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Understanding Pain: Is it all in your head?

You’ve been having pain for years and it just doesn’t seem to go away, no matter what you do. You finally go see your doctor and imaging results show everything is normal… WHAT?!? Your doctor’s diagnosis is simply, “It must be in your head!” The last thing you want to hear is that your pain is in your head; it makes you wonder if you are making up the symptoms and negates what you are truly feeling. However, scientifically speaking, all pain is actually felt in your brain and not in the injured body part. It is commonly believed that the amount of tissue damage should dictate the amount of pain experienced. Furthermore, once the tissue is healed, the pain should disappear. Unfortunately, it is not that simple, and it is possible that once the body has healed, that some people will continue to have pain.

How do you feel pain?

Pain begins with an injury that activates pain receptors called nociceptors. These receptors send a message up your spinal cord to an area in your brain called the thalamus. From the thalamus different areas of the brain are activated to help understand the pain. How you eventually perceive the pain will be based on your emotions at the time, the memory of having a similar pain and your attitude and behaviour following the painful experience. Because so many different aspects of the brain are involved, no two people will experience pain in the same way following the exact same injury. Furthermore, people will vary on time of recovery above and beyond the normal physiological healing time of the tissue.

How does chronic pain develop?

Chronic pain lasts longer than 3 months, and well after the injury should have healed. It is still not fully understood as to why some people continue to have long-standing pain. However, research has demonstrated that individuals with chronic pain have differences in brain activity that could be causing their long-term symptoms. More specifically, it has been shown that individuals who attach strong emotional reactions to the initial injury and over-monitor their symptoms afterwards can amplify the experience of pain. This may cause the brain to become more sensitive, so that even non-painful stimulus can be perceived as painful. For example, if you get into a minor fender bender on the way home from winning the lottery, you will likely attribute less negative emotions to the accident versus coming home from losing your job and getting into the same accident. If you are already in a negative state of mind at the time of accident, you will attribute more negative feelings around the accident, which may create a stronger emotional connection, and likely cause you more anxiety and distress. Studies have shown that anger, anxiety, depression and fear are all related to increased pain and symptoms following an injury.

Can chronic pain be prevented?

Chronic pain costs the health industry millions of dollars a year, so finding ways to prevent and treat chronic pain has been a hot research topic. One theory that is receiving a lot of attention is a behavioural strategy called fear avoidance. It has been demonstrated that people who develop chronic pain are more likely to over-monitor their painful sensations, avoid activities that they think may cause pain and have a higher fear of pain or re-injury. This heightened anxiety and fear towards pain creates a vicious cycle, whereby the individual avoids activity, leading to a more sedentary lifestyle, which could create more disability.

One of the main treatment strategies for health care professionals to help prevent chronic pain is to identify patients early on, that have the attitudes and behaviours that will put them at risk for chronic pain.

In addition, because chronic pain is closely associated with anxiety and fear, providing re-assurance and education at the onset of injury can provide positive reinforcement that the injury will heal. If the patient can change their negative thoughts surrounding pain and their injury, then they are less likely to catastrophize about it.

Furthermore, patients need to get mobile as soon as possible (within pain-free range) in order to prevent fear towards activity and exercise. The sooner the patient can see that movement will not be painful, the higher chance that they will resume normal activities in a timely fashion.

Take home message:

  • Yes, all pain is in your head, but it is still very real and can be treated. You do NOT need to live with chronic pain.
  • Don’t underestimate the power of positive thinking. Lots of research has been developed to show that people who are positive and optimistic about recovery will get better faster than those who are negative.


Consussions and suicide Sheddon Physio Sports Clinic Oakville Mississauga

Concussion and Risk of Suicide: Beware of Misleading Information

Concussions are a hot topic, especially regarding the potential for long term health issues. The recent Hollywood movie “Concussion” is based around some current research that has looked at concussions and its association with long term depression and suicide in NFL athletes. With the growing media coverage around concussions, and numerous professional athletes stating long term debilitating effects due to concussions, parents are starting to doubt putting their kids in high-risk sports such as football and hockey. A recent poll in the States found that roughly 40-45% of parents are considering pulling their kids out of contact sports such as football, hockey and wrestling, due to the higher risk of sustaining a concussion. Fortunately, there is lots of research and public awareness surrounding concussions, which is educating parents, coaches and athletes. Unfortunately, along with this increase in concussion knowledge comes potentially misleading information, which is either not fully supported by research or in the early stages of development.

Last month a group of researchers out of the University of Toronto published a study on the risk of suicide post concussion (Fralick et al., 2016). Their results were not very optimistic, as they found that adults with a diagnosis of concussion had an increased long term risk of suicide 3 times the population norm. These results quickly got picked up by the media, adding more fuel to the concussion crisis and putting fear into the public. Although the article was only recently published, there has been some criticism that the results of the study may not be accurate due to methodological flaws. Their results showed an astonishingly high association between concussions and suicide compared to past studies; therefore, criticism has addressed a number of factors which may have biased the sample group, thus causing these high numbers. If you are interested in the detailed critical analysis, you can read more here.

Another major flaw of the study is not fully excluding individuals with a history of mental illness (depression, substance abuse, etc), which is one of the known leading causes of suicide. With the current study, in order to exclude concussed patients with prior mental conditions, physician notes from the year prior to injury were examined. Unfortunately, this method has its limitations, since roughly 45% of people with mental issues, such as depression or anxiety disorders, are either non-diagnosed or have not yet sought treatment. Including concussed patients with a prior mental disorder will skew the results, since the cause of the suicide may have had nothing to do with the concussion.

Unfortunately, anyone in the general public coming across the results of this study in the news will not likely seek out the article and read through the methods section in order to look for flaws. They will quickly look at the results and likely jump to the conclusion that anyone with a concussion is doomed. The overall goal of the present study was to gather some longitudinal data and answer a question in which many are interested. Please use caution when coming across such articles, and until further research emerges, there still is no definitive answer as to whether or not a concussion directly leads to an increased in suicide risk.

Take home message:

What do we know about concussions and long term health issues?

  • Long term complications following concussion are still not fully understood;
  • Determining who will have long-standing concussion symptoms is also not fully understood;
  • The causes of suicide involve many factors and likely cannot be directly related to a single specific cause;
  • Pre-existing mental health issues is one of the strongest predictors of post concussion depression and anxiety (Yang et al., 2015);
  • Depression scores will increase post concussion; however research shows that even mild musculoskeletal injuries will increase depression scores post injury. Mainwaring et al., (2010) showed that athletes with ACL injuries reported higher emotional disturbances, such as depression and anxiety, and for a longer period of time, compared to the concussed athletes;
  • Football players are likely not doomed. Many studies have examined the risk of depression and suicide in former NFL players and the risk is either similar to that of the general population or even lower;
  • Proper management of concussion is key for full recovery;


Quick Injury Recovery Sheddon Physio Sports Clinic Oakville Mississauga

The Secret to a Quicker Recovery

There is a secret to healing faster and returning to sport quicker post injury, and it doesn’t involve controversial therapy or loads of money. It’s simple, effective and one of the main reasons professional athletes recover much more quickly than the Average Joe. Here’s the secret:

Get your injuries assessed and treated ASAP!

Research has shown that early intervention for an injury will help prevent it from getting worse, prevent muscle loss, weakening and compensation, as well as result in a quicker return to sport and activity.

Supporting Research:

  • Karlsson et al., (2007) showed that early functional treatment (during the first week) following an acute ankle sprain resulted in a significantly earlier return to sport, compared to a group of subjects given crutches and compression wrapping until pain subsided;
  • Studies have shown that following a concussion, athletes who were seen for an assessment by a therapist within the first week had a significantly quicker recovery and return to play, compared to athletes who delayed their initial post-injury evaluation (Bock et al., 2015);
  • Early intervention following lower back injuries has also been heavily researched and showed that treatment soon after injury helps prevent lower back pain from becoming a chronic issue, resulting in less time loss off work, and decreased medication use (Gatchel et al., 2003).

Whether you twisted your ankle or hit your head, being assessed and treated early on has been associated with a quicker recovery and return to sport. At Sheddon Physiotherapy and Sports Clinic, between our team of physiotherapists, chiropractors, massage therapists, athletic therapists and sports medicine doctors, there is no reason for an injury to be left unattended.

Bock et al., (2015). Factors associated with delayed recovery in atheltes with concussion treated at a pediatric neurology concussion clinic. Childs Nervous System. 2111-2116.

Gatchel et al., (2003). Treatment and cost effectiveness of early intervention for acute low back pain patients: A one year propective study. Journal of Occupational Rehabilitation. 1-9.

Karlsson et al., (2007). Early functional treatment for acute ligament injuries of the ankle joint. Scandinavian Journal of Medicine and Science in Sports. 341-345.

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How to Keep your Hamstrings Injury Free

Hamstring injuries have been reported as one of the most common sporting injuries across a variety of sports that involve repetitive kicking and high speed running,  such as soccer, track and field, football, and rugby. Re-injury rates are also an issue affecting many athletes long term, with roughly 30% of athletes suffering a re-injury to the hamstring within the first year. As such, risk factors, injury mechanisms and prevention strategies are essential for coaches and athletes participating in these high-risk sports.

Injury Background

The hamstrings are a group of 3 muscles whose main purpose is to bring the hip back and bend the knee. They play a major role in many daily activities involving walking, running, and jumping. The majority of injuries to the hamstrings are grade 1-2 strains that occur during sprinting, especially as the muscles contract eccentrically to decelerate the leg. Injuries that occur during running usually take an average of 16 weeks to return to pre-injury level. Injury can also occur during activities like dancing and kicking where the muscle is overly stretched. Research has shown that an injury due to over stretching of the muscle will take much longer to heal, with an average of 50 wks to return to pre-injury level (Heiderscheit et al., 2010).

Due to the high prevalence of hamstring injuries, combined with a devastatingly long recovery and high probability of re-injury, research has focused greatly on risk factors and rehabilitation strategies to help prevent hamstring injuries altogether.

Risk Factors:


Unfortunately, the older you get, the higher your chance for hamstring injury. The age when the risk starts to significantly increase is 25 years old, with research suggesting a 30% increase in risk annually thereafter.

Decreased Flexibility

Although a lot of prevention programs focus on only stretching the hamstrings, research has shown that tight hamstrings are not a significant risk factor for injury, interestingly, tight hip flexors and/or quads have been associated with increased hamstring injury.


Although research is conflicting, there are some studies showing that an increased BMI (Body Mass Index) is a risk factor for hamstring injury. Furthermore, research consistently shows that race plays a role, with an increased incidence of hamstring injuries in aboriginal, African and Caribbean populations vs. caucasians.

Time of injury

Research suggests that most hamstring injuries occur later in games/practices and are related to fatigue.

Decreased Strength

Hamstring strength alone is not an important risk factor for injury, but rather the balance between the quads and the hamstrings strength plays an important role in injury prevention. More specifically, athletes with significantly stronger quads vs. hamstrings (as commonly seen with athletes in kicking sports) were at a significantly higher risk of hamstring injury.

Previous Injury

Previous injury to the hamstring, groin and/or knee is one of the most commonly reported risk factors for a hamstring injury. Studies show that even a mild hamstring strain will put you at risk for further injury to the hamstring within the following 2 years.

What can you do right now to keep your hamstrings healthy?

Rehab your Injuries

Whether it’s your knee, groin, lower back or actual hamstring, you need to address the injury sooner than later in order to prevent long-term problems and re-injury. The high rate of re-injury can be related to decreased eccentric strength in the hamstring, tightness related to scar tissue and altered biomechanics.

Eccentric Strengthening Programs

Eccentric strengthening programs have been demonstrated in numerous studies to significantly reduce the prevelance of hamstring injuries. Some common eccentric hamstring exercises widely researched are the Nordic Hamstring exercise, the Glider, and the Diver. Click here to learn more about these exercises.

Work on your core

One main problem with most rehab programs is that they only isolate the hamstrings. Research has shown that the hip flexors, core and pelvic musculature play a major role in injury prevention. A recent study compared a core stability program focusing on trunk stabilization and agility vs. a traditional program of hamstring stretching and strengthening following an injury. Results showed that the core stability group returned to sport sooner and had a reoccurrence rate of only 7% during the year, compared to the traditional rehab group, which took longer to return to sport and had a reoccurence rate of 70% during the year (Sherry and Best 2004). Click here to see the core stability program.

Running Program

Most hamstring injuries occur later in the game when fatigue sets in. Therefore, you must ensure that your conditioning program focuses on interval speed training and endurance training to improve overall conditioning.

Proper Warm-up

As with all injury prevention programs, warming up is key! Studies have shown that the FIFA 11 warm-up program has been successful in the prevention of many different injuries. Click here to learn more about the FIFA 11 program.

Thermal shorts

Some studies have shown a reduced risk in players who wear thermal shorts, which help keep muscles warm during training.

Take home message:

Many risk factors for hamstring injuries are not preventable, so work on what you can control:

  • Core stability, flexibility and strength

If you still have questions about your injury, or want more guidance on injury prevention, book an appointment with one of the Sheddon Therapists.

Heiderscheit et al., (2010). Hamstring strain injuries: Recommendations for Diagnosis, Rehabilitation and Injury Prevention. Journal of Sports Physical Therapy. 67-81.

Liu et al., (2012). Injury rate, mechanism, and risk factors of hamstring strain injuries in sports. A review of the literature. Journal of Sport and Health Science. 92-101.

Prior et al., (2009). An evidence based approach to hamstring strain injury. A systematic review of the literature. Sports Health. 154-164.

K Tape Kinesio Tape for Sports Injuries - Sheddon Physio Sports Clinic Oakville Mississauga

The Sticky Truth Behind Kinesio Tape

Kinesio tape, that colourful elastic athletic tape, has been used for over a decade in the treatment of musculoskeletal injuries. It probably became most popular after the 2008 Olympics, where it was donated to team therapists, which resulted in almost every athlete using it. The majority of the people who have used this tape LOVE it! However, the research on the effectiveness of the tape isn’t so wonderful. There have been hundreds of research studies done on kinesio tape, so we’ll examine some of the more recent systematic reviews that outline what exactly the tape has been proven to achieve.

How the tape works

Kinesio tape is different from regular white athletic tape because it is flexible and 20160217_141404allows for full range of motion, (and it looks a lot cooler). Below are the main functions of kinesio tape:

  • Decrease pain;
  • Improve range of motion;
  • Increase proprioception;
  • Correct joint alignment;
  • Improve swelling and lymphatic drainage;
  • Facilitate or inhibit muscles

In order to achieve any of the desired effects above, the tape MUST be properly applied, including the direction of pull of the tape and the amount of tension applied.

What does the research say?

  • Overall, most studies show that kinesio taping for pain reduction, function and proprioception is better than no treatment, yet it is no better or worse than other traditional treatment options (Choon Wyn Lim et al., 2015)
  • Good support for reduction of pain in individuals with musculoskeletal injuries, (Montalvo et al., 2014)
  • Some support that it may improve painfree range of motion (Taylor et al., 2014).
  • Some support that it may help correct alignment i.e., patellar tracking (Barton et al., 2013).
  • Inconclusive support for improved swelling and lymphatic drainage (Kalron et al., 2013).
  • No support for the facilitation of muscle strength. A review of 19 studies that examined if kinesio tape increases muscle strength or facilitates muscle contraction showed no difference compared to a control group (Csapo et al., 2015).
  • A lot of the research discusses a potential placebo effect to help explain the benefits of kinesio tape

Take home message:

Kinesio tape is inexpensive, noninvasive, and has little to no side effects (there is a potential for skin irritation). Therefore, it is a safe and effective treatment option for pain relief, improvement in range of motion and correction of joint alignment. Future research may show beneficial effects on swelling, lymphatic drainage and facilitation of muscles.


Choon Wyn Lim et al. (2015). Kinesio taping in musculoskeletal pain and disability that lasts for more than 4 weeks: Is it time to peel off the tape and throw it out with the sweat? A systematic review with meta-analysis focused on pain and also methods of tape application. British Journal of Sports Medicine. 

Montalvo, E. Cara and G. Myer. Effect of kinesiology taping on pain in individuals with musculoskeletal injuries: Systematic Review and Meta-analysis. Physician and Sports Medicine.  2014. Vol 42. Issue 2. P. 48-52.

Taylor et al. (2014). A Scoping Review of the use of Elastic Therapeutic Tape for Neck and Upper Extremity Conditions. Journal of Hand Therapy.

Barton, et al. (2014). Patellar taping for patellofemoral pain: a systematic review and meta-analysis to evaluate clinical outcomes and biomechanical mechanisms. British Journal of Sports Medicine, 48(6), 417-424.

Kalron and S. Bar-Sela. A Systematic Review of the Effectiveness of Kinesio Taping-Fact or Fasion? European Journal of Physical and Rehabilitation Medicine. 2013. Vol. 49. Issue 5. P. 699-709.

Csapo et al. (2015). Effects of Kinesio taping on skeletal muscle strength – a meta-analysis of current evidence. Journal of Science and Medicine in Sport, 18(4), 450-456.