause further injury. You probably want to know: When it is safe to do more? Is it OK to push through pain – how much? What is the best way to cross- train for my sport? Do I need a brace? As physiotherapists we can answer your questions and guide you safely through the process of returning to full sporting form.

Prevent recurrence:
The best treatment of all is prevention. By identifying the factors that contributed to cause the injury in the first place, we are able to correct them and prevent future problems. So in addition to treating the torn ligament, for example, we might need to work on strengthening core muscles, correcting muscle imbalances, changing the shoes or the training schedule. By fixing the reason for the injury as well as the injury itself, you can stay well and enjoy peak performance.

PREVENTION, THE BEST MEDICINE
You don’t have to tear your knee ligaments to benefit from the expertise of a physiotherapist. You may feel that one particular body part is “tired”, “stiff” or “untrustworthy” compared to others. Or you may have pain every time you walk a little farther, or run a little faster, or throw a little harder. Many people experience similar problems and think this is something they have to live with forever. This is not always true. Many chronic complaints respond well to physiotherapy. In some cases the solution is as simple as changing posture, building up an underperforming muscle, or re-educating balance reactions. And the best part is that correcting a minor problem prevents a much bigger one down the road.

Do not be surprised if your physiotherapist gives you a prescription for therapeutic exercise. This is a specific program of movement that is tailor-made for you, based on your unique assessment findings. You can’t get this from a magazine, a drug-store pamphlet or a gym; it requires the expertise of a physiotherapist who has examined you.

Therapeutic exercise is an essential component of most physiotherapy treatment plans. The human body requires mobility, strength and coordination in order to move freely and painlessly. When illness or injury strikes, some body parts become weak, swollen, stiff or out of alignment. The result is pain and loss of normal function. While various passive treatments can reduce pain and temporarily improve mobility, therapeutic exercise is necessary to restore the normal muscle function and control required to keep you well in the future.

THERAPY VS FITNESS
Therapeutic exercise is not the same as fitness exercise at all. Therapeutic exercise has a treatment goal – for example, to restore normal control of a joint, or to loosen a tissue that is too tight. It is more about proper technique than working up a sweat! And therapeutic exercise is not necessarily painful; in fact the proper technique is most often the one that does not hurt. (There are cases where some pain is necessary, especially where tight scar tissue is involved, but your physiotherapist will guide you as to how much pain is reasonable in order for the exercise to be beneficial.)
WORK AND SPORT CONDITIONING
If your goal is to return to demanding physical work or play, your physiotherapist will likely instruct you in a conditioning program specifically aimed at regaining the strength, flexibility, endurance and coordination you need for safe return to that activity. In addition, the physiotherapist can advise you on safe techniques for work and sport, appropriate training and cross-training activities, danger signs to watch out for – all the information you need to stay healthy and active in the future.

Vertigo (spinning), dizziness and loss of balance are common symptoms of vestibular dysfunction. The vestibular system includes parts of the inner ear and brain that control balance and eye movements. Damage to this system from disease or injury results in vestibular dysfunction.

BPPV (BENIGN PAROXYSMAL POSITIONAL VERTIGO)
One of the most common causes of vertigo is BPPV. BPPV is characterized by vertigo that arises only with certain head movements, and typically lasts a few seconds or minutes. The spinning sensation, or vertigo, is caused by small crystals floating free in one of the semicircular canals of the inner ear, sending false signals of movement to the brain. Vertigo caused by BPPV is common in seniors and following head trauma (such as auto accidents).

Treatment for BPPV is usually quick and effective in one or two treatment sessions, using specific head movements such as the Epley manoeuvre.

CHRONIC VERTIGO, DIZZINESS & LOSS OF BALANCE
Chronic vertigo, dizziness, loss of balance and fatigue are common symptoms of vestibular disorders such as Menière’s Disease, Labyrinthitis, and Vestibular Neuritis. These conditions can cause abnormal inner ear function in one or both ears. When this happens, you may feel dizziness, vertigo, nausea or loss of balance because the brain can no longer rely on the inner ear for accurate information about position and motion.

Fortunately, in most cases, the brain is able to adapt to abnormal vestibular signals after a few weeks, through a process called compensation. However, if the vestibular compensation process is not completely successful, the body tries to compensate using the eyes (vision), muscles and joints (proprioception). This overworks these areas and results in fatigue, headaches and muscle tension.

Vestibular Rehabilitation Therapy (VRT) is a special form of therapeutic exercise that is especially helpful in these cases. VRT helps to retrain the brain to recognize and process signals from the vestibular system in coordination with vision and proprioception. This process can take several months, and involves exercise that patients can do at home.

SEE YOUR DOCTOR
Vertigo can be caused by a variety of medical conditions besides the vestibular dysfunctions mentioned here. Some of these can be serious, even life-threatening. For this reason, we strongly urge our patients to see their doctor for medical clearance before starting physiotherapy treatment for vertigo.