The most common type of arthritis is osteoarthritis, a progressive disease of the whole joint that leads to the breakdown of joint cartilage and the underlying bone. When there is too much breakdown in the cartilage, it can result in bones rubbing together, which causes swelling and pain.

Andrea Nunn is a physiotherapist at Sunnybrook’s Holland Centre, where she works with patients who have osteoarthritis in the hip or knee, providing exercises and education through the GLA:D Canada program. She also helps patients rehabilitate following joint replacement surgery. Andrea shares some insights into how to reduce your risk of osteoarthritis. Read those tips below, as well as information on signs, symptoms and treatment options from GLA:D Canada and the Arthritis Society of Canada.

Signs and symptoms of osteoarthritis

While osteoarthritis can occur in any cartilage-covered joint, it is especially common in the knees, hips and lower spine because of the load these joints bear on a daily basis.

Typically, symptoms may begin with pain, either in the knee when it is bearing weight (standing, walking, climbing), or in the hip joint. In the hands, osteoarthritis is most common in the ends of the fingers and base of the thumb, leaving them feeling stiff and tender.

People with arthritis may notice that daily tasks become more challenging, such as putting on socks, getting into a car or even clenching a fist.

Symptoms may begin slowly, starting as pain with movement and, as the arthritis progresses, the pain will likely become more constant. Most people will see progression slow, sometimes even stop completely, but others will experience rapid deterioration.

If you are experiencing new pain or stiffness in your joints, or reduced mobility that is making it difficult to do daily tasks you could do before, reach out to your family physician.

Treatment

Since every patient will experience arthritis differently, doctors can’t predict how the disease will progress for an individual. It’s also why, even though a patient may get X-rays to see if there are any changes to the cartilage surrounding the joint, diagnosis is made based on symptoms because oftentimes, a patient is experiencing more severe symptoms than might be indicated in an X-ray.

There is no known cure for cartilage loss, so any treatments for arthritis are designed to reduce symptoms and improve joint function.

Exercise 

Osteoarthritis often causes pain, which can lead to people reducing their physical activity to accommodate the discomfort. According to GLA:D Canada, research has shown that reduced strength in the muscles can worsen arthritis symptoms, so maintaining consistent physical activity is important for patients with arthritis. Exercise can also improve overall health and wellness and quality of life.

People with arthritis can find benefit from improving strength, flexibility and cardiovascular fitness, but before beginning a new exercise program, speak with your family doctor.

Other treatment options

Other treatment options for arthritis can include referrals to healthcare professionals such physical therapists or occupational therapists. Medication is an option for pain management, and if arthritis becomes severe, surgery may be required. It’s important to stay in contact with your family physician who can help develop a plan of care based on Health Quality Ontario’s Quality Standards for Osteoarthritis. They can connect you with any other appropriate healthcare professionals to help manage arthritis symptoms and make a referral to a Rapid Access Clinic for assessment for surgery, if required.

Once diagnosed with osteoarthritis, you will have it for life, says Andrea, but symptoms will vary depending on the person and can be managed with treatment.

Reducing Risk

Andrea says there are several ways for people to reduce their risk of osteoarthritis.

“Preventing joint injury earlier in life can reduce your risk of developing osteoarthritis,” she says. “We’re seeing more joint injury prevention programs for young people playing sports now because there can be long-term consequences if you have traumatic injury to a joint, even as young as teenage years.”

Andrea says people who work in industries such as construction and are putting a lot of load on their joints on a daily basis should be aware of their risk of developing osteoarthritis and can take steps to reduce that likelihood.

“Trying to use ideal body mechanics is important—alignment of hip, knee and foot,” she says. “Being balanced in your whole posture and body will help too.”

Maintaining an optimal body weight can help prevent osteoarthritis. Andrea says two pounds of extra weight can increase the joint load by three to five times, which means that losing weight can improve symptoms of osteoarthritis.

Finally, Andrea says consistent movement and physical activity is important for healthy cartilage and strong muscles, both of which can reduce the risk of osteoarthritis.

“Muscles help absorb some of the load the joints would normally take,” she says. “They also help to improve stability of the joint.”

And she says cartilage needs “dynamic load” to stimulate it, so regular movement means the joints are loaded on a regular basis and that encourages cartilage to regenerate.

Living well with arthritis

Andrea emphasizes that an arthritis diagnosis doesn’t necessarily mean a lifetime of pain and discomfort. Symptoms can be managed, and with some simple adaptations (e.g. jar openers or sitting to put on socks and shoes), many patients will live healthy, active lives with arthritis.

The post Osteoarthritis: symptoms, treatment & reducing risk appeared first on Your Health Matters.

“Some people call us a well-oiled machine, but that seems very impersonal,” says operating room patient care manager Helen Vandoremalen. “I like to consider our team a well-tuned orchestra playing off the same page. The result is more harmonious as our goal is to provide excellent patient outcomes and high patient satisfaction.”

The team at the Holland Bone and Joint Program has implemented several innovative models of care. Most patients are spared a general anesthetic and given a regional instead. This helps reduce complications and gets patients back on their feet more quickly. A highly-skilled interprofessional team helps ensure smooth patient flow.

Recently, donor support has expanded and modernized the function of the operating rooms. “There is a continued high demand for knee and hip replacements, so having highly efficient spaces has increased our capacity and efficiency,” says Dr. John Murnaghan, orthopaedic surgeon and medical director of the Holland Centre.

Here, Holland Centre experts share what it takes to prepare a patient and operating room space for each procedure.

1. Each room is cleaned and prepared to meet strict aseptic (contamination-free) standards.

2. A nurse checks the patient into the “block” area, where they meet with the anesthesiologist and the patient receives a regional anesthetic. This type of localized pain control reduces complications after surgery and allows patients to mobilize and go home more quickly.

3. The operating room is prepared. Between 8 to 13 instrument pans – each containing about 40 surgical instruments – are needed for each surgery.

4. When the patient is brought into the operating room, the team reviews the surgical safety checklist together. Checking all the relevant details of each case is a critical step, reducing the risk of any adverse events. The patient is carefully positioned for surgery, which will take one to two hours to complete.

5. The surgical team verifies the size and type of components for the replacement joint, which is different for every patient. It’s one of many checks and balances that ensure safety and the best possible outcomes.

The post Behind the scenes: Preparing for hip/knee surgery appeared first on Your Health Matters.

Dr. Amanda Mayo is a physiatrist who specializes in amputee care at St. John’s Rehab. Todd Domingo is an active amputee and a certified peer visitor who offers support to other amputees. Both share insights to help you along your journey.

A life-changing event

Says Dr. Mayo, “It is important to recognize limb loss is a life-changing event. Limb loss affects how you move and many aspects of your life. It is common to go through a period of grieving after loss of a limb, and you may have a period of developing a new self image. Having a good support network of friends, family, and/or healthcare providers can help with these transitions.”

Says Todd, “When it comes to body image, keep reminding yourself that value is about who you are and what you can do – and less about physical appearance. Though it takes a lot emotionally the goal is to try to get to a point where you can say, let me make something better of this. People will always stare: it is human nature. Use it as a positive teachable moment.”

Last year Todd had to have a left below knee amputation. “Losing a limb is similar to losing loved one – believe it or not,” he says. “Everyone experiences the process of dealing with limb loss differently.”

Recovery takes time

Dr. Mayo: It is a long process to recover from amputation. Be patient with yourself. It takes time to regain your strength, emotional recovery and for the residual limb to heal.

Patients have to wait at least 4-6 weeks after amputation before being measured for their first prosthetic device by a prosthetist.

Be open to new experiences

Todd: Over time it is then good to get to know the things you can do and to remain open to new experiences. I found it helped to accept that my prosthesis was not replacing my limb. It’s a ‘tool’ to help me do things.

Don’t be discouraged

Todd:  During fittings and adjustments, try to stay positive and get to know the differences between pain, soreness, discomfort and pressure. Acknowledge and address the discomfort and find a way to trust that your device will support you.

Seek support about the financial aspects of a potential device

Dr. Mayo: Patients also often face financial stressors at this time. Talking with members of your medical team – the social worker, the physiotherapist, the occupational therapist – can help you learn more about potential device options and how to navigate assistive devices funding.

Todd: Find out what your options are, and aim for a device that can help match the activities you want to do.

Become adaptive and active

Todd: Learn what being adaptive means. Ask yourself, how am I going to do this? in a strategic way to safely do it.  For example, instead of asking, how am I going to get in my car with my leg prosthesis on since it is low to the ground? Start by thinking how you can physically get into your car. Whether that is by holding on to the car as you sit down and swinging your legs over, it is all about taking that first step. You’ll soon figure out that adapting simply means doing things in a different way, but still getting to the end goal. 

Todd: Be active and involved. Be aware of the community of amputees around you. Advocate for yourself and have good, regular exchanges with your medical team.

The post Going forward after limb loss appeared first on Your Health Matters.

They awaken to stiff joints and spend their days fighting pain as they go through the usual motions of living.

An estimated 4.6 million Canadians suffer from osteoarthritis, a degenerative joint disease – and the most common form of arthritis – that starts with the breakdown of the cartilage that protects joints and keeps the bones from rubbing against each other. This chronic disease results in joint pain, stiffness and swelling, often becomes disabling, and is more prevalent among older people.

The implications are troubling for an aging country like Canada, where there are now more people over the age of 65 than there are children and where seniors will account for two out of 10 residents by 2024.

A number of studies in recent years have highlighted the growing prevalence of osteoarthritis among Canadians, and the greater burden this places on the country’s health-care system.

One study published in 2011 by the Arthritis Alliance of Canada – in a report entitled “The Impact of Arthritis in Canada: Today and Over the Next 30 Years” – predicts that by 2040, one in four Canadians will have osteoarthritis. With a new diagnosis of osteoarthritis every 60 seconds, almost 30 per cent of Canadian workers will have difficulty working because of the disease, the study’s authors wrote.

“Now more than ever, we need to look at how we can best serve the needs of Canadians with osteoarthritis in ways that will also be more optimal for the health-care system,” says Dr. John Murnaghan, interim medical director of the Holland Centre, part of Sunnybrook’s Holland Musculoskeletal Program.

Sunnybrook is leading the way in this effort. About 12 years ago, the Holland Centre introduced an innovative model of care for hip and knee arthritis. As part of its Hip and Knee Arthritis program, the centre pioneered a Central Intake and Assessment process that today continues to improve access and quality of care. Two patients from the Centre share their stories.

For Mary Lou Nawrocki, it was a great relief to learn she didn’t need joint replacement surgery. (Photograph by Kevin Van Paassen)

Mary Lou Nawrocki: non-surgical treatment

Life changed the day Mary Lou Nawrocki’s knees buckled as she was walking about with a friend. Diagnosed shortly after with knee osteoarthritis, the retired elementary- school teacher could no longer take long walks or exercise because of the pain and stiffness in her legs. She became less active and gained weight, which put more pressure on her knees and added to her pain.

“I tried physiotherapy and then a chiropractor, but nothing worked,” recalls Mary Lou, who is 67 and lives in Toronto with her husband. “The osteoarthritis would just flare up and my knees would swell.”

Her life changed again last year, this time for the better, when her doctor sent her to the Holland Centre. Within the month of getting a referral, Mary Lou walked into the Centre’s Assessment Clinic.

A distinctive feature of the Holland Centre Assessment Clinic is that it is led by advanced practice physiotherapists (APPs) and advanced occupational therapists (APP/OTs) – clinicians with extensive credentials that include solid backgrounds in orthopaedics and specialized training from the surgeons.

Instead of immediately putting patients in a long queue to meet with an orthopaedic surgeon, the Holland Centre’s intake process connects them first with an APP/ OT, who works with them on a treatment strategy and, when needed, refers the patient on to an orthopaedic surgeon.

The process starts with a detailed assessment by an APP/ OT that includes a thorough clinical examination and a review of X-rays of the affected joints, as well as functional testing that gives information about a patient’s ability to carry out everyday activities. As part of the assessment, they are asked to do a six-minute walk test.

Using this information and a scoring system developed by the Centre’s experts, the APP/OT determines if the patient needs to see a surgeon about hip or knee replacement surgery or can carry on with non-surgical strategies such as exercises to strengthen weak muscles, weight loss to reduce joint loads, walking aids or other adaptive devices to help with everyday functions.

“Our APP/OTs give patients the tools, confidence and peace of mind to carry on with their daily activities,” says Susan Robarts, an advanced practice physiotherapist and team leader at the Holland Centre. “Many of our patients are pleasantly surprised to learn they don’t have to rush into surgery and that there’s a lot they can do to maximize their ability to move and function well.”

According to Dr. Albert Yee, chief of the Holland Musculoskeletal Program, the Central Intake and Assessment model provides a more efficient triage process because it ensures that only patients who need and want surgery are sent to an orthopaedic surgeon.

Today, about 30 per cent of Holland patients do not go on to see a surgeon. “Everyone’s immediate needs are addressed within a much shorter period,” says Dr. Yee. “Those who need surgery get to see a surgeon sooner and those who don’t need surgery can learn about their other options for treatment.”

Dr. Albert Yee is the chief of the Holland Musculoskeletal Program. (Photograph by Kevin Van Paassen)

For Mary Lou, it was a great relief to learn she didn’t need joint replacement surgery. Instead, her advanced practice physiotherapist recommended a 12-week education and exercise program, which taught her movements to strengthen her damaged joints and muscles and lessen her pain.

“It’s all about strengthening the good muscles you have to support the bad joints,” explains Mary Lou, who signed up for physiotherapist-led education sessions at the Holland Centre. “At the end of the 12 weeks, I saw improvement. I could walk without pain, I had more stamina, I could climb stairs without apprehension. I was even doing knee presses on one of the machines at the Centre, and I was able to press a much greater amount of weight than I thought I ever could.”

Since it started collecting data in 2007, the Holland Centre has managed 20,000 patient visits using the Central Intake and Assessment model. Today it’s widely considered to be the gold standard in hip and knee arthritis care.

“We were the first Centre of Excellence in Ontario for hip and knee replacements,” says Dr. Jeffrey Gollish, a former Holland Centre medical director who was instrumental in the development of the Central Intake and Assessment model. “One of our first mandates was to develop a new model of care delivery to improve access to care for patients with hip and knee arthritis, so a group of us went to Glasgow and Edinburgh in Scotland to study what they were doing there, and we incorporated key elements of their model to form the basis for what we have at the Holland today.”

Dr. Jeffrey Gollish was instrumental in developing the Central Intake and Assessment Model. (Photograph by Kevin Van Paassen)

Other health-care institutions in Canada have adopted similar models of care. Doctors and health administrators from other countries have also shown interest in the Holland Centre model.

“Our Central Intake and Assessment model functions very well,” says Dr. Murnaghan. “Going forward, our hope is to play a key role in working with Ontario’s health-system leaders to help other centres adapt it for their own settings, and to extend this model to other areas of musculoskeletal care, for example, for spine and for shoulders.”

Patricia Petersen: surgical treatment

Getting a referral to the Holland Centre also marked the beginning of the end of four years of pain for Patricia Petersen. In 2006, at age 66, she started feeling pain and tightness in her right leg and hip. Two years later, she was finally diagnosed with hip arthritis.

“I’ve always been very active. I used to hike, cross-country ski, kayak and do a lot of walking, until the pain began to limit my physical activities,” says Patricia, a retired University of Toronto professor and former director of the school’s Urban Studies Program. “Then in 2010, there was significant deterioration and my doctor looked at my X-rays and said, ‘You don’t have a hip joint there anymore.’ That’s when I was sent to Holland [Centre].”

A week after her doctor made the referral, Patricia got a call from the Holland Centre scheduling her for an assessment the following week. Within three weeks, she met with a Holland orthopaedic surgeon.

“I saw the surgeon in mid- May and they had a cancellation in June, but I was scheduled to teach in Germany, so the surgery was scheduled for my return in September. What I found so amazing was that within a month of seeing my own doctor, I had the assessment and was seen by the surgeon and could have had my hip replaced the next month,” Patricia recalls.

This optimal pathway from referral to surgery can be attributed directly to the intake process, says Dr. Richard Jenkinson, an orthopaedic surgeon at the Centre.

A study published last March in the international peer-reviewed BMJ (formerly the British Medical Journal) highlights the importance of joint replacement surgery for those who need it the most.

The study looked at about 4,500 patients in the U.S. between the ages of 45 to 79 and found that patients with severe knee osteoarthritis gained significant quality-of-life benefits from total knee replacement surgery, while those with less severe progression and symptoms of the disease experienced minimal improvement in quality of life after surgery.

“Now we’re only seeing patients who stand to benefit the most from surgery,” says Dr. Jenkinson. “At the same time, all patients are benefiting from a longer discussion about their options with an APP/OT, which typically takes more time than most orthopaedic surgeons are able to commit to in their clinic.”

Patricia resumed hiking, kayaking and other physical activities after her hip surgery.

Last May, she returned to the Holland Centre, this time with a referral for her left hip. While she’s less than thrilled about having a second hip replacement, she’s happy her doctor once again sent her to the Centre.

Says Patricia, “Based on my experience with my right hip replacement and on my recent assessment, I know I’m in good hands.”

To operate or not to operate

Will I need a knee operation right away? Should I stop going to the gym? Patients who are diagnosed with osteoarthritis in the knee are often confused about what it means to have this degenerative joint disease. With so much information available online and through other sources, it can be hard to separate fact from misinformation. Dr. Richard Jenkinson, an orthopaedic surgeon of Sunnybrook’s Holland Musculoskeletal Program, discusses some of the most common myths around knee osteoarthritis.

MYTH: My osteoarthritis is bone-on-bone. I need a knee replacement.

FACT: Not necessarily. While the most reliable surgical treatment for bone-on-bone arthritis is a knee replacement, the key issue is the severity of a patient’s symptoms. Knee replacement is most beneficial for patients experiencing pain, stiffness and functional limitation that significantly diminish their ability to engage and enjoy their daily lives.

MYTH: Knee surgery is the only option.

FACT: Even if a person has severe knee arthritis, non-operative treatment can alleviate the symptoms. The most effective non-operative strategies to relieve symptoms include strengthening the muscles that support the knee joint and decreasing the forces across the knee through weight loss. A program of low-impact exercises, possibly including formal physiotherapy, can be very helpful. Medications, injections, braces and other treatments can also play a role in improving function.

MYTH: I’ve been told that I should have knee surgery now when I’m younger, so I can have a better recovery.

FACT: The time to have knee replacement surgery is when the symptoms are severe enough that a person cannot manage a regular lifestyle without severe limitation. Anyone considering a knee replacement should first make sure they’ve given non-operative strategies a full attempt. Weight loss and exercise can do wonders for knee symptoms. Surgery can be considered for younger patients, but only if their symptoms are severe enough to warrant a significant operation.

MYTH: Knee replacements only last 10 years. My surgeon says I am “too young” for the surgery.

FACT: The vast majority of modern knee replacements can be expected to last longer than 20 years. Surgery should not be rushed into, however, if someone has not fully explored nonoperative treatments and is having severe symptoms. On the other hand, they should not be suffering for many years, to the point where their function and mobility become severely limited before getting a knee replacement.

MYTH: If I can’t have surgery, I should just take pills for the pain.

FACT: Strengthening the muscles around the knee and adding even light physical activity to one’s routine can greatly improve knee arthritis symptoms. Medications such as acetaminophen and ibuprofen, which are over-the-counter drugs, can help manage arthritis symptoms. Stronger narcotic painkillers are not usually recommended to manage arthritic pain due to potential side effects and the risk of addiction. For the minority of those with inflammatory arthritis, like rheumatoid arthritis, medications are very effective and are an important part of the treatment. Injections, braces and other options can also help people manage their symptoms if surgery is not possible.

The post Determining the best treatment for hip & knee problems appeared first on Your Health Matters.

Some competitors will use various types of prosthetics during the competition, so we reached out to Shane Glasford, Sunnybrook’s Team Lead of Prosthetics, Sunnybrook Centre for Independent Living (SCIL) to learn more about these devices.

How long have you been working in this field?
I graduated in 1994 so I have been working for 23 years in prosthetics.

How big is the team you oversee?
We have four technicians and five prosthetists.

What kind of patients do you see in SCIL?
We see patients that have lost a limb due to a multitude of reasons including congenital defects, trauma, and complications to diseases like diabetes.

What is the process of being fitted with a prosthetic entail?
The prosthetic treatment path has many steps. Patients first receive a thorough physical assessment, which includes how they hope to use a prosthetic in their daily lives. After that comes a cast of the remaining limb that is removed immediately and filled with plaster-of-paris. The Prosthetist then reshapes and smooths the plaster to appropriately distribute the body weight over the surface of that residual limb. After the socket is fabricated, the next step is alignment. This involves positioning the knee (where applicable) and foot in a position that ensures knee stability, and proper foot function while the patient is walking. This varies for everyone, and for new amputees, needs to be adjusted as their walking improves. During the entire process, the patient is also working with the physiotherapist to optimize their gait and prevent bad habits.

For our upper extremity amputees, the shape capture, rectification, and socket provision is very similar.

An extremely critical piece of the process is the work of the occupational therapist. No prosthesis can accomplish the range of tasks — from fine control to powerful work — our bodies can, so we work with patients to find the best compromise or a selection of devices to fulfill the patient’s needs.

In addition to the physical needs of your patients, how does your team address the psychological needs of amputees?
The prosthetists work within a multi-disciplinary team. While I have found the use of a prosthesis often improves the patient’s psychological outlook, it can also signify a major step “back” to their former lives.

Both social work and psychology experts are available at Sunnybrook to provide further support to patients if needed.

Tell me more about the customized work happening here at Sunnybrook.
Every prosthesis, be it for everyday wear or for a specific use like sport, is a custom manufactured device. Even the manufactured components – including feet, knees and adapters – are chosen from thousands of options. We try to accommodate each patient’s desires, from pictures or logos on the prosthesis to a realistic “skin”.

Are the technologies around prosthetic devices changing quickly?
We seem to be in a period of change. Some older ideas are getting a fresh spin and there are also a number of advancements becoming available. Overall, it’s a very dynamic field that continues to offer more choices to patients every year.

Will you be watching the Invictus Games?
I hope to! Many of the events are during the workday, but there are a few events on the weekend that I would like to attend.

The post How Sunnybrook’s prosthetics team helps patients return to maximum function appeared first on Your Health Matters.

“The vast majority of cases of scoliosis are not worrisome, and the best treatment is to stay physically fit with strengthening exercises, moderate weight-bearing exercises, and playing sports,” says Dr. Joel Finkelstein, an orthopaedic surgeon who specializes in the treatment of spine conditions as part of the Holland Musculoskeletal Program at Sunnybrook.

Scoliosis is most often diagnosed in children and adolescents. From the side view, our spine has a natural sequence of curves at the cervical (neck), thoracic (chest) and lumbar (lower back) areas. From the front view however, the spine should be straight. With scoliosis, the spine has a C or S-shaped sideways curve. Scoliosis is defined if there is a curvature of greater than 10 degrees. Mild to moderate curves of less than 40 degrees do not significantly change the way your body moves, says Dr. Joel Finkelstein. For these curves, bracing during growth may be required. Occasionally surgery can be recommended if the curve is progressing to a larger magnitude.

“Most cases of scoliosis are the ‘idiopathic’ type, or of unknown cause, which means there is nothing you could have done to prevent the condition. It is not caused by poor posture, one leg being shorter than the other, or by carrying a heavy backpack to school,” says Dr. Finkelstein, who is also the head of the Spine division of orthopaedic surgery at Sunnybrook Health Sciences Centre.

“Scoliosis is also a painless condition,” says Dr. Finkelstein. “Back pain, which we all get from time to time, is often incorrectly linked to scoliosis as its cause”.

There are other less common types of scoliosis. About a fifth of all cases are congenital, or neuromuscular-related [pathological cause],” he says. Congenital scoliosis of the spine forms at birth. Neuromuscular scoliosis may result from the individual having a neuromuscular condition such as muscular dystrophy or spinal cord injury.

“If you have an idiopathic scoliosis, you can do anything for the most part. In fact, you can become the fastest human on the planet! If you are diagnosed, you should still make sure however, that there is no pathological cause,” says Dr. Finkelstein.

The post Scoliosis: be informed & be inspired appeared first on Your Health Matters.

When Linda Veres, Ross Winter and Robert Morassutti happened to sign up for the same physiotherapy class, little did they know the difference group therapy would make.

In fact, studies show that patients who participate in group-based physiotherapy after joint replacement surgery achieve statistically and clinically important improvements in mobility and function, and with similar satisfaction levels as patients who receive one-on-one therapy at home.

“In that group setting, they connected through their experiences of getting through surgery, and a common goal to get moving well again,” says Suzanne Denis, advanced practice physiotherapist, Holland Musculoskeletal Program who remembers Linda, Ross and Robert called themselves ‘the knee people’. They had knee replacement surgery at Sunnybrook’s Holland Centre then returned to join one of the group physiotherapy classes led by physiotherapist Mark Anunciacion.

Even though classes have ended, Linda, Ross and Robert continue to exercise together twice a week, motivating and supporting each other.

Beyond the clinical evidence, here are their reasons why getting together to exercise works:

Camaraderie – social + exercise: Ross says, “Doing physio alongside Linda and Robert who had a similar post-op (post-surgery) sensibility, allowed us to share with each other, experiences, knowledge, advice.“

Context – motivate yourself, but know your limits! “Doing therapy with others helps give you context. Everyone is different, even though we all had the same surgery,” says Robert. “And in some ways, it helped to ‘normalize’ things. We would ask each other: are you still using your cane? Being together gave you permission to either still be using the cane. Or not.”

Commitment: “Sometimes, I’d be thinking to myself: I’d rather not do this [the exercises],” says Robert, “but as a group, we had made a commitment. To be there for each other.” “And keep ourselves motivated,” adds Linda.

Commiserate, but with consideration: “Misery loves company and it’s better to share the pain than to suffer alone,” says Ross. “Group physio gave everyone the occasion to express frustration about their lack of progress, or the discomfort. But temper those occasional complaints, with humour,” says Linda. She recalls the generosity of the volunteers who would get ice for class participants. One particular day, she was feeling quite low and as the volunteer arrived with the ice, she joked, ”Do you have gin with that?”

And because knee replacement is a ‘big deal’ even if some say it isn’t, Linda, Ross and Robert also offer words of encouragement:

• Connect with friends and family: “As you prepare for surgery, think about what you will need, after surgery. It’s hard to ask for help, but do! And ask for specific help!” “Until you know the ‘new’ you, you need someone there, to help you.”
• Careful: “Pace yourself, for yourself, and DO NOT fall!”
• Consistency: “You have to keep at it [exercise]! Keep moving! Stretching and strengthening.”
• Continuum: “Keep up the momentum even after ‘formal’ physio.”
• Celebrate! “Everyone has their markers — milestones of progress, success, recovery.” “Celebrate being closer to what you used to do – getting on a streetcar, being able to put the rugs down again at home, driving a car, taking the bus to go to a movie with a friend…”

The post Exercising together: the benefits of group physiotherapy appeared first on Your Health Matters.

A little bit of pain and fatigue in your feet at the end of the day is normal, says Kevin Fraser, pedorthist at Sunnybrook Centre for Independent Living. But recurring pain is the sign of a problem. The most common foot problems do come from repetitive strain injuries – often brought on by poor footwear choices.

Plantar fasciitis – a strain or tear in the foot’s fascia – is one of the most common foot issues, he says. The plantar fascia connects the heel to the ball of the foot to support the arch structure of the foot. Symptoms are pain (sharp, stabbing or dull) or a burning sensation; swelling; and/or inflammation. Pain in the morning right when you get out of bed could be an indicator of plantar fasciitis.

And while your genes – the shape of your foot, the size of your foot, your arch – play a role in if you develop foot problems like plantar fasciitis, your footwear and lifestyle play a big role too.

Kevin Fraser, pedorthist

“A repetitive strain injury comes from what you do on your feet all day and what shoes you are doing that in,” Kevin says.

A good shoe provides support for your feet, cushions impact of hard walking surfaces and spreads the pressure of the weight of your body.

“Our feet are our mode of transportation. But they are also the foundation for the rest of your body – your knees, your hips and your back,” Kevin says. “This really is a good time of year to reevaluate the footwear you have.”

So if you are getting a head start on your spring cleaning, what better place to start than your shoe closet. It’s an idea that Kevin can happily get behind. (And I can too, since maybe it’ll mean I can go shoe shopping)!

Here are some questions you can ask yourself when tackling your shoe closet:

Does the shoe fit?

A shoe that fit you last year might not fit you this year. Try them on.

“Always try both shoes on and don’t just go by the shoe size you normally buy,” Kevin says. The same goes for when you are buying new shoes. Your feet might be different sizes and every shoe brand is different in sizing. (Here’s more from Kevin about shoe sizing)

Check for about a finger-size space at the heel of the shoe. Be sure the width of the shoe isn’t bulging out but that you can feel the sides of your feet. Try shoes on midday.

“Your feet can swell up to 5 per cent of their size in a day,” Kevin says.

Is the shoe worn out?

“We used to say a shoe lasts 500 miles. But what did that mean? Well, now we are lucky – people are wearing pedometers. We can say, on average, if you wear a shoe consistently, it’ll last about one year,” Kevin says.

Look for worn spots on the ball of the foot or a heel that is worn down. If your heels are worn down unevenly, you may want to see a pedorthist who could help examine your gait and help find the right corrective orthotics.

Is the shoe comfortable?

When you look at that pair of sandals, do you wince in pain thinking of that last time you wore them? Maybe it’s time they retire.

There’s no issue with having some fashion shoes or dressy shoes. Pain from those shoes is often associated with the activity you are doing in the shoe (like standing around for a long time at a wedding in high heels). “It’s ok to have those kinds of shoes,” Kevin says. “You aren’t going running in them.” Look for a heel that has arch support or consider adding an insole or forefoot cushion to improve comfort.

If your shoes are still in good shape but just aren’t right for you, consider donating them, or doing a shoe swap with friends.

Happy Spring Cleaning!

(A version of this post appears in the April edition of Toronto’s Streeter newspaper.)

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Mandana Jam-Modarai, an Occupational Therapist at St. John’s Rehab, offers tips to help you keep your fitness resolve:

Make it NOTEworthy!

We lead busy lives. Many of us need a “to do” list to remember it all, and often we can’t easily see our level of physical fitness. Why not make a reminder note to exercise? Mandana suggests sticking a special label on an empty medication bottle. You can prominently place this physical reminder on your dining table, or on your desk at work, to prompt you to take the time for your daily dose of physical activity. Canada’s Physical Activity Guidelines recommend 30 minutes daily five times a week, or 150 minutes a week of participation in moderate to vigorous intensity physical activity. Moderate intensity means you should be able to talk, but unable to sing, while doing this activity.

Internal motivation

After six months, your doctor would be pleased with your improved blood pressure and cholesterol levels that often occur after doing a daily 30-minute walking program. However, if the longer-term improvement in your health is not motivating, consider the short-term benefits of increased energy, and improved digestion and sleep. What other positive side effects are specific to you? Better mood? Bolstered confidence? Mandana suggests this exploration helps us build our internal motivation, which in turn helps us get more active – and stay that way.

How much activity… and how

Mandana also suggests we keep in mind the quality of our physical activity in addition to how much. A walk becomes a brisk walk with friends. Instead of taking the elevator or the escalator, go up and or down the stairs but do so at a moderate pace. A 6 p.m. jog also becomes time away to get fresh air and enjoy the evening sky.

Make fitness a part of your lifestyle, and of those around you

Can you spare 30 minutes a day? Mandana suggests making fitness a “fabric of your life” and a part of your daily routine. Set a daily fitness appointment in your work calendar. Start or fill in that kitchen calendar with fitness activities. Is it weekend weight training for you? Perhaps it’s a Sunday hour at the community pool or skating rink for you and your family? Perhaps it’s simply putting on the tunes, and dancing after dinner?

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At age 80, Inge Weber is a three-time world tennis champion. She is an inspiration to octogenarians and to people of all ages, not only for her extraordinary feat but for winning all three championship titles with a new pair of hips!

Before winning the Super Seniors World Individual Tennis Championships in 2012, 2014 and 2016, Inge underwent surgeries at the Holland Centre to replace her hips. She had her first surgery in 2010. Eight months later she had her second.

“I was in such pain before the operation. It was bone on bone from all the wear and tear”, she says. “I know I should have had it done sooner, but I just kept putting it off. The pain meant there was no hesitation to choose surgery. I just wanted to get rid of the pain.”

Four months after each surgery she was back on the tennis court but doing controlled hitting only with minimal movement and pivoting. “Your balance is not quite there, and I didn’t want to make the wrong step. As time went on, the safer I felt, the more I moved. It was only after a year after each surgery, that I felt fully comfortable, both mind and body,” she says.

She says she pushed for her own personal best and encourages others to do the same in whatever they enjoy. “When it came to the tennis competitions, I wondered if I could ever win. I had always dreamed about it, and told myself, there’s no way! They’re all so much better than I am,” says Inge.

“After a while, as I kept working on my game, I realized – they’re not much better than I am, but they do have more confidence. Once I saw that, I knew I could push it! That I could do it!”

But even with such stellar athleticism, Inge also sees herself like many aging Canadians whose hips and or knees ‘give out’ and who experience excruciating pain and fear of loss of independence from not being able to walk and move freely again, even after surgical treatment. “The older we are, the more cautious we get – I don’t want to fall,” she says.

Having been through two hip surgeries, Inge advises that you can get back to the level you were before. “Think about how you felt before the pain began, and work hard and push yourself, to get back to that place,” she says.

“In both cases [her surgeries], you have to keep moving and exercising. This is just the first part of your journey back.” She says to do exercises more often but at a moderate level, instead of big exercises all at once!

“You have to be determined! You have to motivate yourself to get back to carrying on with a normal life. Do a little bit more day after day. Go a little further each time.”

She also advises people to try to get as fit as possible before surgery, especially strengthening, prior to surgery, the muscles around the specific area. “That way”, says Inge, “…it’s likely a bit easier to pick up, where you left off!

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