1. Computer screen: Screens should be directly in front of you and your keyboard. The top of the screen should be approximately eye level. Using a laptop, this becomes a challenge. Try hooking up your laptop to a permanent screen so that you don’t have to look down the entire day. If you transcribe word from print, have the written document either directly in front or just off to the side.
2. Keyboards: The height of the keyboard should be below the desk level, just above the thighs when sitting. Reaching to use a keyboard or having your keyboard too high will cause your shoulder and neck muscles to overwork and become tired and tense by the end of the day. Specially curved keyboards can be used, but have not been conclusively shown to add benefit.
3. Mouse: Mousing has been shown to increase wrist, elbow, shoulder and neck pain, especially when required to complete repetitive tasks. Having the mouse at elbow level, resting the elbow on arm rests, and taking frequent breaks are excellent strategies for decreasing the load on the muscles and joints. If mouse use is a major part of your day, switching hands and switching mouse types are a great to decrease overuse of the same muscles joints everyday. Here’s an example:
   1. Monday: Regular mouse right hand
   2. Tuesday: Regular mouse left hand
   3. Wednesday: Trackball mouse right hand
   4. Thursday: Trackball mouse left hand
   5. Friday: Joystick mouse right hand
   6. Saturday: Whey are you mousing 6 days a week? This frequency needs to be addressed.
4. Chair: First off, there is no perfect chair and no perfect position. Previous belief was to have knees and elbows at 90 degrees, feet on the floor while keeping a straight back. This is both impractical and would cause you to load the same tissues in your body all day, week, and month. Instead find a chair that can adjust in multiple directions (tilting seat pan, adjustable lumbar support, tilting back support, adjustable arm rests, adjustable seat height, rolling wheels). Take advantage of this type of chair and change your position multiple times during the day. Here’s an example:
   1. 9:00 – feet on floor, seat pan slightly tilted forward, elbows on arm rests
   2. 11:00 – cross legs (alternate), seat pan level, back slightly tilted back, roll up close to the desk, elbows on arms rests
   3. 1:00 – 1 or both feet on stool, seat pan level, back support straight, keyboard on lap
   4. 3:00 – feet on desk (crossed), seat pan and back support tilted back, elbows on arm rests, keyboard on lap.
5. Phone: phones that are used often should be very close and a headset should also be used to free the hands without pinching the receiver between head and shoulder (we’ve all done that).
6. Printers: ideally a printing station should be used to centralize and optimize the printing for the office. This will also provide a reason to get out of your chair often throughout the day. Visits to the water cooler can also substitute for this purpose.
7. Minibreaks: taking short 30-90 second breaks from your position is ideal for those who suffer from neck and back pain. Simply stand up, lean SLIGHLY back and do some shoulder rolls. You don’t even have to leave your work station. This will provide a minibreak for the muscles and joints that you’re using all day. Complete minibreaks 4-6x an hour.

Dr. Simon Wang, MSc., D.C.
Physiomed Don Mills

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Once the majority of swelling has been reduced, any scar tissue that built up as a result of the sprain or strain must be broken down. A variety of soft-tissue techniques such as shockwave therapy, Graston, and soft-tissue mobilization can be applied to the affected area. Exercises must then be employed to strengthen and rebuild the surrounding muscles correctly.

At Physiomed Don Mills, we are very well equipped to help you overcome any injury you may suffer from. This not only includes new and acute injuries but also chronic injuries acquired over your lifetime. Head in for an initial assessment to find out how we can help you live your life better.

Thanks!

The Physiotherapy Department

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• Overuse – A runner or constant walker, work that consists of prolong standing especially on harder surfaces, etc.
• Poor Biomechanics – If you have excessive pronation (tightness is your calf muscles may be the cause pronation) or if you have arch problems, then the plantar fascia picks up the strain
• Improper footwear – if your footwear is worn out, too flexible, too stiff or does not provide adequate arch support.
• Weight gain – this can include pregnancy, which adds extra stress to the Plantar Fascia

The problem is that the plantar fascia isn’t really able to stretch so if there is too much stress it will tear. When these little tears heal, then scar tissue is created. Scar tissue stretches even less then fascia. Over time the plantar fascia is unable to repair itself and may start to tear off the heal bone which will then cause a bone spur.

Usually people feel pain under the heel and also at the metatarsals. The pain may be in one or both feet and can range from mild to severe. Most pain occurs with the first few steps after non weight-bearing – for example, when getting out of bed in the morning or after long periods of sitting. Usually the pain lessens after about 20-30min of activity, and then intensifies again two or three hours later with continued activity.

Massage can be used to help relax the muscles in the legs that may be causing extra stress on the fascia as well as decrease the pain in the feet themselves. Depending if you are experiencing acute or chronic pain will decipher how the therapist is able to treat the plantar fascia directly or not. Using a cold compress and stretching out your calves and feet will help alleviate some of the pain as well.

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Piriformis Syndrome (sometimes referred to as Pseudo-Sciatica by some Massage Therapists) is believed to mimic sciatica by compressing the sciatic nerve at the level of the buttocks. Piriformis is a tiny muscle that sits underneath the gluteal muscles of the buttocks and passes close to or within the path of the sciatic nerve. It is believed that when the piriformis muscle is tight or knotted it compresses the sciatic nerve and thus mimics sciatica. Piriformis syndrome may also be due to trigger points in the piriformis muscle itself. Trigger points often send out radiating pain to surrounding structures. In this case, the pain signals may be also picked up by the sciatic nerve.

What causes Piriformis Syndrome?

Inflammation of the muscle due to injury or trauma, overuse due to exercise or bending & lifting, and/or structural reasons such as shortened muscles & bony issues.

Symptoms of Piriformis Syndrome:

One-sided pain or numbness that travels down the back of the leg from the buttocks to as far as the calf and foot
Buttock pain
Possible atrophy of the gluteal muscles
Low back pain that stems from the buttock and hips
Marked weakness with use of the hip

Treating Piriformis Syndrome:

One of the goals for treating piriformis syndrome is to decrease the amount of tension and tightness that is occurring in the muscle. Massage Therapy is a good way to do this.

Manually massaging the gluteal muscles and the surrounding structures will decrease teh tone of the piriformis muscle, thus likely uncompressing the sciatic nerve. Direct compression of the trigger points (Trigger Point Massage Therapy) in the piriformis muscle will help relieve any symptomatic referral caused by the trigger point.

Deep moist heat from a hydrocollator or hot water bottle wrapped in the moist towel can be placed ontop of the buttock when the patient is lying prone (on stomach). The moist heat penetrates into the muscles helping them to relax, increase circulation, and flush out any metabolites and toxins in the area.

Stretching the pirifomis muscle after the tension has been reduced will further prevent compression of the sciatic nerve.

Strengthening those hip antagonist (opposite/counteracting) muscles to piriformis which may or may not be weak can also further avoid piriformis syndrome.

If a structural/postural reason is the cause, corrective action may be taken. This may include home self-care, remedial exercises through our Massage Therapist or Kinesiologist, Physiotherapy, Chiropractic, and/or Orthopaedics.

If you suspect that you might be suffering from Piriformis Syndrome, contact one of our health professionals at PhysioMedDonMills.com and we will be happy to help.

Gary Chung, RMT
PhysioMed Don Mills
416-445-2075

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Ingrown nails are a condition where the toenail damages the nail fold or skin tissue beside the nail. This condition is sometimes confused with an involuted nail.

An involuted nail is simply a nail that is curved on one or both sides as depicted in the picture. This is not necessarily a problem but can lead to an ingrown nail if not properly looked after.

Causes or predispositions of an ingrown nail are:

• Improper cutting of the nail, especially when cutting at an angle in the corner of the nails
• Inappropriate footwear, ie. Shoes that are too tight
• Excessive weight
• A longer 1st toe relative the other toes
• Trauma to the nail or surrounding toe
• Anatomy of the nail or tissue surrounding the nail, such as an involuted nail

Any of these factors by themselves or in combination can cause an ingrown nail. The nail does not become ingrown until the nail pierces the skin. This results in pain and inflammation shortly followed by an infection.

Treatment:

Having a chiropodist assess the nail and condition is the first step to treating an ingrown nail. Treatment depends upon the state of the ingrown nail and amount of infection present. The chiropodist will manage the nail using specialized equipment and treat the infection with topical antibiotics or antimicrobials. Conservative treatment is always considered first. The number of treatments varies and depends on the predisposing factors that caused the ingrown nail in the first place. Educating the patient on proper nail cutting techniques and footwear is also emphasized so that this condition is prevented in the future.

Sometimes a minor surgical procedure is warranted such as removing the ingrown part of the nail causing the infection. This procedure is considered when conservative measures are not enough to resolve the issue or due to other factors where conservative measures will not be effective.

Ingrown nails can cause extreme pain especially if they are not treated promptly. Consult a chiropodist or podiatrist if you have any questions about this or any other foot related issue.

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We live in a society where computers and offices (both at work and at home) are commonly present. These elements are crucial in our lives, as they often make things very efficient for us. We heavily rely on computers and offices to get our tasks completed. Not many disadvantages, right?…

The irony of this of course, is despite computers making our lives easier, they have also made us dependent on them for long periods of time. With that in mind, postural and/or repetitive strain injuries are increasingly being reported and are things we see in the clinic every single day.

There are a number of factors that contribute to the onset of postural and repetitive strain injuries, including:

• Posture –
  • Posture is the most critical component. Slouching at the keyboard puts your spine and limbs in positions that contribute to increased strain and tension, as well as increasing the risk of eye strain
• Office set-up –
  • A poorly designed workstation, or one that does not fit you well, can contribute to the onset of RSI (e.g. reaching for the mouse or keyboard too high or low, wrists extended during keyboarding);
• Worker technique –
  • Pounding the keyboard, using your wrists to move the mouse, or gripping the mouse tightly increases the demands on the hand and wrist and can trigger or aggravate symptoms of RSI
• Work Habits –
  • Sitting for extended periods of time without changing position is hard on your whole body and is a factor in developing RSI.

(Source Material: Canadian Physiotherapy Association):

If you are feeling those aches and pains at the end of a workday, you may strongly benefit from a consultation with our Physiotherapy team. We would be happy to talk about ways we can alleviate your current aches, and more importantly, prevent additional injuries in the future!

Thanks!
The Physiotherapy Department

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The whiplash occurs when the victim’s body (head/neck) continues to be in motion when the rest of it has come to an abrupt stop.

In the simplist of whiplashes: rear impact MVAs, the torso is pushed back into the seat as the vehicle lurches forward. The torso itself is prevented from moving in a posterior direction by the seat whereas the head continues to be whipped backwards if the headrest is no properly positioned. As the vehicle come to a rest, the head is then whipped forward like an elastic band pulled to long. This combined motion can cause injury to both the anterior and posterior muscles of the neck.

However, most whiplashes are not as simple as a rear-impact. In most cases whiplashes occur on non-direct angles. This causes the head/neck and even the torso to be whipped in several directions, affecting many muscles at different angles.

The symptom picture of a typical whiplash involves one or many of the following signs: swelling (edema), pain, muscle guarding, muscles spasms, tenderness, stiffness, joint discomfort, limited range of motion, and neuropathies.

Massage Therapy should be considered from the very beginning post-accident. Muscles will often go into a muscle guarding stage to prevent the body from further injury. This muscle guarding increases the degree of pain and suffering a patient will experience following a whiplash. It often helps to have the muscles lightly massaged to release some of the muscle guarding.

Decreasing the muscle spasm, and adhesions/scar tissue from the injured soft tissues is the next priority for those suffering whiplash injuries. Manually stretching and kneading the muscles and joints will improve range of motion and decrease the level of preceived pain. It is important to follow through with manual soft tissue work (massage) throughout the healing/recovery process for a speedier recovery.

Trigger-points from hypertonic muscles (muscles with more tone) needs to be eliminated. These points of pain in muscles will often cause both primary and secondary forms of pain for patients. This pain can take forms of direct pain like muscle spasms, or indirect pain such as headaches and dizziness.

Remedial exercises (home care) is an important aspect for recovery/healing.

Though Massage Therapy is important in cases of whiplash, it should not be considered as the only modality to be used for accidents. It should be received in conjunction with other therapies for full effectiveness. Physiotherapy and Chiropractic care, along with Massage Therapy, and when used in a team approach, can decrease the time in which an injury heals.

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A Grade I Whiplash-Associated Disorder (WAD I) refers to a disorder in which a person complains of neck pain, stiffness or tenderness only.

A Grade II Whiplash-Associated Disorder (WAD II) once again refers to a disorder in which a person complains of neck pain, stiffness or tenderness, but these complaints are accompanied with reduced neck range of motion.

A Grade III Whiplash-Associated Disorder (WAD III) involves a neck complaint in combination with neurological signs such as muscular weakness, abnormal sensation and lack of or reduced reflexes.

A Grade IV Whiplash-Associated Disorder (WAD IV) involves a neck complaint accompanied with a fracture or dislocation involving the bones or joints in the neck.

With the variety of ways in which a whiplash-associated disorder can present, it is important that treatment be personalized to each and every patient in order to maximize results and minimize chronic long-standing negative outcomes. The inter-disciplinary approach utilized at Physiomed Don Mills allows us to address any joint restriction, muscular tightness and imbalance as well as any other problems affecting a patient’s function and ability to participate in daily activities. Combining therapies such as Massage Therapy, Chiropractic and Physiotherapy allows for more complete management, maximizes therapeutic response and increases rate of recovery so that you can take back control of your life and health.

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There is no cookie cutter answer to why somebody may have back pain.
Arthritis, pinched nerves, osteoporosis, sciatica, degenerative discs…And the list may go on!

Often with many back conditions, the treatment that will go a long way is core strengthening. The stronger your core muscles are, the more likely you are to have a reduction in pain. As a result, you will be able to do more of the activities that you’re used to doing!

There are many ways you can strengthen your core, but asking your physiotherapist is one of the best first lines of defence. Because not all exercises are created equally, certain ones may be more beneficial to you than others. Let your physiotherapist show you how do the right exercises for back and core. This will not only ensure your safety, but also make sure you are doing the exercises properly.

Thanks!

The Physiotherapy Department

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There are a number of causes for TOS including whiplash injuries from motor vehicle accidents and sports injuries. Postural issues, especially a forward head posture like that maintained by office workers and computer users, can also trigger the onset of this syndrome. Thoracic Outlet Syndrome may also be the result of overstressing the muscles in that area during exercise or by injury to the shoulder or upper chest area.

There are many ways that massage therapy can help treat Thoracic Outlet Syndrome. Different techniques including trigger point therapy may be able to eliminate the pain. Cold compression and stretching of the scalene and pectoralis muscles can help to relax the compression of the nerves.

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