Tag Archives: rehabilitation

James-White massage therapy Sheddon Sports Clinic Oakville

Welcome new Massage Therapist: James White

Sheddon Physiotherapy and Sports Clinic is excited to introduce our newest Massage Therapist James White. James is currently working Tuesday evenings and Saturdays.

James graduated from the University of Windsor in 2015, completing a Bachelor of Human Kinetics, specializing in Movement Science. He then enrolled in Sutherland-Chan School of Massage Therapy and completed their Advanced Standing Option for Health Professionals, graduating in 2016. He had student clinic experiences at Toronto General Hospital, Princess Margaret Lodge, Toronto Lyndhurst Rehab Centre, and performed treatments at the 2016 Bay Street Hoops Charity Basketball Tournament and the 2015 Scotiabank Marathon.  He is trained in Swedish techniques, sports massage, deep tissue massage, trigger point release, and fascial release. He has knowledge of anatomy, physiology, pathology, remedial exercises, rhythmic techniques, and self-care. James has treated athletes, pregnant mothers, senior citizens, children, as well as cancer, thoracic surgery, and spinal rehabilitation patients.

When he is not treating, James can be found playing soccer in a recreational league, volunteering at his church’s youth group, or waiting for the NFL’s Chicago Bears to win the Super Bowl.

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ACL rehab monster walk Sheddon Physio Sports Clinic Oakville Mississauga

ACL Rehabilitation: What you Knee’d to know.

ACL injuries continue to be one of the most common and devastating sports injuries. Despite the long and extensive rehabilitation process, rates of re-injury range from 3-22% for an operated ACL and 3-24% for the contralateral ACL in the first 5 years after surgery. Due to these numbers, many athletes never return to their sport. A recent systematic review was published by a group of ACL experts in order to help develop evidence-based guidelines for rehabilitation following ACL reconstruction. Topics they examined included:

  1. Preoperative factors that can effect recovery;
  2. Effectiveness of physical therapy;
  3. Benefits of specific exercises;
  4. Return to play guidelines;
  5. Risk for re-injury.

Preoperative factors

Many athletes will start doing physiotherapy prior to surgery in order to strengthen the knee. The above researchers found that quadriceps weakness, as well as extension deficit (not being able to reach 0 degrees of extension or more) prior to surgery, will have a negative consequence on the rehabilitation process post-surgery. Don’t tell yourself these issues will get “fixed” with surgery, prehab is essential to guarantee a successful post-surgery outcome.

Strength and Neuromuscular training

There are many exercise programs designed for ACL injuries. What exactly should you be focusing on? Strengthening, proprioception and neuromuscular training are vital, especially for return to sport. For some ideas on where you should be focusing, please read our earlier blog, here.

Modalities

Most physiotherapy clinics use a variety of different modalities with their patients, but which ones are most useful post ACL?

Muscle stimulation has been shown to be effective when combined with exercise. The muscle stimulation will help activate the muscles, which are either too weak to engage, or are inhibited due to pain and/or swelling. The machine helps turn on the muscle during exercise, and the patient is encouraged to work with it to help regain strength. In addition, cryotherapy has been shown to help with acute pain and swelling.

Return to Play

Return to sport rehabilitation should focus on plyometrics and agility, as well as take off and landing mechanics. A series of different tests need to be performed in order to determine readiness to return to sport. These tests should assess strength, balance, and proprioception, as well as functional sport patterns. It is essential that both the injured and uninjured knees be tested, due to the high rate of injury to the opposite knee with return to sport.

Risk of Re-injury

Rates of re-injury range from 3-24% for either the surgical or non-surgical knee, with some researchers claiming that the opposite knee is twice as likely to get injured upon return to sport.  Other studies have shown that age is a major predictor of recurrent ACL injuries, with young athletes (under 20) having a rate of 20-40% re-injury. Other risk factors include:

  • Poor neuromuscular function and biomechanics;
  • Higher activity level;
  • Allographs vs. autographs.

Whether you have just been diagnosed with an ACL tear and you’re waiting for surgery, or you’ve undergone the surgery and are working on rehabilitation, the staff at SPSC can help guide you along the way to ensure a full and successful return to sport.

Van Melick et al., (2016). Evidence-based clinical practice update: Practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. BJOSM.

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foot

Strong Feet = Less Injuries

You probably don’t see a whole lot of athletes spending time in the gym focusing on strengthening their feet. However, research has shown that exercises targeted at strengthening the feet can help prevent and treat a number of different foot conditions, such as plantar fasciitis, metatarsalgia, tibialis posterior tendinopathy and hallux valgus (bunions).

Why is a strong foot so important?

The intrinsic muscles of the feet help with stability, shock absorption, balance, arch support and foot mechanics. If there is a weakness in these deep muscles, then other structures will take the extra load, which subsequently lead to injuries not only in the feet, but also up the lower extremity, as biomechanics of the whole leg are altered. For example, weak intrinsic foot muscles can lead to over-pronation of the feet, which results in the leg rotating inwards, putting strain on structures of the hip and knee, potentially causing injuries to these areas.

Luckily, you don’t have to devote a whole training workout just to your feet. Research has evaluated EMG muscle activation of the intrinsic foot muscles during a number of different foot exercises in order  to determine which exercise is the most beneficial. The key exercise across a number of different studies is the “short-foot exercise.”This exercise has been widely studied and has been supported in the research for the following conditions:

  • Preventing foot/lower extremity injuries in runners;
  • Decreasing pain and disability due to bunions;
  • Prevention and treatment of plantar fasciitis;
  • Decreasing the risk of falls in the elderly

Instructions:

  • With even weight on both feet, place a business card under the first metatarsal head and slide the card back towards your heel as you lift the inside of the foot (in order to raise your arch)
  • Be sure to keep the weight on the metatarsal heads where the business card is placed – not through the toes; you should be able to lift the big toe up and down.
  • Hold the position for 10 seconds, relax and repeat for 10 repetitions and 2 sets.

Click here for a visual

The short-foot exercise is initially done in a seated position and can be progressed to more challenging positions, such as standing, balancing on 1 leg and eventually while doing functional activities such as squatting. Research has shown that doing this exercise daily for 4 weeks improves postural control of the foot, specifically preventing over-pronation, as well as improving balance and proprioception. 

If you have been suffering from foot pain that won’t go away, contact Sheddon Physiotherapy and Sports Clinic and a therapist can help get you back on your feet.

Fourchet and Gojanovic (2016). Foot core strengthening: relevance n injury prevention and rehabilitation for runners. Swiss Sports and Exercise Medicine. 64,26-30.

Jung et al., (2011). A comparison in the muscle activity of the abductor hallucis and the medial longitudinal arch angle during toe curl and short foot exercises. Physical Therapy in Sport. 30-35.

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