Tag Archives: Physiotherapy

Stress Reduction for Men through Mindfulness

As a physiotherapist who believes that the mind and spirit are just as important as the body in the successful treatment of physical injuries and pain, I want to talk about stress and mindfulness for men during this month of Movember.

I think most people would agree that all of our stress levels seem to be rising – constant downsizing, new technology that means we’re expected to be on-call 24/7, pressure to be perfect parents, perfect partners, stay physically fit… But in the face of these added expectations, I believe that the code of masculinity still inherent in our culture doesn’t encourage men to express their worries, stress or fears openly, and that can amplify the pressure on men and limit their options for coping.

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So what can men do? Practicing yoga is one area where men are still vastly outnumbered by women, but the balance is shifting, and more men are reaping the physical, mental and stress-reducing benefits of this ancient practice. The closely-related field of meditation still suffers from an “identity-crisis”, conjuring up images of turban-clad swamis sitting in lotus pose for days at a time. But have no fear. Mindfulness is a practice that you can do anywhere, anytime, and offers massive benefits without a big time commitment, or sitting in lotus pose.

I have been aware of mindfulness meditation for many years, mostly influenced by Dr. Jon Kabat-Zinn’s work in using this technique for reducing stress, anxiety, pain and illness in people from all walks of life. And optimally one does “meditate” – which means sitting in a comfortable position for 5, 10, maybe 20 minutes every day, focusing on your breath, gently identifying when thoughts appear, and then returning to your breath, over and over. There are countless articles, YouTube videos, and even iPhone apps available online to get you started, and help you to practice regularly.

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But what I want to highlight today is the way this technique can be used in any setting, at any time, to help reduce stress, bring relaxation and increase joy. Mindfulness is simply awareness of the present moment, which is always here, and always accessible. Try this. Instead of moving through your day on auto-pilot, take some breaks to “tune-in” – stop for a few seconds or a few breaths and focus on what you are doing or what you can feel, hear or see. Examples: at every red light, clear your mind of any mental chatter and just focus on your breath. While reading this blog, stop and notice all the sounds you hear. Before you start your next task, take a few breaths and scan your body for tension. When washing your hands, note the temperature of the water, the sensation of your hands touching.

These techniques can reduce your stress in difficult situations, lower your blood pressure, decrease anxiety, improve your interactions and relationships with others, and increase the positivity of your thoughts. So in this month of Movember, try a few moments of mindfulness – your body, mind and spirit deserve it!

Acupuncture and Physiotherapy

I recently completed my second level course through the Acupuncture Foundation of Canada Institute (AFCI), and was humbled at the complexity and versatility of this treatment method within the scope of physiotherapy.

During the course of the weekend, we subjected ourselves to becoming pin cushions as we worked through various acupoints through out the body. By Monday morning, I woke up exhausted, stuffed up and completely lethargic. After surviving the day, I made it an early night, blaming the weather and busy weekend for my less than ideal state of mind.

Tuesday morning came around, and I woke up lighter, happier, and incredibly well-rested.  I noticed during my commute to work that my usual dull back ache did not decide to join me for the drive. My feet felt lighter, my energy levels stayed up for the entire day, even my digestion seemed to have improved! Now, I can not accurately pin-point (excuse the pun)  these positive feelings directly to all the acupuncture that I experienced over the weekend, but something must be said for a form of medicine that has been around for over 2000 years…

ImageAs a physiotherapist, my brain automatically wants to focus on the western mind set of treating the injury from a neuro-anatomical perspective, and will pick my acupuncture points based on the location of the injury.  A Traditional Chinese Medicine (TCM) practitioner or acupuncturist, on the other hand, would treat the same condition from a very different perspective, utilizing acupoints located on meridians that run up and down our entire body.  Therefore, a general, tension-type headache can be successfully treated with acupuncture from an anatomical approach by stimulating points along our scalp and neck to release tension in those muscles. However, if we were to put on our TCM caps for a second, we could also help affect that headache by inserting a needle between our first and second toe as well as in between the first and second finger…all thanks to the meridians!

So, how can acupuncture help you with your physiotherapy treatments?

First off, with any musculoskeletal injury, our general goals in physiotherapy are to control pain, reduce inflammation and restore strength and function  so that you can continue kicking the ball with your kids, maintain your golf handicap,  and take the stairs at work (which we all do everyday, right?!) Well, the goals of acupuncture are very similar:


Goals of Acupuncture:

1. Control pain

2. Resolve inflammation

3. Provide tissue regeneration

4. Restore physiological function

5. Normalize autonomic nervous system (resets the system to allow you to heal)

As Physiotherapists, we practice anatomical acupuncture, which combines the TCM knowledge with western basic sciences in anatomy, physiology and pathology. Using the anatomical approach, we can stimulate both local points based on anatomical effects, as well as TCM points that may be located away from the site of injury.

Acupuncture is used as an adjunct to traditional physiotherapy. It can be used to relax tight muscles and promote relaxation to allow you to achieve a better stretch, or it can be used to decrease pain and inflammation. Some people see an improvement after one session, for others it may be 5-8 sessions to see a change in condition.

As amazing as this treatment tool is, it is important that you get properly assessed by a physiotherapist in order to determine whether you would benefit from acupuncture.  Until then, if that headache creeps up, try pressing into the web space between your thumb and index finger!

What is a pelvic floor physiotherapist?

Pelvic health physiotherapists have additional post graduate training in assessment and treatment of pelvic dysfunctions such as urinary and fecal incontinence, pelvic organ prolapse, and pelvic girdle pain syndromes such as vulvodynia, vestibulodynia, dyspareunia (pain during sex), SI joint dysfunction, and piriformis syndrome.  When I told my husband I was taking the internal pelvic health course his reaction was” you want to do what? Really?” So what is it that I do? I teach my patients how to properly use their pelvic floor to regain core strength and get back to their beloved activities (back to pain free living).

So how do I do that?

The same way I retrain an injured hamstring – manually testing the muscles’ strength, releasing any trigger points, facilitating a stronger more efficient contraction, re-patterning the correct strategies and giving you a home program to get yourself better. What does that all mean you ask? Well, it means I get my hands on it and in it!

ImageAnd how exactly do I do that?

The pelvic floor muscles are often described as a hammock in your pelvis from front to back, although I prefer Katy Bowman’s terminology of a trampoline. I asses vaginally and rectally which allows me to feel the muscles contract and relax against my finger, I can also feel for scar tissue from trauma (pregnancy, birth, surgery, fractured pelvis, tailbone or coccyx), and I can feel the movement of the coccyx.  I can tell which muscles are working well and which ones need help. I can see if there is any pelvic organ prolapse and the effects of movement and loading on the muscles and tissues. Treatment involves identifying the cause of the dysfunction and finding the solution that will work best for you.

Who should see a pelvic floor physiotherapist?

Do you suffer from things like diastasis recti (aka mummy tummy)? doming or tenting of your belly when you exercise? scars from an episiotomy, c-section or perineal tear? pressure or pain in your vagina or rectum? pelvic organ prolapse? pain during sex? pelvic girdle pain? leaking when you cough or sneeze or laugh or jump or run? feel like you can’t make it to the bathroom in time?  If you answered ‘yes’ to any of these then YOU should see a pelvic floor physiotherapist.  We also like to work on the prevention side of things pre-conception, during pregnancy and post natally.

And it’s not only about the women. Men have a pelvic floor too! Men who have urinary incontinence, pelvic girdle pain, or difficulty maintaining an erection can also benefit from seeing a pelvic health physiotherapist.

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How do you find a pelvic floor physiotherapist?

We are located in downtown Toronto. There are a handful of us in the GTA. We are all listed on the Women’s Health Division website (Find a physiotherapist – Women’s Health Division http://www.physiotherapy.ca/PublicUploads/229746WHD_%20Povince.pdf) and all physiotherapists that do internal work must be rostered with the college of Physiotherapists of Ontario http://publicregister.collegept.org/PublicServices/Start.aspx

Have you had your pelvic floor assessed? Tell us about your experience.

Physio After Pregnancy. When to Start?

New moms ask me this all the time, so I thought it would make a great blog post!

Q: How quickly after giving birth can I begin post-natal diastasis physio?

A:The sooner you begin the better.

My preference is to start during the pregnancy, as soon as the diastasis is noticed, presumed or diagnosed. This way we can start patterning your muscles to work together, in synergy. When you are more aware of how your core abdominals work it patterns your neurological system and that’s really half the battle. It also helps bring more blood flow to these muscles, and that translates to quicker healing times. Also if I get to see you before the baby does, I can show you exactly what you need to do immediately post delivery, I’m talking minutes, ok let’s be more realistic, hours, after delivery.

If you have already delivered your baby I can see you now. In my program, the first step is education. The beginning exercises to close the diastasis deal with the synergy between the diaphragm, pelvic floor, transverses abdominis and multifidis. They are 100% safe post natally as there is no resistance involved, just posture, breathing and patterning. We then build this into your everyday patterns of movement (ADLs). Once you are cleared by your midwife or physician, we start to add resistance and peak engagement exercises.

Splinting is often recommended, depending on the size of your diastasis and integrity of the connective tissue (that linea alba between the two recti). Most of the healing happens in your first 6 weeks, so doing the right thing from the start is the most effective way to resolve a DRA.

It is truly never too late to start either. It’s just more work the later you start, and the results can take longer to achieve.

Do you have a DRA? If so, when did you get diagnosed? Have you started treatment?