*NEW* Clinic Now OPEN!!

I am proud to announce that our clinic – PhysioHealth Studios – is now open!  We are located in the heart of the financial district in Downtown Toronto.  We offer many services such as physiotherapy, chiropractic, massage therapy, lymphatic massage, strength and conditioning, weight loss, naturopathic medicine, varicose vein therapy, custom orthotics and bracing, personal training, acupuncture, and athletic therapy.

Yes, we treat sciatic nerve pain!  But we also treat many other conditions as well – aches, pains, sports injuries, neck pain, back pain, arthritis, head aches, motor vehicle accidents, anxiety, stress, and many many other conditions.

Click here for contact information.

I am also proud to introduce Jason White – Certified Athletic Therapist, Registered Massage Therapist, and Contemporary Medical Acupuncture Practitioner.   In addition to his regular practice, he also works with elite athletes is one of the therapists for the National Women’s Rugby Team.  Visit www.jasonwhitetherapy.com for more information.

How to Maintain Good Posture

How to Maintain Good Posture

How to Improve and Maintain Good Posture

We all know that it is important to maintain good posture.  It is important to how we look, how we feel, and how we function.  Your posture depends on both your spine and the muscles and soft tissue around it.  Not all spines are created equal.  For example, some people are born with scoliosis (congenital curvature of the spine), or other spinal structural abnormalities.  This will affect your posture, and how your body functions and holds itself up.  Muscles and soft tissue affect your posture by supporting and pulling your spine in specific directions.  Ideally, you want your muscles to be balanced, so that all the forces on the spine are equal, thus maintaining your spine in neutral alignment, to help you maintain good posture.  If you have muscle imbalances, this can cause your spine to be pulled out of alignment and in turn this can affect your posture.

If you have ever seen a physiotherapist or chiropractor about improving your posture, he or she has likely given you stretching and strengthening exercises to do.  The purposes of these exercises is to help restore the muscle balance in your body to help you achieve and maintain good posture.

How does stretching help?

Basically, when we are in a certain posture for a pronged period of time – even if you are in the perfect posture – your muscles start to get used to that position.  Your body was not designed to be in one position for too long and when certain muscles shorten or tighten (due to constantly being in a certain position), your bones move along with them.  This is one of the most important causes of misalignment.  Now, if you prevent prolonged postures, your muscles have a chance to stay elastic and do not get stuck in any certain position.  Therefore stretching your muscles frequently (ie. every hour ideally!) can help to prevent misalignments and help maintain good posture.

How does strengthening help?

Once you have learned how to achieve good posture, and you have stretched your muscles to keep them flexible enough to get you in this good posture, you will need to keep that position. This is where the strengthening exercises come in.  Your muscles will help keep your spine in the proper position and help you to maintain good posture.  In order for your muscles to effortlessly keep you in good posture, your muscles need to have adequate strength and endurance to maintain that position. You will notice the difference when your muscles are strong and you don’t have to keep reminding yourself to sit properly, they will already know how and keep you there!  For example, you have probably been told many times to sit up straight and keep your shoulders back.  When you adequately strengthen the muscles responsible for this movement, they will help to hold you there in good posture without you even thinking about it.

Motor Vehicle Accident Injuries – Should you get a lawyer?

Motor Vehicle Accident Injuries – Should you get a lawyer?

Injured in a Motor Vehicle Accident?

In my physiotherapy practice, I often see people who have been injured in motor vehicle accidents.  These injuries range from minor to catastrophic, from simple whiplash/neck pain to nerve damage and broken bones.  It is, allegedly, the auto insurer’s responsiblity to provide adequate rehabilitation funding to ensure that the cliamant recovers from injuries sustained in the motor vehicle accident.  Typically, the injured person would come see me for therapy, I would submit the treatment plan to the insurer, and upon approval of the plan I would proceed with treatment.  Treatment plans may include, but are not limited to, physiotherapy, chiropractic, massage therapy, acupuncture, and supplemental goods and services.  In simple cases, the plans are approved and the client receives treatment.  The insurance company is billed for this directly.  If this treatment plan is exhausted, usually within a 6-12 week period, and additional therapy is required, I would submit another treatment plan, and so on and so forth.   If only all motor vehicle accident benefit claims were this simple!

It is not uncommon for treatment plans to get denied.  This means that upon review of the treatment plan (which contains information regarding injuries sustained and treatment required), the insurance adjuster has deemed the request for rehabilitation services unreasonable and/or unnecessary.  The insurer will then proceed to set up an independent medical examination.  If this happens, I would recommended that you get yourself a personal injury lawyer.  Your case may go to mediation.

Personal injury lawyers work on contingency.  They only get paid if you win your case, meaning if you successfully settle with the insurance company.   If you are injured in a motor vehicle accident and you need treatment, and if the insurance company is denying you treatment, you should get a lawyer to ensure you get the funding for treatment that you are entitled to for your motor vehicle accident injuries.  Otherwise, you may be left paying for therapy out of your own pocket (if you don’t have extended health benefits) or, you may end up with no treatment at all. 

If you have a lawyer, many clinics/therapists will continue to treat you even if your claim is denied, provided that they receive a written agreement from your lawyer stating that they will protect the clinic’s account in the settlement.  It only works in your benefit to have a personal injury lawyer representing you when it comes to insurance comapnies, especiallly when all they care about it their bottom line!

If you were injured in a motor vehicle accident and need a personal injury lawyer, you can visit dynamiclawyers.ca to find a personal injury lawyer near you.  Or, email me at physiotherapist@live.ca for more information.

Motor Vehicle Accidents

Motor Vehicle Accidents – Did you get injured?

Injured in a motor vehicle accident?

Motor vehicle accident injuries are, unfortunately, very common occurrences.  If you are injured in a motor vehicle accident, the process of getting treatment for your injuries may seem confusing with all the paperwork set out from your insurance company.  The purpose of this post is to clarify the process.  So, what should you do if you get injured in a motor vehicle accident? Depending on the severity of your injury, it is advisable to see your doctor first to clear any serious injury (unless of course you are taken directly to the hospital).

Injuries associated with motor vehicle accidents often present themselves in a time-delayed fashion.  For example, you may have just been rear-ended and feel fine, however it is not uncommon for you to develop neck and/or back pain in the days to week following the accident.  Often you will feel worse before you start to feel better.  Generally, common complaints include headaches, neck pain, dizziness, stiffness, numbness/tingling, and fatigue.

It is advisable to see your physiotherapist if you have pain or are injured after a motor vehicle accident.  Treatment will help ensure that you recover as quickly as possible and as completely as possible.  Medical/rehabilitation expenses should be covered by your auto insurance.  Here’s a general overview of how the process works in Ontario with respect to accident benefits claims:

1) You have 30 days from the date of the accident (also known as date of loss) to fill out and return an OCF-1 form to your insurance company.  No treatment plans will be approved unless this form is sent in by you, the applicant.

2) Your physiotherapist or other health care provider will complete an initial assessment and send in either an OCF-18 or an OCF-23.  This is the form that requests treatment and specifies what treatment is requested, how many treatments, and what the total cost of treatment is for injuries sustained as a result of the motor vehicle accident.  The insurer has 10 business days to approve or deny the treatment plan.  When a response is overdue, the treatment plan is deemed approved until advised otherwise by the motor vehicle accident insurance company.

3) The treatment plan is either approved or denied.  If it is denied you will be required to attend a medical assessment by an independent examiner as scheduled by your insurer.  The purpose of this assessment is to determine whether the items requested in the treatment plan are reasonable and necessary.

It may get a lot more complicated than this, but your physiotherapist or health care professional will walk you through the rest if it comes up.  Just make sure you send in your OCF-1 on time and provide your physiotherapist with the appropriate insurance information.

The sooner you get treatment after your motor vehicle accident, the better.  Back pain, neck pain, and whiplash due to motor vehicle accidents can turn chronic in many people if not treated appropriately and in a timely manner.

Sciatic Nerve Pain Treatment

Sciatic Nerve Pain Treatment – Part 3

Sciatic Nerve Pain Stretches and Treatment – Part 3

Sciatic Nerve Pain Treatment – Part 2 introduced a couple of basic stretches to help ease your sciatic nerve pain and take the pressure off the sciatic nerve.  However, there are other sciatic nerve stretches that you should do to release your sciatic nerve pain.  These will be described in this section.  As usual, only do what you can and it is better to consult with your physiotherapist to be sure that you are doing the right sciatic nerve stretches for you.

You may notice decreased mobility or stiffness in your lower back with onset of sciatic nerve pain.  I often prescribe this lower back stretch for my patients in order to improve or maintain lumbar mobility.  To perform this stretch, lie on your back (supine position) and place your hands behind your knees.  Slowly pull your knees in towards your chest.  You may want to do one leg at a time first.  You should feel a very mild and gentle stretch across your low back.  Many of my patients do this one first thing in the morning to loosen up, whether they suffer from sciatica or just low back pain.

Sciatic Nerve Pain - Low Back Stretch

Another important stretch that I usually prescribe is a lumbar extension stretch.  This one is especially important if the cause of your sciatic nerve pain is due to a lumbar disc protrusion or pinched nerve in the spine at the level of your low back.  If this is the case, your sciatic nerve pain symptoms usually increase with flexion or any bending forward movements.  For this stretch, lie on your stomach and use your arms to lift your upper body up by pressing up on your hands.  Keep your hips on the floor and your buttocks relaxed.  This is like the cobra move in yoga where your arch your back.  This stretch is helpful because it helps to “pump” the disc back in place (relatively speaking) and opens up the spaces where the nerves exit your lumbar spine.  In this case our target is the sciatic nerve, which originates from lumbar nerve roots.

Sciatic Nerve Pain - Lumbar Extension Stretch

If you can’t extend all the way due to sciatic nerve pain, low back pain, or stiffness, that’s okay.  Just go as far as you can even if you can only manage to push yourself up onto your elbows.  In severe cases or cases that clearly involve a disc bulge, I recommend that you do this stretch 5-10 times every hour or so.  Otherwise, just follow the same stretching guidelines as for the rest of your sciatic nerve stretches: Hold for at least 15-20 seconds, at least 2 reps, a minimum of 2 times per day.  This should get easier the more your do it and as your sciatic nerve pain settles down.  If you cannot lie down for whatever reason, for example at work, you can do a modified version of this sciatic nerve stretch by just standing up, putting your hands on your hips, and leaning backwards (arching your back).  This is especially useful at the office after sitting at a desk for prolonged periods, which would typically flare up your sciatic nerve pain.

Sciatic Nerve Pain Treatment

Sciatic Nerve Treatment – Part 2

Sciatic Nerve Pain Treatment – Part 2

Your physiotherapist will teach you proper positioning techniques to help take the stress off your low back and ease your sciatic nerve pain symptoms.  When your pain starts to settle down, stretches will help to loosen up your muscles and release the tension that has built up.  Some stretches will also help to  increase the mobility of your sciatic nerve, and help restore flexibility. Hopefully at this point you are moving past the acute phase of sciatic nerve pain, or sciatica.  This section will describe appropriate stretching that is commonly prescribed in the treatment of sciatic nerve pain.

It is important to stretch your hamstring muscles.  Your hamstrings are the large muscle group in the back of your thigh, running from your buttocks to behind the knee.  A safe and easy way to stretch this muscle to avoid further injuring your back is to do so from a lying down position.  You will need a long towel or belt.  Wrap the towel or belt around the bottom of your foot or heel, and raise your leg up towards the ceiling, with your knee straight until you feel a pull or stretch behind the knee or back of the thigh.  Hold this for 15-20 seconds and repeat 2x on each leg.

Sciatic Nerve Pain Hamstring Stretch

The sciatic nerve follows the path of the hamstring along the back of the thigh, and for this reason you may not be able to fully raise your leg.  Depending on the severity or cause of your sciatic never pain, you may feel a pull that goes into your low back, numbness down the leg, or a burning sensation in the leg.  If this occurs just go as far as you feel comfortable.  It is important to do this stretch to maintain mobility and flexibility both in your muscles and your nerve for sciatic nerve treatment.  The hamstrings pull on the pelvis which consequently causes a pull on the low back, so if this muscle is tight it could further aggravate your low back pain and/or sciatica.

With sciatic nerve pain and sciatic nerve treatment, another important muscle to stretch is your glute muscle, or your buttocks.  Again, this muscle follows along the sciatic nerve, and when tight, pulls on the pelvis which consequently pulls on the lower back.  This stretch may be a bit more difficult, and is most easily done lying down.  Lie down on your back, and bend both of your knees.  Cross one foot on the opposite knee.  Grab the thigh of the leg that is still touching the floor, and pull that knee toward your chest.  You should feel a pull in the side of the buttocks of the crossed leg.

Sciatic Nerve Pain Glute Stretch

You may notice an asymmetry between sides, as the affected side with sciatic nerve pain will likely feel tighter.  However, it is still a good idea to stretch both sides.  Again, for sciatic nerve treatment stretches, (or any other stretches) hold for 15 seconds, do 2 repetitions on each side, at least two times per day.

Treatment of Sciatic Nerve Pain

Sciatic Nerve Treatment – Part 1

Treatment of Sciatic Nerve Pain – Part 1

Sciatic nerve pain is treatable both at home and by trained health care professionals.   If you are unsure about what to do, please consult with your local physiotherapist.

It is never to early to seek medical help for sciatic nerve pain.  Most importantly, do not let your condition turn chronic.  If your pain is not improving on its own, or if  your sciatic nerve pain is severe, it is advisable that you go see your doctor and/or physiotherapist.

Your doctor may prescribe nonsteroidal anti-inflammatory pain medications (NSAIDs).  These anti-inflammatories will work to decrease the inflammation and swelling of the sciatic nerve itself, and decrease the overall inflammatory response.  They are commonly prescribed for orthopedic conditions.  NSAIDs are available over the counter as well.  Common ones include Ibuprofen, Motrin, Advil, and Aleve.  NSAIDs are effective at relieving pain and reducing swelling.  Ideally, you want something that will address both the pain and inflammation.  Medications such as Tylenol are also good for pain relief, but lack the anti-inflammatory action.  Taking NSAIDs will help make your sciatic nerve pain more manageable and may help you get through the exercises your physiotherapist will recommend.

Physiotherapy treatment of sciatic nerve pain will vary based on the cause and presentation of your symptoms, and will be individualized to your own case.  However, there are a few general principles that we follow in terms of treatment.  The first step is to address the pain,inflammation, and acute phase of sciatica.  Modalities such as TENS, IFC, ultrasound, and laser may be used.  You may also be advised to apply ice to the affected area (usually the low back or buttocks) every few hours for 15-20 minutes at a time.  This will help with pain and swelling.  Your physiotherapist may also show you various positioning techniques that will help to take the stress off of your low back, or help to take the pressure and strain off of your sciatic nerve.  For example, lying on your back with your hips and knees bent at 90 degrees and your legs resting on a chair or stool will help to take the pressure off and should be a relatively pain free position.

Sciatic Nerve Pain and Low Back Relief Position

You may also be advised to put a large pillow under your knees if sleeping on your back, and to put the pillow between your knees if lying on your side.  This helps to take the strain off your low back and pelvis, areas where the sciatic nerve often gets compressed.  It is important to find a comfortable position, or one that is most comfortable, so that you can allow the affected area to rest and settle down.

Your physiotherapist will assess and evaluate the cause of your sciatic nerve pain and prescribe exercises and stretches accordingly.  As a general rule though, we want to maintain/increase range of motion (ROM), decrease muscle tension, reduce pain, and finally restore strength, stabilization, and function.

Sciatic Nerve Pain – Case Study # 1: Leila

sciatic nerve painSciatic Nerve Pain: Case Study #1 – Leila

Leila came to my office complaining of lower back pain, shooting pain from the low back and left buttocks down into the leg, pins and needles and numbness in her left leg all the way down to her toes, and severe muscle cramps behind her knee and in her calf.  Her cramps were severe at night.  She reported suddenly waking up one morning with these symptoms, and she was in a lot of pain when I saw her.  Leila is a 54 year old stay at home mom, who does daycare out of her home as well as computer related work from her home office.

Leila limped into my office, as she could barely put any weight on her left leg.  After taking the history, I proceeded with my assessment.  She had difficulty bending forwards and backwards.  Her back was painful when pressure was applied.  She had difficulty moving around and getting up, especially after being seated for a long time.  Her hamstrings were relatively flexible, although tighter on the left.  Her piriformis (a muscle deep under the gluts in the buttocks) was very tight and almost in spasm.  A large knot had developed in her calf.  Her entire leg was numb.  Twisting movements were painful to the left side.

She was experiencing acute sciatic nerve pain, and it was very debilitating for her.  Normally quite active, Leila was unable to walk to participate in any of her hobbies, such as table tennis and volleyball.

This was the second time she had experienced sciatic nerve pain.  However, this time was much more severe and did not seem to resolve quickly and on its own like her first sciatica episode a year earlier.

Anyway she continued to see me for treatment approximately twice per week, where we would work on loosening tight muscles that might have been putting pressure on her sciatic nerve, stretching, home exercises, modalities, and other techniques.  I also showed her various positions that she could lie in that would help to take the pressure off her low back and ease the sciatic nerve pains temporarily.  Unfortunately Leila has a very low pain tolerance which made it difficult for me to work the muscles as deep as I needed.

Her low back responded well to treatment, and in a few days her low back pain was gone.  However, the pain in her buttocks and all the way down the leg was still there.  As her muscles in that region were very tight, this led me to believe that her piriformis muscle was a likely compressive source of her sciatic nerve pain.

Her pain, numbness,  and night cramps continue to decrease but are still there.  Her sciatica still flares up at times and has not completely resolved.  She has had this condition for about a month and a half now, and she has lost strength in many muscles as a result.

The next step in therapy for her is to work on core strengthening and posture.

Sciatic Nerve Pain – Case Studies

Case Studies about Sciatic Nerve Pain, Sciatica, and Related Conditions

In this section of my website you will find real life cases and scenarios that I have encountered in my current practice as a Registered Physiotherapist in Toronto, Ontario.  All names and identifiers have been removed to maintain anonymity and patient confidentiality.

Sciatica Symptoms

Sciatica Symptoms

What are the symptoms of sciatic nerve pain, or “sciatica?”

Sciatic nerve pain may manifest itself in the low back, buttocks, leg, or any combination of the above.  Pain may be described as a dull ache, or a very sharp shooting pain that shoots from the low back or buttocks down the leg, and in some cases all the way down to the foot.  The pain most commonly originates either in the low back or in the buttocks, depending on the underlying cause of the problem.  If the problem was caused by a disc herniation, or misalignment of the lumbar spine, then the pain will most likely originate in the low back, and radiate down the buttocks through to the leg from there.  However, if there is compression or pressure on the nerve further down (ie. piriformis syndrome), then you will find that the pain likely originates in the buttocks area.   Pain associated with the sciatic nerve will usually be felt as radiating, moving, or shooting.  This pattern is characteristic of sciatica.

In addition to pain in the low back and leg, there will often be numbness and tingling, or pins and needles that can extend anywhere from the buttocks or low back to the toes.   This may be constant or intermittent.   Again, the severity of these symptoms will depend on the degree to which the sciatic nerve is irritated, compressed, or inflammed.  A feeling of weakness or fatigue in the leg is also common.  You may also feel cramping in the leg or burning in the thigh.

The reason that sciatica symptoms are felt in both the muscles via pain, cramping, burning, fatigue, as well as in the skin via numbess, tingling, or pins and needles is simply due to the fact that the sciatic nerve is responsible for supplying both the muscles and skin of the lower leg.  The nerve continues to branch off as it descends into smaller and smaller branches all they way to the sole of the foot.

Symptoms usually get worse with prolonged sitting, bending forward, heavy lifting, or increased pressure on the affected leg.   It is usually worse in the morning or at night.

Alleviating factors that may give you some relief include stretching, ice or heat (depending on your acuity or stage of your condition), rest, gentle exercise such as swimming, hot showers, core exercises, back support, and analgesic gels such as Voltaren or Biofreeze.  Your physiotherapist can guide you through exercises, stretches, positioning, and other tips that can help.  Your doctor may also prescribe anti inflammatories.  Advil or ibuprofen may help alleviate the symptoms as well.  Tylenol may help with the pain, but is not an anti inflammatory.  Please speak to your doctor before starting any medication.