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Body Balance Quarterly

The Opioid Crisis Leads Canadians to Seek Alternative Approaches for the Management of Chronic Pain

By Body Balance Quarterly

Body Balance Quarterly (The BBQ)

The Opioid Crisis Leads Canadians to Seek Alternative Approaches for the Management of Chronic Pain

The Opioid Crisis

In December 2017, a Canadian news report released by CBC news made citizens aware of the rising number of opioid related deaths over the past year. Rising from 2,861 opioid related fatalities in 2016, based on the information reported to the Public Health Agency of Canada, it was projected that Canada was on track to see over 4000 deaths from opioid toxicity at the closing of 2017 (The Canadian Press, 2017). With the rising number of opioid fatalities each calendar year this has caused significant controversy among the Canadian Government, health care professionals, and citizens over the prescription of opioids and the use of these substances in the management of chronic pain.

In light of the unfolding opioid crisis, and the unveiling of the topic of ‘Chronic Pain’ among the recent news headlines in this edition of the Body Balance Quarterly we would like to offer our perspective on chronic pain. We will also discuss the latest evidence in support of alternative methods for chronic pain management.

What is Chronic Pain?

Pain is a complex phenomenon that extends far beyond a standardized feeling of discomfort and soreness. Pain is a subjective and emotional experience, which is characterized differently in every individual. In cases of Acute Pain that is felt following an injury, a signal of tissue damage is sent to the brain. In acute pain cases, the pain felt is typically proportional to the amount of tissue that has been damaged. When people experience pain after an injury, pain is believed to be a useful stage of the healing process as it promotes rest, which ultimately promotes healing. However, in cases of chronic pain the link between the presence of tissue damage and one’s pain levels becomes disconnected.

Until recently, the topic of ‘Chronic Pain’ has not been a hot topic of conversation among the general population. However, even with its increased prevalence in the news today with the current opioid crisis, the concept of chronic pain is still an idea that is not well understood by many. Chronic pain conditions include fibromyalgia, chronic regional pain syndrome (CRPS), spinal pain, and chronic low back pain (among many others). In cases of chronic pain, the pain experienced by an individual extends beyond the typical healing time of newly damaged tissue. In individuals with chronic pain the nervous system becomes hypersensitive to incoming signals causing the pain system to be ‘Turned up’, which reduces an individual’s pain threshold. This ultimately causes an individual to experience pain with tasks or sensations that would not normally be perceived as painful. This can have significant impacts on daily life as it causes increased attention to painful regions, reduced activity levels and subsequently activity tolerance, heightened stress response, poor concentration as well as sleep disturbances. Without intervention this can lead to a cumulative and chronic pain cycle leading to overall deconditioning which further amplifies the effects of chronic pain conditions (WRIISC, 2014).

So what can be done to break this pain cycle? Over the course of the past 5 years, an increased volume of literature has been devoted to the benefits of low – moderate intensity exercise, in the management of chronic pain symptoms. In a recent literature review Geenen et al. (2017) concluded that a general exercise and strengthening program has proven to be effective among individuals with chronic pain conditions in improving both pain severity and overall quality of life. However, self-initiated exercise programs were found to be less effective among this same population (Geenen et al. 2017). Numerous exercise interventions were included among this review from aerobic exercise, strength training and flexibility, to range of motion exercises, balance training, core strengthening, tai chi, yoga and pilates, which displays the wide variety of successful exercise options available (Geenen et al. 2017).

Mechanism of How Exercise Aids in Managing Chronic Pain Symptoms

‘Exercise is medicine’ has been a popular phrase among health care professionals and health advocates among recent years. In cases of chronic pain, exercise has proven to display many benefits in helping to manage chronic pain symptoms. Above we talked about how individuals living with chronic pain have a hypersensitive nervous system causing the pain system to be ‘Turned up’. The goal of exercise is to help retrain the pain system to be ‘Turned down’ by calming the nervous system and reducing its sensitivity to incoming signals. The human body is designed to move, and by introducing graded exercise and daily pacing strategies this can play a substantial role in the management of you or your loved one’s chronic pain symptoms.

Exercise helps to increase your energy stores, giving you a longer charge or battery life. This will help reduce your fatigue levels and make it easier for you to perform your daily activities. Aside from the benefits of pain reduction alone, there are numerous other health benefits that exercise has to offer, including but not limited to; decreased blood pressure and resting heart rate—ultimately lowering one’s risk of developing heart disease or stroke—improved sleep, weight loss, increased muscle mass, as well as improved psychological well being.

Among individuals living with chronic pain conditions, a common misconception is that exercise attempts will cause a flare up of pain symptoms, and therefore these individuals often rely on rest and relaxation to avoid worsening of pain symptoms (WRIISC, 2014). However, for successful long-term management of chronic pain conditions, a low to moderate intensity exercise program should be introduced. Here are some tips to consider with regards to exercising if you or a loved one has been experiencing chronic pain. Remember, although opioids may not be the answer for managing chronic pain, today’s evidence supports that exercise is!

Tips On Exercising Safely and Effectively for Chronic Pain Management

1) Contact your doctor first to determine whether or not you are ready for exercise and to begin exercising safely. It is very important to exercise with proper form and technique in order to prevent injury and training the wrong muscle patterns. If you are unsure about how to exercise safely follow up with a health care professional to get you started on a safe and individualized exercise routine.

2) Gradual exposure to exercise is very important to not ‘flare up’ the pain system. It is important to remember that in the beginning stage of exercise you may experience some worsened symptoms during or after exercising, however, if the pain is too severe that you feel you cause a ‘flare up’ you have likely done too much (Geenen et al. 2017). If you feel abnormally fatigued or have pain symptoms that are more significant than usual, take a break from exercising and return to exercise when your symptoms have decreased.

3) The effects of exercise often may take longer to display in individuals who are dealing with chronic pain (Geenen et al. 2017). Remember to be patient, by choosing a form of exercise you enjoy it will make exercise seem less daunting.

4) Gradually increase the exercise volume before you increase the overall exercise intensity. Once you are able to exercise daily, then slowly increase the difficulty of your exercise routine.

5) Include exercises that target all areas of the body, and all large muscle groups.

If you have a chronic pain condition and are ready to begin an exercise routine but are not sure where to start we can help! Body Balance Health offers numerous Health and Wellness programs to help develop an individualized exercise program for you to begin exercising safely. Check out our website or give us a call to see if Body Balance Health’s programs are right for you!

Health and Wellness Programs

Body Balance Health & Physiotherapy News

In other Body Balance Health & Physiotherapy News, we would like to welcome Conor O’Flynn to the Body Balance team! Conor is a manual osteopath who will be joining the clinic twice weekly (Tuesday’s & Thursday’s). Conor’s therapeutic work focuses on musculoskeletal issues of all kinds. Conor also has experience working with individuals who have been experiencing chronic pain. Osteopathy uses manual (hands on) therapeutic techniques to restore balance and integrity to the body by removing the barriers to healing and recovery.


Works Cited

Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH.
Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No.: CD011279.
DOI: 10.1002/14651858.CD011279.pub3

The Canadian Press. (December 18, 2017). Opioid deaths in Canada expected to hit 4,000 by end of 2017. CBC News.

The Government of Canada. (August 29, 2017). Apparent Opioid-Related Deaths in Canada in 2016*. Public Health Agency of Canada.

War Related Illness & Injury Study Centre. (March, 2014). Exercise to help manage chronic pain and/or fatigue. Veterans Health Administration: Office of Public Health.

Paediatric Lower Back Pain

By Body Balance Quarterly

The Body Balance Quarterly

A newsletter designed for the patients of Body Balance Health & Physiotherapy Inc. that addresses current rehabilitative methods and addresses the current questions people may have regarding Physiotherapy related “HOT TOPICS”.


Paediatric Lower Back Pain

It’s that time of year! The kids are back in school and the scheduling of homework, sports and other activities are in full mode. Lower back pain is one of the most common ailments/disabilities that people suffer from and its not just an injury faced by adults. The incidence of lower back pain in the paediatric population and the effects of lower back issues early in life can have resounding impacts later in life.

In this issue of the BBQ we will look at some recent studies to investigate the incidence, causes and recommendations to help parents deal with lower back pain in children and adolescents.

 Potential Risk Factors

Currently, one of the most common talked about risk factors for Paediatric lower back pain is a sedentary lifestyle. Part of the reason for this trend may be due to the increasingly sedentary lifestyle choices young people make. Below are four explanations of how your children’s decisions can contribute to their lower back pain.

  1. Weaker Supporting Muscles

A general lack of regular exercise gradually weakens muscles that support the spine, including the abdominal and iliopsoas muscles and the obliques, or side muscles. Weaker supporting muscles can place added strain on the joints and bones of the spine and affect posture.

  1. Increased Susceptibility to Injury

Children are more likely to sustain an injury when muscles aren’t conditioned to absorb the impact. A study of more than 300 children with lower back pain found those who had some type of physical therapy reported a greater reduction in pain than those who did not receive therapy.

  1. Excess Weight

A sedentary lifestyle often means an increase in weight beyond what’s ideal for a child’s height. Excess weight also means added pressure on the spine, which can throw off posture and affect bone growth. As a result, some children may develop hyper-lordosis, a condition where a slight spinal arch forms.

  1. Unhealthy Eating Habits

Being consistently inactive tends to translate into making unhealthy eating choices. Children need to maintain an optimal balance of essential nutrients to promote muscle strength and spine health.

Most instances of back-related aches in younger patients are related to muscle strain. However, it is always important to seek the advice of a Medical practioner when concerns arise regarding pain in the lower back. Knowing what to do and how to exercise is very important for children as preventative measures can be as simple as encouraging kids to participate in some type of physical activity for at least an hour a day.


Those Heavy Backpacks!!

“Students carrying heavier backpacks relative to their body weight were more likely to report back pain,” write the researchers in the March/April 2004 issue of the Journal of Pediatric Orthopedics.

How much is too much? Pain was associated with wearing a backpack weighing more than 20% of the student’s body weight, write the researchers.

How Kids’ Backs Respond to Backpacks

A backpack is a great way for children to carry schoolbooks and other items in a practical way by distributing the heavy load across the strong back and shoulder muscles. However, when the back pack is overloaded the risk is injury to the neck, shoulders and lower back.

By overloading a backpack, the following compensations in the back can occur:

  • Distort the natural curves in the middle and lower back, causing muscle strain and irritation to the spine joints and the rib cage
  • Lead to rounding of the shoulders
  • Cause a person to lean forward, reducing balance and making it easier to fall
  • Habitually carrying backpacks over one shoulder will make muscles strain to compensate for the uneven weight distribution. The spine leans to the opposite side, stressing the middle back, ribs, and lower back more on one side than the other. This type of muscle imbalance can cause muscle strain, muscle spasm, and back pain in the short term and speed the development of back problems later in life if not corrected.
  • A heavy backpack can pull on the neck muscles, contributing to headache, shoulder pain, lower back pain and/or neck and arm pain.

“Although there are very few studies and the medical literature does not agree on specific guidelines for backpack safety to avoid back pain, parents can use common sense to reduce the chance that their child or teen will suffer back pain due to carrying a backpack.”

The following back pack features may help in the prevention of back stress and strain.

  • Lightweight material (canvas as opposed to leather)
  • Two padded, wide (2-inches), adjustable shoulder straps on the backpack
  • Padded back
  • Individualized compartments
  • Hip strap, waist belt, or frame to redistribute the weight of the backpack from the shoulders and back to the pelvis
  • Wheels so that the backpack can be pulled rather than carried
  • Consider using a separate bag for the child’s laptop or other heavier electronic items

Habits are important as well so it becomes just as important to teach your child how to properly load and wear the backpack to avoid back pain:

  • Always use both shoulder straps and wear the backpack on the back rather than over one shoulder
  • Pack heaviest objects into the backpack first so they are carried lower and closest to the body
  • Fill compartments so that the load is evenly distributed throughout the backpack and items do not shift during movement
  • Pack sharp or bulky objects in the backpack so they do not contact the back
  • Adjust the straps to fit the backpack snugly to the child’s body, holding the bottom of the backpack 2 inches above the waist and keeping the top just below the base of the skull; do not carry the backpack low near the buttocks
  • Lift the backpack by using the leg muscles and keeping it close to the body, not by bending over with arms extended and arching through the back.
  • Do not lean forward when walking; if this is necessary, there is too much weight in the backpack


Less Common Causes of Back Pain in Children

Recent reviews of common causes of lower back pain in children found that the common causes of pain most often included postural related muscle strain and acute occurrences of sport/activity related muscle strain and less commonly included mechanical pain from pre-existing conditions. However, pre-existing conditions may not be as common but they typically involve more specific care and follow-up. One condition that we would like to review in this edition of the BBQ is Idiopathic Scoliosis in children and adolescents. The following information was obtained from an article that was an overview of articles from the Pediatric Orthopaedic Association of North America and the Scoliosis Research Society.

What is Scoliosis

Scoliosis is a condition that causes the spine to curve sideways. There are several different types of scoliosis that affect children and adolescents. By far, the most common type is “idiopathic,” which means the exact cause is not known.

Most cases of idiopathic scoliosis occur between age 10 and the time a child is fully grown. Scoliosis is rarely painful—small curves often go unnoticed by children and their parents, and are first detected during a school screening or at a regular check-up with the pediatrician.

In many cases, scoliosis curves are small and do not require treatment. Children with larger curves may need to wear a brace or have surgery to restore normal posture.


Scoliosis causes the bones of the spine to twist or rotate so that instead of a straight line down the middle of the back, the spine looks more like the letter “C” or “S.” Scoliosis curves most commonly occur in the upper and middle back (thoracic spine). They can also develop in the lower back, and occasionally, will occur in both the upper and lower parts of the spine.

Idiopathic scoliosis curves vary in size, and mild curves are more common than larger curves. If a child is still growing, a scoliosis curve can worsen rapidly during a growth spurt. Although it can develop in toddlers and young children, idiopathic scoliosis most often begins during puberty. Both boys and girls can be affected, however, girls are more likely to develop larger curves that require medical care.

Other less common types of scoliosis include:

  • Congenital scoliosis. Problems in the spine sometimes develop before a baby is born. Babies with congenital scoliosis may have spinal bones that are not fully formed or are fused together.
  • Neuromuscular scoliosis. Medical conditions that affect the nerves and muscles, such as muscular dystrophy or cerebral palsy, can lead to scoliosis. These types of neuromuscular conditions can cause imbalance and weakness in the muscles that support the spine.


Although doctors do not know the exact cause of idiopathic scoliosis, they do know that it is not related to specific behaviors or activities — like carrying a heavy backpack or having poor posture. Research shows that in some cases genetics plays a role in the development of scoliosis. Approximately 30% of patients with adolescent idiopathic scoliosis have a family history of the condition.


Small curves often go unnoticed until a child hits a growth spurt during puberty and there are more obvious signs, such as:

  • Tilted, uneven shoulders, with one shoulder blade protruding more than the other
  • Prominence of the ribs on one side
  • Uneven waistline
  • One hip higher than the other

If your Health Care Provider suspects scoliosis, he or she may refer you to a pediatric orthopaedic surgeon for a full evaluation and treatment plan.

Health & Wellness Edition

By Body Balance Quarterly





Health and Wellness are at the forefront of most of our lives. Nobody wants to have aches and pains, or lack the energy and stamina that get in the way of us doing what we want to do.

I think we all can agree that staying active leads to better health; but we thought we would take this opportunity to update you on some of the most recent research about the benefits of exercise that you might not even know about.

What does the research say about: Exercise and…..


Research shows that exercise helps to build bone density and prevent fractures. The other benefits of exercising with this diagnosis is that it improves strength and flexibility to help with balance to prevent falls and subsequent bone fractures. You must remember that weight bearing exercises are recommended (this means that the activity must include some form of ground reaction force) instead of something like swimming, where there is no contact from the feet and the ground. It is important to avoid high impact activities or sports that involve quick accelerations or ballistic movements such as running, jumping, golf and tennis as these activities predispose you to a greater risk of having a fracture.


With Parkinsons being a progressive disease, the goal of exercise in this population is to maintain independence and overall physical performance. Recent research supports that people with Parkinsons disease who exercise consistently have improved performance and ability to fulfill their normal activities of daily living. It is believed that this is due to improved signalling efficiency of the affected brain areas and other neuroprotective effects that exercise has for people with Parkinsons. Structured exercise programs where individuals are challenged beyond their own pace (to work at a more intense level) have been shown to be more effective than self-paced or lower intensity exercise efforts. Spin classes have recently been directed toward the younger Parkinson population as offering an appropriate challenge for these individuals. Following vigorous intensity cycling programs improvements in balance, gait and resting tremor have been seen among individuals in this population.


Physical activity has beneficial effects across all phases of cancer. Exercise plays a significant role in risk reduction and prevention of developing cancer in the first place. This is especially true for breast cancer, and colon cancer as exercise reduces your risk of developing these types of cancer by 20-40%. Recent research also shows that physical activity may have a similar effect in up to 10 other types of cancer including lung cancer, and prostate cancer! Exercising at a moderate intensity (able to carry a conversation while exercising) for 30 minutes each day is enough to achieve the benefits of exercise which will reduce your risk of developing cancer. Exercising for longer durations each day is shown to have even greater cancer risk reduction effects. While the specific percentage of risk reduction varies amongst sources, one thing is clear: By exercising regularly you can significantly reduce your risk of developing this life altering condition!

If you or a loved one has been diagnosed with cancer, you are likely aware of the impact it has on an individual’s overall energy levels. This can in part be related to the disease process itself, however, fatigue is also a side effect of common treatment methods such as chemotherapy. Exercise has recently been discovered as an effective fatigue reduction strategy in the cancer population. Exercise releases hormones which help to stimulate the appetite, improve mood, and improve sleep patterns. These all ultimately work together to improve an individuals energy stores. While in the past doctors directed patients towards rest and medication to battle fatigue, today research shows that exercising is more effective than any of these past strategies! How much exercise is required? The Canadian Physical Activity Guidelines recommends 150 minutes of moderate (see above paragraph) to vigorous physical activity each week, which is an adequate amount of activity to reduce fatigue levels in the cancer population. Cancer survivors have had good success with activities such as walking, cycling and yoga in helping to manage post chemotherapy fatigue. If you would like to read a bit more about this topic, take a look at these two articles below from the NBC News! n728241 analysis-suggests-888941123688


Exercise is one of the most effective treatment methods among people with diabetes. One of the more obvious benefits in this population is the role exercise plays in promoting weight loss. With obesity being a significant risk factor among those diagnosed with diabetes, controlling body weight is a relatively simple and important step for treating this condition. Another benefit that exercise has for individuals with diabetes is that it helps to regulate blood sugar levels by increasing its ability to be transported into the muscle cells and used. These benefits persist for hours after exercising! This prevents the spikes and valleys in one’s blood sugar levels and associated symptoms that arise from these large fluctuations.

The Canadian Diabetes Association recommends a minimum of 150 minutes of aerobic physical activity each week, with no more than two consecutive days without exercise. Examples of aerobic exercise that you may enjoy include brisk walking, cycling or swimming. At least two sessions of resistance exercise should be performed each week. If you are exercising with diabetes, here are some other tips that you should consider: Exercise at a consistent time each day. Pay attention to warning signs for low blood sugar such as dizziness, clumsiness, fatigue, and excessive hunger and sweating. Keep sugar rich snacks (such as granola bars and juices) on hand in case your sugar drops during or after exercise. If you require self insulin injections you should do this at least one hour before exercising.


Exercise plays a role in both stroke prevention and rehabilitation. Exercise improves blood circulation throughout the body preventing plaque buildup within the vessels. This reduces the risk of this build-up being dislodged to the brain, causing a stroke. Generally, any type of exercise is beneficial in reducing an individual’s risk of having a stroke, whether it be playing your favourite sport, enjoying a yoga class, or going for a long bike ride.

Following a stroke, because of the many different areas that may be impacted, it is often difficult for people to do a rehabilitation program independently and may require assistance. Exercise and rehabilitation varies based on the location of the stroke. Exercises will likely involve core strengthening, sitting and standing balance and mobility training but will highly vary based on the body structures that were impacted. Lifestyle changes to accommodate safety considerations are very important as you may lack the balance or strength to do things safely that you did in the past. Many people have heard that the greatest recovery occurs within the first few months following a stroke. However, it is very important to know that individuals can continue to see life-long changes and improved function with continued exercise. Be persistent and continue to challenge yourself appropriately as you are able to do knew things to ensure you are getting all of the benefits that exercise can offer you!

Multiple Sclerosis (MS)

Staying active is an important part of healthy living with MS. People with MS often battle from chronic fatigue. Exercising helps to increase your “battery life” to allow you to do more throughout your day and also helps you to “re-charge” your daily energy stores. The Canadian Physical Activity Guidelines recommends two 30 minute bouts of cardiovascular activity each week for people with MS. Remember that you should be exercising at an intensity so that you can talk during exercise, while not exceeding this as you should not feel over heated or exhausted following exercise. These guidelines also recommend that low resistance strengthening should be done for all major muscle groups twice weekly. Exercise should focus on balance, core strengthening, and upper and lower body strengthening. Exercise should be performed in the morning, or times of the day when you have higher energy stores. Fatigue is generally worsened by heat among the MS population, so it is very important for you to avoid extreme temperatures and warm environments such as hot tubs, saunas, or sitting in the direct sunlight on hot summer days.

Other MS related complications have also been shown to improve with exercise including bowel and bladder function, levels of anxiety and depression, and improved function and mobility with daily tasks. Researchers have recently discovered a new “neurological factor” that is released by exercise. Although research has not confirmed this to date, it is believed that the presence of this in the body may have disease modifying affects among individuals with MS. To date this neurological factor has shown to improve nerve cell growth, increase the connections among nerves and may result in delayed or even decreased symptoms among this population. This is yet another reason why exercise is so important!

All of these above recommendations are general precautions for the above specific conditions. It is always important to make sure you check with your Doctor or Health Care Practitioner about your individual safety before starting any exercise program, especially if you have pre-existing conditions or a new medical diagnosis.

The take home message is that exercise and physical activity have a positive influence on many aspects of our lives. Unfortunately, some of us aren’t getting on board the activity train because of time, motivation, pain, etc.

If you are nervous about starting a program because of your pre-existing physical or health issues or just don’t know where to start, Body Balance Health has created some “starter programs” that may be right for you!

Programs include: Exercise for Beginners, Exercise and Osteoporosis (a 4 week program teaching you the basics about how to live with osteoporosis – the do’s and don’ts in day to day life, proper exercises to promote health and prevent injury, etc.), Corporate wellness programs, Weekend warrior, and more!!

For more information, visit our website or call our office at 519-541-9899 Remember: TAKE CONTROL OF YOUR HEALTH! BE ACTIVE! STAY HEALTHY!

“Find Your Path to Health and Wellness”

New Location, Hydrotherapy & Keeping Children Active

By Body Balance Quarterly


The Body Balance Quarterly

A newsletter designed for the patients of Body Balance Health & Physiotherapy Inc. that addresses current rehabilitative methods and addresses the current questions people may have regarding Physiotherapy related “HOT TOPICS”.

Well the weather in 2017 hasn’t been active but at Body Balance Health we have gone through many active changes including our name, logo and location. We are now located at 1315 Michigan Ave, next to the Goodwill. The changes have been positive and we are excited to present our new location during an open house on February 10th, 2017 from 2pm until 7pm. Our new location on Michigan Ave. is shared with Pure Powered by On Edge Fitness and because of this we are now in the process of developing new Integrated Health Programs. One of the programs we have initiated because of our new partnership is a hydrotherapy directed Physiotherapy treatment session. The benefits of Hydrotherapy are discussed further in this issue of the BBQ along with the rising concerns of reduced activity in the Paediatric population.

 The Benefits of Hydrotherapy

  1. Stimulating the immune system
  2. Improving circulation and digestion
  3. Encouraging the flow of blood
  4. Lessening the body’s sensitivity to pain.
  5. Patients can start rehabilitation earlier and recover faster
  6. Decreases joint stress
  7. Increases strength and range of movement
  8. Improves balance and coordination
  9. Reduces muscle spasms
  10. Increases the patient’s feeling of achievement even in the acute stages of rehabilitation

“Generally speaking, heat is used to quiet and soothe the body, and to slow down the activity of internal organs. Cold is used to stimulate and invigorate, increasing internal activity within the body. If you are experiencing tense muscles or anxiety, heat is recommended.”

“When submerged in a body of water such as a bath or a pool, there is a kind of weightlessness, as the water relieves your body of much of the effects of gravity. Water also has a hydrostatic effect and has a massage-like feeling as the water gently kneads your body. Water, when it is moving, stimulates the touch receptors on the skin, increasing blood circulation and releasing tight muscles.”

Who Benefits from Hydrotherapy

Conditions that may Benefit from Hydrotherapy

  • Arthritis
  • Osteoporosis
  • Sports Injuries/Rehabilitation
  • Post Orthopaedic surgery
  • Back pain and shoulder pain
  • Hip, knee, or ankle pain
  • Brain or spinal cord injuries
  • Fatigue/ Weakness or Prolonged inactivity/immobility
  • Fibromyalgia and other rheumatoid conditions
  • Neurological disorders, including stroke, multiple sclerosis, and Parkinson’s disease

A review on the effects of Hydrotherapy on various systems of the body is referenced below. The studies conclusion was basically that Hydrotherapy works but the science behind how it works needs to be further investigated. The literature review concluded that “Based on the available literature”, “hydrotherapy has a scientific evidence-based effect on various systems of the body.” These systems included; the cardiovascular system, the respiratory system, the musculoskeletal system, the nervous system and the gastrointestinal system. “Based on available literature, this review suggests that hydrotherapy was widely used to improve immunity and for the management of pain, asthma, Rheumatoid Arthritis, Osteoarthritis, Fibromyalgia, fatigue, anxiety, and obesity. It produces different effects on various systems of the body depending on the temperature of water.”

N Am J Med Sci. 2014 May; 6(5): 199–209.

Scientific Evidence-Based Effects of Hydrotherapy on Various Systems of the Body

A Mooventhan and L Nivethitha1

Potential Risks and Side Effects of Hydrotherapy

All forms of therapy can have both positive and negative impacts and Hydrotherapy is no different. It is recommended that you discuss Hydrotherapy as an option with your Health Care Provider prior to initiating a program. Along with the fact that some people have a fear of water here are some of the potential risks and side effects of Hydrotherapy:

  • Allergic reactions
  • Skin irritations
  • Overheating


Topic of interest – Keeping Children Active

“Can I play on the Wii?” “Can I watch Netflix?” “Can I play on the Ipad?”

These questions, along with many other similar questions are frequently asked by today’s children. While the use of some devices offers many opportunities to work on academic programs and the downtime of watching a program or reading a book is often necessary to slow the pace of constant day to day happenings; it is important to remember not to replace activity by answering yes to these questions all the time.

Obesity and physical activity in children

 Mia Pradinuk, MDJean-Pierre Chanoine, MD PhD and 

Ran D. Goldman, MD FRCPC


“Obesity has become a leading public health concern, particularly for Canadian youth, for whom rates of obesity have tripled during the past 25 years. Statistics Canada now estimates that 26% of our children and youth aged 2 to 17 years are overweight or obese”

“Interventions aimed at improving diet, increasing physical activity, and decreasing sedentary behaviour form the foundation of childhood obesity prevention and management.”

The article reports that “the beneficial role of physical activity in delaying or preventing metabolic complications such as type 2 diabetes, cardiovascular disease, and hypertension is well recognized.” It also states that “Physical activity has also been shown to improve bone mineral density, increase school performance, and have a positive effect on mental health.”

The article states that “The Canadian Paediatrics Society (CPS) released a position statement in 2002 providing recommendations on healthy living for children and youth. Physicians and health care professionals are advised to encourage “children and adolescents to increase the time that they spend on physical activities and sports by at least 30 min/day, with at least 10 min involving vigorous activities.” The goal being the achievement of 90 minutes of Physical activity in total.

 A recent report from Active Healthy Kids Canada suggests that 87% of children and youth are not meeting Canada’s physical activity guidelines of 90 minutes per day. Given the known health benefits of physical activity, current levels of inactivity are of concern.”

The article made the following conclusions regarding the promotion of Physical Activity. Worth noting in this article is the fact that Physical Activity does not have to come with a cost (dollar value). Physical activity can purely be the direct result of more time engaging with our children in the great outdoors.

 Excerpt from Article:

 Tackling barriers to physical activity

Recommendations to overcome barriers to physical activity

  • Recognize the problem. Measure height and weight, and plot body mass index on growth charts at each visit
  • Ask children and their families about physical activity patterns. Encourage the whole family to become involved in daily activity
  • Support progressive and well-defined steps. Limit sedentary behaviour
  • Encourage adherence to daily physical activity programs in schools
  • Support local community initiatives aimed at increasing activity
  • Advocate for safer and more accessible communities that are more conducive to increased activity

Please feel free to follow the link below which was written in May of 2014. Canada was given a grade of  D for overall activity in children.



Gardening tips, good posture for road trips, tennis elbow bracing

By Body Balance Quarterly

Body Balance Quarterly #4

With the return of warmer weather, comes the return to outdoor activities.

The Spring/Summer edition of the BBQ features some ideas to help you stay fit with gardening, prevent stiffness and pain from those long road trips, and try to help you sift through whether to invest in a brace.


Have you ever felt stiff and sore in your back, neck or knees after a long car ride? Has this soreness taken away some of your enjoyment on your trip?

Here are a few ideas you can easily incorporate to try to help:

  1. Pacing – As much as you may want to just “bite the bullet” and make the trip in one shot, it is very important to take breaks. Ideally, every 20-30 minutes. Realistically, this may not be manageable; but, the take home message is to at the very least, take more breaks than you may have before.
  2. Posture – Everything you try to do to keep good sitting posture is just as important in the car. Most car seats encourage an increased “C” curvature in the low and mid back because of the angle of the seat.


Proper positioning of the car seat should look like the green line in this picture:


As you can see, the 2 don’t match. Most cars now have multiple ways you can adjust the seat. We suggest you work with these to try to get as close to the “right” picture as possible. Also, if more adjustment needs to occur, we suggest adding a folded blanket/towel or cushion at the back half of the seat cushion to get the seat pan closer to neutral. Also, a small roll at the back can help to bring the back rest straighter. But, remember that safety is always the most important. That means that if you have to place yourself too close to the airbag or your head is too close to the roof of the car to be safe driving, then you may have to just try to get close to neutral posture and accept that perfection won’t be possible.



How Do I Minimize Pain With Gardening? :

If you love flowers or having fresh veggies grown in your back yard, it is important to remember that, physically, gardening involves postures that are not ideal for our body. That’s why we suggest you incorporate a few of the following ideas:

  1. Pacing – Our body prefers to be moving. It is not a good idea to be in a certain posture for more than 30 minutes at a time. The ideal situation is to plan and structure periodic rest breaks into your day. Set the timer on your phone as a reminder and then stop your task to do some walking or change from a bending task to one where you are standing.
  2. Proper Lifting – If you have to carry plants or mulch or using the wheel barrel, we suggest you make sure you remember your own personal limits. Just accept that some things you plan to carry might be too heavy for you. Ask someone to help or if you can, split what you are lifting into smaller weights and make more frequent trips.
  3. Proper carrying – Again, we suggest you don’t carry more than you can safely handle. Remember to keep what you are carrying close to your body. If you have to do multiple trips with the watering can, remember to switch which arm you are carrying it with to keep your muscles balanced.
  4. Hydration – Don’t forget to stay hydrated. Cells in the body need water to function properly. Remember to replenish what you lose!


To Brace or Not To Brace:

This is a common question we are often asked in the clinic. It is difficult for a consumer to sift through all the competing brands and gadgets that are currently out on the market or what may show up with a google search.

There are numerous factors to take into consideration when deciding if a brace will help and that is only half the challenge. Once you decide to get a brace, you must now try to decide what to purchase. In the next few editions, we will profile various physical injuries/problems and try to give you some insight into what to consider.

In this edition, we profile elbow bracing. When the tendons at the elbow get inflamed from overuse or repetitive movements, pain can develop at the inner elbow (also known as golfer’s elbow) or the outer elbow (also known as tennis elbow). In our professional experience, these problems respond well to using a brace; however, we do stress that you don’t try to self diagnose yourself and make sure you get the proper advice on whether this is your proper diagnosis.

The brace used for these problems is commonly called a “tennis elbow cuff.” The idea behind it is to create a pressure point about an inch away from the area of pain in the elbow. This allows you to continue to use the muscle from that point; but, reduces the amount of force going through the tendon attachment at the elbow (where the pain is). If it is doing what it is supposed to, there should be an immediate decrease in pain after the cuff is in place and you try to use the arm and hand. You should make sure that you don’t have it on so tight that it affects your circulation. Also, you should consider it’s comfort level because some are made with hard material, which can irritate the skin when bending the elbow.

If there is no immediate benefit, we don’t recommend using one.

Here is an example of what one looks like:

elbow brace

We do not recommend that people self diagnose their injuries and the advice provided is not to replace obtaining a proper assessment and diagnose by a qualified health care professional.

Snow shoveling safety

By Body Balance Quarterly

Body Balance Quarterly #3

2016 has been off to a slow start regarding poor weather conditions and we are very fortunate to that when it comes to shovelling snow and the protection of our backs. We are reminded however that winter is not quite over and spring snow tends to be quite heavy and more difficult to move.

Remember these quick tips to promote safe shovelling:

  • Tip # 1. 
    If you experience pain of any kind, stop immediately and seek assistance.
  • Tip # 2. 
    Choose a snow shovel that is right for you!

    • Be sure that your shovel has a curved handle, as this enables you to keep your back straighter when shoveling.
    • Obtain a shovel with an appropriate length handle. The length is correct when you can slightly bend your knees, flex your back 10 degrees or less, and hold the shovel comfortably in your hands at the start of the “shoveling stroke”.
    • A plastic shovel blade will generally be lighter than a metal one, thus putting less strain on your spine.
    • Sometimes, a smaller blade is better than a larger blade. Although a small blade can’t shovel as much, it avoids the risk of trying to pick up a too heavy pile of snow with a larger blade.
  • Tip # 3.
    Push the snow, do not lift it. Pushing puts far less strain on the spine than lifting.
  • Tip # 4.
    Be sure your muscles are warm before you start shoveling. Cold, tight muscles are more likely to sprain or strain than warm, relaxed muscles.
  • Tip # 5.
    When you grip the shovel, make sure your hands are at least 12 inches apart. By creating distance between your hands, you increase your leverage and reduce the strain on your body.
  • Tip # 6.
    “If you must lift the snow, lift it properly. Squat with your legs apart, knees bent and back straight. Lift with your legs. Do not bend at the waist. Scoop small amounts of snow into the shovel and walk to where you want to dump it. Holding a shovel of snow with your arms outstretched puts too much weight on your spine. Never remove deep snow all at once; do it piecemeal. Shovel and inch or two; then take another inch off. Rest and repeat if necessary.” In addition to these comments, remember to move your feet rather than twisting.
  • Tip # 7.
    Never throw snow over your shoulder.
  • Tip # 8.
    Remember that wet snow can be very heavy. One full shovel load can weigh as much as 25 pounds.
  • Tip # 9. 
    Pace yourself by taking frequent breaks to gently stretch your back, arms and legs.
  • Tip #10.
    Consider buying a snow-blower. When used correctly, a snow-blower will put far less strain on your back than snow shoveling.


Topic of interest – Paediatric Sports Injury

A common injury for Paediatric sports that involve a lot of jumping (basketball, volleyball) is the pain and inflammation caused by “jumpers knee”. The following stretching recommendations are not intended as treatment but are advised to be done in the prevention of injury.

If you suffer from constant pain below the knee or experience episodes of inflammation and pain in relation to the sport that you are participating in; it is recommended that you consult your Physician or Health Care Provider to determine the course of treatment that is best for your injury.

Stretching and strength exercises should not be done or pursued in the presence of pain. It is important to stop any exercise in the presence of pain and consult your Health Care Practitioner.

Key point #1

Maintain ankle mobility – Tight calf muscles or poor ankle mobility have a negative impact on the knee. In picture one the back leg remains straight and in picture two the back leg bends at the knee. These stretches address different muscle groups and assist in the prevention of stiffness at the ankle.


Key point #2

Maintain proper range of motion in the Quads and Hamstring muscles – These muscles have a direct impact on the mechanics of the knee and maintaining good flexibility in these muscles goes a long way in injury prevention


Key point #3

Strengthen the muscles of the hip – It is especially important to strengthen the gluteal muscles and abductor muscles of the hip as these muscles help to control the stability of the femur.


Spring is Near!

This Issue started with reminders on stretches and injury prevention for shovelling and we would like to end it on a more inspiring topic, GOLF! Yes, golf season is getting closer and closer and that’s a lot better to think about than shovelling so if golf is your thing check out this link for a few key points on stretching before you get out and swing that golf club for the first time in four or five months!

Helmet safety, Dizziness/Balance/Vertigo

By Body Balance Quarterly

Body Balance Quarterly #2

Head Injury, Helmets and How to Treat Brain and Vestibular Problems

In this Issue:

  1. Helmet Safety
  2. Dizziness, Balance and Vertigo Treatment
  3. Body Balance Bursary


In our office, we are seeing more and more people for treatment following concussions and other head injuries. Whether this is because more injuries are occurring or whether health care practitioners and the public are better educated to recognize them, is still up for debate; however, the fact remains that head injury is a growing problem.

The best way to treat a head injury is to never have one in the first place. That is why proper helmet use is so important.

Here is a list of a few tips for getting the proper helmet.

  • Understanding How A Helmet Works

The purpose of the shell is to keep the shape of the helmet, distribute impact, protect against sharp objects penetrating the head and to help skid across the ground.

The foam on the inside is designed to “break”. When you hit the ground or surface, your head continues to move within the helmet and crushes the foam inside. The foam then absorbs the impact so the force of the impact on your head lessens.

  • Get the Proper Helmet for the Proper Use/Goal

Helmets have specific designs based on which sport you participate in. They vary in shape based on what part of the head needs protection (ie. Bike helmets are designed for protection from impact at the front and sides, whereas skateboarding helmets are designed to protect the head from impact on all sides.)

In addition, there are helmets designed specifically to protect from a high impact force – known as “single impact helmets” (ie. Skiing), versus ones designed to sustain repeated smaller forces – “multiple impact helmets” (ie. Hockey).

Keep these issues in mind when deciding which helmet to buy and use. HELMETS ARE NOT INTERCHANGEABLE BETWEEN SPORTS.

  • Replace the Helmet as Recommended/Required

Single impact helmets should always be replaced after one crash.

Multiple impact helmets are designed to take smaller, repetitive impacts before needing to be replaced.

Even without a crash, helmets are not designed to last forever. The poly-styrene liners should be replaced every 5 years and the crushable liners should be between 1.5 cm and 3.0 cm thick.

You should also consider temperature conditions and the amount of sweating because this affects the inside foam of the helmet and may be another deciding factor in replacing the helmet.

  • Get the Proper Fit

The Newfoundland and Labrador Brain Injury Association website suggests using the “2-V-1 Rule”:

  • The helmet should sit 2 fingers above brow line for children, 1 finger for adults
  • Straps should form a “V-shape” below each ear
  • 1 finger should fit snugly between the chin and helmet buckle (loose enough that it doesn’t pinch the chin and tight enough that the buckle touches the skin)

It is important to keep the straps firm and snug so the helmet doesn’t move or shift to expose the head.




  • Check inside the helmet for certification stickers, because not all helmets have the same legislated standards.
  • The most recognized association at this time is the Canadian Standards Association (CSA) certification.
  • Remember to wear and use the helmet as instructed by the manufacturer. For example, hockey helmets have an expiry date.


  • Use stickers, tape or paint on the helmet as it can hide cracks or dents, which are signs that the helmet must be replaced.
  • Don’t leave the helmet outside because weather and temperature can affect the materials.
  • Don’t toss helmets on the ground as that is an impact force and can damage or weaken the helmet.


  • Do I feel unsteady?
  • Do I feel as if the room is spinning around me?
  • Do I lose my balance and fall?
  • Do I feel as if I am falling?
  • Do I feel lightheaded or as if I might faint?
  • Do I have blurred vision?
  • Do I ever feel disoriented, such as losing my sense of time or where I am?


If you answered “yes” to any of these questions, you may have a disorder with your vestibular system. While it is not uncommon for everyone to experience some issues of dizziness; people who benefit from vestibular rehab experience these symptoms to a greater extent, which can severely impact on one’s quality of life and ability to perform in society.


What Is a Vestibular Disorder?

The vestibular system is what helps your body adjust to changes in your environment. Information about your environment from vision, proprioception (touch receptors) and the inner ear is sent to the brainstem. The brainstem collects this information, processes it, figures out what the body has to do to adjust, and then sends feedback to steady the vision, adjust muscle position/centre of gravity and balance. When it works properly, these adjustments are done at remarkable speed. If the vestibular system is not working, conflicting information between these components occurs and we end up with dizziness, vertigo or disequilibrium.



  • Dizziness – lightheadedness, faintness
  • Vertigo – sensation of the room spinning/moving
  • Disequilibrium – loss of steadiness

Some examples of what patients describe are the following:

  • Feeling like they drift to one side when walking
  • Uncomfortable in stores
  • Fatigue
  • Difficulty reading
  • Difficulty watching TV or using a computer


What Causes Vestibular Disorders?

Vestibular disorders can be as a result of:

  • Head injuries
  • Medication
  • Disease
  • Viral
  • Aging
  • Inner ear deficit

What can get confusing is that similar symptoms can also be produced by neurological injuries/disorders (Parkinson’s, stroke), circulation problems, eye problems, etc.


As mentioned previously, there can be a variety of causes for vestibular disorders and to make the situation more complex, sometimes the symptoms we experience may not be related to the vestibular system at all. That is why it is so important to have a qualified physiotherapist perform a comprehensive assessment. Specifically, a physiotherapist who has taken advanced level training and has experience in vestibular rehabilitation.

Because of how complex dizziness and vertigo treatment is, it is not possible to condense everything and everyone’s problems into this one article; but, the take home message is to make sure people are aware that, in a number of cases, there are options available to help you feel better and that these are not simply issues you have to “live with”.

For more detailed information, we suggest you visit the website

Don’t forget to visit our Facebook page for contests all year long!

Having knee trouble? Am I a candidate for surgery?

By Body Balance Quarterly

Body Balance Quarterly #1

Topic One

Knee Troubles???
Thinking Surgery For Knee Osteoarthrits?????

Here is the current research:

Over the last few years two studies in particular have adjusted the way we treat patients who enter the clinic with osteoarthritis related knee issues. If we are able to assess this patient case load prior to any further consultation we discuss current research and the importance of the findings and results of physiotherapy intervention verses undergoing surgical intervention.

Although arthroscopic surgery has been widely used for treatment of osteoarthritis of the knee, scientific evidence to support its effectiveness was lacking. Two articles have more recently been released looking at: 1. arthroscopic surgery itself verses a placebo surgery and 2. arthroscopic surgery with physiotherapy intervention verses physiotherapy intervention on its own.

The results were quite interesting.

The two papers of interest are discussed below:

  • (A Controlled Trial of Arthroscopy Surgery for Osteoarthritis of the knee –  Moseley J.B et al. New England Journal of Medicine. Vol. 347,No 2, July 11, 2002 )

This study specifically looked at a Veterans Affairs Hospital in which only men participated as the testing subjects.  All participants in the study underwent either a sham or real surgery – blinded to which group they were in (arthroscopic debridement, arthroscopic lavage, or placebo surgery – in which the arthroscopic debridement procedure was simulated). Data was collected over a 24 month period and all patients received the same walking aids, graduated exercise program and pain killers.


RESULTS: Showed strong evidence that arthroscopic lavage with or without debridement is not better than and appears to be equivalent to a placebo procedure in improving knee pain and self reported function.

Taking these findings into consideration further research was performed by Kirkley et al., which worked to fix the previous studies methodological issues.

  • (A Randomized Trial of Arthroscopic Surgery for Osteoarthritis of the Knee –Kirkley et al. New England Jounral of Medicaine. Vol.359 2008 )

This study looked at patients who were randomly assigned to surgical lavage and arthroscopic debridement together with optimized physical therapy and medical therapy or to treatment with physical and medical therapy alone. With the inclusion criteria listed as such – 18 years or older with idiopathic (unknown cause) or secondary osteoarthritis of the knee, with grade 2, 3,or 4 radiographic severity

Exclusion criteria was  – any large mensical tears, inflammatory or post infections arthritis, previous arthroscopic treatment for the knee Osteoarthritis, greater than 5 degrees varus or valgus deformity, previous knee trauma, grade 4 osteoarthritis in two compartments, previous corticosteroid injection with in the previous 3 months, major neurological deficit, serious medical illness, pregnancy and inability to provide informed consent.

Patients were randomly assigned to receive optimized physical therapy and medical therapy alone or to receive both optimized physical and medical therapy and arthroscopic treatment. Optimized physical therapy and medical therapy were both initiated 7 days after surgery and followed an identical program in both groups.


RESULTS: Arthroscopic surgery for Osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy.

As physiotherapists it is our job to not only supply the current research available to you on these types of surgeries but provide programs to help you have the best functional outcome that we can.  These two studies provide strong evidence and results recommending more of a physical strength building program over that of performing Arthroscopic surgery as a first choice for those struggling with mild to moderate levels of osteoarthritis. Needless to say reading this you must keep in mind the exclusion criteria for these studies – i.e., if worse non-traumatic mensical tears are present over that of Osteoarthritis severity arthroscopic surgery has still been controversial but results have been found to be of benefit in 1/3 of the population.

Further research on this specific population can be found in the article – as an online source – Is Arthroscopic Surgery beneficial in treating  non-traumatic degenerative medial mensical tears? A five year study.

If you have further questions about this research, don’t hesitate to ask one of the Physiotherapists in our office.


Topic Two

Other Options For Knee Oa???
Valgus Knee Braces (For Knocked Knee Problem) ???

Improvements in function have been reported in patients with Osteoarthritis following knee bracing for durations between 6 months and 12 months. Although the bracing achieves effective unloading of the inside compartment of the knee and offers potential for improving outcome in patients with knee osteoarthritis – beyond being an expensive purchase – the success of this intervention relies upon the patient being prepared to wear the brace continually.

Valgus knee braces are bulky, potentially uncomfortable and might not be a practical daily solution for many patients.


Figure 4:
Schematic diagram illustrating how values bracing counteracts the external adduction moment acting about the knee during walking. The brace applies points of force at three locations (indicated by arrows), which create MA1 and MA2, and result in a values moment about the knee. The red dotted line indicates the length of the two separate moment arms: Ma1 and MA2 (distance from outer arrow to center arrow). Abbreviation: MA, moment arm.


Walking Aids???

Cane use in conjunction with a slow walking speed decreases the biomechanical load experienced by the lower limb. The use of a cane and walking slowly could therefore be a simple and effective intervention for patients with osteoarthritis.

Keeping in mind the cane must be placed in the opposite hand to the symptomatic knee.


Flexible shoe verses stability shoe ???

Wearing shoes that have a thin and flexible sole and little to no heel, offers a potentially useful strategy for effectively modifying the biomechanical factors influencing progression of osteoarthritis.

Thin soled, flexible shoes seem to be beneficial for reducing joint loads compared to shoes with thicker soles – why?? Thinner soles provide a shorter stride and smaller ranges of motion in knee and ankle joints.

Reference/Source – Conservation Biomechanical Strategies for Knee OA. Neil D. Reeves and Frank L Bowling. Nature Review/Rheumatology Vol 7, 2011.