PHYSIOTHERAPY CLINIC IN LAVAL

Adult Orthopaedic Physiotherapy

Orthopaedic physiotherapy focuses on the treatment of all the conditions affecting the musculoskeletal system. It is very common to experience pain or other symptoms at a specific part of the body that reveals being an articular dysfunction (ligament sprain, luxation and subluxation, capsulitis, tenosynovitis and synovitis), or a muscle dysfunction (contusion, tear, overstretching, tendinitis, decrease in muscular control and other muscular tension), or neurological (compression, loss in mobility or flexibility of a nerve root, peripheral nerve or tissues that surround the nerve).  

At Physiomédic, we treat people that experience pain following a work related accident (CSST), following a car accident (SAAQ), or people with a medical prescription following a sports injury, an orthopaedic surgery, or any other trauma (with or without private insurance).

Here are some videos from the OPPQ website showing the physiotherapist’s role treating certain orthopaedic affections:

Here are some frequent examples of conditions treated by physiotherapist organized by body part. Note that there are many other reasons you may want to see a physiotherapist.

Back (thoracic or lumbar spine): back sprains, herniated discs, spondylolisthesis, arthritis (thoracic, lumbar, sacral), facet syndromes, stenosis (central or foraminal), muscles spasms, sciatic nerve irritation bring leg and/or back pain, postural dysfunction, muscle imbalances, scoliosis, sports related injuries, and follow ups following surgeries.

Cardiorespiratory Physiotherapy

Any condition affecting the cardiovascular and cardiorespiratory systems can benefit from physiotherapy. A few examples of those conditions are:

• Cardiac insufficiency and other cardiac diseases
• COPD: Chronic obstructive pulmonary disease (Emphysema and chronic bronchitis)
• Reconditioning following cardiac or pulmonary surgery
• Cystic fibrosis 
• General deconditioning
• Bronchiectasis
• Pulmonary fibrosis

Physiotherapy will help people with history of cardiac and pulmonary disease, with or without a history of surgery, to regain their function, recondition themselves and increase gradually their activity level for a better day to day living.

With pulmonary conditions especially, the physiotherapist will teach and help you decrease symptoms like cough, shortness of breath (dyspnea), chronic fatigue and secretion buildup in the respiratory system.

Here is an explicative video from the OPPQ website on the role of physiotherapists in this area.
(Video in French only)

Temporomandibular joint (jaw)

The temporomandibular joint (TMJ) is a joint located in the jaw that can easily get fragilized by overuse of the jaw muscles (talking and eating). This joint will be prone to muscles imbalances, painful muscles spasms, loss of opening or blockage of the mouth during mastication, and chronic pain. Following wisdom teeth extraction or following braces, it is also possible to experience pain at the TMJ. Furthermore, burning sensations on the face can be a result of of a TMJ blockage.

The jaw is composed of a meniscus that acts like a cushion to absorb chocs. Around that cushion is a bundle of muscles and ligaments that can easily be affected by a blockage of the cushion during the opening or the closing of the mouth and become a very unstable joint.

Physiotherapy can be beneficial for any problem at this joint. Interventions include muscle relaxation techniques: stretching, massage, and mobilizations. When the pain has subsided, strengthening exercises need to be done to prevent recurrences.

Oncology Physiotherapy (Cancer rehabilitation)

Following a cancer patients will frequently present physical symptoms that may or may not be related to the cancer itself, but often to the treatments (chemotherapy or radiation, surgery, etc.) that the patient has undergone. For example, these symptoms may include fatigue, pain, stress, anxiety, loss of range of motion, etc. Also, lymphoedema is a common side effect of lymph nodes resection, especially in the case of breast cancer (following a complete or partial mastectomy (see section on lymphoedema)). These symptoms affect greatly the general function on a daily basis and often decrease the patient’s quality of life.

The physiotherapist will help you maximize your function and increase your quality of life by giving you gentle exercises to increase mobility, decrease the oedema, and also manage fatigue and pain.

* Lymphoedema

Lymph is the fluid that circulates throughout the lymphatic system, which is a system resembling the vascular system, which means it is composed of vessels that are located throughout the body. The lymph is made of white blood cells, antibodies, viruses, bacterias, and other foreign elements that may be present in our bodies. The lymph is brought to lymph nodes that drain and clean the lymph of unwanted materials. Lymph nodes are located in key areas in our body: armpits,neck, hips and groin.

When lymph nodes and removed or damages, the lymph drainage is compromised and/or disrupted causing an accumulation of fluid in the body part next to the nonworking lymph node. Thereby, this accumulation of fluid filled with body waste increases the risk of infections and decreases the skin’s strength due to the edema. This fluid accumulation is called lymphoedema.

Cancer and/or treatments to cure it might impair or destroy the lymph nodes. For example, breast cancer often cause damage on the armpit lymph nodes when radiation or surgery is used to cure or slow down the cancer. Also metastasis (other tumors caused by the migration of the primary tumor) may lodge in the lymph nodes themselves and therefore cause damage.

Signs and symptoms of lymphoedema are:

• Edema of the affected body part
• Pain and tightness
• Decrease in mobility or stiffness of the affected body part
• Skin flexibility decrease

There are many possible treatments to act upon lymphoedema, such as lymphatic drainage which can also be delivered by a trained physiotherapist. This will help prevent the loss of mobility, flexibility, and the pain related to lymphoedema.

A lymphoedema that has not been taken care of might bring on complications such as infections, wounds, decrease of function, non negligible psychological impact, and an increase of edema in the affected body part. For example, following breast cancer, the upper limb (arm and forearm) might become up to 3 times the normal size of the limb!

Physiotherapy for central neurological affections

The central nervous system (CNS) is composed of the encephalon (brain, brainstem, and cerebellum) and of the spinal cord. The peripheral nervous system (PNS) is formed of the sensitive and motor nerve and nerve roots that emerge from the spinal cord. Affections that can have an impact on the PNS have been discussed in the orthopaedic physiotherapy section, since the nerve roots and nerves are closely related to the other musculoskeletal structures of the body.

In regards to the CNS, multiple affections can have an impact on its function such as strokes and brain injuries. These can cause cognitive, psycho-affective, and physical deficits that are variable depending on the specific region of the brain that has been damaged. Furthermore, spinal cord lesions cause motor and sensory deficits again variable depending on the specific region of the spinal cord.

These insults on the CNS require specific rehabilitation in order to regain maximum function. Physiotherapy is usually started during the hospital stay (especially following a stroke) but further treatments might be necessary to reach the functional goals that had been established in the hospital. Also, physiotherapy in a private setting may be useful to emphasize on function and quality of life.
Here is a video (French only) from the OPPQ website that explain the physiotherapy role following a brain injury or a stroke.

D’autres atteintes du système nerveux central telles que la maladie de Parkinson, la sclérose en plaque (SEP), la sclérose latérale amyotrophique (SLA), ainsi que plusieurs autres maladies dégénératives telles que les dystrophies musculaires et autres maladies neuromusculaires ont des impacts importants au niveau de la fonction physique. La physiothérapie visera alors à agir sur les différentes séquelles physiques causées par la maladie afin de les minimiser autant que possible et de limiter leur impact au niveau de la fonction physique, de l’autonomie et de la qualité de vie.

Vestibular physiotherapy

Have you ever experienced the unpleasant impression of moving back with your car at a red light when a bus moves forward next to you? Did you know that this weird feeling might be caused by a disagreement between your inner ear and your eyes? Indeed, your eyes send the information to your brain that you are moving, and your inner ear (that acts like a mediator between your head movements and what your eyes see) do not sense any movement from your part. This is when you realize that you are not moving at all but that it is the bus next to you that is going forward, OUF! But before your brain analyzes it all you had time to freak out and imagine the accident that could have happen with the car behind you!

Lets come back to the inner ear (vestibular system) role in our bodies. It is in fact a tiny system located in your inner ear that is well protected in the bony prominences of the side of your head (the temporal bone). This system is so important that your body has put it in a bony castle!

As mentioned above, the vestibular system is responsible for determining where is your head and knowing when it’s moving. If there’s a malfunction of your vestibular system, you can experience vertigo and dizziness, loss of balance, nausea, hearing losses up to complete deafness, blurred vision, and a mix of all those symptoms. The anxiety that comes with all of what is mention above is unfortunately normal.

Sometimes those a malfunction of the vestibular system might be the result of a fall or an impact to the head. For example, a car accident or a sports injury to the head (soccer ball, hit in football, etc.). Pressure inside the head might then be deranged and cause dizziness and movements of the head in an upward fashion may as well increase that dizziness.

Did you also know that it is possible for your vestibular system to get a “cold”? Labyrinthitis is a pathology (virus) that irritates the vestibular system and therefore cause dizziness. Unfortunately in that case physiotherapy comes to no help in the early stage. Medication and rest for a few weeks are often the only treatment available. When the head movements have no impact on the dizziness itself, physiotherapy treatments are not necessary. However, after a few weeks and after the medication has been take your physiotherapist will be able to guide you in regaining your lost vestibular function.

Any insult to the central nervous system (CNS) may provoke vestibular symptoms, like cancer, strokes, brain injuries, aneurysm, etc. In short, any pathology that affects the basal ganglia can be responsible for a derangement in the vestibular system. In that case, physiotherapy can help but function might be impaired for the long term.

Finally, the vestibular system is also responsible for the “mal des transports” we often experience when in a car or a boat. Nausea and dizziness associated with the “mal des transports” are often cause by a lack of habituation of the vestibular system (fragility). To ease up this situation, you can train your vestibular system prior to a trip to make it more performant and decrease the symptoms. Your physiotherapist is there to help!

Here is an explicative video (French only) from the OPPQ website that explains the role of physiotherapy in vestibular rehabilitation:

Physiotherapy for Amputees

Amputation causes deficits and loss of function in the upper limb and the lower limb. Those deficits bring variable impairments related to the amputation site. Following an amputation, people are redirected to specialized centres where they undergo intensive functional rehabilitation.

In intensive functional rehabilitation amputees are followed by a multidisciplinary team which includes a physiotherapist and an occupational therapist. Their goal is to maximise autonomy in order to the safe return home to be possible.

During rehabilitation a decision will be taken in regards to the possibility of the amputee to get a prosthesis (especially for the lower limb). In any case, the team will take into consideration every aspect of the amputees condition to take the best decision in order to maximize the quality of life. To get a lower prosthesis the amputee must be able to walk, climb up and down stairs, climb up and down slopes, pick an object from the floor, go over obstacles, etc. prior to get the prosthesis, and then relearn every of those things once again with the prosthesis. In regards to the upper limb prosthesis, daily living activities must be learned and relearned with and without the prosthesis. Once the functional autonomy level wished is reached a safe return home and discharge from rehabilitation is possible.

Thereafter, the amputee can begin his rehabilitation in a private clinic if he/she desires to achieve certain goals that weren’t reached in the public rehab program but that didn’t have a direct impact on safety for the return home. For example, the amputee might want to be able to perform some physical activities or play sports or even need further skills to be able to perform his/her work to the fullest. In that case, a private physiotherapist and occupational therapist can be helpful achieving those goals. An assessment will be performed and goals/treatment plans will be established by the amputee and the therapist. Another area in which the amputee might seek for further physiotherapy is pain. Indeed, phantom pain has a high occurrence after an amputation and can be very limiting on a daily basis.

Pelvic floor rehabilitation

The pelvic floor is a set of muscles located at the base of the pelvis both in women and in men. Those muscles form a hammock between the pubic bone and the coccyx. Therefore they are located around the urethra and the anus. They are also around the woman’s vagina.

The pelvic floor has many important roles:

• Urine, stools and gas control
• Sexual function
• Organ support (bladder, uterus, rectum, urethra)
• Stabilization

Like any other muscle in our body, the pelvic floor muscle can undergo stress and can be damaged resulting in loss of strength (contraction force), endurance (contracting for long periods), and coordination (contracting at the right time). Spasms, tensions and loss of function can result from pelvic floor stress and damage. Causes for pelvic floor loss of function can be old age, pregnancies, delivery, constipation, sports and other activities with repeated impacts or heavy lifting, lack of stabilization with postural alterations, etc. Any derangement of the pelvic floor function can cause many problems that can be very limiting on a daily basis.

Coughing, sneezing, laughing, pregnancy, physical activity all increase pressure in the abdomen and compress the organs downwards. If the pelvic floor muscles aren’t strong enough or do not have enough endurance to keep their contraction there can be urine, stool or gas leakage (loss of control), lower back and/or sacral pain (stabilization loss), and prolapse of the organs (loss of support). It is to be noted that prolapse can bring symptoms like heavy sensation in the abdomen and vagina. A muscle dysfunction of the pelvic floor can also cause urinary and fecal incontinence.

When spasms or tensions develop it is much more difficult to make them relax or contract efficiently. To add to the problem list above, tensions and spasms of the pelvic floor muscles can cause pain with sexual intercourse, during tampon insertion, difficulty with defecation, difficulty with urination, or pain at the anal, sacral and coccyx regions.

Pelvic floor rehabilitation can treat and lower pain related to scars from previous surgeries in the pelvic floor area.

Here is an explicative video (French only) from the OPPQ website explaining in details what is pelvic floor rehabilitation.

Pediatric Physiotherapy

The physiotherapist role in a pediatric context is to assess your child and identify all the elements that could influence his/her motor development (motricity acquisition such as turning, sitting, crawling, walking on all fours, getting up, walking, etc.). Also, the physiotherapist will assess all possible deficits that could be present at the muscles or joints. Treatment will then include specific exercises that can be performed at home. Treatments are personalized in order to favorise development. The exercises are always to be performed in a controlled environment and without aches or pains.

Here are some reasons your child might need physiotherapy:

• Torticollis/plagiocephaly (skull fattening):Congenital torticollis is a frequent condition with new born babies. Causes include bad positioning in the mother’s wound as well as forceps use during labour. Torticollis forces the baby to have his/her head rotated to one side creating an asymmetrical pressure zone on the skull when the head is supported (during sleep, diaper changes, car seats, etc.). Over time, the skull can deform on the mostly supported side causing a forehead bulge on the other side. This deformity is called plagiocephaly. Flattening can also happen on both sides of the posterior part of the skull when the baby doesn’t show a preferred side of rotation. Plagiocephaly with or without torticollis are frequently encountered for various reasons: baby sleeping on their back, considering the baby’s head is bigger and heavier compared to the rest of the baby’s body creating more pressure on the back of the skull and asymmetrical pressure points.
• Atypical gate (tip of the toes, internally rotated legs)
• Premature children (causing impacts on motor development)
• Hypotonia (flabby baby)/ hypertonia (stiff baby)
• Neurological affections (muscular dystrophies, cerebral palsy/stroke, etc.) and neuromuscular conditons that can be addressed with physiotherapy (complementary with rehabilitation programs).

Here is an explicative video (French only) from the OPPQ website regarding pediatric physiotherapy.