Common Conditions Treated

Tendonitis/Tendinosis
The advances in the understanding of tendon injury indicate that conditions that have been traditionally labelled as Achilles tendonitis, patella tendonitis, lateral Epicondylitis (tennis elbow), and rotator cuff tendonitis are in fact TENDINOSIS. Although the word “Tendonitis” is often still used, it is actually an out-dated term. The suffix “itis” in tendonitis means inflammation, however, research has shown that it is really a build up of scar tissue, and decrease in tissue collagen that is the problem, not inflammation. Therefore, the newer term that replaces tendonitis is “Tendinosis”, which denotes the scar tissue accumulation, and change in tendon tissue composition.

This condition is most common in athletes of jumping sports such as basketball and volleyball, but it also occurs in soccer, track, long distance running, cycling and tennis athletes. The symptoms of a tendinosis injury include pain at the tendon site which is worse with particular movements, reduced range of motion due to scar tissue accumulation and relative relief of pain with rest. The symptoms will depend on the severity of the injury and the length of time the injury has been present. Scar tissue accumulation can build up over a long period of time before symptoms appear. Once symptoms develop, they may come and go with time but the root problem will remain if left untreated. Those patients most at risk for re-injury are those that have symptoms of short duration and are still able to “warm up” the injury and engage in sports. They are the most likely to try to continue playing without undergoing appropriate treatment, and thus worsen the tendinosis.

Because tendinosis results from collagen degeneration and generally, mechanical overload, it is vital to establish why this occurred. Training errors are a common cause, but in some instances a more subtle mechanism underlies tendinosis. Thus, it is important to assess any equipment being used (eg. running shoes, tennis racquet, bike), examine movement biomechanics (eg. running, throwing motion, stroke pattern), and diagnose and treat any muscle imbalances. The importance of biomechanical correction cannot be overemphasized in treatment.

Effective treatment of any tendinosis injury requires an alteration in tissue structure to break up the cross-fibre adhesions. Targeted soft tissue therapy and Acupuncture can be used to restore normal function to the affected soft tissues, Physiotherapy and Chiropractic to restore normal motion and alignment to the involved joints. Functional Rehabilitation, emphasizing eccentric strengthening will be necessary to restore the long strength to the involved tissues. back to top

Sprains and Strains
A SPRAIN is a tear in a ligament and a STRAIN is a tear in a muscle. Sprains and strains are graded into categories depending on the severity of the tear. The three classifications are – mild (1st degree), moderate (2nd degree) and severe (3rd degree). A mild sprain or strain refers to a tear of up to 20% of the fibres (micro-tear); moderate refers to a tear of 20-75% of the fibres (partial tear); and severe refers to a tear of 75-100% of the fibres (complete or full tear).

Factors that contribute to ligament sprains include a sudden movement beyond the normal range of motion, muscle imbalances, prolonged alteration of posture, poor proprioception/balance and altered biomechanics. Contributing factors for muscle strains include overuse or repetitive micro-trauma, contraction of a muscle while it is in a stretched position, un-preparedness for activity, violent contraction, excessive forceful stretch or a sudden movement.

Common areas to sprain include “rolling” the ankle (“inversion sprain”) and knee. These injuries are more frequent in runners, soccer players, tennis players, skiers and snowboarders. Common areas to strain include the adductors (inner thigh muscles, ‘pulled groin”) and the hamstrings. These injuries are more frequent in athletes who are involved in kicking, sprinting, skating, water skiing, or jumping (high jump or hurdles).

There is usually local tenderness in the area. There may be some swelling and/or bruising depending on the severity of the tear. Stretching the area tends to cause more pain and discomfort. The pain, swelling, bruising and tightness are correlated to the degree of the tear. A severe (3rd degree) sprain is often associated with a subluxation or dislocation of the joint. If the sprain is not treated properly, a chronic instability can form in the joint, leading to additional or continual sprains. Similarly, if a strain is not treated properly, scar tissue can form in the muscle and limit the range of motion, which can contribute to further damage.

Once you have sustained a sprain or strain it is important that you receive the appropriate care as quickly as possible. Begin with RICE (rest, ice, compression, elevation) and then make an appointment at the clinic. Treatment at the early stages will focus on decreasing pain, minimize swelling and inflammation and promote healing with Targeted Soft Tissue Therapy and Acupuncture. As the tissues heal treatment will shift focus to re-establishing the appropriate strength and balance of the muscles and proprioception with Functional Rehabilitation. Long term goals are a safe return to activity and prevention of re-occurrences. back to top

Your  Core:

Mechanical Low Back Pain
Low-back pain (LBP) is common in athletes and non-athletes. The odds of getting LBP during your lifetime are 60% to 90%. For Athletes, the lower back is a frequent site of injury in a variety of sports, including gymnastics, football, weight lifting, rowing, golf, dance, tennis, baseball, basketball, and cycling.

The spinal column is made up of 24 bony vertebrae with alternating discs. The vertebrae are made up of the cervical spine (neck), thoracic spine (mid-lower back) and the lumbar spine (low back). Five additional bones are fused together to form the sacrum and three more comprise the coccyx or tailbone. Together, they allow for an upright posture and mobility in several directions and planes. The discs are actually a gelatinous form of cartilage contained within a dense fibrous mesh that lubricate the joints between the vertebrae and act as shock absorbers for the spine.

The lower back is a particularly vulnerable area for discomfort since it supports the entire weight of the upper body. LBP can be caused by a variety of factors including poor posture, weak core stabilizers, stress, pregnancy, compression of nerve roots, bone or joint disease and many others. This can lead to joint or nerve irritation, muscle spasm, disc bulges and spinal degeneration.

Although patients often attribute the onset of their back pain to a specific injury, more often the injury is quite trivial, like bending over, twisting, or sneezing. This is because much of the time onset of low-back pain represents the cumulative trauma over month or even many years. Using the circulatory system as an analogy – If the blood vessels in the body have suffered the chronic insult of atherosclerosis (plaque build-up) over the years, an acute event of shovelling snow may precipitate a heart attack; in the same way, a lifetime of poor posture and poor lifting and bending habits may stress the spinal muscles, joints and discs to the point that even a minor stress precipitates an acute episode of low back pain.

If low back pain is usually due to cumulative trauma, does that mean it’s most often mechanical? Ninety-seven percent of back pain in the population seen by primary care physicians is mechanical in origin – there’s something wrong with the muscles, ligaments, or connective tissue. Even a herniated disk is a mechanical cause. Individuals who are most aerobically fit have the least back pain.

Treatment for low back pain depends on the cause and may include any or all of the following: Chiropractic, Physiotherapy, Targeted Soft Tissue Therapy, Acupuncture, and Functional Rehabilitation. Treatment is initially aimed at decreasing pain, reducing inflammation and muscle spasm, and restoring normal motion to the joints of the spine and pelvis. Subsequently, the goals of treatment are to correct any muscular imbalances that may be contributing to the altered biomechanics, improve core stability, restore appropriate balance to the back, core and pelvic muscles and focus on lifting and sitting posture. back to top

Sciatica
Sciatica is a term used to describe a symptom rather than a diagnosis. Sciatica simply refers to irritation of the sciatica nerve which runs from the back of the pelvis down the thighs, legs, and even into the feet. Irritation of this nerve may be caused by a number of sources including: compression from surrounding tight muscles, disc herniations, degeneration and misalignments of the spine. back to top

Sacroiliac Joint Syndrome
The sacroiliac joint (SI joint) is the joint between the sacrum (lower spine) and illium (pelvic bone). This joint moves every time we take a step. Sometimes this joint becomes stuck or locked causing low back pain. The surrounding muscles of the SI joint often go into spasm as a protective mechanism. Pain is experienced in the buttock and thigh regions. It is typically aggravated by sitting for long periods.

Various athletic activities, including walking, running, jumping, leaping, and squatting, can produce unwanted motion or stress in the SI joint and surrounding tissues. Soft-tissue failure, overload injuries, weak core stabilizing muscles, stress and direct traumas can all contribute to this condition. SI joint pain may also be a distant manifestation of an injury in other parts of the kinetic chain that are stressed during sports activities. back to top

Disc Herniation (slipped Disc)
The intervertebral discs are located throughout the entire length of the spine in between each of the vertebrae (bones of the spine). A disc Herniation occurs when the jelly-like substance from within the disc protrudes out the back and side of the spinal column. It is theorized that the protruded herniated disc material caused the release of irritating substances or initiated an autoimmune inflammatory reaction. This disc, the corresponding inflamed nerve root, or compression of the nerve root by the disc may be the source of pain. This can cause any of the following symptoms; low back pain, tingling, pain and weakness down the affected limb (usually below the knee). The pain is often of sudden onset from a bending and/or twisting manoeuvre but is the result of cumulative repetitive trauma. There is often a past history of several bouts of low back pain that have resolved.

The disc can become dysfunctional due to cumulative trauma (ie: repetitive combined movements of flexion of the back and rotation), the effects of aging, or degenerative disorders of the spine. Most people with back pain however, do not have pain from herniated discs. Current research using an MRI had shown that as many as one third to one half of healthy asymptomatic young men have signs of disc bulge or Herniation. back to top

Neck and Upper Back Pain/Postural Syndrome
Upper back pain may be caused by a number of things including joint irritation, poor posture or a mal-positioned rib. All types of conditions can refer pain to other areas. For example, rib pain can travel around to the front of the chest and is aggravated by deep breaths.

Pain will generally be located between the shoulder blades and anywhere from the base of the head and neck to the tip of the shoulders. People often describe this as constant arching in the middle of upper back region. The pain is usually relieved by activity and made worse by repetitive activity (sitting at a desk, driving, etc).

The imbalance between the front and back muscles of the neck and back are often accentuated by various work posture that emphasize a “hunched”, forward-head position. The large pectoral (chest) muscles become chronically “shortened” and tight in response to this sustained position. Meanwhile, the muscles in between the shoulder blades are weak and constantly strained from overuse having to support this hunched posture. This results in pain, loss of motion in the neck, upper back and shoulders, scar tissue formation and misalignments in the corresponding joints.

Treatment is aimed at minimizing pain, correcting the muscular imbalances and re-storing the normal motion to the neck, upper back and shoulder complex using Functional Rehabilitation, Targeted Soft Tissue Therapy, Physiotherapy Chiropractic and Acupuncture. Treatment and/or prevention of these aches and pains is accomplished by redesigning the work environment making it ergonomically efficient, taking frequent break throughout the day for stretching, varying your task to avoid repetition and mousing with your non-dominant hand at a computer. back to top

Thoracic Outlet Syndrome
The Thoracic Outlet is a tunnel whereby nerves and arteries from the neck run through to get to the arms and hands. Thoracic Outlet Syndrome (TOS) occurs when the nerves and/or arteries are compressed as they travel downward into the arm. Compression can occur at various sites from the neck down to the hands. This condition is characterized by having diffuse arm symptoms, including numbness and tingling. Often the symptoms will follow a path down the inside of the arm to the little ring fingers. This is often made worse by overhead activity.

Contributing factors to TOS include poor posture (forward head and rounded shoulders), muscular imbalances (tight chest, weak back), trauma, cervical ribs, carrying heavy loads and occupations or sports with overhead arm movements (ie: swimming, volleyball, tennis, baseball pitchers). Treatment is aimed at restoring normal mechanics to the neck and shoulder and establishing the correct balance between the postural stabilizing muscles. This is accomplished by breaking down scar tissue formation in the tight muscles with Targeted Soft Tissue Therapy and strengthening the weak postural stabilizing muscles with Functional Rehabilitation.  back to top

Headaches:

Tension-type Headache
Muscle tension headaches, or “stress headaches” make up 90% of all headaches. They occur frequently and are often worse in the afternoon or early evening. The pain is usually on both sides of the head, often at the base of the neck or above the eyes.

The trigger points commonly stem from: the top of the shoulders (upper trapezius), the back of the head (suboccipitals), and the back of the neck and top of the shoulders (levator scapula). The headaches usually last for days or weeks.

Treatment goals:

• Correcting any postural imbalances with Functional rehabilitation
• Ensuring proper ergonomics at the workstation
• Stress management
• Targeted Soft Tissue Therapy and Chiropractic for trigger points and misalignments in the neck and upper back
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Migraine
Migraine patients usually complain of throbbing on one side of the head that may or may not be preceded by an aura. The aura typically consists of progressively increasing blind spots surrounded by flashing lights. This lasts for about 30 minutes and is replaced by a disabling headache that last for several hours to as long as 1 to 3 days, causing the patient to seek a dark, quiet environment. Migraine with an aura accounts for only about 0% of all migraines.

Typically, the initial onset of migraine headaches occurs in adolescence or the early 20’s – the period when people are most physically active. Migraine can occur in children as young as age 5, with a peak from 10 to 13 years. Seventy percent of total migraine sufferers are women, though in children both genders are affected equally.

Patients who have migraine will describe the pain as throbbing or pulsating, usually severe, and often incapacitating. Migraine is considered a “sick” headache with associated symptoms such as nausea, vomiting, and photophobia (sensitivity to sound), diarrhea, dizziness, light headedness, chills, and fatigue.

Once believed to be purely vascular (blood vessel related), migraine headaches are now believed to be neruogenic (nerve related). There appears to be a wide variety of triggers for migraines, including variation in sleeping or eating habits, stress, fatigue, environmental pollutants, certain medications, and food. With food, the primary triggers include chocolate, caffeine, foods containing tyramine, cured meats, cheese, nuts and wine. Patients who routinely consume excessive caffeine may also precipitate a migraine attack if they miss the caffeine-containing beverage or medication. There is usually a family history of migraines.

Management of migraines includes maintaining a regular sleep schedule, stress management, and avoidance of over- or under sleeping, skipping meals and other food triggers. Chiropractic, Physiotherapy, and Targeted Soft Tissue Therapy can help to relieve the overall tension in the neck and upper back during or between your migraine episodes. back to top

Cluster Headaches
The patient is often a middle-aged male complaining of incredibly painful headaches that are located in the eye region.  The headaches cluster over days or weeks and then end, to appear again several weeks or months later. The headaches last on average 20 minutes and are the most painful feeling the patient has felt.

The frequency of attacks is on average several times per day, often at night, lasting of one to several weeks. Recurrence may not occur for months or even years later. There is a possible association with smoking as a trigger and alcohol as an exacerbating factor. There is tearing of the eyes and runny nose on the same side of the headaches. The natural history is for headaches to decrease in frequency and intensity as the patient ages. Avoidance of alcohol and smoking are important in managing cluster headaches. back to top

Upper Limb Conditions:

Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) is caused by an irritation of the Median nerve, one of the nerves that comes from the neck and enters your wrist and supplies your hands and fingers. The work carpal refers to the 8 bones in the wrist. The tunnel is formed on top by a ligament that runs across the carpal bones and on the bottom by the carpal bones themselves. The median nerve runs through this tunnel and controls the feelings and muscle strength of the first three fingers, as well as the palm of your hand, exactly where people with CTS notice most of their symptoms. Overuse, improper use, as well as repetitive strain of the forearm and wrist are just a few of the ways this nerve gets irritated, resulting in tingling and pain in the hands and fingers.

People who do any type of repetitive movements with their hands and wrists are susceptible to this problem. This risk of developing CTS is even higher in people doing activities such as sewing, assembly line work, or jobs such as manufacturing, cleaning, or typing. Women are three times more likely than men to develop these symptoms as well as people with diabetes or other metabolic disorders.

Treatment for CTS may include chiropractic care, medical care or both. Surgery is a common treatment offered to people suffering from CTS, however, depending on the cause of the irritation, conservative care is often just as effective.  Targeted Soft Tissue Therapy, Acupuncture, Physiotherapy Chiropractic, Functional Rehabilitation and nutritional counselling are all effective components of a well-structures treatment plan for CTS.

Prevention however, is always best! First stretch your forearms and fingers before beginning work and at frequent intervals throughout. Secondly, alternate tasks to reduce the amount of repetitive movements that strain your wrists. Last but not least, modify or change your daily activities that put pressure on your wrists. back to top

Frozen Shoulder (Adhesive Capsulitis)
There are three clinical stages of the condition: freezing, frozen and thawing. In the freezing or acute stage moderate to severe pain exists that limits all shoulder movement. In most instances, the patient cannot recall any specific even that triggered the pain. The pain interferes with sleep, and in many instances causes patient to seek prescribed pain medication. In the frozen or middle phase, pain decreases gradually but without very much improvement in motion. The final or thawing phase is marked by slow and gradual return of motion and may be as short as 12 months but may last for years. Adhesive capsulitis has typically been classified into two forms, primary and secondary. In the primary form, no known causes can be identified. The secondary form is associated with trauma or other illnesses or events. Generally, the cause of adhesive capsulitis remains unknown. The condition tends to affect women more than men, occurs in people after their 40’s, does not show a particular preference for handedness, and can on occasion occur on both shoulders.

The most accepted theory is that adhesions develop between or within the capsule of the shoulder. Some individuals may be predisposed, such as those with diabetes, hyperthyroidism, lung disease and those who have had a heart attack.  It has been shown that, contrary to logic, this process is not due to immobilization (lack of movement). This process begins as an inflammatory process that resolves with scar tissue formation.

Because of the favourable natural history, patients can generally expect a good outcome, and in most cases conservative treatment is successful. Some patients will have residual signs and symptoms years after the onset of their disease. Mostly this is pain-free, mild loss of range of motion. Treatment is aimed at controlling pain, increasing range of motion in the shoulder and breaking down scar tissue with Physiotherapy Targeted Soft Tissue Therapy, and Acupuncture. A series of progressive Functional Rehabilitation exercises are used to regain proper movement of the shoulder. back to top

Golfer’s Elbow (Medial Epicondylitis)
Golfer’s elbow is an irritation of the forearm flexor tendons that attach to the inside of the elbow. This is the tendon of the muscles that are responsible for bending the wrist forward. The term Golfer’s elbow is used because this condition commonly affects golfers. It generally occurs in the trailing arm of the golf swing. With golfer’s, the incidence increases with age and the number of rounds played, with more than two to three rounds per week as a threshold for increased incidence. This condition is most frequently associated with overuse and excessive grip tension. Proper grip tension optimizes the function of the forearm muscles, allowing smooth, rapid movement of the forearms and reduced stress on the forearm tendon insertions at the elbow.

Golfer’s elbow is a repetitive strain injury with scar tissue formation that can become chronic if left untreated. The pain is aggravated by activities such as golfing, cooking, gardening, typing, throwing activities, swimming and lifting weights. A Functional Rehabilitation program comprised of stretching and strengthening exercises are incorporated into the treatment plan once the scar tissue has been “broken up” by Targeted Soft Tissue Therapy to reduce the possibility of re-injury. Acupuncture may also be used to treat both the pain and dysfunction of this condition. back to top

Tennis Elbow (Lateral Epicondylitis)
Tendonitis means inflammation of the tendon. Although the word “Tendonitis” is often used, it is actually an out-dated term. The suffix “itis” in tendonitis means inflammation, however, research has shown that it is really a build up of scar tissue and decrease in collagen that is the problem, not inflammation. Therefore, the newer term that replaces tendonitis is “Tendinosis”, which denotes the scar tissue accumulation, and collagen change.

Tennis elbow is an irritation of the forearm extensor tendons that attach to the outside of the elbow. These tendons attach to muscles that are responsible for bending the wrist backward. The term Tennis elbow is used because this condition most commonly affects tennis players with their backhand stroke. Tennis elbow is a repetitive strain injury with scar tissue formation that can become chronic if left untreated. The pain is aggravated by activities such as tennis, cooking, gardening, typing, and lifting weights. The pain is usually at its worst when grasping an object with the elbow in an extended position. The loss of grip strength and accompanying pain are difficult to tolerate for an active patient.

A Functional Rehabilitation program comprised of stretching and strengthening exercising are incorporated into the treatment plan once the scar tissue has been “broken up” by Targeted Soft Tissue Therapy to reduce the possibility of re-injury. Acupuncture has a great success rate for treating this condition and may be incorporated into the treatment plan. back to top

Rotator Cuff Tendonosis / Impingement
The rotator cuff involves four muscles that surround and support the shoulder joint (subscapularis, supraspinatus, infraspinatus, and teres minor). Together with the deltoid, the rotator cuff muscles place the arm in the overhead position essential in many sports. Sometimes these muscles get strained and irritated. Several different mechanisms of rotator cuff injury are presently recognized. These can be divided into acute traumatic injuries and the more common microtrauma caused by repetitive overuse injuries as seen in overhead activities (swimming, volleyball, etc.)

The symptoms of rotator cuff injury caused by both mechanisms include pain, weakness, and limitation of motion. Pain tends to be located in the front, top or side portions of the shoulder. Patients with acute inflammation of the rotator cuff have intermittent mild pain with overhead activities.

Patients with chronic inflammation of the rotator cuff have persistent, moderate pain with overhead activities; there may be pain at rest, but much less than with overhead activities. Patients with partial and full-thickness rotator cuff tears have persistent pain at rest that is often referred to the deltoid (shoulder) muscle insertion on the side of the upper arm. The symptoms of weakness and limitation of active motion may be the result of pain or a rotator cuff tear.

Several weight training exercises, including the upright row, military (shoulder) press and lat pull downs behind the neck jeopardize the muscles and tendons of the rotator cuff. Among the rotator cuff tendons, the supraspinatus tendon is the most frequently involved, probably because of its relative lack of blood flow and location in a potentially narrowed space below the shoulder bones. Frequently, the chest and front shoulder muscles development is disproportionate to that of the scapular (postural) stabilizing muscles.

Treatment is largely non-operative. It is aimed at pain control and scar tissue breakdown utilizing Acupuncture Physiotherapy and Targeted Soft Tissue Therapy, increasing pain-free shoulder range of motion, stretching (with emphasis on the posterior capsule of the shoulder), and strengthening of the scapular stabilizers, rear shoulder muscles, and external rotators with Functional Rehabilitation. back to top

Shoulder Instability
Anterior instability of the shoulder can also be chronic during weight training. Several errors of technique can contribute to anterior instability. Behind the neck (latissimus dorsi) pull-downs load the shoulder at the extreme of external rotation; shoulder hyper-extension during the bench press produces repetitive shoulder capsule trauma and places excessive traction on the AC joint; and behind the neck military presses stress the shoulder capsule, the rotator cuff, and the inferior shoulder ligaments. The patient may report vague symptoms such as a feeling of looseness of the shoulder or transient numbness of the arm.

Patients with instability usually do not have any symptoms. When symptoms occur, they often are the result of a sudden traction on the arm that results in pain and weakness felt in the entire arm. Supporting the arm relieves symptoms. Another common presentation is difficulty working in overhead positions due to a sense of fatigue rather than pain. Most patients have an inherent looseness to their shoulder capsule (born loose). This may be accentuated by sporting activities that constantly stretch the capsule, such as with throwing sports and swimming.

Treatment of anterior shoulder instability is still somewhat controversial. An aggressive Functional Rehabilitation program is advocated involving scapular stabilization, rear deltoid (shoulder) and external rotator cuff strengthening to substitute for the laxity of the joint capsule and prevent future dislocations. Targeted Soft Tissue Therapy is performed to breakdown the scar tissue formation from the chronic overuse. In an overhead throwing athlete or high shoulder demand athlete, however, a case can be made for early evaluation for consideration of surgical repair. Avoidance of positions that further stretch the capsule is important. Surgical stabilization is rarely necessary.  back to top

Lower Limb Conditions:

Achilles Tendinosis
Tendonitis means inflammation of a tendon. Although the work “Tendonitis” is often used, it is actually an out-dated term. The suffix “itis” means inflammation, however, research has shown that it is really a build up of scar tissue and decrease in collagen that is the problem, not inflammation. Therefore the newer term that replaces tendonitis is “Tendinosis”, which denotes the scar tissue accumulation, and change in tendon composition.

The Achilles tendon is the largest tendon in the body. It connects the muscles of the calk to the foot through its junction at the heel. The Achilles tendon is critical for transmitting the force of contraction of the calf muscles to the foot: pushing the foot downwards as when stepping on a gas pedal. During locomotion, the Achilles tendon allows for the push-off phase during running.

Achilles tendinosis is a condition where the Achilles tendon, at or near its insertion into the heel, becomes irritated and causes pain. The demands on the Achilles tendon are high in running and jumping sports. Pain is often felt with running hills, doing speed work or jumping activities. It is thought that over-pronation puts excessive pressure on the tendon of the calf muscle causing irritation of the Achilles tendon. A sudden increase in running mileage or overtraining of any sort contributes to this injury.

Local tenderness is made worse by stretch and/or stretch and contraction. Achilles tendinosis may be viewed as a spectrum that ranges from initial overuse inflammatory changes to chronic degenerative breakdown. In the last stage of this condition the Achilles tendon can completely rupture. Rupture of this tendon is a devastating injury that heals very poorly. Thus properly treating Achilles tendinosis is essential.

Treatment goals:

• Minimizing pain, breaking up scar tissue and promote tissue remodelling with focused specific manual soft tissue therapies
• Correcting poor biomechanics (over-pronation) with Orthotics and/or proper shoe selection
• Modifying the training program to allow proper rest and repair to the injured tissues
• Prevention of re-occurrences
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Bunions (Hallux Valgus)
Several features combine to create the infamous bunions that are the plague of every woman who loves to wear tight fashion shoes. Like many of our physical features, bunions tend to be inherited, but get worse with time. Severe unions can be seen even in a 12 year old, and are more common in females. The shape of the foot however does not usually have much to do with the pain of the bunion. Bunion pain is most often caused by the wider foot and its prominent bump rubbing against the side of the shoe. The bursa (a small, flat, fluid filled sac that lies just below the skin on the outside of the bump), becomes inflamed and thickened. Even shoes that you once thought were loose may be tight enough to create a great deal of pain, but the bump makes fitting tight shoes very difficult.

Bunions formation is likely accelerated by over-pronation because of the excessive weight placed on the big toe joint during the push-ff phase of gait, forcing the toe to further inward movement. It is advised to have this looked at early whish will lessen the chance of having to undergo surgery for it. Conservative treatment options include; Acupuncture, Low level laser therapy, Kinesiotaping, Orthotics, wearing wide-toes shoes, and stretching the Achilles tendon. back to top

IT Band Syndrome
Illotibial band syndrome (ITBS) is the most common cause of knee pain in runners. The illio-tibial band (IT band) is a superficial thickening of tissue on the outside of the thigh, extending from the outside of the pelvis/hip region and inserting just below the knee. ITBS occurs when there is a constant rubbing and friction of the IT band on the outside of the knee. The main symptom of ITBS is sharp pain or burning on the outside aspect of the knee. The pain can also travel up the side of the thigh to the hip region.

Runners often note that they start out running pain free but develop symptoms after a reproducible time or distance, which can be made worse by running downhill. Early on, symptoms subside shortly after a run, but return with the next run. If ITBS progresses, pain can persist even during walking, particularly when the patient foes up or down stairs. ITBS tends to come and go but left untreated can be a nagging injury. Contributing factors include an increase in mileage, running on cambered surfaces, over-pronation, and hip abductor weakness.

Treatment goals:

• Corrective pelvic muscle imbalances and pain control with Physiotherapy, Targeted Soft Tissue Therapy, Acupuncture, and/or Functional Rehabilitation
• Correcting poor biomechanics (over-pronation) with Orthotics and/or proper shoe selection
• Modifying the training program to allow proper rest and repair to the injured tissues
• Prevention of re-occurrences
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Metatarsalgia (pain under sole of foot)
There are five metatarsal bones in the feet. They are the long bones in the feet that join with the toes. Metatarsalgia is a condition where the metatarsals have “dropped” or “fallen” (just like a “fallen arch” in the foot) causing compression and pain. The patient complains of pain on this bottom of the foot, specifically at the sole.

Metatarsal pain may be due to the number of factors. It appears that chronic stretching of the transverse ligaments may be the underlying reason. The transverse ligaments may be the underlying reason. The transverse ligaments help to form the arch that goes from the inside to the outside at the front portion of the foot. This may be the result of excessive weight, repetitive activity, hammer toes, over-pronation or over-supination. Direct trauma from jumping or landing on the toes with running or standing for long periods of time in high-heeled shoes may contribute to metatarsal pain. Shoes with too narrow a toe box will also cause compression and pain.

Treatment is aimed at removing or modifying any underlying problems such as repetitive microtrauma or inappropriate footwear. Orthotics are often successful in treating this condition. The addition of a metatarsal pad to the orthotics is used to correct the fallen or dropped metatarsals. The metatarsal pad is a dome-shaped pad designed to lift and spread the metatarsals, recreating the transverse arch. Persistent pain that does not respond to treatment should be evaluated for a potential fracture. back to top

Plantar Fasciitis / Heel Pain
The plantar fascia is a band of fibres that run from the heel to the base of the toes. Plantar fasciitis occurs when these fibres become irritated, partially torn, or over-stretched. Most commonly over-pronation results in a constant tugging of the plantar fascia attachment site (at the heel). Inflammation results from this constant irritation and scar tissue begins to repair the site of injury. Pain and tightness occur in the arch or heel upon weight bearing. Pain is typically worse in the morning with the first steps as the foot assumes a flexed position during sleep and the plantar fascia contracts. The pain gradually improves with activity and eases throughout the day.

A number of factors contribute to the development of plantar fasciitis including: a leg length difference, overpronation, a supinated foot, inappropriate footwear, muscle tightness, overtraining and overuse. Because the condition is caused by repetitive microtrauma, most athletes experience plantar fasciitis as part of an overuse syndrome following changes in their training regimen.

Treatment Goals:

• Breaking down the scar tissue and pain control with Targeted Soft Tissue Therapy, Acupuncture and/or Physiotherapy
• Correcting poor biomechanics (over-pronation) with Orthotics and/or proper shoe selection
• Modifying the training program to allow proper rest and repair to the injured tissues
• Prevention of re-occurrences
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Patellar Tendinosis (old term Tendonitis)
Tendonitis means inflammation of a tendon. Although the word “Tendonitis” is often used, it is actually an out-dated term. The suffix “itis” means inflammation, however, research has shown that it is really a build up of scar tissue and break down of collagen that is the problem, not inflammation. Therefore, the newer term that replaces tendonitis is “Tendinosis”, which denotes the scar tissue accumulation, and cellular changes to the tissue.

Patellar tendinosis, or “jumper’s knee”, is a relatively common condition in patients who engage in sports that involve explosive lower-limb movements. The patellar tendon attaches the bottom of the kneecap to the top of the shin bone. Pain associated with this condition is located just below the kneecap. Initially, the pain occurs only after activity. As the condition progresses the pain occurs during the activity and then even at rest.

Jumper’s knee may also e viewed as a spectrum that ranges from initial overuse inflammatory changes to chronic degenerative breakdown. In the last stage of this condition the patellar ligament completely ruptures. Prior damage to the knee from repetitive overuse or trauma, biomechanical factors, and the forces inherent in landing from a jump probably contribute to tendon fatigue and patellar tendon rupture.

Treatment goals:

• Breaking down scar tissue with Targeted Soft Tissue Therapy
• Strengthening the weak muscles with Physiotherapy and/or Functional Rehabilitation
• Correcting biomechanical imbalances (over-pronation) with Orthotics and/or proper shoe selection
• Modifying the training program to allow proper rest and repair to the patellar tendon
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Patello-Femoral Syndrome or Runner’s Knee
Patellofemoral syndrome (PFS) is one of the most common causes of knee pain in active patients and stems from problems with the kneecap (patella) as it moves over the front of the knee. The patella (kneecap) normally tracks up and down when the leg bends and straightens. An imbalance in the quadriceps muscles can affect the tracking causing irritation under the kneecap. Pain is felt in the front of one or both knees or underneath the kneecap. The pain increases gradually over time and is aggravated by prolonged sitting, squats and stair climbing. Some patients will experience minor swelling and the feeling that their knee “catches” or gives way.

PFS is usually an overuse syndrome caused by doing “too much, too soon.” Other risk factors for PFS include poor biomechanics of the foot (over-pronation), ankle, knee, and hip, decreased strength or flexibility of the upper leg or hip muscles, poor alignment of the leg bones, or a combination of factors. Symptoms tend to come and go depending on the activity level.

Treatment goals:

• Correcting any muscular imbalances with Targeted Soft Tissue Therapy, Physiotherapy and/or Functional Rehabilitation
• Correcting biomechanical imbalances (over-pronation) with Orthotics and/or proper shoe selection
• Modifying the training program to allow proper rest and repair to the injured tissues
• Prevention of re-occurrences

“Shin Splints” involves a muscular over-use scenario, where very small tears occur in the leg muscles at their point of attachment to the shin bone. They can occur on the outside (called “Anterior shin splints”) or inside portion of the shin bone (called “Posterior or medial shin splints”). Anterior shin splints involve the Tibialis anterior muscle of the front compartment of the leg while Posterior shin splints involve the Tibialis posterior muscle of the back compartment of the leg. Both of these muscles are involved in slowing down pronation during gait. If the foot over-pronates too rapidly, either or both of these muscles may be called upon to work harder than normal. As a result, fatigue sets in, leading to inefficient force production which leads to micro-tearing of the soft tissue and therefore an inflammatory reaction.

The pain begins as a dull ache during or after running and may become more intense, even during walking, if ignored. The pain in posterior shin splints, also known as Medical tibial stress syndrome (MTSS) is described as being diffuse along the middle and lower portion of the tibia (shin bone). Typically this condition affects runners, although the condition is also seen in ballistic (ie. Jumping) activities such as basketball, dancing or racquet sports. Early in the condition the pain occurs at the beginning of a run, may resolve as the workout continues, and then recurs after the workout. The pain usually resolves with several minutes rest at this stage. In later stages the pain becomes more severe, sharper, and more persistent. In advanced stages of MTSS, the pain can complicate activities of daily living (walking, etc.) and can even occur at rest.

Many of the risk factors are modifiable, thus giving ample opportunity for injury prevention. Extrinsic factors include training methods (too much, too soon, too fast), running surfaces, and improper shoe selection or old shoes. Intrinsic factors are unique to individual athletes and most commonly include over-pronation.

MTSS is not a condition that you want to “run through” without proper diagnosis and treatment. MTSS occurs along a continuum of stress injuries and can lead to a stress fracture if training continues and the pain is ignored.

Treatment goals:

• Minimizing pain
• Breaking up scar tissue with Targeted Soft Tissue Therapy
• Correcting poor biomechanics (over-pronation) with Orthotics and/or proper shoe selection
• Modifying the training program to allow proper rest and repair to the injured tissues
• Prevention of re-occurrences
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Stress Fractures
The localized pain with a stress fracture is usually exercise-related and increases with activity and either abates with rest or persists at a lower level. A local bony tenderness is common. If training continues, the pain progressively worsens and is brought on with less intense activity.

The most common sites for stress fractures are the tibia (shin bone), metatarsals (foot bone), and fibula (outside lower leg bone) and navicular (foot bone, especially with sprinters and hurdlers). Sports associated with specific stress fractures include rowing and golf (ribs), baseball pitching (humerus), and gymnastics (spine).

Of the many risk factors for stress fractures that have been proposed, training errors are probably the most important. They include a sudden increase in the quantity or intensity of training, introducing a new activity (eg. Hill running), poor equipment (eg. worn-out running shoes), and change of environment (eg. changing surfaces from asphalt roads to cement sidewalks). Other risk factors include low bone density, increased age, dietary deficiencies (ie: low calcium intake), abnormal body composition, menstrual irregularities, disordered eating and biomechanical abnormalities (ie: excessive pronation).  Often, a combination of factors is involved. Among athletes, females have been reported to be at 1.5 to 3.5 time’s greater risk of stress fractures than makes. Studies suggest that the difference is not related to athletes’ sex per se, but to factors such as amenorrhea (absent period), bone density, and diet.

Often an X-ray will initially not show any signs of a fracture. It is only after it has begun the healing process that the fracture site will show up on X-ray as new bone formation. If the X-ray is negative, a procedure called a bone scan is then used. This procedure uses radioactive markers to detect stress fractures. When a stress fracture is diagnosed an immediate 6 weeks minimum rest periods is required. back to top