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Happy New Year 2013

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The staff at North Shore Orthopaedic and Sports would like to wish all a Happy New Year!!

Plantar Fasciitis – November 2012 Newsletter

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NSOSC Cryotherapy Rental ProgramCryotherapy Purchase and Rental Program
North Shore Orthopeadic & Sports Clinic has started a program for in-home cold therapy. These “cryotherapy” units may be rented or purchased. Two negative side effects of orthopedic trauma or surgery include pain and swelling. These conditions affect the healing pocess and can lead to longer rehabilitation times. Cold therapy is widely recognized as an effective treatment strategy to combat these issues. By using cold therapy you are taking an important step in speeding up the recovery process, getting you back to the pain-free life you deserve. For further information please feel free to contact our office or visit our web site at
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Anatomy of Plantar Fasciitis
The average person takes about 10,000-15,000 steps a day & running 1 mile results in 800-2000 foot steps.The plantar fascia is a band of virtually non-elastic tissue running the length of the bottom of your foot, functioning like a bowstring. It is thickest at the heel and broadens out to attach at the base of each toe.
Signs and Symptoms
• Heel pain exacerbated by full weight bearing.
NSOSC Cryotherapy Rental Program• Sharp pain, burning heel pain with walking, running, jumping &   standing
• A.M. pain with the first steps out of bed
• Pain after prolonged sitting & then standing up again. After   standing for a while pain may   reduce.
• Palpation tenderness on the inside aspect of the heel bone.
• Localized swellingNSOSC Golf Elbow
Biomechanics & Pathology
The cycle of plantar fascia inflammation and pain is frequently caused by prolonged full weight bearing which flattens (pronate) the foot & over stretches the fascia.1. Heel spurs develop due to the constant pull of the short toe flexors / plantar fascia at the     heel bone attachment.
2. Full weight bearing activities compress the calcaneal (heel bone) nerves with resultant     nerve trapping in the connective tissue.
3. Normally there is a pad of fatty tissue under the heel bone. Both aging & weight gain flatten     this shock absorber, compromising it’s ability to absorb weight-bearing shock and     subsequently causes heel pain.
4 Calf muscle tightness results in compensatory patterns of weight bearing, overstretching     the fascia. This may be structural or functional:
4.1 “structural” (“equinus”) or,
4.2 “functional” such as wearing high heels & then changing to flats
5. Forefoot structure: reduced ankle range of motion with associated shortened fascia length     results in excess tension on the plantar fascia
5.1 eg. “structurally” high arches (“pes cavus”) = shortened fascia
5.2 eg.“structurally” low arches (“pes planus”) = lengthened fascia
6. During sleep the fascia begins adhere to the heel. The first few A.M. foot-steps exacerbate     pain due to stretching of the adhering tissue
7. Training Habit Changes such as an increase in mileage & frequency of workouts or     changes in exercise surface / terrain
Treatment Principles
NSOSC Newsletter ImageEarly treatment is advocated.1. Physician’s Examination: indications for medication
2. P.R.I.C.E. Principals: Ice 4 times/day and rest as indicated     by your physio-therapist
3. Activity Modification: reduce walking, running, full weight     bearing time, eliminate barefoot walking, avoid jarring to the     heel & cross train (water run, swim, cycle, upper body     training & core strengthening).
4. Shock Absorb: use heel cushions in all shoe-ware
5. Foot Control: Mechanically control heel & longitudinal arch     movement with taping & if indicated progress to orthotics
6. Shoe-ware: Always use supportive shoes, including in the morning before touching your     foot to the ground. Get new shoes before their support & cushion functions are lost
7. Weight: Maintain the recommended healthy weight
8. Physical Therapy: stretch the plantar fascia, strengthen the lower leg muscles to stabilize     the ankle & heel
9. Splint: use night splint to maintain optimal fascia length
When can I return to my Sport or Activity?
• you must be pain free,
• have full range of   motion,
• have full strength of the   injured foot.
  AND you must be able to:
• move straight ahead without pain or limping.
• spring straight ahead without pain or limping.
• do 45-degree cuts, both at half-speed & at full-speed.
• do 10-yard figures-of-eight, both at half-speed & at full-speed.
• jump on both feet without pain, together & separately.
We are pleased to welcome to our staff…
Greg Welwood - RMT,BA,BPD Candace McCurdy, B.Sc(P.T.), REDCORD-NEURAC”Weak Link Identification”

Candace graduated from Dalhousie Univ. with her B.S(P.T.). Before that she was actively involved in outdoor endeavors as a wilderness guide, specializing in back country skiing, expedition rafting & sea kayaking. These experiences helped shape her basis for post graduate training in a unique Norwegian system focusing on “weak link” identification & associated neuromuscular reactivation treatment. She completed “Redcord-Neurac” training at The Neurac Institute in New Jersey, under the expert guidance of the system developer & then proceeded to attain level of certified Redcord-Neurac instructor. Candace is also trained in the Canadian Orthopaedic system of manual therapy & medical acupuncture (AFCE).

  Stay tuned for our next newletter!
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Principles of ICE Treatment

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A proactive approach to your healthcare helps create a healthier and more enjoyable lifestyle.  

Our goal is to provide insight into injury principles using application of the well known acronym “R.I.C.E,” (Rest, Ice, Compression, Elevation).  This represents the initial injury self-management, which most effectively facilitates recoveryPRINCIPLE #1  REST
Rest does not imply that you terminate all activity / training and become inactive.  Our philosophy is to encourage activity, but in a “non-provocative” manner which may manifest as a movement pattern possibly modified from your norm.  “Rest” predicates placing the injured tissue, whether muscle, tendon or ligament into the position of least tension / strain for up to 72 hours.  This “Relaxed / rest” position is maintained with external assistance (tape, support or bracing).  Experience suggests that injuries which have become chronic were not appropriately treated, in the early stages, by not selectively resting the injured tissue in it’s Relaxed position.

The correct first thought(s) following injury or trauma is always to apply Ice.  In fact, if you are not sure whether ice or heat is the self-treatment of choice remember, “If in doubt ALWAYS ICE FIRST.”  However, please do not “fall asleep” while resting on an ice pack.  It may be applied frequently, but never for longer than 20 minutes at a time. Following the first 72 hours from injury onset, evaluation may indicate that it is appropriate to progress from ice to a “contrast” (cold / hot).

PRINCIPLE #3  COMPRESSION  (Circumferential)
Compression is the component of RICE that is often mis-understood, in our experience. Circumferential compression combined with ice is the optimal protocol, having its’ most observable impact within the first 0 – 72 hours following acute injury. During this time the volume of swelling progresses to a peak.  To prevent this dynamic swelling increase   expedites healing because we reverse the natural course of swelling accumulation & pressure build-up.  The more peripheral the injury, the easier it is to apply circumferential compression usually with compression taping or tensor bandages

Elevation creates a counter-pressure facilitating movement of the interstitial fluid out of the injured area & back towards the heart.  Elevation combined with circumferential compression within the first 0 – 48 hours is most efficient. If, after training, you visibly see swelling persisting in the injured area continue to elevate the affected extremity (combined with ice if necessary). Often the “E” for elevation may be modified to read, Elevation / Exercise, usually following the initial 72 hours following acute injury.

CONCLUSIONS:    Remember that the first 24 hours following acute injury can be critical in directing the prognosis for successful return to your selected activity.   Following clearance from your physician, rehab may commence.   It is not necessary to suffer with an acute or chronic injury. If you are not sure of the correct approach to use, please phone. Also, if an injury has not cleared or does not appear to be resolving with the above-mentioned principles, do not “leave it.” You may require more comprehensive, professional consultation.

Kevin Steinberg on completes 4th marathon in 4 months

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Congratulations Kevin Steinberg,
We even help our families. Kevin, Jacqui’s spouse is in the process of trying to run 12 marathons in 12 months to remember those that we have lost to Cancer and to raise funds for the Canadian Cancer Society. Even Physios’s spouses get injured. NSOSC has helped Kevin to come back from injury. Read what Kevin has to say in his blog dated September 26, 2011 on his website
thanking NSOSC for their ongoing help and support.


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NSOSC Cryotherapy Rental ProgramCryotherapy Purchase and Rental Program

North Shore Orthopeadic & Sports Clinic has started a program for in-home cold therapy. These “cryotherapy” units may be rented or purchased. Two negative side effects of orthopedic trauma or surgery include pain and swelling. These conditions affect the healing pocess and can lead to longer rehabilitation times. Cold therapy is widely recognized as an effective treatment strategy to combat these issues. By using cold therapy you are taking an important step in speeding up the recovery process, getting you back to the pain-free life you deserve. For further information please feel free to contact our office or visit our web site at

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North Shore Orthopoedic - Allow/Download Image to view
The ITB is a fibrous band (unlike muscle) spanning the distance between the hip & outer tibia.
It has no nerve innervations to stimulate shortening. Lengthening, however, is adjusted by:
1. “Muscle Operating System”: contractile action of the hip muscles or,
2. “Angular Operating System”: relative change in ITB length with knee movement
ITBS findings may include:
1. Testing: Pain produced @ 30°knee flexion with varus stress, palpating the ITB insertion
2. Abnormal gait: Compensatory gait when extending the affected knee
3. Strength: Single leg squat weakness produces premature inward thigh rotation
4. Flexibility: Ober’s test is positive when the examiner applies adduction & encounters resistance
ITBS is caused by either internal biomechanics or external conditions & equipment issues.
The commonality is that the ITB is forced to workat a longer than normal length due to:
Internal Factors: for more information go to for more detail go to
1. Structural Biomechanical Alignment: Lower extremity alignment is critical because the kinetic chain is closed and alignment challenges can precipitate too much friction of the ITB as it crosses the knee
2. Hip Muscle Weakness: The ITB functions synergistically with several hip muscles. Weakness results in too much pelvic tilt & subsequent inward knee rotation, when standing on 1 leg 2.1 Thigh Muscle Weakness: Quadricep weakness results in knee hyper-extension (locking compensation) & ITB tautening
3. Hip Muscle Tightness: tensor fascia lata & / or gluteus medius muscle tightness pulls the ITB tighter
External Factors:
1. Training Habits: too much / too soon; eg. ramping up mileage too quickly, rapidly increasing activity duration, quantity of training sessions, warm-up errors (improper warm-up & stretching).
2. Surface: Running on camber surfaces, circular track running, both downhill & slower running speed because the knee extends at foot strike to elongate the ITB.
3. Equipment: incorrect shoe-ware, poorly fitted bicycle saddle (cyclist over-reaches for the pedal).
NSOSC Newsletter ImageThe ultimate goal is to relieve ITBS symptoms by correcting both biomechanics & external factors
1. Medical – NSAID’S: Anti-inflammatory Medications prescribed by your doctor
2. Physical Therapy: R.I.C.E. Principles
2.1 Rest: relative resting, pain-free range exercise only or     cross training
2.2 Ice: use ice packs for 15 minutes every 2 – 3 hours,
2.3 Compression: N/A
2.4 Elevate / Exercise: following appropriate rest, strategic exercise commences
3. Application of Therapeutic Modalities: ultrasound, laser,
4. Mechanical Assessment: identify & correct mechanical problems at rest during activity, evaluate running technique for errors
5. Strengthen Weakened Hip Muscles: to control gradual ITB lengthening
5.1 Strengthen Weakened Knee Muscles: to unload the lengthened ITB
6. Flexibility: Implement targeted stretching
7. Equipment Correction: Assistive positioning (taping), wearing motion control shoes & orthotics if indicated, bicycle seating
8. Training: examining your training regime
We are pleased to welcome to our staff…
Andrew Bell BSC Honors Kineseology Andrew Bell, MSc, MPT (HON) BSc, KIN (HON)

Andrew Bell graduated from Ottawa University Magna Cum Laude with a Baccalaureate in Science, Honours Human Kinetics.
During his four years of undergraduate studies he acquired fundamental knowledge in the disciplines of biomechanics, exercise physiology, and psychomotor behaviour.
Andrew continued his studies at Queen’s University where
he graduated with honours from the Master of Science in Physical Therapy program.

In order to optimize a patient’s physical function, Andrew’s physiotherapy practice uses a blend of education, exercise, advanced biomechanical analysis, therapeutic and athletic taping, modalities, acupuncture, and manual therapy techniques, including joint mobilization, myofascial release, and neural tissue mobilization. Andrew develops a customized treatment plan for each patient to aid their recovery and help them achieve
their personal goals.

Throughout his life, Andrew has had an intrinsic understanding of the importance of fitness and training. He stays active by participating in recreational sports including snowboarding, hockey, tennis, golf, basketball, volleyball, soccer, football, biking and running. Andrew gained first hand knowledge of the benefits of physiotherapy when a knee injury prevented him from pursuing his passion for sports. Following surgery, he turned to physiotherapy for the first time as a patient, and after a regiment of rehabilitative exercise was restored to full functionality with no limitations, allowing him to return to all the sports he so enjoys.

Quad Strength Predicts Knee OA & Pain!
The question: “Can knee extensor strength predict risk for radiographic tibio-femoral osteoarthritis (OA) or knee pain?” This relatively massive study involved a few thousand adults ages 50 – 79 years. The researchers followed over 5000 knees that at the baseline did not have any evidence of radiographic knee OA. Quadriceps isokinetic strength was measured at baseline and the subjects were re-x-rayed after 30 months.
Results Summary: Two and a half years later, about 10% of the people in the study developed knee OA, and those with weak quad muscles, had significantly more OA and pain.
In a Nutshell: Knee extensor strength was not predictive of radiographic knee OA, BUT was predictive of symptomatic knee OA. It’s important to mention the other potential risk factors in the development of knee OA & pain such as: inactivity, obesity, congenital deformities, joint injuries or surgery and vitamin D deficiency.
What PTs need to promote: A 2009 study involving thousands of men and women showed that having strong thigh muscles could help prevent knee pain and osteoarthritis. Physiotherapists are the ideal health care providers and experts in prescribing the correct strengthening exercise program for the prevention of knee arthritis.
Reference: Segal NA et al, Effect of thigh strength on incident radiographic and symptomatic knee osteoarthritis in a longitudinal cohort, Arthritis Care & Research, 2009 Volume 61 Issue 9; 1210
Stay tuned for our next newletter!
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